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The American journal of medicine 05/2013; · 4.47 Impact Factor
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ABSTRACT: BACKGROUND: There have been recent calls for improved internal medicine outpatient training, yet assessment of clinical and educational variables within existing models is lacking. OBJECTIVE: To assess the impact of clinic redesign from a traditional weekly clinic model to a 50/50 outpatient-inpatient model on clinical and educational outcomes. DESIGN: Pre-intervention and post-intervention study intervals, comparing the 2009-2010 and 2010-2011 academic years. PARTICIPANTS: Ninety-six residents in a Primary Care Internal Medicine site of a large academic internal medicine residency program who provide care for > 13,000 patients. INTERVENTION: Continuity clinic redesign from a traditional weekly clinic model to a 50/50 model characterized by 50 % outpatient and 50 % inpatient experiences scheduled in alternating 1 month blocks, with twice weekly continuity clinic during outpatient months and no clinic during inpatient months. MAIN MEASURES: 1) Clinical outcomes (panel size, patient visits, adherence with chronic disease and preventive service guidelines, continuity of care, patient satisfaction, and perceived safety/teamwork in clinic); 2) Educational outcomes (attendance at teaching conference, resident and faculty satisfaction, faculty assessment of resident clinic performance, and residents' perceived preparedness for outpatient management). RESULTS: Redesign was associated with increased mean panel size (120 vs. 137.6; p ≤ 0.001), decreased continuity of care (63 % vs. 48 % from provider perspective; 61 % vs. 51 % from patient perspective; p ≤ 0.001 for both; team continuity was preserved), decreased missed appointments (12.5 % vs. 10.9 %; p ≤ 0.01), improved perceived safety and teamwork (3.6 vs. 4.1 on 5-point scale; p ≤ 0.001), improved mean teaching conference attendance (57.1 vs. 64.4; p ≤ 0.001), improved resident clinic performance (3.6 vs. 3.9 on 5-point scale; p ≤ 0.001), and little change in other outcomes. CONCLUSION: Although this model requires further study in other settings, these results suggest that a 50/50 model may allow residents to manage more patients while enhancing the climate of teamwork and safety in the continuity clinic, compared to traditional models. Future work should explore ways to preserve continuity of care within this model.
Journal of General Internal Medicine 04/2013; · 2.83 Impact Factor
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ABSTRACT: OBJECTIVES: To develop and validate a new instrument for measuring participant reflection on continuing medical education (CME) and determine associations between the reflection instrument scores and CME presenter, participant, and presentation characteristics. PARTICIPANTS AND METHODS: This was a prospective validation study of presenters and faculty at the weekly medical grand rounds at Mayo Clinic in Rochester, Minnesota, from January 1, 2011, through June 30, 2011. Eight items (5-point Likert scales) were developed on the basis of 4 reflection levels: habitual action, understanding, reflection, and critical reflection. Factor analysis was performed to account for clustered data. Interrater and internal consistency reliabilities were calculated. Associations between reflection scores and characteristics of presenters, participants, and presentations were determined. RESULTS: Participants completed a total of 1134 reflection forms. Factor analysis revealed a 2-dimensional model (eigenvalue; Cronbach α): minimal reflection (1.19; 0.77) and high reflection (2.51; 0.81). Item mean (SD) scores ranged from 2.97 (1.17) to 4.01 (0.83) on a 5-point scale. Interrater reliability (intraclass correlation coefficient) for individual items ranged from 0.58 (95% CI, 0.31-0.78) to 0.88 (95% CI, 0.80-0.94). Reflection scores were associated with presenters' speaking effectiveness (P<.001) and prior CME teaching experience (P=.02), participants' prior clinical experiences (P<.001), and presentations that were case based (P<.001) and used the audience response system (P<.001). CONCLUSION: We report the first validated measure of reflection on CME at medical grand rounds. Reflection scores were associated with presenters' effectiveness and prior teaching experience, participants' clinical exposures, and presentations that were interactive and clinically relevant. Future research should determine whether reflection on CME leads to better patient outcomes.
Mayo Clinic Proceedings 03/2013; 88(3):277-284. · 5.70 Impact Factor
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ABSTRACT: Musculoskeletal joint pain of varied etiology can be diagnosed and treated with joint and soft-tissue corticosteroid injections.
