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Tyler N, Wright N, Gregoriou K, Waring J. Improving mental health care transitions through information capture during admission to inpatient mental health services: a quality improvement study. BMC Health Serv Res 2021; 21:1132. [PMID: 34674690 PMCID: PMC8529804 DOI: 10.1186/s12913-021-07136-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Many interventions aim to improve the transition from ward to community at the time of discharge, with varying success. Guidelines suggest that discharge planning should begin at admission, but in reality this is ideal rather than standard practice. We aimed to develop a novel information capture tool during admission that facilitates and accelerates discharge. Methods A quality improvement study to develop, implement and evaluate a novel tool that improves information capture upon admission to acute mental health wards within a single English National Health Service (NHS) trust. We developed the tool by synthesising existing evidence and working with multi-agency and multi-disciplinary professionals in two co-design workshops. During implementation the tool was piloted on three wards. Ethnographic observations (145 h) and interviews (45) were used to evaluate the implementation of the tool across the three wards. Thematic synthesis was used to consolidate the findings. Results The tool developed considerably as the process evolved. The finished product is a list of 10 information categories that should be captured from external agencies upon admission to hospital to facilitate discharge planning to community settings. Reported advantages of the tool were: (1) facilitating confidence in junior staff to legitimately question the suitability of a patient for an acute ward (2) collecting and storing essential information in a single accessible place that can be used throughout the care pathway and (3) collecting information from the services/agencies to which patients will eventually be discharged. Conclusions Improving the quality of information at admission has the potential to facilitate and accelerate discharge. The novel tool provides a framework for capturing this information that can be incorporated into existing information systems. However, the introduction of the tool exacerbated complex, fragile distributed team dynamics, highlighting the importance of sociocultural context in information flow transitional interventions within distributed teams. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07136-2.
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Affiliation(s)
- Natasha Tyler
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom.
| | - Nicola Wright
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | | | - Justin Waring
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom.,Health Services Management Centre, University of Birmingham, Birmingham, United Kingdom
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Zirulnik A, Chary A, Thatphet P, Wongtangman T, Gacioch B, Ouchi K, Kennedy M, Liu SW. The Interface of Emergency and Palliative Care. J Geriatr Emerg Med 2021; 2:4. [PMID: 34296215 PMCID: PMC8294785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Alexander Zirulnik
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anita Chary
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Phraewa Thatphet
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Thiti Wongtangman
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Brian Gacioch
- Section of Hospice and Palliative Medicine, Division of General Medicine, Beth Israel Deaconess Medical Center
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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Frank A, Berlin R, Adelsky S, Robinson L. Transitions in Care: A Workshop to Help Residents and Fellows Provide Safe, Effective Handoffs for Acute Psychiatric Patients. MedEdPORTAL 2020; 16:10951. [PMID: 32875095 PMCID: PMC7449575 DOI: 10.15766/mep_2374-8265.10951] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/09/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Focused training in care transitions is an ACGME-required component of resident education. However, there are limited published curricular resources specific to trainees in psychiatry to help develop this crucial skill. METHODS We developed a 90-minute interactive workshop on care transitions in psychiatry for general adult psychiatry residents (PGY 2-PGY 4), child and adolescent fellows, and consult-liaison fellows. Trainees collaborated in interdisciplinary teams to explore a vignette in which a patient moved through four different venues of care (outpatient, emergency department, inpatient medical, and inpatient psychiatric). Guiding questions prompted discussions of critical issues related to logistics and clinical communication for each transition between care environments. RESULTS In a postworkshop anonymous survey, 100% of trainee participants (n = 30) felt the workshop was successful in creating the opportunity to develop relationships with, and learn from, colleagues at other levels of psychiatry training. Ninety percent responded affirmatively that they were able to identify key elements of an effective handoff for an acute psychiatric patient. Eighty-three percent identified being able to describe logistical steps for transferring the care of patients between mental health services at their institution. DISCUSSION Trainee participants found the workshop beneficial for understanding the steps needed to transfer patients between levels of care safely, discussing and debating gray areas with peers and faculty, and developing interdisciplinary relationships within psychiatry. Faculty participants described an interest in using the workshop as a faculty development exercise. This workshop fills a critical gap in available curricula on transitions in care in psychiatry.
