scholarly journals Advancing Internal Medicine Training: Experience of a Bedside Procedure Service as A Resident Elective

2020 ◽  
Author(s):  
Sheila Swartz ◽  
Adrian Umpierrez De Reguero ◽  
Joseph Puetz ◽  
Lara Voigt ◽  
Nikola Cuzovic ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Ultrasound Guidance ◽  
Improve Patient Safety ◽  
Tertiary Care ◽  
Hospital Medicine ◽  
Complication Rates ◽  
Training Experience ◽  
Internal Medicine Training ◽  
Internal Medicine Residents ◽  
Procedural Complications

Abstract Background: In 2007, the American Board of Internal Medicine eliminated numeric procedure requirements for licensing. The level of exposure to procedures during residency, and subsequent competence of graduating residents, is variable. In 2015, our institution developed a bedside procedure service (BPS) with the intent to teach ultrasound guidance and procedural training to internal medicine residents with direct supervision of technique by Hospital Medicine faculty to optimize learning, increase confidence, and improve patient safety. Objective: In this study, we review the number and complication rates of resident procedures on a dedicated internal medicine bedside procedure service (BPS) as a resident elective.Methods: In this retrospective, observational, single-center study, we reviewed internally collected data from BPS procedures performed from 2015-2019. The BPS offers a variety of procedures done with ultrasound guidance at an adult tertiary care referral center. BPS services are available to all inpatient hospital services. A rotation with the BPS was offered as a stand-alone resident elective for the first time in 2015. Results: 69 residents performed a total of 2700 ultrasound-guided/assisted procedures and 146 diagnostic ultrasound scans from 2015-2019. Residents performed an average of 40 procedures during their elective month. There were 5 resident performed procedural complications with an overall complication rate of 0.19%.Conclusions: Our BPS increased procedural opportunities for residents and allowed for real-time feedback by an experienced faculty member in a one-on-one setting. A dedicated rotation allows the time to focus on becoming proficient in invasive procedures with expert supervision.

scholarly journals Timing and Predictors of Subspecialty Career Choice Among Internal Medicine Residents: A Retrospective Cohort Study

2020 ◽  
Vol 12 (2) ◽  
pp. 212-216
Author(s):  
Jingkun Yang ◽  
Surbhi Singhal ◽  
Yingjie Weng ◽  
Jason P. Bentley ◽  
Neel Chari ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Career Choice ◽  
Residency Training ◽  
Career Choices ◽  
Hospital Medicine ◽  
Care Hospital ◽  
Clinical Exposure ◽  
Internal Medicine Residents ◽  
Primary Care Hospital ◽  
Early Clinical Exposure

ABSTRACT Background Internal medicine residents face numerous career options after residency training. Little is known about when residents make their final career choice. Objective We assessed the timing and predictive factors of final career choices among internal medicine residents at graduation, including demographics, pre-residency career preferences, and rotation scheduling. Methods We conducted a retrospective study of graduates of an academic internal medicine residency program from 2014 to 2017. Main measures included demographics, rotation schedules, and self-reported career choices for residents at 5 time points: recruitment day, immediately after Match Day, end of postgraduate year 1 (PGY-1), end of PGY-2, and at graduation. Results Of the 138 residents eligible for the study, 5 were excluded based on participation in a fast-track program for an Accreditation Council for Graduate Medical Education subspecialty fellowship. Among the remaining 133 residents, 48 (36%) pursued general internal medicine fields and 78 (59%) pursued fellowship training. Career choices from recruitment day, Match Day, and PGY-1 were only weakly predictive of the career choice. Many choices demonstrated low concordance throughout training, and general medicine fields (primary care, hospital medicine) were frequently not decided until after PGY-2. Early clinical exposure to subspecialty rotations did not predict final career choice. Conclusions Early career choices before and during residency training may have low predictability toward final career choices upon graduation in internal medicine. These choices may continue to have low predictability beyond PGY-2 for many specialties. Early clinical exposure may not predict final career choice for subspecialties.

scholarly journals Fulfilling the Promise of Hospital Medicine: Tailoring Internal Medicine Training to Address Hospitalists’ Needs

2008 ◽  
Vol 23 (11) ◽  
pp. 1931-1931 ◽  
Author(s):  
Jeffrey J. Glasheen ◽  
Eric M. Siegal ◽  
Kenneth Epstein ◽  
Jean Kutner ◽  
Allan V. Prochazka
Keyword(s):  
Internal Medicine ◽  
Hospital Medicine ◽  
Internal Medicine Training

scholarly journals Assessing Physician Barriers to Cardiac Rehabilitation Referral Rates in a Tertiary Teaching Centre

1970 ◽  
Vol 11 (1) ◽  
Author(s):  
Andrew Duncan MD ◽  
MK Natarajan ◽  
JD Schwalm
Keyword(s):  
Internal Medicine ◽  
Cardiac Rehabilitation ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
Eligibility Criteria ◽  
Referral Rates ◽  
General Internal ◽  
Internal Medicine Residents ◽  
Tertiary Teaching ◽  
Question Survey

