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Abstract
OBJECTIVES A large discrepancy exists in resident educational activities between daytime and nighttime medical rotations. The Accreditation Council for Graduate Medical Education duty-hour regulations led to the increased adoption of the dedicated nighttime rotation called night float. Nighttime education has largely been negatively perceived by night float medical residents. Although there have been attempts to improve nighttime education, none of the initiatives included faculty-guided structured night curriculum. Our objective was to improve resident experience with and perception of nighttime education by implementing a structured, faculty-guided, nighttime educational curriculum. METHODS This was an assessment of an educational initiative at a single academic medical center, Virginia Commonwealth University Health System. The internal medicine residency program implemented a teaching nocturnist program in 2013 and a novel faculty-guided nighttime teaching curriculum in 2016 called midnight report. We then evaluated resident experience with and perception of nighttime education at our institution using anonymous free-response surveys for the academic year July 2016-June 2017. RESULTS Of the 142 eligible residents, 95 (67%) responded to the survey. The majority of the residents (54%-77%) positively perceived their experience of the nighttime educational environment during their night float rotation after implementation of the teaching nocturnist program and midnight report. CONCLUSIONS Compared with the published literature reporting negative perceptions of the nighttime educational environment by residents at different academic centers, our results showed that the majority of our residents positively perceived the impact of our new faculty-guided nighttime educational curriculum.
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Affiliation(s)
- Jawad Al-Khafaji
- From the Department of Medicine, University of Michigan, Ann Arbor, and the Department of Medicine, Virginia Commonwealth University, Richmond
| | - Venkata Rajesh Konjeti
- From the Department of Medicine, University of Michigan, Ann Arbor, and the Department of Medicine, Virginia Commonwealth University, Richmond
| | - Stephanie Call
- From the Department of Medicine, University of Michigan, Ann Arbor, and the Department of Medicine, Virginia Commonwealth University, Richmond
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Obiols C, Call S, Rami-Porta R, Jaen A, De Antonio DG, Crowley S, Royo I, Embún R. OA12.07 Radicality of Lymphadenectomy in Lung Cancer According to Surgical Approach. Results from the Spanish Group of Video-Assisted Thoracic Surgery. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chacko KM, Reddy S, Kisielewski M, Call S, Willett LL, Chaudhry S. Postinterview Communications: Two Surveys of Internal Medicine Residency Program Directors Before and After Guideline Implementation. Acad Med 2018; 93:1367-1373. [PMID: 29697427 DOI: 10.1097/acm.0000000000002261] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Guidelines surrounding postinterview communication (PIC) after residency interviews were issued by the National Resident Matching Program and Association of Program Directors in Internal Medicine. How they have influenced PIC and program directors' (PDs') reasons for PIC is unknown. METHOD Annual surveys of 365 U.S. internal medicine residency PDs in 2013 and 368 in 2015 were used. Questions about frequency, intent, and usefulness of PIC and knowledge of guidelines before and after new PIC guidelines were included. Chi-square tests were used to compare data sets, and multivariate logistic regression was performed for 2015 data to identify factors predicting engagement in PIC, using program characteristics, PD characteristics, and beliefs about the benefits of PIC as independent variables. RESULTS There were 265 (73%) respondents in 2013 and 227 (62%) in 2015. While the number of programs with a PIC policy increased 43%, the level of contact increased 7%. Few PDs indicated PIC was helpful to them; however, PDs who felt PIC helps target applicants were more likely to engage in PIC (OR 4.21, SE 1.88, P = .001). The main reason for continuing PIC (50% of PDs) was that PIC, part of their program's culture, was considered "good manners." CONCLUSIONS New guidelines increased the number of programs with a PIC policy, but the overall rate of applicant contact did not change despite few PDs feeling PIC was helpful to recruitment. The culture surrounding PIC may be difficult to overcome via guidelines alone, and more definitive rules are necessary to implement change.
