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Peppler R, Klapheke M, La Rochelle J. University of Central Florida College of Medicine. Acad Med 2020; 95:S115-S118. [PMID: 33626660 DOI: 10.1097/acm.0000000000003273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Abstract
UNLABELLED Phenomenon: Fourth-year medical students obtain Department of Medicine (DOM) letters ("Chair" letters) to support their residency applications. Writing and interpreting DOM letters are challenging. There is heterogeneity in the letters that makes it difficult to both write and read these letters. APPROACH The purpose of this study is to determine the value of new guidelines developed by a task force of clerkship directors and program directors in internal medicine and assess the implementation of these guidelines. The Clerkship Directors in Internal Medicine performed a cross-sectional survey of internal medicine clerkship directors at U.S. and Canadian medical schools in 2014. In addition, the primary author's institution reviewed 1,347 DOM letters between 2012 and 2014 to assess the implementation of these guidelines. FINDINGS The survey response rate was 78%. DOM letter writers reported the guidelines were better, easier to implement, and more compatible with the purpose of DOM letters than previously. Most letter readers reported that letters using the guidelines were more credible. Writers of DOM letters in lower academic ranks rated the letters with guidelines higher in several domains than those in higher academic ranks. Readers of DOM letters in higher academic ranks rated the letters with guidelines higher in several domains than those in lower academic ranks. In the DOM letters examined, the odds of meeting each guideline increased with each additional year. However, for 3 guidelines there was an initial decline in adherence from 2012 to 2013 before increasing again in 2014-the recommended length, clerkship description, and detailed narrative guidelines. Letters solely written by a chair were less likely to incorporate the guidelines. Insights: Clerkship directors often write the DOM letters and identify with the purpose of the guidelines. As writers, lower ranking academic faculty value the guidelines more than higher ranking academic faculty. As readers of DOM letters, higher academic ranking faculty value letters that incorporate the guidelines more than lower academic ranking faculty. DOM letters implemented more guideline criteria since the guidelines were released. If implementing the guidelines, chairs should solicit the help of their clerkship director or educational representative when writing DOM letters. Although many clerkship directors read letters for their residency programs, additional program directors' opinions are needed.
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Affiliation(s)
- Matthew Fitz
- a Department of Internal Medicine , Loyola University , Maywood , Illinois , USA
| | - Jeffrey La Rochelle
- b Department of Medical Education , University of Central Florida College of Medicine , Orlando , Florida , USA
| | - Valerie Lang
- c Hospital Medicine, University of Rochester Medical Center , Rochester , New York , USA
| | - Deborah DeWaay
- d Department of Internal Medicine , University of South Florida , Tampa , Florida , USA
| | - William Adams
- e Office of Clinical Research, Loyola University , Maywood , Illinois , USA
| | - Farah Nasraty
- a Department of Internal Medicine , Loyola University , Maywood , Illinois , USA
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Werntz RP, Martinez-Acevedo A, Amadi H, Kopp R, La Rochelle J, Koppie T, Amling C, Sajadi KP. Prophylactic antibiotics following radical cystectomy reduces urinary tract infections and readmission for sepsis from a urinary source. Urol Oncol 2018; 36:238.e1-238.e5. [PMID: 29338914 DOI: 10.1016/j.urolonc.2017.12.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/15/2017] [Accepted: 12/26/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Urinary tract infections (UTI) and sepsis contribute significantly to the morbidity associated with cystectomy and urinary diversion in the first 30 days. We hypothesized that continuous antibiotic prophylaxis decreased UTIs in the first 30 days following radical cystectomy. METHODS Patients with urothelial carcinoma of the bladder who underwent a radical cystectomy with urinary diversion for bladder cancer at Oregon Health and Science University from January 2014 to May 2015 were included in the study. The ureteral stents were kept for 3 weeks in both groups. In October 2014, we enacted a Department Quality Initiative to reduce UTIs. Following the initiative, all radical cystectomy patients were discharged home on antibiotic prophylaxis following a postoperative urine culture obtained during hospitalization. To evaluate the effectiveness of the initiative, the last 42 patients before the initiative were compared to the first 42 patients after the initiative with regard to the rate of UTI in the first 30 days following surgery. We used a combination of comprehensive chart review and the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) to determine UTI and readmission for urosepsis in the first 30 days following surgery. This ensured accurate capture of all patients developing a UTI. RESULTS A total of 12% in the prophylactic antibiotic group had a documented UTI, whereas 36% in the no antibiotic group had a urinary tract infection (P<0.004). A total of 1 (2%) patient in the antibiotic group was readmitted for urosepsis whereas 7 (17%) patients in the no antibiotic group were admitted for urosepsis (P = 0.02). There was no association noted between urine culture at discharge and the development of UTI in the 30-day postdischarge period (P = 0.75). The median time to UTI was 19 days and the most common organism was Enterococcus (32%). Thirty-percent of patients not receiving prophylaxis developed a UTI 1 day after ureteral stent removal. No patients had a UTI following stent removal in the prophylaxis group. No adverse antibiotic related events were noted. CONCLUSION Prophylactic antibiotics in the 30 days following radical cystectomy is associated with a significant decrease in urinary tract infections and readmission from urosepsis after surgery.
