Are Internal Medicine Residents Meeting the Bar? Comparing Resident Knowledge and Self-Efficacy to Published Palliative Care Competencies

2020 ◽  
pp. 104990912095480
Author(s):  
Kristen M. Moyer ◽  
Matthew S. Ellman ◽  
John Encandela ◽  
Laura J. Morrison
Keyword(s):  
Internal Medicine ◽  
Palliative Care ◽  
Self Efficacy ◽  
Rank Analysis ◽  
Cultural Aspects ◽  
Internal Medicine Residents ◽  
Significant Difference ◽  
New Instrument ◽  
The Mean ◽  
One Way Anova

Background: There is a need for improved primary palliative care (PC) education and resident comfort with providing end-of-life care. Objective: Utilize a new instrument derived from published PC competencies to assess baseline Internal Medicine (IM) resident knowledge and self-efficacy in PC to identify educational gaps and create new PC curricula. Design: We created a 2-part instrument including a Knowledge Test (KT) and a Self-Efficacy Inventory (SEI) addressing 18 PC resident competencies across 5 domains: Pain and Symptom Management (PSM), Communication (COMM), Psychosocial, Spiritual, and Cultural Aspects of Care (PSC), Terminal Care and Bereavement (TCB), and Palliative Care Principles and Practice (PCPP). Setting/Subjects: The instrument was emailed to IM residents at our institution during academic years 2015-2016 and 2016-2017. Measurements: Basic descriptive statistics were performed for the KT and SEI. Mean Rank Analysis and One-way ANOVA were utilized for the KT and SEI, respectively. Congruence was calculated between knowledge and self-efficacy. Results: The mean score on the KT was 73% (range 33-80%). There was no significant difference in knowledge among post-graduate year cohorts. Self-efficacy scores were lower for interns overall and in PCPP, TCB, and COMM domains. Knowledge was concordant with self-efficacy in 42% of participants, higher than self-efficacy in 10% of participants, and lower than self-efficacy in 48% of participants. Conclusions: For approximately half of respondents, high self-efficacy in PC did not correlate with high PC knowledge. A more focused curriculum is needed to help IM residents facilitate mastery of PC competencies by graduation.

scholarly journals The Effect of Teaching Palliative Care on the Self-Efficacy of Elderly Patients with Chronic Heart Failure

2020 ◽  
Vol 12 (3) ◽  
pp. 201-207
Author(s):  
Mahnaz Modanloo ◽  
Ameneh Tazikeh-Lemeski ◽  
Shohreh Kolagari
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Chronic Heart Failure ◽  
Self Efficacy ◽  
Intervention Group ◽  
Control Group ◽  
Significant Difference ◽  
The Mean ◽  
And Control

ABSTRACTObjetive: Determine the effect of teaching palliative care on the self-efficacy of elderly with Chronic Heart Failure. Material and Methods: This single-blind randomized clinical trial was done on patients with Chronic Heart Failure attending to the heart clinics of Golestan University of Medical Sciences in 2018. 48 eligible patients with class-III were selected via convenience sampling. Patients allocated into control and intervention group randomly (n=32). Palliative care training was done for intervention group for six weeks. Data was gathered through the Cardiac Self-Efficacy Scale (CSES) on three time points (before, immediately, and one month after intervention). Data were analyzed in SPSS-18 using independent t-test, chi-squared, Fisher's exact, and repeated-measures ANOVA with corrected Bonferroni post-hoc test. Results: Finding showed that before intervention the mean scores of self-efficacy in intervention and control group was 23.95±8.34 and 24.11±9.41, respectively. Immediate and one month after intervention it was 26.30±8.30 vs. 28.95±8.53 in intervention group and 24.68±9.32 vs. 25.53±10.39 in control group. In intervention group there was no significant difference between the mean scores of before with immediate and one month after intervention. However, there was a significant difference between the two time follow up in both intervention (p<0.0001) and control (p<0.003) groups. Conclusion: Although the education of palliative care has increased the ability to care in elderly, it seems that self-managing in complex conditions is required follow-up over time.

A New Competency-Based Instrument to Assess Resident Knowledge and Self-Efficacy in Primary Palliative Care

2019 ◽  
Vol 37 (2) ◽  
pp. 117-122 ◽  
Author(s):  
Kristen M. Moyer ◽  
Laura J. Morrison ◽  
John Encandela ◽  
Catherine Kennedy ◽  
Matthew S. Ellman
Keyword(s):  
Palliative Care ◽  
Factor Analysis ◽  
Psychometric Properties ◽  
Self Efficacy ◽  
Item Analysis ◽  
Educational Interventions ◽  
Management Communication ◽  
Cultural Aspects ◽  
Internal Medicine Residents ◽  
Competency Based

