scholarly journals Restructuring the Orthopedic Resident Research Curriculum to Increase Scholarly Activity

2013 ◽  
Vol 5 (4) ◽  
pp. 646-651 ◽  
Author(s):  
Laura Robbins ◽  
Mathias Bostrom ◽  
Robert Marx ◽  
Timothy Roberts ◽  
Thomas P. Sculco
Keyword(s):  
Medical Center ◽  
Academic Research ◽  
Scholarly Activity ◽  
Research Quality ◽  
Full Time ◽  
Full Time Equivalent ◽  
Resident Research ◽  
Protected Time ◽  
Skills Laboratory ◽  
Research Curriculum

Abstract Background Limited time and funding are challenges to meeting the research requirement of the orthopedic residency curriculum. Objective We report a reorganized research curriculum that increases research quality and productivity at our academic orthopedic medical center. Methods Changes made to the curriculum, which began in 2006 and were fully phased in by 2008, included research milestones for each training year, a built-in support structure, use of an accredited bio-skills laboratory, mentoring by National Institutes of Health–funded scientists, and protected time to engage in required research and prepare scholarly peer-reviewed publications. Results Total grant funding of resident research increased substantially, from $15,000 in 2007 (8 graduates) to $380,000 in 2010 (9 graduates), and the number of publications also increased. The 12 residents who graduated in 2005 published 16 papers from 2000 to 2006, compared to 84 papers published by the 9 residents who graduated in 2010. The approximate costs per year included $19,000 (0.3 full-time equivalent) for an academic research coordinator; $16,000 for resident travel to professional meetings; reimbursement for 213 faculty hours; and funding for resident salaries while on the research rotation, paid through the general hospital budget. Conclusions The number of grants and peer-reviewed publications increased considerably after our residency research curriculum was reorganized to allow dedicated research time and improved mentoring and infrastructure.

Measurement of Individual Clinical Productivity in an Academic Anesthesiology Department

2000 ◽  
Vol 93 (6) ◽  
pp. 1509-1516 ◽  
Author(s):  
Amr E. Abouleish ◽  
Mark H. Zornow ◽  
Ronald S. Levy ◽  
James Abate ◽  
Donald S. Prough
Keyword(s):  
Medical Center ◽  
Clinical Care ◽  
Obstetric Anesthesia ◽  
Fiscal Year ◽  
Full Time ◽  
Full Time Equivalent ◽  
High Productivity ◽  
Academic Settings ◽  
Individual Productivity ◽  
American Society

Background The ability to measure productivity, work performed, or contributions toward the clinical mission has become an important issue facing anesthesiology departments in private practice and academic settings. Unfortunately, the practice and billing of anesthesia services makes it difficult to quantify individual productivity. This study examines the following methods of measuring individual productivity: normalized clinical days per year (nCD/yr); time units per operating-room day worked (TU/OR day); normalized time units per year (nTU/yr); total American Society of Anesthesiologists (ASA) units per OR day (tASA/OR day); and normalized total ASA units per year (ntASA/yr). Methods Billing and scheduling data for clinical activities of faculty members of an anesthesiology department at a university medical center were collected and analyzed for the 1998 fiscal year. All clinical sites and all clinical faculty anesthesiologists were included unless they spent less than 20% of their time during the fiscal year providing clinical care, i.e., less than 0.2 clinical full-time equivalent. Outliers, defined as faculty who had productivity greater or less than 1 SD from the mean, were examined in detail. Results Mean and median values were reported for each measurement, and different groups of outliers were identified. nCD/yr identified faculty who worked more than their clinical full-time equivalent would have predicted. TU/OR day and tASA/OR day identified apparently low-productivity faculty as those who worked a large portion of their time in obstetric anesthesia or an ambulatory surgicenter. tASA/OR day identified specialty anesthesiologists as apparently high-productivity faculty. nTU/yr and ntASA/yr were products of the per-OR day measurement and nCD/yr. Conclusion Each of the measurements studied values certain types of productivity more than others. By defining what type of service is most important to reward, the most appropriate measure or combination of measures of productivity can be chosen. In the authors' department, nCD/yr is the most useful measure of individual productivity because it measures an individual anesthesiologist's contribution to daily staffing, includes all clinical sites, is independent of nonanesthesia factors, and is easy to collect and determine.

scholarly journals Extending the Population Health Workforce Through Service Learning Internships During COVID: A Community Case Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Jeffrey Belkora ◽  
Tia Weinberg ◽  
Jasper Murphy ◽  
Sneha Karthikeyan ◽  
Henrietta Tran ◽  
...  
Keyword(s):  
Service Learning ◽  
Population Health ◽  
San Francisco ◽  
Medical Center ◽  
Academic Medical Center ◽  
University Of California ◽  
Full Time ◽  
Learning Program ◽  
Full Time Equivalent ◽  
The University

