scholarly journals Internal Medicine Resident Experiences With a 5-Month Ambulatory Panel Management Curriculum

2018 ◽  
Vol 10 (5) ◽  
pp. 559-565
Author(s):  
Emily K. Hadley Strout ◽  
Alison R. Landrey ◽  
Charles D. MacLean ◽  
Halle G. Sobel
Keyword(s):  
Internal Medicine ◽  
Patient Care ◽  
Patient Engagement ◽  
Hemoglobin A1c ◽  
Medical Center ◽  
Internal Medicine Resident ◽  
Diabetic Group ◽  
Medicine Resident ◽  
Panel Management ◽  
Management Curriculum

ABSTRACT Background  Panel management is emphasized as a subcompetency in internal medicine graduate medical education. Despite its importance, there are few published curricula on population medicine in internal medicine residency programs. Objective  We explored resident experiences and clinical outcomes of a 5-month diabetes and obesity ambulatory panel management curriculum. Methods  From August through December 2016, internal medicine residents at the University of Vermont Medical Center reviewed registries of their patients with diabetes, prediabetes, and obesity; completed learning modules; coordinated patient outreach; and updated gaps in care. Resident worksheets, surveys, and reflections were analyzed using descriptive and thematic analyses. Before and after mean hemoglobin A1c results were obtained for patients in the diabetic group. Results  Most residents completed the worksheet, survey, and reflection (93%–98%, N = 42). The worksheets showed 70% of participants in the diabetic group had appointments scheduled after outreach, 42% were offered referrals to the Community Health Team, and 69% had overdue laboratory tests ordered. Residents reported they worked well with staff (95%), were successful in coordinating outreach (67%), and increased their sense of patient care ownership (66%). In reflections, identified successes were improved patient care, teamwork, and relationship with patients, while barriers included difficulty ensuring follow-up, competing patient priorities, and difficulty with patient engagement. Precurricular mean hemoglobin A1c was 7.7%, and postcurricular was 7.6% (P = .41). Conclusions  The curriculum offered a feasible, longitudinal model to introduce residents to population health skills and interdisciplinary care coordination. Although mean hemoglobin A1c did not change, residents reported improved patient care. Identified barriers present opportunities for resident education in patient engagement.

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

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.

scholarly journals EMR-based handoff tool improves completeness of internal medicine residents’ handoffs

2018 ◽  
Vol 7 (3) ◽  
pp. e000188 ◽  
Author(s):  
Rebecca L Tisdale ◽  
Zac Eggers ◽  
Lisa Shieh
Keyword(s):  
Internal Medicine ◽  
Medical Center ◽  
Internal Medicine Resident ◽  
Objective Data ◽  
Code Status ◽  
Medicine Resident ◽  
Communication Breakdown ◽  
Internal Medicine Residents ◽  
Action List ◽  
Identical Fashion

BackgroundThe majority of adverse events in healthcare involve communication breakdown. Physician-to-physician handoffs are particularly prone to communication errors, yet have been shown to be more complete when systematised according to a standardised bundle. Interventions that improve thoroughness of handoffs have not been widely studied.AimTo measure the effect of an electronic medical record (EMR)-based handoff tool on handoff completeness.InterventionThis EMR-based handoff tool included a radio button prompting users to classify patients as stable, a ‘watcher’ or unstable. It automatically pulled in EMR data on the patient’s 24-hour vitals, common lab tests and code status. Finally, it provided text boxes labelled ‘Active Issues’, ‘Action List (To-Dos)’ and ‘If/Then’ to fill in.Implementation and evaluationWritten handoffs from general and specialty (haematology, oncology, cardiology) Internal Medicine resident-run inpatient wards were evaluated on a randomly chosen representative sample of days in April and May 2015 at Stanford University Medical Center, focusing on a predefined set of content elements. The intervention was then implemented in June 2015 with postintervention data collected in an identical fashion in August to September 2016.ResultsHandoff completeness improved significantly (p<0.0001). Improvement in inclusion of illness severity was notable for its magnitude and its importance in establishing a consistent mental model of a patient. Elements that automatically pulled in data and those prompting users to actively fill in data both improved.ConclusionA simple EMR-based handoff tool providing a mix of frameworks for completion and automatic pull-in of objective data improved handoff completeness. This suggests that EMR-based interventions may be effective at improving handoffs, possibly leading to fewer medical errors and better patient care.

