Strategies for Effective On-Call Supervision for Internal Medicine Residents: The Superb/Safety Model

Abstract Background Supervision is central to resident education and patient safety, yet there is little published evidence to describe a framework for clinical supervision. The aim of this study was to describe supervision strategies for on-call internal medicine residents. Methods Between January and November 2006, internal medicine residents and attending physicians at a single hospital were interviewed within 1 week of their final call on the general medicine rotation. Appreciative inquiry and critical incident technique were used to elicit perspectives on ideal and suboptimal supervision practices. A representative portion of transcripts were analyzed using an inductive approach to develop a coding scheme that was then applied to the entire set of transcripts. All discrepancies were resolved via discussion until consensus was achieved. Results Forty-four of 50 (88%) attending physicians and 46 of 50 (92%) eligible residents completed an interview. Qualitative analysis revealed a bidirectional model of suggested supervisory strategies, the “SUPERB/SAFETY” model; an interrater reliability of 0.70 was achieved. Suggestions for attending physicians providing supervision included setting expectations, recognizing uncertainty, planning communication, having easy availability, reassuring residents, balancing supervision, and having autonomy. Suggested resident strategies for seeking supervision from attending physicians included seeking input early, contacting for active clinical decisions or feeling uncertain, end of life issues, transitions in care, or help with systems issues. Common themes suggested by trainees and attending physicians included easy availability and preservation of resident decision-making autonomy. Discussion Residents and attending physicians have explicit expectations for optimal supervision. The SUPERB/SAFETY model of supervision may be an effective resource to enhance the clinical supervision of residents.

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The Forgotten Educational Needs of the House Staff: Training Internal Medicine Residents to Address End-of-Life Issues

OMEGA - Journal of Death and Dying ◽

10.2190/om.67.1-2.q ◽

2013 ◽

Vol 67 (1-2) ◽

pp. 147-153 ◽

Cited By ~ 3

Author(s):

Sara Moore Kerai ◽

Margot Wheeler

Keyword(s):

Internal Medicine ◽

End Of Life ◽

Death And Dying ◽

Comfort Level ◽

Listening Skills ◽

Internal Medicine Residents ◽

Life Issues ◽

Teaching Point ◽

On Line ◽

End Of Life Issues

An intervention was conducted, aimed at providing residents in internal medicine with communication skills to address end-of-life issues with patients. Residents participated in two 1-hour educational sessions designed to teach a communication protocol, enhance listening skills, and to provide practice in effective communication in a safe, small-group format. An anonymous on-line survey assessed the effectiveness of the intervention. Twenty-five residents completed the intervention. There was a trend toward increased comfort level in addressing end-of-life issues among residents who completed the intervention, versus a comparison group. Residents who completed the intervention reported that using the words “death” and “dying” with patients and families was an important teaching point.

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General Medicine vs Subspecialty Career Plans Among Internal Medicine Residents

JAMA ◽

10.1001/jama.2012.47535 ◽

2012 ◽

Vol 308 (21) ◽

pp. 2241 ◽

Cited By ~ 65

Author(s):

Colin P. West ◽

Denise M. Dupras

Keyword(s):

Internal Medicine ◽

General Medicine ◽

Career Plans ◽

Internal Medicine Residents

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A retrospective analysis and quality improvement education initiative to increase HPV vaccination rates in an inner city primary care clinic.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.213 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 213-213

Author(s):

Jasmin Hundal ◽

Matthew J Hadfield ◽

Alifaiz Saiyed ◽

William Rabitaille

Keyword(s):

Internal Medicine ◽

Primary Care ◽

Hpv Vaccine ◽

Current Practice ◽

Insurance Coverage ◽

Hpv Vaccination ◽

Shared Decision ◽

Resident Physicians ◽

Internal Medicine Residents ◽

Attending Physicians

213 Background: Human papillomavirus (HPV) is the most commonly spread sexually transmitted infection and is implicated in the oncogenesis of several cancers, including cervical, anal,vaginal and oropharyngeal cancers. HPV vaccinations have a high efficacy, and recent data demonstrated adults aged 18-26 years old are not adequately fully vaccinated. Our objective was to assess the current practice regarding HPV vaccination among persons 9-45 years of age, knowledge about the HPV guidelines, and recommendation practice. Methods: A retrospective review was conducted of Internal Medicine residents acting as primary care physicians at an urban clinic based in Hartford, Connecticut, USA. The survey was administered to internal medicine residents and attending physicians to assess the current practice regarding the HPV vaccination for adults and knowledge of the updated guidelines. The key drivers identified were resident knowledge, communication, insurance coverage, and availability of HPV vaccination in the clinic. An educational handout and lecture was provided with a follow-up survey. Results: A total of 347 charts were reviewed. Of those eligible to receive the HPV vaccine, it was found that only 5.2% received the total dosage. The response rate to our initial survey was 60%. 47.83% did not inquire about the HPV vaccination or recommended it to patients compared to 71.43% of attending physicians (AP) who inquired, but only 28.47% discussed it during precepting sessions. 27.7% of the residents and 71.43% AP correctly identified the updated guidelines. The biggest three barriers were unfamiliarity with the availability of HPV vaccination, insurance coverage, and current guidelines. A short educational review and summary were provided to close the gaps identified with the questionnaire.100% of residents correctly identified the updated guidelines, risks, benefits, importance of shared decision-making, and more likely recommend the HPV vaccination. However, 69.2% were unaware that HPV vaccination does not prevent the progression of HPV-related cancers. Conclusions: Adherence to CDC guidelines regarding vaccinating against HPV amongst resident physicians is poor. The percentage of patients, who received the complete Gardasil-9 vaccination series, was significantly below the national average. Our study highlights a large practice gap that exists amongst resident physicians regarding the HPV vaccine. There was minimal documentation amongst resident physicians regarding shared decision-making conversations with patients. We addressed the knowledge and resource deficit with an educational handout and information session. Our intervention demonstrated improved confidence in discussing the vaccine with the patients and resolved the concern of insurance coverage and availability of vaccines in the clinic and pharmacy.

