scholarly journals The Core Internal Medicine Training: Evolving beyond the Clinical Teaching Unit

2020 ◽  
Vol 15 (1) ◽  
pp. e8-e11
Author(s):  
Mohamed Panju ◽  
Lori Whitehead ◽  
Leslie Martin
Keyword(s):  
Internal Medicine ◽  
Clinical Teaching ◽  
Training Needs ◽  
Teaching Hospitals ◽  
Internal Medicine Training ◽  
Academic Teaching ◽  
The Core ◽  
The Past ◽  
Teaching Unit ◽  
Core Part

AbstractOver the past 50 years, the CTU has remained a core part of training for residents within internal medicine training programs. At the same time, the needs of society have changed significantly over the years, and current training needs to reflect this change. This is not a novel idea, but one that we feel requires greater attention to adequately address the needs of academic teaching hospitals across the country. ResumeAu cours des 50 dernières années, la CTU est restée un élément essentiel de la formation des résidents dans le cadre des programmes de formation en médecine interne. Dans le même temps, les besoins de la société ont considérablement évolué au fil des ans, et la formation actuelle doit refléter ce changement. Il ne s’agit pas d’une idée nouvelle, mais d’une idée qui, selon nous, nécessite une plus grande attention afin de répondre adéquatement aux besoins des hôpitaux universitaires d’enseignement à travers le pays.  

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.

The kinase module of the Mediator complex: an important signalling processor for the development and survival of plants

2020 ◽  
Author(s):  
Rekha Agrawal ◽  
Fajkus Jiří ◽  
Jitendra K Thakur
Keyword(s):  
Plant Growth ◽  
Rna Polymerase Ii ◽  
Growth And Development ◽  
Regulation Of Gene Expression ◽  
Plant Growth And Development ◽  
Biochemical Processes ◽  
The Core ◽  
The Past ◽  
And Function ◽  
Core Part

Abstract Mediator, a multisubunit protein complex, is a signal processor that conveys regulatory information from transcription factors to RNA polymerase II and therefore plays an important role in the regulation of gene expression. This megadalton complex comprises four modules, namely, the head, middle, tail, and kinase modules. The first three modules form the core part of the complex, whereas association of the kinase module is facultative. The kinase module is able to alter the function of Mediator and has been established as a major transcriptional regulator of numerous developmental and biochemical processes. The kinase module consists of MED12, MED13, CycC, and kinase CDK8. Upon association with Mediator, the kinase module can alter its structure and function dramatically. In the past decade, research has established that the kinase module is very important for plant growth and development, and in the fight against biotic and abiotic challenges. However, there has been no comprehensive review discussing these findings in detail and depth. In this review, we survey the regulation of kinase module subunits and highlight their many functions in plants. Coordination between the subunits to process different signals for optimum plant growth and development is also discussed.

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 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 SELECTION OF OPTIMAL SUMMARY STATISTICS FOR DATA ANALYSIS

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Vanshika Lamba
Keyword(s):  
Decision Making ◽  
Data Analysis ◽  
Data Exploration ◽  
Summary Statistics ◽  
Data Set ◽  
The Core ◽  
The Past ◽  
Main Barrier ◽  
Core Part ◽  
Selection Of

Data analysis is the core part which needs to be done over the data in order to gather its characteristics for further specifications and estimations. But achieving the goal of extracting the maximum useful characteristics is the main barrier in the path of any organization. Data analysis plays an important role in the success of organization as it helps in proper decision making. And the best decision comes out by analyzing the past information, their present scenario and future impacts. But most of the information is extracted in the numerical form from the data set collected. Therefore, we need to select some proper summary statistics for the data exploration purpose. For eg - mean, median, mode, etc. This paper focuses on the classes of summary statistics to be used for the data analysis and how important is its use in the data exploration. The paper majorly concentrates on the measure of location and a brief idea about measure of dispersion and how measure of location is related to measure of spread.

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.

scholarly journals Teaching Residents how to Effectively Prescribe Nicotine Replacement Therapy on the Clinical Teaching Unit

2018 ◽  
Vol 13 (4) ◽  
pp. e17-e20
Author(s):  
Shannon Riley ◽  
Nicole Sitzer ◽  
Sophie Corriveau ◽  
Gregory Pond ◽  
Yayoi Goto ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Clinical Teaching ◽  
Teaching Session ◽  
Post Intervention ◽  
Nicotine Replacement ◽  
Exact Test ◽  
Prescribing Behaviour ◽  
Teaching Unit

Residents and medical students identified a lack of knowledge regarding Nicotine Replacement Therapy (NRT) as a barrier to smoking cessation counselling. We hypothesized that a teaching session on NRT during an inpatient Internal Medicine rotation would increase learner comfort in prescribing these products. Medical trainees on the Internal Medicine Clinical Teaching Unit (CTU) attended a teaching session during week 4 of an 8-week rotation. Pharmacy records from the 8-week period were retrospectively analyzed to determine NRT prescribing behaviour. Pre-intervention, 5.8% (13/225) of new admissions received a NRT prescription. Post-intervention, 17% (31/182) of new admissions received a NRT prescription. Using a Fisher’s exact test, the percentage of new admissions that received a prescription was significantly different (p<0.001) between the pre- and post-intervention time frames. This data suggests that integrating education on NRT into CTU teaching can significantly alter prescribing behaviour and improve access to NRT for patients who need it.

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