Internal medicine residents' perception of cancer prognosis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18214-e18214
Author(s):  
Jared David Acoba ◽  
Loni Belyea
Keyword(s):  
Internal Medicine ◽  
Median Survival ◽  
Cancer Prognosis ◽  
Accurate Information ◽  
Cross Sectional ◽  
Internal Medicine Residents ◽  
Significant Difference ◽  
Oncologic Patients ◽  
Attending Physician ◽  
Attending Physicians

e18214 Background: Cancer is the second leading cause of death in the US. Many internal medicine physicians feel uncomfortable having to prognosticate, however oncology patients often ask this of them. The inability to provide an accurate prognosis could lead a patient to make a treatment decision incongruent with their true wishes. We conducted this study to assess resident and attending physicians’ knowledge of cancer prognosis. Methods: We conducted a prospective cross-sectional study to assess internal medicine resident and attending physician knowledge of median survival for seven different oncologic case scenarios. We asked participants to choose a median survival of: (a) ≤6 mo, (b) 10-12 mo, (c) 24-36 mo, or (d) 48-60 mo for each scenario. Residents were asked to identify the source(s) of information that most significantly influenced their choices. All internal medicine residents and attending physicians affiliated with the University of Hawaii Internal Medicine Residency Program were invited to participate. Results: A total of 67 of 85 surveys were completed, representing 41 residents and 26 attending physicians. Overall, the respondents correctly estimated median survival 42.6% of the time. The respondents underestimated more often than overestimated median survival (46.3% vs 14.9%, p = 0.0001). Survival in colon and pancreatic cancer were most often underestimated (61% and 53%, respectively). We found no statistically significant difference between resident and attending physician responses. Of the residents who underestimated survival, 73% sited inpatient experience as influencing their oncologic knowledge. Conclusions: Internal medicine residents and attending physicians correctly estimate median survival of cancer patients less than 50% of the time and often underestimate survival. Inpatient rotations, where residents care for the oncologic patients experiencing significant complications of their cancer and treatment, may be giving them an unbalanced perspective on cancer prognosis. Improving oncologic education to provide a more balanced perspective may be critical in improving perception of prognosis so that patients can be provided with accurate information when trying to make critical treatment decisions.

Learning Electrocardiogram Interpretation: Insights from Residents and a Proposed Solution in an Observational Study (Preprint)

2020 ◽  
Author(s):  
Mohammad Alakchar ◽  
Abdisamad M. Ibrahim ◽  
Mohsin Salih ◽  
Mukul Bhattarai ◽  
Nitin Tandan ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Correlation Coefficient ◽  
Online Survey ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Resident Attitudes ◽  
Internal Medicine Residents ◽  
Life Threatening ◽  
Degree Of Participation ◽  
Electrocardiogram Interpretation

BACKGROUND Interpretation of electrocardiograms (EKG) is an essential tool for every physician. Despite this, the diagnosis of life-threatening pathology on EKG remains suboptimal in trainees. The purpose of this study is to study resident attitudes and behaviours towards EKGs, and describe an innovative way to teach EKGs. OBJECTIVE Study attitudes and behaviours towards EKGs. Describe an innovative way to teach EKGs. METHODS Design: An observational cross-sectional study through an anonymous online survey of resident attitudes and comfort with EKG interpretation. This was followed by creation of a WhatsApp group for discussion and interpretation of EKGs with peers. At the end of the day, the official EKG interpretation was posted. Setting: Internal medicine residency at Southern Illinois University. Participants: Internal medicine residents Interventions: Creation of WhatsApp group to aid with EKG interpretation Measurements: A 17 item questionnaire, followed by detection of degree of participation in a WhatsApp group. RESULTS Forty-one out of 63 residents (65%) completed the survey. 85% of respondents thought that an interactive way to teach EKGs is the best method of teaching, and 73% did not feel confident interpreting EKGs. 30% often rely on automated EKG interpretation. Further analysis indicated that PGY-1 residents reported ordering fewer EKGs (correlation coefficient -0.399, p = 0.012) and were uncomfortable diagnosing QT prolongation on an EKG (correlation coefficient -0.310, p = 0.049). Residents in the third or greater year of training ordered more EKGs (correlation coefficient 0.379, p = 0.015), less frequently relied on the computer for EKG diagnosis (correlation coefficient 0.399, p = 0.010), and were comfortable diagnosing an acute myocardial infarction and atrial arrhythmias. CONCLUSIONS In conclusion, most IM trainees do not feel comfortable interpreting EKG, however, this does improve with PGY year. WhatsApp is a possible platform for teaching EKGs.

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.