This report arises from the intersection of service learning and population health at an academic medical center. At the University of California, San Francisco (UCSF), the Office of Population Health and Accountable Care (OPHAC) employs health care navigators to help patients access and benefit from high-value care. In early 2020, facing COVID-19, UCSF leaders asked OPHAC to help patients and employees navigate testing, treatment, tracing, and returning to work protocols. OPHAC established a COVID hotline to route callers to the appropriate resources, but needed to increase the capacity of the navigator workforce. To address this need, OPHAC turned to UCSF's service learning program for undergraduates, the Patient Support Corps (PSC). In this program, UC Berkeley undergraduates earn academic credit in exchange for serving as unpaid patient navigators. In July 2020, OPHAC provided administrative funding for the PSC to recruit and deploy students as COVID hotline navigators. In September 2020, the PSC deployed 20 students collectively representing 2.0 full-time equivalent navigators. After training and observation, and with supervision and escalation pathways, students were able to fill half-day shifts and perform near the level of staff navigators. Key facilitators relevant to success reflected both PSC and OPHAC strengths. The PSC onboards student interns as institutional affiliates, giving them access to key information technology systems, and trains them in privacy and other regulatory requirements so they can work directly with patients. OPHAC strengths included a learning health systems culture that fosters peer mentoring and collaboration. A key challenge was that, even after training, students required around 10 h of supervised practice before being able to take calls independently. As a result, students rolled on to the hotline in waves rather than all at once. Post-COVID, OPHAC is planning to use student navigators for outreach. Meanwhile, the PSC is collaborating with pipeline programs in hopes of offering this internship experience to more students from backgrounds that are under-represented in healthcare. Other campuses in the University of California system are interested in replicating this program. Adopters see the opportunity to increase capacity and diversity while developing the next generation of health and allied health professionals.

scholarly journals Implementation of a Health-System Wide Antimicrobial Stewardship Program in Omaha, NE

Pharmacy ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 156
Author(s):  
Jennifer Anthone ◽  
Dayla Boldt ◽  
Bryan Alexander ◽  
Cassara Carroll ◽  
Sumaya Ased ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Health System ◽  
Antimicrobial Stewardship ◽  
Program Effectiveness ◽  
Medical Center ◽  
Academic Medical Center ◽  
Full Time ◽  
Critical Access Hospitals ◽  
Full Time Equivalent ◽  
Stewardship Program

The Centers for Medicare and Medicaid Services (CMS) have mandated that acute care and critical access hospitals implement an Antimicrobial stewardship (AMS) program. This manuscript describes the process that was implemented to ensure CMS compliance for AMS, across a 14-member health system (eight community hospitals, five critical access hospitals, and an academic medical center) in the Omaha metro area, and surrounding cities. The addition of the AMS program to the 14-member health system increased personnel, with a 0.5 full-time equivalent (FTE) infectious diseases (ID) physician, and 2.5 FTE infectious diseases trained clinical pharmacists to support daily AMS activities. Clinical decision support software had previously been implemented across the health system, which was also key to the success of the program. Overall, in its first year, the AMS program demonstrated a $1.2 million normalized reduction (21% total reduction in antimicrobial purchases) in antimicrobial expenses. The ability to review charts daily for antimicrobial optimization with ID pharmacist and physician support, identify facility specific needs and opportunities, and to collect available data endpoints to determine program effectiveness helped to ensure the success of the program.

Using pharmacists’ documentation of clinical activities to reclaim employees and reposition the department

1996 ◽  
Vol 53 (3) ◽  
pp. 285-288 ◽  
Author(s):  
Michael R. McDaniel ◽  
Douglas J. DeJong
Keyword(s):  
Total Quality Management ◽  
Task Force ◽  
Medical Center ◽  
Antimicrobial Use ◽  
Full Time ◽  
Clinical Documentation ◽  
Total Quality ◽  
Full Time Equivalent ◽  
Pharmacy Department ◽  
Evening Shift