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Affiliation(s)
- Amber Frank
- Co-director, Adult Psychiatry Residency, Cambridge Health Alliance; Instructor, Department of Psychiatry, Harvard Medical School
| | - Rachel Berlin
- Attending Psychiatrist, Commonwealth Psychology Associates
| | - Solomon Adelsky
- Attending Psychiatrist, Child and Adolescent Psychiatry, Cambridge Health Alliance
| | - Lee Robinson
- Training Director, Child and Adolescent Psychiatry Fellowship, Cambridge Health Alliance; Instructor, Department of Psychiatry, Harvard Medical School
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Nall RW, Herndon BB, Mramba LK, Vogel-Anderson K, Hagen MG. An Interprofessional Primary Care-Based Transition of Care Clinic to Reduce Hospital Readmission. Am J Med 2020; 133:e260-e268. [PMID: 31877267 DOI: 10.1016/j.amjmed.2019.10.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hospital readmission is a major burden for patients, caregivers, and health systems. Some readmissions may be avoided through timely follow-up in a transition clinic with an interprofessional approach to care. METHODS We prospectively evaluated a cohort of adults >18 years, n = 203, who are patients of an affiliated academic internal medicine clinic with University of Florida Health and discharged from the hospital between November 1, 2016, and May 1, 2017. We sought to determine if follow-up in an interprofessional transition-of-care (TCM) clinic after discharge was associated with a reduction in hospital readmission when compared to standard follow-up at 30, 60, and 90 days. RESULTS Follow-up in the TCM clinic was associated with reduced odds of hospital readmission at 90 days by 60%, (odds ratio [OR]: 0.40, P = 0.044, 95% confidence interval [CI] 0.16-0.97). Although the clinic failed to demonstrate a statistically significant association between clinic follow-up and in readmission at 30 (OR: 0.66, P = 0.36, 95% CI 0.27-1.59) and 60 days (OR: 0.67, P = 0.31, 95% CI 0.31-1.47), fewer readmissions were seen in patients seen by the TCM clinic. CONCLUSIONS A primary care nested interprofessional transition-of-care clinic was associated with a reduction in hospital readmission.
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Affiliation(s)
- Ryan W Nall
- University of Florida, College of Medicine, Gainesville.
| | | | - Lazarus K Mramba
- University of Kansas, Department of Biostatistics and Data Science, Kansas City, KS
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Kohler G, Holland T, Sharpe A, Irwin M, Sampalli T, MacDonell K, Kidd N, Edwards L, Gibson R, Legate A, Ampi Kanakam R. The Newcomer Health Clinic in Nova Scotia: A Beacon Clinic to Support the Health Needs of the Refugee Population. Int J Health Policy Manag 2018; 7:1085-1089. [PMID: 30709083 PMCID: PMC6358655 DOI: 10.15171/ijhpm.2018.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/03/2018] [Indexed: 11/16/2022] Open
Abstract
Refugees tend to have greater vulnerability compared to the general population reporting greater need for physical,
emotional, or dental problems compared to the general population. Despite the importance of creating strong
primary care supports for these patients, it has been demonstrated that there is a significant gap in accessing
primary care providers who are willing to accept the refugee population. These have resulted in bottlenecks in the
transition or bridge clinics and have left patients orphaned without a primary care provider. This in turn results
in higher use of emergency service and other unnecessary costs to the healthcare system. Currently there are few
studies that have explored these challenges from primary care provider perspectives and very few to none from
patient perspectives. A novel collaborative implementation initiative in primary healthcare (PHC) is seeking to
improve primary medical care for the refugee population by creating a globally recommended transition or beacon
clinic to support care needs of new arrivals and transitions to primary care providers. We discuss the innovative
elements of the clinic model in this paper.
