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Rouse M, Newman JR, Waller C, Fink J. R.I.M.E. and reason: multi-station OSCE enhancement to neutralize grade inflation. Med Educ Online 2024; 29:2339040. [PMID: 38603644 PMCID: PMC11011230 DOI: 10.1080/10872981.2024.2339040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
To offset grade inflation, many clerkships combine faculty evaluations with objective assessments including the Medical Examiners Subject Examination (NBME-SE) or Objective Structured Clinical Examination (OSCE), however, standardized methods are not established. Following a curriculum transition removing faculty clinical evaluations from summative grading, final clerkship designations of fail (F), pass (P), and pass-with-distinction (PD) were determined by combined NBME-SE and OSCE performance, with overall PD for the clerkship requiring meeting this threshold in both. At the time, 90% of students achieved PD on the Internal Medicine (IM) OSCE resulting in overall clerkship grades primarily determined by the NBME-SE. The clerkship sought to enhance the OSCE to provide a more thorough objective clinical skills assessment, offset grade inflation, and reduce the NBME-SE primary determination of the final clerkship grade. The single-station 43-point OSCE was enhanced to a three-station 75-point OSCE using the Reporter-Interpreter-Manager-Educator (RIME) framework to align patient encounters with targeted assessments of progressive skills and competencies related to the clerkship rotation. Student performances were evaluated pre- and post-OSCE enhancement. Student surveys provided feedback about the clinical realism of the OSCE and the difficulty. Pre-intervention OSCE scores were more tightly clustered (SD = 5.65%) around a high average performance with scores being highly negatively skewed. Post-intervention OSCE scores were more dispersed (SD = 6.88%) around a lower average with scores being far less skewed resulting in an approximately normal distribution. This lowered the total number of students achieving PD on the OSCE and PD in the clerkship, thus reducing the relative weight of the NMBE-SE in the overall clerkship grade. Student response was positive, indicating the examination was fair and reflective of their clinical experiences. Through structured development, OSCE assessment can provide a realistic and objective measurement of clinical performance as part of the summative evaluation of students.
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Affiliation(s)
- Michael Rouse
- Internal Medicine, The University of Kansas School of Medicine, Kansas City, USA
| | - Jessica R. Newman
- Internal Medicine, The University of Kansas School of Medicine, Kansas City, USA
| | - Charles Waller
- Evaluation Analyst in the Office of Medical Education, The University of Kansas School of Medicine, Kansas City, MO, USA
| | - Jennifer Fink
- Internal Medicine, The University of Kansas School of Medicine, Kansas City, USA
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Cahill A, Martin M, Beachy B, Bauman D, Howard-Young J. The contextual interview: a cross-cutting patient-interviewing approach for social context. Med Educ Online 2024; 29:2295049. [PMID: 38320114 PMCID: PMC10848999 DOI: 10.1080/10872981.2023.2295049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024]
Abstract
Patient interviewing pedagogy in medical education has not evolved to comprehensively capture the biopsychosocial model of healthcare delivery. While gathering a patient's social history targets important aspects of social context it does not adequately capture and account for the real-time reassessment required to understand evolving factors that influence exposure to drivers of health inequities, social determinants of health, and access to supports that promote health. The authors offer a patient interviewing approach called the Contextual Interview (CI) that specifically targets dynamic and ever-changing social context information. To substantiate the use of the CI in medical education, the authors conducted a qualitative review of the Accreditation Council for Graduate Medical Education Milestones for primary care specialties (Family Medicine, Internal Medicine, and Pediatrics). Milestones were coded to the extent to which they reflected the learner's need to acknowledge, assess, synthesize and/or apply patient contextual data in real-time patient encounters. Approximately 1 in 5 milestones met the context-related and patient-facing criteria. This milestone review further highlights the need for more intentional training in eliciting meaningful social context data during patient interviewing. The CI as a cross-cutting, practical, time-conscious, and semi-structured patient interviewing approach that deliberately elicits information to improve the clinician's sense and understanding of a patient's social context. The authors reviewed future directions in researching adapted versions of the CI for undergraduate and graduate medical education.
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Affiliation(s)
- Amber Cahill
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Matthew Martin
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Bridget Beachy
- Central Washington Family Medicine Residency, Community Health of Central Washington, Yakima, WA, USA
| | - David Bauman
- Central Washington Family Medicine Residency, Community Health of Central Washington, Yakima, WA, USA
| | - Jordan Howard-Young
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Ganguly AP, Oren H, Jack HE, Abe R. Equity M&M - Adaptation of the Morbidity and Mortality Conference to Analyze and Confront Structural Inequity in Internal Medicine. J Gen Intern Med 2024; 39:867-872. [PMID: 37904072 DOI: 10.1007/s11606-023-08487-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/13/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND At morbidity and mortality (M&M) conferences, medical teams review cases for medical education and system improvement. Adverse outcomes are often driven by social inequity, but processes to analyze such outcomes are lacking. AIM Adapt quality improvement and patient safety (QIPS) tools in the M&M format to systematically analyze adverse patient outcomes rooted in social and structural determinants of health (SSDH). SETTING One-hour conferences conducted in health systems in Seattle, WA, and Dallas, TX. PARTICIPANTS Equity M&M conferences were held 11 times, each with approximately 45 participants comprised of internal medicine trainees, faculty, and non-medical staff. PROGRAM DESCRIPTION Conferences included a case narrative and counternarrative highlighting SSDH, an equity-framed root cause analysis, and potential interventions. PROGRAM EVALUATION Conferences were received well across both institutions. Following conferences, most respondents reported increased identification of opportunities for action towards equity (88.5%) and confidence in discussing equity issues with colleagues (92.3%). DISCUSSION Equity M&M conferences are a structured tool for deconstructing and confronting structural inequity that leads to adverse patient outcomes. Evaluations demonstrate educational impact on participants. Anecdotal examples suggest institutional impact. Other health systems could adopt this model for similar advocacy and system improvement.
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Affiliation(s)
- Anisha P Ganguly
- Center of Innovation and Value at Parkland, Parkland Health, Dallas, TX, USA.
- Division of General Internal Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Hannah Oren
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ryan Abe
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
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Chapman E, Rodriguez V, Bennett K. Fumbling the handoff-Exploring the transition experiences of program directors in geriatric medicine. J Am Geriatr Soc 2024; 72:1280-1282. [PMID: 38251426 DOI: 10.1111/jgs.18747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/09/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Elizabeth Chapman
- William S. Middleton Memorial VA Medical Center, Geriatrics Research Education and Clinical Center, Madison, Wisconsin, USA
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Vanessa Rodriguez
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Katherine Bennett
- Division of Gerontology & Geriatric Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA
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Vehreschild MJ, Fätkenheuer G, Sander LE, Lübbert C, Rieg S, Ertl G, Salzberger B. [Infectious Diseases - a new specialty for postgraduate training in Germany]. Dtsch Med Wochenschr 2024; 149:533-536. [PMID: 38499041 PMCID: PMC11018382 DOI: 10.1055/a-2258-7265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 03/20/2024]
Abstract
Medicine in Germany is currently facing major structural and economic challenges. Infectious Diseases, with the recent introduction of a new specialty in "Internal Medicine and Infectious Diseases" and with the existing additional training for almost all specializations, will make an important contribution to overcoming these challenges. Expertise in infectious diseases has to be very broad and requires high interdisciplinarity, which makes infectious diseases an attractive and demanding specialty. The complex fundamentals of infectious diseases must now be quickly conveyed to as many physicians as possible in a short period of time, as part of their specialization or as additional training. Until this is achieved, transitional solutions will be necessary for some time. The adaptation of the current billing and reimbursement system for infectious diseases services and improved intersectoral cooperation are of the utmost importance for the further development of the specialty.
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Affiliation(s)
- Maria J.G.T. Vehreschild
- Goethe Universität Frankfurt, Universitätsklinikum Frankfurt, Zentrum für Innere Medizin, Infektiologie, Frankfurt am Main
| | - Gerd Fätkenheuer
- Klinik I für Innere Medizin, Schwerpunkt Infektiologie, Universitätsklinikum Köln
| | - Leif Erik Sander
- Klinik für Infektiologie und Intensivmedizin, Charité – Universitätsmedizin, Berlin
| | - Christoph Lübbert
- Bereich Infektiologie und Tropenmedizin, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsmedizin Leipzig
| | - Siegbert Rieg
- Abteilung Infektiologie, Klinik für Innere Medizin II, Universitätsklinikum Freiburg
| | - Georg Ertl
- Deutsche Gesellschaft für Innere Medizin (DGIM), Wiesbaden
- Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg
| | - Bernd Salzberger
- Abteilung Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg,
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Shikino K, Sekine M, Nishizaki Y, Yamamoto Y, Shimizu T, Fukui S, Nagasaki K, Yokokawa D, Watari T, Kobayashi H, Tokuda Y. Distribution of internal medicine rotations among resident physicians in Japan: a nationwide, multicenter, cross-sectional study. BMC Med Educ 2024; 24:316. [PMID: 38509553 PMCID: PMC10956328 DOI: 10.1186/s12909-024-05314-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND In Japan, postgraduate clinical training encompasses a 2-year residency program, including at least 24 weeks of internal medicine (IM) rotations. However, the fragmented structure of these rotations can compromise the training's quality and depth. For example, a resident might spend only a few weeks in cardiology before moving to endocrinology, without sufficient time to deepen their understanding or have clinical experience. This study examined current patterns and lengths of IM rotations within the Japanese postgraduate medical system. It scrutinized the piecemeal approach-whereby residents may engage in multiple short-term stints across various subspecialties without an overarching, integrated experience-and explored potential consequences for their clinical education. METHODS This nationwide, multicenter, cross-sectional study used data from self-reported questionnaires completed by participants in the 2022 General Medicine In-Training Examination (GM-ITE). Data of 1,393 postgraduate year (PGY) one and two resident physicians who participated in the GM-ITE were included. We examined the IM rotation duration and number of IM subspecialties chosen by resident physicians during a 2-year rotation. RESULTS Approximately half of the participants chose IM rotation periods of 32-40 weeks. A significant proportion of participants rotated in 5-7 internal medicine departments throughout the observation period. Notable variations in the distribution of rotations were observed, characterized by a common pattern where resident physicians typically spend 4 weeks in each department before moving to the next. This 4-week rotation is incrementally repeated across different subspecialties without a longer, continuous period in any single area. Notably, 39.7% of participants did not undertake general internal medicine rotations. These results suggest a narrowed exposure to medical conditions and patient care practices. CONCLUSIONS Our study highlights the need to address the fragmented structure of IM rotations in Japan. We suggest that short, specialized learning periods may limit the opportunity to gain broad in-depth knowledge and practical experience. To improve the efficacy of postgraduate clinical education, we recommend fostering more sustained and comprehensive learning experiences.
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Grants
- 21IA2004 Ministry of Health, Labour, and Welfare
- 21IA2004 Ministry of Health, Labour, and Welfare
- 21IA2004 Ministry of Health, Labour, and Welfare
- 21IA2004 Ministry of Health, Labour, and Welfare
- 21IA2004 Ministry of Health, Labour, and Welfare
- 21IA2004 Ministry of Health, Labour, and Welfare
- 21IA2004 Ministry of Health, Labour, and Welfare
- 21IA2004 Ministry of Health, Labour, and Welfare
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Affiliation(s)
- Kiyoshi Shikino
- Department of Community-oriented Medical Education, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chu-ou-ku, Chiba, Japan.
