scholarly journals The Resident Voice: Identifying Qualities of Resident Leadership with a Focus Group of Second Year Residents

2021 ◽  
Author(s):  
Charlotte Chaiklin ◽  
Dana Hassneiah ◽  
Barry Issenberg ◽  
Sabrina Taldone
Keyword(s):  
Internal Medicine ◽  
Emotional Intelligence ◽  
Focus Group ◽  
Residency Program ◽  
Core Competency ◽  
Point Of View ◽  
Team Members ◽  
Principal Characteristics ◽  
Program Leaders ◽  
Institutional Review

Abstract Background The Accreditation Council for Graduate Medical Education (ACGME) Internal Medicine Residency Program Guidelines identifies leadership as a core competency. The definition of strong resident leadership is not clearly defined. Prior studies have identified characteristics of resident leadership from the perspective of residency program leaders with little emphasis on the resident point of view. Objective This study aims to identify qualities of effective resident leadership from the perspective of Internal Medicine (IM) residents. Methods Participants were recruited through email invitations. An online focus group with five IM residents was conducted in September 2020. The transcribed discussion was inductively analyzed using thematic data analysis.Results Analysis resulted in four main themes of strong resident leadership: mentorship, team ownership, communication, and emotional intelligence. All four themes were further characterized by subthemes. Being a mentor as a resident leader was described as having the ability to guide, motivate, and empower team members. Team ownership was defined as caring about team image, adaptability, and accountability for team performance. Communication skills included setting expectations, giving feedback, and utilizing closed-loop communication. Emotional intelligence was characterized as practicing empathy, psychological safety, and appreciation.Conclusions Strong resident leadership is crucial to providing effective residency training and the highest level of patient care. This study identifies from the perspective of residents, the principal characteristics of strong resident leadership: mentorship, communication, team ownership, and emotional intelligence. The identification of these characteristics provides an opportunity to create leadership curricula for residents that focus on developing these specific skills. Trial Registration The University of Miami institutional review board (IRB) approved this study: IRB number MOD0041899 on September 14, 2020.

scholarly journals Effect of resident and assessor gender on entrustment-based observational assessment in an internal medicine residency program

MedEdPublish ◽  
2021 ◽  
Vol 11 ◽  
pp. 2
Author(s):  
Danielle E. Weber ◽  
Benjamin Kinnear ◽  
Matthew Kelleher ◽  
Melissa Klein ◽  
Dana Sall ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Gender Bias ◽  
Residency Program ◽  
Repeated Measures ◽  
Core Competency ◽  
Internal Medicine Residency ◽  
Group Differences ◽  
Internal Medicine Residency Program ◽  
Mixed Effect ◽  
Significant Group

Background: Implicit gender bias leads to differences in assessment. Studies examining gender differences in resident milestone assessment data demonstrate variable results. The purpose of this study was to determine if observational entrustment scores differ by resident and assessor gender in a program of assessment based on discrete, observable skills.  Methods: We analyzed overall entrustment scores and entrustment scores by Accreditation Council for Graduate Medical Education (ACGME) core competency for 238 residents (49% female) from 396 assessors (38% female) in one internal medicine residency program from July 2012 to June 2019. We conducted analyses at 1-12 months, 1-36 months, 1-6 months, 7-12 months, and 31-36 months. We used linear mixed-effect models to assess the role of resident and assessor gender, with resident-specific and assessor-specific random effect to account for repeated measures.  Results: Statistically significant interactions existed between resident and assessor gender for overall entrustment at 1-12 months (p < 0.001), 1-36 months (p< 0.001), 1-6 months (p<0.001), 7-12 months (p=0.04), and 31-36 months (p<0.001). However, group differences were not statistically significant. In several instances an interaction was significant between resident and assessor gender by ACGME core competency, but there were no statistically significant group differences for all competencies at any time point. When applicable, subsequent analysis of main effect of resident or assessor gender independently of one another revealed no statistically significant differences.   Conclusions: No significant differences in entrustment scores were found based on resident or assessor gender in our large, robust entrustment-based program of assessment. Determining the reasons for our findings may help identify ways to mitigate gender bias in assessment.