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4192 Decreasing Inappropriate STAT Image Ordering

Journal of Clinical and Translational Science ◽

10.1017/cts.2020.173 ◽

2020 ◽

Vol 4 (s1) ◽

pp. 47-47

Author(s):

Michael Cui ◽

Jonathan Chung ◽

Pritesh Patel ◽

Ingrid Reiser

Keyword(s):

Internal Medicine ◽

Preliminary Analysis ◽

Ct Images ◽

Ct Image ◽

Targeted Interventions ◽

Internal Medicine Residents ◽

Imaging Results ◽

Fishbone Diagram ◽

Study Population ◽

Attending Physicians

OBJECTIVES/GOALS: Currently physicians are able to order CT Chest/Abd/Pelvis images as STAT or Routine. STAT images denote an emergency and are done immediately. We aim to determine the percentage of CT images that are inappropriately ordered as STAT, determine physician image ordering habits, and develop targeted interventions to encourage appropriate STAT image ordering. METHODS/STUDY POPULATION: A fishbone diagram helped reveal possible causes of inappropriate STAT image ordering. Based on the fishbone diagram, a survey was created to assess CT image ordering habits amongst radiology and internal medicine residents and attending physicians. All CT Chest/Abd/Pelvis images ordered over a 3 month period of time (July-Oct 2017) was obtained. The dataset included whether the image was ordered Stat vs Routine, time of image order, physician name and location, and reason for the imaging study.The STAT images were evaluated based on the explanation provided in the CT image order. Currently 2 radiology residents, 2 internal medicine residents, and 2 internal medicine hospitalists are evaluating all STAT CT images to determine appropriateness and how long they are willing to wait for the image to result in a read. RESULTS/ANTICIPATED RESULTS: Analysis of all CT Chest/Abd/Pelvis imaging orders revealed that 51% (1710/3345) of them were ordered as STAT. The preliminary analysis of 227 STAT images showed that 6% were inappropriate. We anticipate results of our survey to show differences in how long a STAT vs Routine image orders should take amongst Radiology and Internal Medicine clinicians. We also anticipate our survey to show differences in factors that warrant STAT imaging amongst the different medical fields. We anticipate that the clinician manual evaluation of all STAT CT image will reveal a large percentage of imaging orders to be inappropriate. All STAT imaging that were flagged as inappropriate will be characterized by the department who ordered the image and the reason provided for the imaging to assess for common themes. DISCUSSION/SIGNIFICANCE OF IMPACT: STAT images are the new routine with more images ordered STAT than Routine. Inappropriate STAT imaging results in truly urgent patients not getting the medical care they need. Many images ordered stat could potentially be switched to routine. By evaluating why clinicians are ordering STAT CT image inappropriately, we will be able to develop targeted interventions to decrease inappropriate STAT CT imaging.

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Waiting it out: consultation delays prolong in-patient length of stay

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2018-136269 ◽

2019 ◽

Vol 95 (1119) ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Arifeen Sylvanna Rahman ◽

Siyu Shi ◽

Pamela Katherine Meza ◽

Justin Lee Jia ◽

David Svec ◽

...

Keyword(s):

Internal Medicine ◽

Quality Of Care ◽

Length Of Stay ◽

General Medicine ◽

Late Response ◽

Healthcare Expenditures ◽

Average Delay ◽

Hospitalised Patients ◽

Attending Physicians

BackgroundDecreasing delays for hospitalised patients results in improved hospital efficiency, increased quality of care and decreased healthcare expenditures. Delays in subspecialty consultations and procedures can cause increased length of stay due to reasons outside of necessary medical care.ObjectiveTo quantify, describe and record reasons for delays in consultations and procedures for patients on the general medicine wards.MethodologyWe conducted weekly audits of all admitted patients on five Internal Medicine teams over 8 weeks. A survey was reviewed with attending physicians and residents on five internal medicine teams to identify patients with a delay due to consultation or procedure, quantify length of delay and record reason for delay.ResultsDuring the study period, 316 patients were reviewed and 48 were identified as experiencing a total of 53 delays due to consultations or procedures. The average delay was 1.8 days for a combined total of 83 days. Top reasons for delays included scheduling, late response to page and a busy service. The frequency in length of consult delays vary among different specialties. The highest frequency of delays was clustered in procedure-heavy specialties.ConclusionThis report highlights the importance of reviewing system barriers that lead to delayed service in hospitals. Addressing these delays could lead to reductions in length of stay for inpatients.