- Department of General Medicine, Chiba University Hospital, Chiba, Japan.
| | - Miwa Sekine
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuji Nishizaki
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Sho Fukui
- Emergency and general Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazuya Nagasaki
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Internal Medicine, Mito Kyodo General Hospital, Tsukuba, Japan
| | - Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Takashi Watari
- General Medicine Center, Shimane University Hospital, Izumo, Japan
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Hiroyuki Kobayashi
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Internal Medicine, Mito Kyodo General Hospital, Tsukuba, Japan
| | - Yasuharu Tokuda
- Muribushi Okinawa Center for Teaching Hospitals, Okinawa, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
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7
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Sharief MH, Elghazaly AA, Al Abbas AM, Al Basri RS, Alsirafy SA. Does hematology rotation impact the interest of internal medicine residents in considering hematology as a career? BMC Med Educ 2024; 24:223. [PMID: 38431580 PMCID: PMC10909288 DOI: 10.1186/s12909-024-05192-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/17/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The ongoing need for hematologists is not met in many parts of the world. The hematology rotation during internal medicine residency is an opportunity to attract more physicians to the hematology field. This study aimed to assess the impact of a hematology rotation on internal medicine residents' interest in considering a hematology career. METHODS Internal medicine residents were invited to complete an anonymous questionnaire before and after a mandatory hematology rotation. Their interest in pursuing a hematology career was assessed by asking them to rate "Consider hematology as a career" on a 0 to 10 scale (0 = never, 10 = strongly agree). In addition, viewing the hematology workload as manageable, comfort in dealing with cancer and satisfaction with the hematologist lifestyle were assessed before and after the rotation. RESULTS Sixty out of 62 IM residents completed the pre- and post-hematology rotation questionnaire (response rate 97%). 80% were in the age range of 25-29 years and 73% were males. Two-thirds were in the senior level (3rd and 4th year) of their residency program and 40% had a prior rotation in a hematology unit. Rating considering hematology as a career increased significantly from a median of 7 (IQR: 5-9) pre-rotation to 8.5 (IQR: 7-10) post-rotation (p = 0.0018). Subgroup analysis showed a significant increase in interest among subgroups except residents > 29 years of age, those with prior hematology rotation and junior residents (1st and 2nd year residency). The change in viewing hematology workload as manageable, comfort in dealing with cancer patients and perceiving the hematologist lifestyle as satisfactory were strongly positively correlated with the change in considering hematology as a career (p = 0.0014, < 0.0001 and < 0.0001; respectively). CONCLUSIONS A hematology rotation is associated with an increase in the interest of internal medicine residents in considering hematology as a career. Further research is needed to Identify factors that may make hematology rotations an effective tool in attracting residents to the hematology field.
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Affiliation(s)
- Mamoun Hassan Sharief
- Department of Adult Haematology-Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Assem A Elghazaly
- Department of Adult Haematology-Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Raed Saleh Al Basri
- Department of Adult Haematology-Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Samy A Alsirafy
- Department of Adult Haematology-Oncology, King Saud Medical City, Riyadh, Saudi Arabia.
- Palliative Medicine Unit, Department of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.
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Noble C, Hilder J, Billett S, Teodorczuk A, Ajjawi R. Supervisory knowing in practice across medical specialities. Adv Health Sci Educ Theory Pract 2024; 29:107-128. [PMID: 37310524 DOI: 10.1007/s10459-023-10251-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 06/04/2023] [Indexed: 06/14/2023]
Abstract
Clinical supervisors play key roles in facilitating trainee learning. Yet combining that role with patient care complicates both roles. So, we need to know how both roles can effectively co-occur. When facilitating their trainees' learning through practice, supervisors draw on their skills - clinical and supervisory - and available opportunities in their practice. This process can be conceptualised as supervisory knowing in practice (or contextual knowing) and offers ways to elaborate on how facilitating trainees' learning can be optimised. The practice-based study presented and discussed here examined clinical supervisors' knowing in practice related to facilitating trainee learning, across three medical specialities. Nineteen clinical supervisors from emergency medicine, internal medicine and surgery, were interviewed about their roles and engagement with trainees. Interview transcripts were analysed in two stages. Firstly, a framework analysis, informed by interdependent learning theory was conducted, focussing on affordances and individual engagement. Secondly, drawing on practice theory, a further layer of analysis was undertaken interrogating supervisors' knowing in practice. We identified two common domains of supervisor practice used to facilitate trainee learning: (1) orientating and assessing trainees' readiness (or capabilities), (2) sequencing and enriching pedagogic practices. Yet across the speciality groups the supervisors' knowing in practice differed and were shaped by a trio of: (i) disciplinary practices, (ii) situational requirements and (iii) clinician preference. Overall, we offer a new reading of clinical supervision as practice differences generated distinct supervisory knowing in practice. These findings emphasise clinical supervision as fundamentally entwined in the speciality's practice; and reinforce alignments with patient care.
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Affiliation(s)
- Christy Noble
- Academy for Medical Education, Medical School, The University of Queensland, Herston, Queensland, Australia.
| | - Joanne Hilder
- Department of Allied Health Services, Gold Coast University Hospital, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Stephen Billett
- School of Education and Professional Studies, Griffith University, Brisbane, Queensland, Australia
| | - Andrew Teodorczuk
- Academy for Medical Education, Medical School, The University of Queensland, Herston, Queensland, Australia
- The Prince Charles Hospital, Metro North Mental Health, Brisbane, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Victoria, Australia
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Catalanotti JS, Abraham R, Choe JH, Corning KA, Fick L, Finn KM, Higgins S, Mechaber HF, Mohr T, Raj J, Swails J. Rethinking the Internal Medicine Residency Application Process to Prioritize the Public Good: A Consensus Statement of the Alliance for Academic Internal Medicine. Am J Med 2024; 137:284-289. [PMID: 38042242 DOI: 10.1016/j.amjmed.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Jillian S Catalanotti
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Reeni Abraham
- Department of Internal Medicine, University of Texas Southwestern, Dallas
| | - John H Choe
- Internal Medicine Residency Program, University of Washington, Seattle
| | - Kelli A Corning
- Internal Medicine Residency Program, University of Washington, Seattle
| | - Laurel Fick
- Internal Medicine Residency Program, Ascension St. Vincent Hospital, Indianapolis, Ind
| | - Kathleen M Finn
- Internal Medicine Residency Program, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass
| | - Stacy Higgins
- Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Hilit F Mechaber
- Clinical Medicine, University of Miami Miller School of Medicine, Fla
| | - Thomas Mohr
- Department of Internal Medicine, Sam Houston State University College of Osteopathic Medicine, Conroe, Texas
| | - Jaya Raj
- Department of Medicine, Creighton University School of Medicine Phoenix Regional Campus, Ariz
| | - Jennifer Swails
- Internal Medicine Residency Program, Department of Internal Medicine, University of Texas Houston
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Wang T, O'Neill TR, Peterson LE, Newton WP. COVID-19 Impact on Family Medicine Residents Exam Performance. Fam Med 2024; 56:163-168. [PMID: 38467034 DOI: 10.22454/fammed.2024.719362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/13/2024]
Abstract
BACKGROUND AND OBJECTIVES The COVID-19 pandemic began interrupting family medicine residency training in spring 2020. While a decline in scores on the American Board of Family Medicine In-Training Examination (ITE) has been observed, whether this decline has translated into the high-stakes Family Medicine Certification Examination (FMCE) is unclear. The goal of this study was to systematically assess the magnitude of COVID-19 impact on medical knowledge acquisition during residency, as measured by the ITE and FMCE. METHODS A total of 19,101 initial certification candidates from 2017 to 2022 were included in this study. Annual ITE scores and FMCE scores were reported on the same scale (200-800) and served as the outcome measure. We conducted multilevel regression analysis to determine ITE score growth and FMCE scores compared to cohorts prior to COVID-19. RESULTS During COVID-19, the increase in ITE scores from postgraduate year 2 (PGY-2) to PGY-3 was 25.5 points less, representing a 57.6% relative decrease; and from PGY-3 ITE to FMCE, it was 8.6 points less, a 12.7% relative decrease, compared with cohorts prior to COVID-19. FMCE scores were 6.6 points less during COVID-19, representing a 1.2% relative decline from the average FMCE score prior to COVID-19. CONCLUSIONS This study found nonsubstantive COVID-19 impact on FMCE scores, but a considerable knowledge acquisition decline during residency, especially during the PGY-2 to PGY-3 period. While COVID-19 impacted learning, our findings indicated that residencies were largely able to remediate knowledge deficits before residents took the FMCE.
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Affiliation(s)
- Ting Wang
- American Board of Family Medicine, Lexington, KY
| | | | - Lars E Peterson
- American Board of Family Medicine, Lexington, KY
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY
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Paralkar N, LaVine N, Block L. Omitting the Fifth Largest Subspecialty from the Medical Residents Survey?-Reply. JAMA Intern Med 2024; 184:333. [PMID: 38190134 DOI: 10.1001/jamainternmed.2023.7141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Affiliation(s)
- Neha Paralkar
- Division of General Internal Medicine, Department of Medicine, Hackensack University Medical Center, Hackensack, New Jersey
| | - Nancy LaVine
- Division of General Internal Medicine, Department of Medicine, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Lauren Block
- Division of General Internal Medicine, Department of Medicine, Northwell Health, Manhasset, New York
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12
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Shalev D, Robbins-Welty G, Sinclair CT. Omitting the Fifth Largest Subspecialty From the Medical Residents Survey? JAMA Intern Med 2024; 184:332-333. [PMID: 38190124 DOI: 10.1001/jamainternmed.2023.7138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Affiliation(s)
- Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
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13
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Sève P, Morlat P, Ranque B, Lavigne C, Bourgarit A, Rauzy O, Godeau B, Mouthon L. [Messages from the estates general on French internal medicine]. Rev Med Interne 2024; 45:69-78. [PMID: 38290857 DOI: 10.1016/j.revmed.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/06/2024] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
Internal medicine is a medical specialty that is often poorly understood by the general public and sometimes misidentified. In an era of increasing subspecialization and high technicality, it is characterized by a comprehensive approach centered on clinical evaluation. Unlike what is observed in most developed countries, where systemic autoimmune diseases are managed by organ specialists based on their mode of presentation, French internists are at the forefront for diagnosing and managing these diseases. Their multidisciplinary training gives them legitimacy to justify this role. Internists also play a crucial role in the management of patients requiring unplanned hospitalizations downstream from emergency departments and in connection with primary care. Internists primarily practice in a hospital setting, with a specific position in the French healthcare system aligned with the training frameworks of all medical specialties. To better define internal medicine, its role in care activities, as well as in education and research, internists organized a General Assembly of internal medicine that took place on September 28, 2023, in Paris. Structured around think tanks focusing on care, education, and research activities, the general assembly aimed to improve visibility on internal medicine and internists. This article recounts the discussions that animated this meeting and highlights the main ideas that emerged. These general assemblies constitute a foundational step and will be followed by a Consultation Conference in order to better identify and promote internal medicine and internists, regardless of their types and places of practice.
