scholarly journals Night Float Teaching and Learning: Perceptions of Residents and Faculty

2010 ◽  
Vol 2 (2) ◽  
pp. 236-241 ◽  
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.

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

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.

scholarly journals Exploring the evolving concept of ‘patient ownership’ in the era of resident duty hour regulations—experience of residents and faculty in an internal medicine night float system

2019 ◽  
Vol 8 (6) ◽  
pp. 353-359 ◽  
Author(s):  
Vanessa Masson ◽  
Linda Snell ◽  
Diana Dolmans ◽  
Ning-Zi Sun
Keyword(s):  
Internal Medicine ◽  
Potential Threat ◽  
Residency Programs ◽  
Fitness For Duty ◽  
Night Float ◽  
Role Modelling ◽  
Downstream Effects ◽  
Qualitative Descriptive ◽  
Key Features ◽  
Professional Capacity

Abstract Background Despite the use of ‘patient ownership’ as an embodiment of professionalism and increasing concerns over its loss among trainees, how its development in residents has been affected by duty hour regulations has not been well described. In this qualitative study, we aim to outline the key features of patient ownership in internal medicine, factors enabling its development, and how these have been affected by the adoption of a night float system to comply with duty hour regulations. Methods In this qualitative descriptive study, we interviewed 18 residents and 12 faculty internists at one university centre and conducted a thematic analysis of the data focused on the concept of patient ownership. Results We identified three key features of patient ownership: personal concern for patients, professional capacity for autonomous decision-making, and knowledge of patients’ issues. Within the context of a night float system, factors that facilitate development of patient ownership include improved fitness for duty and more consistent interactions with patients/families resulting from working the same shift over consecutive days (or nights). Conversely, the increase in patient handovers, if done poorly, is a potential threat to patient ownership development. Trainees often struggle to develop ownership when autonomy is not supported with supervision and when role-modelling by faculty is lacking. Discussion These features of patient ownership can be used to frame discussions when coaching trainees. Residency programs should be mindful of the downstream effects of shift-based scheduling. We propose strategies to optimize factors that enable trainee development of patient ownership.

Hematology and Oncology: Natural Allies Or Time To Part Ways? Results Of a Medicine Resident Survey

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2920-2920
Author(s):  
Esha Kaul ◽  
John Paul Flores ◽  
Jessica K Paulus ◽  
Krishna S. Gunturu
Keyword(s):  
Internal Medicine ◽  
Conflicts Of Interest ◽  
Treatment Strategies ◽  
Fellowship Training ◽  
The Body ◽  
Intellectual Stimulation ◽  
Training Environment ◽  
Residency Programs ◽  
Medicine Resident ◽  
Internal Medicine Residents

