Internal Medicine Resident Perspectives Regarding Broad-Spectrum Antibiotic Usage

Abstract Focus groups held with internal medicine residents discussed their perspectives regarding broad-spectrum antibiotic (BSA) usage. Residents knew of BSA-associated adverse events, but they did not associate such events with increased patient morbidity and mortality, and they were more likely to use BSA in situations with diagnostic uncertainty and sick patients.

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Drug Alert Experience and Salience during Medical Residency at Two Healthcare Institutions

Applied Clinical Informatics ◽

10.1055/s-0041-1729167 ◽

2021 ◽

Vol 12 (02) ◽

pp. 355-361

Author(s):

Kinjal Gadhiya ◽

Edgar Zamora ◽

Salim M. Saiyed ◽

David Friedlander ◽

David C. Kaelber

Keyword(s):

Internal Medicine ◽

Residency Training ◽

Medical Center ◽

Internal Medicine Resident ◽

Clinical Decision ◽

University Of Pennsylvania ◽

Teaching Hospitals ◽

Medicine Resident ◽

Internal Medicine Residents ◽

The University

Abstract Background Drug alerts are clinical decision support tools intended to prevent medication misadministration. In teaching hospitals, residents encounter the majority of the drug alerts while learning under variable workloads and responsibilities that may have an impact on drug-alert response rates. Objectives This study was aimed to explore drug-alert experience and salience among postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2), and postgraduate year 3 (PGY-3) internal medicine resident physicians at two different institutions. Methods Drug-alert information was queried from the electronic health record (EHR) for 47 internal medicine residents at the University of Pennsylvania Medical Center (UPMC) Pinnacle in Pennsylvania, and 79 internal medicine residents at the MetroHealth System (MHS) in Ohio from December 2018 through February 2019. Salience was defined as the percentage of drug alerts resulting in removal or modification of the triggering order. Comparisons were made across institutions, residency training year, and alert burden. Results A total of 126 residents were exposed to 52,624 alerts over a 3-month period. UPMC Pinnacle had 15,574 alerts with 47 residents and MHS had 37,050 alerts with 79 residents. At MHS, salience was 8.6% which was lower than UPMC Pinnacle with 15%. The relatively lower salience (42% lower) at MHS corresponded to a greater number of alerts-per-resident (41% higher) compared with UPMC Pinnacle. Overall, salience was 11.6% for PGY-1, 10.5% for PGY-2, and 8.9% for PGY-3 residents. Conclusion Our results are suggestive of long-term drug-alert desensitization during progressive residency training. A higher number of alerts-per-resident correlating with a lower salience suggests alert fatigue; however, other factors should also be considered including differences in workload and culture.

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EMR-based handoff tool improves completeness of internal medicine residents’ handoffs

BMJ Open Quality ◽

10.1136/bmjoq-2017-000188 ◽

2018 ◽

Vol 7 (3) ◽

pp. e000188 ◽

Cited By ~ 3

Author(s):

Rebecca L Tisdale ◽

Zac Eggers ◽

Lisa Shieh

Keyword(s):

Internal Medicine ◽

Medical Center ◽

Internal Medicine Resident ◽

Objective Data ◽

Code Status ◽

Medicine Resident ◽

Communication Breakdown ◽

Internal Medicine Residents ◽

Action List ◽

Identical Fashion

BackgroundThe majority of adverse events in healthcare involve communication breakdown. Physician-to-physician handoffs are particularly prone to communication errors, yet have been shown to be more complete when systematised according to a standardised bundle. Interventions that improve thoroughness of handoffs have not been widely studied.AimTo measure the effect of an electronic medical record (EMR)-based handoff tool on handoff completeness.InterventionThis EMR-based handoff tool included a radio button prompting users to classify patients as stable, a ‘watcher’ or unstable. It automatically pulled in EMR data on the patient’s 24-hour vitals, common lab tests and code status. Finally, it provided text boxes labelled ‘Active Issues’, ‘Action List (To-Dos)’ and ‘If/Then’ to fill in.Implementation and evaluationWritten handoffs from general and specialty (haematology, oncology, cardiology) Internal Medicine resident-run inpatient wards were evaluated on a randomly chosen representative sample of days in April and May 2015 at Stanford University Medical Center, focusing on a predefined set of content elements. The intervention was then implemented in June 2015 with postintervention data collected in an identical fashion in August to September 2016.ResultsHandoff completeness improved significantly (p<0.0001). Improvement in inclusion of illness severity was notable for its magnitude and its importance in establishing a consistent mental model of a patient. Elements that automatically pulled in data and those prompting users to actively fill in data both improved.ConclusionA simple EMR-based handoff tool providing a mix of frameworks for completion and automatic pull-in of objective data improved handoff completeness. This suggests that EMR-based interventions may be effective at improving handoffs, possibly leading to fewer medical errors and better patient care.

