Effect of a Computer-Assisted General Medicine Diagnostic Consultation Service on Housestaff Diagnostic Strategy

1989 ◽  
Vol 28 (04) ◽  
pp. 352-356 ◽  
Author(s):  
R. Bankowitz ◽  
M. McNeil ◽  
S. Challinor ◽  
R. Miller
Keyword(s):  
Internal Medicine ◽  
General Medicine ◽  
Patient Specific ◽  
Computer Assisted ◽  
Diagnostic Strategy ◽  
Consultation Service ◽  
Internal Medicine Training ◽  
Before And After ◽  
Lab Test ◽  
The Impact

Abstract:Quick Medical Reference (QMR) is a microcomputer-based decision sup´port system designed to provide diagnostic assistance in the field of internal medicine. In addition to providing plausible diagnostic hypotheses based upon patient specific findings, the program highlights history, physical and laboratory items which are potentially useful in discriminating among the diagnoses under consideration. We have evaluated the impact of a computer-assisted diagnostic consultation service on the diagnostic and management strategy of a housestaff in a university internal medicine training program. Differential diagnoses were obtained before and after the use of the program, and a questionnaire was used to asses the educational value of the service and the effect of the service on the diagnosis and planned management. Over an eight week period, 31 cases were identified which met inclusion criteria. The QMR consultation added a diagnosis to the original list in 14 out of 31 cases. The consultation reordered the diagnosis in an additional 7 cases, and in 8 cases a diagnosis was ruled out by the use ofthe program. After the use of the program the housestaff reported they would obtain an additional lab test in 10 cases, change the order of planned tests. in two cases and eliminate a lab test in one case. The use of the program V)las rated as helpful educationally in 81 % of the cases, and helpful with respect to management in also 81 % of the cases.

59. General medicine residents' perception of the mini-CEXs

2007 ◽  
Vol 30 (4) ◽  
pp. 61
Author(s):  
S. Malhotra ◽  
R. Hatala ◽  
C.-A. Courneya
Keyword(s):  
Internal Medicine ◽  
Medical Education ◽  
Focus Group ◽  
Qualitative Study ◽  
Focus Groups ◽  
General Medicine ◽  
Clinical History ◽  
Phenomenological Approach ◽  
Medical Teacher ◽  
The Impact

The mini-CEX is a 30 minute observed clinical encounter. It can be done in the outpatient, inpatient or emergency room setting. It strives to look at several parameters including a clinical history, physical, professionalism and overall clinical competence. Trainees are rated using a 9-point scoring system: 1-3 unsatisfactory, 4-6 satisfactory and 7-9 superior. Eight months after the introduction of the mini-CEX to the core University of British Columbia Internal Medicine Residents, a one hour semi-structured focus group for residents in each of the three years took place. The focus groups were conducted by an independent moderator, audio-recorded and transcribed. Using a phenomenological approach the comments made by the focus groups participants were read independently by three authors, organized into major themes. In doing so, several intriguing common patterns were revealed on how General Medicine Residents perceive their experience in completing a mini-CEX. The themes include Education, Assessment and Preparation for the Royal College of Physicians and Surgeons Internal Medicine exam. Resident learners perceived that the mini-CEX process provided insight into their clinical strengths and weaknesses. Focus group participants favored that the mini-CEX experience will benefit them in preparation, and successful completion of their licensing exam. Daelmans HE, Overmeer RM, van der Hem-Stockroos HH, Scherpbier AJ, Stehouwer CD, van der Vleuten CP. In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation. Medical Education 2006; 40(1):51-8. De Lima AA, Henquin R, Thierer J, Paulin J, Lamari S, Belcastro F, Van der Vleuten CPM. A qualitative study of the impact on learning of the mini clinical evaluation exercise in postgraduate training. Medical Teacher January 2005; 27(1):46-52. DiCicco-Bloom B, Crabtree BF. The Qualitative Research Interview. Medical Education 2006; 40:314-32.

scholarly journals Evaluation of an Online Program To Teach Microbiology to Internal Medicine Residents

