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Abstract
According to research lore, the second peer reviewer (Reviewer 2) is believed to rate research manuscripts more harshly than the other reviewers. The purpose of this study was to empirically investigate this common belief. We measured word count, positive phrases, negative phrases, question marks, and use of the word “please” in 2546 open peer reviews of 796 manuscripts published in the British Medical Journal. There was no difference in the content of peer reviews between Reviewer 2 and other reviewers for word count (630 vs 606, respectively, P = .16), negative phrases (8.7 vs 8.4, P = .29), positive phrases (4.2 vs 4.1, P = .10), question marks (4.8 vs 4.6, P = .26), and uses of “please” (1.0 vs 1.0, P = .86). In this study, Reviewer 2 provided reviews of equal sentiment to other reviewers, suggesting that popular beliefs surrounding Reviewer 2 may be unfounded.
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Affiliation(s)
- Christopher Worsham
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jaemin Woo
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - André Zimerman
- Postgraduate Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Charles F. Bray
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Anupam B. Jena
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
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Shoults B, Barber M, Millham L, Mulla M, Nanji N, Steele G, Peck T, Smithedajkul P, Worsham C, Currier P, Raphaely RA. Feasibility and Limitations of Proning Protocol for Nonintubated Patients With COVID-19. J Patient Exp 2021; 8:2374373520981486. [PMID: 34179358 PMCID: PMC8205337 DOI: 10.1177/2374373520981486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Proning awake patients with COVID-19 is associated with lower mortality and intubation rates. However, these studies also demonstrate low participation rates and tolerance of awake proning. In this study, we attempt to understand barriers to proning. Medical and dental students surveyed nonintubated patients to understand factors affecting adherence to a proning protocol. Only patients who discussed proning with their medical team attempted the practice. Eight of nine patients who were informed about benefits of proning attempted the maneuver. Discomfort was the primary reason patients stopped proning. Addressing discomfort and implementing systematic patient education may increase adherence to proning.
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Affiliation(s)
- Benjamin Shoults
- Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | | | - Tyler Peck
- Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | | | - Christopher Worsham
- Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Paul Currier
- Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Rebecca A Raphaely
- Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
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Abstract
This cross-sectional study examines the association between thunderstorm-related atmospheric changes and emergency department visits for acute respiratory illnesses among Medicare beneficiaries.
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Affiliation(s)
- Eric Zou
- Department of Economics, University of Oregon, Eugene
| | - Christopher Worsham
- Harvard Medical School, Department of Health Care Policy, Boston, Massachusetts
| | - Nolan H Miller
- Department of Finance, University of Illinois at Urbana-Champaign, Urbana
| | - David Molitor
- Department of Finance, University of Illinois at Urbana-Champaign, Urbana
| | - Julian Reif
- Department of Finance, University of Illinois at Urbana-Champaign, Urbana
| | - Anupam B Jena
- Harvard Medical School, Department of Health Care Policy, Boston, Massachusetts
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Abstract
OBJECTIVE To determine whether fast driving, luxury car ownership, and leniency by police officers differ across medical specialties. DESIGN Observational study. SETTING Florida, USA. PARTICIPANTS 5372 physicians and a sample of 19 639 non-physicians issued a ticket for speeding during 2004-17. MAIN OUTCOME MEASURES Observed rates of extreme speeding (defined as driving >20 mph above the speed limit), luxury car ownership, and leniency of the speeding ticket by police officers, by physician specialty, after adjustment for age and sex. RESULTS The sample included 5372 physicians who received 14 560 speeding tickets. The proportion of drivers who were reported driving at speeds greater than 20 mph was similar between physicians and a sample of 19 639 non-physicians who received a ticket for speeding (26.4% v 26.8% of tickets, respectively). Among physicians who received a ticket, psychiatrists were most likely to be fined for extreme speeding (adjusted odds ratio of psychiatry compared with baseline specialty of anesthesia 1.51, 95% confidence interval 1.07 to 2.14). Among drivers who received a ticket, luxury car ownership was most common among cardiologists (adjusted proportion of ticketed cardiologists who owned a luxury car 40.9%, 95% confidence interval 35.9% to 45.9%) and least common among physicians in emergency medicine, family practice, pediatrics, general surgery, and psychiatry (eg, adjusted proportion of luxury car ownership among family practice physicians 20.6%, 95% confidence interval 18.2% to 23.0%). Speed discounting, a marker of leniency by police officers in which ticketed speed is recorded at just below the threshold at which a larger fine would otherwise be imposed, was common, but rates did not differ by specialty and did not differ between physicians and a sample of non-physicians. CONCLUSIONS Rates of extreme speeding were highest among psychiatrists who received a ticket, whereas cardiologists were the most likely to be driving a luxury car when ticketed. Leniency by police officers was similar across specialties and between physicians and non-physicians.