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Pharmacogenomics education and perceptions: is there a gap between internal medicine resident and attending physicians?

Pharmacogenomics ◽

10.2217/pgs-2020-0141 ◽

2021 ◽

Author(s):

Carolyn R Rohrer Vitek ◽

Jyothsna Giri ◽

Pedro J Caraballo ◽

Timothy B Curry ◽

Wayne T Nicholson

Keyword(s):

Internal Medicine ◽

Point Of Care ◽

Internal Medicine Resident ◽

Current Clinical Practice ◽

Medicine Resident ◽

Resident Physicians ◽

Internal Medicine Residents ◽

Care Gaps ◽

Attending Physicians ◽

Do So

Aim: To determine if differences in self-reported pharmacogenomics knowledge, skills and perceptions exist between internal medicine residents and attending physicians. Materials & methods: Forty-six internal medicine residents and 54 attending physicians completed surveys. Thirteen participated in focus groups to explore themes emerging from the surveys. Results: Resident physicians reported a greater amount of pharmacogenomics training compared with attending physicians (48 vs 13%, p < 0.00012). No differences were found in self-reported knowledge, skills and perceptions. Conclusion: Both groups expressed pharmacogenomics was relevant to their current clinical practice; they should be able to provide information to patients and use to guide prescribing, but lacked sufficient education to be able to do so effectively. Practical approaches are needed to teach pharmacogenomics concepts and address point-of-care gaps.

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How internal medicine residents resolve conflicts with attending physicians

Academic Medicine ◽

10.1097/00001888-199011000-00019 ◽

1990 ◽

Vol 65 (11) ◽

pp. 713-5 ◽

Cited By ~ 14

Author(s):

N J Farber ◽

J L Weiner ◽

E G Boyer ◽

E J Robinson

Keyword(s):

Internal Medicine ◽

Internal Medicine Residents ◽

Attending Physicians

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Bedside Rounds Valued But Not Preferred: Perceptions of Internal Medicine Residents and Attending Physicians in a Diverse Academic Training Program

Southern Medical Journal ◽

10.14423/smj.0000000000000689 ◽

2017 ◽

Vol 110 (8) ◽

pp. 531-537 ◽

Cited By ~ 4

Author(s):

Naseema B. Merchant ◽

Daniel G. Federman

Keyword(s):

Internal Medicine ◽

Training Program ◽

Academic Training ◽

Internal Medicine Residents ◽

Bedside Rounds ◽

Attending Physicians ◽

Academic Training Program

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Night Float Teaching and Learning: Perceptions of Residents and Faculty

Journal of Graduate Medical Education ◽

10.4300/jgme-d-10-00005.1 ◽

2010 ◽

Vol 2 (2) ◽

pp. 236-241 ◽

Cited By ~ 20

Author(s):

Dean A. Bricker ◽

Ronald J. Markert

Keyword(s):

Internal Medicine ◽

Teaching And Learning ◽

Learning Opportunities ◽

State University ◽

Educational Value ◽

Residency Programs ◽

Night Float ◽

Internal Medicine Residents ◽

Perceptions Of Education ◽

Attending Physicians

Abstract Background Most internal medicine residency programs use a night float system to comply with resident duty hour limits. Night float assignments often comprise 7 to 10 weeks of scheduled clinical time during training. Despite this substantial allotment of time to night float, few studies have assessed the adequacy of learning opportunities during these rotations. We designed an exploratory study to assess resident and faculty views about the educational aspects of a typical internal medicine night float system. Methods Wright State University Boonshoft School of Medicine internal medicine residents and attending faculty were asked to complete a 25-item voluntary, anonymous survey. A 5-point Likert scale was used to assess perceptions of education during day and night rotations. Results The response rate was 52% (85 of 164). Residents rated teaching and learning on day rotations more positively than on night rotations for 17 of 25 (68%) items. Regarding night float, residents rated 14 of 25 items below 3.00; only one item was rated below 3.00 (“…H & P skills observed by attending”) for day rotations. Attending physicians rated day rotations more highly for all 25 survey items. Faculty rated 13 of 25 items below 3.00 for night float and they rated no items below 3.00 for day rotations. Resident and faculty ratings differed significantly for 10 items, with 5 items receiving higher ratings by residents and 5 being rated more positively by faculty. Conclusion Despite a substantial allotment of time to night rotations, there appear to be lost teaching and learning opportunities in the current night float system. Modification of the existing format may improve its educational value.

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