2014 ◽  
Vol 53 (1) ◽  
pp. 278-281 ◽  
Author(s):  
Jeannette Guarner ◽  
Eileen M. Burd ◽  
Colleen S. Kraft ◽  
Wendy S. Armstrong ◽  
Kenya Lenorr ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Infectious Disease ◽  
Knowledge Level ◽  
Online Program ◽  
Consultation Service ◽  
Content Type ◽  
Internal Medicine Residents ◽  
Average Improvement ◽  
Before And After ◽  
Case Based

Microbiology rounds are an integral part of infectious disease consultation service. During microbiology rounds, we highlight microbiology principles using vignettes. We created case-based, interactive, microbiology online modules similar to the vignettes presented during microbiology rounds. Since internal medicine residents rotating on our infectious disease elective have limited time to participate in rounds and learn microbiology, our objective was to evaluate the use of the microbiology online modules by internal medicine residents. We asked residents to complete 10 of 25 online modules during their infectious disease elective. We evaluated which modules they chose and the change in their knowledge level. Forty-six internal medicine residents completed assessments given before and after accessing the modules with an average of 11/20 (range, 6 to 19) and 16/20 (range, 9 to 20) correct questions, respectively (average improvement, 5 questions;P= 0.0001). The modules accessed by more than 30 residents included those related toClostridium difficile, anaerobes,Candidaspp.,Streptococcus pneumoniae, influenza,Mycobacterium tuberculosis, andNeisseria meningitidis. We demonstrated improved microbiology knowledge after completion of the online modules. This improvement may not be solely attributed to completing the online modules, as fellows and faculty may have provided additional microbiology education during the rotation.

scholarly journals Effects of electronic health record use on the exam room communication skills of resident physicians: a randomized within-subjects study

2014 ◽  
Vol 22 (1) ◽  
pp. 192-198 ◽  
Author(s):  
Teresa Taft ◽  
Leslie Lenert ◽  
Farrant Sakaguchi ◽  
Gregory Stoddard ◽  
Caroline Milne
Keyword(s):  
Internal Medicine ◽  
Communication Skills ◽  
Simulated Patients ◽  
First Year ◽  
Laptop Computer ◽  
Internal Medicine Training ◽  
Paper Chart ◽  
Within Subjects ◽  
Electronic Health ◽  
The Impact

Abstract Background The effects of electronic health records (EHRs) on doctor–patient communication are unclear. Objective To evaluate the effects of EHR use compared with paper chart use, on novice physicians’ communication skills. Design Within-subjects randomized controlled trial using observed structured clinical examination methods to assess the impact of use of an EHR on communication. Setting A large academic internal medicine training program. Population First-year internal medicine residents. Intervention Residents interviewed, diagnosed, and initiated treatment of simulated patients using a paper chart or an EHR on a laptop computer. Video recordings of interviews were rated by three trained observers using the Four Habits scale. Results Thirty-two residents completed the study and had data available for review (61.5% of those enrolled in the residency program). In most skill areas in the Four Habits model, residents performed at least as well using the EHR and were statistically better in six of 23 skills areas (p<0.05). The overall average communication score was better when using an EHR: mean difference 0.254 (95% CI 0.05 to 0.45), p = 0.012, Cohen's d of 0.47 (a moderate effect). Residents scoring poorly (>3 average score) with paper methods (n = 8) had clinically important improvement when using the EHR. Limitations This study was conducted in first-year residents in a training environment using simulated patients at a single institution. Conclusions Use of an EHR on a laptop computer appears to improve the ability of first-year residents to communicate with patients relative to using a paper chart.

scholarly journals Quick diagnostic unit integrated in an emergency department setting reduces medical admissions – an observational study

2013 ◽  
Vol 3 (3) ◽  
pp. 17 ◽  
Author(s):  
Dan Brun Petersen ◽  
Thomas Andersen Schmidt
Keyword(s):  
Internal Medicine ◽  
Emergency Department ◽  
General Medicine ◽  
University Hospital ◽  
First Year ◽  
Special Focus ◽  
Diagnostic Study ◽  
Diagnostic Unit ◽  
Number Of Patients ◽  
The Impact

