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 Can the CROSS protocol be safely implemented in real world scenario with broader eligibility criteria? Experience from a tertiary care centre in India

2021 ◽  
Vol 15 ◽  
Author(s):  
Tapesh Bhattacharyya ◽  
Moses Arunsingh ◽  
Santam Chakraborty ◽  
Vishnu Harilal ◽  
Rohit Sasidharan ◽  
...  
Keyword(s):  
Real World ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Eligibility Criteria ◽  
The Cross

scholarly journals Validation of content of clinical cases in obstetric medicine for a shared web-based educational tool

2018 ◽  
Vol 12 (3) ◽  
pp. 129-135
Author(s):  
Annabelle Cumyn ◽  
Paul Gibson
Keyword(s):  
Internal Medicine ◽  
General Internal Medicine ◽  
Web Based ◽  
Clinical Exposure ◽  
General Internal ◽  
Internal Medicine Residents ◽  
Obstetric Medicine ◽  
The Creation ◽  
High Level ◽  
Clinical Cases

Subsequent to the validation of a Canadian Curriculum blueprint for Obstetric Medicine (OM), the Canadian Consensus for a Curriculum in Obstetric Medicine (CanCOM) research group was approached to develop 20 cases to address gaps in clinical exposure during clinical rotations in OM. Forty-nine Obstetric Internists were identified and 43 confirmed their affiliation to the group. Participants (N = 22) reviewed the content of the CanCOM blueprint and identified curriculum content that they considered essential for a rotation for senior General Internal Medicine residents. This survey led to the creation of the CanCOM II essential content blueprint for General Internal Medicine. Following this step, a second subgroup of participants (N = 21) participated in a Delphi survey to identify the content that should be addressed by a teaching case for senior General Internal Medicine residents. A high-level of consensus was obtained for 13 topics and a moderate level for the 7 subsequent topics resulting in the creation of the CanCOM II clinical cases available at http://gemoq.ca/cancom-ii-clinical-case-databank/

Development of an Intravenous-to-Oral Route Conversion Program for Antimicrobial Therapy at a Canadian Tertiary Care Health Facility

1997 ◽  
Vol 31 (5) ◽  
pp. 564-570 ◽  
Author(s):  
Monique T Zamin ◽  
Monique M Pitre ◽  
John M Conly
Keyword(s):  
Internal Medicine ◽  
Oral Therapy ◽  
Respiratory Tract Infections ◽  
Tertiary Care ◽  
Soft Tissue Infections ◽  
Intravenous Therapy ◽  
General Internal ◽  
Care Health ◽  
Internal Medicine Wards ◽  
Tract Infections

OBJECTIVE: To describe the effect of introducing a route conversion program on the prescribing of antimicrobials for the treatment of respiratory tract infections and skin/soft tissue infections in a sample population. DESIGN: Concurrent, pre- and postintervention study. SETTING: Four general internal medicine wards at The Toronto Hospital, a 1170-bed, tertiary care health center in Toronto, Ontario, Canada. PARTICIPANTS: Patients receiving antimicrobial therapy for respiratory tract infections and skin/soft tissue infections. INTERVENTION: Written guidelines and education sessions were presented to residents, interns, medical students, and pharmacists responsible for the care of patients admitted to four general internal medicine wards. MAIN OUTCOME MEASURES: Clinical and laboratory parameters related to the status of the infection were monitored prospectively and compared with the course of drug therapy, with consideration of the patient's ability to meet the criteria established in the guidelines. The number of days of intravenous therapy prescribed despite appropriateness of oral therapy was tallied. RESULTS: Twenty-seven patients (28 infections) were identified for inclusion in the 7-week preliminary audit, and 30 patients (32 infections) were included in the audit after the program, which continued for 5 weeks. Following implementation of the program, the number of days that intravenous therapy was continued despite the appropriateness of oral therapy was reduced from 41% to 26% of the total days of intravenous therapy prescribed. CONCLUSIONS: The program had a positive influence on antimicrobial prescribing behavior in the population studied. Strategies to ensure continued benefit from the program have been developed.

scholarly journals System-Based Approach to Educating Internal Medicine Residents on Preventable Hospital Readmissions

