scholarly journals An Ambulatory Clinical Teaching Unit: Filling the Outpatient Gap in Internal Medicine Residency Training

2016 ◽  
Vol 11 (3) ◽  
Author(s):  
Mohamed Panju MSc MD ◽  
Ali Kara MD ◽  
Akbar Panju MB ◽  
Martha Fulford MD ◽  
Paul O'Bryne MB ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Royal College ◽  
Clinical Teaching ◽  
Formal Structure ◽  
General Internist ◽  
Clinical Environment ◽  
Educational Curriculum ◽  
General Internal ◽  
Ambulatory Medicine ◽  
Teaching Unit

The majority of time in a core General Internal Medicine (GIM) residency is spent focusing on inpatient medicine, with relatively little time devoted to ambulatory medicine. The Royal College of Physicians and Surgeons of Canada has mandated an improvement in ambulatory exposure. Unfortunately, most ambulatory experiences tend to lack formal structure, a dedicated educational curriculum, and graduated learner-specific responsibilities. The recent Royal College recognition of GIM as a subspecialty places renewed emphasis on core IM training providing a more comprehensive exposure to outpatient medicine as management of patients with multiple complex conditions may be best managed by a general internist. In July 2015, McMaster University opened an outpatient medicine clinic which is designed to be an Ambulatory Clinical Teaching Unit (A-CTU). The A-CTU provides a structured clinical environment which is focused on the management of medically-complex patients. It uses a multidisciplinary model, graded learner levels of responsibility and a dedicated educational curriculum. The unique structure of the A-CTU allows for the assessment of milestones and EPAs (entrustable professional activities) pertaining to consultation skills and chronic disease management, in keeping with competence by design.

scholarly journals Infectious Diseases on a General Internal Medicine Clinical Teaching Unit

1999 ◽  
Vol 10 (1) ◽  
pp. 33-38
Author(s):  
LE Nicolle ◽  
J Uhanova ◽  
P Orr ◽  
A Kraut ◽  
K Van Ameyde ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Length Of Stay ◽  
Infectious Diseases ◽  
General Internal Medicine ◽  
Clinical Teaching ◽  
Cost Of Care ◽  
Therapeutic Interventions ◽  
General Internal ◽  
Teaching Unit ◽  
Time Of Admission

OBJECTIVE: To describe the spectrum of infectious diseases and characteristics of patients admitted with infections on a general internal medicine clinical teaching unit.DESIGN: Retrospective review of patients admitted to one general internal medicine unit at a tertiary care teaching hospital during two three-month periods.METHODS: Data collection through chart review.OUTCOME MEASURES: Descriptive analysis of types of infections: therapeutic interventions; consultations and outcomes, including death; hospital-acquired infection; and length of stay.RESULTS: During the two three-month periods, 76 of 233 (33%) and 52 of 209 (25%) admissions were associated with a primary diagnosis of infection. An additional 23 (10%) and 24 (12%) patients had infection at the time of admission, but this was not the primary admitting diagnosis. Pneumonia, urinary infection, and skin and soft tissue infection were the most frequent diagnosis at the time of admission, but these accounted for only about 50% of admissions with infection. Patients admitted with infection were characterized by a younger age, greater number of therapeutic interventions in the first 24 h, and increased medication costs, entirely attributable to antimicrobial therapy, but patients admitted with infection did not differ in comorbidity, death, nosocomial infection or length of stay compared with patients without infection.CONCLUSIONS: A wide variety of infections contribute to admissions to general internal medical clinical teaching units. Patients with infection have more interventions and an increased cost of care, but do not differ in outcome.

scholarly journals Why I Wrote the New Royal College General Internal Medicine Exam: Redefining Our Identity and Revalidation

2015 ◽  
Vol 10 (2) ◽  
Author(s):  
Nadine Abdullah, MD, Med, FRCPC
Keyword(s):  
Internal Medicine ◽  
Professional Identity ◽  
General Internal Medicine ◽  
Royal College ◽  
General Internist ◽  
Successful Completion ◽  
Internal Medicine Training ◽  
Certification Exams ◽  
General Internal

In 2010, the Royal College of Physicians and Surgeons of Canada (RCPSC) recognized General Internal Medicine (GIM) as a distinct subspecialty. Soon after this recognition came a new written certificationexam, the successful completion of which awards the applicant the title of General Internist. For those of us who trained prior to the new status and examination, GIM was the default designation after four years of internal medicine training if a subspecialty was not pursued.What does this new subspecialty status mean for our professional identity, qualifications, and public credibility? Twelve years aftermy successful completion of the Internal Medicine (IM) certification exams, I voluntarily applied for consideration to write the first RCPSC exam in GIM, without a clear reason why. My reflection on the days leading up to the exam and writing the exam itself led me to understand why I did it. The process addressed my skepticism around designating GIM as a unique subspecialty, and through this I have come to appreciate the need for our profession to embrace revalidation.