Abstract The use of documentation on pharmacist clinical activities to encourage greater hospital investment in a department is described. From 1983 through 1988, the number of full-time-equivalent (FTE) positions in the pharmacy department at a 468-bed medical center was reduced from 63 to 39.4. To cope with the challenge of a sharply reduced staff, the department established a permanent pharmacy-nursing task force, developed a pharmacy strategic plan, used total quality management, recruited the best staff possible when openings appeared, and held staff retreats. In addition, measures were taken to begin documenting all pharmacist clinical activities online. As data were accumulated, it became clear that more pharmacist involvement in patient care areas was needed and that more resources would be necessary to achieve that. Presentations were made to hospital administration to demonstrate the existing and potential contributions of the department; the presentations drew heavily on the clinical documentation. Formal reports were also submitted. As a result, the department received approval for a pharmacist career ladder, an increase of 1.6 pharmacist FTEs for the evening shift, a large salary-range adjustment for staff pharmacists, and an increase of 1 pharmacist FTE to focus on antimicrobial use. A pharmacy department successfully used documentation of its clinical activities to make a case to administration for reclaiming some of the pharmacist FTEs lost through downsizing.

How Much Labor Is in a Labor Epidural?

2000 ◽  
Vol 92 (3) ◽  
pp. 851-858 ◽  
Author(s):  
Elizabeth D. Bell ◽  
Donald H. Penning ◽  
Edward F. Cousineau ◽  
William D. White ◽  
Andrew J. Hartle ◽  
...  
Keyword(s):  
Operating Room ◽  
Medical Center ◽  
Labor Cost ◽  
Full Time ◽  
Full Time Equivalent ◽  
Medicaid Reimbursement ◽  
Tertiary Referral Center ◽  
Time And Motion ◽  
Obstetric Analgesia ◽  
Duke University

Background Some anesthesiologists avoid provision of obstetric analgesia services (OAS) because of low reimbursement rates for the work involved. This study defines the manpower costs of operating an OAS in a tertiary referral center and examines reimbursement for this cost. Methods The time spent providing OAS in a total of 55 parturients was studied prospectively using a modification of classic time and motion studies. Results Mean duration of OAS in our population was 412 +/- 313 min. Mean bedside anesthesia staff time was 90 +/- 40 min, and mean number of visits to each patient's bedside was 6.3 +/- 2.0 visits. Assuming staffing on demand for service (intermittent staffing), a minimum of 2.5 full-time equivalent (FTE) attending anesthesiologists was required to meet demand. With intermittent staffing, labor cost was $325 per patient. Actual practice at Duke University Medical Center is around-the-clock (dedicated) staffing, which requires 4.4 FTEs at a cost of $728 per patient. Neither average indemnity reimbursement ($299) nor Medicaid reimbursement ($204) covered the cost per OAS patient. Breaking even is possible under indemnity reimbursement because operating room reimbursement subsidizes OAS costs. Breaking even cannot occur with Medicaid reimbursement under any circumstances. Conclusions Obstetric analgesia services requires a minimum of 2.5 FTE attending anesthesiologists at Duke University Medical Center. With the current payer mix, positive-margin operating room activities associated with the obstetric service are not sufficient to compensate for the losses incurred by an OAS. Around-the-clock dedicated obstetric staffing (4.4 FTEs) cannot operate profitably under any reasonable circumstances at our institution.

A dozen years of evolution of neurology clerkships in the United States

Neurology ◽  
2018 ◽  
Vol 91 (15) ◽  
pp. e1440-e1447 ◽  
Author(s):  
Joseph E. Safdieh ◽  
Adam D. Quick ◽  
Pearce J. Korb ◽  
Diego Torres-Russotto ◽  
Karissa L. Gable ◽  
...  
Keyword(s):  
Medical School ◽  
Racial Diversity ◽  
Fold Increase ◽  
The United States ◽  
School Curriculum ◽  
Full Time ◽  
Full Time Equivalent ◽  
Black African ◽  
Protected Time ◽  
Neurology Clerkship

ObjectiveTo report a 2017 survey of all US medical school neurology clerkship directors (CDs) and to compare the results to similar surveys conducted in 2005 and 2012.MethodsAn American Academy of Neurology (AAN) Consortium of Neurology Clerkship Directors (CNCD) workgroup developed the survey that was sent to all neurology CDs listed in the AAN CNCD database. Comparisons were made to similar 2005 and 2012 surveys.ResultsThe response rate was 92 of 146 programs (63%). Among the responding institutions, neurology is required in 94% of schools and is 4 weeks in length in 75%. From 2005 to 2017, clerkships shifted out of a fourth-year-only rotation (p = 0.035) to earlier curricular time points. CD protected time averages 0.24 full-time equivalent (FTE), with 31% of CDs reporting 0.26 to 0.50 FTE support, a >4-fold increase from prior surveys (p < 0.001). CD service of >12 years increased from 9% in 2005 to 23% in 2017. Twenty-seven percent also serve as division chief/director, and 22% direct a preclinical neuroscience course. Forty-nine percent of CDs are very satisfied in their role, increased from 34% in 2012 (p = 0.046). The majority of CDs identify as white and male, with none identifying as black/African American.ConclusionChanges since 2005 and 2012 include shifting of the neurology clerkship to earlier in the medical school curriculum and an increase in CD salary support. CDs are more satisfied than reflected in previous surveys and stay in the role longer. There is a lack of racial diversity among neurology CDs.

