Truth Disclosure at the End of Life: A Qualitative Study of Internal Medicine Residents in the United Arab Emirates

2021 ◽  
pp. 104990912110638
Author(s):  
Halah Ibrahim ◽  
Thana Harhara
Keyword(s):  
Internal Medicine ◽  
End Of Life ◽  
United Arab Emirates ◽  
Terminal Illness ◽  
Medical Information ◽  
Moral Distress ◽  
Medical Training ◽  
Truth Telling ◽  
Truth Disclosure ◽  
Internal Medicine Residents

Background Respect for patient autonomy has become the guiding biomedical ethical tenet in the West; yet, moral values are contextual and culturally relevant. In the collectivist society of the Middle East, families and physicians have historically believed that concealing truth about a terminal illness is more ethical and compassionate. Recent studies reveal a trend toward truth disclosure. Objective To gain insight into resident experiences with, and barriers to, truth disclosure in terminally ill patients in the United Arab Emirates (UAE). Methods Focus group interviews were conducted with first through fourth year internal medicine residents and recent graduates at two large academic medical centers in the UAE. Qualitative thematic content analysis was used to identify themes related to communication and truth telling in end-of-life care. Results Residents revealed that non-disclosure of medical information in serious illness is a common practice in UAE hospitals. Barriers to truth telling include family objection, deficits in medical training, and inconsistently implemented institutional guidelines. Conclusion Educational and policy interventions are needed to improve physician-patient communication, decrease patient-family-physician tension, and alleviate trainee moral distress.

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 Promoting Quality Care for Recently Resettled Populations: Curriculum Development for Internal Medicine Residents

2014 ◽  
Vol 6 (2) ◽  
pp. 310-314 ◽  
Author(s):  
Marina MacNamara ◽  
April Wilhelm ◽  
Geolani Dy ◽  
Sarah Andiman ◽  
Carol Landau ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Focus Groups ◽  
Medical Training ◽  
Quality Care ◽  
Hospital Staff ◽  
Online Information ◽  
Preliminary Assessment ◽  
Internal Medicine Residents ◽  
Adequate Education ◽  
Survey Results

Abstract Background Residents report they lack preparation for caring for an increasingly diverse US population. In response, a variety of curricula have been developed to integrate cultural competency into medical training programs. To date, none of these curricula has specifically addressed members of recently resettled populations. Methods A preliminary assessment was conducted among internal medicine (IM) residents at 1 program (N  =  147). Based on 2 conceptual frameworks and the survey results, a pilot curriculum was developed and integrated into the interns' ambulatory block education within the general IM track (n  =  9). It included (1) online information made available to all hospital staff; (2) 4 interactive didactic sessions; and (3) increased exposure to newly arrived patients. The curriculum was qualitatively evaluated through 2 focus groups. Results The preliminary assessment was completed by 101 of 147 residents (69%), with 61% of respondents indicating they felt that they received less than adequate education in this area. Eight of the 9 interns exposed to the new curriculum participated in the focus groups. Overall, respondents reported they thought patient care had improved for recently resettled populations and across their patient panels after exposure to the curriculum. Conclusions This study demonstrated that an intervention that included didactics and enhanced exposure to a diverse population improved IM interns' perceptions of care for all patients, including recently settled individuals.

Predictors of Internal Medicine Resident Satisfaction with Teaching by Attendings

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 resident’s 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.

scholarly journals Moral distress and burnout in internal medicine residents

2017 ◽  
Vol 8 (1) ◽  
pp. e36-43 ◽  
Author(s):  
Sharareh Sajjadi ◽  
Monica Norena ◽  
Hubert Wong ◽  
Peter Dodek
Keyword(s):  
Internal Medicine ◽  
Moral Distress ◽  
Clinical Teaching ◽  
Maslach Burnout Inventory ◽  
Intention To Leave ◽  
Internal Medicine Residents ◽  
Distress Score ◽  
Teaching Unit ◽  
High Level ◽  
Distress Scale