scholarly journals A collective case study of supervision and competence judgments on the inpatient internal medicine ward

2021 ◽  
Author(s):  
Tristen Gilchrist ◽  
Rose Hatala ◽  
Andrea Gingerich
Keyword(s):  
Internal Medicine ◽  
Clinical Supervision ◽  
Clinical Teaching ◽  
Senior Resident ◽  
Structured Interviews ◽  
Collective Case Study ◽  
Teaching Unit ◽  
Competency Based ◽  
Trainee Competence

Abstract Introduction Workplace-based assessment in competency-based medical education employs entrustment-supervision scales to suggest trainee competence. However, clinical supervision involves many factors and entrustment decision-making likely reflects more than trainee competence. We do not fully understand how a supervisor’s impression of trainee competence is reflected in their provision of clinical support. We must better understand this relationship to know whether documenting level of supervision truly reflects trainee competence. Methods We undertook a collective case study of supervisor-trainee dyads consisting of attending internal medicine physicians and senior residents working on clinical teaching unit inpatient wards. We conducted field observations of typical daily activities and semi-structured interviews. Data was analysed within each dyad and compared across dyads to identify supervisory behaviours, what triggered the behaviours, and how they related to judgments of trainee competence. Results Ten attending physician-senior resident dyads participated in the study. We identified eight distinct supervisory behaviours. The behaviours were enacted in response to trainee and non-trainee factors. Supervisory behaviours corresponded with varying assessments of trainee competence, even within a dyad. A change in the attending’s judgment of the resident’s competence did not always correspond with a change in subsequent observable supervisory behaviours. Discussion There was no consistent relationship between a trigger for supervision, the judgment of trainee competence, and subsequent supervisory behaviour. This has direct implications for entrustment assessments tying competence to supervisory behaviours, because supervision is complex. Workplace-based assessments that capture narrative data including the rationale for supervisory behaviours may lead to deeper insights than numeric entrustment ratings.

scholarly journals General Internal Medicine Subspecialty Training Update

2016 ◽  
Vol 7 (4) ◽  
Author(s):  
Sharon E. Card MD MSc
Keyword(s):  
Internal Medicine ◽  
Training Program ◽  
General Internal Medicine ◽  
Royal College ◽  
Working Group ◽  
Subspecialty Training ◽  
Internal Medicine Training ◽  
General Internal

The vast majority of general internal medicine (GIM) programs in Canada have become distinct entities that provide training in additional competencies and leadership above and beyond those required for the specialty of internal medicine. In December 2010, after many years of effort, GIM finally achieved recognition as a distinct subspecialty by the Royal College of Physicians and Surgeons of Canada. A GIM Working Group has finalized the objectives and requirements for a 2-year subspecialty training program in GIM that will follow after the existing 3-year core internal medicine training program. These documents have now been approved by the Royal College.

scholarly journals Moral distress and burnout in internal medicine residents

2017 ◽  
Vol 8 (1) ◽  
pp. e36-43 ◽  
Author(s):  
Sharareh Sajjadi ◽  
Monica Norena ◽  
Hubert Wong ◽  
Peter Dodek
Keyword(s):  
Internal Medicine ◽  
Moral Distress ◽  
Clinical Teaching ◽  
Maslach Burnout Inventory ◽  
Intention To Leave ◽  
Internal Medicine Residents ◽  
Distress Score ◽  
Teaching Unit ◽  
High Level ◽  
Distress Scale

Background: Residents frequently encounter situations in their workplace that may induce moral distress or burnout. The objective of this study was to measure overall and rotation-specific moral distress and burnout in medical residents, and the relationship between demographics and moral distress and burnout.Methods: The revised Moral Distress Scale and the Maslach Burnout Inventory (Human Service version) were administered to Internal Medicine residents in the 2013-2014 academic year at the University of British Columbia.Results: Of the 88 residents, 45 completed the surveys. Participants (mean age 30+/-3; 46% male) reported a median moral distress score (interquartile range) of 77 (50-96). Twenty-six percent of residents had considered quitting because of moral distress, 21% had a high level of burnout, and only 5% had a low level of burnout. Moral distress scores were highest during Intensive Care Unit (ICU) and Clinical Teaching Unit (CTU) rotations, and lowest during elective rotations (p<0.0001). Women reported higher emotional exhaustion. Moral distress was associated with depersonalization (p=0.01), and both moral distress and burnout were associated with intention to leave the job.Conclusion: Internal Medicine residents report moral distress that is greatest during ICU and CTU rotations, and is associated with burnout and intention to leave the job.

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