A Systemic Approach to Trainee Physician Wellness: Using the Theory of Change to Restructure a Pediatric Residency Program

2021 ◽  
Author(s):  
Mahanoor Raza ◽  
Arshalooz Jamila Rahman ◽  
Khadija Humayun ◽  
Shafeen Gulamani ◽  
Muneera Rasheed ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Patient Care ◽  
Residency Program ◽  
Well Being ◽  
Attrition Rate ◽  
Theory Of Change ◽  
Feedback Form ◽  
Improvement Project ◽  
Final Theory ◽  
Pediatric Residency

Abstract Background: Resident well-being leads to better patient care practices, but a systematic approach is needed to achieve the wellness agenda. The Theory of Change was used for developing an interventional model for wellness in our study, after identifying the causes of burnout and attrition in a pediatric residency program. Methods: This was a quality improvement project where residents were asked about their main stressors in an anonymous open-ended feedback form. Workload (n=63, 37.5%) was identified as the main source of dissatisfaction. A database of 43 residents who quit in the past ten years was examined to find 40.0% of residents left after the first year of training and the main cause was marriage and/or family concerns (28.9%). Then literature was reviewed to build a wellness intervention's framework. Finally, the Theory of Change was applied focusing on restructuring the residency core, accountability and communication, and stress management. The final theory of the change model included the assumptions that the program needed restructuring because of high attrition, low first pass exam rate, and decreased patient satisfaction. The goal was to increase resident wellness and performance, while keeping patient care at the core. Results: The short-term outcomes were drop in attrition rate from an average of 8.67% to 1.75%, decrease in FCPS exam attempt from 3.3 to almost 1, and an increase in patient satisfaction. Conclusion: Using the Theory of Change, it was possible to address residents’ concerns, increase their retention and improve patient satisfaction by reconstructing the wellness program.

scholarly journals Utilizing Quality Improvement Methods to Improve Patient Care Outcomes in a Pediatric Residency Program

2009 ◽  
Vol 1 (2) ◽  
pp. 299-303 ◽  
Author(s):  
Ralitsa B. Akins ◽  
Gilbert A. Handal
Keyword(s):  
Quality Improvement ◽  
Patient Care ◽  
Residency Program ◽  
Improve Patient Care ◽  
Resident Training ◽  
Lessons Learned ◽  
Residency Programs ◽  
Pediatric Residency ◽  
Care Outcomes ◽  
Improve Patient

Abstract Objective Although there is an expectation for outcomes-oriented training in residency programs, the reality is that few guidelines and examples exist as to how to provide this type of education and training. We aimed to improve patient care outcomes in our pediatric residency program by using quality improvement (QI) methods, tools, and approaches. Methods A series of QI projects were implemented over a 3-year period in a pediatric residency program to improve patient care outcomes and teach the residents how to use QI methods, tools, and approaches. Residents experienced practice-based learning and systems-based assessment through group projects and review of their own patient outcomes. Resident QI experiences were reviewed quarterly by the program director and were a mandatory part of resident training portfolios. Results Using QI methodology, we were able to improve management of children with obesity, to achieve high compliance with the national patient safety goals, improve the pediatric hotline service, and implement better patient flow in resident continuity clinic. Conclusion Based on our experiences, we conclude that to successfully implement QI projects in residency programs, QI techniques must be formally taught, the opportunities for resident participation must be multiple and diverse, and QI outcomes should be incorporated in resident training and assessment so that they experience the benefits of the QI intervention. The lessons learned from our experiences, as well as the projects we describe, can be easily deployed and implemented in other residency programs.

scholarly journals Novel Changes in Resident Education during a Pandemic: Strategies and Approaches to Maximize Residency Education and Safety

2020 ◽  
Vol 24 (03) ◽  
pp. e267-e271
Author(s):  
Jared Johnson ◽  
Michael T. Chung ◽  
Michael A. Carron ◽  
Eleanor Y. Chan ◽  
Ho-Sheng Lin ◽  
...  
Keyword(s):  
Patient Care ◽  
Residency Program ◽  
Resident Education ◽  
Geographical Location ◽  
Well Being ◽  
Residency Education ◽  
Training Experience ◽  
The Third ◽  
The Core ◽  
Traditional Training

Abstract Introduction The COVID-19 pandemic has led to a reduction in surgical and clinical volume, which has altered the traditional training experience of the otolaryngology resident. Objective To describe the strategies we utilized to maximize resident education as well as ensure patient and staff safety during the pandemic. Methods We developed a system that emphasized three key elements. First and foremost, patient care remained the core priority. Next, clinical duties were restructured to avoid unnecessary exposure of residents. The third component was ensuring continuation of resident education and maximizing learning experiences. Results To implement these key elements, our residency divided up our five hospitals into three functional groups based on geographical location and clinical volume. Each team works for three days at their assigned location before being replaced by the next three-person team at our two busiest sites. Resident teams are kept completely separate from each other, so that they do not interact with those working at other sites. Conclusions Despite the daily challenges encountered as we navigate through the COVID-19 pandemic, our otolaryngology residency program has been able to establish a suitable balance between maintenance of resident safety and well-being without compromise to patient care.