scholarly journals A Reliable Billing Method for Internal Medicine Resident Clinics: Financial Implications for an Academic Medical Center

2010 ◽  
Vol 2 (2) ◽  
pp. 181-187 ◽  
Author(s):  
Suraj Kapa ◽  
Thomas J. Beckman ◽  
Stephen S. Cha ◽  
Joyce A. Meyer ◽  
Charlotte A. Robinet ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Interrater Reliability ◽  
Medical Center ◽  
Academic Medical Center ◽  
Internal Medicine Resident ◽  
Educational Interventions ◽  
Medicine Resident ◽  
Academic Medical ◽  
Outpatient Practice ◽  
Financial Losses

Abstract Background The financial success of academic medical centers depends largely on appropriate billing for resident-patient encounters. Objectives of this study were to develop an instrument for billing in internal medicine resident clinics, to compare billing practices among junior versus senior residents, and to estimate financial losses from inappropriate resident billing. Methods For this analysis, we randomly selected 100 patient visit notes from a resident outpatient practice. Three coding specialists used an instrument structured on Medicare billing standards to determine appropriate codes, and interrater reliability was assessed. Billing codes were converted to US dollars based on the national Medicare reimbursement list. Inappropriate billing, based on comparisons with coding specialists, was then determined for residents across years of training. Results Interrater reliability of Current Procedural Terminology components was excellent, with κ ranging from 0.76 for examination to 0.94 for diagnosis. Of the encounters in the study, 55% were underbilled by an average of $45.26 per encounter, and 18% were overbilled by an average of $51.29 per encounter. The percentages of appropriately coded notes were 16.1% for postgraduate year (PGY) 1, 26.8% for PGY-2, and 39.3% for PGY-3 residents (P &lt; .05). Underbilling was 74.2% for PGY-1, 48.8% for PGY-2, and 42.9% for PGY-3 residents (P &lt; .01). There was significantly less overbilling among PGY-1 residents compared with PGY-2 and PGY-3 residents (9.7% versus 24.4% and 17.9%, respectively; P &lt; .05). Conclusions Our study reports a reliable method for assessing billing in internal medicine resident clinics. It exposed large financial losses, which were attributable to junior residents more than senior residents. The findings highlight the need for educational interventions to improve resident coding and billing.

scholarly journals Novel Internal Medicine Residency Ultrasound Curriculum Led by Critical Care and Emergency Medicine Staff

2021 ◽  
Author(s):  
Robert N Geis ◽  
Michael J Kavanaugh ◽  
James Palma ◽  
Matthew Speicher ◽  
Adrianna Kyle ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Critical Care ◽  
Medical Center ◽  
Internal Medicine Resident ◽  
Internal Medicine Residency ◽  
Critical Care Medicine ◽  
Assessment Score ◽  
Medicine Resident ◽  
Hands On