Multipronged Intervention Strategy to Control an Outbreak of Clostridium difficile Infection (CDI) and Its Impact on the Rates of CDI from 2002 to 2007

2009 ◽  
Vol 30 (2) ◽  
pp. 156-162 ◽  
Author(s):  
Karl Weiss ◽  
Annie Boisvert ◽  
Miguel Chagnon ◽  
Caroline Duchesne ◽  
Sylvie Habash ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Infection Control ◽  
Virulent Strain ◽  
Medical Center ◽  
Intervention Strategy ◽  
Global Strategy ◽  
Full Time ◽  
Surveillance Period ◽  
Full Time Equivalent ◽  
Monthly Basis

Objective.At the end of 2002, a new, more virulent strain of Clostridium difficile, designated BI/NAP1, was the cause of a massive outbreak of infection in the province of Quebec. This particular strain was associated with a dramatic increase in morbidity and mortality among affected patients in 2003–2004. We tested and implemented a multipronged infection control approach to curtail the rate of C. difficile infection (CDI).Design.Five-year observational study.Setting.A 554-bed, acute care tertiary hospital, the largest single medical center in Quebec, Canada.Methods.To curtail the magnitude of the outbreak, we implemented a global strategy consisting of rapid C. difficile testing for all hospitalized patients who had at least 1 occurrence of liquid stool, the rapid isolation of patients infected with C. difficile in a dedicated ward with a specially trained housekeeping team, a global hand hygiene program, and the hiring of infection control practitioners. Antibiotic consumption at the institutional level was also monitored during the 5-year surveillance period. Cases of hospital-acquired CDI per 1,000 admissions were continuously monitored on a monthly basis during the entire surveillance period.Results.The highest recorded CDI rate was 42 cases per 1,000 admissions in January 2004. Once additional infection control resources were put in place, the rate descreased significantly during the period from April 2005 to March 2007. During the 2003–2004 period, there were 762 cases of CDI (mean annual rate, 37.28 cases per 1,000 admissions) recorded in our study, compared with 292 cases of CDI (14.48 cases per 1,000 admissions) during the 2006–2007 period (OR, 0.379 [95% CI, 0.331–0.435]; P < .001 ), a 61% reduction. In March 2007, the equivalent of 4 full-time equivalent infection control practitioners were in place, which gave a ratio of 0.96 infection control practitioners per 133 beds in use, compared with the ratio of 0.24 infection control practitioners per 133 beds in use in 2003, and the total number of hours dedicated to cleaning and housekeeping increased by 26.2%. The total amount of antibiotics used in the hospital did not vary significantly from 2002 to 2007, although there were changes in the classes antibiotic used.Conclusion.The implementation of a multipronged intervention strategy to control the outbreak of CDI significantly improved the overall situation at the hospital and underlined the importance of investing in stringent infection control practices.

Research 101: An Initiative to Encourage and Facilitate Quality Resident Research in a Military Setting

2017 ◽  
Vol 156 (6) ◽  
pp. 1054-1059 ◽  
Author(s):  
Kathryn E. Marshall ◽  
Tanisha L. Hammill
Keyword(s):  
Research Program ◽  
Medical Training ◽  
Medical Center ◽  
Research Experience ◽  
Research Activity ◽  
Resident Research ◽  
Academic Achievements ◽  
Medical Education Program ◽  
Research Curriculum

Objective Describe and evaluate a structured research program initiated at a tertiary Department of Defense (DOD) Medical Training Facility (MTF) to encourage and facilitate the conduct of research investigations, specifically among residents and junior or inexperienced investigators, but applicable for all DOD otolaryngology (ENT) and audiology providers. Methods A new comprehensive program was deployed in the ENT clinic at Madigan Army Medical Center (MAMC) to help improve the research program. Identified gaps in research methods and regulatory training were incorporated into the existing graduate medical education program along with structured mentorship between residents and senior staff. Academic achievements (eg, research protocols, publications, presentations at national/international meetings, and funding) for the ENT clinic were examined from 1992 to 2016, and changes in academic achievements were analyzed for success. Results The implementation of a structured research curriculum improved the number of protocols submitted and the quality of research being accepted for publication (ie, journal impact factor). Funding for research increased significantly to represent a third of the total research portfolio for the entire hospital. Discussion The benefit of employing a research specialist to oversee the resident research experience can greatly influence the quantity and quality of a resident program’s research portfolio. Implications for Practice Improving resident research activity can potentially advance the quality of the resident program, help with evidence-based medical approaches, and increase residents’ chances of matching for fellowship.