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Affiliation(s)
- Karen M Chacko
- K.M. Chacko is associate professor of medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado. S. Reddy is professor of medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois. M. Kisielewski is survey and data manager, Alliance for Academic Internal Medicine, Alexandria, Virginia. S. Call is professor of medicine, Department of Medicine, Virginia Commonwealth, University, Richmond, Virginia. L.L. Willett is professor of medicine, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama. S. Chaudhry is vice president of academic affairs, Memorial Healthcare System, Hollywood, Florida
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Decaluwe H, Dooms C, D'Journo X, Call S, Sanchez-Lorente D, Haager B, Beelen R, Kara V, Klikovits T, Aigner C, Tournoy K, Moons J, Brioude G, Trujillo J, Bethe B, Klepetko W, Turna A, Passlick B, Molins L, Rami-Porta R, Thomas P, De Leyn P. OA 16.06 Mediastinal Staging by Videomediastinoscopy in Clinical N1 Non-Small Cell Lung Cancer: a Prospective Multicenter Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chacko KM, Halvorsen AJ, Swenson SL, Wahi-Gururaj S, Steinmann AF, Call S, Myers JS, Vidyarthi A, Arora VM. US Internal Medicine Program Director Perceptions of Alignment of Graduate Medical Education and Institutional Resources for Engaging Residents in Quality and Safety. Am J Med Qual 2017; 33:405-412. [DOI: 10.1177/1062860617739119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alignment between institutions and graduate medical education (GME) regarding quality and safety initiatives (QI) has not been measured. The objective was to determine US internal medicine residency program directors’ (IM PDs) perceived resourcing for QI and alignment between GME and their institutions. A national survey of IM PDs was conducted in the Fall of 2013. Multivariable linear regression was used to test association between a novel Integration Score (IS) measuring alignment between GME and the institution via PD perceptions. The response rate was 72.6% (265/365). According to PDs, residents were highly engaged in QI (82%), but adequate funding (14%) and support personnel (37% to 61%) were lower. Higher IS correlated to reports of funding for QI (76.3% vs 54.5%, P = .012), QI personnel (67.3% vs 41.1%, P < .001), research experts (70.5% vs 50.0%, P < .001), and computer experts (69.0% vs 45.8%, P < .001) for QI assistance. Apparent mismatch between GME and institutional resources exists, and the IS may be useful in measuring GME–institutional leadership alignment in QI.
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Affiliation(s)
| | | | - Sara L. Swenson
- California Pacific Medical Center, San Francisco, CA
- University of California, San Francisco, CA
| | | | | | | | | | - Arpana Vidyarthi
- Duke-NUS Medical School, Singapore, Singapore
- National University Health Services, Singapore, Singapore
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Braun SE, Auerbach SM, Rybarczyk B, Lee B, Call S. Mindfulness, burnout, and effects on performance evaluations in internal medicine residents. Adv Med Educ Pract 2017; 8:591-597. [PMID: 28860889 PMCID: PMC5565254 DOI: 10.2147/amep.s140554] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Burnout has been documented at high levels in medical residents with negative effects on performance. Some dispositional qualities, like mindfulness, may protect against burnout. The purpose of the present study was to assess burnout prevalence among internal medicine residents at a single institution, examine the relationship between mindfulness and burnout, and provide preliminary findings on the relation between burnout and performance evaluations in internal medicine residents. METHODS Residents (n = 38) completed validated measures of burnout at three time points separated by 2 months and a validated measure of dispositional mindfulness at baseline. Program director end-of-year performance evaluations were also obtained on 22 milestones used to evaluate internal medicine resident performance; notably, these milestones have not yet been validated for research purposes; therefore, the investigation here is exploratory. RESULTS Overall, 71.1% (n = 27) of the residents met criteria for burnout during the study. Lower scores on the "acting with awareness" facet of dispositional mindfulness significantly predicted meeting burnout criteria χ2(5) = 11.88, p = 0.04. Lastly, meeting burnout criteria significantly predicted performance on three of the performance milestones, with positive effects on milestones from the "system-based practices" and "professionalism" domains and negative effects on a milestone from the "patient care" domain. CONCLUSION Burnout rates were high in this sample of internal medicine residents and rates were consistent with other reports of burnout during medical residency. Dispositional mindfulness was supported as a protective factor against burnout. Importantly, results from the exploratory investigation of the relationship between burnout and resident evaluations suggested that burnout may improve performance on some domains of resident evaluations while compromising performance on other domains. Implications and directions for future research are discussed.