Background: Hospitals in countries with public health systems have recently adopted organizational changes to improve efficiency and resource allocation, and reducing inappropriate hospitalizations has been established as an important goal, as well as avoiding or buffering overcrowding in Emergency Departments (EDs). Aims: Our goal was to describe the impact of a Quick Diagnostic Unit established on January 1, 2012, integrated in an ED setting in a Danish public university hospital following its function for the first year. Design: Observational, descriptive and comparative study. Methods: Our sample comprised the total number of patients being admitted and discharged from the Department of Internal Medicine in 2011 and 2012, with special focus on the General Medicine Ward. Results: Compared with 2011 the establishment of the Quick Diagnostic Unit integrated in the Emergency Department resulted in the admittance and discharge of fewer patients (40%; p < .0001) to the hospital’s General Medicine Ward and 11.6% (p < .0001) fewer patients in the whole Department of Internal Medicine. Conclusions: A Quick Diagnostic Unit integrated in an ED setting represents a useful and fast track model for the diagnostic study and treatment of patients with simple internal medicine ailments, and also serves as a buffer for overcrowding of the ED.

Beyond acute stroke: Rate of stroke transfers to a tertiary centre following the implementation of a dedicated inpatient teleneurology network

2019 ◽  
pp. 1357633X1986809
Author(s):  
Sami Al Kasab ◽  
Eyad Almallouhi ◽  
Ellen Debenham ◽  
Nancy Turner ◽  
Kit N Simpson ◽  
...  
Keyword(s):  
Cost Reduction ◽  
Stroke Patients ◽  
Consultation Service ◽  
Tertiary Centre ◽  
Before And After ◽  
Baseline Characteristics ◽  
Significant Cost Reduction ◽  
The Cost ◽  
Mean Cost ◽  
The Impact

Introduction This study evaluated the impact of establishing an inpatient teleneurology consultation service alongside an already established telestroke network on the stroke transfers to the hub. The study also aimed to assess the financial impact of establishing this network. Methods Prospectively collected data on all stroke patients evaluated through our telestroke and teleneurology networks between January 2008 and March 2018 were interrogated. For all spokes (eight sites) that had both teleneurology and telestroke services, we compared the rate of transfers to the hub before and after the establishment of the teleneurology network in August 2014. The cost reduction was estimated using the Medicare 5% standard analytic files. Results A total of 4296 stroke patients were evaluated during the study period. Of these, 2493 were seen before and 1803 were seen after the implementation of the teleneurology network at the included sites. Patients in the pre-teleneurology group were older (66.4 years ( SD = 14.7 years) vs. 67.8 years ( SD = 15.1 years); p = 0.002). Otherwise, there were no differences in baseline characteristics. Patients in the pre-teleneurology group were more likely to be transferred to the telestroke hub (29.4% vs. 20.2%; p < 0.001). The estimated mean cost reduction for each one minus the cost of transfer was estimated to be US$4997. Discussion The implementation of an inpatient teleneurology network was associated with a significant reduction in the transfer rate of stroke patients to hospitals with a higher level of care and could lead to a significant cost reduction.

scholarly journals Internal Medicine Residents’ Views About Care Transitions: Results of an Educational Intervention

2021 ◽  
Vol 8 ◽  
pp. 238212052098859
Author(s):  
Fatima Sheikh ◽  
Evelyn Gathecha ◽  
Alicia I Arbaje ◽  
Colleen Christmas
Keyword(s):  
Internal Medicine ◽  
Qualitative Analysis ◽  
Continuity Of Care ◽  
Transitional Care ◽  
Care Transitions ◽  
Reflective Writing ◽  
Patient Specific ◽  
Transition Of Care ◽  
Internal Medicine Residents ◽  
The Impact

