scholarly journals Training and Performance Differences in US Internal Medicine Residents Trained in Community- and University-Based Programs – a Systematic Review

2018 ◽  
Vol 7 (2) ◽  
pp. 98
Author(s):  
Yasir Rehman
Keyword(s):  
Internal Medicine ◽  
Meta Analysis ◽  
Pass Rate ◽  
Cross Sectional ◽  
Publication Rates ◽  
Performance Differences ◽  
Internal Medicine Residents ◽  
The Difference ◽  
And Performance ◽  
Review Reports

Introduction:Residents’ learning and performance depends on program structures, clinical setting and faculty mentors; however,performance differences between and community based vs. university based residents have not been exploredsystematically.Objectives:To systematically review the performance differences between internal medicine residents trained in community-basedprograms [CBPs] versus university-based programs [UBPs] in the US.Methods:Eligible studies were identified in Medline and Embase databases from 1990- June 2018. Eligible studies comparedlearning and performance differences between UBP and CBP internal medicine residency programs aligned withACGME recommendations.Results:Out of 4916 titles, 14 cross-sectional studies were included in the analysis. Diverse reporting among the includedstudies precluded meta-analysis. Significant differences were found in specific practice areas, such as knowledge aboutHIV, nutrition training, and program accreditation cycle. Residents in UBPs participated more often in hypothesisdriven research and had higher publication rates than residents in CBPs. Residents trained in CBPs experienced moreburnt out than those in UBPs and had higher prevalence of residents with problematic behaviors and deficiencies.Nonsignificant differences were found among residents regarding ABIM pass rate, medical procedures, and publichealth training.Conclusion:Our review reports inconsistent trends in residents’ learning and performances following RRC- IM and ACGMErecommendations. Significant differences were noted in areas that required more practice and system based learning,non-procedural skills and patient care. Future studies with larger sample sizes and adjusted analyses are needed toevaluate the difference between residents’ performance and learning in UBPs versus CBPs.

Learning Electrocardiogram Interpretation: Insights from Residents and a Proposed Solution in an Observational Study (Preprint)

2020 ◽  
Author(s):  
Mohammad Alakchar ◽  
Abdisamad M. Ibrahim ◽  
Mohsin Salih ◽  
Mukul Bhattarai ◽  
Nitin Tandan ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Correlation Coefficient ◽  
Online Survey ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Resident Attitudes ◽  
Internal Medicine Residents ◽  
Life Threatening ◽  
Degree Of Participation ◽  
Electrocardiogram Interpretation

BACKGROUND Interpretation of electrocardiograms (EKG) is an essential tool for every physician. Despite this, the diagnosis of life-threatening pathology on EKG remains suboptimal in trainees. The purpose of this study is to study resident attitudes and behaviours towards EKGs, and describe an innovative way to teach EKGs. OBJECTIVE Study attitudes and behaviours towards EKGs. Describe an innovative way to teach EKGs. METHODS Design: An observational cross-sectional study through an anonymous online survey of resident attitudes and comfort with EKG interpretation. This was followed by creation of a WhatsApp group for discussion and interpretation of EKGs with peers. At the end of the day, the official EKG interpretation was posted. Setting: Internal medicine residency at Southern Illinois University. Participants: Internal medicine residents Interventions: Creation of WhatsApp group to aid with EKG interpretation Measurements: A 17 item questionnaire, followed by detection of degree of participation in a WhatsApp group. RESULTS Forty-one out of 63 residents (65%) completed the survey. 85% of respondents thought that an interactive way to teach EKGs is the best method of teaching, and 73% did not feel confident interpreting EKGs. 30% often rely on automated EKG interpretation. Further analysis indicated that PGY-1 residents reported ordering fewer EKGs (correlation coefficient -0.399, p = 0.012) and were uncomfortable diagnosing QT prolongation on an EKG (correlation coefficient -0.310, p = 0.049). Residents in the third or greater year of training ordered more EKGs (correlation coefficient 0.379, p = 0.015), less frequently relied on the computer for EKG diagnosis (correlation coefficient 0.399, p = 0.010), and were comfortable diagnosing an acute myocardial infarction and atrial arrhythmias. CONCLUSIONS In conclusion, most IM trainees do not feel comfortable interpreting EKG, however, this does improve with PGY year. WhatsApp is a possible platform for teaching EKGs.