ABSTRACT Introduction Point-of-care ultrasound (POCUS) is an integral aspect of critical care and emergency medicine curriculums throughout the country, but it has been slow to integrate into internal medicine residency programs. POCUS has many benefits for internal medicine providers, guiding diagnostic decisions and aiding in procedures. Additionally, POCUS is a convenient and portable resource specifically for internal medicine providers in the military when practicing in deployed or critical care settings. Critical care and emergency medicine clinicians are excellent resources to lead these courses. We sought to develop a new POCUS curriculum for internal medicine residents within the Naval Medical Center Portsmouth Internal Medicine Residency program with the support of emergency medicine and critical care medicine staff to lead and oversee the training. The project’s aim was to increase internal medicine resident confidence with POCUS by 20% and proficiency with POCUS as evidenced by pretest and posttest analysis by 10%. Materials and Methods The program consisted of a 2-day, 9-hour, introductory course, combining lecture with hands-on scanning taught by emergency medicine physicians who had completed emergency ultrasound fellowship-level training. This was followed by a longitudinal component of hands-on scanning throughout the academic year built into the residents’ schedules. Emergency and critical care medicine ultrasound staff reviewed all studies for quality assurance (QA). The residents were given both precourse and post-course knowledge tests and confidence surveys, which utilized a 5-point Likert scale. The knowledge assessments were analyzed with a paired t-test, and the Likert scale data were analyzed using the Wilcoxon signed-rank test. The Naval Medical Center Portsmouth Institutional Review Board deemed this project nonhuman subjects’ research. Results Twenty participants were enrolled, with 10 (50%) of those enrolled completing all course requirements. The average precourse knowledge assessment score was 76.60%, and postcourse assessment score was 80.95% (+4.35%, P = .33). The confidence survey scores were initially 73.33% and improved to 77.67% (+4.34%, P = .74). Conclusions A curriculum comprised of a 9-hour workshop followed by a longitudinal hands-on experience can provide improvement in internal medicine resident POCUS knowledge and confidence. This model emphasizes the benefit of emergency and critical care cooperation for ultrasound training and provides an emphasis on medicine-relevant scans and longitudinal training.

scholarly journals Military Internal Medicine Resident Decision to Apply to Fellowship and Extend Military Commitment

2018 ◽  
Vol 183 (7-8) ◽  
pp. e299-e303 ◽  
Author(s):  
Alice E Barsoumian ◽  
Joshua D Hartzell ◽  
Erin M Bonura ◽  
Roseanne A Ressner ◽  
Timothy J Whitman ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Internal Medicine Resident ◽  
Medicine Resident

scholarly journals Educational Conference Scheduling, Patient Discharge Time, and Resident Satisfaction

2014 ◽  
Vol 6 (3) ◽  
pp. 574-576 ◽  
Author(s):  
Steffanie Campbell ◽  
Matthew Campbell ◽  
Chirayu Shah ◽  
Alexander M. Djuricich
Keyword(s):  
Internal Medicine ◽  
Medical Patient ◽  
Patient Discharge ◽  
Internal Medicine Resident ◽  
Case Conference ◽  
Morning Report ◽  
Discharge Time ◽  
Medicine Resident ◽  
Medicine Service ◽  
Internal Medicine Residents

Abstract Background Limits on resident duty hours instituted in 2003 and 2011 have compressed medical resident daily workload. Despite this compression, residents must gain competence to practice medicine without supervision. Objective We sought to determine whether moving the time our educational conference is scheduled affects the time when patient discharges are completed on an internal medicine teaching service. Methods The study was conducted at a county hospital within a large internal medicine residency program. During the 4-month study period, the morning report conference for internal medicine residents was shifted from 8:30 am to 2 pm. Patient discharge times, defined as the time the discharge order set was signed, were obtained for the service via the electronic health record. The outcomes measured were patient discharge time variation and internal medicine resident preference for conference time. Results Survey response rate was 82% (42 of 51). Of the residents who responded, 64% (27 of 42) preferred the 8:30 am report time, and 74% (31 of 42) felt the 8:30 am time was also better for education and timing of teaching rounds. There was no difference in discharge times for 2999 patients on the medicine teaching service, whether educational case conference morning report occurred at 8:30 am or at 2 pm. Conclusions Medical patient average discharge time was not influenced by time of educational conference. Factors other than the timing of educational conference appear to influence hospital discharge times on an inpatient internal medicine service.

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