The purpose of our study was to compare patients' bodily pain and quality of life (QOL), in addition to the procedural benefit and patient satisfaction, before and after musculoskeletal injections in the office setting.
Patients were eligible for recruitment if they were over age 18 and had an injection for musculoskeletal pain from a primary care provider in an office procedural practice. Included in our analysis were knee joint/bursa, trochanteric bursa, and shoulder joint/bursa injection sites. The variables measured were pain, benefit from the injection, QOL physical and mental components, and patient satisfaction. This was a retrospective cohort study approved by the institutional review board.
Patients' pain was assessed by the patients using a six-point Likert scale (none, very mild, mild, moderate, severe, and very severe). We noted that self-perception of pain decreased from 3.10 (± standard deviation at baseline 0.96) before to 2.36 (± standard deviation after the infection 1.21) (P = 0.0001) after the injection. In terms of the impact on QOL, our patients had a pre-injection physical score of 37.25 ± 8.39 and a mental score at 52.81 ± 8.98. After the injections, the physical score improved to 42.35 ± 9.07 (P = 0.0001) and the mental to 53.54 ± 8.20 (P = 0.0001) for the overall group. Ninety-six percent of the patients reported they were satisfied or extremely satisfied in the procedure clinic.
In this study, we found significant pain relief and improved physical QOL in patients undergoing an injection in the knee joint/bursa, shoulder joint/bursa, or trochanteric bursa by primary care providers in the office setting.
International Journal of General Medicine 01/2013; 6:237-43.
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ABSTRACT: Improving professional attitudes and behaviors requires critical self reflection. Research on reflection is necessary to understand professionalism among medical students. The aims of this prospective validation study at the Mayo Medical School and Cleveland Clinic Lerner College of Medicine were: (1) to develop and validate a new instrument for measuring reflection on professionalism, and (2) determine whether learner variables are associated with reflection on the gross anatomy experience. An instrument for assessing reflections on gross anatomy, which was comprised of 12 items structured on five-point scales, was developed. Factor analysis revealed a three-dimensional model including low reflection (four items), moderate reflection (five items), and high reflection (three items). Item mean scores ranged from 3.05 to 4.50. The overall mean for all 12 items was 3.91 (SD = 0.52). Internal consistency reliability (Cronbach's α) was satisfactory for individual factors and overall (Factor 1 α = 0.78; Factor 2 α = 0.69; Factor 3 α = 0.70; Overall α = 0.75). Simple linear regression analysis indicated that reflection scores were negatively associated with teamwork peer scores (P = 0.018). The authors report the first validated measurement of medical student reflection on professionalism in gross anatomy. Critical reflection is a recognized component of professionalism and may be important for behavior change. This instrument may be used in future research on professionalism among medical students. Anat Sci Educ. © 2012 American Association of Anatomists.
Anatomical Sciences Education 12/2012; · 2.98 Impact Factor
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ABSTRACT: To examine the effect of census caps and unit-based admissions on resident workload, conference attendance, duty hour compliance, and patient safety.
We implemented a census cap of 14 patients on 6 Mayo Clinic internal medicine resident hospital services and a unit-based admissions process in which patients and care teams were consolidated within hospital units. All 280 residents and 15,926 patient admissions to resident and nonresident services 1 year before the intervention (September 1, 2006, through August 31, 2007) and 1 year after the intervention (May 1, 2008, through April 30, 2009) were included. Residents' workload, conference attendance, and duty hours were tracked electronically. Patient safety variables including Rapid Response Team and cardiopulmonary resuscitation events, intensive care unit transfers, Patient Safety Indicators, and 30-day readmissions were compared preintervention and postintervention.
After the intervention, residents' mean (SE) ratings of workload appropriateness improved (3.10 [0.08] vs 3.87 [0.08] on a 5-point scale; P<.001), as did conference attendance (1523 [56. 8%] vs 1700 [63.5%] conferences attended; P<.001). Duty hour violations for working more than 30 consecutive hours and not having 10 hours off between duty periods decreased from 77 of 9490 possible violations (0.81%) to 27 (0.28%) and from 70 (0.74%) to 14 (0.15%) violations, respectively (both, P<.001). Thirty-day readmissions to resident services decreased (1010 [18.14%] vs 682 [15. 37%]; P<.001). All other patient safety measures remained unchanged. After adjustment for illness severity, there were no significant differences in patient outcomes between resident and nonresident services.