scholarly journals Plasma Amino Acids and Residual Hypertriglyceridemia in Diabetic Patients Under Statins: Two Independent Cross-Sectional Hospital-Based Cohorts

2021 ◽  
Vol 8 ◽  
Author(s):  
Shuang Wang ◽  
Yun-Feng Cao ◽  
Xiao-Yu Sun ◽  
Mo Hong ◽  
Zhong-Ze Fang ◽  
...  
Keyword(s):  
Amino Acids ◽  
Meta Analysis ◽  
Statin Treatment ◽  
Pooled Analysis ◽  
Fixed Effect ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Inverse Variance ◽  
The Difference ◽  
Medical University

Objective: The objective of the study was to investigate the relationship of amino acid metabolism with hypertriglyceridemia in diabetic patients under statins free of prior cardiovascular diseases.Methods: Two independent cross-sectional hospital based cohorts, i.e., Liaoning Medical University First Affiliated Hospital (LMUFAH, n = 146) and the Second Affiliated Hospital of Dalian Medical University (SAHDMU, n = 294) were included in the current analysis. Hypertriglyceridemia was defined as triglyceride ≥1.7 mmol/L, and well-controlled LDL-C was defined as <2.6 mmol/L. The adjusted ORs (95% CI) of circulating metabolic measures for hypertriglyceridemia were assessed using logistic regression. Pooled results of metabolites with the same direction of association in both cohorts were combined using inverse variance-weighted fixed-effect meta-analysis. Difference of identified metabolites in patients with and without hypertriglyceridemia were also obtained in the context of LDL-C.Results: Patients, 86 and 106, were with hypertriglyceridemia in LMUFAH and SAHDMU, respectively. We observed that elevated alanine, asparagine, leucine, and valine were consistently associated with increased hypertriglyceridemia in both cohorts. In fixed-effect pooled analysis, the OR (95% CI) per SD increase was 1.71 (1.32–2.20) for alanine, 1.62 (1.20–2.19) for asparagine, 1.64 (1.22–2.20) for leucine, and 1.62 (1.22–2.13) for valine (all P values ranged from 0.0018 to <0.0001); adjusting for C-peptide attenuated effect sizes of Ala, Leu, and Val for hypertriglyceridemia. The difference were robust in groups with well- or bad-controlled LDL-C.Conclusion: Among 23 amino acids, alanine, asparagine, leucine, and valine were positively associated with increased residual risk of hypertriglyceridemia in diabetic patients with statin treatment.

scholarly journals Internal medicine residents identify gaps in medical education on outpatient referrals

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Masha J. Slavin ◽  
Mangala Rajan ◽  
Lisa M. Kern
Keyword(s):  
Internal Medicine ◽  
New York ◽  
Medical Education ◽  
Clinical Information ◽  
Ambulatory Setting ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Internal Medicine Residents ◽  
Strongly Agree ◽  
Residents Attitudes

Abstract Background Relevant clinical information is often missing when a patient sees a specialist after being referred by another physician in the ambulatory setting. This can result in missed or delayed diagnoses, delayed treatment, unnecessary testing, and drug interactions. Residents’ attitudes toward providing clinical information at the time of referral and their perspectives toward training on referral skills are not clear. We sought to assess internal medicine residents’ attitudes toward and experiences with outpatient referrals. Methods We conducted a cross-sectional survey in October–December 2018 of all internal medicine interns and residents affiliated with a large, urban internal medicine residency program in New York, NY. We used a novel survey instrument that included 13 questions about attitudes toward and experiences with outpatient referrals. We used descriptive statistics to characterize the results. Results Overall, 122 of 132 residents participated (92% response rate). Respondents were approximately equally distributed across post-graduate years 1–3. Although 83% of residents reported that it is “always” important to provide the clinical reason for a referral, only 11% stated that they “always” provide a sufficient amount of clinical information for the consulting provider when making a referral. Only 9% of residents “strongly agree” that residency provides sufficient training in knowing when to refer patients, and only 8% “strongly agree” that residency provides sufficient training in what information to provide the consulting physician. Conclusions These results suggest a substantial discrepancy between the amount of information residents believe they should provide at the time of a referral and the amount they actually provide. Many residents report not receiving adequate training during residency on when to refer patients and what clinical information to provide at the time of referral. Improvements to medical education regarding outpatient referrals are urgently needed.

