A substance use disorder training curriculum for internal medicine residents using resident-empaneled patients

BACKGROUND

Internal Medicine (IM) residents frequently encounter, but feel unprepared to diagnose and treat, patients with substance use disorders (SUD). This is compounded by negative regard for patients with SUD. Optimal education strategies are needed to empower IM residents to care for patients with SUD. The objective of this study was to evaluate a brief SUD curriculum for IM residents, using resident-empaneled patients as an engaging educational strategy.

METHODS

Following a needs assessment, a 2-part SUD curriculum was developed for IM residents at the University of Chicago during the 2018-2019 academic year as part of the ambulatory curriculum. During sessions on Opioid Use Disorder (OUD) and Alcohol Use Disorder (AUD), a facilitator covered concepts about screening, diagnosis, and treatment. In session, residents completed structured worksheets applying concepts to one of their primary care patients. A post-session assessment included questions on knowledge, preparedness & attitudes.

RESULTS

Resident needs assessment (n = 44/105, 42% response rate) showed 86% characterized instruction received during residency in SUD as none or too little, and residents did not feel prepared to treat SUD. Following the AUD session, all residents (n = 22) felt prepared to diagnose and treat AUD. After the OUD session, all residents (n = 19) felt prepared to diagnose, and 79% (n = 15) felt prepared to treat OUD. Residents planned to screen for SUD more or differently, initiate harm reduction strategies and increase consideration of pharmacotherapy.

CONCLUSIONS

A brief curricular intervention for AUD and OUD using resident-empaneled patients can empower residents to integrate SUD diagnosis and management into practice.

Telehealth Attitudes, Training, and Preparedness Among First-Year Internal Medicine Residents in the COVID-19 Era

Background: Telehealth, especially the use of real-time video and phone visits in ambulatory care, is increasingly important in the wake of the COVID-19 pandemic. The current state of internal medicine (IM) interns' telehealth training at the start of residency is unknown. Objective: To characterize the attitudes, training, and preparedness of IM interns regarding the use of telehealth video and phone visits in ambulatory care. Methods: We conducted a cross-sectional survey of IM interns at four IM residency programs in the United States in 2020. Results: One hundred fifty-six surveys were analyzed (response rate 82%). Seventy-five percent of interns rated training in the use of real-time video and phone visits for ambulatory care as important or very important. The vast majority received no training (74%) or clinical experience (90% no prior video visits, 81% no prior phone visits) during medical school. More interns believed that primary care may be effectively delivered via video visits compared with phone visits (77% vs. 35%). Most interns (69%) missed clinical time during medical school due to the COVID-19 pandemic; 41% felt that the pandemic negatively affected their ambulatory care preparation. Overall, the majority of interns (58%) felt prepared for primary care; only 12% felt prepared to deliver primary care using either video or phone visits. Conclusions: Although IM interns had favorable attitudes toward video and phone visits, few had training or clinical experience; most felt unprepared. Residency programs may need to close training gaps for current interns in conducting telehealth video and phone visits.

Bridging the Gap: Interdepartmental Quality Improvement and Patient Safety Curriculum Created by Hospital Leaders, Faculty, and Trainees

BACKGROUND

The Accreditation Council for Graduate Medical Education Clinical Learning Environment Review recommends that quality improvement/patient safety (QI/PS) experts, program faculty, and trainees collectively develop QI/PS education.

OBJECTIVE

Faculty, hospital leaders, and resident and fellow champions at the University of Chicago designed an interdepartmental curriculum to train postgraduate year 1 (PGY-1) residents on core QI/PS principles, measuring outcomes of knowledge, attitudes, and event reporting.

METHODS

The curriculum consisted of 3 sessions: PS, quality assessment, and QI. Faculty and resident and fellow leaders taught foundational knowledge, and hospital leaders discussed institutional priorities. PGY-1 residents attended during protected conference times, and they completed in-class activities. Knowledge and attitudes were assessed using pretests and posttests; graduating residents (PGY-3-PGY-8) were controls. Event reporting was compared to a concurrent control group of nonparticipating PGY-1 residents.

RESULTS

From 2015 to 2017, 140 interns in internal medicine (49%), pediatrics (33%), and surgery (13%) enrolled, with 112 (80%) participating and completing pretests and posttests. Overall, knowledge scores improved (44% versus 57%, P < .001), and 72% of residents demonstrated increased knowledge. Confidence comprehending quality dashboards increased (13% versus 49%, P < .001). PGY-1 posttest responses were similar to those of 252 graduate controls for accessibility of hospital leaders, filing event reports, and quality dashboards. PGY-1 residents in the QI/PS curriculum reported more patient safety events than PGY-1 residents not exposed to the curriculum (0.39 events per trainee versus 0.10, P < .001).

CONCLUSIONS

An interdepartmental curriculum was acceptable to residents and feasible across 3 specialties, and it was associated with increased event reporting by participating PGY-1 residents.