Census caps and unit-based admissions were associated with improvements in resident workload, conference attendance, duty hour compliance, and readmission rates while patient outcomes were maintained.
Mayo Clinic Proceedings 04/2012; 87(4):320-7. · 5.70 Impact Factor
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ABSTRACT: Maintenance of certification examination performance is associated with quality of care. We aimed to examine relationships between electronic medical knowledge resource use, practice characteristics and examination scores among physicians recertifying in internal medicine.
We conducted a cross-sectional study of 3,958 United States physicians who took the Internal Medicine Maintenance of Certification Examination (IM-MOCE) between January 1, 2006 and December 31, 2008, and who held individual licenses to one or both of two large electronic knowledge resource programs. We examined associations between physicians' IM-MOCE scores and their days of electronic resource use, practice type (private practice, residency teaching clinic, inpatient, nursing home), practice model (single or multi-specialty), sex, age, and medical school location.
In the 365 days prior to the IM-MOCE, physicians used electronic resources on a mean (SD, range) of 20.3 (36.5, 0-265) days. In multivariate analyses, the number of days of resource use was independently associated with increased IM-MOCE scores (0.07-point increase per day of use, p = 0.02). Increased age was associated with decreased IM-MOCE scores (1.8-point decrease per year of age, p < 0.001). Relative to physicians working in private practice settings, physicians working in residency teaching clinics and hospital inpatient practices had higher IM-MOCE scores by 29.1 and 20.0 points, respectively (both p < 0.001).
Frequent use of electronic resources was associated with modestly enhanced IM-MOCE performance. Physicians involved in residency education clinics and hospital inpatient practices had higher IM-MOCE scores than physicians working in private practice settings.
Journal of General Internal Medicine 02/2012; 27(8):917-23. · 2.83 Impact Factor
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ABSTRACT: Few studies have examined residents' retained knowledge and confidence regarding essential evidence-based medicine (EBM) topics.
To compare postgraduate year-3 (PGY-3) residents' confidence with EBM topics taught during internship with that of PGY-1 residents before and after exposure to an EBM curriculum.
All residents participated in an EBM curriculum during their intern year. We surveyed residents in 2009. PGY-1 residents completed a Likert-scale type survey (which included questions from the validated Berlin questionnaire and others, developed based on input from local EBM experts). We administered the Berlin questionnaire to a subset of PGY-3 residents.
Forty-five PGY-3 (88%; n = 51) and 42 PGY-1 (91%; n = 46) residents completed the survey. Compared with PGY-1 residents pre-curriculum, PGY-3 residents were significantly more confident in their knowledge of pre- and posttest probability (mean difference, 1.14; P = .002), number needed to harm (mean difference, 1.09; P = .002), likelihood ratio (mean difference, 1.01; P = .003), formulation of a focused clinical question (mean difference, 0.98; P = .001), and critical appraisal of therapy articles (mean difference, 0.91; P = .002). Perceived confidence was significantly lower for PGY-3 than post-curriculum PGY-1 residents on relative risk (mean difference, -0.86; P = .002), study design for prognosis questions (mean difference, -0.75; P = .004), number needed to harm (mean difference, -0.67; P = .01), ability to critically appraise systematic reviews (mean difference, -0.65, P = .009), and retrieval of evidence (mean difference, -0.56; P = .008), among others. There was no relationship between confidence with and actual knowledge of EBM topics.
Our findings demonstrate lower confidence among PGY-3 than among PGY-1 internal medicine residents for several EBM topics. PGY-3 residents demonstrated poor knowledge of several core topics taught during internship. Longitudinal EBM curricula throughout residency 5 help reinforce residents' EBM knowledge and their confidence.
Journal of graduate medical education. 12/2011; 3(4):490-6.
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Darcy A. Reed,
Tait D. Shanafelt,
Daniel W. Satele,
David V. Power,
Anne Eacker,
William Harper,
Christine Moutier,
Steven Durning,
F. Stanford Jr Massie,
Matthew R. Thomas,
Jeff A. Sloan,
Liselotte N. Dyrbye
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ABSTRACT: Purpose: Psychological distress is common among medical students. Curriculum structure and grading scales are modifiable learning environment factors that may influence student well-being. The authors sought to examine relationships among curriculum structures, grading scales, and student well-being.