scholarly journals Sustainable Curriculum to Increase Scholarly Activity in a Family Medicine Residency

2019 ◽  
Vol 51 (3) ◽  
pp. 271-275 ◽  
Author(s):  
Sajeewane Manjula Seales ◽  
Robert P. Lennon ◽  
Kristian Sanchack ◽  
Dustin K. Smith
Keyword(s):  
Family Medicine ◽  
Scholarly Activity ◽  
Future Research ◽  
Point System ◽  
Resident Research ◽  
Family Medicine Residency ◽  
Scholarly Output ◽  
Research Coordinator ◽  
Research Curriculum ◽  
Over Time

Background and Objectives: Scholarly activity (SA) is an Accreditation Council for Graduate Medical Education (ACGME) requirement for family medicine residency programs. Engaging residents in scholarly activity can be challenging. In 2010, the Naval Hospital Jacksonville Family Medicine Residency (NHJ FMR) program pioneered a research curriculum that dramatically increased resident SA output. The purpose of this study was to determine whether this output sustained over time. Methods: A retrospective records review was performed on resident SA at the NHJ FMR program between academic years 2012-2013 to 2016-2017 (N=185). The following research curriculum interventions were implemented over academic years 2010-2012: a faculty research coordinator position, a scholarly activity point system, and a peer-driven resident research coordinator position. SA output was calculated based on total resident projects per year and “quality projects” or peer-reviewed projects per year. Regression analysis and Mann-Whitney U test tested nonparametric group comparisons. Results: The number of quality projects per resident per year increased from 0.34 in 2012-2013 to 1.05 in the 2016-2017 academic year. The quality projects per resident per year demonstrated a statistically significant increase over time (F(1,9)-18.98, P&lt;.005, R2 of 0.6784). When comparing preintervention years to postintervention years the average quality projects per resident was statistically significant (P&lt;.005). Conclusions: This curriculum model emphasizes unique and reliably sustainable interventions to increase scholarly output that can be implemented at any residency program. SA volume and quality increased over 5 postintervention years despite annual resident research coordinator turnover. This research demonstrates a resident-driven culture change that warrants future research on adaptability to other programs.

scholarly journals Factors Associated With Successfully Filling Faculty Vacancies in Family Medicine

2019 ◽  
Vol 51 (6) ◽  
pp. 489-492
Author(s):  
Kelly M. Everard ◽  
Kimberly Zoberi ◽  
Christine Jacobs
Keyword(s):  
Family Medicine ◽  
Clinical Teaching ◽  
Department Chairs ◽  
Full Time ◽  
New Faculty ◽  
Full Time Equivalent ◽  
Protected Time ◽  
Signing Bonus ◽  
Signing Bonuses ◽  
Research Alliance

Background and Objectives: Faculty vacancies are a concern for chairs of academic family medicine departments who regularly face having to recruit new faculty. Faculty physicians who report lack of support for research and teaching or excessive time in activities that are not meaningful may experience burnout resulting in leaving academic medicine. Methods: Data were collected via a Council of Academic Family Medicine Educational Research Alliance (CERA) survey of US family medicine department chairs. To determine characteristics associated with success in hiring new physician faculty, chairs answered questions about the number of vacancies in the previous 12 months, the number of vacancies filled in the previous 12 months, the months the longest vacancy was open, starting salary, whether signing bonus was offered, and the full-time equivalent (FTE) for clinical, research, teaching, and administrative time. Results: The response rate was 52%. Chairs reported an average of 3.9 vacancies in the previous 12 months, and an average of 2.5 (66%) were filled. Chairs who didn’t offer protected time for teaching filled a higher percentage of their vacancies, but they did not fill them faster than departments that did offer teaching time. Higher salary and a signing bonus were associated with filling positions faster. Chairs who offered a signing bonus filled positions nearly 4 months sooner than those who didn’t. Conclusions: Offering protected time for teaching or research and FTE allocation for clinical, teaching, research, and administrative time were not associated with success in hiring new faculty. Chairs who offered higher salaries and signing bonuses were able to hire faculty more quickly than those who didn’t.

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