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Affiliation(s)
- P Sève
- Service de médecine interne, centre de référence maladies auto-inflammatoires et des amyloses, hôpital universitaire Croix-Rousse, hospices civils de Lyon, Lyon, France; Research on Healthcare Performance (RESHAPE), Inserm U1290, université Claude-Bernard Lyon 1, Lyon, France.
| | - P Morlat
- Service de médecine interne et maladies infectieuses, CHU et université de Bordeaux, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France
| | - B Ranque
- Service de médecine interne, centre de référence des maladies héréditaires du globule rouge, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris-Centre, université Paris Cité, Paris, France
| | - C Lavigne
- Service de médecine interne-immunologie clinique, centre de référence des maladies auto-immunes et auto-inflammatoires rares du Nord, Nord-Ouest, Méditerranée et Guadeloupe, CHU d'Angers, université d'Angers, Angers, France
| | - A Bourgarit
- Service de médecine interne polyvalente et immunologie clinique, hôpital Jean-Verdier, HUPSSD AP-HP, université Sorbonne Paris Nord, Bondy, France; Immunité, infection et cancer des cellules NK & T UMRS SU - Inserm U1135 - CNRS EMR 8255, faculté de médecine Sorbonne université, 91, boulevard de l'Hôpital, 75013 Paris, France; Conseil National Professionnel (CNP) de Médecine Interne, Paris, France
| | - O Rauzy
- Institut universitaire du cancer Toulouse Oncopole, Toulouse University Hospital, Toulouse, France
| | - B Godeau
- Service de médecine interne, centre de référence des cytopénies auto-immunes de l'adulte, CHU Henri-Mondor, AP-HP, UPEC, Créteil, France
| | - L Mouthon
- Service de médecine interne, centre de référence maladies auto-immunes et auto-inflammatoires systémiques rares d'Ile de France, de l'Est et de l'Ouest, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, université Paris Cité, Paris, France
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Jordan KA, Gable EK, Morgan AP, McNeal-Trice K, Byerley JS. A Longitudinal Pediatric Primary Care Residency Tailored to Meet Workforce Need: A 10-Year Evaluation. J Grad Med Educ 2024; 16:80-83. [PMID: 38304590 PMCID: PMC10829916 DOI: 10.4300/jgme-d-23-00453.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/05/2023] [Accepted: 12/04/2023] [Indexed: 02/03/2024] Open
Abstract
Background We started a primary care residency program intended to prepare graduates for primary care and increase entry into primary care, using time-limited funds from the Health Resources and Services Administration (HRSA). Objective To compare the graduates of the primary care residency program to their categorical peers, and whether they remained in the state, began primary care careers, and whether they identified as underrepresented in medicine. Methods This is a retrospective study of a cohort of 39 residents who graduated from the University of North Carolina primary care residency program from 2014-2023. In 2016, HRSA grant funding expired and the program continued with ongoing financial support from the 2 institutions. Graduate demographics and career choices were compared to categorical residents (159 total) for graduate years 2014 to 2023. Results The primary care pediatrics residency has graduated 39 residents to date. Job placement data was obtained for all 39 graduates. Graduates of the program have 5.5-fold greater odds (95% CI, 2.5-12.5) of working in primary care roles following graduation than peer categorical residents. Most graduates (33 of 39, 85%) have taken jobs in general pediatrics (including primary care, urgent care, adolescent medicine, or hospital medicine). The program has recruited a large proportion of its residents (12 of 39, 31%) from groups historically underrepresented in medicine. Conclusions We developed an innovative primary care pediatric residency in collaboration with a community partner, spurred by HRSA funds, that has trained a diverse group of new primary care pediatricians.
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Affiliation(s)
- Katherine A. Jordan
- Katherine A. Jordan, MD, is Assistant Professor and Associate Program Director, Pediatric Residency Program, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Elizabeth Kaye Gable
- Elizabeth Kaye Gable, MD, is Professor and Program Director, Pediatric Primary Care Residency, Pediatric Teaching Program, Cone Health, Greensboro, North Carolina, USA
| | - Andrew P. Morgan
- Andrew P. Morgan, MD, PhD, is Assistant Professor, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Kenya McNeal-Trice
- Kenya McNeal-Trice, MD, is Professor and Vice Chair of Education, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA; and at the time of writing
| | - Julie S. Byerley
- Julie S. Byerley, MD, MPH, was Professor and Vice Dean for Academic Affairs and Chief Education Officer, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA, and is now Professor and President and Dean, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
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Wykowski JH, Kelly ME, Tong HH, Osobamiro OO, Albert TJ. An Opportunity for Change: Principles for Reforming Internal Medicine Inpatient Conferences. J Gen Intern Med 2024; 39:481-486. [PMID: 37989816 PMCID: PMC10897115 DOI: 10.1007/s11606-023-08399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/24/2023] [Indexed: 11/23/2023]
Abstract
Inpatient educational conferences are a key part of internal medicine residency training. Many residencies made conferences virtual during the COVID-19 pandemic, and are now returning to in-person sessions. As we navigate this change, we can seize this opportunity to re-evaluate the role that inpatient conferences serve in resident education. In this paper, we briefly review the history of inpatient educational conferences before offering five recommendations for improvement. Our recommendations include grounding conference formats in educational theory, leveraging the expertise of all potential educators, broadening content to include health equity and justice throughout all curricula, and explicitly focusing on cultivating community among participants. Recognizing that each residency program is different, we anticipate that these recommendations may be implemented differently based on program size, available resources, and current institutional practices. We also include examples of prior successful curricular reforms aligned with our principles. We hope these recommendations ensure inpatient conferences continue to be a central part of residency education for future generations of internal medicine residents.
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Affiliation(s)
- James H Wykowski
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Molly E Kelly
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Hao H Tong
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Tyler J Albert
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
- Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA
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16
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Manzoor F, Lefkowitz A, Redelmeier DA. On-call absences and academic recognition: A retrospective cohort analysis. Med Educ 2024; 58:196-203. [PMID: 37102508 DOI: 10.1111/medu.15106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Resident call schedules require careful planning and are vulnerable to unanticipated absences from unpredictable factors. We tested whether unplanned absences from resident call schedules were associated with the likelihood of subsequent academic recognition. METHODS We examined unplanned absences from call shifts for internal medicine residents at the University of Toronto from 2014 to 2022 (8 years). We identified institutional awards granted at the end of the academic year as an indicator of academic recognition. We defined the resident-year as the unit-of-analysis that started in July and ended in June of the subsequent year. Secondary analyses examined the association between unplanned absences and the likelihood of academic recognition in later years. RESULTS We identified 1668 resident-years of training in internal medicine. In total, 579 (35%) had an unplanned absence, and the remaining 1089 (65%) had no unplanned absence. Baseline characteristics were similar between the two groups of residents. In total, 301 awards were received for academic recognition. The likelihood of receiving an award at the end of the year was 31% lower for residents who had any unplanned absence compared with those who had no absence (adjusted odds ratio = 0.69, 95% confidence interval 0.51-0.93, p = 0.015). The likelihood of receiving an award was further decreased for residents with multiple unplanned absences compared with those with none (odds ratio 0.54, 95% confidence interval 0.33-0.83, p = 0.008). An absence during the first year of residency was not significantly associated with the likelihood of academic recognition in later years of training (odds ratio 0.62, 95% confidence interval 0.36-1.04, p = 0.081). CONCLUSIONS The results of this analysis suggest unplanned absences from scheduled call shifts may be associated with a decreased likelihood of academic recognition for internal medicine residents. This association could reflect countless confounders or the prevailing culture of medicine.
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Affiliation(s)
- Fizza Manzoor
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ariel Lefkowitz
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Donald A Redelmeier
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
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17
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Salib S. Long Live Primary Care Internal Medicine! J Gen Intern Med 2024; 39:340. [PMID: 37884840 PMCID: PMC10853137 DOI: 10.1007/s11606-023-08470-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Sherine Salib
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
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Klein R, Snyder ED, Koch J, Volerman A, Alba-Nguyen S, Julian KA, Thompson V, Ufere NN, Burnett-Bowie SAM, Kumar A, White BAA, Park YS, Palamara K. Analysis of narrative assessments of internal medicine resident performance: are there differences associated with gender or race and ethnicity? BMC Med Educ 2024; 24:72. [PMID: 38233807 PMCID: PMC10795394 DOI: 10.1186/s12909-023-04970-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Equitable assessment is critical in competency-based medical education. This study explores differences in key characteristics of qualitative assessments (i.e., narrative comments or assessment feedback) of internal medicine postgraduate resident performance associated with gender and race and ethnicity. METHODS Analysis of narrative comments included in faculty assessments of resident performance from six internal medicine residency programs was conducted. Content analysis was used to assess two key characteristics of comments- valence (overall positive or negative orientation) and specificity (detailed nature and actionability of comment) - via a blinded, multi-analyst approach. Differences in comment valence and specificity with gender and race and ethnicity were assessed using multilevel regression, controlling for multiple covariates including quantitative competency ratings. RESULTS Data included 3,383 evaluations with narrative comments by 597 faculty of 698 residents, including 45% of comments about women residents and 13.2% about residents who identified with race and ethnicities underrepresented in medicine. Most comments were moderately specific and positive. Comments about women residents were more positive (estimate 0.06, p 0.045) but less specific (estimate - 0.07, p 0.002) compared to men. Women residents were more likely to receive non-specific, weakly specific or no comments (adjusted OR 1.29, p 0.012) and less likely to receive highly specific comments (adjusted OR 0.71, p 0.003) or comments with specific examples of things done well or areas for growth (adjusted OR 0.74, p 0.003) than men. Gendered differences in comment specificity and valence were most notable early in training. Comment specificity and valence did not differ with resident race and ethnicity (specificity: estimate 0.03, p 0.32; valence: estimate - 0.05, p 0.26) or faculty gender (specificity: estimate 0.06, p 0.15; valence: estimate 0.02 p 0.54). CONCLUSION There were significant differences in the specificity and valence of qualitative assessments associated with resident gender with women receiving more praising but less specific and actionable comments. This suggests a lost opportunity for well-rounded assessment feedback to the disadvantage of women.
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Affiliation(s)
- Robin Klein
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, 80 Jesse Hill Jr Dr SE, Atlanta, GA, 30303, USA.
| | - Erin D Snyder
- Department of Medicine, Division of General Internal Medicine, University of Alabama Birmingham School of Medicine, Birmingham, AL, USA
| | - Jennifer Koch
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, IL, USA
| | - Sarah Alba-Nguyen
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, CA, USA
| | - Katherine A Julian
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Vanessa Thompson
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Nneka N Ufere
- Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Anshul Kumar
- Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Bobbie Ann A White
- Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois Chicago, Chicago, IL, USA
| | - Kerri Palamara
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Affiliation(s)
- Dipesh Uprety
- Department of Medical Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
| | - Howard Jack West
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
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Affiliation(s)
| | - Richard J Baron
- ABIM Foundation, American Board of Internal Medicine, Philadelphia, Pennsylvania
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21
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Henschen BL, Pascoe J, Kisielewski M, Duca NS, Lang VJ, Levine D, Jasti H, Blatt A. Bias Reporting in the Clinical Learning Environment: A National Survey of Internal Medicine Clerkship Directors. Acad Med 2024; 99:76-82. [PMID: 37801579 DOI: 10.1097/acm.0000000000005472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
PURPOSE Bias exists in the internal medicine (IM) clinical learning environment; however, it is unclear how often bias is identified by clerkship directors (CDs), how bias is addressed, and whether best practices exist for identifying or mitigating bias. This study investigated how IM CDs receive and respond to bias reports in the clinical learning environment. METHOD In May 2021, the Clerkship Directors in Internal Medicine (CDIM) created an 18-question survey assessing the frequency of bias reports, macroaggressions and microaggressions, and report outcomes. Of the 152 U.S. medical schools that met study accreditation criteria, the final survey population included 137 CDs (90%) whose medical schools held valid CDIM membership. RESULTS Of the 137 surveys sent, 100 were returned (survey response rate, 73%). Respondents reported a median of 3 bias events (interquartile range, 1-4; range, 0-50) on the IM clerkship in the past year. Among 76 respondents who reported 1 or more event, microaggressions represented 43 of the 75 total events (57%). No mechanism emerged as the most commonly used method for reporting bias. Race/ethnicity (48 of 75 [64%]) and gender (41 of 75 [55%]) were cited most as the basis for bias reports, whereas the most common sources of bias were student interactions with attending physicians (51 of 73 [70%]) and residents (40 of 73 [55%]). Of the 75 respondents, 53 (71%) described the frequency of bias event reports as having increased or remained unchanged during the past year. Only 48 CDs (49%) responded that they were "always" aware of the outcome of bias reports. CONCLUSIONS Bias reports remain heterogeneous, are likely underreported, and lack best practice responses. There is a need to systematically capture bias events to work toward a just culture that fosters accountability and to identify bias events through more robust reporting.