Method: The authors surveyed 2,056 first- and second-year medical students at seven U.S. medical schools in 2007. They used the Perceived Stress Scale, Maslach Burnout Inventory, and Medical Outcomes Study Short Form (SF-8) to measure stress, burnout, and quality of life, respectively. They measured curriculum structure using hours spent in didactic, clinical, and testing experiences. Grading scales were categorized as two categories (pass/fail) versus three or more categories (e.g., honors/pass/fail).
Results: Of the 2,056 students, 1,192 (58%) responded. In multivariate analyses, students in schools using grading scales with three or more categories had higher levels of stress (beta 2.65; 95% CI 1.54–3.76, P < .0001), emotional exhaustion (beta 5.35; 95% CI 3.34–7.37, P < .0001), and depersonalization (beta 1.36; 95% CI 0.53–2.19, P = .001) and were more likely to have burnout (OR 2.17; 95% CI 1.41–3.35, P = .0005) and to have seriously considered dropping out of school (OR 2.24; 95% CI 1.54–3.27, P < .0001) compared with students in schools using pass/fail grading. There were no relationships between time spent in didactic and clinical experiences and well-being.
Conclusions: How students are evaluated has a greater impact than other aspects of curriculum structure on their well-being. Curricular reform intended to enhance student well-being should incorporate pass/fail grading.
Academic Medicine 10/2011; 86(11):1367-1373. · 3.52 Impact Factor
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ABSTRACT: Few internal medicine residency programs provide formal ultrasound training. This study sought to assess the feasibility of simulation based ultrasound training among first year internal medicine residents and measure their comfort at effectively using ultrasound to perform invasive procedures before and after this innovative model of ultrasound training.
A simulation based ultrasound training module was implemented during intern orientation that incorporated didactic and practical experiences in a simulation and cadaver laboratory. Participants completed anonymous pre and post surveys in which they reported their level of confidence in the use of ultrasound technology and their comfort in identifying anatomic structures including: lung, pleural effusion, bowel, peritoneal cavity, ascites, thyroid, and internal jugular vein. Survey items were structured on a 5-point Likert scales (1 = extremely unconfident, 5 = extremely confident).
Seventy-five out of seventy-six interns completed the pre-intervention survey and 55 completed the post-survey. The mean confidence score (SD) increased to 4.00 (0.47) (p < 0.0001). The mean (SD) comfort ranged from 3.61 (0.84) for peritoneal cavity to 4.48 (0.62) for internal jugular vein. Confidence in identifying all anatomic structures showed an increase over the pre-intervention means (p < 0.002).
A simulation based ultrasound learning module can improve the self-reported confidence with which residents identify structures important in performing invasive ultrasound guided procedures. Incorporating an ultrasound module into residents' education may address perceived need for ultrasound training, improve procedural skills, and enhance patient safety.
BMC Medical Education 09/2011; 11:75. · 1.15 Impact Factor
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Darcy A Reed,
Tait D Shanafelt,
Daniel W Satele,
David V Power,
Anne Eacker,
William Harper,
Christine Moutier,
Steven Durning,
F Stanford Massie,
Matthew R Thomas,
Jeff A Sloan,
Liselotte N Dyrbye
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ABSTRACT: Psychological distress is common among medical students. Curriculum structure and grading scales are modifiable learning environment factors that may influence student well-being. The authors sought to examine relationships among curriculum structures, grading scales, and student well-being.
The authors surveyed 2,056 first- and second-year medical students at seven U.S. medical schools in 2007. They used the Perceived Stress Scale, Maslach Burnout Inventory, and Medical Outcomes Study Short Form (SF-8) to measure stress, burnout, and quality of life, respectively. They measured curriculum structure using hours spent in didactic, clinical, and testing experiences. Grading scales were categorized as two categories (pass/fail) versus three or more categories (e.g., honors/pass/fail).
