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.

scholarly journals The Impact of Trainee and Standardized Patient Race and Gender on Internal Medicine Resident Communication Assessment Scores

2021 ◽  
Vol 13 (5) ◽  
pp. 643-649
Author(s):  
Janae K. Heath ◽  
C. Jessica Dine ◽  
Denise LaMarra ◽  
Serena Cardillo
Keyword(s):  
Internal Medicine ◽  
Communication Skills ◽  
Medical Training ◽  
Secondary Analysis ◽  
Internal Medicine Resident ◽  
Estimating Equation ◽  
Equation Model ◽  
Standardized Patient ◽  
Racial Concordance ◽  
The Impact

ABSTRACT Background Standardized patient (SP) encounters are commonly used to assess communication skills in medical training. The impact of SP and resident demographics on the standardized communication ratings in residents has not been evaluated. Objective To examine the impact of gender and race on SP assessments of internal medicine (IM) residents' communication skills during postgraduate year (PGY) 1. Methods We performed a retrospective cohort study of all SP assessments of IM PGY-1 residents for a standardized communication exercise from 2012 to 2018. We performed descriptive analyses of numeric communication SP ratings by gender, race, and age (for residents and SPs). A generalized estimating equation model, clustered on individual SP, was used to determine the association of gender (among SP and residents) with communication ratings. A secondary analysis was performed to determine the impact of residents and SP racial concordance in communication scores. Results There were 1356 SP assessments of 379 IM residents (199 male residents [53%] and 178 female residents [47%]). There were significant differences in average numeric communication rating (mean 3.40 vs 3.34, P = .009) by gender of resident, with higher scores in female residents. There were no significant interactions between SP and resident gender across the communication domains. There were no significant interactions noted with racial concordance between interns and SPs. Conclusions Our data demonstrate an association of resident gender on ratings in standardized communication exercises, across multiple communication skills. There was not an interaction impact for gender or racial concordance between SPs and interns.

scholarly journals A Randomized Controlled Trial of the Impact of a Teaching Procedure Service on the Training of Internal Medicine Residents

2012 ◽  
Vol 4 (2) ◽  
pp. 170-175 ◽  
Author(s):  
Michelle Mourad ◽  
Sumant Ranji ◽  
Diane Sliwka
Keyword(s):  
Internal Medicine ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
First Year ◽  
Randomized Controlled ◽  
Teaching Procedure ◽  
Viable Solution ◽  
The Impact

Abstract Introduction Academic medical centers must provide safe inpatient procedures while balancing resident autonomy and education. We performed a randomized, controlled trial to evaluate the effect of a 2-week hospitalist procedure service (HPS) rotation on interns' self-perceived procedure ability, knowledge, and autonomy versus the standard curriculum. Methods We randomly selected 16 of 57 internal medicine interns (28%) to participate in the intervention group rotation, with 29 interns in the control group. All interns were surveyed before the start of residency and at the end of the postgraduate year-1 (PGY-1) and PGY-2 years to evaluate self-reported knowledge and ability to (1) safely perform procedures, (2) supervise procedures, and (3) use bedside ultrasound. Results Ninety-four percent of HPS interns (15/16) and 71% of control interns (29/41) completed all surveys. Baseline knowledge and experience did not differ significantly between the groups. The intervention group performed significantly more paracentesis (9 versus 4; P &lt; .001), thoracentesis (6 versus 2; P &lt; .001), and lumbar puncture (4 versus 3; P &lt; .001) procedures than did the control group. After their first year, residents who completed the HPS rotation rated their ability to safely perform and supervise all of the assessed procedures as higher (P &lt; .05 for all procedures) and were more likely to rate self-perceived knowledge as very good or excellent in all surveyed aspects of procedure performance (P &lt; .05). Discussion A 2-week hospitalist-supervised procedure service rotation substantially improved residents' experience, confidence, and knowledge in performing bedside procedures early in their training, with this effect sustained through the PGY-2 year. Standardized procedure service rotations are a viable solution for programs seeking to improve their procedure-based education.

scholarly journals ACTup: advanced communication training simulation enhanced by actors trained in the Stanislavski system

2020 ◽  
Vol 7 (1) ◽  
pp. 35-37
Author(s):  
Rory Sweeney ◽  
Ben McNaughten ◽  
Andrew Thompson ◽  
Lesley Storey ◽  
Paul Murphy ◽  
...  
Keyword(s):  
Communication Skills ◽  
Life Experience ◽  
Child Death ◽  
Good Clinical Practice ◽  
Communication Training ◽  
Simulated Patients ◽  
Formal Training ◽  
Training Simulation ◽  
The Impact