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Affiliation(s)
- Sarah E Braun
- Department of Psychology, School of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen M Auerbach
- Department of Psychology, School of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Bruce Rybarczyk
- Department of Psychology, School of Humanities and Sciences, Virginia Commonwealth University, Richmond, VA, USA
| | - Bennett Lee
- Department of Internal Medicine, Division of General Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephanie Call
- Department of Internal Medicine, Division of General Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Brown DR, Warren JB, Hyderi A, Drusin RE, Moeller J, Rosenfeld M, Orlander PR, Yingling S, Call S, Terhune K, Bull J, Englander R, Wagner DP. Finding a Path to Entrustment in Undergraduate Medical Education: A Progress Report From the AAMC Core Entrustable Professional Activities for Entering Residency Entrustment Concept Group. Acad Med 2017; 92:774-779. [PMID: 28557941 DOI: 10.1097/acm.0000000000001544] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PROBLEM To better prepare graduating medical students to transition to the professional responsibilities of residency, 10 medical schools are participating in an Association of American Medical Colleges pilot to evaluate the feasibility of explicitly teaching and assessing 13 Core Entrustable Professional Activities for Entering Residency. The authors focused on operationalizing the concept of entrustment as part of this process. APPROACH Starting in 2014, the Entrustment Concept Group, with representatives from each of the pilot schools, guided the development of the structures and processes necessary for formal entrustment decisions associated with students' increased responsibilities at the start of residency. OUTCOMES Guiding principles developed by the group recommend that formal, summative entrustment decisions in undergraduate medical education be made by a trained group, be based on longitudinal performance assessments from multiple assessors, and incorporate day-to-day entrustment judgments by workplace supervisors. Key to entrustment decisions is evidence that students know their limits (discernment), can be relied on to follow through (conscientiousness), and are forthcoming despite potential personal costs (truthfulness), in addition to having the requisite knowledge and skills. The group constructed a developmental framework for discernment, conscientiousness, and truthfulness to pilot a model for transparent entrustment decision making. NEXT STEPS The pilot schools are studying a number of questions regarding the pathways to and decisions about entrustment. This work seeks to inform meaningful culture change in undergraduate medical education through a shared understanding of the assessment of trust and a shared trust in that assessment.
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Affiliation(s)
- David R Brown
- D.R. Brown is vice chair, chief of family and community medicine, and associate professor of humanities, health, and society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida. J.B. Warren is assistant professor of pediatrics, Oregon Health & Science University School of Medicine, Portland, Oregon. A. Hyderi is associate dean for curriculum and associate professor of family medicine, University of Illinois College of Medicine, Chicago, Illinois. R.E. Drusin is vice dean for education and professor of medicine, Columbia University College of Physicians and Surgeons, New York, New York. J. Moeller is residency program director and assistant professor of neurology, Yale School of Medicine, New Haven, Connecticut. M. Rosenfeld is senior associate dean for medical education and associate professor of cell biology, New York University School of Medicine, New York, New York. P.R. Orlander is associate dean for curricular affairs, vice chair for education, and professor of internal medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas. S. Yingling is associate dean for educational planning and quality improvement and assistant professor of medical education, University of Illinois College of Medicine, Chicago, Illinois. She was manager, Division of Education Quality, Institute for Innovations in Medical Education, New York University School of Medicine, New York, New York, at the time this work began. S. Call is associate chair for education, residency program director, and professor of medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia. K. Terhune is residency program director and associate professor of surgery, Vanderbilt University School of Medicine, Nashville, Tennessee. J. Bull is lead specialist in competency-based learning and assessment, Association of American Medical Colleges, Washington, DC. R. Englander is associate dean for undergraduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota. D.P. Wagner is associate dean for undergraduate medical education and professor of medicine, Michigan State University College of Human Medicine, East Lansing, Michigan
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Angus SV, Vu TR, Willett LL, Call S, Halvorsen AJ, Chaudhry S. Internal Medicine Residency Program Directors' Views of the Core Entrustable Professional Activities for Entering Residency: An Opportunity to Enhance Communication of Competency Along the Continuum. Acad Med 2017; 92:785-791. [PMID: 28557944 DOI: 10.1097/acm.0000000000001419] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To examine internal medicine (IM) residency program directors' (PDs') perspectives on the Core Entrustable Professional Activities for Entering Residency (Core EPAs)-introduced into undergraduate medical education to further competency-based assessment-and on communicating competency-based information during transitions. METHOD A spring 2015 Association of Program Directors in Internal Medicine survey asked PDs of U.S. IM residency programs for their perspectives on which Core EPAs new interns must or should possess on day 1, which are most essential, and which have the largest gap between expected and observed performance. Their views and preferences were also requested regarding communicating competency-based information at transitions from medical school to residency and residency to fellowship/employment. RESULTS The response rate was 57% (204/361 programs). The majority of PDs felt new interns must/should possess 12 of the 13 Core EPAs. PDs' rankings of Core EPAs by relative importance were more varied than their rankings by the largest gaps in performance. Although preferred timing varied, most PDs (82%) considered it important for medical schools to communicate Core EPA-based information to PDs; nearly three-quarters (71%) would prefer a checklist format. Many (60%) would be willing to provide competency-based evaluations to fellowship directors/employers. Most (> 80%) agreed that there should be a bidirectional communication mechanism for programs/employers to provide feedback on competency assessments. CONCLUSIONS The gaps identified in Core EPA performance may help guide medical schools' curricular and assessment tool design. Sharing competency-based information at transitions along the medical education continuum could help ensure production of competent, practice-ready physicians.