Of the 2,056 students, 1,192 (58%) responded. In multivariate analyses, students in schools using grading scales with three or more categories had higher levels of stress (beta 2.65; 95% CI 1.54-3.76, P<.0001), emotional exhaustion (beta 5.35; 95% CI 3.34-7.37, P<.0001), and depersonalization (beta 1.36; 95% CI 0.53-2.19, P=.001) and were more likely to have burnout (OR 2.17; 95% CI 1.41-3.35, P=.0005) and to have seriously considered dropping out of school (OR 2.24; 95% CI 1.54-3.27, P<.0001) compared with students in schools using pass/fail grading. There were no relationships between time spent in didactic and clinical experiences and well-being.
How students are evaluated has a greater impact than other aspects of curriculum structure on their well-being. Curricular reform intended to enhance student well-being should incorporate pass/fail grading.
Academic medicine: journal of the Association of American Medical Colleges 09/2011; 86(11):1367-73. · 2.34 Impact Factor
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ABSTRACT: Medical knowledge and clinical performance ratings are major criteria for assessing the competence of resident physicians. However, these assessments may be influenced by residents' mental health. The relationship between residents' well-being and empathy and assessments of their global performance remains unclear.
To determine whether resident well-being and empathy are associated with assessments of their medical knowledge and clinical performance.
We studied 730 clinical performance assessments completed by peers, supervising residents, and allied health professionals; 193 mini-clinical evaluation exercise (mini-CEX) evaluations; and 260 in-training examinations (ITE) of Mayo Clinic internal medicine residents between January 2009 and August 2010. Multivariate generalized estimating equations were used to evaluate associations between residents' well-being and empathy and assessments of their knowledge and clinical performance.
Independent variables were empathy using the Interpersonal Reactivity Index (IRI), burnout using the Maslach Burnout Inventory, depression using a standardized two-question screening instrument, and quality of life using a Linear Analog Self-Assessment item and the Medical Outcomes Study Short Form (SF-8). Dependent variables were mini-CEX, ITE, and the validated six-item Mayo clinical performance assessment.
202 residents (64.7%) provided both well-being and at least one category of assessment data. In multivariate models, residents' scores on the IRI empathy measure of "the tendency to adopt the psychological view of others" were associated with higher peer ratings on "desirability as a physician for a family member" (beta = 0.023, 95% CI = 0.007-0.039, p = 0.004). Additionally, burnout was associated with higher supervisor ratings of communication (beta = 0.309, 95% CI = 0.100-0.517, p = 0.004). There were no observed associations between ITE or mini-CEX scores and resident quality of life, burnout, fatigue, depression, or empathy.
Most dimensions of resident well-being were not associated with residents' knowledge scores and assessments of their clinical performance by other members of the health care team, which supports the trustworthiness of these measures. Nonetheless, correlations of resident empathy and burnout with assessments completed by peers and supervising residents suggest that some ratings of residents may be influenced by interpersonal factors.
Journal of General Internal Medicine 09/2011; 27(3):325-30. · 2.83 Impact Factor
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Academic medicine: journal of the Association of American Medical Colleges 08/2011; 86(8):922. · 2.34 Impact Factor
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ABSTRACT: Residents' reflections on quality improvement (QI) opportunities are poorly understood. The authors used the Mayo Evaluation of Reflection on Improvement Tool (MERIT) to measure residents' reflection scores across three years and to determine associations between reflection scores and resident and adverse patient event characteristics.
From 2006 to 2009, 48 Mayo Clinic internal medicine residents completed biannual reflections on adverse events and classified event severity and preventability. Faculty assessed residents' reflections using MERIT, which contains 18 Likert-scaled items and measures three factors-personal reflection, systems reflection, and event merit. ANOVA was used to identify changes in MERIT scores across three years of training and among factors, paired t tests were used to identify differences between MERIT factor scores, and generalized estimating equations were used to examine associations between MERIT scores and resident and adverse event characteristics.
The residents completed 240 reflections. MERIT reflection scores were stable over time. Individual factor scores differed significantly (P < .0001), with event merit being the highest and systems reflection the lowest. Event preventability was significantly associated with MERIT factor scores and overall scores (beta = 0.415; CI = 0.186-0.643; P = .0004). No significant associations between MERIT scores and resident characteristics or event severity were identified.
Residents' reflections on adverse events remained constant over time, were lowest for systems factors, and were associated with adverse event preventability. Future research should explore learners' emphasis on systems aspects of QI and the relationship between QI and event preventability.