A retrospective analysis and quality improvement education initiative to increase HPV vaccination rates in an inner city primary care clinic.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 213-213
Author(s):  
Jasmin Hundal ◽  
Matthew J Hadfield ◽  
Alifaiz Saiyed ◽  
William Rabitaille
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Hpv Vaccine ◽  
Current Practice ◽  
Insurance Coverage ◽  
Hpv Vaccination ◽  
Shared Decision ◽  
Resident Physicians ◽  
Internal Medicine Residents ◽  
Attending Physicians

213 Background: Human papillomavirus (HPV) is the most commonly spread sexually transmitted infection and is implicated in the oncogenesis of several cancers, including cervical, anal,vaginal and oropharyngeal cancers. HPV vaccinations have a high efficacy, and recent data demonstrated adults aged 18-26 years old are not adequately fully vaccinated. Our objective was to assess the current practice regarding HPV vaccination among persons 9-45 years of age, knowledge about the HPV guidelines, and recommendation practice. Methods: A retrospective review was conducted of Internal Medicine residents acting as primary care physicians at an urban clinic based in Hartford, Connecticut, USA. The survey was administered to internal medicine residents and attending physicians to assess the current practice regarding the HPV vaccination for adults and knowledge of the updated guidelines. The key drivers identified were resident knowledge, communication, insurance coverage, and availability of HPV vaccination in the clinic. An educational handout and lecture was provided with a follow-up survey. Results: A total of 347 charts were reviewed. Of those eligible to receive the HPV vaccine, it was found that only 5.2% received the total dosage. The response rate to our initial survey was 60%. 47.83% did not inquire about the HPV vaccination or recommended it to patients compared to 71.43% of attending physicians (AP) who inquired, but only 28.47% discussed it during precepting sessions. 27.7% of the residents and 71.43% AP correctly identified the updated guidelines. The biggest three barriers were unfamiliarity with the availability of HPV vaccination, insurance coverage, and current guidelines. A short educational review and summary were provided to close the gaps identified with the questionnaire.100% of residents correctly identified the updated guidelines, risks, benefits, importance of shared decision-making, and more likely recommend the HPV vaccination. However, 69.2% were unaware that HPV vaccination does not prevent the progression of HPV-related cancers. Conclusions: Adherence to CDC guidelines regarding vaccinating against HPV amongst resident physicians is poor. The percentage of patients, who received the complete Gardasil-9 vaccination series, was significantly below the national average. Our study highlights a large practice gap that exists amongst resident physicians regarding the HPV vaccine. There was minimal documentation amongst resident physicians regarding shared decision-making conversations with patients. We addressed the knowledge and resource deficit with an educational handout and information session. Our intervention demonstrated improved confidence in discussing the vaccine with the patients and resolved the concern of insurance coverage and availability of vaccines in the clinic and pharmacy.

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 Internal medicine residents identify gaps in medical education on outpatient referrals

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Masha J. Slavin ◽  
Mangala Rajan ◽  
Lisa M. Kern
Keyword(s):  
Internal Medicine ◽  
New York ◽  
Medical Education ◽  
Clinical Information ◽  
Ambulatory Setting ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Internal Medicine Residents ◽  
Strongly Agree ◽  
Residents Attitudes

Abstract Background Relevant clinical information is often missing when a patient sees a specialist after being referred by another physician in the ambulatory setting. This can result in missed or delayed diagnoses, delayed treatment, unnecessary testing, and drug interactions. Residents’ attitudes toward providing clinical information at the time of referral and their perspectives toward training on referral skills are not clear. We sought to assess internal medicine residents’ attitudes toward and experiences with outpatient referrals. Methods We conducted a cross-sectional survey in October–December 2018 of all internal medicine interns and residents affiliated with a large, urban internal medicine residency program in New York, NY. We used a novel survey instrument that included 13 questions about attitudes toward and experiences with outpatient referrals. We used descriptive statistics to characterize the results. Results Overall, 122 of 132 residents participated (92% response rate). Respondents were approximately equally distributed across post-graduate years 1–3. Although 83% of residents reported that it is “always” important to provide the clinical reason for a referral, only 11% stated that they “always” provide a sufficient amount of clinical information for the consulting provider when making a referral. Only 9% of residents “strongly agree” that residency provides sufficient training in knowing when to refer patients, and only 8% “strongly agree” that residency provides sufficient training in what information to provide the consulting physician. Conclusions These results suggest a substantial discrepancy between the amount of information residents believe they should provide at the time of a referral and the amount they actually provide. Many residents report not receiving adequate training during residency on when to refer patients and what clinical information to provide at the time of referral. Improvements to medical education regarding outpatient referrals are urgently needed.

scholarly journals Career interest and perceptions of nephrology: A repeated cross-sectional survey of internal medicine residents