Obstructive Sleep Apnea in Acromegaly and the Effect of Treatment: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 105 (3) ◽  
pp. e23-e31 ◽  
Author(s):  
Matteo Parolin ◽  
Francesca Dassie ◽  
Luigi Alessio ◽  
Alexandra Wennberg ◽  
Marco Rossato ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Meta Analysis ◽  
Upper Airway ◽  
Apnea Hypopnea Index ◽  
Cross Sectional ◽  
Obstructive Sleep ◽  
Before And After ◽  
The Difference

Abstract Background Obstructive sleep apnea (OSA) is a common disorder characterized by upper airway collapse requiring nocturnal ventilatory assistance. Multiple studies have investigated the relationship between acromegaly and OSA, reporting discordant results. Aim To conduct a meta-analysis on the risk for OSA in acromegaly, and in particular to assess the role of disease activity and the effect of treatments. Methods and Study Selection A search through literature databases retrieved 21 articles for a total of 24 studies (n = 734). Selected outcomes were OSA prevalence and apnea-hypopnea index (AHI) in studies comparing acromegalic patients with active (ACT) vs inactive (INACT) disease and pretreatment and posttreatment measures. Factors used for moderator and meta-regression analysis included the percentage of patients with severe OSA, patient sex, age, body mass index, levels of insulin-like growth factor 1, disease duration and follow-up, and therapy. Results OSA prevalence was similar in patients with acromegaly who had ACT and INACT disease (ES = −0.16; 95% CI, −0.47 to 0.15; number of studies [k] = 10; P = 0.32). In addition, AHI was similar in ACT and INACT acromegaly patients (ES = −0.03; 95% CI, −0.49 to 0.43; k = 6; P = 0.89). When AHI was compared before and after treatment in patients with acromegaly (median follow-up of 6 months), a significant improvement was observed after treatment (ES = −0.36; 95% CI, −0.49 to −0.23; k = 10; P < 0.0001). In moderator analysis, the percentage of patients with severe OSA in the populations significantly influenced the difference in OSA prevalence (P = 0.038) and AHI (P = 0.04) in ACT vs INACT patients. Conclusion Prevalence of OSA and AHI is similar in ACT and INACT patients in cross-sectional studies. However, when AHI was measured longitudinally before and after treatment, a significant improvement was observed after treatment.

scholarly journals BELIEFS REGARDING GERIATRICS PRIMARY CARE TOPICS AMONG MEDICAL STUDENTS AND INTERNAL MEDICINE RESIDENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S297-S297
Author(s):  
Dylan J Jester ◽  
Kathryn Hyer ◽  
Ross Andel
Keyword(s):  
Internal Medicine ◽  
Older Adults ◽  
Primary Care ◽  
Medical Students ◽  
Psychiatric Symptoms ◽  
Content Areas ◽  
Internal Medicine Residents ◽  
Images Of Aging ◽  
The Difference ◽  
First Year Medical Students

Abstract Our study evaluated and contrasted responses to 25 content areas essential to the primary care of older adults by medical students and residents, and identified attitudes toward aging amongst students and residents. One hundred and thirty-six medical students and 61 Internal Medicine residents completed a survey including the 25-item Geriatrics Clinician-Educator Survey and 18-item Images of Aging Scale. Students and residents rated importance and knowledge for content areas from 1 (low) to 10 (high). Gap scores reflecting the difference in ratings between importance and knowledge were calculated. The Images of Aging scale ranges between 0 (furthest from what you think) and 6 (closest to what you think). Results indicated that students and residents reflected similar beliefs about the importance of content areas, but students provided lower ratings in knowledge. Students revealed larger gap scores in areas that reflected general primary care (e.g., assess chronic conditions, medications), whereas residents revealed larger gap scores in areas that reflected specialists’ expertise (e.g., driving risk, cognition, psychiatric symptoms). Attitudes toward older adults did not differ appreciably between students and residents. In sum, primary care topics applicable for any age demographic were rated as most important by first-year medical students and Internal Medicine residents. Topics relevant to older populations – particularly those requiring specialists’ knowledge of or requiring sensitive discussion with older adults – were rated as less important and were less well mastered.

