Effectiveness of a graduate medical education program for improving medical event reporting attitude and behavior

OBJECTIVES

To evaluate the effectiveness of an educational program for improving medical event reporting attitude and behavior in the ambulatory care setting among graduate medical trainees.

DESIGN

One group pre- and post-test study.

SETTING

The University of Texas Southwestern Medical Center at Dallas Family Medicine Residency Program.

PARTICIPANTS

All family practice residents (n = 30).

INTERVENTION

Patient safety educational program implemented through an introductory lecture and 6 monthly conferences, June to December 2002, involving medical events that occurred in the ambulatory care setting.

OUTCOME MEASURES

Medical event reporting attitude and behavior at baseline and at 6 month follow up, and barriers to medical event reporting at the 6 month follow up.

RESULTS

Program attendance was significantly correlated with medical event reporting attitude and behavior change (rho = 0.525, p = 0.003). The median change in medical event reporting attitude and behavior was zero and not statistically significant (p = 0.566). Major barriers to medical event reporting were lack of time, extra paper work, and concern about career and personal reputation.

CONCLUSIONS

Attending the patient safety educational program was key for promoting a positive medical event reporting attitude and behavior change among graduate trainees. Major barriers to medical event reporting were lack of time, extra paper work, and concern about career and personal reputation. Future research will need to focus on reducing these barriers and to evaluate the effectiveness of such a program over longer periods of time, since making a positive change in medical event reporting attitude and behavior must be made at the individual and organizational levels.

Electronic medical records: the family practice resident perspective

BACKGROUND AND OBJECTIVES

Few studies have included family practice residents' perceptions regarding the use of electronic medical records (EMR) in a residency program. This study determined residents' perceptions of EMR systems and what variables influenced those perceptions. Specifically, we studied how EMR training and previous computer background influenced resident perception of difficulty in EMR implementation, time efficiency, preventive care opportunities, accuracy of medical records, and desired future use of EMR systems. Questions targeted the use of the EMR in the resident continuity clinic.

METHODS

Survey questionnaires about the use of EMR systems in the residents' continuity clinic were mailed to residency directors and residents of 219 family practice residency programs. Respondents were given the opportunity to comment on benefits of and concerns about EMR.

RESULTS

Resident response rate was 46% in programs using EMR systems. Findings revealed that the length of EMR training a resident received was unrelated to the perceived adequacy of training but was related to the residents' assessment of the difficulty of implementing the EMR in their continuity clinic. Residents who perceived training to be adequate and perceived a relative ease of implementing the EMR were more likely to perceive the EMR to be beneficial and were more likely to choose the EMR over traditional paper records for future use. Computer background/experience was not related to perceived satisfaction with the EMR, nor was it related to perceived difficulty of implementation, adequacy of training, or anticipated future use of an EMR system.

CONCLUSIONS

Although residents recognize the benefits of the EMR, our study demonstrates an overall ambivalence and frustration toward EMR systems currently in use in family practice residency continuity clinics. However, the training they receive regarding EMR use in their residency may influence not only the perceived ease of EMR implementation but attitudes regarding the ability of the EMR to assist them with preventive opportunities, time management, and medical record accuracy. This may in turn have influence on the use of EMR systems in their practices after residency.

A wellness program model for family practice residency programs

For some time health promotion and disease prevention have been expected tenets of medical practices with the public. However, the medical profession has only recently emphasized prevention and wellness promotion as required curricula for study at the undergraduate and graduate levels. Family physicians have been at the forefront in accepting this additional responsibility, but actual implementation of such practices has been difficult for the individual physician. To address this needed transitional step from public demand to practice, a wellness program for residents, faculty, staff, and patients was designed for the Family Practice Residency Program at Cheyenne.

Interaction between the socio-demographic variables of physicians and their patients: its impact upon patient satisfaction

An investigation of resident physician socio-demographic characteristics and how they may interact with patient socio-demographic characteristics to influence satisfaction was done. Physician characteristics of gender, age, marital and parental status, ethnic background, level of training and demonstrated cognitive skills, was compared with similar patient socio-demographics, to ascertain if a patient's preconceived images of who a physician is, rather than what a physician does will impact significantly upon patient satisfaction outcome. Results suggest that patients make these judgments separately from physician socio-demographic variables and support the belief that communication skills are a major determinant of patient satisfaction.