scholarly journals 1329. Beyond Reporting: Using an Accreditation Council for Graduate Medical Education (ACGME) Milestone-Linked Evaluation System to Improve Clinical Infectious Diseases Rotations for Baylor College of Medicine Internal Medicine (BCM IM) Residents

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S406-S406
Author(s):  
Lauren Nicholas Herrera ◽  
Richard J Hamill ◽  
Stacey R Rose
Keyword(s):  
Internal Medicine ◽  
Infectious Diseases ◽  
Evaluation System ◽  
Latent Tuberculosis ◽  
Ambulatory Setting ◽  
Educational Goals ◽  
Inpatient Setting ◽  
Clinical Exposure ◽  
Sexually Transmitted ◽  
Immune Deficiencies

Abstract Background ACGME requires reporting of trainee performance on specialty-specific “milestones.” Online evaluation platforms facilitate reporting by linking evaluation questions to these milestones. Whether a milestone-linked evaluation system can be used to identify educational strengths and weaknesses within a training program has not been reported. Methods In 2016, the BCM IM residency program implemented a milestone-linked evaluation system to increase transparency to residents regarding educational goals and streamline milestone reporting. Residents are evaluated on rotation-specific educational objectives; scores range from 1 to 5 (Figure 1), or “not observed” if the skill was not observed during the rotation. Evaluation data from residents on infectious diseases (ID) rotations between 2016 and 2018 were analyzed to compare performance by post-graduate year (PGY) and to assess curricular strengths and deficiencies. Results Two hundred five inpatient and 43 ambulatory ID rotation evaluations were analyzed. In the inpatient setting, mean scores for PGY-1, -2, and -3 trainees were 2.62, 3.06, and 3.88. Residents scored highly on communicating consult recommendations and collecting data from the health record. Residents received lower scores on identifying infections associated with immune deficiencies and in knowledge of antimicrobial spectrum/indications. In the ambulatory setting, mean scores for PGY-2 and -3 trainees were 3.44 and 3.61. Relative to the inpatient setting, more objectives on ambulatory rotations were rated as “not observed.” Objectives with high rates of “not observed” ratings included managing infections in returning travelers (70%); testing/treating latent tuberculosis (63%); interpreting viral hepatitis studies (31%); and managing sexually transmitted infections (25%). Conclusion Data from a milestone-linked evaluation system identified educational strengths and weaknesses of clinical ID experiences for internal medicine residents. Objectives with consistently low or “not observed” ratings may be judged as educational deficiencies, and should prompt modifications to the curriculum to provide increased clinical exposure and/or dedicated didactics to help residents develop these important skills. Disclosures All authors: No reported disclosures.

scholarly journals 1947. Educational Impact of a Hybrid Infectious Diseases Rotation for Internal Medicine Residents

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S57-S57
Author(s):  
James B Cutrell ◽  
James B Cutrell ◽  
Binh-Minh Le ◽  
Heather R Wolfe ◽  
Helen King ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Infectious Diseases ◽  
Educational Innovation ◽  
Mobile App ◽  
Curriculum Innovation ◽  
Educational Impact ◽  
Educational Innovations ◽  
Clinical Exposure ◽  
Internal Medicine Residents ◽  
Board Review

