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

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.

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 1947. Educational Impact of a Hybrid Infectious Diseases Rotation for Internal Medicine Residents

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S57-S57
Author(s):  
James B Cutrell ◽  
James B Cutrell ◽  
Binh-Minh Le ◽  
Heather R Wolfe ◽  
Helen King ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Infectious Diseases ◽  
Educational Innovation ◽  
Mobile App ◽  
Curriculum Innovation ◽  
Educational Impact ◽  
Educational Innovations ◽  
Clinical Exposure ◽  
Internal Medicine Residents ◽  
Board Review

Abstract Background Traditional infectious diseases (ID) rotations for internal medicine (IM) residents focus on inpatient consultation, potentially skewing trainees’ perspectives on ID. We report our experience with a hybrid inpatient–outpatient ID rotation which provides broader ID clinical exposure and an effective venue for educational innovation. Methods We included all IM residents completing an assigned ID rotation in the UT Southwestern IM residency since July 2013. From July 2013 to June 2017, a 4-week ambulatory ID (Amb ID) rotation, consisting of general and subspecialty ID clinics and weekly teaching sessions focused on ID board review, was offered in parallel to traditional inpatient ID consult rotations. From July 2017 to present, all assigned residents complete up to a 4-week ID hybrid rotation, consisting of 2 weeks of ambulatory ID and 2 weeks of inpatient ID consults, with all residents receiving weekly teaching sessions; in some cases, the 4 weeks were not completed sequentially. Data were collected on resident numbers and training level, quantitative and qualitative course evaluations, and program in-training examination scores in ID content areas. Results From July 2013 to June 2019, IM residents completed a total of 626 ID rotations, an average of 104 per year (Table 1). A sample ID hybrid schedule is shown in Table 2. Overall resident satisfaction with the ID hybrid rotation was 4.7 (std. dev. 0.7) on a 5-point Likert scale. This rotation has consistently been among the highest rated rotations by residents. In-training examination ID scores increased significantly with creation of the Amb ID rotation in 2013 and further increased since 2017 with creation of the ID hybrid, in which both inpatient and ambulatory residents receive the weekly teaching sessions (Figure 1). Pilot educational innovations through this rotation include an online web-based antibiotic stewardship curriculum (2014–2015) and a mobile app-based ID board review platform utilizing spaced interval learning (2018–2019). Conclusion A hybrid inpatient–outpatient ID rotation for IM residents has proven to be a highly effective platform for ID education and curriculum innovation at our institution. This concept could be exported to other institutions and increase IM resident interest and breadth of clinical exposure in ID. Disclosures Ank E. Nijhawan, MD, MPH, Gilead Sciences, Inc.: Research Grant.

scholarly journals Validation of content of clinical cases in obstetric medicine for a shared web-based educational tool

2018 ◽  
Vol 12 (3) ◽  
pp. 129-135
Author(s):  
Annabelle Cumyn ◽  
Paul Gibson
Keyword(s):  
Internal Medicine ◽  
General Internal Medicine ◽  
Web Based ◽  
Clinical Exposure ◽  
General Internal ◽  
Internal Medicine Residents ◽  
Obstetric Medicine ◽  
The Creation ◽  
High Level ◽  
Clinical Cases

Subsequent to the validation of a Canadian Curriculum blueprint for Obstetric Medicine (OM), the Canadian Consensus for a Curriculum in Obstetric Medicine (CanCOM) research group was approached to develop 20 cases to address gaps in clinical exposure during clinical rotations in OM. Forty-nine Obstetric Internists were identified and 43 confirmed their affiliation to the group. Participants (N = 22) reviewed the content of the CanCOM blueprint and identified curriculum content that they considered essential for a rotation for senior General Internal Medicine residents. This survey led to the creation of the CanCOM II essential content blueprint for General Internal Medicine. Following this step, a second subgroup of participants (N = 21) participated in a Delphi survey to identify the content that should be addressed by a teaching case for senior General Internal Medicine residents. A high-level of consensus was obtained for 13 topics and a moderate level for the 7 subsequent topics resulting in the creation of the CanCOM II clinical cases available at http://gemoq.ca/cancom-ii-clinical-case-databank/

scholarly journals Internal Medicine Student Education on Direct-Care Hospital Medicine Services: Results of a National Survey

