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Park S, Zhou G, Ke C, Leung FH. A new model of understanding 'service' versus 'education' in medical education. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:125-127. [PMID: 38226300 PMCID: PMC10787856 DOI: 10.36834/cmej.77633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Affiliation(s)
- Stephanie Park
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Grace Zhou
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Calvin Ke
- Department of Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, Toronto General Hospital, University Health Network, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Fok-Han Leung
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Ontario, Canada
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Carlsson Y, Nilsdotter A, Bergman S, Liljedahl M. Junior doctors' experiences of the medical internship: a qualitative study. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2022; 13:66-73. [PMID: 35321942 PMCID: PMC9017508 DOI: 10.5116/ijme.6229.d795] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to explore medical interns' experiences of medical internships. METHODS Situated in an interpretivist paradigm, a qualitative study was carried out to explore medical interns' experiences of the internship. Invitations to participate were sent via email to medical interns currently in their last six months of internship. The first ones to respond were included. The study sample comprised twelve participants, of whom seven were women. Data were collected through individual, semi-structured and in-depth interviews with volunteering medical interns from three different hospital sites. Data were transcribed verbatim and analysed through qualitative content analysis, generating overarching themes. RESULTS Four main themes were identified in our data. The interns felt increasingly comfortable as doctors ('finding one's feet') by taking responsibility for patients while receiving necessary help and assistance ('a doctor with support'). Although appreciative of getting an overview of the healthcare organisation ('healthcare sightseeing'), interns were exhausted by repeatedly changing workplaces and felt stuck in a rigid framework ('stuck at the zoo'). CONCLUSIONS In contrast to previous studies, this study shows that the transition from medical school to clinical work as a professional does not necessarily have to be characterised by stress and mental exhaustion but can, with extensive support, provide a fruitful opportunity for medical interns to grow into their roles as doctors. However, there is still unutilised potential for the medical internship to act as a powerful catalyser for learning, which educators and programme directors need to consider.
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Affiliation(s)
- Yvonne Carlsson
- General Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Nilsdotter
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stefan Bergman
- General Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Matilda Liljedahl
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Fisseha H, Mulugeta B, Argaw AM, Kassu RA. Internal Medicine Residents' Perceptions of the Learning Environment of a Residency Training Program in Ethiopia: a Mixed Methods Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1175-1183. [PMID: 34675744 PMCID: PMC8504702 DOI: 10.2147/amep.s335205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The learning environment is an important determinant of the quality of medical education. Having a good learning climate leads to improved learning process, satisfaction with education, and helps achieve the goals of the curriculum. Assessment of the quality of learning environment helps with the identification of areas that need improvement. The aim of this study was to assess the learning environment of internal medicine training program in Ethiopia. METHODS A mixed methods study using a cross-sectional survey using Postgraduate Hospital Educational Environment Measure and a qualitative study using a focus group discussion was done on internal medicine residents from December 2020 to May 2021. Comparison of quantitative data was done using Mann-Whitney U-Test and Kruskal-Wallis H-test. P-value <0.05 was considered statistically significant. RESULTS A total of 100 residents participated in the study. The overall total mean score of the responses of the participants was 70.87 (±19.8) with mean perceptions of role autonomy, perceptions of teaching and perceptions of social support of 25.9 (±7.1), 27.1 (10.2) and 17.9 (±5.1), respectively. These values suggest the presence of plenty of problems in the program. Higher mean scores were reported by males and by earlier years of residency. Ten residents participated in the focus group discussion. Four recurring themes that negatively affect learning environment were identified and included excessive workload, inadequate teaching activity, non-conducive hospital physical environment and lack of diagnostic and therapeutic modalities. CONCLUSION The internal medicine residency learning environment has many challenges that need immediate attention and follow-up.