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Affiliation(s)
- Steven V Angus
- S.V. Angus is internal medicine residency program director and vice chair of education, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut. T.R. Vu is associate professor of clinical medicine and associate director of internal medicine clerkships, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana. L.L. Willett is internal medicine residency program director and vice chair of education, Department of Medicine, University of Alabama, Birmingham, Birmingham, Alabama. S. Call is associate chair for education and program director, Internal Medicine Training Program, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia. A.J. Halvorsen is project and data manager, Office of Educational Innovations, Internal Medicine Residency Program, Mayo Clinic, Rochester, Minnesota. S. Chaudhry is vice president for academic affairs and chief academic officer, Memorial Healthcare System, Fort Lauderdale, Florida
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Affiliation(s)
- Eric S Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Stephanie Call
- Department of Internal Medicine,Virginia Commonwealth University, Richmond
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Englander R, Flynn T, Call S, Carraccio C, Cleary L, Fulton TB, Garrity MJ, Lieberman SA, Lindeman B, Lypson ML, Minter RM, Rosenfield J, Thomas J, Wilson MC, Aschenbrener CA. Toward Defining the Foundation of the MD Degree: Core Entrustable Professional Activities for Entering Residency. Acad Med 2016; 91:1352-1358. [PMID: 27097053 DOI: 10.1097/acm.0000000000001204] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Currently, no standard defines the clinical skills that medical students must demonstrate upon graduation. The Liaison Committee on Medical Education bases its standards on required subject matter and student experiences rather than on observable educational outcomes. The absence of such established outcomes for MD graduates contributes to the gap between program directors' expectations and new residents' performance.In response, in 2013, the Association of American Medical Colleges convened a panel of experts from undergraduate and graduate medical education to define the professional activities that every resident should be able to do without direct supervision on day one of residency, regardless of specialty. Using a conceptual framework of entrustable professional activities (EPAs), this Drafting Panel reviewed the literature and sought input from the health professions education community. The result of this process was the publication of 13 core EPAs for entering residency in 2014. Each EPA includes a description, a list of key functions, links to critical competencies and milestones, and narrative descriptions of expected behaviors and clinical vignettes for both novice learners and learners ready for entrustment.The medical education community has already begun to develop the curricula, assessment tools, faculty development resources, and pathways to entrustment for each of the 13 EPAs. Adoption of these core EPAs could significantly narrow the gap between program directors' expectations and new residents' performance, enhancing patient safety and increasing residents', educators', and patients' confidence in the care these learners provide in the first months of their residency training.
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Affiliation(s)
- Robert Englander
- R. Englander was senior director of competency-based learning and assessment, Association of American Medical Colleges, Washington, DC, at the time this work was done. He is now associate dean for undergraduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota.T. Flynn is senior associate dean for clinical affairs, University of Florida College of Medicine, Gainesville, Florida.S. Call is program director for internal medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia.C. Carraccio is vice president for competency-based assessment programs, American Board of Pediatrics, Chapel Hill, North Carolina.L. Cleary is vice president for academic affairs, State University of New York Upstate Medical University, Syracuse, New York.T.B. Fulton is professor of biochemistry and biophysics and competency director for medical knowledge, University of California, San Francisco, School of Medicine, San Francisco, California.M.J. Garrity is associate professor of medicine and physiology and associate dean, University of Colorado Anschutz Medical Campus, Aurora, Colorado.S.A. Lieberman is senior dean for administration, University