Abstract Background Traditional infectious diseases (ID) rotations for internal medicine (IM) residents focus on inpatient consultation, potentially skewing trainees’ perspectives on ID. We report our experience with a hybrid inpatient–outpatient ID rotation which provides broader ID clinical exposure and an effective venue for educational innovation. Methods We included all IM residents completing an assigned ID rotation in the UT Southwestern IM residency since July 2013. From July 2013 to June 2017, a 4-week ambulatory ID (Amb ID) rotation, consisting of general and subspecialty ID clinics and weekly teaching sessions focused on ID board review, was offered in parallel to traditional inpatient ID consult rotations. From July 2017 to present, all assigned residents complete up to a 4-week ID hybrid rotation, consisting of 2 weeks of ambulatory ID and 2 weeks of inpatient ID consults, with all residents receiving weekly teaching sessions; in some cases, the 4 weeks were not completed sequentially. Data were collected on resident numbers and training level, quantitative and qualitative course evaluations, and program in-training examination scores in ID content areas. Results From July 2013 to June 2019, IM residents completed a total of 626 ID rotations, an average of 104 per year (Table 1). A sample ID hybrid schedule is shown in Table 2. Overall resident satisfaction with the ID hybrid rotation was 4.7 (std. dev. 0.7) on a 5-point Likert scale. This rotation has consistently been among the highest rated rotations by residents. In-training examination ID scores increased significantly with creation of the Amb ID rotation in 2013 and further increased since 2017 with creation of the ID hybrid, in which both inpatient and ambulatory residents receive the weekly teaching sessions (Figure 1). Pilot educational innovations through this rotation include an online web-based antibiotic stewardship curriculum (2014–2015) and a mobile app-based ID board review platform utilizing spaced interval learning (2018–2019). Conclusion A hybrid inpatient–outpatient ID rotation for IM residents has proven to be a highly effective platform for ID education and curriculum innovation at our institution. This concept could be exported to other institutions and increase IM resident interest and breadth of clinical exposure in ID. Disclosures Ank E. Nijhawan, MD, MPH, Gilead Sciences, Inc.: Research Grant.

scholarly journals Infectious diseases screening approach among refugees: results from a single-center study

2021 ◽  
Vol 15 (06) ◽  
pp. 847-852
Author(s):  
Vito Fiore ◽  
Andrea De Vito ◽  
Petrana Martineková ◽  
Elija Princic ◽  
Nicholas Geremia ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Screening Program ◽  
Latent Tuberculosis ◽  
Good Method ◽  
Screening Tests ◽  
Hiv Screening ◽  
Healthcare Provision ◽  
Positive Serology ◽  
Sexually Transmitted ◽  
Demographical Data

Introduction: Our aim was to evaluate a screening program, with active case-finding and treatment for active tuberculosis (TB), latent tuberculosis infection (LTBI), blood-borne viruses (BBV), and sexually transmitted diseases (STDs) among refugees living in facility centers. Methodology: We collected data on refugees arriving to our attention in migrant centers in Sardinia, Italy. Socio-demographical data, anamnesis, and clinical features were collected. TST Mantoux was conducted, and X-ray chest (XRC) was performed if TST was positive. Blood-borne virus screening was proposed to all patients. Screening for STDs was offered according to guidelines, anamnesis, and physical examination. Results: Eighty-one patients were included. Seventy (86.4%) were male, and the mean age was 24.8±5.7 years. Thirty-three (40.7%) had scabies. Overall, 40/81 (49.4%) had a positive TST Mantoux. One (2.5%) was hospitalized and died for multi-drug-resistant TB. One (2.5%) patient had intestinal-TB. 52/81 (64.2%) refused HIV screening, whereas no positivity was found among tested migrants. Sixty-two (76.5%) accepted HCV screening, and one (1.6%) had a positive test. Fifty-eight (71.6%%) accepted HBV testing, and 29 (50%) of them had positive serology. Ten (12.3%) patients had anal or genital lesions due to syphilis, Molluscum contagiosum, and HPV in 7 (70%), 2 (20%), and one (10%) case, respectively. Conclusions: Infectious diseases control and prevention are a key strategy among refugees. The stay in a migrant center is an extraordinary occasion for healthcare provision. This condition could allow a broad screening program in which quick BBV screening tests could be a good method to implement uptake. More information and educational programs would allow a higher understanding and acceptance of HIV screening.

Internal Medicine in World War II. Volume 3. Infectious Diseases and General Medicine.