Abstract Background Over the last decade there has been a rapid increase in the body of knowledge in Hematology and Oncology with major changes in treatment strategies and available therapies. In this current climate, the majority of physicians with Hematology-Oncology training focus their practice on either Hematology or Oncology. However, currently most fellowship programs combine the two specialties. In 2012, only 16 Hematology-specific fellowship positions were available nationwide, and the number of applicants per position in the NRMP Match for Hematology and Hematology-Oncology (Hem-Onc) was 7.4 and 1.5, respectively. A report from the American Society of Clinical Oncology (ASCO) predicted an acute shortage in the Hem-Onc workforce by the year 2020. As we attempt to meet this demand by training more fellows, it is important to understand the Hem-Onc environment in which the internal medicine residents are surrounded as they choose their career pathways. We therefore conducted a survey of internal medicine residents to understand their perceptions about this field and how they make decisions about fellowship training. Methods The content and wording of the survey were developed in focus group discussions of the authors. A 5 point Likert scale was used to identify a range of responses. A pilot was performed with the Hem-Onc fellows to test the survey for clarity and relevance. The Research Electronic Database electronic capture (REDCap) software was used for survey development and distribution. Program directors were contacted via email regarding study participation. The invitation to complete a 4 page anonymous web based survey was sent to Internal Medicine residents at 4 residency programs in Massachusetts (1 university-based and 3 community-based) between January 2012 and July 2012. Counts and proportions were used to summarize survey responses. Results 77 out of the 171 current residents enrolled in the 4 residency programs completed the survey (response rate: 45%). 59 (77%) of the respondents were either committed to or had considered pursuing fellowship training. Among these residents, Hem-Onc was among the top three choices for 20 (26%) of the respondents. The top three factors that led them to consider a fellowship in Hem-Onc were intellectual stimulation, the rapidly expanding field, and a personality fit (Table 1). The top reasons cited for not considering a career in Hem-Onc were the lack of curative options, personality fit, and dealing with end of life issues (Table 2). Of the 57 residents not considering a combined Hem-Onc fellowship, 16 (26%) were willing to consider fellowships in Hematology or Oncology if tracks where offered separately [11 (69%) for Hematology alone or 5 (31%) for Oncology alone]. Even among those considering combined Hem-Onc fellowships, 3 (15%) would consider fellowships in Hematology alone and 3 (15%) would consider oncology alone. In terms of the residency training environment, the areas of Hem-Onc training where most residents felt their exposure to the field be lacking were outpatient oncology (59,77%) and benign hematology (49, 64%). (Fig.1) Discussion While Hematology and Oncology have traditionally been offered as a combined 3 year fellowship, there is substantial interest in separate Hematology and Oncology fellowships as evidenced by our survey results and NRMP data. A greater number of Hematology- or Oncology-specific fellowships could attract more residents to these subspecialties and help meet the increasing demand for Hematologists and Oncologistsin clinical practice. Also, increased exposure to outpatient, in addition to inpatient, Hem-Onc during residency would be more representative of actual practice, could dispel misconceptions about dismal outcomes in Hem-Onc, and may help attract more residents to the field. Disclosures: No relevant conflicts of interest to declare.

The impact of the night float system on internal medicine residency programs

1991 ◽  
Vol 6 (5) ◽  
pp. 445-449 ◽  
Author(s):  
Marie C. Trontell ◽  
Jeffrey L. Carson ◽  
Mark I. Taragin
Keyword(s):  
Internal Medicine ◽  
Internal Medicine Residency ◽  
Residency Programs ◽  
Night Float ◽  
The Impact

scholarly journals Brief report: Internal medicine residents’, attendings’, and nurses’ perceptions of the night float system

2006 ◽  
Vol 21 (5) ◽  
pp. 494-497 ◽  
Author(s):  
Elie A. Akl ◽  
Anshu Bais ◽  
Ellen Rich ◽  
Joseph Izzo ◽  
Brydon J. B. Grant ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Night Float ◽  
Internal Medicine Residents ◽  
Nurses Perceptions

scholarly journals 4192 Decreasing Inappropriate STAT Image Ordering

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.

scholarly journals Do USMLE Steps and ITE Results Predict Performance in the American Board of Internal Medicine Certifying Exam?

2019 ◽  
Author(s):  
Supratik Rayamajhi ◽  
Prajwal Dhakal ◽  
Ling Wang ◽  
Manoj P Rai ◽  
Shiva Shrotriya
Keyword(s):  
Internal Medicine ◽  
Pearson Correlation ◽  
Pass Rate ◽  
Michigan State University ◽  
State University ◽  
Probability Curve ◽  
Internal Medicine Residents ◽  
Service Training ◽  
Usmle Step 1 ◽  
Usmle Step