Fund Flow Volatility and Performance

2009 ◽  
Vol 45 (1) ◽  
pp. 223-237 ◽  
Author(s):  
David Rakowski
Keyword(s):  
Mutual Fund ◽  
Negative Relationship ◽  
Fund Flows ◽  
Cross Sectional ◽  
Fund Flow ◽  
Performance Differences ◽  
Significant Negative Relationship ◽  
Equity Funds ◽  
And Performance ◽  
The Impact

AbstractThis paper provides a detailed analysis of the impact of daily mutual fund flow volatility on fund performance. I document a significant negative relationship between the volatility of daily fund flows and cross-sectional differences in risk-adjusted performance. This relationship is driven by domestic equity funds, as well as small funds, well-performing funds, and funds that experience inflows over the sample period. My results are consistent with performance differences arising from the transaction costs of nondiscretionary trading driven by daily fund flows, but not with performance differences arising from the suboptimal cash holdings that arise from fund flows.

scholarly journals Career interest and perceptions of nephrology: A repeated cross-sectional survey of internal medicine residents

PLoS ONE ◽  
2017 ◽  
Vol 12 (2) ◽  
pp. e0172167 ◽  
Author(s):  
Michael N. Daniels ◽  
Sharon Maynard ◽  
Ivan Porter ◽  
Hope Kincaid ◽  
Deepika Jain ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Career Interest ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Internal Medicine Residents

MEASURING THE DIFFERENCE BETWEEN TEACHING AND NON-TEACHING ANESTHESIA STAFF WORKLOAD at AL-NOOR SPECIALIST HOSPITAL, MAKKAH, SAUDI ARABIA, MARCH 2021 (Preprint)

2021 ◽  
Author(s):  
Ali anesthesia
Keyword(s):  
Saudi Arabia ◽  
Induction Period ◽  
Recovery Period ◽  
Health Sector ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
The Difference ◽  
Teaching Cases ◽  
And Performance ◽  
Strongly Agree

BACKGROUND Workload on health sector workers has increased dramatically in recent years. In this research we studied anesthesia staff in terms of teaching and non-teaching workload at AL Noor Specialist hospital and the extent of its impact on performance and vigilance. Decreased workload improves the performance and vigilance of anesthesia staff. OBJECTIVE To determine the difference between the workload of teaching and non-teaching anesthesia staff. 2. To measure the workload of anesthesia staff in teaching and non-teaching cases. 3. To identify the definition, component, and effect of workload. 4. To explain the importance of the work of anesthesia staff. METHODS This is a cross-sectional study carried out using a Google form survey conducted among anesthesia staff at Al-Noor specialist Hospital, Makkah, Saudi Arabia. The target of the study included anesthesia staff (Anesthesia Technologist, Anesthesia Specialist, Anesthesia Consultant). RESULTS The workload density graph shows that the induction period in teaching cases was slightly higher compared to non-teaching cases. during the maintenance period and recovery period, workload density was slightly higher in teaching cases compared to the induction period. The degree of agreement with the statement, “stress and pressure increase during surgery (teaching cases)”, was mostly in the normal range. The degree of agreement with the statement, “increased workload will reduce your performance level and vigilance during the surgery”, was mostly in the strongly agree range. The degree of agreement with the statement, “increasing the workload reduces patient safety”, was mostly in the strongly agree range. CONCLUSIONS There is only a slight difference in workload between teaching and non-teaching cases, but this slight change may stand between the life or death of a patient in an area of fine margins, such as anesthesia. We recommend further study to include all hospitals in Makkah. We recommend that difficult cases, especially patients with American Society of Anesthesiologists (ASA) 3 or above, do not have students because that may jeopardize the safety of the patient and inhibit the vigilance and performance of anesthesia providers.

Graduating internal medicine residents’ self-assessment and performance of advanced cardiac life support skills

2006 ◽  
Vol 28 (4) ◽  
pp. 365-369 ◽  
Author(s):  
Diane B. Wayne ◽  
John Butter ◽  
Viva J. Siddall ◽  
Monica J. Fudala ◽  
Leonard D. Wade ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Self Assessment ◽  
Internal Medicine Residents ◽  
Support Skills ◽  
And Performance
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