391: THE EFFECT OF ICU TELEMEDICINE ON RESIDENT PERCEPTIONS OF EDUCATION, AUTONOMY, AND PATIENT CARE

Abstract Background The Accreditation Council for Graduate Medical Education states that education needs to have priority over service. There is a potential for residents to have a negative perception of activities termed service. Objective To understand how residents of one obstetrics and gynecology program conceptualize service and clinical education in their daily training experiences. Methods We conducted a qualitative survey using semistructured interviews with 9 residents in obstetrics and gynecology. Verbatim transcripts underwent phenomenologic analysis for themes and statements exemplifying the essence and nuances of residents' experiences. Results The conceptualization of service and clinical education encompassed 6 categories, with some overlap between terms. The category education encompassed (1) tasks and situations with some educational value termed indirect patient care; (2) tasks and situations with high educational values subdivided into direct patient care and teacher-learner interactions; and (3) traditional educational activities, including reflection. Service denoted: (1) tasks and situations with little to no educational value subdivided into indirect and direct patient care categories; (2) tasks and situations with some educational value described as direct patient care; and (3) community service to patients and communities. Conclusions Definitions and the relative educational value of service and clinical education experiences overlapped considerably, but they varied by systematic, environmental, and personal factors. Service was used interchangeably to connote negative experiences that interfered with educational goals and positive experiences at the core of the profession's higher calling, the raison d'être of many physicians. The community needs to agree on the definitions of these terms and clarify the meaning of an appropriate balance.

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In reference to “The effect of a rapid response team on resident perceptions of education and autonomy”

Journal of Hospital Medicine ◽

10.1002/jhm.2358 ◽

2015 ◽

Vol 10 (6) ◽

pp. 418-418

Author(s):

Nancy H Stewart ◽

Audrey Tanksley ◽

Vineet M Arora

Keyword(s):

Rapid Response Team ◽

Rapid Response ◽

Resident Perceptions ◽

Response Team ◽

Perceptions Of Education

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

Journal of Graduate Medical Education ◽

10.4300/jgme-d-16-00211.1 ◽

2017 ◽

Vol 9 (2) ◽

pp. 245-249 ◽

Cited By ~ 3

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 < .001), and the number of residents reporting that they felt unable to admit patients in a timely manner decreased from 14 to 2 (P < .001). Reports of adequate time with patients increased from 16 to 36 (P < .001), and residents indicating that they had time to learn from patients increased from 19 to 35 (P < .001). Reports of leaving on time after call days rose from 12 to 33 (P < .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.

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The effect of a rapid response team on resident perceptions of education and autonomy

Journal of Hospital Medicine ◽

10.1002/jhm.2270 ◽

2015 ◽

Vol 10 (1) ◽

pp. 8-12 ◽

Cited By ~ 10

Author(s):

Brad W. Butcher ◽

Christina E. Quist ◽

James D. Harrison ◽

Sumant R. Ranji

Keyword(s):

Rapid Response Team ◽

Rapid Response ◽

Resident Perceptions ◽

Response Team ◽

Perceptions Of Education

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Utilizing Electronic Medical Records to Standardize Handoffs in Academic Ophthalmology

Journal of Academic Ophthalmology ◽

10.1055/s-0040-1718566 ◽

2020 ◽

Vol 12 (02) ◽

pp. e205-e213

Author(s):

Lynn W. Sun ◽

Andrea L. Stahulak ◽

Deborah M. Costakos

Keyword(s):

Patient Care ◽

Ease Of Use ◽

Resident Perceptions ◽

Medical Centers ◽

Resident Physicians ◽

Major Metropolitan Area ◽

Academic Medical ◽

Before And After ◽

Measured Efficiency ◽

Inpatient Settings

Abstract Purpose Formalized handoff procedures have been shown to increase patient safety and quality of care across multiple medical and surgical specialties,1–4 but literature regarding handoffs in ophthalmology remains sparse. We instituted a standardized handoff utilizing an electronic medical record (EMR) system to improve care for patients shared by multiple resident physicians across weekday, weeknight, and weekend duty shifts. We measured efficiency, efficacy, and resident satisfaction before and after the standardized handoff was implemented. Methods Resident physicians surveyed were primarily responsible for patient care on consult and call services at two quaternary academic medical centers in a major metropolitan area. Patient care was performed in outpatient, emergency, and inpatient settings. Annual anonymous questionnaires consisting of 6 questions were used to collect pre- and postintervention impressions of the standardized EMR handoff process from ophthalmology resident physicians (9 per year; 3 preintervention years and 1 postintervention year). An additional anonymous postintervention questionnaire consisting of 12 questions was used to further characterize resident response to the newly implemented handoff procedure. Results Prior to implementation of a standardized EMR-based handoff procedure, residents unanimously reported incomplete, infrequently updated handoff reports that did not include important clinical and/or psychosocial information. Following implementation, residents reported a statistically significant increase in completeness and timeliness of handoff reports. Additionally, resident perception of EMR handoff utility, efficiency, and usability were comprehensively favorable. Residents reported handoffs only added a mean of 6.5 minutes to a typical duty shift. Conclusion Implementation of our protocol dramatically improved resident perceptions of the handoff process at our institution. Improvements included increased quality, ease-of-use, and efficiency. Our standardized EMR-based handoff procedure may be of use to other ambulatory-based services.