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Affiliation(s)
- Graeme Kohler
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Timothy Holland
- Newcomer Health Clinic, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Ashley Sharpe
- Newcomer Health Clinic, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Mandi Irwin
- Newcomer Health Clinic, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Tara Sampalli
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Kolten MacDonell
- Newcomer Health Clinic, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Natalie Kidd
- Newcomer Health Clinic, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lynn Edwards
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Rick Gibson
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Amy Legate
- Newcomer Health Clinic, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Ruth Ampi Kanakam
- Newcomer Health Clinic, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
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Abstract
OBJECTIVES We examined the role of discharge instructions in postoperative recovery for patients undergoing colorectal surgery and report themes related to patient perceptions of discharge instructions and postdischarge experience. DESIGN Semistructured interviews were conducted as part of a formative evaluation of a Project Re-Engineered Discharge intervention adapted for surgical patients. SETTING Michael E. DeBakey VA Medical Center, a tertiary referral centre in Houston, Texas. PARTICIPANTS Twelve patients undergoing elective colorectal surgery. Interviews were conducted at the two-week postoperative appointment. RESULTS Participants demonstrated understanding of the content in the discharge instructions. During the interviews, participants reported several positive roles for discharge instructions in their postdischarge care: a sense of security, a reminder of inhospital education, a living document and a source of empowerment. Despite these positive associations, participants reported that the instructions provided insufficient information to promote access to care that effectively addressed acute issues following discharge. Participants noted difficulty reaching providers after discharge, which resulted in the adoption of workarounds to overcome system barriers. CONCLUSIONS Despite concerted efforts to provide patient-centred instructions, the discharge instructions did not provide enough context to effectively guide postdischarge interactions with the healthcare system. Insufficient information on how to access and communicate with the most appropriate personnel in the healthcare system is an important barrier to patients receiving high-quality postdischarge care. Tools and strategies from team training programmes, such as team strategies and tools to enhance performance and patient safety, could be adapted to include patients and provide them with structured methods for communicating with healthcare providers post discharge.
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Affiliation(s)
- Molly J Horstman
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA Quality Scholars Coordinating Center, IQuESt, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Whitney L Mills
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Levi I Herman
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Jesse H. Jones Graduate School of Business, Rice University, Houston, Texas, USA
| | - Cecilia Cai
- Internal Medicine Residency Program, Baylor College of Medicine, Houston, Texas, USA
| | - George Shelton
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Tareq Qdaisat
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - David H Berger
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Aanand D Naik
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA Quality Scholars Coordinating Center, IQuESt, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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Smith TE, Abraham M, Bolotnikova NV, Donahue SA, Essock SM, Olfson M, Shao WS, Wall MM, Radigan M. Psychiatric Inpatient Discharge Planning Practices and Attendance at Aftercare Appointments. Psychiatr Serv 2017; 68:92-95. [PMID: 27582241 DOI: 10.1176/appi.ps.201500552] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined discharge planning practices by hospital providers for 17,053 psychiatric discharges in New York's statewide Medicaid program. METHODS Claims data were linked to information reported to New York State by managed behavioral health care organizations (MBHOs) conducting inpatient utilization reviews. MBHOs documented hospital providers' reports of the presence of three discharge planning practices for each discharge: communicating with an outpatient provider prior to discharge, scheduling an aftercare appointment, and forwarding a discharge summary. RESULTS Hospital providers reported completing at least one of the three discharge planning practices for 85% of discharges. Individuals who received all three discharge planning practices had a higher likelihood of follow-up and kept their first outpatient follow-up visit at almost twice the speed compared with individuals who received none of the practices (hazard ratio=1.96, p<.001). CONCLUSIONS This study provided baseline information concerning routine discharge planning practices and their relationship to timeliness of care transitions.
