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ABSTRACT: While experiential learning is a desirable goal of residency education, little is known regarding the actual clinical experience of internal medicine residents during their training.
We modified an electronic patient handoff tool to include a system for resident entry of a primary diagnosis for each of their patients. Using the International Classification of Diseases, Ninth Revision (ICD-9) system, we created two methods to select the code: 1) an organ system-based dropdown list containing frequently used codes; and 2) a search option for the complete ICD-9 database. The codes were then grouped using ICD-9 categorization.
A total of 7562 resident-patient diagnostic encounters were studied. A wide spectrum of clinical conditions was observed, with symptoms and ill-defined conditions, circulatory disorders, respiratory disorders, neoplasms, genitourinary disorders, digestive disorders, diseases of the blood/blood forming organs, endocrinologic/nutritional/metabolic/immune disorders, and disorders of the skin and subcutaneous tissue accounting for about 86% of resident clinical experience. Symptoms and ill-defined conditions were noted to represent a sizable portion of resident clinical experience. Within this category, the most common conditions were fever; abdominal pain; and chest pain, unspecified.
Analysis of resident-selected ICD-9 codes might serve as a method to attempt to define resident clinical experience, and may be useful in the development of innovative experiential learning-based residency curricula. This might also be used to assess gaps in experiential learning at the program or resident level, and may serve to identify topics that require additional teaching supplementation.
Journal of Hospital Medicine 09/2011; 6(7):395-400. · 1.40 Impact Factor
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ABSTRACT: CD-ROM-based educational methods are not new to residency training, yet little is known about how they affect resident knowledge and patient care practices.
We evaluated the effects of a CD-ROM-based educational tool on residents' knowledge of anticoagulation and their adherence to anticoagulation guidelines.
Residents in the departments of cardiothoracic surgery, emergency medicine, otolaryngology, internal medicine, neurosurgery, dental medicine, neurology, obstetrics and gynecology, orthopedics, surgery, and urology at a university hospital participated in the study.
Residents were provided with CD-ROM-based training on the proper use of anticoagulation based on the sixth ACCP guidelines for antithrombotic therapy. Multiple choice testing was carried out before and after the CD-ROM intervention to assess resident knowledge, and resident compliance with venous thromboembolism prophylaxis guidelines was assessed via inpatient chart review by an independent committee.
Changes in knowledge were measured via test scores and the rate of compliance with anticoagulation guidelines.
Multiple choice test scores of 117 residents increased significantly after reviewing the CD-ROM (from 46.7% +/- 15.1% to 77.8% +/- 15.1%, P < .005). As a control, we administered the same test at the same 2 times at a comparable institution but without the CD-ROM intervention and found that test scores did not significantly increase. Chart review revealed a rate of compliance with anticoagulation guidelines for prophylaxis of venous thromboembolism of 75% before the CD-ROM intervention, which increased to 95% after the intervention, an increase that was sustained for at least 7 months.
These findings suggest that CD-ROM-based interventions might be useful not only in enhancing resident knowledge but also in improving the quality of care by favorably affecting clinical practice.
Journal of Hospital Medicine 01/2008; 3(1):42-7. · 1.40 Impact Factor
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ABSTRACT: The purpose of this study was to determine residents' perception of the utility of personal digital assistants (PDAs) and their influence on clinical practice at two teaching hospitals, one of which subsidized resident purchase of a PDA. A total of 21 residents in the unsubsidized group (32%) and 24 residents in the subsidized group (96%) owned a PDA. Medical residents who were provided with PDAs perceived them to be less useful than residents who were not provided with them. Palm owners in both groups responded that they used these devices to organize their record keeping and the most frequently used programs were pharmacopoeias, medical reference and clinical calculators. Residents quickly adapted PDA to clinical care and further research is needed to assess their impact on resident education and patient outcomes.
Medical Teacher 07/2006; 28(4):382-4. · 1.22 Impact Factor
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ABSTRACT: Personal digital assistants (PDAs) have become widely used in medicine and may be especially useful in achieving the goals of graduate medical education. The complex challenges that residents and their program directors in graduate medical education programs confront may be met more readily with the use of these devices. The PDA's ability to serve as an informational database, an organizer of patient-specific information, a tracking tool that can be used by program directors to enhance curriculum design, and a tool for conducting education research are some of the ways that these devices might favorably affect residency training in graduate medical education programs.
American Journal of Medical Quality 20(5):262-7. · 1.64 Impact Factor