1968 ◽  
Author(s):  
Leonard D. Heaton ◽  
Robert S. Anderson ◽  
W. P. Havens ◽  
Jr
Keyword(s):  
Internal Medicine ◽  
World War Ii ◽  
Infectious Diseases ◽  
General Medicine ◽  
World War

scholarly journals Perception of usefulness of laboratory tests ordering by internal medicine residents in ambulatory setting: A single-center prospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250769
Author(s):  
Dimitria Doi ◽  
Romulo Ribeiro do Vale ◽  
Jean Michell Correia Monteiro ◽  
Glauco Cabral Marinho Plens ◽  
Mario Ferreira Junior ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Laboratory Tests ◽  
Medical Training ◽  
Outpatient Service ◽  
Ambulatory Setting ◽  
Subjective Perception ◽  
Internal Medicine Residents ◽  
Co Morbidity ◽  
Test Ordering

The demand for high value health care uncovered a steady trend in laboratory tests ordering and inappropriate testing practices. Residents’ training in laboratory ordering practice provides an opportunity for quality improvement. We collected information on demographics, the main reason for the appointment, preexisting medical conditions and presence of co-morbidities from first-visit patients to the internal medicine outpatient service of our university general hospital. We also collected information on all laboratory tests ordered by the attending medical residents. At a follow-up visit, we recorded residents’ subjective perception on the usefulness of each ordered laboratory test for the purposes of diagnosis, prognosis, treatment or screening. We observed that 17.3% of all ordered tests had no perceived utility by the attending resident. Tests were usually ordered to exclude differential diagnoses (26.7%) and to help prognosis estimation (19.1%). Age and co-morbidity influenced the chosen category to legitimate usefulness of tests ordering. This study suggests that clinical objectives (diagnosis, prognosis, treatment or prevention) as well as personalization to age and previous health conditions should be considered before test ordering to allow a more appropriate laboratory tests ordering, but further studies are necessary to examine this framework beyond this medical training scenario.

scholarly journals Surveillance of sexually transmitted infections in England and Wales

1998 ◽  
Vol 3 (6) ◽  
pp. 61-5 ◽  
Author(s):  
G Hughes ◽  
M Catchpole
Keyword(s):  
Infectious Diseases ◽  
Sexually Transmitted Infections ◽  
Human Behaviour ◽  
England And Wales ◽  
Sexually Transmitted

Owing to the unique link between the epidemiology of sexually transmitted infections (STIs) and human behaviour, the surveillance of STIs requires the collection of more demographic and behavioural data than for other infectious diseases. In order to supp

scholarly journals Nitazoxanide against COVID-19 in three explorative scenarios

2020 ◽  
Vol 14 (09) ◽  
pp. 982-986
Author(s):  
José Meneses Calderón ◽  
Ma. del Rocío Figueroa Flores ◽  
Leopoldo Paniagua Coria ◽  
Jesús Carlos Briones Garduño ◽  
Jazmín Meneses Figueroa ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Positive Outcome ◽  
Hospitalized Patients ◽  
Ambulatory Setting ◽  
Medical Attention ◽  
Clinical Settings ◽  
Medicine Service ◽  
Ambulatory Patients

Introduction: Nitazoxanide has shown efficacy in vitro against coronavirus infections (MERS, SARS, SARS-CoV-2). The aim of this report is to describe the results of treating COVID-19 positive patients with nitazoxanide in three clinical settings: pregnancy/puerperium, hospitalized patients in an Internal Medicine Service and in an ambulatory setting. Methodology: This was a prospective follow-up and report of COVID-19 cases in three different situations, pregnant women, hospitalized patients receiving medical attention in an Internal Medicine Service and ambulatory patients residing in Toluca City, and Mexico City. Results: The experience with a first group of 20 women, pregnant (17) or in immediate puerperium (3) was successful in 18 cases with two unfortunate deaths. The five cases treated in an Internal Medicine service showed a positive outcome with two patients weaned from mechanical ventilation. Of the remaining 16 patients treated in an ambulatory setting, all got cured. Nitazoxanide seems to be useful against SARS-CoV-2, not only in an early intervention but also in critical condition as well as in pregnancy without undesired effects for the babies. As an adjunctive therapy budesonide was used that seems to contribute to the clinical improvement. Conclusions: Nitazoxanide could be useful against COVID-19 as a safe and available regimen to be tested in a massive way immediately.