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Affiliation(s)
- Thomas E Smith
- Dr. Smith, Dr. Essock, Dr. Olfson, and Dr. Wall are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (e-mail: ). They are also with the New York State Psychiatric Institute, New York, where Dr. Abraham is affiliated. Ms. Bolotnikova, Ms. Donahue, Ms. Shao, and Dr. Radigan are with the Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany
| | - Maria Abraham
- Dr. Smith, Dr. Essock, Dr. Olfson, and Dr. Wall are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (e-mail: ). They are also with the New York State Psychiatric Institute, New York, where Dr. Abraham is affiliated. Ms. Bolotnikova, Ms. Donahue, Ms. Shao, and Dr. Radigan are with the Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany
| | - Natalia V Bolotnikova
- Dr. Smith, Dr. Essock, Dr. Olfson, and Dr. Wall are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (e-mail: ). They are also with the New York State Psychiatric Institute, New York, where Dr. Abraham is affiliated. Ms. Bolotnikova, Ms. Donahue, Ms. Shao, and Dr. Radigan are with the Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany
| | - Sheila A Donahue
- Dr. Smith, Dr. Essock, Dr. Olfson, and Dr. Wall are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (e-mail: ). They are also with the New York State Psychiatric Institute, New York, where Dr. Abraham is affiliated. Ms. Bolotnikova, Ms. Donahue, Ms. Shao, and Dr. Radigan are with the Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany
| | - Susan M Essock
- Dr. Smith, Dr. Essock, Dr. Olfson, and Dr. Wall are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (e-mail: ). They are also with the New York State Psychiatric Institute, New York, where Dr. Abraham is affiliated. Ms. Bolotnikova, Ms. Donahue, Ms. Shao, and Dr. Radigan are with the Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany
| | - Mark Olfson
- Dr. Smith, Dr. Essock, Dr. Olfson, and Dr. Wall are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (e-mail: ). They are also with the New York State Psychiatric Institute, New York, where Dr. Abraham is affiliated. Ms. Bolotnikova, Ms. Donahue, Ms. Shao, and Dr. Radigan are with the Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany
| | - Wenjun S Shao
- Dr. Smith, Dr. Essock, Dr. Olfson, and Dr. Wall are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (e-mail: ). They are also with the New York State Psychiatric Institute, New York, where Dr. Abraham is affiliated. Ms. Bolotnikova, Ms. Donahue, Ms. Shao, and Dr. Radigan are with the Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany
| | - Melanie M Wall
- Dr. Smith, Dr. Essock, Dr. Olfson, and Dr. Wall are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (e-mail: ). They are also with the New York State Psychiatric Institute, New York, where Dr. Abraham is affiliated. Ms. Bolotnikova, Ms. Donahue, Ms. Shao, and Dr. Radigan are with the Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany
| | - Marleen Radigan
- Dr. Smith, Dr. Essock, Dr. Olfson, and Dr. Wall are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (e-mail: ). They are also with the New York State Psychiatric Institute, New York, where Dr. Abraham is affiliated. Ms. Bolotnikova, Ms. Donahue, Ms. Shao, and Dr. Radigan are with the Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany
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Lyons MD, Miles DB, Davis AM, Saathoff MB, Pincavage AT. Preventing Breakdowns in Communication: Teaching Patient-Centered Posthospital Care Transitions to Medical Students. MedEdPORTAL 2016; 12:10435. [PMID: 31008214 PMCID: PMC6464408 DOI: 10.15766/mep_2374-8265.10435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/16/2016] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Patient-centered discharge care is critical to teach in clerkships: Studies have shown that patient-centered discharge care may reduce rehospitalization rates as well as ensure patient understanding after discharge. While these skills are necessary to be a successful intern, this is infrequently taught formally in clerkships. This session introduces medical students to challenges patients and providers face during care transitions, specifically, the transition after discharge from an inpatient hospital stay. METHODS This workshop experience fosters the use of best communication-skills practices and team collaboration in discharge education and planning through reflective observation and role-play. Learners first identify common challenges faced when providing effective care transitions and then identify solutions to encourage patient-centered discharge care practices. Students also have the opportunity to be directly observed providing discharge care and to receive feedback using an observation tool. The materials associated with this publication include guidelines for workshop facilitators, blank video worksheet, completed video worksheet, teaching video, role-play exercise instructions and answer sheet for facilitators, direct observation tool, and workshop evaluation form. RESULTS The majority of students agreed the workshop would be helpful in practicing effective discharge education (69/75, 92%) and in providing patient-centered care during care transitions (72/75, 96%). Observers and students using the discharge education card reported an average score of 4.3 out of 5 that the observation was a helpful educational experience, and 84% of the completed discharge education tools included comments on areas of improvement or an action plan. DISCUSSION The tool is brief and user friendly, allowing for this exercise to be completed without difficulty during busy ward days. It also can be completed by residents or attendings depending on time constraints.
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Affiliation(s)
- Maureen D. Lyons
- Internal Medicine Resident, University of Chicago Medicine
- Chief Resident, University of Chicago Medicine
| | - D. Bailey Miles
- Resident, Department of Medicine, Johns Hopkins University School of Medicine
| | - Andrew M. Davis
- Associate Professor, Department of Medicine, University of Chicago Medicine
| | - Mark B. Saathoff
- Director of Educational Technology & Learning for Clinical Skills Education, University of Chicago Division of Biological Sciences The Pritzker School of Medicine
| | - Amber T. Pincavage
- Assistant Professor, Department of Medicine, University of Chicago Medicine
- Co-Clerkship Director, Department of Medicine, University of Chicago Medicine
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