scholarly journals Advanced Care Directives: Overcoming the Obstacles

2015 ◽  
Vol 7 (1) ◽  
pp. 91-94 ◽  
Author(s):  
Sarah Leatherman Allen ◽  
Kimberly S. Davis ◽  
Paul C. Rousseau ◽  
Patty J. Iverson ◽  
Patrick D. Mauldin ◽  
...  
Keyword(s):  
End Of Life ◽  
Internal Medicine Resident ◽  
Living Will ◽  
Clinical Environment ◽  
Family Meeting ◽  
Continuity Clinic ◽  
Medicine Resident ◽  
Resident Physicians ◽  
Advanced Care Directives ◽  
Resident Continuity Clinic

Abstract Background Advanced care directives (ACDs) and end-of-life discussions are important and typically difficult to initiate because of the sensitive nature of the topic and competing clinical priorities. Resident physicians need to have these conversations but often do not in their continuity clinics. Objective We implemented a program to (1) increase physician opportunity to discuss end-of-life wishes with their patients, and (2) improve residents' confidence in leading discussions regarding ACDs. Intervention A total of 95 residents in an academic outpatient internal medicine resident continuity clinic participated in a formalized curriculum (didactic sessions, simulations, and academic detailing). Clinic workflow alterations prompted the staff to question if patients had an ACD or living will, and then cued residents to discuss these issues with the patients if they did not. Results Of the 77% of patients who were asked about ACDs, 74% had no ACD but were interested in discussing this topic. After our intervention, 65% (62 of 95) of our residents reported having at least 1 outpatient discussion with their patients. Residents reported increased confidence directing and discussing advanced care planning with older patients and conducting a family meeting (P < .01). Conclusions By delivering a formalized curriculum and creating a clinical environment that supports such discussions, resident physicians had more ACD discussions with their patients and reported increased confidence. When provided information and opportunity, patients consistently expressed interest in talking with their physician about their advanced care wishes.

scholarly journals Outcomes of a novel office-based opioid treatment program in an internal medicine resident continuity practice

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jarratt D. Pytell ◽  
Megan E. Buresh ◽  
Ryan Graddy
Keyword(s):  
Retrospective Chart Review ◽  
Internal Medicine Resident ◽  
Patient Characteristics ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Continuity Clinic ◽  
Opioid Treatment ◽  
Attitudes And Practices ◽  
Medicine Resident ◽  
Resident Continuity Clinic

Abstract Background The integration of opioid use disorder (OUD) care and competencies in graduate medical education training is needed. Previous research shows improvements in knowledge, attitudes, and practices after exposure to OUD care. Few studies report outcomes for patients with OUD in resident physician continuity practices. Methods A novel internal office-based opioid treatment (OBOT) program was initiated in a resident continuity clinic. Surveys of resident and staff knowledge and attitudes of OBOT were administered at baseline and 4 months. A retrospective chart review of the 15-month OBOT clinic obtained patient characteristics and outcomes. Results Twelve patients with OUD were seen in the OBOT clinic. Seven patients (58%) were retained in care at the end of the study period for a range of 9–15 months. Eight patients demonstrated a good clinical response. Surveys of residents and staff at 4 months were unchanged from baseline showing persistent lack of comfort in caring for patients with OUD. Conclusions OBOT can be successfully integrated into resident continuity practices with positive patient outcomes. Improvement in resident and staff attitudes toward OBOT were not observed and likely require direct and frequent exposure to OUD care to increase acceptance.

scholarly journals Burned Out at the Bedside: Patient Perceptions of Physician Burnout in an Internal Medicine Resident Continuity Clinic

2015 ◽  
Vol 31 (2) ◽  
pp. 203-208 ◽  
Author(s):  
Justin P. Lafreniere ◽  
Rebeca Rios ◽  
Hillary Packer ◽  
Sharon Ghazarian ◽  
Scott M. Wright ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Internal Medicine Resident ◽  
Patient Perceptions ◽  
Physician Burnout ◽  
Continuity Clinic ◽  
Medicine Resident ◽  
Resident Continuity Clinic

scholarly journals Quality of Cardiovascular Care in an Internal Medicine Resident Clinic