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Affiliation(s)
- Ryan P Werntz
- Department of Urology, Oregon Health and Science University, Portland, OR.
| | | | - Hamed Amadi
- Department of Urology, Oregon Health and Science University, Portland, OR
| | - Ryan Kopp
- Department of Urology, Oregon Health and Science University, Portland, OR
| | | | - Theresa Koppie
- Department of Urology, Oregon Health and Science University, Portland, OR
| | - Christopher Amling
- Department of Urology, Oregon Health and Science University, Portland, OR
| | - Kamran P Sajadi
- Department of Urology, Oregon Health and Science University, Portland, OR
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Goren EN, Leizman DS, La Rochelle J, Kogan JR. Overnight Hospital Experiences for Medical Students: Results of the 2014 Clerkship Directors in Internal Medicine National Survey. J Gen Intern Med 2015; 30:1245-50. [PMID: 26173530 PMCID: PMC4539329 DOI: 10.1007/s11606-015-3405-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 11/24/2022]
Abstract
BACKGROUND Since the 2011 Accreditation Council of Graduate Medical Education (ACGME) work hour rules for residents were implemented, 24-30 h call for interns has been replaced by shift work, including night-float. The impact of these changes on undergraduate medical education experiences in internal medicine has not been described. OBJECTIVE We aimed to determine the current status of medical students' overnight experiences in Internal Medicine clerkships and sub-internships, and to assess internal medicine educators' perceptions of the importance of overnight work during internal medicine rotations. DESIGN AND PARTICIPANTS In May 2014, the Clerkship Directors in Internal Medicine (CDIM) conducted its annual survey. Twenty-eight questions about student participation in overnight work and perceptions of the importance of overnight work (rated on 1-5 Likert scale, 1 = very unimportant and 5 = ery important) were included. Descriptive statistics were used to summarize responses. Free text results were analyzed qualitatively. KEY RESULTS The response rate was 78 %. A minority of respondents reported students having any overnight experience during the clerkship (38.7 %) or the sub-internship (40.7 %). Only 5 % of respondents reported having students assigned to night-float rotations outside of clerkships or sub-internships. Respondents agreed that overnight experiences were more important during the sub-internship than the clerkship, 4.0 ± 1.1 vs. 3.2 ± 1.2, p < 0.001. Admitting new patients, following their course and responding to emergencies were rated as important overnight tasks for both clerkship and sub-internship students. CONCLUSIONS Overnight experiences offer students additional educational opportunities. Clerkship directors felt that the overnight experience for the sub-intern in particular was an important chance to practice providing emergency cross coverage and other intern roles. In the era of ACGME duty hours, there is a need to further examine whether there is a role for increased overnight hospital experiences for medical students.
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Affiliation(s)
- Eric N Goren
- Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St #2009, Philadelphia, PA, 19104, USA,
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Durning SJ, Artino A, Boulet J, La Rochelle J, Van der Vleuten C, Arze B, Schuwirth L. The feasibility, reliability, and validity of a post-encounter form for evaluating clinical reasoning. Med Teach 2012; 34:30-7. [PMID: 22250673 DOI: 10.3109/0142159x.2011.590557] [Citation(s) in RCA: 24] [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: 05/18/2023]
Abstract
BACKGROUND Developing feasible, reliable and valid methods for the evaluation of clinical reasoning is challenging. AIM To explore feasibility, reliability, and validity evidence for a post-encounter form assessing clinical reasoning. METHOD A free-text, post-encounter form was used in an Objective Structured Clinical Examination (OSCE) station to assess clinical reasoning for end-of-second-year medical students. Feasibility was assessed by time to complete form. Inter-rater reliability was assessed by kappa. Validity evidence was obtained by comparing scores from individual items on the post-encounter form and other components in this OSCE station (i.e., standardized patient checklist and oral presentation rating form). Additional validity evidence was gathered by comparing scores on this station with other course performance graded events. RESULTS Feasibility and estimated reliability were high, and several lines of validity evidence were supported. CONCLUSIONS The scores from an end-of-second-year, medical school, post-encounter form yielded adequate psychometric properties and can be used for the evaluation of clinical reasoning. Moreover, this form of assessment and its scoring could translate to other venues.
