scholarly journals A Cross-Sectional Survey of Internal Medicine Residents’ Knowledge, Attitudes, and Current Practices Regarding Patient Transitions to Post-Acute Care

2021 ◽  
Author(s):  
Julia Limes ◽  
Catherine Callister ◽  
Eric Young ◽  
Robert E. Burke ◽  
Tyler Albert ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Acute Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Internal Medicine Residents ◽  
Post Acute Care ◽  
Current Practices

scholarly journals Internal medicine residents identify gaps in medical education on outpatient referrals

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.

scholarly journals Career interest and perceptions of nephrology: A repeated cross-sectional survey of internal medicine residents

PLoS ONE ◽  
2017 ◽  
Vol 12 (2) ◽  
pp. e0172167 ◽  
Author(s):  
Michael N. Daniels ◽  
Sharon Maynard ◽  
Ivan Porter ◽  
Hope Kincaid ◽  
Deepika Jain ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Career Interest ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Internal Medicine Residents

scholarly journals Why Residents Consider Working Beyond the Duty Hour Limits: Implications of the ACGME 2011 Duty Hour Standards

2011 ◽  
Vol 3 (4) ◽  
pp. 571-573 ◽  
Author(s):  
Kathlyn E. Fletcher ◽  
Sarah Nickoloff ◽  
Jeff Whittle ◽  
Jeffrey L. Jackson ◽  
Michael Frank ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Educational Opportunities ◽  
Descriptive Statistics ◽  
Care Hospital ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Internal Medicine Residents ◽  
Program Leadership

Abstract Background The Accreditation Council for Graduate Medical Education 2011 duty hour standards became effective on July 1, 2011. One of the new standards allows residents to exceed the limit on continuous duty hours in unusual circumstances relating to patient or family need or rare educational opportunities. There are no data about how often or in what circumstances residents would consider exceeding their duty hour limits using this new provision in the standards. We surveyed internal medicine residents to explore these questions. Methods We conducted an anonymous cross-sectional survey of internal medicine residents at a midwestern tertiary-care hospital to determine how often they had considered exceeding duty hour limits in the preceding 2 weeks. We analyzed responses using descriptive statistics and χ2 tests for comparisons. Results We obtained responses from 51 of 86 residents (59%). Of those residents, 69% (35/51) indicated that they had wanted to exceed duty hour limits at least once in the prior 2 weeks. The most common reason cited was to provide continuity of care for a patient. The 24 + 6–hour rule was the standard most likely to be broken (cited by 66%; 23/35). Conclusions Program leadership should anticipate that residents will commonly identify situations in which they will consider exceeding duty hour limits. It will be important to provide guidance to residents early in the year about the situations that would be appropriate for the application of this new standard.

Time Allocation and Well-Being in Internal Medicine Residents: A Multi-Institutional Cross-Sectional Survey

2020 ◽  
Vol 133 (4) ◽  
pp. 515-519
Author(s):  
Rebecca E. Miller ◽  
Matthew Kelleher ◽  
Ashley Duckett ◽  
Paul O'Rourke ◽  
Miao-Shan Yen ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Time Allocation ◽  
Well Being ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Internal Medicine Residents

scholarly journals Cardiorespiratory Fitness in Internal Medicine Residents: Are Future Physicians Becoming Deconditioned?

2017 ◽  
Vol 9 (1) ◽  
pp. 97-101 ◽  
Author(s):  
Farshid Daneshvar ◽  
Michael Weinreich ◽  
Danial Daneshvar ◽  
Michael Sperling ◽  
Chadi Salmane ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Physical Activity ◽  
Cardiorespiratory Fitness ◽  
Health Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Cardiopulmonary Fitness ◽  
Exercise Habits ◽  
Internal Medicine Residents ◽  
Resident Burnout

ABSTRACT Background  Previous studies have shown a falloff in physicians' physical activity from medical school to residency. Poor fitness may result in stress, increase resident burnout, and contribute to mortality from cardiovascular disease and other causes. Physicians with poor exercise habits are also less likely to counsel patients about exercise. Prior studies have reported resident physical activity but not cardiorespiratory fitness age. Objective  The study was conducted in 2 residency programs (3 hospitals) to assess internal medicine residents' exercise habits as well as their cardiorespiratory fitness age. Methods  Data regarding physical fitness levels and exercise habits were collected in an anonymous cross-sectional survey. Cardiopulmonary fitness age was determined using fitness calculator based on the Nord-Trøndelag Health Study (HUNT). Results  Of 199 eligible physicians, 125 (63%) responded to the survey. Of respondents, 11 (9%) reported never having exercised prior to residency and 45 (36%) reported not exercising during residency (P < .001). In addition, 42 (34%) reported exercising every day prior to residency, while only 5 (4%) reported exercising daily during residency (P < .001), with 99 (79%) participants indicating residency obligations as their main barrier to exercise. We found residents' calculated mean fitness age to be 5.6 years higher than their mean chronological age (P < .001). Conclusions  Internal medicine residents reported significant decreases in physical activity and fitness. Residents attributed time constraints due to training as a key barrier to physical activity.