PLoS ONE ◽  
2017 ◽  
Vol 12 (2) ◽  
pp. e0172167 ◽  
Author(s):  
Michael N. Daniels ◽  
Sharon Maynard ◽  
Ivan Porter ◽  
Hope Kincaid ◽  
Deepika Jain ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Career Interest ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Internal Medicine Residents

scholarly journals 4192 Decreasing Inappropriate STAT Image Ordering

2020 ◽  
Vol 4 (s1) ◽  
pp. 47-47
Author(s):  
Michael Cui ◽  
Jonathan Chung ◽  
Pritesh Patel ◽  
Ingrid Reiser
Keyword(s):  
Internal Medicine ◽  
Preliminary Analysis ◽  
Ct Images ◽  
Ct Image ◽  
Targeted Interventions ◽  
Internal Medicine Residents ◽  
Imaging Results ◽  
Fishbone Diagram ◽  
Study Population ◽  
Attending Physicians

OBJECTIVES/GOALS: Currently physicians are able to order CT Chest/Abd/Pelvis images as STAT or Routine. STAT images denote an emergency and are done immediately. We aim to determine the percentage of CT images that are inappropriately ordered as STAT, determine physician image ordering habits, and develop targeted interventions to encourage appropriate STAT image ordering. METHODS/STUDY POPULATION: A fishbone diagram helped reveal possible causes of inappropriate STAT image ordering. Based on the fishbone diagram, a survey was created to assess CT image ordering habits amongst radiology and internal medicine residents and attending physicians. All CT Chest/Abd/Pelvis images ordered over a 3 month period of time (July-Oct 2017) was obtained. The dataset included whether the image was ordered Stat vs Routine, time of image order, physician name and location, and reason for the imaging study.The STAT images were evaluated based on the explanation provided in the CT image order. Currently 2 radiology residents, 2 internal medicine residents, and 2 internal medicine hospitalists are evaluating all STAT CT images to determine appropriateness and how long they are willing to wait for the image to result in a read. RESULTS/ANTICIPATED RESULTS: Analysis of all CT Chest/Abd/Pelvis imaging orders revealed that 51% (1710/3345) of them were ordered as STAT. The preliminary analysis of 227 STAT images showed that 6% were inappropriate. We anticipate results of our survey to show differences in how long a STAT vs Routine image orders should take amongst Radiology and Internal Medicine clinicians. We also anticipate our survey to show differences in factors that warrant STAT imaging amongst the different medical fields. We anticipate that the clinician manual evaluation of all STAT CT image will reveal a large percentage of imaging orders to be inappropriate. All STAT imaging that were flagged as inappropriate will be characterized by the department who ordered the image and the reason provided for the imaging to assess for common themes. DISCUSSION/SIGNIFICANCE OF IMPACT: STAT images are the new routine with more images ordered STAT than Routine. Inappropriate STAT imaging results in truly urgent patients not getting the medical care they need. Many images ordered stat could potentially be switched to routine. By evaluating why clinicians are ordering STAT CT image inappropriately, we will be able to develop targeted interventions to decrease inappropriate STAT CT imaging.

scholarly journals Resident Scores on a Patient Satisfaction Survey: Evidence for Maintenance of Communication Skills Throughout Residency

2011 ◽  
Vol 3 (4) ◽  
pp. 487-489 ◽  
Author(s):  
Emily A. Stewart ◽  
Dina Halegoua-De Marzio ◽  
Douglas E. Guggenheim ◽  
Joanne Gotto ◽  
J. Jon Veloski ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Patient Satisfaction ◽  
Communication Skills ◽  
Satisfaction Survey ◽  
Patient Satisfaction Survey ◽  
Patient Rating ◽  
Internal Medicine Residents ◽  
Significant Difference ◽  
Different Levels ◽  
Satisfaction Surveys

Abstract Objective To examine whether resident communication skills evaluated through patient satisfaction surveys demonstrate evidence of decline through the 3 years of internal medicine residency. Methods Data for this study were collected retrospectively from a database of patient satisfaction surveys completed for internal medicine residents at different levels of training. Patient satisfaction was measured with the Aggregated EVGFP (excellent, very good, good, fair, or poor) questionnaire recommended by the American Board of Internal Medicine. Results Over a span of 5 years (2005–2009), a total of 768 patient rating forms were completed for 67 residents during their 3 years of residency training. In postgraduate year (PGY)–1, the residents had a mean satisfaction rating of 4.33 ± 0.48 compared to a mean rating of 4.37 ± 0.45 in their PGY-3 year. Analysis of variance indicated no significant difference by PGY level. Conclusion Our findings demonstrate that resident communication skills and patient satisfaction do not decline during the 3 years of residency. This is contrary to our hypothesis that patient satisfaction would worsen as residents progressed through training.

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