2020 ◽  
Vol 133 (7) ◽  
pp. 868-875
Author(s):  
Amulya Nagarur ◽  
Cindy J. Lai ◽  
Leigh H. Simmons ◽  
Michael Kisielewski ◽  
Temple A. Ratcliffe ◽  
...  
Keyword(s):  
Internal Medicine ◽  
National Survey ◽  
Hospital Medicine ◽  
Direct Care ◽  
Care Hospital ◽  
Student Education

scholarly journals Career Choice and Primary Care in the United Arab Emirates

2015 ◽  
Vol 7 (4) ◽  
pp. 663-666 ◽  
Author(s):  
Nicoline Schiess ◽  
Halah Ibrahim ◽  
Sami Shaban ◽  
Maria Nichole Perez ◽  
Satish Chandrasekhar Nair
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Career Choice ◽  
United Arab Emirates ◽  
Primary Care Physicians ◽  
Career Choices ◽  
Calculated Data ◽  
Subspecialty Training ◽  
Limited Information ◽  
Cross Sectional Survey

ABSTRACT Background  The low number of medical trainees entering primary care is contributing to the lack of access to primary care services in many countries. Despite the need for primary care physicians in the Middle East, there is limited information regarding trainees' career choices, a critical determinant in the supply of primary care physicians. Objective  We analyzed the career choices of medical students in the United Arab Emirates (UAE), with a larger goal of reforming postgraduate training in the region and enhancing the focus on primary care. Methods  We conducted a cross-sectional survey of applicants to a large established internal medicine residency program in the UAE. We calculated data for demographics, subspecialty choice, and factors affecting subspecialty choice, and we also reported descriptive statistics. Results  Our response rate was 86% (183 of 212). Only 25% of applicants (n = 46) were interested in general internal medicine. The majority of respondents (n = 126, 69%) indicated a desire to pursue subspecialty training, and the remainder chose careers in research or administration. A majority of respondents (73%) were women, unmarried, and childless. Educational debt or lifestyle were not indicated as important factors in career choice. Conclusions  Low interest in primary care was similar to that in many Western countries, despite a much higher percentage of female applicants and a reduced emphasis on lifestyle or income factors in career decisions. Reasons for the reduced interest in primary care deserve further exploration, as do tests of interventions to increase interest, such as improving the primary care clerkship experience.

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

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.

scholarly journals Managed care, attitudes, and career choices of internal medicine residents

1998 ◽  
Vol 13 (1) ◽  
pp. 39-42 ◽  
Author(s):  
Heidi D. Nelson ◽  
Annette M. Matthews ◽  
Glen R. Patrizio ◽  
Thomas G. Cooney
Keyword(s):  
Internal Medicine ◽  
Managed Care ◽  
Career Choices ◽  
Internal Medicine Residents

scholarly journals Why Residents Consider Working Beyond the Duty Hour Limits: Implications of the ACGME 2011 Duty Hour Standards

2011 ◽  
Vol 3 (4) ◽  
pp. 571-573 ◽  
Author(s):  
Kathlyn E. Fletcher ◽  
Sarah Nickoloff ◽  
Jeff Whittle ◽  
Jeffrey L. Jackson ◽  
Michael Frank ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Educational Opportunities ◽  
Descriptive Statistics ◽  
Care Hospital ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Internal Medicine Residents ◽  
Program Leadership

Abstract Background The Accreditation Council for Graduate Medical Education 2011 duty hour standards became effective on July 1, 2011. One of the new standards allows residents to exceed the limit on continuous duty hours in unusual circumstances relating to patient or family need or rare educational opportunities. There are no data about how often or in what circumstances residents would consider exceeding their duty hour limits using this new provision in the standards. We surveyed internal medicine residents to explore these questions. Methods We conducted an anonymous cross-sectional survey of internal medicine residents at a midwestern tertiary-care hospital to determine how often they had considered exceeding duty hour limits in the preceding 2 weeks. We analyzed responses using descriptive statistics and χ2 tests for comparisons. Results We obtained responses from 51 of 86 residents (59%). Of those residents, 69% (35/51) indicated that they had wanted to exceed duty hour limits at least once in the prior 2 weeks. The most common reason cited was to provide continuity of care for a patient. The 24 + 6–hour rule was the standard most likely to be broken (cited by 66%; 23/35). Conclusions Program leadership should anticipate that residents will commonly identify situations in which they will consider exceeding duty hour limits. It will be important to provide guidance to residents early in the year about the situations that would be appropriate for the application of this new standard.

scholarly journals The Neighborhood Health Exchange: Developing a Community Partnership in Residency

2010 ◽  
Vol 2 (3) ◽  
pp. 456-461 ◽  
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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