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Affiliation(s)
- Henok Fisseha
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Biruk Mulugeta
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abel M Argaw
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Rodas Asrat Kassu
- Department of Neurosurgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Meo N, Kim CS, Ilgen JS, Choe JH, Singh N, Joyner B. Redeploying Residents and Fellows in Response to COVID-19: Tensions, Guiding Principles, and Lessons From the University of Washington. J Grad Med Educ 2020; 12:678-681. [PMID: 33391590 PMCID: PMC7771595 DOI: 10.4300/jgme-d-20-00430.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Nicholas Meo
- Assistant Professor, Department of Medicine, University of Washington
| | - Christopher S Kim
- Associate Professor, Department of Medicine, University of Washington School of Medicine
| | - Jonathan S Ilgen
- Associate Professor, Department of Emergency Medicine, and Associate Chair for Faculty Development and Education, University of Washington School of Medicine
| | - John H Choe
- Associate Professor, Department of Medicine, and Associate Program Director, Internal Medicine Residency Program, University of Washington School of Medicine
| | - Niten Singh
- Professor, Department of Surgery, and Program Director, Vascular Surgery Integrated Residency And Fellowship Program, University of Washington School of Medicine
| | - Byron Joyner
- Professor, Department of Urology, and Designated Institutional Officer, University of Washington School of Medicine
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Salib S. The Delicate Dance of Teaching Rounds. MEDICAL SCIENCE EDUCATOR 2019; 29:871-874. [PMID: 34457553 PMCID: PMC8368817 DOI: 10.1007/s40670-019-00741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Sherine Salib
- The Department of Internal Medicine, Dell Medical School at the University of Texas at Austin, Austin, TX USA
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Lam ST. Has the Movement on Service Versus Education Shifted Too Far Toward Education? ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:352-353. [PMID: 30767160 DOI: 10.1007/s40596-019-01041-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/04/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Sherrell T Lam
- Walter Reed National Military Medical Center, Bethesda, MD, USA.
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Bushuven S, Juenger J, Moeltner A, Dettenkofer M. Overconfidence in infection control proficiency. Am J Infect Control 2019; 47:545-550. [PMID: 30528170 DOI: 10.1016/j.ajic.2018.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Infection control partially depends on hygiene and communication skills. Unfortunately, motivation for continuous training is lower than desired. Many health care providers (HCPs) do not recognize the need for training but express this need for others. This is attributable to heuristic errors, such as the overconfidence effect. The aim of this study was to quantify the flawed self-assessment in infection-control. METHODS In this cross-sectional multicenter study, 255 HCPs of different specialties participated in the 29-item, 5-point Likert scale questionnaire, assessing perceived proficiency in hand hygiene and communication skills for both themselves and others (colleagues, trainees, and supervisors of their own specialty and HCPs of others). RESULTS 222 of 255 surveys could be analyzed. Respondents rated themselves to be better trained in handhygiene (P < .001) than trainees, colleagues, and supervisors; the same was seen for feedback skills (P < .001). HCPs of other specialties were consistently rated worse in all aspects (P < .001). CONCLUSION Results show an overplacement effect in infection prevention skills. The belief of being well educated creates a subjective conviction that no further education in hand hygiene is needed. Thus, HCPs may face motivation barriers that require specialized programs to overcome these beliefs.
