An Effective Multimodal Curriculum to Teach Internal Medicine Residents Evidence-Based Breast Health

Abstract Background Breast health is an area fraught with controversy and missed opportunities to meet women's needs, and the state of internal medicine residency training in this area is inadequate. Objective Our objective was to develop, implement, and evaluate a curriculum to equip internal medicine residents with the knowledge and skills to deliver high-quality, comprehensive breast health care. Methods We developed a 4-hour curriculum for internal medicine interns. It incorporated a team-based learning format and used MammaCare breast model software to teach and evaluate the clinical breast examination. We compared interns' precurriculum and postcurriculum test results to a historical comparison group of postgraduate year (PGY)–2 interns who did not complete the curriculum. We retested interns as PGY-2s to assess knowledge retention. Results A total 41 of 52 interns (79%) completed the curriculum. Their average MammaCare scores improved from 63% to 91%. Scores on a knowledge-based assessment improved from 47% on the pretest to 85% on the posttest (P < .001). Comparison PGY-2s who did not complete the curriculum averaged a score of 52% (P < .001). When retested 9 months after exposure to the curriculum, participants' mean score was 63% (compared to historical comparison PGY-2 group, P < .001). Only 9% of interns who retook the test as PGY-2s reported having received any breast health training subsequent to curriculum completion. Conclusions A targeted half-day, low-cost breast health curriculum significantly improved knowledge and skills in multiple domains, and these improvements were retained in subsequent assessment despite minimal reinforcement in residency training.

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Drug Alert Experience and Salience during Medical Residency at Two Healthcare Institutions

Applied Clinical Informatics ◽

10.1055/s-0041-1729167 ◽

2021 ◽

Vol 12 (02) ◽

pp. 355-361

Author(s):

Kinjal Gadhiya ◽

Edgar Zamora ◽

Salim M. Saiyed ◽

David Friedlander ◽

David C. Kaelber

Keyword(s):

Internal Medicine ◽

Residency Training ◽

Medical Center ◽

Internal Medicine Resident ◽

Clinical Decision ◽

University Of Pennsylvania ◽

Teaching Hospitals ◽

Medicine Resident ◽

Internal Medicine Residents ◽

The University

Abstract Background Drug alerts are clinical decision support tools intended to prevent medication misadministration. In teaching hospitals, residents encounter the majority of the drug alerts while learning under variable workloads and responsibilities that may have an impact on drug-alert response rates. Objectives This study was aimed to explore drug-alert experience and salience among postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2), and postgraduate year 3 (PGY-3) internal medicine resident physicians at two different institutions. Methods Drug-alert information was queried from the electronic health record (EHR) for 47 internal medicine residents at the University of Pennsylvania Medical Center (UPMC) Pinnacle in Pennsylvania, and 79 internal medicine residents at the MetroHealth System (MHS) in Ohio from December 2018 through February 2019. Salience was defined as the percentage of drug alerts resulting in removal or modification of the triggering order. Comparisons were made across institutions, residency training year, and alert burden. Results A total of 126 residents were exposed to 52,624 alerts over a 3-month period. UPMC Pinnacle had 15,574 alerts with 47 residents and MHS had 37,050 alerts with 79 residents. At MHS, salience was 8.6% which was lower than UPMC Pinnacle with 15%. The relatively lower salience (42% lower) at MHS corresponded to a greater number of alerts-per-resident (41% higher) compared with UPMC Pinnacle. Overall, salience was 11.6% for PGY-1, 10.5% for PGY-2, and 8.9% for PGY-3 residents. Conclusion Our results are suggestive of long-term drug-alert desensitization during progressive residency training. A higher number of alerts-per-resident correlating with a lower salience suggests alert fatigue; however, other factors should also be considered including differences in workload and culture.

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Timing and Predictors of Subspecialty Career Choice Among Internal Medicine Residents: A Retrospective Cohort Study

Journal of Graduate Medical Education ◽

10.4300/jgme-d-19-00556.1 ◽

2020 ◽

Vol 12 (2) ◽

pp. 212-216

Author(s):

Jingkun Yang ◽

Surbhi Singhal ◽

Yingjie Weng ◽

Jason P. Bentley ◽

Neel Chari ◽

...