Teletinnitus Program at the VA Gulf Coast Veterans Health Care System

2014 ◽  
Vol 4 (1) ◽  
pp. 23-29
Author(s):  
Constance Hilory Tomberlin
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Patient Care ◽  
Health Care System ◽  
Gulf Coast ◽  
New Technology ◽  
Cost Effective ◽  
Veterans Health ◽  
Potential Benefits ◽  
Care System

There are a multitude of reasons that a teletinnitus program can be beneficial, not only to the patients, but also within the hospital and audiology department. The ability to use technology for the purpose of tinnitus management allows for improved appointment access for all patients, especially those who live at a distance, has been shown to be more cost effective when the patients travel is otherwise monetarily compensated, and allows for multiple patient's to be seen in the same time slots, allowing for greater access to the clinic for the patients wishing to be seen in-house. There is also the patient's excitement in being part of a new technology-based program. The Gulf Coast Veterans Health Care System (GCVHCS) saw the potential benefits of incorporating a teletinnitus program and began implementation in 2013. There were a few hurdles to work through during the beginning organizational process and the initial execution of the program. Since the establishment of the Teletinnitus program, the GCVHCS has seen an enhancement in patient care, reduction in travel compensation, improvement in clinic utilization, clinic availability, the genuine excitement of the use of a new healthcare media amongst staff and patients, and overall patient satisfaction.

Educate! Developing a Theory of Change for “Changemakers”

2018 ◽  
Author(s):  
Mary Kay Gugerty ◽  
Dean Karlan
Keyword(s):  
Change Process ◽  
Evaluation System ◽  
Program Design ◽  
Field Research ◽  
Monitoring And Evaluation ◽  
Theory Of Change ◽  
Youth Empowerment ◽  
Evaluation Plan ◽  
Final Theory

A theory of change can build consensus on a program’s vision and guide the development of a right-fit monitoring and evaluation system. This case examines how the Uganda-based youth empowerment NGO Educate! used the theory of change process to clearly define its intended impact and decide how to measure it. After analyzing the process Educate! used to develop its theory of change, readers will be able to discuss the value of gathering internal perspectives and conducting field research to develop a theory of change. Readers will also assess how successive iterations of the theory of change provide clarity on program design and objectives and determine whether the final theory of change is sufficient to design a monitoring and evaluation plan that adheres to CART principles.

261 Using Technology to Improve Inpatient Surgical Lists

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Gowda ◽  
Z Chia ◽  
T Fonseka ◽  
K Smith ◽  
S Williams
Keyword(s):  
Quality Improvement ◽  
Patient Care ◽  
Junior Doctors ◽  
Research Projects ◽  
Point Scale ◽  
Improvement Project ◽  
Surgical Department ◽  
Team Meetings ◽  
And Training ◽  
Multi Disciplinary Team

Abstract Introduction Every day in our surgical department; prior to our quality improvement project, Junior Doctors spent on average 3.26 clinical hours maintaining 5 surgical inpatient lists of different specialities with accessibility of lists rated as “neutral” based on a 5-point scale from difficult to easy. Our hospital previously had lists stored locally on designated computers causing recurrent difficulties in accessing and editing these lists. Method We used surveys sent to clinicians to collect data. Cycle 1: Surgical Assessment Units list on Microsoft Teams Cycle 2: Addition of surgical specialities and wards lists onto Microsoft Teams. Cycle 3 (current): expand the use of Microsoft Teams to other specialities. Results Utilising technology led to a 25% reduction in time spent on maintaining inpatient lists, to 2.46 hours a day, and an improvement in the accessibility of lists to “easy”. Across a year, this saves over 220 hours clinician hours which can be used towards patient care and training. Furthermore, use of Microsoft Teams has improved communication and patient care, in the form of virtual regional Multi-Disciplinary Team meetings and research projects. Conclusions Microsoft Teams is currently free to all NHS organisations in England so there is potential for these efficiency savings to be replicated nationwide.

Identification of the Optimal Recipient Layer for Transplanted Fat: A Prospective Study on Breast Lipoaugmentation

2018 ◽  
Vol 39 (10) ◽  
pp. 1071-1081 ◽  
Author(s):  
Xiaoshuang Guo ◽  
Dali Mu ◽  
Wenshan Xing ◽  
Yaping Qu ◽  
Jie Luan
Keyword(s):  
Patient Satisfaction ◽  
Prospective Study ◽  
Retention Rate ◽  
Well Being ◽  
Retention Rates ◽  
Prospective Clinical Study ◽  
Pectoralis Muscle ◽  
Recipient Site ◽  
Minimal Invasiveness ◽  
Volume Retention

Abstract Background Fat grafting has become a popular procedure in aesthetic and reconstructive surgeries due to its safety, minimal invasiveness, and favorable visual outcomes, although the volume retention rate is unpredictable. Objectives A prospective clinical study on lipoaugmentation of the breast was conducted to compare fat retention rates in the pectoralis muscle and the periglandular area. Methods This prospective study included 20 breasts from 11 patients who underwent primary lipoaugmentation. Volume retention rate and percentage augmentation among different recipient layers, as well as complications and patient satisfaction, were evaluated. Magnetic resonance imaging was performed preoperatively and at 1 day and 3 months postoperatively. Complications were recorded, and patient satisfaction was appraised through the use of the Breast-Q questionnaire. Results Breasts were injected with 207 ± 29 mL of fat, achieving overall volume retention rates of 56.63% ± 16.40%. The overall augmentation was 21.53% ± 10.27%. Volume retention rate was significantly higher (59.00% ± 13.84%) in the periglandular area than in the pectoralis muscle (47.21% ± 22.41%) (P = 0.04). Augmentation was significantly higher (32.13% ± 12.96%) in the periglandular area than in the pectoralis muscle (4.95% ± 4.23%) (P = 0.00). Pain and numbness were the only reported complications. The Breast-Q score increased significantly for the measures “satisfaction with breasts,” “psychosocial well-being,” and “sexual well-being.” Conclusions Fat transfer is a safe and acceptable method for aesthetic and reconstructive breast surgery. The periglandular area was a better recipient site than muscle for transferred fat. Level of Evidence: 4

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