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Malau-Aduli BS, Alele F, Collares CF, Reeve C, Van der Vleuten C, Holdsworth M, Heggarty P, Teague PA. Validity of the scan of postgraduate educational environment domains (SPEED) questionnaire in a rural general practice training setting. BMC MEDICAL EDUCATION 2019; 19:25. [PMID: 30654772 PMCID: PMC6337755 DOI: 10.1186/s12909-019-1455-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND The educational environment is critical to learning and is determined by social interactions. Trainee satisfaction translates to career commitment, retention and a positive professional attitude as well as being an important factor in assessing the impact of the training program. This study aimed to validate the Scan of Postgraduate Educational Environment Domain (SPEED) tool and assess its appropriateness in evaluating the quality of General Practice (GP) rural postgraduate educational environment. METHODS A questionnaire containing the 15-item SPEED tool was administered to GP registrars to examine their perceptions of the educational environment. Principal component analysis (PCA) and exploratory factor analysis (EFA) were used to gather evidences of the validity of the instrument based on its internal structure. Additional validity evidence and reliability estimates were obtained using many-facet Rasch model analysis (MFRM). RESULTS The survey was completed by 351 registrars with a response rate of 60%. Parallel analysis performed using principal component analysis and exploratory factor analysis suggests that the SPEED tool is unidimensional. The MFRM analysis demonstrated an excellent degree of infit and outfit for items and training sites, but not for persons. The MFRM analysis also estimated high reliability levels for items (0.98), training sites (0.95) and persons within training sites (ranging from 0.87 to 0.93 in each training sites). Overall, the registrars agreed that the educational environment had high quality, with most (13 out of 15) of the items rated above 4 out of 5. CONCLUSIONS This study demonstrated a high degree of validity and reliability of the SPEED tool for the measurement of the quality of the educational environment in a rural postgraduate GP training context. However, when applied in a new setting, the tool may not function as a multidimensional tool consistent with its theoretical grounding.
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Affiliation(s)
- Bunmi S. Malau-Aduli
- College of Medicine and Dentistry, James Cook University, QLD, Townsville, Australia
| | - Faith Alele
- College of Medicine and Dentistry, James Cook University, QLD, Townsville, Australia
| | - Carlos Fernando Collares
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
- European Board of Medical Assessors, Maastricht, Netherlands
| | - Carole Reeve
- College of Medicine and Dentistry, James Cook University, QLD, Townsville, Australia
| | - Cees Van der Vleuten
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Marcy Holdsworth
- College of Medicine and Dentistry, James Cook University, QLD, Townsville, Australia
| | - Paula Heggarty
- College of Medicine and Dentistry, James Cook University, QLD, Townsville, Australia
| | - Peta-Ann Teague
- College of Medicine and Dentistry, James Cook University, QLD, Townsville, Australia
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Lee SY. Adaptation of Oncology Fellowship to Reflect Contemporary Practice. J Oncol Pract 2018; 15:1-2. [PMID: 30433843 DOI: 10.1200/jop.18.00551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Steve Y Lee
- 1 Perlmutter Cancer Center at NYU Langone Health, New York, NY
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10
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Ross S, Liu EL, Rose C, Chou A, Battaglioli N. Strategies to Enhance Wellness in Emergency Medicine Residency Training Programs. Ann Emerg Med 2017; 70:891-897. [DOI: 10.1016/j.annemergmed.2017.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Indexed: 01/26/2023]
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Abstract
Program directors (PDs) and trainees are often queried regarding the balance of service and education during pediatric residency training. We aimed to use qualitative methods to learn how pediatric residents and PDs define service and education and to identify activities that exemplify these concepts. Focus groups of pediatric residents and PDs were performed and the data qualitatively analyzed. Thematic analysis revealed 4 themes from focus group data: (1) misalignment of the perceived definition of service; (2) agreement about the definition of education; (3) overlapping perceptions of the value of service to training; and (4) additional suggestions for improved integration of education and service. Pediatric residents hold positive definitions of service and believe that service adds value to their education. Importantly, the discovery of heterogeneous definitions of service between pediatric residents and PDs warrants further investigation and may have ramifications for Accreditation Council for Graduate Medical Education and those responsible for residency curricula.