Keyword(s):

Internal Medicine ◽

Career Choice ◽

Residency Training ◽

Career Choices ◽

Hospital Medicine ◽

Care Hospital ◽

Clinical Exposure ◽

Internal Medicine Residents ◽

Primary Care Hospital ◽

Early Clinical Exposure

ABSTRACT Background Internal medicine residents face numerous career options after residency training. Little is known about when residents make their final career choice. Objective We assessed the timing and predictive factors of final career choices among internal medicine residents at graduation, including demographics, pre-residency career preferences, and rotation scheduling. Methods We conducted a retrospective study of graduates of an academic internal medicine residency program from 2014 to 2017. Main measures included demographics, rotation schedules, and self-reported career choices for residents at 5 time points: recruitment day, immediately after Match Day, end of postgraduate year 1 (PGY-1), end of PGY-2, and at graduation. Results Of the 138 residents eligible for the study, 5 were excluded based on participation in a fast-track program for an Accreditation Council for Graduate Medical Education subspecialty fellowship. Among the remaining 133 residents, 48 (36%) pursued general internal medicine fields and 78 (59%) pursued fellowship training. Career choices from recruitment day, Match Day, and PGY-1 were only weakly predictive of the career choice. Many choices demonstrated low concordance throughout training, and general medicine fields (primary care, hospital medicine) were frequently not decided until after PGY-2. Early clinical exposure to subspecialty rotations did not predict final career choice. Conclusions Early career choices before and during residency training may have low predictability toward final career choices upon graduation in internal medicine. These choices may continue to have low predictability beyond PGY-2 for many specialties. Early clinical exposure may not predict final career choice for subspecialties.

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COVID-19: The Impact on Internal Medicine Residency Training (Preprint)

10.2196/preprints.23146 ◽

2020 ◽

Author(s):

Odalys Estefania Lara Garcia ◽

Khalid Sawalha ◽

Oswaldo Aristides Madrid Suarez ◽

Mohsin Salih ◽

Mukul Bhattarai ◽

...

Keyword(s):

Internal Medicine ◽

Residency Training ◽

Internal Medicine Residency ◽

Internal Medicine Residents ◽

Internal Medicine Residency Training ◽

The Impact ◽

The Way

UNSTRUCTURED The SARS-CoV-2 (COVID-19) pandemic outreach has not only affected the care we provide to patients, but also the way our residents are trained, especially internal medicine residents. We review the current challenges and changes that have taken place in the education of internal medicine residents. Proposed solutions are discussed.

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Attitudes, knowledge, and skills of internal medicine residents regarding pre-conception care

Academic Medicine ◽

10.1097/00001888-199405000-00014 ◽

1994 ◽

Vol 69 (5) ◽

pp. 389-91 ◽

Cited By ~ 8

Author(s):

T Conway ◽

E Mason ◽

T C Hu

Keyword(s):

Internal Medicine ◽

Knowledge And Skills ◽

Internal Medicine Residents

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The Neighborhood Health Exchange: Developing a Community Partnership in Residency

Journal of Graduate Medical Education ◽

10.4300/jgme-d-10-00067.1 ◽

2010 ◽

Vol 2 (3) ◽

pp. 456-461 ◽

Cited By ~ 1

Author(s):

Kimberly M. Tartaglia ◽

Valerie G. Press ◽

Benjamin H. Freed ◽

Timothy Baker ◽

Joyce W. Tang ◽

...