of Texas Medical Branch School of Medicine, Galveston, Texas.B. Lindeman is chief resident, Department of General Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.M.L. Lypson is professor of internal medicine and learning health sciences, University of Michigan Medical School, and associate chief of staff for education, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.R.M. Minter was associate professor of surgery and learning health sciences, associate chair for education, Department of Surgery, and associate program director in general surgery, University of Michigan Medical School, Ann Arbor, Michigan, at the time this work was done. She is now professor and Alvin Baldwin Jr. Chair, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas.J. Rosenfield is vice dean of the MD program, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.J. Thomas is a resident in emergency medicine, Mayo Clinic, Rochester, Minnesota.M.C. Wilson is clinical professor of internal medicine and associate dean for graduate medical education, University of Iowa Carver College of Medicine, and designated institutional official, University of Iowa Hospitals and Clinics, Iowa City, Iowa.C.A. Aschenbrener was chief medical education officer, Association of American Medical Colleges, Washington, DC, at the time this work was done
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Rusch VW, Chansky K, Kindler HL, Nowak AK, Pass HI, Rice DC, Shemanski L, Galateau-Sallé F, McCaughan BC, Nakano T, Ruffini E, van Meerbeeck JP, Yoshimura M, Rami-Porta R, Asamura H, Ball D, Beer D, Beyruti R, Bolejack V, Chansky K, Crowley J, Detterbeck FC, Eberhardt WEE, Edwards J, Galateau-Sallé F, Giroux D, Gleeson F, Groome P, Huang J, Kennedy C, Kim J, Kim YT, Kingsbury L, Kondo H, Krasnik M, Kubota K, Lerut T, Lyons G, Marino M, Marom EM, van Meerbeeck JP, Mitchell A, Nakano T, Nicholson AG, Nowak A, Peake M, Rice TW, Rosenzweig K, Ruffini E, Rusch VW, Saijo N, Van Schil P, Sculier JP, Shemanski L, Stratton K, Suzuki K, Tachimori Y, Thomas CF, Travis WD, Tsao MS, Turrisi A, Vansteenkiste J, Watanabe H, Wu YL, Baas P, Erasmus J, Hasegawa S, Inai K, Kernstine K, Kindler H, Krug L, Nackaerts K, Pass H, Rice D, Falkson C, Filosso PL, Giaccone G, Kondo K, Lucchi M, Okumura M, Blackstone E, Asamura H, Batirel H, Bille A, Pastorino U, Call S, Cangir A, Cedres S, Friedberg J, Galateau-Sallé F, Hasagawa S, Kernstine K, Kindler H, McCaughan B, Nakano T, Nowak A, Ozturk CA, Pass H, de Perrot M, Rea F, Rice D, Rintoul R, Ruffini E, Rusch V, Spaggiari L, Galetta D, Syrigos K, Thomas C, van Meerbeeck J, Nafteux P, Vansteenkiste J, Weder W, Optiz I, Yoshimura M. The IASLC Mesothelioma Staging Project: Proposals for the M Descriptors and for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Mesothelioma. J Thorac Oncol 2016; 11:2112-2119. [PMID: 27687962 DOI: 10.1016/j.jtho.2016.09.124] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/11/2016] [Accepted: 09/11/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The M component and TNM stage groupings for malignant pleural mesothelioma (MPM) have been empirical. The International Association for the Study of Lung Cancer developed a multinational database to propose evidence-based revisions for the eighth edition of the TNM classification of MPM. METHODS Data from 29 centers were submitted either electronically or by transfer of existing institutional databases. The M component as it currently stands was validated by confirming sufficient discrimination (by Kaplan-Meier analysis) with respect to overall survival (OS) between the clinical M0 (cM0) and cM1 categories. Candidate stage groups were developed by using a recursive partitioning and amalgamation algorithm applied to all cM0 cases. RESULTS Of 3519 submitted cases, 2414 were analyzable and 84 were cM1 cases. Median OS for cM1 cases was 9.7 months versus 13.4 months (p = 0.0013) for the locally advanced (T4 or N3) cM0 cases, supporting inclusion of only cM1 in the stage IV group. Exploratory analyses suggest a possible difference in OS for single- versus multiple-site cM1 cases. A recursive partitioning and amalgamation-generated survival tree on the OS outcomes restricted to cM0 cases with the newly proposed (eighth edition) T and N components indicates that optimal stage groupings for the eighth edition will be as follows: stage IA (T1N0), stage IB (T2-3N0), stage II (T1-2N1), stage IIIA (T3N1), stage IIIB (T1-3N2 or any T4), and stage IV (any M1). CONCLUSIONS This first evidence-based revision of the TNM classification for MPM leads to substantial changes in the T and N components and the stage groupings.