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Tung-Chen Y, García de Casasola Sánchez G, García Rubio S, Beltrán Romero L, Bernabéu Wittel M, Briongos Figuero LS, Canora Lebrato J, García Gil D, López Palmero S, Luordo Tedesco D, Martín Rico P, Mateos González M, Méndez Bailón M, Porcel JM, Serralta G, Torres Arrese M, Oteiza Olaso J, Varela García P, Torres Macho J. Executive summary of the consensus document for the training and development of clinical ultrasound in Internal Medicine: Recommendations from the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine (GTECO-SEMI). Rev Clin Esp 2024; 224:57-63. [PMID: 38142977 DOI: 10.1016/j.rceng.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Given the increasing adoption of clinical ultrasound in medicine, it is essential to standardize its application, training, and research. OBJECTIVES AND METHODS The purpose of this document is to provide consensus recommendations to address questions about the practice and operation of clinical ultrasound units. Nineteen experts and leaders from advanced clinical ultrasound units participated. A modified Delphi consensus method was used. RESULTS A total of 137 consensus statements, based on evidence and expert opinion, were considered. The statements were distributed across 10 areas, and 99 recommendations achieved consensus. CONCLUSIONS This consensus defines the most important aspects of clinical ultrasound in the field of Internal Medicine, with the aim of standardizing and promoting this healthcare advancement in its various aspects. The document has been prepared by the Clinical Ultrasound Working Group and endorsed by the Spanish Society of Internal Medicine.
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Affiliation(s)
- Yale Tung-Chen
- Coordinador del Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medina Interna (GTECo-SEMI), Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España; Departamento de Medicina, Universidad Alfonso X El Sabio, Madrid, Spain.
| | | | | | - Luis Beltrán Romero
- Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | - Jesús Canora Lebrato
- Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Daniel García Gil
- Servicio de Medicina Interna, Complejo Hospitalario-Puerta del Mar (Hospital San Carlos), Cádiz, Spain
| | | | | | | | - María Mateos González
- Servicio de Medicina Interna, Hospital Infanta Cristina de Parla, Parla, Madrid, Spain
| | - Manuel Méndez Bailón
- Servicio de Medicina Interna, Hospital Universitario Clínico San Carlos, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IDISSC), Madrid, Spain
| | - José M Porcel
- Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lérida, Spain
| | - Gonzalo Serralta
- Servicio de Medicina Interna, Hospital Universitario Infanta Sofía, San Sebastian de los Reyes, Madrid, Spain
| | - Marta Torres Arrese
- Servicio de Urgencias, Hospital Universitario Fundación de Alcorcón, Alcorcón, Madrid, Spain
| | - Julio Oteiza Olaso
- Servicio de Medicina Interna, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Pablo Varela García
- Servicio de Medicina Interna, Complejo Universitario Hospital de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Juan Torres Macho
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, Spain
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Lagina M, Grum C, Sandhu G, Ruff AL. Sources of Joy in Medical Educators as Described by the PERMA Model. Teach Learn Med 2024; 36:53-60. [PMID: 36251799 DOI: 10.1080/10401334.2022.2131556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Phenomenon: Burnout is prevalent amongst long-practicing physicians. For medical educators, it has deleterious effects not only on the educator themselves, but also the students they are teaching. Though significant research has focused on factors associated with burnout, there is limited understanding of its counter: how physicians, particularly medical educators, derive joy from their work. Approach: This qualitative study included 15 highly-rated clinician educators in Internal Medicine who took part in individual semi-structured interviews. Participants were invited to discuss their sources of professional joy. After transcription, we used thematic content analysis: 50 themes were identified. Themes were then coded using the domains of the PERMA (Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment) model of positive psychology, assigning each theme a best fit domain. Forty-five themes were mapped into the PERMA model. Findings: When describing professional joy, highly-rated clinician educators displayed high levels of overlap with all domains of the PERMA model. Interaction with the learner was a prominent source of professional joy, particularly within Positive Emotion, Engagement, and Relationship domains. Insights: Our findings indicate that the PERMA model appropriately defines the sources of professional joy for these educators. Future research could employ this model to identify targets for interventions aimed at amplifying joy at work for this group.
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Affiliation(s)
- Madeline Lagina
- Department of Internal Medicine, Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Cyril Grum
- Department of Internal Medicine, Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Gurjit Sandhu
- Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Allison L Ruff
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Orr A, Lee J, Bhatt V, Kosak Z, Wilson S, Linganna A. TaskMaster: The Subintern Adventure Game-Game-Based Learning for Medical Subintern Task Prioritization. MedEdPORTAL 2023; 19:11373. [PMID: 38162952 PMCID: PMC10755083 DOI: 10.15766/mep_2374-8265.11373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/24/2023] [Accepted: 10/09/2023] [Indexed: 01/03/2024]
Abstract
Introduction The medical subinternship (also known as an acting internship) offers postclerkship medical students an opportunity for significant professional development. However, the skills required of a successful subintern-efficiency, patient triage, and advanced organization-are distinct from skills generally refined during the medicine clerkship. Few published curricula exist to prepare postclerkship students for success in this new role. To address this training gap, we introduced a novel tabletop role-playing game to equip medical subinterns with the necessary skills to deliver safe and efficient patient care. Methods We created an hour-long game-based learning session for rising internal medicine and family medicine subinterns. Led by a single facilitator, students worked together to triage and complete tasks in a gamified simulated environment of a morning on the wards. To assess the session, we surveyed participants (N = 130) immediately after activity completion. Results Eighty-three participants completed the postactivity survey, for a response rate of 64%. A majority of students agreed that TaskMaster: The Subintern Adventure Game met its educational goals of increasing comfort with task prioritization, organization, and patient triage. Ninety-three percent of respondents (77 of 83) either agreed or strongly agreed that they felt more prepared to be a covering provider for patients after the activity. Participants also reported high engagement with the activity. Discussion Leveraging the interactivity, teamwork, and contextualized practice of game-based learning can offer low-cost and adaptable opportunities to teach higher-order clinical skills and increase preparedness for the subinternship.
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Affiliation(s)
- Andrew Orr
- Assistant Professor of Clinical Medicine and Internal Medicine Subinternship Co-Director, Perelman School of Medicine at the University of Pennsylvania
| | - Jennifer Lee
- Assistant Professor of Clinical Family Medicine and Community Health and Family Medicine Subinternship Director, Perelman School of Medicine at the University of Pennsylvania
| | - Vatsal Bhatt
- Instructor of Clinical Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - Zachary Kosak
- Assistant Professor of Clinical Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania
| | - Steven Wilson
- Instructor of Clinical Medicine, Perelman School of Medicine at the University of Pennsylvania
| | - Ashok Linganna
- Associate Professor of Clinical Medicine and Internal Medicine Subinternship Co-Director, Perelman School of Medicine at the University of Pennsylvania
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St-Pierre F, Petrosyan R, Gupta A, Hughes S, Trickett J, Read S, Van Doren V, Zeveney A, Shoushtari C. Impact of the COVID-19 pandemic on internal medicine training in the United States: results from a national survey. BMC Health Serv Res 2023; 23:1285. [PMID: 37993947 PMCID: PMC10666403 DOI: 10.1186/s12913-023-10237-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 10/28/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Internal medicine (IM) residency is a notoriously challenging time generally characterized by long work hours and adjustment to new roles and responsibilities. The COVID-19 pandemic has led to multiple emergent adjustments in training schedules to accommodate increasing needs in patient care. The physician training period, in itself, has been consistently shown to be associated with vulnerability with respect to mental well-being. The impact of the COVID-19 pandemic on the experience of IM trainees is not well established. OBJECTIVE Characterize the impact of the COVID-19 pandemic on trainee clinical education, finances, and well-being. METHODS We developed a survey composed of 25 multiple choice questions, 6 of which had an optional short-answer component. The survey was distributed by the American College of Physicians (ACP) to 23,289 IM residents and subspecialty fellows. We received 1,128 complete surveys and an additional 269 partially completed surveys. RESULTS The majority of respondents reported a disruption in their clinical schedule (76%) and a decrease in both didactic conferences (71%) and protected time for education (56%). A majority of respondents (81%) reported an impact on their well-being with an increase in their level of burnout and 41% of respondents reported a decrease in level of direct supervision. Despite these changes, the majority of trainee respondents (78%) felt well prepared for clinical practice after graduation. CONCLUSIONS These results outline the vulnerable position of internal medicine physicians in training. Preserving educational experiences, adequate supervision, and humane work hours are essential in protecting trainees from mental illness and burnout during global emergencies.
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Affiliation(s)
- Frederique St-Pierre
- Department of Internal Medicine, Division of Hematology/Oncology, Northwestern University, 676 N St Clair St (Suite 850), Chicago, IL, 60611, USA.
| | - Romela Petrosyan
- Combined Brigham and Women's Hospital and Massachusetts General Hospital Department of Medicine, Division of Nephrology, Harvard University, Boston, MA, USA
| | - Arjun Gupta
- Department of Cardiology, The Mount Sinai Hospital, New York, NY, USA
| | - Stephen Hughes
- Department of Pulmonary, Critical Care, and Sleep Medicine, Naval Medical Center San Diego, San Diego, CA, USA
| | - John Trickett
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Susan Read
- Research Center, American College of Physicians, Philadelphia, PA, USA
| | - Vanessa Van Doren
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew Zeveney
- Research Center, American College of Physicians, Philadelphia, PA, USA
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Anderson LM, Rowland K, Edberg D, Wright KM, Park YS, Tekian A. An Analysis of Written and Numeric Scores in End-of-Rotation Forms from Three Residency Programs. Perspect Med Educ 2023; 12:497-506. [PMID: 37929204 PMCID: PMC10624145 DOI: 10.5334/pme.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
Introduction End-of-Rotation Forms (EORFs) assess resident progress in graduate medical education and are a major component of Clinical Competency Committee (CCC) discussion. Single-institution studies suggest EORFs can detect deficiencies, but both grades and comments skew positive. In this study, we sought to determine whether the EORFs from three programs, including multiple specialties and institutions, produced useful information for residents, program directors, and CCCs. Methods Evaluations from three programs were included (Program 1, Institution A, Internal Medicine: n = 38; Program 2, Institution A, Anesthesia: n = 9; Program 3, Institution B, Anesthesia: n = 11). Two independent researchers coded each written comment for relevance (specificity and actionability) and orientation (praise or critical) using a standardized rubric. Numeric scores were analyzed using descriptive statistics. Results 4869 evaluations were collected from the programs. Of the 77,434 discrete numeric scores, 691 (0.89%) were considered "below expected level." 71.2% (2683/3767) of the total written comments were scored as irrelevant, while 3217 (85.4%) of total comments were scored positive and 550 (14.6%) were critical. When combined, 63.2% (n = 2379) of comments were scored positive and irrelevant while 6.5% (n = 246) were scored critical and relevant. Discussion <1% of comments indicated below average performance; >70% of comments scored irrelevant. Critical, relevant comments were least frequently observed, consistent across all 3 programs. The low rate of constructive feedback and the high rate of irrelevant comments are inadequate for a CCC to make informed decisions. The consistency of these findings across programs, specialties, and institutions suggests both local and systemic changes should be considered.