Keyword(s):

Internal Medicine ◽

Residency Training ◽

Current System ◽

Hospital Setting ◽

Community Outreach ◽

Community Partnership ◽

Community Members ◽

Training Experience ◽

Ambulatory Training ◽

Internal Medicine Residents

Abstract Background The current system of residency training focuses on the hospital setting, and resident exposure to the surrounding community is often limited. However, community interaction can play an important role in ambulatory training and in learning systems-based practice, a residency core competency. The goal of the Neighborhood Health Exchange was to develop a community partnership to provide internal medicine residents with an opportunity to interface with community members through a mutually beneficial educational experience. Methods Internal medicine residents received training during their ambulatory block and participated in a voluntary field practicum designed to engage community members in discussions about their health. Community members participated in education sessions led by resident volunteers. Results Resident volunteers completed a survey on their experiences. All residents stated that the opportunity to lead an exchange was very useful to their overall residency training. Eight exchanges were held with a total of 61 community participants, who completed a 3-question survey following the session. This survey asked about the level of material, the helpfulness of the exchanges, and opportunities for improvement. We received 46 completed surveys from community members: 91% stated that the material was presented “at the right level” and 93% stated that the presentations were somewhat or very helpful. Eighty percent gave positive and encouraging comments about the exchange. Conclusion Effective community partnerships involve assessing needs of the stakeholders, anticipating leadership turnover, and adapting the Neighborhood Health Exchange model to different groups. Community outreach can also enhance internal medicine ambulatory training experience, provide residents with patient counseling opportunities, and offer a novel method to enhance resident understanding of systems-based practice, especially within the larger community in which their patients live.

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Mo1072 Reduction of Inappropriate Stress Ulcer Prophylaxis by the General Internal Medicine Residents: an Impact of a Low-Cost Intervention

Gastroenterology ◽

10.1016/s0016-5085(12)62252-5 ◽

2012 ◽

Vol 142 (5) ◽

pp. S-587

Author(s):

Gaurav Jain ◽

Sayeeda A. Jabeen ◽

Srikanth Vallurupalli

Keyword(s):

Internal Medicine ◽

General Internal Medicine ◽

Stress Ulcer ◽

Low Cost ◽

Stress Ulcer Prophylaxis ◽

General Internal ◽

Internal Medicine Residents ◽

Ulcer Prophylaxis

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Internal Medicine Residents' Retention of Knowledge and Skills in Bedside Ultrasound

Journal of Graduate Medical Education ◽

10.4300/jgme-d-15-00383.1 ◽

2016 ◽

Vol 8 (4) ◽

pp. 553-557 ◽

Cited By ~ 13

Author(s):

James A. Town ◽

Paul A. Bergl ◽

Akhil Narang ◽

John F. McConville

Keyword(s):

Internal Medicine ◽

Bedside Ultrasound ◽

Skills Assessment ◽

Independent Practice ◽

Knowledge And Skills ◽

Assessment Score ◽

Internal Medicine Residents ◽

Practice Performance ◽

Retention Of Knowledge ◽

Over Time

ABSTRACT Background The long-term retention of knowledge and skills in bedside ultrasound by internal medicine residents after ultrasound training is not well understood. Objective We sought to determine whether knowledge and skills acquired from focused training in bedside ultrasound are retained over time, and whether retention is related to independent practice. Methods We conducted a prospective observational trial of 101 internal medicine residents at an academic medical center who participated in a bedside ultrasound workshop followed by 12 months of independent practice. Performance was measured on image-based knowledge and skills assessment using direct observation, both before the workshop and 12 months later. Individual usage data were obtained along with a survey on attitudes toward bedside ultrasound. Results Participants' mean knowledge assessment score increased from a baseline of 63.7% to 84.5% immediately after training (P < .001). At 12 months, mean knowledge score fell to 73.0%, significantly different from both prior assessments (P < .001). Despite knowledge decline, the mean skills assessment score improved from a baseline of 30.5% to 50.4% at 12 months (P < .001). Residents reporting more ultrasound use (> 25 examinations) had higher scores in baseline knowledge and skills assessments than those with lower usage (< 25 examinations). Change in knowledge and image acquisition skills between assessments was equal in both subgroups. Conclusions Residents' knowledge of ultrasound improved after brief training but decayed over time, whereas skills showed marginal improvement over the study, with minimal support. Growth and retention of ultrasound abilities were not impacted by usage rates.

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