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Affiliation(s)
- Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Kari Chansky
- Cancer Research And Biostatistics, Seattle, Washington
| | - Hedy L Kindler
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - Anna K Nowak
- National Centre for Asbestos Related Diseases, School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University Medical Center, New York, New York
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, M.D. Anderson Cancer Center, Houston, Texas
| | | | | | - Brian C McCaughan
- Sydney Cardiothoracic Surgeons, Royal Prince Alfred Medical Centre, Sydney, New South Wales, Australia
| | - Takashi Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Enrico Ruffini
- Department of Surgical Sciences, City of Health and Science Hospital, University of Turin, Turin, Italy
| | - Jan P van Meerbeeck
- Department of Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Masahiro Yoshimura
- Department of Thoracic Surgery, Hyogo Cancer Center, Akashi City, Hyogo, Japan
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Nowak AK, Chansky K, Rice DC, Pass HI, Kindler HL, Shemanski L, Billé A, Rintoul RC, Batirel HF, Thomas CF, Friedberg J, Cedres S, de Perrot M, Rusch VW, Rami-Porta R, Asamura H, Ball D, Beer D, Beyruti R, Bolejack V, Chansky K, Crowley J, Detterbeck F, Eberhardt WEE, Edwards J, Galateau-Sallé F, Giroux D, Gleeson F, Groome P, Huang J, Kennedy C, Kim J, Kim YT, Kingsbury L, Kondo H, Krasnik M, Kubota K, Lerut A, Lyons G, Marino M, Marom EM, van Meerbeeck J, Mitchell A, Nakano T, Nicholson AG, Nowak A, Peake M, Rice T, Rosenzweig K, Ruffini E, Rusch V, Saijo N, Van Schil P, Sculier JP, Shemanski L, Stratton K, Suzuki K, Tachimori Y, Thomas CF, Travis W, Tsao MS, Turrisi A, Vansteenkiste J, Watanabe H, Wu YL, Baas P, Erasmus J, Hasegawa S, Inai K, Kernstine K, Kindler H, Krug L, Nackaerts K, Pass H, Rice D, Falkson C, Filosso PL, Giaccone G, Kondo K, Lucchi M, Okumura M, Blackstone E, Asamura H, Batirel H, Bille A, Pastorino U, Call S, Cangir A, Cedres S, Friedberg J, Galateau-Salle F, Hasagawa S, Kernstine K, Kindler H, McCaughan B, Nakano T, Nowak A, Ozturk CA, Pass H, de Perrot M, Rea F, Rice D, Rintoul R, Ruffini E, Rusch V, Spaggiari L, Galetta D, Syrigos K, Thomas C, van Meerbeeck J, Nafteux P, Vansteenkiste J, Weder W, Optiz I, Yoshimura M. The IASLC Mesothelioma Staging Project: Proposals for Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Pleural Mesothelioma. J Thorac Oncol 2016; 11:2089-2099. [PMID: 27687963 DOI: 10.1016/j.jtho.2016.08.147] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 08/18/2016] [Accepted: 08/20/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The current T component for malignant pleural mesothelioma (MPM) has been predominantly informed by surgical data sets and consensus. The International Association for the Study of Lung Cancer undertook revision of the seventh edition of the staging system for MPM with the goal of developing recommendations for the eighth edition. METHODS Data elements including detailed T descriptors were developed by consensus. Tumor thickness at three pleural levels was also recorded. An electronic data capture system was established to facilitate data submission. RESULTS A total of 3519 cases were submitted to the database. Of those eligible for T-component analysis, 509 cases had only clinical staging, 836 cases had only surgical staging, and 642 cases had both available. Survival was examined for T categories according to the current seventh edition staging system. There was clear separation between all clinically staged categories except T1a versus T1b (hazard ratio = 0.99, p = 0.95) and T3 versus T4 (hazard ratio = 1.22, p = 0.09), although the numbers of T4 cases were small. Pathological staging failed to demonstrate a survival difference between adjacent categories with the exception of T3 versus T4. Performance improved with collapse of T1a and T1b into a single T1 category; no current descriptors were shifted or eliminated. Tumor thickness and nodular or rindlike morphology were significantly associated with survival. CONCLUSIONS A recommendation to collapse both clinical and pathological T1a and T1b into a T1 classification will be made for the eighth edition staging system. Simple measurement of pleural thickness has prognostic significance and should be examined further with a view to incorporation into future staging.