2010 ◽  
Vol 2 (3) ◽  
pp. 467-473 ◽  
Author(s):  
Eileen Masterson ◽  
Priyanka Patel ◽  
Yen-Hong Kuo ◽  
Charles K. Francis
Keyword(s):  
Internal Medicine ◽  
Internal Medicine Resident ◽  
Diabetic Patients ◽  
Treatment Goals ◽  
Risk Factor Control ◽  
Continuity Clinic ◽  
Medicine Resident ◽  
Resident Continuity Clinic ◽  
Cardiovascular Care

Abstract Background Attainment of treatment goals derived from evidence-based practice guidelines can be a useful measure of the quality of cardiovascular care. To date, there are few studies of the quality of care provided in a resident continuity clinic, as measured by success in meeting nationally defined guidelines for control of cardiovascular risk factors. There also is limited information regarding the quality of care in resident continuity clinics serving multiethnic uninsured/underinsured populations. This study assessed the efficacy of residents in internal medicine in attaining evidence-based, guideline-defined treatment goals for control of hypertension, dyslipidemia, and hyperglycemia in an uninsured/underinsured multiethnic population. Methods In a cross-sectional study of patients treated exclusively by residents (with faculty supervision) between July 1 and December 31, 2005, data were abstracted from the medical records of 628 consecutive patients (mean age, 55.6 years; 62% female; 61.3% non-white; 55.5% uninsured) with hypertension, hyperlipidemia, and/or diabetes mellitus. Quality measures were the proportion of diabetic and nondiabetic patients who met guideline-defined treatment goals for hypertension, dyslipidemia, and hyperglycemia in diabetic patients. Results Goal attainment overall was 44.9% for high blood pressure, 55.7% for dyslipidemia, and 43.3% for hemoglobin A1c for diabetic patients. There was no relationship between age, gender, race/ethnicity, insurance, or body weight to attainment of hypertension, dyslipidemia, or hemoglobin A1c goals in diabetic and nondiabetic cohorts from multivariate analysis. Risk factor control rates were higher in this study than in comparable educational programs. Conclusion An internal medicine resident continuity clinic can provide high-quality care that meets guideline-defined cardiovascular risk factor control goals in a racially and ethnically diverse, underinsured/uninsured, low-income population in a community-based academic medical center.

How do resident physicians prefer to seek help from burnout? A best-worst scaling survey of internal medicine resident physicians examining rank-ordered factors for help-seeking and barriers to utilizing mental health supports (Preprint)

2021 ◽  
Author(s):  
Andrew Wu ◽  
Varsha Radhakrishnan ◽  
Elizabeth Targan ◽  
Timothy P Scarella ◽  
John Torous ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Peer Support ◽  
Help Seeking ◽  
Latent Class ◽  
Internal Medicine Resident ◽  
Wellness Programs ◽  
Specific Information ◽  
Medicine Resident ◽  
Resident Physicians ◽  
Best Worst Scaling

BACKGROUND Burnout interventions are limited by low utilization. Understanding resident physician preferences for burnout interventions may increase utilization and improve assessment of interventions. OBJECTIVE An econometric best-worst scaling (BWS) framework was used to survey internal medicine resident physicians to establish help-seeking preferences for burnout and barriers to utilizing wellness supports. METHODS Internal medicine resident physicians at our institution completed an anonymous online BWS survey during the 2020-2021 academic year. This cross-sectional study was analyzed with multinomial logistic regression and latent class modeling to determine relative rank-ordering of factors for seeking support for burnout and barriers to utilizing wellness supports. ANOVA with post-hoc Tukey HSD was used to analyze differences in mean utility scores representing choice for barriers and support options. RESULTS 77 residents completed the survey (47% response rate). Top-ranking factors for seeking wellness supports were seeking informal peer support (best: 71%/worst: 0.6%) and support from friends and family (best: 70%/worst: 1.6%). Top-ranking barriers to seeking counseling were time (best: 75%/worst: 5%) and money (best: 35%/worst: 21%). Latent class analysis identified two segments, a Formal Help-Seeking group (n=6) that preferred seeking therapy as their 2nd-ranking factor (best: 63%/worst: 0%), and an Open to Isolating group (n=20) that preferred to not seek support from others as their 3rd ranking factor (best: 14%/worst: 18%). CONCLUSIONS Overall, resident physicians reported high preference for informal peer support, though there exists a segment that prefer counseling services and a segment that prefers not to seek help at all. Time and cost are more significant barriers compared to stigma against utilizing wellness supports. Using BWS-informed studies are a promising and easy-to-administer methodology for clinician wellness programs to gather specific information on clinician preferences to determine best practices for wellness programs. CLINICALTRIAL N/A

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