Introduction: Cardiac rehabilitation (CR) has a proven morbidity and mortality benefit, yet rates of referral remain low. We sought to elucidate the knowledge, utilization, referral, and endorsement practices of cardiac rehabilitation in a tertiary care centre.Methods: A 13-question survey was electronically distributed to all Internal Medicine residents, Cardiology residents and subspecialty fellows, General Internal Medicine attendings and Cardiology attendings practising in a tertiary care centre. The survey assessed the physicians’ knowledge of what CR entails, its benefits, patient eligibility and personal practices with respect to CR referral.Results: The survey was distributed to 153 physicians with a response rate of nearly 60 percent. Compared to their medicine counterparts, Cardiology residents and staff had significantly improved knowledge with respect to what CR entails and eligibility criteria for referral (6.92 vs. 6.11 out of 9, p=0.036; 12.04 vs. 10.76 out of 17, p = 0.013). Medicine residents and staff were less likely to be familiar with CR guidelines (72.02 vs. 32.69, p<0.01), and were less likely to discuss the importance of CR attendance with their patients (43.28 vs. 71.15, p=0.0002). A higher proportion of those in Medicine also reported being unsure of both how to refer eligible patients (59.12 vs. 13.46, p<0.0001) and which patients were eligible for CR (64.92 vs. 23.08, p<0.0001). Higher knowledge scores and familiarity with CR guidelines was associated with higher self-reported referral rates. Conclusion: This survey has identified clear physician barriers, most significant among internal medicine residents and staff. These barriers can help inform interventions to improve CR referral and enrolment rates.

scholarly journals Why Residents Consider Working Beyond the Duty Hour Limits: Implications of the ACGME 2011 Duty Hour Standards

2011 ◽  
Vol 3 (4) ◽  
pp. 571-573 ◽  
Author(s):  
Kathlyn E. Fletcher ◽  
Sarah Nickoloff ◽  
Jeff Whittle ◽  
Jeffrey L. Jackson ◽  
Michael Frank ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Educational Opportunities ◽  
Descriptive Statistics ◽  
Care Hospital ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Internal Medicine Residents ◽  
Program Leadership

Abstract Background The Accreditation Council for Graduate Medical Education 2011 duty hour standards became effective on July 1, 2011. One of the new standards allows residents to exceed the limit on continuous duty hours in unusual circumstances relating to patient or family need or rare educational opportunities. There are no data about how often or in what circumstances residents would consider exceeding their duty hour limits using this new provision in the standards. We surveyed internal medicine residents to explore these questions. Methods We conducted an anonymous cross-sectional survey of internal medicine residents at a midwestern tertiary-care hospital to determine how often they had considered exceeding duty hour limits in the preceding 2 weeks. We analyzed responses using descriptive statistics and χ2 tests for comparisons. Results We obtained responses from 51 of 86 residents (59%). Of those residents, 69% (35/51) indicated that they had wanted to exceed duty hour limits at least once in the prior 2 weeks. The most common reason cited was to provide continuity of care for a patient. The 24 + 6–hour rule was the standard most likely to be broken (cited by 66%; 23/35). Conclusions Program leadership should anticipate that residents will commonly identify situations in which they will consider exceeding duty hour limits. It will be important to provide guidance to residents early in the year about the situations that would be appropriate for the application of this new standard.

scholarly journals A Survey of Practitioner’s Knowledge of Psychiatric Medication Costs

2013 ◽  
Vol 6 (3) ◽  
pp. 89-93
Author(s):  
Deepak Rajpoot ◽  
Albert B Poje ◽  
Larry Carver ◽  
Jyoti Rajpoot ◽  
Ravi Rajpoot ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Psychiatric Symptoms ◽  
Psychiatric Training ◽  
Psychiatric Medication ◽  
Training Experience ◽  
Internal Medicine Training ◽  
Medication Costs ◽  
Accurate Knowledge ◽  
Contemporary Medicine ◽  
Attending Physicians

Introduction. Escalating medical costs continue to be an issue facing contemporary medicine. One factor contributing to this escalation may be physicians’ knowledge of medication costs. As physicians increasingly face opportunities to treat a variety of symptoms and conditions in a single patient, including co-morbid psychiatric disorders or complications, accurate knowledge of medication costs becomes increasingly important. Methods. Resident and attending physicians (N = 16) across the disciplines of internal medicine, psychiatry, and combined internal medicine/psychiatry from a large, mid-western medical school were surveyed on the costs of several medications that are used to manage physical and psychiatric symptoms. Results. Differences were found in the perceived estimated cost of medications among practitioners particularly with specialty internal medicine training as compared to those with additional psychiatric training/experience. Trends also were noted across practitioners with psychiatric and internal medicine/psychiatry training. Conclusions. The breadth of training and experience can affect accuracy in estimating anticipated costs of medication regimens.