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Affiliation(s)
- Debra Boyer
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Josh Gagne
- 3 Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer C Kesselheim
- 2 Harvard Medical School, Boston, MA, USA.,3 Dana-Farber Cancer Institute, Boston, MA, USA
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Kesselheim JC, Schwartz A, Boyer D. Integrating Education and Service in Pediatric Residency Training: Results of a National Survey. Acad Pediatr 2017; 17:907-914. [PMID: 28668724 DOI: 10.1016/j.acap.2017.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 06/13/2017] [Accepted: 06/22/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The definition and proper role of service, as it relates to education, in the residency training experience has been long debated. In this study we aimed to develop definitions for service and education, delineate how each is perceived to contribute value to training, and to measure respondents' ratings of service and education using case vignettes. METHODS We conducted a multisite cohort survey study of pediatric residents (n = 797) and program directors (PDs; n = 37) using a region-stratified sample of 2 to 3 participating pediatric residency programs per region. RESULTS Surveys were completed by 34 PDs (92%) and 359 trainees (45%). PDs and residents agree that service can, in the absence of formal teaching, be considered educational. When asked how often rotations provide an appropriate balance between education and service, 94% of PDs responded 'extremely/very often' whereas only 68% of residents agreed (P = .005). Residents were significantly more likely than PDs to endorse definitions for service that included volunteer work (82% vs 59%; P = .002), going above and beyond for a patient (91% vs 78%; P = .017), and routine patient care activities (91% vs 72%; P < .001). For 6 of 12 case vignettes, trainees gave median service ratings that were significantly higher than PDs (P = .03). CONCLUSIONS Medical educators and pediatric residents hold mismatched impressions of their training programs' balance of service obligations with clinical education. Specifically, residents more frequently report an overabundance of service. Both groups acknowledge that service activities can be educationally valuable although the groups' definitions of service are not fully aligned.
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Affiliation(s)
- Jennifer C Kesselheim
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Mass.
| | - Alan Schwartz
- Departments of Medical Education and Pediatrics, University of Illinois at Chicago
| | - Debra Boyer
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Mass
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13
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Stoff BK, MacKelfresh JB, Stoddard HA. Education Versus Service in Residency: A False Dichotomy? J Grad Med Educ 2017; 9:395-396. [PMID: 28638537 PMCID: PMC5476408 DOI: 10.4300/jgme-d-16-00836.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Benjamin K Stoff
- Assistant Professor of Dermatology, Department of Dermatology, Emory University School of Medicine
- Senior Faculty Fellow, Emory Center for Ethics
| | - Jamie B MacKelfresh
- Assistant Professor and Residency Program Director, Department of Dermatology, Emory University School of Medicine
| | - Hugh A Stoddard
- Assistant Dean for Medical Education Research and Professor of Medicine, Emory University School of Medicine
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Institutional Pressure to Reduce Report Turnaround Time Is Damaging the Educational Mission. J Am Coll Radiol 2017; 14:537-540. [DOI: 10.1016/j.jacr.2016.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/02/2016] [Accepted: 12/06/2016] [Indexed: 11/22/2022]
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Fang M, Linson E, Suneja M, Kuperman EF. Impact of adding additional providers to resident workload and the resident experience on a medical consultation rotation. BMC MEDICAL EDUCATION 2017; 17:44. [PMID: 28228099 PMCID: PMC5322644 DOI: 10.1186/s12909-017-0874-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 01/31/2017] [Indexed: 05/24/2023]
Abstract
BACKGROUND Excellence in Graduate Medical Education requires the right clinical environment with an appropriate workload where residents have enough patients to gain proficiency in medicine with optimal time for reflection. The Accreditation Council for Graduate Medical Education (ACGME) has focused more on work hours rather than workload; however, high resident workload has been associated with lower resident participation in education and fatigue-related errors. Recognizing the potential risks associated with high resident workload and being mindful of the costs of reducing resident workload, we sought to reduce residents' workload by adding an advanced practice provider (APP) to the surgical comanagement service (SCM) and study its effect on resident satisfaction and perceived educational value of the rotation. METHODS In Fiscal Year (FY) 2014 and 2015, an additional faculty member was added to the SCM rotation. In FY 2014, the faculty member was a staff physician, and in FY 2015, the faculty member was an APP.. Resident workload was assessed using billing data. We measured residents' perceptions of the rotation using an anonymous electronic survey tool. We compared FY2014-2015 data to the baseline FY2013. RESULTS The number of patients seen per resident per day decreased from 8.0(SD 3.3) in FY2013 to 5.0(SD 1.9) in FY2014 (p < 0.001) and 5.7(SD 2.0) in FY2015 (p < 0.001). A higher proportion of residents reported "just right" patient volume (64.4%, 91.7%, 96.7% in FY2013, 2014, 2015 respectively p < 0.001), meeting curricular goals (79.9%, 95.0%, 97.2%, in FY2013, 2014 and 2015 respectively p < 0.001), and overall educational value of the rotation (40.0%, 72.2%, 72.6% in FY2013, 2014, 2015 respectively, p < 0.001). CONCLUSIONS Decreasing resident workload through adding clinical faculty (both staff physician and APPs) was associated with improvements on resident perceived educational value and clinical experience of a medical consultation rotation.