Evaluation and Treatment of Hirsutism in Premenopausal Women

GUIDELINE TITLE

Evaluation and Treatment of Hirsutism in Premenopausal Women

DEVELOPER

Endocrine Society, Androgen Excess and Polycystic Ovary Syndrome Society, European Society of Endocrinology

RELEASE DATE

March 2018

PRIOR VERSION

February 5, 2008

FUNDING SOURCE

Endocrine Society

TARGET POPULATION

Premenopausal women with excess hair growth

MAJOR RECOMMENDATIONS

DIAGNOSIS: Obtain a random serum total testosterone measurement to assess for androgen excess in all women with an abnormal hirsutism score (weak recommendation, low-quality evidence). Obtain an early-morning 17-hydroxyprogesterone measurement in all women with elevated testosterone and in women with hirsutism who are at high risk of congenital adrenal hyperplasia (weak recommendation; low-quality evidence). Do not measure androgen levels in women with normal menses and a normal hirsutism score (weak recommendation; low-quality evidence). PHARMACOLOGIC TREATMENT: Start with pharmacologic therapy and add direct hair removal methods for women with a normal hirsutism score but patient-important hirsutism despite shaving or plucking (weak recommendation; very low-quality evidence). In women who are not seeking pregnancy, oral contraceptive pills (OCPs) are recommended as initial therapy (weak recommendation; low-quality evidence). Either OCPs or antiandrogens are acceptable initial therapies in women who are not sexually active, have undergone permanent sterilization, or are using long-acting reversible contraception (weak recommendation; very low-quality evidence). Combination therapy with an antiandrogen is recommended if patient-important hirsutism persists despite 6 months of monotherapy with an OCP (weak recommendation; low-quality evidence).

Preparing for the primary care clinic: an ambulatory boot camp for internal medicine interns

INTRODUCTION

Internal medicine (IM) interns start continuity clinic with variable ambulatory training. Multiple other specialties have utilized a boot camp style curriculum to improve surgical and procedural skills, but boot camps have not been used to improve interns' ambulatory knowledge and confidence. The authors implemented and assessed the impact of an intern ambulatory boot camp pilot on primary care knowledge, confidence, and curricular satisfaction.

METHODS

During July 2014, IM interns attended ambulatory boot camp. It included clinically focused case-based didactic sessions on common ambulatory topics as well as orientation to the clinic and electronic medical records. Interns anonymously completed a 15-question pre-test on topics covered in the boot camp as well as an identical post-test after the boot camp. The interns were surveyed regarding their confidence and satisfaction.

RESULTS

Thirty-eight interns participated in the boot camp. Prior to the boot camp, few interns reported confidence managing common outpatient conditions. The average pre-test knowledge score was 46.3%. The average post-test knowledge score significantly improved to 76.1% (p<0.001). All interns reported that the boot camp was good preparation for clinics and 97% felt that the boot camp boosted their confidence.

CONCLUSIONS

The ambulatory boot camp pilot improved primary care knowledge, and interns thought it was good preparation for clinic. The ambulatory boot camp was well received and may be an effective way to improve the preparation of interns for primary care clinic. Further assessment of clinical performance and expansion to other programs and specialties should be considered.

Using a resident discharge clinic for resident education and patient care: a feasibility study

BACKGROUND

Many patients in internal medicine resident continuity clinics experience difficulty accessing care, making posthospitalization ambulatory follow-up challenging. Experiential learning in care transitions is also lacking for residents.

OBJECTIVE

We sought to assess the feasibility and impact of a weekly Resident Discharge Clinic (RDC) in increasing access to early posthospitalization follow-up and providing learning opportunities for residents.

METHODS

We staffed the RDC with an ambulatory block resident, an internal medicine preceptor, and a clinical pharmacist. We assessed time to posthospitalization follow-up, readmission rates, and resident perceptions of postdischarge care for resident-clinic patients, comparing data before and after RDC implementation.

RESULTS

There were 636 discharges in the baseline group, 662 during the intervention period, and 56 in the RDC group. Six months after RDC implementation, the percentage of discharged resident-clinic patients with follow-up within 7 days improved from 6.6% at baseline to 9.7% (P  =  .04). The mean interval to the posthospitalization follow-up appointment in the RDC group was 7.4 days compared with 33.9 days in the baseline group (P < .001). The percentage of surveyed residents (n  =  72) who agreed that early follow-up was easy to arrange increased from 21% to 77% (P < .001). There was no significant decrease in the 30-day readmission rate for patients in the RDC group (18.1% versus 12.5%, P  =  .29).

CONCLUSIONS

The RDC was easily implemented, increased access to timely posthospitalization follow-up, and provided a platform for resident learning about care transitions.

A resident-led quality improvement initiative to improve obesity screening

Instruction on quality improvement (QI) methods is required as part of residency education; however, there is limited evidence regarding whether internal medicine residents can improve patient care using these methods. Because obesity screening is not done routinely in clinical practice, residents aimed to improve screening using QI techniques. Residents streamlined body mass index (BMI) documentation, created educational materials about obesity, and launched an obesity screening QI initiative in a residency clinic. Residents designed plan-do-study-act cycles focused on increasing awareness and maintaining improvements in screening over a 1-year period. Documentation rates were collected at baseline, 2 weeks, 6 months, and 1 year post-intervention. At 1 year, obesity treatment rates also were collected. BMI documentation rates after 1 year were higher than baseline (43% vs 4%, P < .0001). In obese patients, BMI documentation was associated with lifestyle counseling (34% vs 14%, P < .01). An internal medicine resident-led QI project targeting obesity can improve screening.