Problem: Suboptimal care transitions can lead to re-hospitalizations. Intervention: We developed a 2-week “Transitions of Care Curriculum” to train first-year internal medicine residents to improve their knowledge and skills to deliver optimal transitional care. Our objective was to use reflective writing essays to evaluate the impact of the curriculum on the residents. Methods: The rotation included: Transition of Care Teaching modules, Transition Audit, Transitional Care Site Visits, and Transition of Care Conference. Residents performed the above elements of care transitions during the curriculum and wrote reflective essays about their experiences. These essays were analyzed to assess for the overall impact of the curriculum on the residents. Qualitative analysis of reflective essays was used to evaluate the impact of the curriculum. Of the 20 residents who completed the rotation, 18 reflective essays were available for qualitative analysis. Results: Five major themes identified in the reflective essays for improvement were: discharge planning, patient-centered care, continuity of care, goals of care discussions, and patient safety. The most discussed theme was continuity of care, with following subthemes: fragmentation of the healthcare system, disjointed care to the patients, patient specific factors contributing to lack of continuity of care, lack of primary care provider role as a coordinator of care, and challenges during discharge process. Residents also identified system-based gaps and suggested solutions to overcome these gaps. Conclusions: This experiential learning and use of reflective writing enhanced the residents’ self-identified awareness of gaps in care transitions and prompted them to generate ideas for systems improvement and personal actions to improve their practice during care transitions.

scholarly journals Use of a 90-Minute Admission Window and Front-Fill System to Reduce Work Compression on a General Medicine Inpatient Teaching Service

2017 ◽  
Vol 9 (2) ◽  
pp. 245-249 ◽  
Author(s):  
Youngjee Choi ◽  
Daniel Kim ◽  
Hyemi Chong ◽  
Christopher Mallow ◽  
Jason Bill ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Patient Care ◽  
General Medicine ◽  
General Ward ◽  
Timely Manner ◽  
Training Experience ◽  
Resident Perceptions ◽  
Before And After ◽  
Time To Learn ◽  
Resident Learning

ABSTRACT Background Duty hour limits have shortened intern shifts without concurrent reductions in workload, creating work compression. Multiple admissions during shortened shifts can result in poor training experience and patient care. Objective To relieve work compression, improve resident satisfaction, and improve duty hour compliance in an academic internal medicine program. Methods In 2014, interns on general ward services were allotted 90 minutes per admission from 3 pm to 7 pm, when the rate of admissions was high. Additional admissions arriving during the protected period were directed to hospitalists. Resident teams received 2 patients admitted by the night float team to start the call day (front-fill). Results Of the 51 residents surveyed before and after the implementation of the intervention, 39 (77%) completed both surveys. Respondents reporting an unmanageable workload fell from 14 to 1 (P &lt; .001), and the number of residents reporting that they felt unable to admit patients in a timely manner decreased from 14 to 2 (P &lt; .001). Reports of adequate time with patients increased from 16 to 36 (P &lt; .001), and residents indicating that they had time to learn from patients increased from 19 to 35 (P &lt; .001). Reports of leaving on time after call days rose from 12 to 33 (P &lt; .01), and overall satisfaction increased from 26 to 35 (P = .002). Results were similar when residents were resurveyed 6 months after the intervention. Conclusions Call day modifications improved resident perceptions of their workload and time for resident learning and patient care.

WED 028 One person can make a difference: our experience in a busy london dgh

2018 ◽  
Vol 89 (10) ◽  
pp. A5.1-A5
Author(s):  
Aadila Lalloo ◽  
Bazo Raheem ◽  
Giovanni Cocco ◽  
Ana Guzman ◽  
Michael Rose ◽  
...  
Keyword(s):  
Significant Proportion ◽  
District General Hospital ◽  
Full Time ◽  
Consultation Service ◽  
Number Of Patients ◽  
Before And After ◽  
Specialist Nurses ◽  
Working Day ◽  
Junior Colleague ◽  
The Impact

Our Neurology unit is in a busy district general hospital; serving a deprived inner London community, providing a ward consultation service 5 days a week. The unit consists of 5 consultant Neurologists, a consultant Neuroradiologist and 2 specialist nurses. In 2016, a junior doctor was appointed. By analysing data from 10 months in 2015 and 2017; we assessed the impact on the delivery of Neurological care, before and after the appointment. The unit saw a 157% increase in number of patients seen, including a significant proportion now seen in ED and ambulatory care. This is equivalent to a minimum of 2 more patients each working day (n=872 vs. 1317). The percentage of patients seen on same day of referral (<12 hours) increased from 47% to 77%. The proportion of inpatients reviewed who were then followed up on the ward during their stay, increased from 13.9% to 35.5%, representing increased availability of continuing Neurology advice. The percentage of patients who waited more than 24 hours for Neurology input decreased from 14.9% to 5.83%. Our results support the appointment of a full time junior colleague to allow rapid, safe and ongoing Neurological input to patients and to support ED and admitting colleagues.