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Affiliation(s)
- Steven J Durning
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
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Abstract
Two large randomized trials on prostate cancer screening have recently reported their 10-year results with somewhat differing conclusions. The Prostate, Lung, Colorectal, and Ovarian Cancer Screening (PLCO) study found a slightly higher risk of a prostate cancer diagnosis in the screening cohort, but no cancer-specific survival advantage was seen for this group. However, the study had widespread screening contamination in the control arm that significantly weakens the study's ability to reach a valid conclusion about the benefits of screening. The European Randomized Study of Screening in Prostate Cancer (ERSPC) was less affected by screening contamination of the control arm, and a cancer-specific survival benefit for the screening arm was seen by 7-8 years (RR, 0.70-0.80). Based on these studies, it is reasonable to conclude that there is a survival benefit for screening, but it may not extend to older men (>75 years) who have undergone prior screening.
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Affiliation(s)
- Jeffrey La Rochelle
- Department of Surgery, Division of Urology, Oregon Health and Sciences University, 3303 SW Bond Avenue, Mail Code CH10U, Portland, OR, 97239, USA.
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Durning SJ, Artino A, Boulet J, Van Der Vleuten CPM, La Rochelle J, Arze B, Schuwirth L. Making use of contrasting participant views of the same encounter. Med Educ 2010; 44:953-961. [PMID: 20880364 DOI: 10.1111/j.1365-2923.2010.03756.x] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
CONTEXT The practice of medicine involves many stakeholders (or participant groups such as patients, doctors and trainees). Based on their respective goals, perceptions and understandings, and on what is being measured, these stakeholders may have dramatically different viewpoints of the same event. There are many ways to characterise what occurred in a clinical encounter; these include an oral presentation (faculty perspective), a written note (trainee perspective), and the patient's perspective. In the present study, we employed two established theories as frameworks with the purpose of assessing the extent to which different views of the same clinical encounter (a three-component, Year 2 medical student objective structured clinical examination [OSCE] station) are similar to or differ from one another. METHODS We performed univariate comparisons between the individual items on each of the three components of the OSCE: the standardised patient (SP) checklist (patient perspective); the post-encounter form (trainee perspective), and the oral presentation rating form (faculty perspective). Confirmatory factor analysis (CFA) of the three-component station was used to assess the fit of the three-factor (three-viewpoint) model. We also compared tercile performance across these three views as a form of extreme groups analysis. RESULTS Results from the CFA yielded a measurement model with reasonable fit. Moderate correlations between the three components of the station were observed. Individual trainee performance, as measured by tercile score, varied across components of the station. CONCLUSIONS Our work builds on research in fields outside medicine, with results yielding small to moderate correlations between different perspectives (and measurements) of the same event (SP checklist, post-encounter form and oral presentation rating form). We believe obtaining multiple perspectives of the same encounter provides a more valid measure of a student's clinical performance.
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Affiliation(s)
- Steven J Durning
- Department of Medicine, Uniformed Services University, Bethesda, Maryland 20814-4712, USA.
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Gilliland WR, La Rochelle J, Hawkins R, Dillon GF, Mechaber AJ, Dyrbye L, Papp KK, Durning SJ. Changes in clinical skills education resulting from the introduction of the USMLE step 2 clinical skills (CS) examination. Med Teach 2008; 30:325-327. [PMID: 18484462 DOI: 10.1080/01421590801953026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Step 2 Clinical Skills (CS) was recently introduced into the United States Medical Licensing Examination (USMLE) to ensure that successful candidates for licensure possess the clinical skills to provide safe and effective patient care. AIMS To explore if medical schools had changed the objectives, content, or emphasis in their pre-clinical curriculum in response to its implementation. METHODS In April 2005, the Clerkship Directors in Internal Medicine (CDIM) sent an electronic survey to a single member from each medical school with a CDIM member. The survey instrument included 26 pre-clinical curricular questions with nine questions specifically addressing changes in response to implementation of the Step 2 CS. RESULTS Forty-five percent of respondents reported changes to the Introduction to Clinical Medicine (ICM) course objectives while 39% and 40% reported changes in content and emphasis. Seventy-four percent felt their students were adequately prepared for the Step 2 CS and 18% were unsure. CONCLUSIONS Over a third of medical schools are implementing changes to the objectives, content, and/or emphasis of their curriculum, at least partially in response to the institution of Step 2 CS.
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La Rochelle J, Belldegrun AS. Which pathological features of renal cell carcinoma have the greatest prognostic value? Nat Clin Pract Urol 2007; 5:74-5. [PMID: 18059390 DOI: 10.1038/ncpuro0997] [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] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 11/06/2007] [Indexed: 11/09/2022]
Affiliation(s)
- Jeffrey La Rochelle
- UCLA School of Medicine, Department of Urology, Division of Urologic Oncology, Box 951738, Los Angeles, CA 90095-1738, USA
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