2012 ◽  
Vol 4 (4) ◽  
pp. 505-509 ◽  
Author(s):  
Mario Njeim ◽  
Maguy Chiha ◽  
Sarah Whitehouse ◽  
Kimberly Baker-Genaw
Keyword(s):  
Internal Medicine ◽  
General Practice ◽  
Assessment Tool ◽  
Hospital Readmissions ◽  
Tertiary Hospital ◽  
General Internal ◽  
Multiple Factors ◽  
Internal Medicine Residents ◽  
Additional Feedback ◽  
Education Initiative

Abstract Background A literature gap exists in educating internal medicine residents about hospital readmissions and how to prevent them. Intervention The study aimed to implement a readmissions education initiative for general internal medicine inpatient resident teams in 3 general practice units at an urban, tertiary hospital. Methods Senior residents were given access to a daily list of readmissions, used a readmission assessment tool to investigate causes and to assess whether each readmission was preventable, led a monthly general practice unit team meeting to discuss each case, and presented their findings at the monthly multidisciplinary readmissions meeting for additional feedback. For program evaluation, we hypothesized that the “preventable” readmissions count tracked via the readmissions assessment tool would increase as residents became better educated on the root causes of readmissions. We also conducted a survey to assess perception of the readmissions education initiative. Results “Preventable” readmissions increased from 21% for the first 3 months of the intervention (September–November 2010) to 46% for the most recent 3 months (January–March 2011). The survey showed that 98% (41 of 42) of respondents who had attended a multidisciplinary readmissions meeting felt involved in an effort to review or improve the rate of hospital readmissions, whereas only 40% (21 of 53) of the group that never attended a session shared the same answer. Conclusions This initiative required few resources, and it appeared to help residents identify “preventable” reasons for readmissions, as well as increased their perceptions of being actively involved in reducing hospital readmissions. The intervention was not associated with a statistically significant reduction in readmissions, which may be influenced primarily by multiple factors outside residents' control.

scholarly journals Analysis of Smartphone Interruptions on Academic General Internal Medicine Wards

2017 ◽  
Vol 26 (01) ◽  
pp. 01-11 ◽  
Author(s):  
Alon Vaisman ◽  
Robert Wu
Keyword(s):  
Internal Medicine ◽  
General Internal Medicine ◽  
Text Messaging ◽  
Linear Regression Analysis ◽  
Tertiary Care ◽  
Significant Interaction Effect ◽  
General Internal ◽  
Multivariable Linear Regression Analysis ◽  
Academic General Internal Medicine ◽  
Day Of The Week

SummaryIntroduction: Hospital-based medical services are increasingly utilizing team-based pagers and smartphones to streamline communications. However, an unintended consequence may be higher volumes of interruptions potentially leading to medical error. There is likely a level at which interruptions are excessive and cause a ‘crisis mode’ climate.Methods: We retrospectively collected phone, text messaging, and email interruptions directed to hospital-assigned smartphones on eight General Internal Medicine (GIM) teams at two tertiary care centres in Toronto, Ontario from April 2013 to September 2014. We also calculated the number of times these interruptions exceeded a pre-specified threshold per hour, termed ‘crisis mode’, defined as at least five interruptions in 30 minutes. We analyzed the correlation between interruptions and date, site, and patient volumes.Results: A total of 187,049 interruptions were collected over an 18-month period. Daily weekday interruptions rose sharply in the morning, peaking between 11 AM to 12 PM and measuring 4.8 and 3.7 mean interruptions/hour at each site, respectively. Mean daily interruptions per team totaled 46.2 ± 3.6 at Site 1 and 39.2 ± 4.2 at Site 2. The ‘crisis mode’ threshold was exceeded, on average, 2.3 times/day per GIM team during weekdays. In a multivariable linear regression analysis, site ([uni03B2]6.43 CI95% 5.44 –7.42, p<0.001), day of the week (with Friday having the most interruptions) ([uni03B2]0.481 CI95% 0.236 –0.730, p<0.05) and patient census ([uni03B2]1.55 CI95% 1.42 –1.67, p<0.05) were all predictive of daily interruption volume although there was a significant interaction effect between site and patient census ([uni03B2]-0.941 CI95% -1.18 –-0.703, p<0.05).Conclusion: Interruptions were related to site-specific features, including volume, suggesting that future interventions should target the culture of individual hospitals. Excessive interruptions may have implications for patient safety especially when exceeding a maximal threshold over short periods of time.

