The State of Morning Report in the Current Healthcare Landscape: a National Survey of Internal Medicine Program Directors

Resident physicians routinely perform bedside procedures that pose substantial risk to patients. However, no standard programmatic approach to supervision and procedural competency assessment among residents currently exists. The authors performed a national survey of internal medicine (IM) program directors to examine procedural assessment and supervision practices of IM residency programs. Procedures chosen were those commonly performed by medicine residents at the bedside. Of the 368 IM programs, 226 (61%) completed the survey. Programs reported the predominant method of training as 171 (74%) apprenticeship and 106 (46%) as module based. The majority of programs used direct observation to attest to competence, with 55% to 62% relying on credentialed residents. Most programs also relied on a minimum number of procedures to determine competence (64%-88%), 72% of which reported 5 procedures (a lapsed historical standard). This national survey demonstrates that procedural assessment practices for IM residents are insufficiently robust and may put patients at undue risk.

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Awareness of Bullying in Residency: Results of a National Survey of Internal Medicine Program Directors

Journal of Graduate Medical Education ◽

10.4300/jgme-d-17-00386.1 ◽

2018 ◽

Vol 10 (2) ◽

pp. 209-213 ◽

Cited By ~ 5

Author(s):

Manasa S. Ayyala ◽

Saima Chaudhry ◽

Donna Windish ◽

Denise Dupras ◽

Shalini T. Reddy ◽

...

Keyword(s):

Internal Medicine ◽

Medical Education ◽

Learning Environment ◽

National Survey ◽

Negative Impact ◽

Geographic Location ◽

Program Directors ◽

Residency Programs ◽

Annual Survey ◽

Program Characteristics

ABSTRACT Background Bullying of medical trainees is believed to occur more frequently in medical education than once thought. Objective We conducted a survey to understand internal medicine program director (PD) perspectives and awareness about bullying in their residency programs. Methods The 2015 Association of Program Directors in Internal Medicine (APDIM) annual survey was e-mailed to 368 of 396 PDs with APDIM membership, representing 93% of internal medicine residency programs. Questions about bullying were embedded within the survey. Bivariate analyses were performed on PD and program characteristics. Results Of a total of 368 PD APDIM members, 227 PDs (62%) responded to the survey. Less than one-third of respondents (71 of 227, 31%) reported being aware of bullying in their residency programs during the previous year. There were no significant differences in program or PD characteristics between respondents who reported bullying in their programs and those who did not (gender, tenure as PD, geographic location, or specialty, all P > .05). Those who acknowledged bullying in their program were more likely to agree it was a problem in graduate medical education (P < .0001), and it had a significant negative impact on the learning environment (P < .0001). The majority of reported events entailed verbal disparagements, directed toward interns and women, and involved attending physicians, other residents, and nurses. Conclusions This national survey of internal medicine PDs reveals that a minority of PDs acknowledged recent bullying in their training programs, and reportedly saw it as a problem in the learning environment.

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