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Affiliation(s)
- André Zimerman
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
| | - Christopher Worsham
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jaemin Woo
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
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Swamy L, Worsham C, Bialas MJ, Wertz C, Thornton D, Breu A, Ronan M. The 60-Minute Root Cause Analysis: A Workshop to Engage Interdisciplinary Clinicians in Quality Improvement. MedEdPORTAL 2018; 14:10685. [PMID: 30800885 PMCID: PMC6342415 DOI: 10.15766/mep_2374-8265.10685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION We created a standardized workshop to engage residents in quality improvement (QI) using the root cause analysis model. The workshop allows for a robust learning experience while providing solutions derived from clinicians to address important local problems. No prerequisite knowledge or experience is required. METHODS The workshop is facilitated by one or more moderators, ideally with experience in QI. An interdisciplinary group of residents, medical students, nurses, and other attendees comprise an audience which actively engages in workshop activities. Facilitators follow a scripted model to teach important patient safety concepts with frequent break-outs for hands-on application of QI tools. During the workshop, participants create a process map and fishbone diagram, as well as develop and critically evaluate novel interventions. RESULTS Over the course of one academic year, the workshop has been implemented 17 times with roughly 25 internal medicine residents in attendance at each workshop. In addition, the workshop was run online for 126 participants with varied exposure to QI techniques. Forty percent of these participants completed a survey indicating that over 89% learned something new, 87% felt they could apply the material to their work, and 95% would recommend the workshop to a colleague. DISCUSSION This 60-minute workshop can provide hands-on QI experience in a standardized format to achieve the dual objectives of teaching QI to clinicians and allowing them to generate innovations. The module can be used for internal case development and trainee participation, but prepared cases are provided for facilitators without the resources for local case development.
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Affiliation(s)
- Lakshman Swamy
- Co-Chief Resident, Quality and Patient Safety, Veterans Affairs Boston Healthcare System
- Corresponding author:
| | - Christopher Worsham
- Co-Chief Resident, Quality and Patient Safety, Veterans Affairs Boston Healthcare System
| | - Mark J. Bialas
- Clinical Coordinator, Medicine Department, Veterans Affairs Boston Healthcare System
| | - Christa Wertz
- Nurse Manager, Veterans Affairs Boston Healthcare System
| | - David Thornton
- Assistant Professor, Boston University School of Medicine
| | | | - Matthew Ronan
- Instructor in Medicine, Medicine, Harvard Medical School
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Abstract
INTRODUCTION In recent years, undergraduate and graduate medical education has been rightfully emphasizing education in quality improvement and patient safety (QIPS). However, the best methods for teaching the foundational principles of QIPS and associated skills are unknown. METHODS In collaboration with the Institute for Healthcare Improvement Open School, we developed an approachable simulation for teams of health care trainees at any level and any discipline. The simulation is based on the investigation of a case regarding a psychiatric patient admitted to a fictional hospital for medical treatment who has eloped. In teams, participants investigate the incident by collecting data and using basic QI principles to brainstorm and design interventions. Participants are guided through this paper-based simulation by QI facilitators who have working knowledge of basic QI principles and techniques. RESULTS The simulation has been successfully used with hundreds of medical students and other health professional trainees. While working in teams, participants gained exposure to patient-safety incident reporting and investigation, process mapping, plan-do-study-act cycles, run charts, intervention design, and interactions with hospital administrators. Surveyed participants reported that they had learned QI principles, gained confidence in their ability to do QI work, and increased their likelihood of leading a QI initiative in the future. DISCUSSION Simulation has become a standard way to teach many clinical topics in undergraduate and graduate medical education, and QIPS should be no exception. This simulation has been shown to be effective in increasing understanding of and interest in QIPS.
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Affiliation(s)
- Christopher Worsham
- Clinical and Research Fellow, Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital
| | - Lakshman Swamy
- Fellow, Department of Pulmonary and Critical Care, Boston University Medical Center
| | - Amir Gilad
- Medical Student, Boston University School of Medicine
| | - Jodi Abbott
- Associate Professor, Obstetrics and Gynecology Department, Boston University School of Medicine
- Assistant Dean, Office of Academic Affairs for Patient Safety and Quality Improvement Education, Boston University School of Medicine
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Affiliation(s)
- Payel Jhoom Roy
- Clinical Addiction Research & Education Unit, Boston University School of Medicine, Boston, Massachusetts
| | - Christopher Worsham
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Ganatra RB, Swamy L, Worsham C, Frosch Z, Breu AC. A Mission for Graduate Medical Education at VA. Fed Pract 2017; 34:12-15. [PMID: 30766234 PMCID: PMC6370407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Chief medical residents from the 3 affiliate residency training programs at VA Boston Healthcare System developed a mission statement for the educational experience of all medical trainees rotating through VA medical centers.