Background: Residents frequently encounter situations in their workplace that may induce moral distress or burnout. The objective of this study was to measure overall and rotation-specific moral distress and burnout in medical residents, and the relationship between demographics and moral distress and burnout.Methods: The revised Moral Distress Scale and the Maslach Burnout Inventory (Human Service version) were administered to Internal Medicine residents in the 2013-2014 academic year at the University of British Columbia.Results: Of the 88 residents, 45 completed the surveys. Participants (mean age 30+/-3; 46% male) reported a median moral distress score (interquartile range) of 77 (50-96). Twenty-six percent of residents had considered quitting because of moral distress, 21% had a high level of burnout, and only 5% had a low level of burnout. Moral distress scores were highest during Intensive Care Unit (ICU) and Clinical Teaching Unit (CTU) rotations, and lowest during elective rotations (p<0.0001). Women reported higher emotional exhaustion. Moral distress was associated with depersonalization (p=0.01), and both moral distress and burnout were associated with intention to leave the job.Conclusion: Internal Medicine residents report moral distress that is greatest during ICU and CTU rotations, and is associated with burnout and intention to leave the job.

Confidence in palliative care issues by medical students and internal medicine residents

2017 ◽  
Vol 9 (1) ◽  
pp. e1-e1 ◽  
Author(s):  
Ana Carolina Montouro Storarri ◽  
Giovana Dalmedico de Castro ◽  
Lilian Castiglioni ◽  
Patricia Maluf Cury
Keyword(s):  
Internal Medicine ◽  
Palliative Care ◽  
Medical Students ◽  
Medical School ◽  
Medical Practice ◽  
Terminal Illness ◽  
First Year ◽  
School Students ◽  
Internal Medicine Residents ◽  
Second Year

BackgroundPalliative care (PC) is a relatively new field in Brazil, but this knowledge is of great importance in medical practice.ObjectiveTo evaluate the degree of confidence among medical students and first-year and second-year internal medicine residents in addressing issues of death and terminal illness with patients and their families.MethodA modified version of the Self-Efficacy in Palliative Care Scale was applied to 293 students in their first year to sixth year at the School of Medicine of São José do Rio Preto and to 43 residents in their first year or second year of medical practice at the same institution in Brazil, in 2015. The questionnaire evaluated students' opinions on the need to include theoretical and practical classes on PC in the medical school.ResultsStudents in their fifth year of medical school were more confident than the students in their first, second, third and fourth years; there were no statistically significant differences between fifth-year students, sixth-year students and the internal medicine residents.ConclusionResidents were more confident than all of the medical school students except those in their fifth year (P<0.05) because they have more contact with terminally ill patients than other students do; fifth-year medical students are likely overestimating their abilities.

Genomics in medicine: a novel elective rotation for internal medicine residents

2019 ◽  
Vol 95 (1128) ◽  
pp. 569-572
Author(s):  
Linda N Geng ◽  
Jennefer N Kohler ◽  
Peter Levonian ◽  
Jonathan A Bernstein ◽  
James M Ford ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Medical Training ◽  
Clinical Care ◽  
Genomic Medicine ◽  
Allied Health Professionals ◽  
Postgraduate Medical Training ◽  
Internal Medicine Residents ◽  
Genomics Education ◽  
Undiagnosed Diseases

It is well recognised that medical training globally and at all levels lacks sufficient incorporation of genetics and genomics education to keep up with the rapid advances and growing application of genomics to clinical care. However, the best strategy to implement these desired changes into postgraduate medical training and engage learners is still unclear. We developed a novel elective rotation in ‘Genomic Medicine and Undiagnosed Diseases’ for categorical Internal Medicine Residents to address this educational gap and serve as an adaptable model for training that can be applied broadly across different specialties and at other institutions. Key curriculum goals achieved include increased understanding about genetic testing modalities and tools available for diagnosis and risk analysis, the role of genetics-trained allied health professionals, and indications and limitations of genetic and genomic testing in both rare and common conditions.

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