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Affiliation(s)
- Lauren M. Anderson
- Department of Family and Preventive Medicine, Rush University, Chicago, Illinois, US
| | - Kathleen Rowland
- Department of Family and Preventive Medicine, Rush University, Chicago, Illinois, US
| | - Deborah Edberg
- Department of Family and Preventive Medicine, Rush University, Chicago, Illinois, US
| | - Katherine M. Wright
- Department of Family & Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, US
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois Chicago, Chicago, Illinois, US
| | - Ara Tekian
- Department of Medical Education, University of Illinois Chicago, Chicago, Illinois, US
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Dussault N, Nickolopoulos E, Henderson K, Hemming P, Cho A, Ma JE. Internal Medicine Resident Barriers to Advance Care Planning in the Primary Care Continuity Clinic. Am J Hosp Palliat Care 2023; 40:1205-1211. [PMID: 36722713 DOI: 10.1177/10499091231154606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 02/02/2023] Open
Abstract
Background: While primary care providers regularly engage in Advance Care Planning (ACP) conversations, it is not well known what challenges resident physicians face to achieving this core competency. Objectives: We aimed to assess resident perceptions of barriers and potential interventions to outpatient ACP. Methods: We distributed an electronic survey to Internal Medicine and Medicine-Psychiatry residents at our institution in 2022. Questions addressed outpatient ACP barriers and potential interventions in several domains: structural issues, personal knowledge, and communication skills. We reported results using descriptive statistics and Wilcoxon rank-sum tests, comparing responses by residency year (interns vs upperyears). Likert-scale responses were dichotomized to a "not at all or slightly" vs "moderate or extreme" barrier or helpful intervention. Results: Of 149 residents, 71 completed the survey (48%). Highest scoring barriers were structural, including 1) lack of clinic time (99%), 2) need to prioritize other medical problems (94%), and 3) lack of patient continuity (62%). Highest scoring interventions included the ability to schedule dedicated ACP visits with themselves (96%) or another clinician (82%). Interns were statistically significantly less confident in their ability to conduct ACP, and more likely to report lack of knowledge (i.e., not understanding ACP, patient prognosis, or how to complete paperwork, P < .05). Conclusions: Residents report significant structural barriers to outpatient ACP, including limitations in time, continuity, and competing medical priorities, that may warrant greater program attention to interventions such as clinic schedules and work-flow. Additional trainings may be most beneficial if targeted to the beginning of intern year.
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Affiliation(s)
- Nicole Dussault
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Elissa Nickolopoulos
- Division of Clinical Social Work, Department of Case Management, Duke University Health System, Durham, NC, USA
| | - Katherine Henderson
- Department of Chaplain Services and Education, Duke University Health System, Durham, NC, USA
| | - Patrick Hemming
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Alex Cho
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jessica E Ma
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Geriatric Research Education and Clinical Center, Durham VA Health System, Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Reilly JM, Greenberg I. An 8-Year Review of Match Outcomes From a Primary Care Pipeline Program. Fam Med 2023; 55:646-652. [PMID: 37540531 PMCID: PMC10741713 DOI: 10.22454/fammed.2023.297644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Primary care supports the global health care system. With an increased need for primary care physicians, medical schools must provide resources, role models, and opportunities to increase the number of medical students matching into primary care residencies. Some medical schools have developed primary care pipeline programs for students. The outcomes of one such program-the Primary Care Program (PCP)-at the Keck School of Medicine (KSOM) of the University of Southern California (USC), an urban and private academic medical training center, are evaluated here. METHODS We reviewed PCP student outcome data for students who graduated between 2015 and 2022. Data were gathered through surveys, residency match lists, and graduation records. RESULTS Among PCP matriculates (n=134), 70% were female and 39% were underrepresented in medicine. Thirteen percent (n=16) of PCP graduates (n=122) completed a master of public health (MPH) degree. Among PCP graduates, 70% matched into primary care residencies compared to 36% of non-PCP graduates (P<.001). The most common residencies that PCP graduates matched into were family medicine (n=45, 37%), internal medicine (n=20, 16%), pediatrics (n=12, 10%), surgery (n=10, 8%), and psychiatry (n=9, 7%). A higher percentage of KSOM students matched into primary care residencies in the 8 graduation years after PCP was instituted (39%) than in the 8 graduation years before PCP was instituted (33%, P=.003). CONCLUSIONS The PCP data demonstrate the program's success at increasing the number of KSOM graduates matching into primary care residencies. The program provides a replicable training model.
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Affiliation(s)
- Jo Marie Reilly
- Department of Family Medicine, Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA
| | - Ilana Greenberg
- Department of Family Medicine, Keck School of Medicine, University of Southern CaliforniaLos Angeles, CA
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Drum B, Shi J, Peterson B, Lamb S, Hurdle JF, Gradick C. Using Natural Language Processing to Identify Key Values in Internal Medicine-Pediatrics Residency Applications. Acad Med 2023; 98:S171-S172. [PMID: 37983414 DOI: 10.1097/acm.0000000000005376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Benjamin Drum
- Author affiliations: B. Drum, S. Lamb, C. Gradick, University of Utah School of Medicine; J. Shi, B. Peterson, J.F. Hurdle, University of Utah
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Drum B, Shi J, Peterson B, Lamb S, Hurdle JF, Gradick C. Using Natural Language Processing and Machine Learning to Identify Internal Medicine-Pediatrics Residency Values in Applications. Acad Med 2023; 98:1278-1282. [PMID: 37506388 DOI: 10.1097/acm.0000000000005352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
PROBLEM Although holistic review has been used successfully in some residency programs to decrease bias, such review is time-consuming and unsustainable for many programs without initial prescreening. The unstructured qualitative data in residency applications, including notable experiences, letters of recommendation, personal statement, and medical student performance evaluations, require extensive time, resources, and metrics to evaluate; therefore, previous applicant screening relied heavily on quantitative metrics, which can be socioeconomically and racially biased. APPROACH Using residency applications to the University of Utah internal medicine-pediatrics program from 2015 to 2019, the authors extracted relevant snippets of text from the narrative sections of applications. Expert reviewers annotated these snippets into specific values (academic strength; intellectual curiosity; compassion; communication; work ethic; teamwork; leadership; self-awareness; diversity, equity, and inclusion; professionalism; and adaptability) previously identified as associated with resident success. The authors prospectively applied a machine learning model (MLM) to snippets from applications from 2023, and output was compared with a manual holistic review performed without knowledge of MLM results. OUTCOMES Overall, the MLM had a sensitivity of 0.64, specificity of 0.97, positive predictive value of 0.62, negative predictive value of 0.97, and F1 score of 0.63. The mean (SD) total number of annotations per application was significantly correlated with invited for interview status (invited: 208.6 [59.1]; not invited: 145.2 [57.2]; P < .001). In addition, 8 of the 10 individual values were significantly predictive of an applicant's invited for interview status. NEXT STEPS The authors created an MLM that can identify several values important for resident success in internal medicine-pediatrics programs with moderate sensitivity and high specificity. The authors will continue to refine the MLM by increasing the number of annotations, exploring parameter tuning and feature engineering options, and identifying which application sections have the highest correlation with invited for interview status.
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Affiliation(s)
- Benjamin Drum
- B. Drum is assistant professor, Department of Internal Medicine, and adjunct professor, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jianlin Shi
- J. Shi is a research associate, Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah
| | - Bennet Peterson
- B. Peterson is a graduate student, Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah
| | - Sara Lamb
- S. Lamb is vice dean of education, University of Utah School of Medicine, Salt Lake City, Utah
| | - John F Hurdle
- J.F. Hurdle is professor, Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah
| | - Casey Gradick
- C. Gradick is assistant professor, Department of Internal Medicine, and adjunct professor, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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Gips JR, Stein AA, Luckin J, Garibaldi BT. Internal medicine intern performance on the gastrointestinal physical exam. Diagnosis (Berl) 2023; 10:412-416. [PMID: 37475198 DOI: 10.1515/dx-2023-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/26/2023] [Accepted: 06/27/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES The gastrointestinal (GI) physical exam provides critical information about underlying disease states. However, since assessment of physical examination skills is rarely conducted as part of internal medicine residency training, little is known about resident performance on the GI physical exam. METHODS During a clinical skills assessment that took place between November 2019 and February 2020, internal medicine interns examined the same patient with chronic liver disease while being observed by faculty preceptors. We compared the exam maneuvers performed with those expected by the faculty evaluators. We noted which maneuvers were performed incorrectly, whether physical exam technique correlated with identification of physical exam findings, and if performance on the physical exam was associated with building an appropriate differential diagnosis. This four-hour assessment was required for internal medicine interns within two different residency programs in the Baltimore area. RESULTS More than half of the 29 participating interns (n=17, 58.6 %) received a "needs improvement" score on their physical exam technique. Technique was highly correlated with identifying the correct physical signs (r=0.88, p<0.0001). The most commonly excluded maneuvers were assessing for splenomegaly and hepatomegaly. The most commonly missed findings were splenomegaly and hepatomegaly. Most interns included chronic liver disease as part of their differential diagnosis even if they received "needs improvement" scores on physical exam technique or identifying physical signs. CONCLUSIONS Internal medicine interns would benefit from learning an organized approach to the gastrointestinal exam. This would likely lead to increased identification of important gastrointestinal findings.
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Puri A, Raghavan S, Sottile E, Singh M, Snydman LK, Donovan AK, Bonnema R, Lo MC. New ACGME Clinician Educator Milestones as a Roadmap for Faculty Development: a Position Paper from the Society of General Internal Medicine Education Committee. J Gen Intern Med 2023; 38:3053-3059. [PMID: 37407763 PMCID: PMC10593649 DOI: 10.1007/s11606-023-08272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/07/2023] [Indexed: 07/07/2023]
Abstract
Traditionally, clinician educators are tasked with the responsibility of training future physician workforce. However, there is limited identification of skills required to fulfill this responsibility and a lack of consensus on effective faculty development for career growth as a clinician educator. The newly released Accreditation Council of Graduate Medical Education (ACGME) Clinician Educator (CE) Milestones framework outlines important skills for clinician educators and provides the opportunity to create robust faculty development. In this paper, members of the Society of General Internal Medicine Education Committee discuss the importance of these CE Milestones, outline the novel themes highlighted in the project, and provide recommendations for proper application on both the individual and institutional levels to optimize faculty development. The paper discusses strategies for how to apply the CE Milestones as a tool to create a culture of professional growth and self-directed learning. Using a reflective approach, CE faculty and mentors can identify areas of proficiency and opportunities for growth, thereby creating individualized professional development plans for career success. Institutions should use aggregate CE Milestones data as a needs assessment of their faculty "population" to create targeted faculty development. Most importantly, institutions should not use CE Milestones for high-stakes assessments but rather encourage reflection by CE faculty and create subsequent robust faculty development programs. The ACGME CE Milestones present an exciting opportunity and lay an important foundation for future CE faculty development.
