Counting Quality, Not Hours: Understanding the Impact of Duty Hour Reform on Internal Medicine Residency Education

Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA, .
Journal of General Internal Medicine (Impact Factor: 3.42). 08/2012; 27(11):1400-1. DOI: 10.1007/s11606-012-2185-3
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    Journal of General Internal Medicine 08/2012; 27(11):1395-6. DOI:10.1007/s11606-012-2205-3 · 3.42 Impact Factor
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    ABSTRACT: BACKGROUND: The rising number of medical students and the impact this has on students' learning of clinical skills is a matter of concern. Cooperative learning in pairs, called dyad training, might help address this situation. OBJECTIVE: The aim of this study was to evaluate the effect of dyad training on students' patient encounter skills. DESIGN: Experimental, randomized, observer-blinded trial. PARTICIPANTS: Forty-nine pre-clerkship medical students without prior clinical experience. INTERVENTION: All students underwent a 4-h course on how to manage patient encounters. Subsequently, the students were randomized into a dyad practice group (n = 24) or a single practice group (n = 25). Both groups practiced for 4 h on four different case scenarios, using simulated patients. Students in the dyad group practiced together and took turns as the active participant, whereas students in the single group practiced alone. MAIN MEASURE: Performance tests of patient encounter skills were conducted 2 weeks after the training by two blinded raters. Students had no clinical training during those weeks. A questionnaire-based evaluation surveyed students' confidence in their patient management skills. KEY RESULTS: The dyad group scored significantly higher on the performance test, mean 40.7 % (SD 6.6), than the single group, mean 36.9 % (SD 5.8), P = 0.04, effect size 0.61. Inter-rater reliability was 0.69. The dyad group expressed significantly higher confidence in managing future clinical patient encounters than the single group, mean 7.6 (SD 0.9) vs. mean 6.5 (SD 1.1), respectively, P < 0.001, effect size 1.16. CONCLUSION: Dyad training of pre-clerkship medical students' patient encounter skills is effective, efficient, and prompts higher confidence in managing future patient encounters compared to training alone. This training format may help maintain high-quality medical training in the face of an increasing number of students in medical schools.
    Journal of General Internal Medicine 04/2013; 28(8). DOI:10.1007/s11606-013-2378-4 · 3.42 Impact Factor
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    The American Journal of Medicine 06/2014; 127(9). DOI:10.1016/j.amjmed.2014.05.027 · 5.00 Impact Factor
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