Internal Medicine Residents’ Attitudes Toward Simulated Depressed Cardiac Patients During an Objective Structured Clinical Examination: A Randomized Study

ABSTRACT Internal medicine residents care for a sizable number of patients with chronic pain. Programs need educational strategies to promote safe opioid prescribing.Background To describe a safe opioid prescribing education program utilizing an objective structured clinical examination (OSCE) and report the resulting impact on residents' knowledge, confidence, and self-reported practices.Objective Using a quasi-experimental design, 39 internal medicine residents from an urban academic medical center were assigned to 1 of 4 groups: 1-hour lecture only, lecture followed by immediate OSCE, lecture followed by 4-month delayed OSCE, and control. Safe opioid prescribing knowledge, confidence, and self-reported practices were assessed at baseline and at 8 months.Methods At 8 months, knowledge, confidence, and self-reported practices improved in the control and in all 3 intervention groups. The immediate OSCE group had the greatest improvements in combined confidence scores within group (0.74, P = .01) compared to controls (0.52, P = .05), using a 5-point scale. This group also had the greatest improvement in self-reported practice changes (1.04, P = .04), while other groups showed nonsignificant improvements—delayed OSCE (0.43, P = .44), lecture only (0.66, P = .24), and control (0.43, P = .19).Results Safe opioid prescribing education that includes a lecture immediately followed by an OSCE had an impact on residents' confidence and self-reported practices greater than those for delayed OSCE or lecture only groups. There was no difference in knowledge improvement among the groups. Lecture followed by an OSCE was highly regarded by residents, but required additional resources.Conclusions

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The use of an objective structured clinical examination to assess internal medicine residents' transfusion knowledge

Transfusion ◽

10.1111/trf.12508 ◽

2013 ◽

Vol 54 (6) ◽

pp. 1537-1541 ◽

Cited By ~ 16

Author(s):

Elianna Saidenberg ◽

Debra Pugh

Keyword(s):

Internal Medicine ◽

Clinical Examination ◽

Objective Structured Clinical Examination ◽

Internal Medicine Residents

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Incorporating Interactive Workshops into Bedside Teaching: Completion of a Multi- Modal Rheumatology Rotation Significantly Increases Internal Medicine Residents’ Competency and Comfort with Comprehensive Knee Examinations

10.21203/rs.3.rs-451910/v1 ◽

2021 ◽

Author(s):

Alysia Kwiatkowski ◽

Najia Shakoor ◽

Augustine Manadan ◽

Joel A. Block ◽

Sonali Khandelwal

Keyword(s):

Internal Medicine ◽

Educational Research ◽

Clinical Examination ◽

Objective Structured Clinical Examination ◽

Diagnosis And Treatment ◽

Bedside Teaching ◽

Traditional Methods ◽

Modal Approach ◽

Internal Medicine Residents ◽

Interactive Models

Abstract Background: Studies have elucidated the lack of competency in musculoskeletal (MSK) examination skills amongst trainees. Various modalities have been studied, however, there remains a dearth of literature regarding the effectiveness of bedside teaching versus dedicated workshops. Our aim was to determine if incorporating a workshop into a rheumatology rotation would be effective in increasing medicine residents’ competency and comfort with knee examinations when compared to the rotation alone.Methods: Over 16 months, rotators were randomized to workshop plus rotation versus rotation alone. Participants were tested on their knee examination skills using an objective structured clinical examination (OSCE). Surveys were administered assessing to what degree the rotation was beneficial. Comfort and helpfulness were measured using a 5-point Likert scale. Paired and independent samples t-tests were used for comparisons. Results: Fifty-seven residents participated. For both groups, there were improvements between pre and post OSCE scores (workshop p < 0.001, no workshop p = 0.003), and levels of comfort with examination (workshop p < 0.001, no workshop p < 0.001). When comparing groups, there were differences favoring the workshop in post OSCE score (p = < 0.001), mean change in OSCE score (p < 0.001) and mean change in comfort with knee examination (p = 0.025).Conclusion: An elective in rheumatology augmented residents’ MSK competency and comfort. Incorporation of a workshop further increased knowledge, skills and comfort with diagnosis and treatment. Current educational research focuses on alternatives to traditional methods. This study provides evidence that a multi-modal approach, combining traditional bedside and interactive models, is of benefit.