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Affiliation(s)
- Anna K Nowak
- National Centre for Asbestos Related Diseases, School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia; Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
| | - Kari Chansky
- Cancer Research And Biostatistics, Seattle, Washington
| | | | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York
| | - Hedy L Kindler
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | | | - Andrea Billé
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Robert C Rintoul
- Department of Thoracic Oncology, Papworth Hospital National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Hasan F Batirel
- Department of Thoracic Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Charles F Thomas
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joseph Friedberg
- Department of Thoracic Surgery, University of Maryland Cancer Center, Baltimore, Maryland
| | - Susana Cedres
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Valerie W Rusch
- Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Call S, Rami-Porta R, Embun R, Rivas De Andres JJ, Molins L, Belda-Sanchis J. F-071 * IMPACT OF LYMPH NODE INVOLVEMENT AND ROLE OF LYMPHADENECTOMY IN THE SURGERY OF LUNG METASTASES OF COLORECTAL CANCER: RESULTS FROM THE SPANISH PROSPECTIVE COLORECTAL METASTASECTOMY REGISTRY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Obiols C, Call S, Rami-Porta R, Trujillo-Reyes JC, Iglesias M, Saumench R, Serra-Mitjans M, Belda-Sanchis J. O-085 * ALTERNATIVE APPROACH TO BILATERAL SYNCHRONOUS BRONCHOGENIC CARCINOMA. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu167.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rodriguez-Fuster A, Belda-Sanchis J, Aguilo R, Embun R, Mojal S, Call S, Molins L, Rivas de Andres JJ, Zafra JR, Navarrete CP, de la Cruz Lozano J, Rivas de Andres JJ, Flor RE, Freixinet J, Carbajo MC, Rombola CA, Heras F, Molins L, Mier Odriozola JM, Doyague FR, Rodriguez-Fuster A, Arrayas EC, Garay MR, Call S, Araujo EF, Barajas SG, Prim JMG, Gonzalez D, Ramos MB, Sarceda JRJ, Pascual RP, Molina GM, Fernandez MCM, Olaiz BD, Tristan AA, Franco CG, Wins R, Arnau A, Padilla JMC, Carriquiry G, Rosenberg M, Smith D. Morbidity and mortality in a large series of surgical patients with pulmonary metastases of colorectal carcinoma: a prospective multicentre Spanish study (GECMP-CCR-SEPAR). Eur J Cardiothorac Surg 2013; 45:671-6. [DOI: 10.1093/ejcts/ezt459] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Trujillo JC, Call S, Obiols C, Rami-Porta R, Gonzalez JM, Ysamat M, Gonzalez-Pont G, Belda-Sanchis J. 257 * NEGATIVE PREDICTIVE VALUE OF POSITRON EMISSION TOMOGRAPHY FOR MEDIASTINAL LYMPH NODE STAGING IN A COHORT OF PATIENTS WHO UNDERWENT DIRECT THORACOTOMY FOR NON-SMALL-CELL LUNG CANCER. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Willett LL, Estrada CA, Adams M, Arora V, Call S, Chacko K, Chaudhry S, Halvorsen AJ, Hopkins R, McDonald FS. Challenges with continuity clinic and core faculty accreditation requirements. Am J Med 2013; 126:550-6. [PMID: 23684398 DOI: 10.1016/j.amjmed.2013.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 02/22/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Lisa L Willett
- Division of General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA.
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Lang VJ, Aboff BM, Bordley DR, Call S, Dezee KJ, Fazio SB, Fitz M, Hemmer PA, Logio LS, Wayne DB. Guidelines for writing department of medicine summary letters. Am J Med 2013; 126:458-63. [PMID: 23582937 DOI: 10.1016/j.amjmed.2013.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 01/29/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Valerie J Lang
- University of Rochester School of Medicine & Dentistry, Rochester, NY 14642, USA.
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Adams M, Morrison TB, Call S, Halvorsen AJ, Moore J, Lucarelli M, Angus S, McDonald FS. Changes in the national residency matching program policy: are internal medicine program directors "all-in"? J Grad Med Educ 2012; 4:148-53. [PMID: 23730433 PMCID: PMC3399604 DOI: 10.4300/jgme-d-11-00258.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Friedman SR, Reynolds J, Quan MA, Call S, Crusto CA, Kaufman JS. Measuring changes in interagency collaboration: an examination of the Bridgeport Safe Start Initiative. Eval Program Plann 2007; 30:294-306. [PMID: 17689334 DOI: 10.1016/j.evalprogplan.2007.04.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Indexed: 05/16/2023]
Abstract
This paper describes the evaluation of interagency collaboration in a network of child-serving providers as part of the evaluation of the Bridgeport Safe Start Initiative (BSSI). In line with the system of care approach, the objectives of BSSI included reducing fragmentation of efforts and delivering integrated services to families of young children exposed to or at risk of exposure to family violence. Interagency collaboration was examined via social network and focus group data collected at three time points starting at baseline. Network analysis findings suggest that over time the network structure became consistent with BSSI's vision of an ideal collaborative network structure. Focus group findings, however, present a more complex picture of the status of collaboration. This paper sheds light on approaches and challenges to measuring interagency collaboration in a service delivery system and communicating social network analysis findings to stakeholders in a way that is accessible and useful.