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Affiliation(s)
- Rahul B Ganatra
- was formerly chief medical resident and is a hospitalist at Beth Israel Deaconess Medical Center in Boston; was formerly chief medical resident at Boston Medical Center and is a fellow in Pulmonary & Critical Care Medicine at Boston Medical Center; was formerly chief medical resident at Boston Medical Center and is a clinical and research fellow, Pulmonary & Critical Care Medicine at Massachusetts General Hospital in Boston; was formerly chief medical resident at Brigham and Women's Hospital and is a hospitalist at Dana-Farber Cancer Institute in Boston; and is director of medical resident education at VA Boston Healthcare System; all in Massachusetts. Dr. Ganatra is an instructor of medicine, and Dr. Breu is an assistant professor of medicine, both at Harvard Medical School
| | - Lakshmana Swamy
- was formerly chief medical resident and is a hospitalist at Beth Israel Deaconess Medical Center in Boston; was formerly chief medical resident at Boston Medical Center and is a fellow in Pulmonary & Critical Care Medicine at Boston Medical Center; was formerly chief medical resident at Boston Medical Center and is a clinical and research fellow, Pulmonary & Critical Care Medicine at Massachusetts General Hospital in Boston; was formerly chief medical resident at Brigham and Women's Hospital and is a hospitalist at Dana-Farber Cancer Institute in Boston; and is director of medical resident education at VA Boston Healthcare System; all in Massachusetts. Dr. Ganatra is an instructor of medicine, and Dr. Breu is an assistant professor of medicine, both at Harvard Medical School
| | - Christopher Worsham
- was formerly chief medical resident and is a hospitalist at Beth Israel Deaconess Medical Center in Boston; was formerly chief medical resident at Boston Medical Center and is a fellow in Pulmonary & Critical Care Medicine at Boston Medical Center; was formerly chief medical resident at Boston Medical Center and is a clinical and research fellow, Pulmonary & Critical Care Medicine at Massachusetts General Hospital in Boston; was formerly chief medical resident at Brigham and Women's Hospital and is a hospitalist at Dana-Farber Cancer Institute in Boston; and is director of medical resident education at VA Boston Healthcare System; all in Massachusetts. Dr. Ganatra is an instructor of medicine, and Dr. Breu is an assistant professor of medicine, both at Harvard Medical School
| | - Zachary Frosch
- was formerly chief medical resident and is a hospitalist at Beth Israel Deaconess Medical Center in Boston; was formerly chief medical resident at Boston Medical Center and is a fellow in Pulmonary & Critical Care Medicine at Boston Medical Center; was formerly chief medical resident at Boston Medical Center and is a clinical and research fellow, Pulmonary & Critical Care Medicine at Massachusetts General Hospital in Boston; was formerly chief medical resident at Brigham and Women's Hospital and is a hospitalist at Dana-Farber Cancer Institute in Boston; and is director of medical resident education at VA Boston Healthcare System; all in Massachusetts. Dr. Ganatra is an instructor of medicine, and Dr. Breu is an assistant professor of medicine, both at Harvard Medical School
| | - Anthony C Breu
- was formerly chief medical resident and is a hospitalist at Beth Israel Deaconess Medical Center in Boston; was formerly chief medical resident at Boston Medical Center and is a fellow in Pulmonary & Critical Care Medicine at Boston Medical Center; was formerly chief medical resident at Boston Medical Center and is a clinical and research fellow, Pulmonary & Critical Care Medicine at Massachusetts General Hospital in Boston; was formerly chief medical resident at Brigham and Women's Hospital and is a hospitalist at Dana-Farber Cancer Institute in Boston; and is director of medical resident education at VA Boston Healthcare System; all in Massachusetts. Dr. Ganatra is an instructor of medicine, and Dr. Breu is an assistant professor of medicine, both at Harvard Medical School
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Affiliation(s)
| | - Anthony C Breu
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts3Harvard Medical School, Boston, Massachusetts
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Worsham C, Ackrivo J, Breu AC. Prompt Extubation After Intensive Care Unit Procedures: A Teachable Moment. JAMA Intern Med 2015; 175:1447-8. [PMID: 26193488 DOI: 10.1001/jamainternmed.2015.3656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Jason Ackrivo
- Boston University Internal Medicine Residency, Boston, Massachusetts
| | - Anthony C Breu
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts3Harvard Medical School, Boston, Massachusetts
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