Learning Electrocardiogram Interpretation: Insights from Residents and a Proposed Solution in an Observational Study (Preprint)

2020 ◽  
Author(s):  
Mohammad Alakchar ◽  
Abdisamad M. Ibrahim ◽  
Mohsin Salih ◽  
Mukul Bhattarai ◽  
Nitin Tandan ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Correlation Coefficient ◽  
Online Survey ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Resident Attitudes ◽  
Internal Medicine Residents ◽  
Life Threatening ◽  
Degree Of Participation ◽  
Electrocardiogram Interpretation

BACKGROUND Interpretation of electrocardiograms (EKG) is an essential tool for every physician. Despite this, the diagnosis of life-threatening pathology on EKG remains suboptimal in trainees. The purpose of this study is to study resident attitudes and behaviours towards EKGs, and describe an innovative way to teach EKGs. OBJECTIVE Study attitudes and behaviours towards EKGs. Describe an innovative way to teach EKGs. METHODS Design: An observational cross-sectional study through an anonymous online survey of resident attitudes and comfort with EKG interpretation. This was followed by creation of a WhatsApp group for discussion and interpretation of EKGs with peers. At the end of the day, the official EKG interpretation was posted. Setting: Internal medicine residency at Southern Illinois University. Participants: Internal medicine residents Interventions: Creation of WhatsApp group to aid with EKG interpretation Measurements: A 17 item questionnaire, followed by detection of degree of participation in a WhatsApp group. RESULTS Forty-one out of 63 residents (65%) completed the survey. 85% of respondents thought that an interactive way to teach EKGs is the best method of teaching, and 73% did not feel confident interpreting EKGs. 30% often rely on automated EKG interpretation. Further analysis indicated that PGY-1 residents reported ordering fewer EKGs (correlation coefficient -0.399, p = 0.012) and were uncomfortable diagnosing QT prolongation on an EKG (correlation coefficient -0.310, p = 0.049). Residents in the third or greater year of training ordered more EKGs (correlation coefficient 0.379, p = 0.015), less frequently relied on the computer for EKG diagnosis (correlation coefficient 0.399, p = 0.010), and were comfortable diagnosing an acute myocardial infarction and atrial arrhythmias. CONCLUSIONS In conclusion, most IM trainees do not feel comfortable interpreting EKG, however, this does improve with PGY year. WhatsApp is a possible platform for teaching EKGs.

scholarly journals Hidden bedside rationing in the Netherlands: a cross-sectional survey among physicians in internal medicine

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ursula W. de Ruijter ◽  
Hester F. Lingsma ◽  
Willem A. Bax ◽  
Johan Legemaate
Keyword(s):  
Internal Medicine ◽  
The Netherlands ◽  
Patient Choice ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Physician Characteristics ◽  
Distribution Of Resources ◽  
Healthcare Rationing ◽  
Do So

Abstract Background Healthcare rationing can be defined as withholding beneficial care for cost reasons. One form in particular, hidden bedside rationing, is problematic because it may result in conflicting loyalties for physicians, unfair inequality among patients and illegitimate distribution of resources. Our aim is to establish whether bedside rationing occurs in the Netherlands, whether it qualifies as hidden and what physician characteristics are associated with its practice. Methods Cross-sectional online questionnaire on knowledge of -, experience with -, and opinion on rationing among physicians in internal medicine within the Dutch healthcare system. Multivariable ordinal logistic regression was used to explore relations between hidden bedside rationing and physician characteristics. Results The survey was distributed among 1139 physicians across 11 hospitals with a response rate of 18% (n = 203). Most participants (n = 129; 64%) had experience prescribing a cheaper course of treatment while a more effective but more expensive alternative was available, suggesting bedside rationing. Subsequently, 32 (24%) participants never disclosed this decision to their patient, qualifying it as hidden. The majority of participants (n = 153; 75%) rarely discussed treatment cost. Employment at an academic hospital was independently associated with more bedside rationing (OR = 17 95%CI 6.1–48). Furthermore, residents were more likely to disclose rationing to their patients than internists (OR = 3.2, 95%CI 2.1–4.7), while salaried physicians were less likely to do so than physicians in private practice (OR = 0.5, 95%CI 0.4–0.8). Conclusion Hidden bedside rationing occurs in the Netherlands: patient choice is on occasion limited with costs as rationale and this is not always disclosed. To what extent distribution of healthcare should include bedside rationing in the Netherlands, or any other country, remains up for debate.