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Educational Conference Scheduling, Patient Discharge Time, and Resident Satisfaction

Journal of Graduate Medical Education ◽

10.4300/jgme-d-13-00400.1 ◽

2014 ◽

Vol 6 (3) ◽

pp. 574-576 ◽

Cited By ~ 1

Author(s):

Steffanie Campbell ◽

Matthew Campbell ◽

Chirayu Shah ◽

Alexander M. Djuricich

Keyword(s):

Internal Medicine ◽

Medical Patient ◽

Patient Discharge ◽

Internal Medicine Resident ◽

Case Conference ◽

Morning Report ◽

Discharge Time ◽

Medicine Resident ◽

Medicine Service ◽

Internal Medicine Residents

Abstract Background Limits on resident duty hours instituted in 2003 and 2011 have compressed medical resident daily workload. Despite this compression, residents must gain competence to practice medicine without supervision. Objective We sought to determine whether moving the time our educational conference is scheduled affects the time when patient discharges are completed on an internal medicine teaching service. Methods The study was conducted at a county hospital within a large internal medicine residency program. During the 4-month study period, the morning report conference for internal medicine residents was shifted from 8:30 am to 2 pm. Patient discharge times, defined as the time the discharge order set was signed, were obtained for the service via the electronic health record. The outcomes measured were patient discharge time variation and internal medicine resident preference for conference time. Results Survey response rate was 82% (42 of 51). Of the residents who responded, 64% (27 of 42) preferred the 8:30 am report time, and 74% (31 of 42) felt the 8:30 am time was also better for education and timing of teaching rounds. There was no difference in discharge times for 2999 patients on the medicine teaching service, whether educational case conference morning report occurred at 8:30 am or at 2 pm. Conclusions Medical patient average discharge time was not influenced by time of educational conference. Factors other than the timing of educational conference appear to influence hospital discharge times on an inpatient internal medicine service.

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Comparison of analogue and electronic stethoscopes for pulmonary auscultation by internal medicine residents

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2018-136052 ◽

2018 ◽

Vol 94 (1118) ◽

pp. 700-703

Author(s):

Eric R. Gottlieb ◽

Jason M. Aliotta ◽

Dominick Tammaro

Keyword(s):

Internal Medicine ◽

Clinical Decision Making ◽

Statistical Significance ◽

Internal Medicine Resident ◽

Clinical Decision ◽

P Value ◽

Lung Sounds ◽

Electronic Stethoscope ◽

Medicine Resident ◽

Internal Medicine Residents

BackgroundElectronic stethoscopes are becoming more common in clinical practice. They may improve the accuracy and efficiency of pulmonary auscultation, but the data to support their benefit are limited.ObjectiveTo determine how auscultation with an electronic stethoscope may affect clinical decision making.MethodsAn online module consisting of six fictional ambulatory cases was developed. Each case included a brief history and lung sounds recorded with an analogue and electronic stethoscope. Internal medicine resident participants were randomly selected to hear either the analogue or electronic lung sounds. Numbers of correct answers, time spent on each case and numbers of times the recordings were played were compared between the groups who heard each mode of auscultation, with a p value of less than 0.05 indicating statistical significance.Results61 internal medicine residents completed at least one case, and 41 residents completed all six cases. There were no significant differences in overall scores between participants who heard analogue and electronic lung sounds (3.14±0.10 out of 6 correct for analogue, 3.20±0.10 out of 6 for electronic, p=0.74). There were no significant differences in performance for any of the six cases (p=0.78), time spent on the cases (p=0.67) or numbers of times the recordings were played (p=0.85).ConclusionWhen lung sounds were amplified with an electronic stethoscope, we did not detect an effect on performance, time spent on the cases or numbers of times participants listened to the recordings.