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Affiliation(s)
- Michele Fang
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA USA
- Department of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Section of Hospital Medicine, Hospital of the University of Pennsylvania, Department of Medicine, Section of Hospital Medicine, 3400 Spruce Street, Maloney Building, 5th floor, Suite 5033, Philadelphia, PA 19104 USA
| | - Eric Linson
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA USA
| | - Manish Suneja
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA USA
| | - Ethan F. Kuperman
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA USA
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Catalanotti JS, Amin AN, Caverzagie K, Gilden J, Walsh K, Vinciguerra SF, Laird-Fick HS. Balancing Service and Education: An AAIM Consensus Statement. Am J Med 2017; 130:237-242. [PMID: 27984011 DOI: 10.1016/j.amjmed.2016.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Affiliation(s)
| | - Alpesh N Amin
- Department of Medicine, University of California-Irvine
| | - Kelly Caverzagie
- Department of Internal Medicine, University of Nebraska College of Medicine, Omaha
| | - Janice Gilden
- Department of Medicine, Rosalind Franklin University of Medicine and Science/Chicago Medical School, North Chicago, Ill
| | - Katherine Walsh
- Department of Internal Medicine, Ohio State University, Columbus
| | | | - Heather S Laird-Fick
- On behalf of the AAIM Education Committee, Department of Medicine, Michigan State University, East Lansing
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Sajisevi M, Wilken R, Lee WT. The Role of Professional Identity Formation in Balancing Residency Service Versus Educational Needs. J Grad Med Educ 2016; 8:154-5. [PMID: 27168880 PMCID: PMC4857491 DOI: 10.4300/jgme-d-15-00123.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | | | - Walter T. Lee
- Corresponding author: Walter T. Lee, MD, MHSc, Duke University Medical Center, Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Room 3532–Blue Zone, DUMC 3805, Durham, NC 27710, 919.681.8449, fax 919.613.6524,
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Hendershot KM, Woods R, Parikh PP, Whitmill M, Runkle M. Service vs education: situational and perceptional differences in surgery residency. JOURNAL OF SURGICAL EDUCATION 2014; 71:e111-e115. [PMID: 25037505 DOI: 10.1016/j.jsurg.2014.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/30/2014] [Accepted: 06/12/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study determined whether situational or perceptional differences exist when trying to define what constitutes "service" and "education" in surgery residency in relation to the Accreditation Council of Graduate Medical Education (ACGME) survey. DESIGN An institutional review board-approved, single institute, cross-sectional study was conducted through a survey. Participants were asked to rate common resident tasks. Participants were also asked general questions regarding "service" and "education." SETTING Wright State University surgery program, Dayton, OH. PARTICIPANTS The study included 69 participants, which included medical students (19), residents (26), nurses/advanced practitioners (14), and attending surgeons (10). RESULTS A significantly high number of attending surgeons reported that writing a history and physical examination is educational compared with residents and students. Similar results were found regarding talking with patients/families. Drawing blood and starting peripheral intravenous access were universally rated as service tasks. For laparoscopic cholecystectomy, when the resident had done one previously, it was universally thought educational. When the resident had done more, most attending surgeons thought the task educational, but residents and students thought it much less educational. When analyzing only residents, in talking with families, most interns rated this as service, whereas postgraduate years 2 and 3 reported it as more educational and postgraduate years 4 and 5 ranked it equally as service and educational. Similar results were seen in answering nursing phone calls and writing admission orders. Residents (88%) and attending surgeons (90%) agreed that service is part of residency training. Only 40% of residents, however, stated they know what the term "service" means in regard to the ACGME survey. Overall, 80% of attending surgeons and 44% of residents agree that "service" has not been well defined by the ACGME. CONCLUSIONS Situational and perceptional differences do exist regarding "service" and "education" in our program, and most participants are unclear about the terms. As the definitions are situational and change with the person queried, then should this be the ACGME standard to assess programs and issue citations?