scholarly journals Analysis of syphilis incidence in the Republic of Mordovia

2019 ◽  
Vol 4 (4) ◽  
pp. 29-32
Author(s):  
Ekaterina V. Blinova ◽  
Oksana P. Balykova ◽  
Denis I. Laseev ◽  
Natalya N. Chernova ◽  
Ludmila I. Kitaeva
Keyword(s):  
Sexual Behavior ◽  
Health Education ◽  
Infectious Diseases ◽  
Annual Report ◽  
Skin Diseases ◽  
Morbidity Rate ◽  
Sexually Transmitted ◽  
Social Patterns ◽  
The Subject ◽  
The Republic

Objectives - to study the syphilis morbidity rate in the population of the Republic of Mordovia in years 2015-2017, to determine the age, sex and social patterns of morbidity. Material and methods. The subject of the analysis was the data of the official annual report on sexually transmitted infectious diseases, and contagious skin diseases in the Republic of Mordovia in 2015-2017. Results. In 2017 the syphilis morbidity comprised 21.1 per 100k (total of 171 cases), this result is 2.8% lower than in 2016 (21.7 per 100k). In general, the morbidity rate remains 1.5 times higher than overage in Russia. Despite the positive dynamics, the preconditions for the further prevalence of syphilis among the population remain. Conclusion. Additional measures are required, aimed at raising the general cultural level and health education of the population, regarding to the safe sexual behavior, especially among people of fertile age.

scholarly journals Are We Choosing Wisely in Canada?

2017 ◽  
Vol 12 (3) ◽  
Author(s):  
Mitch Levine
Keyword(s):  
Internal Medicine ◽  
Health Care ◽  
Choosing Wisely ◽  
Inpatient Setting ◽  
Evidence Based ◽  
X Rays ◽  
Stress Tests ◽  
General Internists ◽  
Physician Knowledge ◽  
Geographical Regions

The Choosing Wisely Canada program is intended to facilitate the more efficient use of health care resources. The program has messages for patients to align their expectations with an evidence based delivery of health care and to increase physician knowledge regarding evidence based directives for the appropriate use of investigations and treatments. In the current issue of CJGIM, an assessment was conducted regarding physician knowledge of the program, and the message was not positive. While many physicians acknowledged awareness of the Choosing Wisely Canada program, an appreciation of the specific messages on how to steer practice to evidence based activity was lacking amongst many. As these were the 33% who agreed to participate in the survey, one can only wonder whether a greater lack of knowledge about the program resides in the 67% that refused to participate. Despite having just laid a foundation of pessimism, I still wonder whether physicians are practicing evidence-based health care even if they do not know the detailed recommendations provided by the Choosing Wisely Canada program. The array of recommendations was developed by professional societies representing different clinical specialties in Canada. The Canadian Society of Internal Medicine (CSIM) established its Choosing Wisely Canada Top 5 recommendations by convening a Committee of 20 members that represented a diverse group of general internists from across Canada, reflecting a broad range of geographical regions, practice settings, institution types and experience.1 Below is the list of the five most recent recommendations targeted for physicians practicing in the field of internal medicine. Don’t routinely obtain neuro-imaging studies (computed tomography, magnetic resonance imaging, or carotid Doppler) in the evaluation of simple syncope in patients with a normal neurological examination.Don’t place, or leave in place, urinary catheters without an acceptable indication (such as critical illness, obstruction, palliative care).Don’t transfuse red blood cells for arbitrary hemoglobin or hematocrit thresholds in the absence of symptoms, active coronary disease, heart failure, or stroke.In the inpatient setting, don’t order repeated CBC and chemistry testing in the face of clinical and lab stability.Don’t routinely perform preoperative testing (such as chest X-rays, echocardiograms, or cardiac stress tests) for patients undergoing low risk surgeries.So, how are you doing in your practice? Mitchell LevineEditor, CJGIM

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