Academic medicine: journal of the Association of American Medical Colleges 06/2011; 86(6):737-41. · 2.34 Impact Factor
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ABSTRACT: To determine whether standardized admissions data in residents' Electronic Residency Application Service (ERAS) submissions were associated with multisource assessments of professionalism during internship.
ERAS applications for all internal medicine interns (N=191) at Mayo Clinic entering training between July 1, 2005, and July 1, 2008, were reviewed by 6 raters. Extracted data included United States Medical Licensing Examination scores, medicine clerkship grades, class rank, Alpha Omega Alpha membership, advanced degrees, awards, volunteer activities, research experiences, first author publications, career choice, and red flags in performance evaluations. Medical school reputation was quantified using U.S. News & World Report rankings. Strength of comparative statements in recommendation letters (0 = no comparative statement, 1 = equal to peers, 2 = top 20%, 3 = top 10% or "best") were also recorded. Validated multisource professionalism scores (5-point scales) were obtained for each intern. Associations between application variables and professionalism scores were examined using linear regression.
The mean ± SD (minimum-maximum) professionalism score was 4.09 ± 0.31 (2.13-4.56). In multivariate analysis, professionalism scores were positively associated with mean strength of comparative statements in recommendation letters (β = 0.13; P = .002). No other associations between ERAS application variables and professionalism scores were found.
Comparative statements in recommendation letters for internal medicine residency applicants were associated with professionalism scores during internship. Other variables traditionally examined when selecting residents were not associated with professionalism. These findings suggest that faculty physicians' direct observations, as reflected in letters of recommendation, are useful indicators of what constitutes a best student. Residency selection committees should scrutinize applicants' letters for strongly favorable comparative statements.
Mayo Clinic Proceedings 03/2011; 86(3):197-202. · 5.70 Impact Factor
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ABSTRACT: transformative learning theory supports the idea that reflection on quality improvement (QI) opportunities and the ability to develop successful QI projects may be fundamentally linked. We used validated methods to explore associations between resident doctors' reflections on QI opportunities and the quality of their QI project proposals.
eighty-six residents completed written reflections on practice improvement opportunities and developed QI proposals. Two faculty members assessed residents' reflections using the 18-item Mayo Evaluation of Reflection on Improvement Tool (MERIT), and assessed residents' QI proposals using the seven-item Quality Improvement Project Assessment Tool (QIPAT-7). Both instruments have been validated in previous work. Associations between MERIT and QIPAT-7 scores were determined. Internal consistency reliabilities of QIPAT-7 and MERIT scores were calculated.
there were no significant associations between MERIT overall and domain scores, and QIPAT-7 overall and item scores. The internal consistency of MERIT and QIPAT-7 item groups were acceptable (Cronbach's α 0.76-0.94).
the lack of association between MERIT and QIPAT-7 scores indicates a distinction between resident doctors' skills at reflection on QI opportunities and their abilities to develop QI projects. These findings suggest that practice-based reflection and QI project development are separate constructs, and that skilful reflection may not predict the ability to design meaningful QI initiatives. Future QI curricula should consider teaching and assessing QI reflection and project development as distinct components.
Medical Education 02/2011; 45(2):149-54. · 3.18 Impact Factor
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ABSTRACT: To describe the views of residency program directors regarding the effect of the 2010 duty hour recommendations on the 6 core competencies of graduate medical education.
US residency program directors in internal medicine, pediatrics, and general surgery were e-mailed a survey from July 8 through July 20, 2010, after the 2010 Accreditation Council for Graduate Medical Education (ACGME) duty hour recommendations were published. Directors were asked to rate the implications of the new recommendations for the 6 ACGME core competencies as well as for continuity of inpatient care and resident fatigue.
Of 719 eligible program directors, 464 (65%) responded. Most program directors believe that the new ACGME recommendations will decrease residents' continuity with hospitalized patients (404/464 [87%]) and will not change (303/464 [65%]) or will increase (26/464 [6%]) resident fatigue. Additionally, most program directors (249-363/464 [53%-78%]) believe that the new duty hour restrictions will decrease residents' ability to develop competency in 5 of the 6 core areas. Surgery directors were more likely than internal medicine directors to believe that the ACGME recommendations will decrease residents' competency in patient care (odds ratio [OR], 3.9; 95% confidence interval [CI], 2.5-6.3), medical knowledge (OR, 1.9; 95% CI, 1.2-3.2), practice-based learning and improvement (OR, 2.7; 95% CI, 1.7-4.4), interpersonal and communication skills (OR, 1.9; 95% CI, 1.2-3.0), and professionalism (OR, 2.5; 95% CI, 1.5-4.0).