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Internal medicine residents identify gaps in medical education on outpatient referrals

BMC Medical Education ◽

10.1186/s12909-020-02177-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Masha J. Slavin ◽

Mangala Rajan ◽

Lisa M. Kern

Keyword(s):

Internal Medicine ◽

New York ◽

Medical Education ◽

Clinical Information ◽

Ambulatory Setting ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Internal Medicine Residents ◽

Strongly Agree ◽

Residents Attitudes

Abstract Background Relevant clinical information is often missing when a patient sees a specialist after being referred by another physician in the ambulatory setting. This can result in missed or delayed diagnoses, delayed treatment, unnecessary testing, and drug interactions. Residents’ attitudes toward providing clinical information at the time of referral and their perspectives toward training on referral skills are not clear. We sought to assess internal medicine residents’ attitudes toward and experiences with outpatient referrals. Methods We conducted a cross-sectional survey in October–December 2018 of all internal medicine interns and residents affiliated with a large, urban internal medicine residency program in New York, NY. We used a novel survey instrument that included 13 questions about attitudes toward and experiences with outpatient referrals. We used descriptive statistics to characterize the results. Results Overall, 122 of 132 residents participated (92% response rate). Respondents were approximately equally distributed across post-graduate years 1–3. Although 83% of residents reported that it is “always” important to provide the clinical reason for a referral, only 11% stated that they “always” provide a sufficient amount of clinical information for the consulting provider when making a referral. Only 9% of residents “strongly agree” that residency provides sufficient training in knowing when to refer patients, and only 8% “strongly agree” that residency provides sufficient training in what information to provide the consulting physician. Conclusions These results suggest a substantial discrepancy between the amount of information residents believe they should provide at the time of a referral and the amount they actually provide. Many residents report not receiving adequate training during residency on when to refer patients and what clinical information to provide at the time of referral. Improvements to medical education regarding outpatient referrals are urgently needed.

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Evaluating Simulation-Based ACLS Education on Patient Outcomes: A Randomized, Controlled Pilot Study

Journal of Graduate Medical Education ◽

10.4300/jgme-d-13-00420.1 ◽

2014 ◽

Vol 6 (3) ◽

pp. 501-506 ◽

Cited By ~ 4

Author(s):

Jenny E. Han ◽

Antoine R. Trammell ◽

James D. Finklea ◽

Timothy N. Udoji ◽

Daniel D. Dressler ◽

...

Keyword(s):

Internal Medicine ◽

Life Support ◽

Randomized Study ◽

Heart Association ◽

Advanced Cardiac Life Support ◽

Common Error ◽

Internal Medicine Residents ◽

Simulation Based ◽

Improved Performance ◽

Mock Codes

Abstract Background Simulation training is widely accepted as an effective teaching tool, especially for dealing with high-risk situations. Objective We assessed whether standardized, simulation-based advanced cardiac life support (ACLS) training improved performance in managing simulated and actual cardiac arrests. Methods A total of 103 second- and third-year internal medicine residents were randomized to 2 groups. The first group underwent conventional ACLS training. The second group underwent two 2 1/2-hour sessions of standardized simulation ACLS teaching. The groups were assessed by evaluators blinded to their assignment during in-hospital monthly mock codes and actual inpatient code sheets at 3 large academic hospitals. Primary outcomes were time to initiation of cardiopulmonary resuscitation, time to administration of first epinephrine/vasopressin, time to delivery of first defibrillation, and adherence to American Heart Association guidelines. Results There were no differences in primary outcomes among the study arms and hospital sites. During 21 mock codes, the most common error was misidentification of the initial rhythm (67% [6 of 9] and 58% [7 of 12] control and simulation arms, respectively, P = .70). There were no differences in primary outcome among groups in 147 actual inpatient codes. Conclusions This blinded, randomized study found no effect on primary outcomes. A notable finding was the percentage of internal medicine residents who misidentified cardiac arrest rhythms.

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