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Affiliation(s)
- Aditi Puri
- Loyola University Health System, MacNeal Hospital, 3722 South Harlem Avenue, Apartment LL34, Berwyn, IL, 60402, USA.
| | | | - Elisa Sottile
- Division of General Internal Medicine, Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Mamta Singh
- Case Western Reserve University School of Medicine and Primary Care Service, VA Northeast Ohio Health Care System, Cleveland, OH, USA
| | - Laura K Snydman
- Division of General Internal Medicine, Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Anna K Donovan
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rachel Bonnema
- Division of General Internal Medicine, Department of Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Margaret C Lo
- Division of General Internal Medicine, Department of Medicine, University of Florida College of Medicine, Malcom Randall VAMC, Gainesville, FL, USA
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Nathanson R, Baher H, Phillips J, Freeman M, Sehgal R, O'Rorke J, Soni NJ. Development of a Chief Resident Medical Procedure Service: a 10-Year Experience. J Gen Intern Med 2023; 38:3077-3081. [PMID: 37237120 PMCID: PMC10593632 DOI: 10.1007/s11606-023-08234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Lack of experienced faculty to supervise internal medicine (IM) residents is a significant barrier to establishing a medical procedure service (MPS). AIM Describe the development and 10-year outcomes of an MPS led by IM chief residents. SETTING University-based IM residency program affiliated with a county and Veterans Affairs hospital. PARTICIPANTS Categorical IM interns (n=320) and 4th-year IM chief residents (n=48) from 2011 to 2022. PROGRAM DESCRIPTION The MPS operated on weekdays, 8 am-5 pm. After training and sign-off by the MPS director, chief residents trained and supervised interns in ultrasound-guided procedures during a 4-week rotation. PROGRAM EVALUATION From 2011 to 2022, our MPS received 5967 consults and 4465 (75%) procedures were attempted. Overall procedure success, complication, and major complication rates were 94%, 2.6%, and 0.6%, respectively. Success and complication rates for paracentesis (n=2285) were 99% and 1.1%, respectively; 99% and 4.2% for thoracentesis (n=1167); 76% and 4.5% for lumbar puncture (n=883); 83% and 1.2% for knee arthrocentesis (n=85); and 76% and 0% for central venous catheterization (n=45). The rotation was rated 4.6 out of 5 for overall learning quality. DISCUSSION A chief resident-led MPS is a practical and safe approach for IM residency programs to establish an MPS when experienced attending physicians are unavailable.
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Affiliation(s)
- Robert Nathanson
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.
- Division of Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA.
| | - Hasan Baher
- Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jason Phillips
- Division of Cardiology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Megan Freeman
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Raj Sehgal
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jane O'Rorke
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of General Internal Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA
- Division of Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
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Readlynn J, Houchens N, Shah SS. Preparing future generations of hospitalist educators. J Hosp Med 2023; 18:875-876. [PMID: 37583033 DOI: 10.1002/jhm.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/17/2023]
Affiliation(s)
- Jennifer Readlynn
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Nathan Houchens
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Samir S Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Renting N, Jaarsma D, Borleffs JC, Slaets JPJ, Cohen-Schotanus J, Gans ROB. Effectiveness of a supervisor training on quality of feedback to internal medicine residents: a controlled longitudinal multicentre study. BMJ Open 2023; 13:e076946. [PMID: 37770280 PMCID: PMC10546104 DOI: 10.1136/bmjopen-2023-076946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES High-quality feedback on different dimensions of competence is important for resident learning. Supervisors may need additional training and information to fulfil this demanding task. This study aimed to evaluate whether a short and simple training improves the quality of feedback residents receive from their clinical supervisors in daily practice. DESIGN Longitudinal quasi-experimental controlled study with a pretest/post-test design. We collected multiple premeasurements and postmeasurements for each supervisor over 2 years. A repeated measurements ANOVA was performed on the data. SETTING Internal medicine departments of seven Dutch teaching hospitals. PARTICIPANTS Internal medicine supervisors (n=181) and residents (n=192). INTERVENTION Half of the supervisors attended a short 2.5-hour training session during which they could practise giving feedback in a simulated setting using video fragments. Highly experienced internal medicine educators guided the group discussions about the feedback. The other half of the supervisors formed the control group and received no feedback training. OUTCOME MEASURES Residents rated the quality of supervisors' oral feedback with a previously validated questionnaire. Furthermore, the completeness of the supervisors' written feedback on evaluation forms was analysed. RESULTS The data showed a significant increase in the quality of feedback after the training F (1, 87)=6.76, p=0.04. This effect remained significant up to 6 months after the training session. CONCLUSIONS A short training session in which supervisors practise giving feedback in a simulated setting increases the quality of their feedback. This is a promising outcome since it is a feasible approach to faculty development.
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Affiliation(s)
- Nienke Renting
- Faculty of Behavioral & Social Sciences, GION, University of Groningen, Groningen, The Netherlands
| | - Debbie Jaarsma
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jan Cc Borleffs
- Center for Education Developmand and Research in Health Professions, University Medical Center Groningen, Groningen, The Netherlands
| | - Joris P J Slaets
- Geriatric Medicine, Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
| | - Janke Cohen-Schotanus
- Center for Education Developmand and Research in Health Professions, University Medical Center Groningen, Groningen, The Netherlands
| | - Rob O B Gans
- Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Pfeil A, Krusche M, Proft F, Vossen D, Braun J, Baraliakos X, Berliner MN, Keyßer G, Krause A, Lorenz HM, Manger B, Schuch F, Specker C, Wollenhaupt J, Voormann A, Fleck M. [Rheumatology training positions in Germany]. Z Rheumatol 2023; 82:539-551. [PMID: 36264331 PMCID: PMC10495514 DOI: 10.1007/s00393-022-01284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the next few years many general practitioners and specialists will retire. As in other disciplines the question arises in rheumatology whether sufficient training positions are available to maintain or expand the supply of care according to demand. Therefore, the German Society of Rheumatology (DGRh) has assigned its committee for education and training to review the currently available training opportunities in Germany. The aim of this work is the quantitative survey of the training capacity to become a specialist in internal medicine and rheumatology. METHODS Within the framework of this study, a survey was conducted via the homepages of the 17 state medical associations to determine the postgraduate medical officers, their place of work and the duration of their postgraduate training capabilities. Based on the data, a nationwide survey of training positions was conducted. RESULTS Specialized rheumatology training is established at 229 training centers in Germany, whereby data from 187 training sites were available for analysis. The training locations are distributed as followed: 52.4% clinical sector and 47.6% outpatient sector. In total, 478.4 training positions are available in Germany (clinical sector: 391.4 and outpatient sector: 87) and 17.2% of the positions (clinical sector: 11.4% and outpatient sector: 43.1%) are not occupied. CONCLUSION Based on this study, it can be shown that most of the continuing education positions are available in the clinical sector. In contrast, half of the training positions in the outpatient area are not filled. In order to improve the training situation, it is essential to integrate outpatient colleagues into the training program. This presupposes that further training is supported or financed by the healthcare system. In this context, optimal rheumatological care must be permanently guaranteed throughout Germany in order to provide sufficient care for the approximately 2 million patients with inflammatory rheumatic diseases.
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Affiliation(s)
- Alexander Pfeil
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland.
- Klinik für Innere Medizin III, Funktionsbereich Rheumatologie und Osteologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - Martin Krusche
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Sektion für Rheumatologie und Entzündliche Systemerkrankungen, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Fabian Proft
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Abteilung für Rheumatologie, Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Campus Benjamin Franklin, Charité Universitätsmedizin, Berlin, Deutschland
| | - Diana Vossen
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Rheinisches Rheumazentrum Meerbusch-Lank, St. Elisabeth Hospital, Meerbusch, Deutschland
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - Xenofon Baraliakos
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - Michael N Berliner
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Rheumatologie und Geriatrie, Helios Klinikum Berlin-Buch, Berlin, Deutschland
| | - Gernot Keyßer
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Department für Innere Medizin, Klinik für Innere Medizin II, Universitätsklinikum Halle, Halle (Saale), Deutschland
| | - Andreas Krause
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Klinik für Innere Medizin, Abteilung Rheumatologie, klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Hanns-Martin Lorenz
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Bernhard Manger
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Medizinische Klinik 3, Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Florian Schuch
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Internistische Praxisgemeinschaft Rheumatologie - Nephrologie, Erlangen, Deutschland
| | - Christof Specker
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, Evangelisches Krankenhaus Kliniken Essen-Mitte, Essen, Deutschland
| | - Jürgen Wollenhaupt
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Immunologikum Hamburg, Hamburg, Deutschland
| | - Anna Voormann
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| | - Martin Fleck
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Regenburg, Deutschland
- Asklepios Klinikum Bad Abbach, Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Bad Abbach, Deutschland
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Henrich JB, Schwarz EB, McClintock AH, Rusiecki J, Casas RS, Kwolek DG. Position Paper: SGIM Sex- and Gender-Based Women's Health Core Competencies. J Gen Intern Med 2023; 38:2407-2411. [PMID: 37079185 PMCID: PMC10117249 DOI: 10.1007/s11606-023-08170-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/10/2023] [Indexed: 04/21/2023]
Abstract
Women's health care has evolved significantly since it was first acknowledged as an integral part of internal medicine training more than two decades ago. To update and clarify core competencies in sex- and gender-based women's health for general internists, the Society of General Internal Medicine (SGIM) Women and Medicine Commission prepared the following Position Paper, approved by the SGIM council in 2023. Competencies were developed using several sources, including the 2021 Accreditation Council for Graduate Medical Education Program Requirements for Internal Medicine and the 2023 American Board of Internal Medicine Certification Examination Blueprint. These competencies are relevant to the care of patients who identify as women, as well as gender-diverse individuals to whom these principles apply. They align with pivotal advances in women's health and acknowledge the changing context of patients' lives, reaffirming the role of general internal medicine physicians in providing comprehensive care to women.
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Affiliation(s)
| | | | | | | | - Rachel S Casas
- Penn State Milton S. Hershey Medical Center, Hershey, USA
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Clark EH, Haltom TM, Freytag J, Hysong SJ, Dang BN, Giordano TP, Kulkarni PA. Impact of the COVID-19 Pandemic on Medical Education during Inpatient Internal Medicine Rounds. South Med J 2023; 116:690-695. [PMID: 37536697 PMCID: PMC10417251 DOI: 10.14423/smj.0000000000001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Inpatient rounding is a foundational component of medical education in academic hospitals. The coronavirus 2019 (COVID-19) pandemic disrupted traditional inpatient rounding practices. The objectives of this study were to describe how Internal Medicine inpatient team rounding changed because of COVID-19-related precautions and the effect of these changes on education during rounds. METHODS During February to March 2021, we conducted four virtual focus groups with medical and physician assistant students, interns, upper-level residents, and attending physicians at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, and designed a codebook to categorize focus group commentary. RESULTS Focus groups revealed that students believed that certain physical-distancing measures in place early on during the pandemic were ineffective and significantly limited their ability to evaluate patients in person. Residents described increased stress levels related to potential severe acute respiratory-coronavirus 2 exposure and limited time at the bedside, which affected their confidence with clinical assessments. Rounding-team fragmentation precluded the entire team learning from all of the patients on the team's census. Loss of intrateam camaraderie impaired the development of comfortable learning environments. CONCLUSIONS This study evaluated Internal Medicine team member focus groups to describe how the COVID-19 pandemic affected medical education during rounds. Academic teaching programs can adapt the findings from this study to address and prevent pandemic-related gaps in medical education during rounds now and during future potential disruptions to medical education.