scholarly journals The Neighborhood Health Exchange: Developing a Community Partnership in Residency

2010 ◽  
Vol 2 (3) ◽  
pp. 456-461 ◽  
Author(s):  
Kimberly M. Tartaglia ◽  
Valerie G. Press ◽  
Benjamin H. Freed ◽  
Timothy Baker ◽  
Joyce W. Tang ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Residency Training ◽  
Current System ◽  
Hospital Setting ◽  
Community Outreach ◽  
Community Partnership ◽  
Community Members ◽  
Training Experience ◽  
Ambulatory Training ◽  
Internal Medicine Residents

Abstract Background The current system of residency training focuses on the hospital setting, and resident exposure to the surrounding community is often limited. However, community interaction can play an important role in ambulatory training and in learning systems-based practice, a residency core competency. The goal of the Neighborhood Health Exchange was to develop a community partnership to provide internal medicine residents with an opportunity to interface with community members through a mutually beneficial educational experience. Methods Internal medicine residents received training during their ambulatory block and participated in a voluntary field practicum designed to engage community members in discussions about their health. Community members participated in education sessions led by resident volunteers. Results Resident volunteers completed a survey on their experiences. All residents stated that the opportunity to lead an exchange was very useful to their overall residency training. Eight exchanges were held with a total of 61 community participants, who completed a 3-question survey following the session. This survey asked about the level of material, the helpfulness of the exchanges, and opportunities for improvement. We received 46 completed surveys from community members: 91% stated that the material was presented “at the right level” and 93% stated that the presentations were somewhat or very helpful. Eighty percent gave positive and encouraging comments about the exchange. Conclusion Effective community partnerships involve assessing needs of the stakeholders, anticipating leadership turnover, and adapting the Neighborhood Health Exchange model to different groups. Community outreach can also enhance internal medicine ambulatory training experience, provide residents with patient counseling opportunities, and offer a novel method to enhance resident understanding of systems-based practice, especially within the larger community in which their patients live.

An Integrated Geriatric Training Experience for Internal Medicine Residents

1988 ◽  
Vol 7 (3-4) ◽  
pp. 29-41 ◽  
Author(s):  
Galen L. Barbour ◽  
Mary Jane Tompkins ◽  
Myron G. Eisenberg
Keyword(s):  
Internal Medicine ◽  
Training Experience ◽  
Internal Medicine Residents

scholarly journals Fulfilling the Promise of Hospital Medicine: Tailoring Internal Medicine Training to Address Hospitalists’ Needs

2008 ◽  
Vol 23 (7) ◽  
pp. 1110-1115 ◽  
Author(s):  
Jeffrey J. Glasheen ◽  
Eric M. Siegal ◽  
Kenneth Epstein ◽  
Jean Kutner ◽  
Allan V. Prochazka
Keyword(s):  
Internal Medicine ◽  
Hospital Medicine ◽  
Internal Medicine Training

A Survey of Arthrocentesis and Soft-Tissue Injection Procedures Performed in Primary Care Practice: Effect of Resident Training and Using Data to Shape Curriculum

2011 ◽  
Vol 38 (9) ◽  
pp. 1986-1989 ◽  
Author(s):  
CATHERINE J. BAKEWELL ◽  
GREGORY C. GARDNER
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Soft Tissue ◽  
Primary Care Practice ◽  
Hospital Medicine ◽  
Resident Training ◽  
Practice Effect ◽  
Care Practice ◽  
Internal Medicine Training ◽  
Using Data

Objective.The purpose of this study is (1) to survey graduates of our internal medicine program for use of musculoskeletal (MSK) procedures in primary care practice and assess the influence of participating in a first-year resident arthrocentesis and soft-tissue injection training course on their MSK procedure comfort/utilization; and (2) to use the results to modify our MSK procedure curriculum.Methods.A questionnaire designed to assess numbers of, comfort with, and effect of resident training on MSK procedures in the preceding year was sent to 2002–2006 graduates of the internal medicine training program in outpatient primary care (OPC). Graduates practicing hospital medicine (HM) also received the questionnaire and served as a comparison group.Results.There were 52 responses from this group of 84 graduates (64% response rate). OPC graduates (N = 32) were more comfortable doing procedures than those practicing HM exclusively (N = 20), and performed significantly more procedures in the preceding year (32.9 procedures per OPC/year vs 2.2 for HM). The most common procedures performed were knee joint, subacromial bursa, and trochanteric bursa, comprising > 75% of all procedures performed. A structured resident course in MSK procedures had a significant effect on the OPC physicians. Course participants (N = 17) performed almost twice the number of procedures/year as the nonparticipants (N = 15), were more comfortable with the procedures, and were significantly less likely to refer procedures to other clinicians. Written comments by respondents suggest additional MSK procedure training during and after residency is needed.Conclusion.Our results suggest a structured resident course in MSK procedures has a longterm influence. A progressively more focused approach to training is needed.

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