Context: There is a need to improve both primary palliative care (PPC) education and its assessment in graduate medical education (GME). We developed an instrument based on published palliative care (PC) competencies to assess resident competency and educational interventions. Objectives: To describe the development and psychometric properties of a novel, competency-based instrument to measure resident knowledge and self-efficacy in PPC. Methods: We created a 2-part instrument comprised of a knowledge test (KT) and a self-efficacy inventory (SEI) addressing 18 consensus, core PC resident competencies across 5 domains: pain and symptom management; communication; psychosocial, spiritual, and cultural aspects of care; terminal care and bereavement; and PC principles and practice. The instrument was distributed to 341 internal medicine residents during academic years 2015 to 2016 and 2016 to 2017. A standard item analysis was performed on the KT. Internal consistency (Cronbach α) and variable relationships (factor analysis) were measured for the SEI. Results: One hundred forty-four residents completed the survey (42% response). For 15 KT items, difficulty ranged from 0.17 to 0.98, with 7 items ranging 0.20 to 0.80 (typical optimum difficulty); discrimination ranged from 0.03 to 0.60 with 10 items ≥0.27 (good to very good discrimination). Cronbach α was 0.954 for 35 SEI items. Factor analysis of combined 2015 to 2016 items yielded 4 factors explaining the majority of variance for the entire set of variables. Conclusion: Our instrument demonstrates promising psychometric properties and reliability in probing the constructs of PC and can be further utilized in PC GME research to assess learners and evaluate PPC educational interventions.

scholarly journals Creative Solution for Implementation of Experiential, Competency-Based Palliative Care Training for Internal Medicine Residents

2011 ◽  
Vol 26 (3) ◽  
pp. 436-443 ◽  
Author(s):  
Douglas D. Ross ◽  
Deborah W. Shpritz ◽  
Susan D. Wolfsthal ◽  
Ann B. Zimrin ◽  
Timothy J. Keay ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Palliative Care ◽  
Internal Medicine Residents ◽  
Competency Based ◽  
Care Training

scholarly journals Internal Medicine Trainee Understanding and Reaction to Out of Pocket Costs

2021 ◽  
Vol 8 ◽  
pp. 238212052199636
Author(s):  
Jeffrey Chidester ◽  
Rebecca Vigen ◽  
Sandeep R Das
Keyword(s):  
Internal Medicine ◽  
Graduate Education ◽  
Parametric Analysis ◽  
Cost Of Care ◽  
Patient Centered ◽  
Internal Medicine Residents ◽  
Significant Difference ◽  
Centered Care ◽  
Barrier To Care ◽  
Out Of Pocket Costs

Background: Out-of-pocket costs are a serious barrier to care and drive suboptimal medical therapy. Understanding of these costs can lead to care oriented around the limits they generate. Despite this, there is minimal attention paid to these costs in post-graduate education. Objective: To define a potential knowledge gap regarding costs experienced by patients by surveying Internal Medicine residents at our large academic institution. Methods: We surveyed Internal Medicine residents in spring 2019 about knowledge and practices surrounding patient out-of-pocket costs. Participants answered questions considering their most recent inpatient panel and their clinic patient panel. Familiarity was ranked on a 5-point Likert scale, and for the purposes of presentation, was divided into “Poor” and “Moderate or Better.” Non-parametric analysis was used to test differences between outpatients and inpatients and by year of training. Results: Of 159 residents, 109 (67%) responded. Familiarity with patient insurance status was moderate or better in 85%. Reported understanding of costs associated with medications, testing, and clinic visits was less common. Respondents had higher familiarity with out-of-pocket costs for clinic patients compared with inpatients. Knowledge of cost of care was not an often-considered factor in decision making. There was no significant difference in response by year of training. Conclusion: Patient out-of-pocket costs are an important dimension of patient care which Internal Medicine Trainees at our institution do not confidently understand or utilize. Improvements in education around this topic may enable more patient-centered care.

scholarly journals Clinical and Educational Outcomes of an Integrated Inpatient Quality Improvement Curriculum for Internal Medicine Residents

2016 ◽  
Vol 8 (4) ◽  
pp. 563-568 ◽  
Author(s):  
Greg Ogrinc ◽  
Emily S. Cohen ◽  
Robertus van Aalst ◽  
Beth Harwood ◽  
Ellyn Ercolano ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Quality Improvement ◽  
Self Efficacy ◽  
Intervention Group ◽  
Educational Outcome ◽  
Free Text ◽  
Internal Medicine Residents ◽  
Late Intervention ◽  
Hands On ◽  
The Impact

ABSTRACT Background  Integrating teaching and hands-on experience in quality improvement (QI) may increase the learning and the impact of resident QI work. Objective  We sought to determine the clinical and educational impact of an integrated QI curriculum. Methods  This clustered, randomized trial with early and late intervention groups used mixed methods evaluation. For almost 2 years, internal medicine residents from Dartmouth-Hitchcock Medical Center on the inpatient teams at the White River Junction VA participated in the QI curriculum. QI project effectiveness was assessed using statistical process control. Learning outcomes were assessed with the Quality Improvement Knowledge Application Tool–Revised (QIKAT-R) and through self-efficacy, interprofessional care attitudes, and satisfaction of learners. Free text responses by residents and a focus group of nurses who worked with the residents provided information about the acceptability of the intervention. Results  The QI projects improved many clinical processes and outcomes, but not all led to improvements. Educational outcome response rates were 65% (68 of 105) at baseline, 50% (18 of 36) for the early intervention group at midpoint, 67% (24 of 36) for the control group at midpoint, and 53% (42 of 80) for the late intervention group. Composite QIKAT-R scores (range, 0–27) increased from 13.3 at baseline to 15.3 at end point (P &lt; .01), as did the self-efficacy composite score (P &lt; .05). Satisfaction with the curriculum was rated highly by all participants. Conclusions  Learning and participating in hands-on QI can be integrated into the usual inpatient work of resident physicians.