Strong communication, empathy and interpersonal skills are crucial to good clinical practice. Actors trained in interpretations of the Stanislavski system draw on their own life experience to develop the character. We hypothesised that simulation enhanced by trained actors would be an ideal way for our senior trainees to develop advanced communication skills. We developed a communication training course based on challenging situations which occur in paediatrics like child death and safeguarding. Actors were briefed and invited to develop characters that would behave and respond as a parent/carer might do in complex and stressful clinical scenario. Paediatric trainees then participated in simulations, with a focus on communication skills. Feedback and debrief were provided by a multidisciplinary faculty. The impact of the course was evaluated by analysis of data collected in focus groups held after the simulation. Trainees noted the actor’s ability to respond in vivo to emotive situations and felt it was much more effective than their previous experience of simulation with simulated patients without formal training. Actors were able to offer feedback on aspects of body language, tone and use of language from a non-medical perspective. Actors enhanced the realism of the simulations by changing their language and emotional performance in response to the trainee’s performance, improving trainee engagement.

scholarly journals Understanding the impact of simulated patients on health care learners’ communication skills: a systematic review

2017 ◽  
Vol 51 (12) ◽  
pp. 1209-1219 ◽  
Author(s):  
Jessica Kaplonyi ◽  
Kelly-Ann Bowles ◽  
Debra Nestel ◽  
Debra Kiegaldie ◽  
Stephen Maloney ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Communication Skills ◽  
Simulated Patients ◽  
The Impact

Virtualization of University Education

2017 ◽  
Vol 9 (4) ◽  
pp. 24-40 ◽  
Author(s):  
Samuel Adu Gyamfi ◽  
Patrick Ohemeng Gyaase
Keyword(s):  
Communication Skills ◽  
Teaching And Learning ◽  
University Education ◽  
First Year ◽  
Mediated Learning ◽  
First Year Students ◽  
Large Classes ◽  
Learning Platform ◽  
Before And After ◽  
The Impact

The increasing intake of students in tertiary institutions has resulted in large classes sizes in the universities in Ghana with the attendant reduction in quality in teaching and learning. This study was carried out to assess the impact of integrating ICT to teaching and learning in Universities on students' performance. This study adopted formative experimental approach using Moodle, an online learning platform to supplement the traditional face-face lecturing. This was carried out using seventy-five first year students on a communication skills course over two semesters. The Students' score in four learning outcomes were collected before and after the experiment. The data were quantitatively analyzed and compared to identify the impact of the ICT-mediated learning environment on students' performance. The results showed marked improvement in the students' performance in all aspects of communication skills. The lecturers of the course also confirmed improvements in students' performance, engagement and participation in the course compared to previous years.

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.

Enhanced Ambulatory Electronic Health Record Training for Residents: Prospective Cohort Study. (Preprint)

2019 ◽  
Author(s):  
Shawn Y. Ong ◽  
Jesse O'Shea ◽  
Julie R. Rosenbaum
Keyword(s):  
Internal Medicine ◽  
Electronic Health Record ◽  
Control Group ◽  
Health Record ◽  
Orientation Programs ◽  
Course Content ◽  
Boot Camps ◽  
Ambulatory Training ◽  
Electronic Health ◽  
The Impact

BACKGROUND Physicians spend a significant amount of time with Electronic Health Record (EHR) systems but receive inadequate training. Prior studies have shown benefit from intern orientation programs such as “boot camps” for clinical knowledge or skills but few have examined courses for enhanced EHR orientation. OBJECTIVE To improve EHR clinic workflow processes and assess the impact of a structured course on intern confidence and preparedness. METHODS One faculty and two resident physicians spent approximately 30 hours creating a four-hour course curriculum, which was taught to a group of incoming Internal Medicine interns in June and July 2017. The interns completed a course feedback survey along with self-reported outpatient EHR workflow process confidence surveys at 1, 6, and 12 months. A control group also completed the same confidence surveys at the same intervals. RESULTS A total of 15 out of 18 Internal Medicine interns (83%) took the course. All 15 reported they learned useful information and had increased overall confidence. A majority (93%) agreed the course would allow them to provide better care for their patients and that the course content was best delivered by a physician. Most interns (80%) agreed the course should be a required part of internship. Confidence scores in eight major workflow areas significantly increased after the course and persisted throughout intern year. A control group of interns had low initial confidence scores that increased at 6 and 12 months. CONCLUSIONS A 4-hour targeted EHR ambulatory training course was feasible, highly rated, and increased workflow confidence scores for the first 6 months.

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