Climatizing the Internal Medicine Residency Curriculum: A Practical Guide for Integrating the Topic of Climate and Health into Resident Education

ABSTRACT Background Team-based learning (TBL) is used in undergraduate medical education to facilitate higher-order content learning, promote learner engagement and collaboration, and foster positive learner attitudes. There is a paucity of data on the use of TBL in graduate medical education. Our aim was to assess resident engagement, learning, and faculty/resident satisfaction with TBL in internal medicine residency ambulatory education. Methods Survey and nominal group technique methodologies were used to assess learner engagement and faculty/resident satisfaction. We assessed medical learning using individual (IRAT) and group (GRAT) readiness assurance tests. Results Residents (N = 111) involved in TBL sessions reported contributing to group discussions and actively discussing the subject material with other residents. Faculty echoed similar responses, and residents and faculty reported a preference for future teaching sessions to be offered using the TBL pedagogy. The average GRAT score was significantly higher than the average IRAT score by 22%. Feedback from our nominal group technique rank ordered the following TBL strengths by both residents and faculty: (1) interactive format, (2) content of sessions, and (3) competitive nature of sessions. Conclusions We successfully implemented TBL pedagogy in the internal medicine ambulatory residency curriculum, with learning focused on the care of patients in the ambulatory setting. TBL resulted in active resident engagement, facilitated group learning, and increased satisfaction by residents and faculty. To our knowledge this is the first study that implemented a TBL program in an internal medicine residency curriculum.

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Abstract P164: Reduction of Heart Failure Readmissions Through an Enhanced Internal Medicine Residency Curriculum

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_2.ap164 ◽

2011 ◽

Vol 4 (suppl_2) ◽

Author(s):

Mercy P Chandrasekaran ◽

Janice Barry ◽

Barbra White ◽

Paula L Eryazici ◽

Sorin C Danciu

Keyword(s):

Internal Medicine ◽

Heart Failure ◽

Internal Medicine Residency ◽

Post Discharge ◽

Post Intervention ◽

Statistical Comparison ◽

Residency Curriculum ◽

Core Measures ◽

The Impact

Background: Heart failure (HF) carries a significant economic burden and hospitalizations account for 70% of the total costs of heart failure. Rehospitalizations are particularly costly and potentially avoidable. As part of the National Initiative for Alliance of Independent Academic Medical Centers, we aimed to decrease the HF readmissions by 5% through enhancements in the Internal Medicine Residency Curriculum. Methods: Between 7/10-2/11, we implemented a HF lecture series, multidisciplinary rounds, article and case reviews. Cardiac Rehabilitation, Information Systems, HF Team, Case Managers/Social Work and Nursing staff collaborated to develop better documentation and discharge protocols. To determine the impact of our intervention, the change in 30-day readmission and pre and post questionnaire about HF knowledge/attitudes were statistically analyzed. Results: The pre test questionnaire showed: 1) Residents felt more confident in treating/ counseling patients with HF and were not as confident in identifying precipitants of readmissions or applying core measures. 2) Most residents felt the key factors to preventing readmissions were close post-discharge follow up and patient education. Post intervention questionnaire showed: 1) More residents were confident about the core measures, quality indicators, appropriate documentation of HF. 2) More residents were satisfied with the Internal Medicine Residency Curriculum. The average HF readmission rate reduced from 24.6% to 20.9% between 7/10-11/10 (above goal). January - August 2010 (Before Intervention) September - November 2010 (After Intervention) All HF Admissions 1178 464 All HF Readmissions 292 (24.8 %) 103 (22.2%) Primary HF Admissions 167 63 Primary HF Readmissions 40 (24.0%) 12 (19.0%) Statistical comparison of All HF p=0.483, OR 1.339, 95% CI 0.656-2.727 Statistical comparison of Primary HF p=0.276, OR 1.155 95% CI 0.895-1.491 Conclusions: A 6-month resident-oriented multidisciplinary intervention improved patient care, documentation, and resident understanding of HF syndrome. This led to promising trends towards a significant decrease in 30-day HF readmissions. Further improvement in outcomes should be evident at the completion of 12-month follow-up.

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