scholarly journals Effects of prophylactic ketamine and pethidine to control postanesthetic shivering: A comparative study

2018 ◽  
Vol 5 (12) ◽  
pp. 2898-2903 ◽  
Author(s):  
Masoum Khoshfetrat ◽  
Ali Rosom Jalali ◽  
Gholamreza Komeili ◽  
Aliakbar Keykha
Keyword(s):  
Normal Saline ◽  
Pearson Correlation ◽  
Saline Group ◽  
Normal Saline Group ◽  
Chi Square ◽  
Double Blind ◽  
Postanesthetic Shivering ◽  
Significant Difference ◽  
The Mean ◽  
One Way Anova

Background: Shivering is an undesirable complication following general anesthesia and spinal anesthesia, whose early control can reduce postoperative metabolic and respiratory complications. Therefore, this study aims to compare the effects of prophylactic injection of ketamine and pethidine on postoperative shivering. Methods: This double-blind clinical trial was performed on 105 patients with short-term orthopedic and ENT surgery. The patients were randomly divided into three groups; 20 minutes before the end of the surgery, 0.4 mg/kg of pethidine was injected to the first group, 0.5 mg/kg of ketamine was injected to the second group, and normal saline was injected to the third group. After the surgery, the tympanic membrane temperature was measured at 0, 10, 20, and 30 minutes. The shivering was also measured by a four-point grading from zero (no shivering) to four (severe shivering). Data were analyzed by one-way ANOVA, Kruskal Wallis, Chi-square and Pearson correlation. Results: The mean age of patients was 35.8+/-11.45 years in the ketamine group, 34.8+/-11.64 years in the normal saline group, and 33.11+/-10.5 years in the pethidine group. The one-way ANOVA showed no significant difference in the mean age between the three groups (P=0.645). The incidence and intensity of shivering were significantly higher in the normal saline group than in the ketamine and pethidine groups (p=0.001). However, there was no significant difference in the incidence and the intensity of shivering between the ketamine and the pethidine groups (p=0.936). Conclusion: The results showed that the 0.5 mg/kg of ketamine could control the post-anesthetic shivering.  

scholarly journals Comparison of electrocardiographic parameters of racing and non-racing horses in Sokoto Nigeria

2020 ◽  
Vol 18 (1) ◽  
pp. 33-38
Author(s):  
B. Saidu ◽  
A.J. Ishaq ◽  
H.M. Ibrahim ◽  
A. Dahiru ◽  
A.M. Abdullahi ◽  
...  
Keyword(s):  
Standing Position ◽  
P Wave ◽  
Average Weight ◽  
T Wave ◽  
Qt Intervals ◽  
Significant Difference ◽  
The Mean ◽  
Electrocardiographic Parameters ◽  
Electrical Activities ◽  
One Way Anova

The study was conducted due to the economic importance of horses and shortage of information on electrocardiographic parameters of horses in Sokoto, Nigeria. This study established the normal electrocardiographic parameters of racing and non-racing horses in Sokoto and statistically compared the values. The study used forty horses comprising of 20 racing and 20 non-racing horses with mean age of 8 ± 0.5 years and average weight of 200 ± 2.0 kg. ECG was recorded using the base apex system with the animals in standing position using single lead channel ECG recorder (EDAN VE-100 manufactured by Edan instruments China). The paper speed was set at 25mm/s while the sensitivity of the machine was adjusted to 10 mm/mV. The durations and amplitudes of P, R and T, the durations of Q and S and the durations of PR, QRS and QT intervals were all determined. These parameters were determined for the three standard limb leads (I, II and III) as well as the augmented limb leads (aVR, aVL and aVF). Descriptive statistics using SPSS version 16 was used to calculate the means and standard error of mean at 95 % confidence interval. One-way ANOVA was used to compare between the values of the racing and non-racing horses. The highest values of P amplitude, R amplitude, Q amplitude, QRS complex and P-R interval were recorded in racing horses, while highest T wave amplitude was recorded in non-racing horses. Highest duration of P wave, T wave and QRS was recorded in racing horses while highest duration of Q wave was recorded in non-racing horses. Significant difference was found in the T amplitude in racing horses in lead aVF. The mean heart rate for the racing and non-racing horses was 80.3 ± 8.4 and 63.1 ± 9.2 beats/minute respectively. Higher values recorded in racing horses indicates that exercise has influence on electrical activities in horses. Keywords: Electrocardiograph, Non-racing horses, Parameters, Racing horses, Sokoto

Sign in / Sign up

Export Citation Format

Share Document