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Predictors of Internal Medicine Resident Satisfaction with Teaching by Attendings

Forum for Health Economics & Policy ◽

10.2202/1558-9544.1183 ◽

2010 ◽

Vol 13 (2) ◽

Author(s):

Cassandra M Guarino ◽

Chung Pham ◽

Elaine Quiter ◽

Jose J Escarce

Keyword(s):

Internal Medicine ◽

Clinical Teaching ◽

Medical Training ◽

Internal Medicine Resident ◽

Resident Satisfaction ◽

Factors Associated ◽

Medicine Resident ◽

Internal Medicine Residents ◽

Number Of Patients ◽

Negative Factors

This study identifies factors that predict internal medicine resident satisfaction with the quality of teaching by attendings. A key issue facing educators is whether high-quality instruction can be maintained in an environment in which attending physicians have many competing demands placed on their time. A national survey of clinical third-year internal medicine residents in 125 academically affiliated generally medical training programs was conducted. Univariate analyses describe the characteristics of the sample, and multivariate analyses evaluate the factors associated with resident satisfaction with teaching. The response rate was 64.1% (n=1354). Positive factors relating to satisfaction with teaching on inpatient ward rotations included: number of patients seen during rounds, attendings were fulltime, attending did clinical teaching during bedside work rounds, attending gave spontaneous and prepared presentations, and attendings were reached soon when needed. Negative factors included: number of residents in a ward team, number of patients admitted on overnight call, attendings seemed rushed and eager to finish rounds, and attendings were temporarily called away during rounds. Positive factors relating to satisfaction with teaching in continuity clinics included: residents being female and amount of time spent on talking to or examining patients. Negative factors included: amount of time spent on paperwork or routine work, attending changed residents decisions, attendings were difficult to reach, and attendings were temporarily called away during teaching. Different clinic settings also affected satisfaction. This study identifies several factors associated with internal medicine residents satisfaction with teaching and highlights mutable factors that faculty may consider changing to improve education and satisfaction.

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Pharmacogenomics education and perceptions: is there a gap between internal medicine resident and attending physicians?

Pharmacogenomics ◽

10.2217/pgs-2020-0141 ◽

2021 ◽

Author(s):

Carolyn R Rohrer Vitek ◽

Jyothsna Giri ◽

Pedro J Caraballo ◽

Timothy B Curry ◽

Wayne T Nicholson

Keyword(s):

Internal Medicine ◽

Point Of Care ◽

Internal Medicine Resident ◽

Current Clinical Practice ◽

Medicine Resident ◽

Resident Physicians ◽

Internal Medicine Residents ◽

Care Gaps ◽

Attending Physicians ◽

Do So

Aim: To determine if differences in self-reported pharmacogenomics knowledge, skills and perceptions exist between internal medicine residents and attending physicians. Materials & methods: Forty-six internal medicine residents and 54 attending physicians completed surveys. Thirteen participated in focus groups to explore themes emerging from the surveys. Results: Resident physicians reported a greater amount of pharmacogenomics training compared with attending physicians (48 vs 13%, p < 0.00012). No differences were found in self-reported knowledge, skills and perceptions. Conclusion: Both groups expressed pharmacogenomics was relevant to their current clinical practice; they should be able to provide information to patients and use to guide prescribing, but lacked sufficient education to be able to do so effectively. Practical approaches are needed to teach pharmacogenomics concepts and address point-of-care gaps.