59. General medicine residents' perception of the mini-CEXs

2007 ◽  
Vol 30 (4) ◽  
pp. 61
Author(s):  
S. Malhotra ◽  
R. Hatala ◽  
C.-A. Courneya
Keyword(s):  
Internal Medicine ◽  
Medical Education ◽  
Focus Group ◽  
Qualitative Study ◽  
Focus Groups ◽  
General Medicine ◽  
Clinical History ◽  
Phenomenological Approach ◽  
Medical Teacher ◽  
The Impact

The mini-CEX is a 30 minute observed clinical encounter. It can be done in the outpatient, inpatient or emergency room setting. It strives to look at several parameters including a clinical history, physical, professionalism and overall clinical competence. Trainees are rated using a 9-point scoring system: 1-3 unsatisfactory, 4-6 satisfactory and 7-9 superior. Eight months after the introduction of the mini-CEX to the core University of British Columbia Internal Medicine Residents, a one hour semi-structured focus group for residents in each of the three years took place. The focus groups were conducted by an independent moderator, audio-recorded and transcribed. Using a phenomenological approach the comments made by the focus groups participants were read independently by three authors, organized into major themes. In doing so, several intriguing common patterns were revealed on how General Medicine Residents perceive their experience in completing a mini-CEX. The themes include Education, Assessment and Preparation for the Royal College of Physicians and Surgeons Internal Medicine exam. Resident learners perceived that the mini-CEX process provided insight into their clinical strengths and weaknesses. Focus group participants favored that the mini-CEX experience will benefit them in preparation, and successful completion of their licensing exam. Daelmans HE, Overmeer RM, van der Hem-Stockroos HH, Scherpbier AJ, Stehouwer CD, van der Vleuten CP. In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation. Medical Education 2006; 40(1):51-8. De Lima AA, Henquin R, Thierer J, Paulin J, Lamari S, Belcastro F, Van der Vleuten CPM. A qualitative study of the impact on learning of the mini clinical evaluation exercise in postgraduate training. Medical Teacher January 2005; 27(1):46-52. DiCicco-Bloom B, Crabtree BF. The Qualitative Research Interview. Medical Education 2006; 40:314-32.

scholarly journals A comparison of orthopaedic surgery and internal medicine perceptions of USMLE Step 1 pass/fail scoring

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Frederick Mun ◽  
Alyssa R. Scott ◽  
David Cui ◽  
Erik B. Lehman ◽  
Seong Ho Jeong ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Extracurricular Activities ◽  
Residency Program ◽  
Medical Schools ◽  
Program Directors ◽  
Program Director ◽  
Personal Knowledge ◽  
Clinical Knowledge ◽  
Alpha Omega ◽  
Residency Program Directors

Abstract Background United States Medical Licensing Examination Step 1 will transition from numeric grading to pass/fail, sometime after January 2022. The aim of this study was to compare how program directors in orthopaedics and internal medicine perceive a pass/fail Step 1 will impact the residency application process. Methods A 27-item survey was distributed through REDCap to 161 U.S. orthopaedic residency program directors and 548 U.S. internal medicine residency program directors. Program director emails were obtained from the American Medical Association’s Fellowship and Residency Electronic Interactive Database. Results We received 58 (36.0%) orthopaedic and 125 (22.8%) internal medicine program director responses. The majority of both groups disagree with the change to pass/fail, and felt that the decision was not transparent. Both groups believe that the Step 2 Clinical Knowledge exam and clerkship grades will take on more importance. Compared to internal medicine PDs, orthopaedic PDs were significantly more likely to emphasize research, letters of recommendation from known faculty, Alpha Omega Alpha membership, leadership/extracurricular activities, audition elective rotations, and personal knowledge of the applicant. Both groups believe that allopathic students from less prestigious medical schools, osteopathic students, and international medical graduates will be disadvantaged. Orthopaedic and internal medicine program directors agree that medical schools should adopt a graded pre-clinical curriculum, and that there should be a cap on the number of residency applications a student can submit. Conclusion Orthopaedic and internal medicine program directors disagree with the change of Step 1 to pass/fail. They also believe that this transition will make the match process more difficult, and disadvantage students from less highly-regarded medical schools. Both groups will rely more heavily on the Step 2 clinical knowledge exam score, but orthopaedics will place more importance on research, letters of recommendation, Alpha Omega Alpha membership, leadership/extracurricular activities, personal knowledge of the applicant, and audition electives.

scholarly journals Enhancing Competency in Professionalism: Targeting Resident Advance Directive Education

2010 ◽  
Vol 2 (2) ◽  
pp. 278-282 ◽  
Author(s):  
Colleen Y. Colbert ◽  
Curtis Mirkes ◽  
Paul E. Ogden ◽  
Mary Elizabeth Herring ◽  
Christian Cable ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Medical School ◽  
Advance Directives ◽  
Advance Directive ◽  
Residency Program ◽  
Health Science ◽  
Science Center ◽  
Sufficient Knowledge ◽  
Significant Difference ◽  
School Curricula