Educating Internal Medicine Residents on Palliative Medicine and Hospice Care at a Community Teaching Hospital

2020 ◽  
pp. 104990912097917
Author(s):  
Cassandra Nicotra ◽  
Martin Barnes ◽  
Phyllis Macchio ◽  
Greg Haggerty ◽  
Carolina De Elia ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Palliative Medicine ◽  
Hospice Care ◽  
Medical Knowledge ◽  
Educational Opportunities ◽  
Short Term ◽  
Internal Medicine Residents ◽  
Post Test ◽  
Community Teaching ◽  
Question Survey

Background: The Accreditation Council of Graduate Medical Education (ACGME) currently requires Internal Medicine (IM) GME programs to incorporate educational opportunities for training and structured experiences in Palliative and Hospice Medicine. Miscomprehension of the differences between palliative medicine and hospice care is a barrier for IM residents ordering palliative consults as many residents may underutilize palliative medicine if a patient is not appropriate for hospice. Objective: This educational performance improvement (PI) project assessed 3 domains, including Medical Knowledge (MK) of palliative versus hospice medicine at baseline and following a single didactic session. Additionally, the number of palliative consults ordered was used as a surrogate for interpersonal and communication skills (ICS) and patient care (PC) domains. Methods: An 8-question survey and 30-minute didactic session were created based upon experientially-determined issues most confusing to IM residents. Participants included 33 IM residents (PGY-1s-3 s) from July 2018 (first cohort) and 32 (PGY-1 s and any PGY-2s-3 s who did not participate in the first cohort) from July 2019 (second cohort). Results: 65 of a possible 73 residents participated (89% response rate) Pre-test Questions 5, 6, and 8 correct responses were <50% in both cohorts with average scores, respectively, of 43.1%, 35.4%, and 40%. Residents improved on the post-test for Q5, 6, 8 to, respectively, 80%, 86.7%, and 48.3% (t = 7.68, df = 59, p < 001). Correct Q1 responses declined in the first cohort, but clarification for the second cohort improved from pre-test (36.4%) to post-test (65.5%). The total number of palliative consults placed by IM residents increased as well. Conclusions: Baseline MK of palliative versus hospice medicine was <50% on 4/8 questions. A brief educational session significantly improved residents’ short-term comprehension and increased the number of palliative consults.

scholarly journals Performance of Residents Serving as Clinical Teachers: A Student-Based Assessment

2014 ◽  
Vol 6 (1) ◽  
pp. 123-126 ◽  
Author(s):  
Mayowa O. Owolabi ◽  
Adefemi O. Afolabi ◽  
Akinyinka O. Omigbodun
Keyword(s):  
Internal Medicine ◽  
Medical Students ◽  
Clinical Teaching ◽  
Development Program ◽  
Teaching Skills ◽  
Validity And Reliability ◽  
Faculty Development Program ◽  
Clinical Teachers ◽  
Internal Medicine Residents ◽  
Tertiary Teaching

Abstract Background Little is known about the competences of residents as clinical teachers in African health care institutions. Objective We evaluated the clinical teaching skills of internal medicine residents from the perspective of medical students in a tertiary teaching institution in Africa. Methods We used the augmented Stanford Faculty Development Program Questionnaire, which has evidence of validity and reliability. To avoid a Hawthorne effect, students completed the questionnaire anonymously and confidentially after clinical teaching sessions by residents. A minimum score of 4 on a scale of 1 to 5 was defined a priori as possession of good clinical teaching skills. Results Sixty-four medical students assessed all 20 internal medicine residents in the Department of Medicine, University of Ibadan. Mean performance scores for the domains ranged from 3.07 to 3.66. Residents performed best in creating a good learning climate and worst in the promotion of understanding and retention. Sex of the resident, duration of residency, and rank had no significant impact (.09 &lt; P &lt; .94) on their teaching skills. Conclusions Consistent with other observations in the literature, residents' clinical teaching skills were suboptimal, particularly in their ability to promote understanding and retention. To enhance these skills, we recommend the integration of appropriately tailored programs to teach pedagogic skills programs in residency training.

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