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Affiliation(s)
- Kimberly M Hendershot
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio.
| | - Randy Woods
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Priti P Parikh
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Melissa Whitmill
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Mary Runkle
- Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
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Kesselheim JC, Sun P, Woolf AD, London WB, Boyer D. Balancing education and service in graduate medical education: data from pediatric trainees and program directors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:652-657. [PMID: 24556769 PMCID: PMC4885597 DOI: 10.1097/acm.0000000000000174] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To measure pediatric program directors' (PDs') and trainees' perceptions of and expectations for the balance of service and education in their training programs. METHOD In fall 2011, an electronic survey was sent to PDs and trainees at Boston Children's Hospital. Respondents described perceptions and expectations for service and education and rated the education and service inherent to 12 vignettes. Wilcoxon rank sum tests measured the agreement between PD and trainee perceptions and ratings of service and education assigned to each vignette. RESULTS Responses were received from 28/39 PDs (78%) and 223/430 trainees (52%). Seventy-five (34%) trainees responded that their education had been compromised by excessive service obligations; only 1 (4%) PD agreed (P < .0001). Although 132 (59%) trainees reported that service obligations usually/sometimes predominated over clinical education, only 3 (11%) PDs agreed (P < .0001). One hundred trainees (45%) thought rotations never/rarely/sometimes provided a balance between education and clinical demands compared with 2 PDs (7%) (P < .0001). Both groups agreed that service can, without formal teaching, be considered educational. Trainees scored 6 vignettes as having greater educational value (P ≤ .01) and 10 as having lower service content (P ≤ .04) than PDs did. CONCLUSIONS Trainees and medical educators hold mismatched impressions of their training programs' balance of service and education. Trainees are more likely to report an overabundance of service. These data may impact the interpretation of Accreditation Council for Graduate Medical Education survey results and should be incorporated into dialogue about future curricular design initiatives.
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Affiliation(s)
- Jennifer C Kesselheim
- Dr. Kesselheim is assistant professor of pediatrics, Department of Pediatric Oncology, Dana-Farber/Children's Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts. Ms. Sun is statistician, formerly with the Department of Pediatric Oncology, Dana-Farber/Children's Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts. Dr. Woolf is associate professor of pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. Dr. London is statistician, Department of Pediatric Oncology, Dana-Farber/Children's Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts. Dr. Boyer is assistant professor of pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
- Pete Yunyongying
- Assistant Professor of Medicine, Department of General Internal Medicine, University of Texas Southwestern and VA North Texas Health Care System
| | - Margot Savoy
- Medical Director, Family Medicine Centers and Youth Protective Services, Department of Family and Community Medicine, Christiana Care Health System, and Level II Faculty Family Medicine Residency Program, Clinical Assistant Professor of Family Medicine, Jefferson Medical College
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