scholarly journals 1057. The Impact of Temporary Suspensions of an Antimicrobial Stewardship Audit and Feedback Program on Antimicrobial Utilization of General Internal Medicine Inpatients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S373-S374
Author(s):  
Cynthia Wong ◽  
Linda R Taggart ◽  
Elizabeth Leung
Keyword(s):  
Internal Medicine ◽  
General Internal Medicine ◽  
Antimicrobial Stewardship ◽  
Audit And Feedback ◽  
Patient Specific ◽  
Antimicrobial Use ◽  
Patient Acuity ◽  
General Internal ◽  
Antimicrobial Utilization ◽  
The Impact

Abstract Background A goal of Antimicrobial Stewardship Programs (ASP) is to optimize antimicrobial use; many using audit and feedback (AAF). Although AAF decreases unnecessary target antimicrobial use, it is resource-intensive. As a result, temporary suspensions in AAF activity may occur from human resource limitations or other factors. We describe the impact of these temporary suspensions and intensity of care on antimicrobial utilization trends. Methods This retrospective study describes the initiation and temporary suspensions of AAF in the General Internal Medicine (GIM) unit at an urban teaching hospital. Data were collected over 65 months. During active-AAF, a dedicated ID trained clinical pharmacist and ID physician-reviewed antimicrobial use for all GIM patients and provided patient-specific advice to physicians. Antimicrobial use was measured by Defined Daily Doses (DDD) normalized per 1,000 patient-days. To assess the impact of temporary suspensions, data were compared in two ways: 1. All nonactive-AAF time-frames were compared with active AAF 2. Pre-ASP was compared with Post-ASP Initiation which includes suspension periods. To determine whether differences in trends were seen based on acuity level of the patients (identified at admission as benefiting from frequent monitoring), analyses were repeated after stratification of patients admitted to the Step-Up unit (GIM-SU) and the regular ward (GIM-W). Results Comparing nonactive AAF vs. active-AAF, significant changes (P < 0.05) in mean normalized DDD were observed for total antimicrobials (-19%), antipseudomonals (-21%) fluoroquinolones (−41%) and first-generation β lactams (−30%). Pre ASP vs. Post ASP comparisons showed similar but less pronounced trends. Following stratification to GIM-SU and GIM-W, greater variation in significant changes to targeted antimicrobials between comparisons was observed. Different significant antimicrobial changes were seen in SU vs. W. Conclusion Our results show that the temporary suspension of ASP AAF impacts antimicrobial utilization trends. Greater sustained decreases in targeted antimicrobials utilization were associated with active AAF. Stratification by patient acuity lead to increased variation in the impact on target antimicrobials and increased the impact of suspension. Disclosures All authors: No reported disclosures.

scholarly journals Student Perception of Traditional English Teaching Methods (CLT approach) and Comparison to Modern Methods (Using Technology)

2021 ◽  
Vol 15 ◽  
pp. 35-43
Author(s):  
Feras Mohammed AL-Madani
Keyword(s):  
Language Learning ◽  
Teaching Methods ◽  
Speech Synthesis ◽  
English Language ◽  
Language Teaching ◽  
Student Perception ◽  
English Language Teaching ◽  
Computer Assisted ◽  
Before And After ◽  
The Impact

This study aimed to assess the perception of students regarding traditionally used CLT approach for teaching English language and its comparison to modern teaching methods based on technology. Survey was carried out using a quantitative analysis on 200 students of English language teaching institutes that are currently using CLT approach. Pre and post responses survey was carried out wherein their perspectives were assessed before and after exposure to technology-based ELT methods. Analysis was carried out using Wilcoxin test which revealed the impact of modern technological tools used in language teaching, such as, video conferencing, audio CDs, online oral versions, text-to-speech synthesis, interactive books, digital game-based learning and computer assisted language learning (CALL).

Sign in / Sign up

Export Citation Format

Share Document