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Telehealth for the internal medicine resident: A 3-year longitudinal curriculum

Journal of Telemedicine and Telecare ◽

10.1177/1357633x19896683 ◽

2019 ◽

pp. 1357633X1989668 ◽

Cited By ~ 2

Author(s):

Elizabeth Barnhardt Kirkland ◽

Ragan DuBose-Morris ◽

Ashley Duckett

Keyword(s):

Internal Medicine ◽

Healthcare System ◽

Patient Monitoring ◽

Internal Medicine Resident ◽

System Level ◽

Remote Patient Monitoring ◽

Medicine Resident ◽

Resident Physicians ◽

Internal Medicine Residents ◽

Remote Patient

Aims Across the United States of America, patients are increasingly receiving healthcare using innovative telehealth technologies. As healthcare continues to shift away from traditional office-based visits, providers face new challenges. Telehealth champions are needed to adapt technologies to meet the needs of patients, providers and communities, especially within the realm of primary care specialties. Given these challenges, this intervention aimed to incorporate telemedicine into internal medicine resident training across multiple training years to prepare them for practice in the current and changing healthcare system. Methods Education and telehealth leaders at the Medical University of South Carolina identified key topics relevant to telehealth and the provision of general internal medicine services. With this as a framework, we developed a 3-year longitudinal telehealth curriculum for internal medicine resident physicians, consisting of an introduction to telemedicine equipment in the first year, didactic learning through in-person education and online modules in the second year and experiential learning through remote monitoring of chronic disease in the third year. Participants included approximately 100 internal medicine residents per year (2016–2019). Self-perceived knowledge, comfort and ability to provide telehealth services was assessed via a survey completed before and after participation in the curriculum. Results Resident physicians’ self-reported knowledge of telehealth history, access to care, contributions of telehealth applications and quality of care and communication each improved after completion of the online curriculum. There were also significant improvements in resident comfort and perceived ability to provide telehealth services after participation in the curriculum, as assessed via a survey. Overall, 41% of residents felt their ability to utilize telehealth as part of their current or future practice was greater than average after completion of the online modules compared to only 2% at baseline ( p<0.01). Results also show residents accurately identify barriers to telehealth adoption at the healthcare system level, including the lack of clinical time to implement services (67% post- vs 47% pre-curriculum, p = 0.02), unfamiliarity with concepts (65% post- vs 21% pre-curriculum, p<−0.01) and concerns about consistent provider reimbursement (74% post- vs 39% pre-curriculum, p < 0.01). Conclusion Telemedicine and remote patient monitoring are an increasingly prevalent form of healthcare delivery. Internal medicine residents must be adept in caring for patients utilizing this technology. This curriculum was effective in improving resident comfort and self-efficacy in providing care through telehealth and provided residents with hands-on opportunities through supervised inclusion in remote patient-monitoring services. This curriculum model could be employed and evaluated within other internal medicine residency programmes to determine the feasibility at institutions with and without advanced telehealth centres.

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Initial Characterization of Internal Medicine Resident Resilience and Association with Stress and Burnout

Journal of Biomedical Education ◽

10.1155/2016/3508638 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Amber-Nicole Bird ◽

Amber T. Pincavage

Keyword(s):

Internal Medicine ◽

General Population ◽

Internal Medicine Resident ◽

Convenience Sample ◽

Medicine Resident ◽

Resilience Scale ◽

Internal Medicine Residents ◽

Wide Range ◽

Resident Resilience

Introduction. Burnout is prevalent in medical trainees. Little data exists on resident resilience. Methods. Anonymous surveys were provided to a convenience sample of internal medicine residents. Resilience was assessed using the Connor-Davidson resilience scale. Responses were categorized into low (<70), intermediate (70–79), and high (80–100) resilience. Results. 77 residents from six institutions completed surveys. 26% of residents had high resilience, 43% intermediate, and 31% low. The mean resilience score was 73.6±9.6 and lower than the general population (mean 80.4±12.5, p<0.001). Trainees with high resilience were more likely to never have stress interfere with their relationships outside of work (high: 40%; low: 0%; p<0.001). High resilience residents were more likely to have the skills to manage stress and burnout (high: 80%; low: 46%; p=0.02) and less likely to feel inferior to peers (high: 20.0%; low: 70.8%; p<0.001). There was a trend towards those with high resilience reporting less burnout (high: 40.0%; intermediate: 27%; low: 16.7%; p=0.08). Only 60% report a program outlet to discuss burnout. Conclusions. There is a wide range of resilience among IM residents and scores were lower than the general population. Low resilience is associated with more stress interfering with relationships, feeling inferior to peers, and fewer skills to manage stress and burnout.

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