Residency program directors' reactions to ACGME duty hour recommendations demonstrate a marked degree of concern about educating a competent generation of future physicians in the face of increasing duty hour standards and regulation.
Mayo Clinic Proceedings 02/2011; 86(3):185-91. · 5.70 Impact Factor
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ABSTRACT: Because those selected for leadership in academic medicine often have a record of academic productivity, publication disparities may help explain the gender imbalance in leadership roles. The authors aimed to compare the publication records, academic promotions, and leadership appointments of women and men physicians longitudinally throughout academic careers.
In 2007, the authors conducted a retrospective, longitudinal cohort study of all 25 women physicians then employed at Mayo Clinic with ≥20 years of service at Mayo and of 50 male physician controls, matched 2:1 by appointment date and career category, to women. The authors recorded peer-reviewed publications, timing of promotion, and leadership appointments throughout their careers.
Women published fewer articles throughout their careers than men (mean [standard deviation] 29.5 [28.8] versus 75.8 [60.3], P = .001). However, after 27 years, women produced a mean of 1.57 more publications annually than men (P < .001). Thirty-three men (66%) achieved an academic rank of professor compared with seven women (28%) (P = .01). Throughout their careers, women held fewer leadership roles than men (P < .001). Nearly half (no. = 11; 44%) of women attained no leadership position, compared with 15 men (30%).
Women's publication rates increase and actually exceed those of men in the latter stages of careers, yet women hold fewer leadership positions than men overall, suggesting that academic productivity assessed midcareer may not be an appropriate measure of leadership skills and that factors other than publication record and academic rank should be considered in selecting leaders.
Academic medicine: journal of the Association of American Medical Colleges 01/2011; 86(1):43-7. · 2.34 Impact Factor
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ABSTRACT: Medical residents frequently participate in code status discussions, yet their competency in this role has not been evaluated.
The objective is to determine the quality of code status discussions from the perspective of both resident and patient.
We conducted a cross-sectional survey of consecutive pairs of hospitalized patients and admitting residents at Mayo Clinic in March 2007. We measured perceptions of occurrence and content of code status discussions, admission volume, and demographic information.
Among the 41 matched pairs, residents and patients agreed that a code status conversation occurred in 63% of cases. Agreement was more likely if residents performed less than 4 admissions (p= .02). Patients reported the inclusion of specific discussion components, such as resuscitation procedures (7%) and outcomes (0%), less frequently than residents (71% and 27%, respectively, p< .001).
Residents and patients demonstrated poor agreement on the occurrence and components of code status conversations. Residency programs should identify ways to enhance residents' competency in eliciting patients' code status preferences and provide adequate time for code status discussions.
Teaching and Learning in Medicine 10/2010; 22(4):251-6. · 0.75 Impact Factor
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ABSTRACT: Quality improvement (QI) in health care involves activities ranging from enhancing personal practice to reforming the larger health care system. The Accreditation Council for Graduate Medical Education recognizes this broad definition of QI in its requirement that physicians-in-training demonstrate competence in practice-based learning and improvement (PBLI) and systems-based practice (SBP). Creative metaphors have been used to teach the PBLI and SBP competencies, but conceptual frameworks describing the relationship between these competencies are needed. Transformative learning is an adult education theory that states individuals must critically reflect on life events in order to change their beliefs or behaviors. The authors propose that critical reflection during transformative learning can conceptually link PBLI and SBP. Reflection on personal experience with suboptimal patient care leads to recognizing personal or system limitations. Addressing personal limitations improves individual practice (PBLI), whereas applying QI methodologies leads to large-scale improvements (SBP). Educators who adopt the transformative learning framework should be able to design meaningful QI curricula that encourage residents to be reflective and empower them with QI skills.
Academic medicine: journal of the Association of American Medical Colleges 09/2010; 85(11):1790-3. · 2.34 Impact Factor