Interfacility transfer communication of multidrug-resistant organism colonization or infection status: Practices and barriers in the acute-care setting

2021 ◽  
pp. 1-6
Author(s):  
Katherine D. Ellingson ◽  
Brie N. Noble ◽  
Genevieve L. Buser ◽  
Graham M. Snyder ◽  
Jessina C. McGregor ◽  
...  
Keyword(s):  
Acute Care ◽  
Infection Prevention ◽  
Multidrug Resistant ◽  
Research Network ◽  
Resistant Organism ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Hospital Size ◽  
Academic Affiliation ◽  
Healthcare Epidemiology

Abstract Objective: To describe interfacility transfer communication (IFTC) methods for notification of multidrug-resistant organism (MDRO) status in a diverse sample of acute-care hospitals. Design: Cross-sectional survey. Participants: Hospitals within the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN). Methods: SRN members completed an electronic survey on protocols and methods for IFTC. We assessed differences in IFTC frequency, barriers, and perceived benefit by presence of an IFTC protocol. Results: Among 136 hospital representatives who were sent the survey, 54 (40%) responded, of whom 72% reported having an IFTC protocol in place. The presence of a protocol did not differ significantly by hospital size, academic affiliation, or international status. Of those with IFTC protocols, 44% reported consistent notification of MDRO status (>75% of the time) to receiving facilities, as opposed to 13% from those with no IFTC protocol (P = .04). Respondents from hospitals with IFTC protocols reported significantly fewer barriers to communication compared to those without (2.8 vs 4.3; P = .03). Overall, however, most respondents (56%) reported a lack of standardization in communication. Presence of an IFTC protocol did not affect whether respondents perceived IFTC protocols as having a significant impact on infection prevention or antimicrobial stewardship. Conclusions: Most respondents reported having an IFTC protocol, which was associated with reduced communication barriers at transfer. Standardization of protocols and clarity about expectations for sending and receipt of information related to MDRO status may facilitate IFTC and promote appropriate and timely infection prevention practices.

scholarly journals The Comparison of Role Conflict Among Registered Nurses and Registered Practical Nurses Working in Acute Care Hospitals in Ontario Canada

2021 ◽  
pp. 084456212110144
Author(s):  
Behdin Nowrouzi-Kia ◽  
Mary T. Fox ◽  
Souraya Sidani ◽  
Sherry Dahlke ◽  
Deborah Tregunno
Keyword(s):  
Emergency Department ◽  
Role Conflict ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Cross Sectional Survey ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Medical Unit ◽  
Scale Scores ◽  
Surgical Unit

Objectives The study aimed to describe and compare nurses’ perceptions of role conflict by professional designation [registered nurse (RN) vs registered practical nurse (RPN)] in three primary areas of practice (emergency department, medical unit, and surgical unit). Methods This analysis used data (n = 1,981) from a large cross-sectional survey of a random sample of RNs and RPNs working as staff nurses in acute care hospitals in Ontario, Canada. Role conflict was measured by the Role Conflict Scale. Results A total of 1,981 participants (RN = 1,427, RPN = 554) met this study’s eligibility criteria and provided complete data. In general, RN and RPN mean total scale scores on role conflict hovered around the scale’s mid-point (2.72 to 3.22); however, RNs reported a higher mean score than RPNs in the emergency department (3.22 vs. 2.81), medical unit (2.95 vs 2.81) and surgical unit (2.90 vs 2.72). Where statistically significant differences were found, the effect sizes were negligible to medium in magnitude with the largest differences noted between RNs and RPNs working in the emergency department. Conclusions The results suggest the need to implement strategies that diminish role conflict for both RNs and RPNs.

scholarly journals Delivering on the Promise: Exploring Training Characteristics and Graduate Career Pursuits of Primary Care Internal Medicine Residency Programs and Tracks

2019 ◽  
Vol 11 (4) ◽  
pp. 447-453
Author(s):  
Robin Klein ◽  
Samantha Alonso ◽  
Caitlin Anderson ◽  
Akanksha Vaidya ◽  
Nour Chams ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Clinical Experiences ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Training Time ◽  
Residency Programs ◽  
Primary Care Internal Medicine ◽  
Ambulatory Training ◽  
Curricular Content

ABSTRACT Background Specialized primary care internal medicine (PC IM) residency programs and tracks aim to provide dedicated PC training. How programs deliver this is unclear. Objective We explored how PC IM programs and tracks provide ambulatory training. Methods We conducted a cross-sectional survey from 2012 to 2013 of PC IM program and track leaders via a search of national databases and program websites. We reported PC IM curricular content, clinical experiences, and graduate career pursuits, and assessed correlation between career pursuits and curricular content and clinical experiences. Results Forty-five of 70 (64%) identified PC IM programs and tracks completed the survey. PC IM programs provide a breadth of curricular content and clinical experiences, including a mean 22.8 weeks ambulatory training and a mean 69.4 continuity clinics per year. Of PC IM graduates within 5 years, 55.8% pursue PC or general internal medicine (GIM) careers and 23.1% pursue traditional subspecialty fellowship training. Curricular content and clinical experiences correlate weakly with career choices. PC IM graduates pursuing PC or GIM careers correlated with ambulatory rotation in women's health (correlation coefficient [rho] = 0.36, P = .034) and mental health (rho = 0.38, P = .023) and curricular content in teaching and medical education (rho = 0.35, P = .035). PC IM graduates pursuing subspecialty fellowship negatively correlated with curricular content in leadership and teams (rho = -0.48, P = .003) and ambulatory training time (rho = -0.38, P = .024). Conclusions PC IM programs and tracks largely deliver on the promise to provide PC training and education and produce graduates engaged in PC and GIM.

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