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Affiliation(s)
- Eva H. Clark
- From the Department of Medicine-Infectious Diseases, Baylor College of Medicine, Houston, Texas
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Trenton M. Haltom
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Department of Medicine-Health Services Research, Baylor College of Medicine, Houston, Texas
| | - Jennifer Freytag
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Sylvia J. Hysong
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
- Department of Medicine-Health Services Research, Baylor College of Medicine, Houston, Texas
| | - Bich N. Dang
- From the Department of Medicine-Infectious Diseases, Baylor College of Medicine, Houston, Texas
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Thomas P. Giordano
- From the Department of Medicine-Infectious Diseases, Baylor College of Medicine, Houston, Texas
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Prathit A. Kulkarni
- From the Department of Medicine-Infectious Diseases, Baylor College of Medicine, Houston, Texas
- Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
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Wietlisbach LE, Asch DA, Eriksen W, Barg FK, Bellini LM, Desai SV, Yakubu AR, Shea JA. Using poetry to elicit internal medicine residents' perspectives on wellness. Postgrad Med J 2023; 99:428-432. [PMID: 37294722 PMCID: PMC9530064 DOI: 10.1136/postgradmedj-2021-141493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/19/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To elicit internal medicine residents' perspectives on wellness through poetry writing, examining (1) response rates, (2) the tone/sentiment of their submissions and (3) the primary thematic content. STUDY DESIGN In academic year 2019-2020, a random sample of 88 residents from four internal medicine residency programmes was invited to participate in a year-long study of wellness. In December 2019, an open-ended prompt asked residents to write a poem reflecting on their well-being. Responses were inductively coded using content analysis techniques. RESULTS The response rate for the poetry prompt was 94%. The tone of the entries was most often neutral or contradictory (42%), followed by negative (33%) and positive (25%). There were three main themes: (1) Mindsets: most residents simply wanted to make it through their programme; (2) wellness influencers: the main wellness supporters were external to the programme such as vacationing and exercise; within hospitals, friendships with colleagues and boosted wellness and (3) scheduling/repetition: difficult schedules drained energy as did the monotony of administrative tasks. CONCLUSIONS Poetry appears to be an innovative and effective vehicle to elicit residents' perspectives without compromising response rate. Poetry survey techniques allow medical trainees to provide powerful messaging to leadership. Most of what is known about trainee wellness is derived from quantitative surveys. This study showed medicine trainees' willingness to engage in poetry and add richness and personal detail to highlight key drivers of wellness. Such information provides context and brings attention in a compelling manner to an important topic.
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Affiliation(s)
- Larissa E Wietlisbach
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David A Asch
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Whitney Eriksen
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frances K Barg
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa M Bellini
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay V Desai
- Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Abdul-Rakeem Yakubu
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Judy A Shea
- Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Para O, Caruso L, Merilli I, Carleo C, Bucci F, Nozzoli C. Safety of arterial catheters in internal medicine ward: A new competence for the internist? Eur J Intern Med 2023; 112:136-137. [PMID: 36872140 DOI: 10.1016/j.ejim.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 03/06/2023]
Affiliation(s)
- O Para
- Internal Medicine 1, University Hospital Careggi, Florence, Italy
| | - L Caruso
- Internal Medicine 1, University Hospital Careggi, Florence, Italy.
| | - I Merilli
- Internal Medicine 1, University Hospital Careggi, Florence, Italy
| | - C Carleo
- Internal Medicine 1, University Hospital Careggi, Florence, Italy
| | - F Bucci
- Internal Medicine 1, University Hospital Careggi, Florence, Italy
| | - C Nozzoli
- Internal Medicine 1, University Hospital Careggi, Florence, Italy
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Rosenberg ME, Anderson S, Farouk SS, Gibson KL, Hoover RS, Humphreys BD, Orlowski JM, Udani SM, Waitzman JS, West M, Ibrahim T. Reimagining Nephrology Fellowship Education to Meet the Future Needs of Nephrology: A Report of the American Society of Nephrology Task Force on the Future of Nephrology. Clin J Am Soc Nephrol 2023; 18:816-825. [PMID: 36848491 PMCID: PMC10278777 DOI: 10.2215/cjn.0000000000000133] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 03/01/2023]
Abstract
The American Society of Nephrology (ASN) Task Force on the Future of Nephrology was established in April 2022 in response to requests from the American Board of Internal Medicine and the Accreditation Council for Graduate Medical Education regarding training requirements in nephrology. Given recent changes in kidney care, ASN also charged the task force with reconsidering all aspects of the specialty's future to ensure that nephrologists are prepared to provide high-quality care for people with kidney diseases. The task force engaged multiple stakeholders to develop 10 recommendations focused on strategies needed to promote: ( 1 ) just, equitable, and high-quality care for people living with kidney diseases; ( 2 ) the value of nephrology as a specialty to nephrologists, the future nephrology workforce, the health care system, the public, and government; and ( 3 ) innovation and personalization of nephrology education across the scope of medical training. This report reviews the process, rationale, and details (the "why" and the "what") of these recommendations. In the future, ASN will summarize the "how" of implementing the final report and its 10 recommendations.
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Affiliation(s)
| | | | | | - Keisha L. Gibson
- University of North Carolina Kidney Center, Raleigh, North Carolina
| | | | | | | | - Suneel M. Udani
- Nephrology Associates of Northern Illinois and Indiana (NANI), Chicago, Illinois
| | | | | | - Tod Ibrahim
- American Society of Nephrology, Washington, DC
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Khawaja HR, Greene SM, Darling R. Redesigning the sub-internship experience in internal medicine. Med Educ 2023; 57:480. [PMID: 36814070 DOI: 10.1111/medu.15034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
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He R, Xie Y, Liu F, Zhao L, Zhang O, Xiang W, Kong L, Miao L, Zhang P. Implementing case-based collaborative learning curriculum via webinar in internal medicine residency training: A single-center experience. Medicine (Baltimore) 2023; 102:e33601. [PMID: 37083783 PMCID: PMC10118346 DOI: 10.1097/md.0000000000033601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/03/2023] [Indexed: 04/22/2023] Open
Abstract
This study aimed to investigate the effects of the Case-based collaborative learning (CBCL) curriculum in webinar format on internal medicine residents' knowledge covering cardiologic topics and their attitudes toward the CBCL teaching module. CBCL is a novel small-group approach, that incorporates elements of problem-based learning and case-based learning, and it has shown to improve medical students' knowledge mastery. However, few studies have explored its applicability for internal medicine residents, especially in the webinar format. This prospective cohort study included internal medicine residents in a residency program in Beijing, China. Eight CBCL sessions in webinar format covering cardiologic topics were delivered to them from February to April 2020. Pre-session reading materials included textbook and guidelines published by the academic societies. Multiple-choice questions were delivered to assess participants' knowledge before and after the sessions. Changes in participants' knowledge were determined using the paired t test to compare mean values. In addition, surveys based on 5-point Likert scale scores assessed satisfaction at the end of the second and eighth sessions. The Wilcoxon signed-rank test was used to identify any potential satisfaction improvement. In total, 9 internal medicine residents participated in the study, of whom 33.3% were male, and the overall rate of participation in CBCL sessions in webinar format was 94.4%. The mean scores of 50 multiple-choice questions were 68.0 ± 12.3 and 75.1 ± 9.9 in the pre- and post-curriculum assessments (P = .029). In the first survey performed at the second week, 5 (55.6%) residents chose "like" or "extremely like" in overall satisfaction, "neutral" by 3 (33.3%) residents and "dislike" by 1 (11.1%) resident. In the second survey, only 1 (11.1%) resident selected a neutral reply in satisfactory assessment, and the other 8 (88.9%) residents selected either "like" or "extremely like" choices. Compared with the results of the first survey, the overall satisfaction rate significantly improved (P = .031). Implementing the CBCL sessions in webinar format for cardiology residents was resulted in the improved knowledge mastery and a high acceptance rate.
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Affiliation(s)
- Rong He
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ying Xie
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Fang Liu
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Lanting Zhao
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ou Zhang
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wei Xiang
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Lingyun Kong
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Le Miao
- Postgraduate Office, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ping Zhang
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Weinstein A, MacPherson P, Schmidt S, Van Opstal E, Chou E, Pogemiller M, Gibbs K, Held M. Needs assessment for enhancing pediatric clerkship readiness. BMC Med Educ 2023; 23:188. [PMID: 36978085 PMCID: PMC10044806 DOI: 10.1186/s12909-023-04167-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Many students report feeling inadequately prepared for their clinical experiences in pediatrics. There is striking variability on how pediatric clinical skills are taught in pre-clerkship curricula. METHODS We asked students who completed their clerkships in pediatrics, family medicine, surgery, obstetrics-gynecology and internal medicine to rate their pre-clinical training in preparing them for each clerkship, specifically asking about medical knowledge, communication, and physical exam skills. Based on these results, we surveyed pediatric clerkship and clinical skills course directors at North American medical schools to describe the competence students should have in the pediatric physical exam prior to their pediatric clerkship. RESULTS Close to 1/3 of students reported not feeling adequately prepared for their pediatrics, obstetrics-gynecology, or surgery clerkship. Students felt less prepared to perform pediatric physical exam skills compared to physical exam skills in all other clerkships. Pediatric clerkship directors and clinical skills course directors felt students should have knowledge of and some ability to perform a wide spectrum of physical exam skills on children. There were no differences between the two groups except that clinical skills educators identified a slightly higher expected competence for development assessment skills compared to pediatric clerkship directors. CONCLUSIONS As medical schools undergo cycles of curricular reform, it may be beneficial to integrate more pre-clerkship exposure to pediatric topics and skills. Further exploration and collaboration establishing how and when to incorporate this learning could serve as a starting point for curricular improvements, with evaluation of effects on student experience and performance. A challenge is identifying infants and children for physical exam skills practice.