Abstract Background Education about advance directives typically is incorporated into medical school curricula and is not commonly offered in residency. Residents' experiences with advance directives are generally random, nonstandardized, and difficult to assess. In 2008, an advance directive curriculum was developed by the Scott & White/Texas A&M University System Health Science Center College of Medicine (S&W/Texas A&M) internal medicine residency program and the hospital's legal department. A pilot study examining residents' attitudes and experiences regarding advance directives was carried out at 2 medical schools. Methods In 2009, 59 internal medicine and family medicine residents (postgraduate year 2–3 [PGY-2, 3]) completed questionnaires at S&W/Texas A&M (n  =  32) and The University of Texas Medical School at Houston (n  =  27) during a validation study of knowledge about advance directives. The questionnaire contained Likert-response items assessing attitudes and practices surrounding advance directives. Our analysis included descriptive statistics and analysis of variance (ANOVA) to compare responses across categories. Results While 53% of residents agreed/strongly agreed they had “sufficient knowledge of advance directives, given my years of training,” 47% disagreed/strongly disagreed with that statement. Most (93%) agreed/strongly agreed that “didactic sessions on advance directives should be offered by my hospital, residency program, or medical school.” A test of responses across residency years with ANOVA showed a significant difference between ratings by PGY-2 and PGY-3 residents on 3 items: “Advance directives should only be discussed with patients over 60,” “I have sufficient knowledge of advance directives, given my years of training,” and “I believe my experience with advance directives is adequate for the situations I routinely encounter.” Conclusion Our study highlighted the continuing need for advance directive resident curricula. Medical school curricula alone do not appear to be sufficient for residents' needs in this area.

scholarly journals Navigating uncharted waters: Developing a standardized approach for evaluating and implementing biosimilar products at a comprehensive cancer center

2020 ◽  
Author(s):  
Mara N Villanueva ◽  
Jennifer E Davis ◽  
Stacey M Sobocinski
Keyword(s):  
Transition Period ◽  
Treatment Protocol ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Specific Product ◽  
Team Members ◽  
Research Protocols ◽  
Institutional Review ◽  
Multiple Challenges ◽  
Coordinate Changes

Abstract Purpose The processes for formulary implementation and electronic health record (EHR) integration of biosimilar products at a comprehensive cancer center are described. Implications for research protocols are also discussed. Summary The existing literature focuses on practical considerations for formulary addition of biosimilar products, but there is a lack of guidance on how to implement the change, particularly within the EHR. Before building the ordering tools for biosimilars, the clinical and informatics teams should determine the role of biosimilars at the institution, identify drug-specific product characteristics that affect medication build, and characterize implications of future formulary changes or drug shortages. Leveraging an orderable record provides the ability to include logic that maps to multiple products and also allows for future implementation of changes within the medication record rather than requiring “swaps” at the treatment protocol level. The institutional review board should coordinate changes in affected research protocols and consent forms and work with principal investigators to amend protocols when necessary. Pharmacy leaders should develop processes to oversee inventory during the transition period and minimize the risk of errors. Conclusion The development of a standardized approach for evaluating and implementing biosimilar products improves efficiency and collaboration among the various team members responsible for the products’ integration into existing workflows, including implications for clinical research. Implementing biosimilars for agents used to treat cancer will pose new challenges and require additional considerations. Partial implementation of biosimilars continues to pose multiple challenges in the provision of patient care.

Supporting the pursuit of professionalism during a crisis

BMJ Leader ◽  
2021 ◽  
pp. leader-2021-000458
Author(s):  
William O Cooper ◽  
Nancy M Lorenzi ◽  
Heather A Davidson ◽  
Cynthia A Baldwin ◽  
Daniel M Feinberg ◽  
...  
Keyword(s):  
Focus Group ◽  
Essential Elements ◽  
Healthcare Organisation ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Crisis Plans ◽  
Team Members ◽  
Professional Accountability ◽  
Physical Plant

BackgroundCrisis plans for healthcare organisations most often focus on operational needs including staffing, supplies and physical plant needs. Less attention is focused on how leaders can support and encourage individual clinical team members to conduct themselves as professionals during a crisis.MethodsThis qualitative study analysed observations from 79 leaders at 160 hospitals that participate in two national professionalism programmes who shared their observations in focus group discussions about what they believed were the essential elements of leading and addressing professional accountability during a crisis.ResultsAnalysis of focus group responses identified six leadership practices adopted by healthcare organisations, which were felt to be essential for organisations to navigate the crisis successfully. Unique aspects of maintaining professionalism during each phase of the pandemic were identified and described.ConclusionsLeaders need a plan to support an organiation’s pursuit of professionalism during a crisis. Leaders participating in this study identified practices that should be carefully woven into efforts to support the ongoing safety and quality of the care delivered by healthcare organisations before, during and after a crisis. The lessons learnt from the COVID-19 pandemic may be useful during subsequent crises and challenges that a healthcare organisation might experience.

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