Abstract Objective To evaluate if United States Medical Licensing Examination (USMLE) Step 1, USMLE Step 2, USMLE Step 3, and residency third-year in-service training exam (ITE) results predict performance of Internal Medicine (IM) residents in American Board of Internal Medicine Certifying Exam (ABIM-CE). Methods A retrospective review of USMLE Step 1, USMLE Step 2, USMLE Step 3 scores, residency third year ITE and ABIM-CE of IM residents at Michigan State University from 2004 through 2017 was conducted. Pearson correlation coefficient and two sample t-tests were used to assess the relationship between various scores and pass or fail results in ABIM-CE. Results Among 114 MD residents included in the study; 92% (n=105) passed the ABIM-CE. There was a significant correlation of passing ABIM-CE with USMLE Step 1 (OR 1.042; 95% CI 1.004- 1.082), Step 2 (OR 1.043; 95% CI 1.004-1.085) and Step 3 (OR 1.046; 95% CI 1.004- 1.089) independently, with the combined odds of all USMLE exams being 1.044 (p=0.031). Increase in ITE percentage increased the likelihood of passing ABIM-CE (OR 1.28, 95% CI 1.160-1.419). The increase in the gap was associated with decreased chances of passing ABIM-CE (OR 0.774; 95% CI 0.670-0.893). All residents who failed ABIM-CE had Step 1 scores <220. Among 31 residents with Step 2 score <220, 20% (n=6) failed ABIM. Similarly, 9% of residents with USMLE Step 3 score less than 220 failed ABIM-CE; all residents who failed had scores less than 220. The probability curve predicted that the chance of passing ABIM- CE was around 80% with USMLE scores greater than 200 and increased to almost 100% with USMLE scores of 250 or more. Conclusion There is a strong correlation between ABIM-CE results with scores of USMLE Steps and third-year ITE. Thus, performance in these exams may identify the internal medicine residents who might need more help in ABIM-CE. This helps the residents as well as the program to plan and implement various measures to improve the pass rate.

scholarly journals Point-of-Care Ultrasound in Internal Medicine

2017 ◽  
Vol 12 (2) ◽  
Author(s):  
Mitch Levine
Keyword(s):  
Internal Medicine ◽  
Needs Assessment ◽  
Point Of Care ◽  
Digital Health ◽  
Pericardial Tamponade ◽  
Point Of Care Ultrasound ◽  
Residency Programs ◽  
Technological Advances ◽  
Internal Medicine Residents ◽  
Similar Survey

Over the past few decades a variety of technological advances have dramatically change the manner in which physicians practice medicine. Both clinically and administratively the practice of medicine is in evolution – for example; stents instead of surgery and digital health records instead of paper charts. For internal medicine physicians one of the biggest transformations with respect to how we will practice medicine is just on the horizon. The routine use of point-of-care ultrasound (PoCUS) will become an essential skill for the practicing internist. The application for PoCUS in the field of internal medicine is immense – accurately assessing the JVP in critically ill patients, performing arterial and venipunctures, diagnosing pericardial tamponade or determining the likelihood of a pulmonary embolus, or the diagnostic and therapeutic removal of body fluids, to name a few.While some of our colleagues have adopted this technology as an adjunct to the clinical examination or as an aid to conducting bedside procedures most have not adopted this as a routine skill set. Some of the barriers include insufficient training and a lack of readily accessible equipment in all clinical settings. But this will change, and the use of PoCUS will eventually become a required skill of all practicing internists.In the current issue of CJGIM Lewis et al have conducted a needs assessment of PoCUS in answering either a clinical question or in guiding a procedure. As the Royal College of Physicians and Surgeons does not yet require all internal medicine residency programs to provide a formal PoCUS curriculum, the objective of their study was to conduct a systematic needs assessment for the introduction of a PoCUS curriculum to an internal medicine program. The results showed that some internal medicine residents were already using PoCUS yet they had never been formal trained in the skill. One is left to wonder what a similar survey would find if conducted amongst practicing internists.While each residency programs will inevitably develop a PoCUS curriculum for their trainees, it will remain a continuing education challenge for internists already in practice. The importance of this skill cannot be under estimated and it will require the leadership in the internal medicine community to ensure that they create the opportunity for all internists to master the use of PoCUS.

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

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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