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Affiliation(s)
- Adam Weinstein
- Frank H. Netter MD School of Medicine, North Haven, CT, USA.
| | | | - Suzanne Schmidt
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Erica Chou
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Melissa Held
- University of Connecticut School of Medicine, Farmington, CT, USA
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Hernandez BC, ChenFeng JL, Schill-Depew AE, Lee S. A biopsychosocial-spiritual wellness check program for internal medicine residents: A brief report. Fam Syst Health 2023; 41:54-60. [PMID: 36951698 DOI: 10.1037/fsh0000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 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
INTRODUCTION The pandemic has significantly impacted medical residents. We created and implemented a biannual biopsychosocial-spiritual Wellness Check Program (WCP) to help internal medicine residents self-assess for burnout, enhance resilience, and to promote early identification and referral to mental health services. We report the preliminary findings from our quality improvement pilot effort at Loma Linda University Health (LLUH). METHOD Residents participated in biannual sessions with licensed therapists employed by Loma Linda University, Office of Physician Vitality (OPV). Visits consisted of an evidence-guided discussion about general wellbeing, relationships, family life, coping strategies, and referrals. Archived, confidential WCP session notes between July 1, 2019 and December 31, 2019 were reviewed and a simple tally system was used to record coping strategies, concerns, and referrals made. RESULTS Partner and family issues were the most prevalent concern, followed by mental health issues, and relationships with colleagues, faculty, or staff. Most residents described several coping strategies: 66.36% listed two to three, and 26.36% listed four or more. Referrals were offered to community or employee assistance program therapists, follow-up with the OPV, psychiatry, couple counseling, given Web based psychoeducational links, or referred to their program director. Nine other residencies requested the WCP providing anecdotal evidence of its feasibility and usefulness. DISCUSSION As the pandemic surged, these visits normalized reflections about wellbeing, intentional coping strategies, and resilience practices. We continue to gather data to refine and further structure this program and help residents monitor and address their resilience needs and wellness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Sheikh N, Ng SL, Flett H, Shah R. Internal medicine trainee perspectives on back-up call systems and relationships to burnout. Med Educ 2023; 57:256-264. [PMID: 36490279 DOI: 10.1111/medu.15003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/05/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION As burnout within medicine escalates, residency programmes should strive to understand how training structures may contribute. Back-up call systems that address gaps in overnight resident call coverage are one possible contributing structure. However, the intersection between back-up call policies and burnout remains unclear. The authors explored residents' decision-making process when deciding whether or not to activate a back-up resident for call coverage, perspectives surrounding the legitimacy of call activations and the impact of back-up call systems on education and experienced burnout. METHODS Internal medicine residents at the University of Toronto were recruited through email. Eighteen semi-structured one-on-one interviews were conducted with residents from September 2019 to February 2020. Interviews explored participants' experiences and perceptions with back-up call and call activations. A constructivist grounded theory approach was used to develop a conceptual understanding of the back-up system as it relates to residents' decisions underlying activations, downstream impacts and relationships to burnout. RESULTS Residents described a complex thought process when deciding whether to activate back-up. Decisions were coloured by inner conflicts including sense of collegiality, need to maintain an image and time of year balanced against self-reported burnout. Residents described how back-up calls can lead to burnout, usually in the form of exhaustion, lowering their threshold to trigger future back-up activations. Impacts included anxiety of not knowing whether an activation would occur, decreased educational productivity and the 'domino effect' of increased workload for colleagues. DISCUSSION Residents weigh inner tensions when deciding to activate back-up. Their collective experience suggests that burnout is both a trigger and consequence of back-up calls, creating a cyclical relationship. Escalating rates of call activations may signal that burnout amongst residents is high, warranting educational leads to assess for resident wellness and to critically evaluate the structure of such systems with respect to unintended consequences.
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Affiliation(s)
- Natasha Sheikh
- Internal Medicine Residency Program, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stella L Ng
- Centre for Interprofessional Education, University of Toronto, Toronto, Ontario, Canada
| | - Heather Flett
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rupal Shah
- Division of General Internal Medicine, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- HoPingKong Centre for Excellence in Education and Practice, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Farrell L, Cuncic C, Hartford W, Hatala R, Ajjawi R. Goal co-construction and dialogue in an internal medicine longitudinal coaching programme. Med Educ 2023; 57:265-271. [PMID: 36181337 DOI: 10.1111/medu.14942] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/18/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Longitudinal coaching in residency programmes is becoming commonplace and requires iterative and collaborative discussions between coach and resident, with the shared development of goals. However, little is known about how goal development unfolds within coaching conversations over time and the effects these conversations have. We therefore built on current coaching theory by analysing goal development dialogues within resident and faculty coaching relationships. METHODS This was a qualitative study using interpretive description methodology. Eight internal medicine coach-resident dyads consented to audiotaping coaching meetings over a 1-year period. Transcripts from meetings and individual exit interviews were analysed thematically using goal co-construction as a sensitising concept. RESULTS Two themes were developed: (i) The content of goals discussed in coaching meetings focused on how to be a resident, with little discussion around challenges in direct patient care, and (ii) co-construction mainly occurred in how to meet goals, rather than in prioritising goals or co-constructing new goals. CONCLUSIONS In analysing goal development in the coach-resident relationships, conversations focused mainly around how to manage as a resident rather than how to improve direct patient care. This may be because academic coaching provides space separate from clinical work to focus on the stage-specific professional identity development of a resident. Going forward, focus should be on how to optimise longitudinal coaching conversations to ensure co-regulation and reflection on both clinical competencies and professional identity formation.
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Affiliation(s)
- Laura Farrell
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cary Cuncic
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy Hartford
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rose Hatala
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Victoria, Australia
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Redinger JW, Heppe DB, Albert TJ, Cornia PB, Gordon KS, Arundel C, Bradley JM, Caputo LM, Chun JW, Cyr JE, Ehlers ET, Guidry MM, Jagannath AD, Kwan BK, Laudate JD, Mitchell CA, Smeraglio AC, Sweigart JR, Tuck MG, Gunderson CG. What internal medicine attendings talk about at morning report: a multicenter study. BMC Med Educ 2023; 23:84. [PMID: 36732763 PMCID: PMC9893973 DOI: 10.1186/s12909-023-04057-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Morning report is a core educational activity in internal medicine resident education. Attending physicians regularly participate in morning report and influence the learning environment, though no previous study has described the contribution of attending physicians to this conference. This study aims to describe attending comments at internal medicine morning reports. METHODS We conducted a prospective, observational study of morning reports conducted at 13 internal medicine residency programs between September 1, 2020, and March 30, 2021. Each attending comment was described including its duration, whether the comment was teaching or non-teaching, teaching topic, and field of practice of the commenter. We also recorded morning report-related variables including number of learners, report format, program director participation, and whether report was scripted (facilitator has advance knowledge of the case). A regression model was developed to describe variables associated with the number of attending comments per report. RESULTS There were 2,344 attending comments during 250 conferences. The median number of attendings present was 3 (IQR, 2-5). The number of comments per report ranged across different sites from 3.9 to 16.8 with a mean of 9.4 comments/report (SD, 7.4). 66% of comments were shorter than one minute in duration and 73% were categorized as teaching by observers. The most common subjects of teaching comments were differential diagnosis, management, and testing. Report duration, number of general internists, unscripted reports, and in-person format were associated with significantly increased number of attending comments. CONCLUSIONS Attending comments in morning report were generally brief, focused on clinical teaching, and covered a wide range of topics. There were substantial differences between programs in terms of the number of comments and their duration which likely affects the local learning environment. Morning report stakeholders that are interested in increasing attending involvement in morning report should consider employing in-person and unscripted reports. Additional studies are needed to explore best practice models of attending participation in morning report.
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Affiliation(s)
- Jeffrey W Redinger
- VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA.
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| | - Daniel B Heppe
- VA Eastern Colorado Health Care System, Aurora, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tyler J Albert
- VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Paul B Cornia
- VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Kirsha S Gordon
- VA Connecticut Health Care System, West Haven, CT, USA
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Cherinne Arundel
- Washington, DC VA Medical Center, Washington, DC, USA
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Department of Medicine, Georgetown University School of Medicine, Washington, DC, USA
| | - Joel M Bradley
- White River Junction VA Medical Center, White River Junction, VT, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Laura M Caputo
- Durham VA Health Care System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jonathan W Chun
- VA Palo Alto Health Care System, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jessica E Cyr
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Erik T Ehlers
- Omaha VA Medical Center, Omaha, NE, USA
- Department of Internal Medicine, University of Nebraska College of Medicine, Omaha, NE, USA
| | - Michelle M Guidry
- Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Anand D Jagannath
- VA Portland Health Care System, Portland, OR, USA
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Brian K Kwan
- San Diego VA Medical Center, San Diego, CA, USA
- Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, USA
| | - James D Laudate
- White River Junction VA Medical Center, White River Junction, VT, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Christine A Mitchell
- Omaha VA Medical Center, Omaha, NE, USA
- Department of Internal Medicine, University of Nebraska College of Medicine, Omaha, NE, USA
| | - Andrea C Smeraglio
- VA Portland Health Care System, Portland, OR, USA
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Joseph R Sweigart
- Lexington VA Health Care System, Lexington, KY, USA
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Matthew G Tuck
- Washington, DC VA Medical Center, Washington, DC, USA
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Craig G Gunderson
- VA Connecticut Health Care System, West Haven, CT, USA
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
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49
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Amundsen DB, Choi Y, Nekhlyudov L. Cancer Care Continuum Research and Educational Innovation: Are Academic Internists Keeping up with Population Trends? J Cancer Educ 2023; 38:28-33. [PMID: 34302292 DOI: 10.1007/s13187-021-02073-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
Academic internists play a unique role in conducting innovative research, developing educational curricula, and influencing policy. As the population of patients living with and beyond cancer is expected to reach 22 million by 2030, it is essential for academic internists to lead innovative research in clinical care and medical education across the cancer care continuum. We characterized cancer-related topics presented at the 2015-2019 annual meetings of the Society of General Internal Medicine, a national organization of over 3,000 academic general internists. We analyzed all scientific (n = 3,437), Innovation in Medical Education (n = 756), and Innovation in Clinical Practice (n = 664) abstracts for content across the cancer continuum: prevention, screening, diagnosis, treatment, survivorship, and palliative/end-of-life care (P/EOL). Of 3,437 scientific abstracts, 304 (8.8%) related to cancer. Prevention, screening, diagnosis, treatment, survivorship, and P/EOL were addressed in 52 (17.1%), 145 (47.7%), 18 (5.9%), 57 (18.8%), 12 (4.0%), and 29 (9.5%) of scientific abstracts, respectively. Some addressed multiple phases, and 6 were classified as "other." Breast (mean = 18.2, SD = 4.66), colorectal (mean = 12.8, SD = 3.11), and lung (mean = 8.2, SD = 2.29) cancers were most presented in scientific abstracts per year. Five (0.66%) of the 756 Innovation in Medical Education abstracts and 41 (6.2%) of the 665 Innovation in Clinical Practice abstracts addressed cancer. Similarly, they primarily focused on screening and prevention. To lead innovation in clinical care, education, and policy across the cancer continuum and prepare the future workforce, academic internists should expand their focus to later phases, particularly survivorship and P/EOL.
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Affiliation(s)
| | - Youngjee Choi
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
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50
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Chodoff A, Conyers L, Wright S, Levine R. "I never should have been a doctor": a qualitative study of imposter phenomenon among internal medicine residents. BMC Med Educ 2023; 23:57. [PMID: 36694199 PMCID: PMC9875476 DOI: 10.1186/s12909-022-03982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Imposter phenomenon is common among medical trainees and may influence learning and professional development. The authors sought to describe imposter phenomenon among internal medicine residents. METHODS In 2020, using emailed invites we recruited a convenience sample of 28 internal medicine residents from a teaching hospital in Baltimore, Maryland to participate in an exploratory qualitative study. In one-on-one interviews, informants described experiences of imposter phenomenon during residency training. Using thematic analysis to identify meaningful segments of text, the authors developed a coding framework and iteratively identified and refined themes. Informants completed the Clance Imposter Phenomenon Scale. RESULTS Informants described feelings and thoughts related to imposter phenomenon, the contexts in which they developed and the impact on learning. Imposter phenomenon has profound effects on residents including: powerful and persistent feelings of inadequacy and habitual comparisons with others. Distinct contexts shaping imposter phenomenon included: changing roles with increasing responsibilities; constant scrutiny; and rigid medical hierarchy. Learning was impacted by inappropriate expectations, difficulty processing feedback, and mental energy diverted to impression management. DISCUSSION Internal medicine residents routinely experience imposter phenomenon; these feelings distort residents' sense of self confidence and competence and may impact learning. Modifiable aspects of the clinical learning environment exacerbate imposter phenomenon and thus can be acted upon to mitigate imposter phenomenon and promote learning among medical trainees.
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Affiliation(s)
- Alaina Chodoff
- Division of General Internal Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Lynae Conyers
- Division of General Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Scott Wright
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rachel Levine
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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