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Rounds Today: A Qualitative Study of Internal Medicine and Pediatrics Resident Perceptions

Journal of Graduate Medical Education ◽

10.4300/jgme-d-15-00106.1 ◽

2016 ◽

Vol 8 (4) ◽

pp. 523-531 ◽

Cited By ~ 9

Author(s):

Raphael Rabinowitz ◽

Jeanne Farnan ◽

Oliver Hulland ◽

Lisa Kearns ◽

Michele Long ◽

...

Keyword(s):

Internal Medicine ◽

Qualitative Study ◽

Patient Care ◽

Family Involvement ◽

Clinical Education ◽

Comparative Method ◽

Teaching Hospitals ◽

Resident Perceptions ◽

Attending Rounds ◽

Teaching Learning

ABSTRACT Background Attending rounds is a key component of patient care and education at teaching hospitals, yet there is an absence of studies addressing trainees' perceptions of rounds. Objective To determine perceptions of pediatrics and internal medicine residents about the current and ideal purposes of inpatient rounds on hospitalist services. Methods In this multi-institutional qualitative study, the authors conducted focus groups with a purposive sample of internal medicine and pediatrics residents at 4 teaching hospitals. The constant comparative method was used to identify themes and codes. Results The study identified 4 themes: patient care, clinical education, patient/family involvement, and evaluation. Patient care included references to activities on rounds that forwarded care of the patient. Clinical education pertained to teaching/learning on rounds. Patient/family involvement encompassed comments about incorporating patients and families on rounds. Evaluation described residents demonstrating skill for attendings. Conclusions Resident perceptions of the purposes of rounds aligned with rounding activities described by prior observational studies of rounds. The influence of time pressures and the divergent needs of participants on today's rounds placed these identified purposes in tension, and led to resident dissatisfaction in the achievement of all of them. Suboptimal congruency exists between perceived resident clinical education and specialty-specific milestones. These findings suggest a need for education of multiple stakeholders by (1) enhancing faculty teaching strategies to maximize clinical education while minimizing inefficiencies; (2) informing residents about the value of patient interactions and family-centered rounds; and (3) educating program directors in proper alignment of inpatient rotational objectives to the milestones.

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A Thematic Review of Resident Commentary on Duty Hours and Supervision Regulations

Journal of Graduate Medical Education ◽

10.4300/jgme-d-11-00259.1 ◽

2012 ◽

Vol 4 (4) ◽

pp. 454-459 ◽

Cited By ~ 15

Author(s):

Brian C. Drolet ◽

Ina Y. Soh ◽

Paul A. Shultz ◽

Staci A. Fischer

Keyword(s):

Medical Education ◽

Patient Care ◽

Graduate Medical Education ◽

Negative Impact ◽

Free Text ◽

Negative Effects ◽

Duty Hours ◽

Graduate Medical ◽

Resident Perceptions ◽

Likert Scale Response

Abstract Background The implementation on July 1, 2011, of new Accreditation Council for Graduate Medical Education (ACGME) standards for resident supervision and duty hours has prompted considerable debate about the potential positive and negative effects of these changes on patient care and resident education. A recent large-sample study analyzed resident responses to these changes, using a Likert scale response. In this same study, 874 residents also provided free-text comments, which provide added insight into resident perspectives on duty hours and supervision. Methods A mixed-methods quantitative and qualitative survey of residents was conducted in August 2010 to assess resident perceptions of the proposed ACGME regulations. Common concerns in the residents' free responses were synthesized and quantified using content analysis, a common method for qualitative research. Results A total of 11 617 residents received the survey. Completed surveys were received from 2561 residents (22.0%), with 874 residents (34.1%) providing free-text responses. Most residents (83.0%) expressed unfavorable opinions about the new standards. The most frequently cited concerns included coverage issues, and a negative impact on patient care and education, as well as lack of preparation for senior roles. A smaller portion of residents commented they thought the standards would contribute to improvements in quality of life (36.1%) and patient care (4.9%). Conclusions ACGME standards are important for graduate medical education, and their aim is to promote high-quality education and better care to patients in teaching institutions. Yet, many residents are concerned about the day-to-day impact of the 2011 regulations, in particular the 16-hour duty period for interns. Most residents who provided free-text responses had a negative impression of the new ACGME regulations. Residents' resistance to duty hour changes may represent a realization that residents are losing a central role in patient care. The concerns identified in this study demonstrate important issues for administrators and policymakers. Resident ideas and opinions should be considered in future revisions of ACGME requirements.

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