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Affiliation(s)
- Stacey R Friedman
- Division of Prevention and Community Research, Yale University School of Medicine, 389 Whitney Avenue, New Haven, CT 06511, USA
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Kaufman JS, Crusto CA, Quan M, Ross E, Friedman SR, O'Rielly K, Call S. Utilizing program evaluation as a strategy to promote community change: evaluation of a comprehensive, community-based, family violence initiative. Am J Community Psychol 2006; 38:191-200. [PMID: 17086485 DOI: 10.1007/s10464-006-9086-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This paper describes the authors' work in a community that received Federal funding for an integrated system of care to reduce the impact and incidence of exposure to violence for children less than six years of age. The paper includes a review of the conceptual framework that guided the work of the authors and provides a brief overview of the issue of family violence, the impact of this violence on young children, and the Federal response to this issue. In addition, a description of the Initiative and the community in which it was based is provided along with some aspects of the evaluation plan. Finally, the authors discuss how their work with this Initiative depicts an approach to facilitating change within communities.
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Affiliation(s)
- Joy S Kaufman
- The Division of Prevention and Community Research and The Consultation Center, Yale University School of Medicine, 389 Whitney Avenue, New Haven, CT 06511, USA.
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Chen RY, Accortt NA, Westfall AO, Mugavero MJ, Raper JL, Cloud GA, Stone BK, Carter J, Call S, Pisu M, Allison J, Saag MS. Distribution of health care expenditures for HIV-infected patients. Clin Infect Dis 2006; 42:1003-10. [PMID: 16511767 DOI: 10.1086/500453] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2005] [Accepted: 11/02/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Health care expenditures for persons infected with human immunodeficiency virus (HIV) in the United State determined on the basis of actual health care use have not been reported in the era of highly active antiretroviral therapy. METHODS Patients receiving primary care at the University of Alabama at Birmingham HIV clinic were included in the study. All encounters (except emergency room visits) that occurred within the University of Alabama at Birmingham Hospital System from 1 March 2000 to 1 March 2001 were analyzed. Medication expenditures were determined on the basis of 2001 average wholesale price. Hospitalization expenditures were determined on the basis of 2001 Medicare diagnostic related group reimbursement rates. Clinic expenditures were determined on the basis of 2001 Medicare current procedural terminology reimbursement rates. RESULTS Among the 635 patients, total annual expenditures for patients with CD4+ cell counts <50 cells/microL (36,533 dollars per patient) were 2.6-times greater than total annual expenditures for patients with CD4+ cell counts > or =350 cells/microL (13,885 dollars per patient), primarily because of increased expenditures for nonantiretroviral medication and hospitalization. Expenditures for highly active antiretroviral therapy were relatively constant at approximately 10,500 dollars per patient per year across CD4+ cell count strata. Outpatient expenditures were 1558 dollars per patient per year; however, the clinic and physician component of these expenditures represented only 359 dollars per patient per year, or 2% of annual expenses. Health care expenditures for patients with HIV infection increased substantially for those with more-advanced disease and were driven predominantly by medication costs (which accounted for 71%-84% of annual expenses). CONCLUSIONS Physician reimbursements, even with 100% billing and collections, are inadequate to support the activities of most clinics providing HIV care. These findings have important implications for the continued support of HIV treatment programs in the United States.
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Affiliation(s)
- Ray Y Chen
- Department of Internal Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ingram RJ, Call S, Andrade A, White C, Wheeler D. Management and outcome of pneumothoraces in patients infected with human immunodeficiency virus. Clin Infect Dis 1996; 23:624-7. [PMID: 8879789 DOI: 10.1093/clinids/23.3.624] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
To better understand the natural history, management, and outcome of pneumothoraces in HIV-infected patients, we reviewed hospital charts and chest radiographs of HIV-infected adults discharged from the University of Maryland Medical Center over a 6-year period. Sixty pneumothoraces occurred in 39 patients. Twenty-three pneumothoraces resulted from trauma and 37 were spontaneous. Thirty-two (86%) of the spontaneous pneumothoraces occurred in patients with Pneumocystis carinii pneumonia (PCP). Eight percent of the traumatic pneumothoraces in patients who did not have PCP resolved. Patients who had pneumothorax as well as PCP were more difficult to manage and had a poorer outcome (50% mortality) than those who did not have PCP (25% mortality).
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Affiliation(s)
- R J Ingram
- Department of Medicine, University of Maryland Medical Center, Baltimore, USA
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