scholarly journals Analyzing Anatomic Pathology On-Call Summaries to Improve Resident Education

2021 ◽  
Author(s):  
Ying Liu ◽  
Danielle Payne-Uprichard ◽  
Dorina Gui ◽  
Morgan A. Darrow ◽  
Hooman H. Rashidi ◽  
...  
Keyword(s):  
Resident Education ◽  
Frozen Section ◽  
System Level ◽  
Independent Practice ◽  
Clinical Exposure ◽  
Anatomic Pathology ◽  
Hand Off ◽  
Resident Time ◽  
After Hours ◽  
Few Data

Context.— Pathology on-call experiences help prepare trainees for successful transition from residency to independent practice, and as such are an integral component of training. However, few data exist on anatomic pathology resident on-call workload and experience. Objective.— To obtain an overall picture of the anatomic pathology on-call experience to inform and improve resident education. Design.— Retrospective and prospective review of the daily anatomic pathology on-call summaries from July 2016 to June 2020. Results.— During the first 2 years of the study (ie, retrospective portion), only 19% of on-call summaries (138 of 730) were available for review. After interventions, the on-call summary submission rate jumped to 98% (716 of 731). After-hours calls were most frequent on weekdays from 5 to 8 pm. The most frequent requests were for frozen sections (55%; 619 of 1125 calls), inquiries regarding disposition of fresh placentas (13%; 148 of 1125 calls), and inquiries regarding disposition of various other specimens (6%; 68 of 1125 calls). After-hours frozen section requests were most frequent for gynecologic and head and neck specimens. Notably, a significant number of after-hours calls were recurring preanalytic issues amenable to system-level improvements. We were able to eliminate the most common of these recurring preanalytic calls with stepwise interventions. Conclusions.— To our knowledge, this is the first study analyzing the anatomic pathology resident on-call experience. In addition to obtaining a broad overview of the residents' clinical exposure on this service, we identified and resolved issues critical to optimal patient care (eg, inconsistent “patient hand-off”) and improved the resident on-call experience (eg, fewer preanalytic calls increased resident time for other clinical, educational, or wellness activities).

scholarly journals Electronic Health Record Use among Ophthalmology Residents while on Call

2020 ◽  
Vol 12 (02) ◽  
pp. e143-e150
Author(s):  
Christopher P. Long ◽  
Ming Tai-Seale ◽  
Robert El-Kareh ◽  
Jeffrey E. Lee ◽  
Sally L. Baxter
Keyword(s):  
Internal Medicine ◽  
Electronic Health Record ◽  
Chart Review ◽  
Health Record ◽  
Physician Burnout ◽  
Single Institution ◽  
Clinical Exposure ◽  
Future Studies ◽  
After Hours ◽  
Electronic Health

Abstract Background As electronic health record (EHR) use becomes more widespread, detailed records of how users interact with the EHR, known as EHR audit logs, are being used to characterize the clinical workflows of physicians including residents. After-hours EHR use is of particular interest given its known association with physician burnout. Several studies have analyzed EHR audit logs for residents in other fields, such as internal medicine, but none thus far in ophthalmology. Here, we focused specifically on EHR use during on-call shifts outside of normal clinic hours. Methods In this retrospective study, we analyzed raw EHR audit log data from on-call shifts for 12 ophthalmology residents at a single institution over the course of a calendar year. Data were analyzed to characterize total time spent using the EHR, clinical volume, diagnoses of patients seen on call, and EHR tasks. Results Across all call shifts, the median and interquartile range (IQR) of the time spent logged into the EHR per shift were 88 and 131 minutes, respectively. The median (IQR) unique patient charts accessed per shift was 7 (9) patients. When standardized to per-hour measures, weekday evening shifts were the busiest call shifts with regard to both EHR use time and clinical volume. Total EHR use time and clinical volume were greatest in the summer months (July to September). Chart review comprised a majority (63.4%) of ophthalmology residents' on-call EHR activities. Conclusion In summary, EHR audit logs demonstrate substantial call burden for ophthalmology residents outside of regular clinic hours. These data and future studies can be used to further characterize the clinical exposure and call burden of ophthalmology residents and could potentially have broader implications in the fields of physician burnout and education policy.

scholarly journals An Analysis of the On-Call Clinical Experience of a Junior Neurosurgical Resident

Neurosurgery ◽  
2018 ◽  
Vol 85 (2) ◽  
pp. 290-297 ◽  
Author(s):  
William E Gordon ◽  
Andrew J Gienapp ◽  
Morgan Jones ◽  
L Madison Michael ◽  
Paul Klimo
Keyword(s):  
Medical Student ◽  
Intracranial Pressure ◽  
Clinical Experience ◽  
Resident Education ◽  
Educational Experience ◽  
Junior Resident ◽  
Patient Encounter ◽  
The Mean ◽  
Few Data ◽  
Neurosurgical Intervention

Abstract The process of transforming a medical student to a competent neurosurgeon is becoming increasingly scrutinized and formalized. However, there are few data on resident workload. We sought to quantify the workload and educational experience of a junior resident while “on-call.” A single resident's on-call log was reviewed from the period of July 1, 2014 to June 30, 2016, corresponding to that resident's postgraduate years 2 and 3. For each patient encounter (ie, consult or admission), information pertaining to the patient's demographics, disease or reason for consult, date/time/location of consult, and need for any neurosurgical intervention within the first 24 hours was collected. In total, 1929 patients were seen in consultation. The majority of patients were male (62%) with a median age of 50 years (range, day of life 0-102 years) and had traumatic diagnoses (52%). The number of consults received during the 16:00 to 17:00 and 17:00 to 18:00 hours was +1.6 and +2.5 standard deviations above the mean, respectively. The busiest and slowest months were May and January, respectively. Neurosurgical intervention performed within the first 24 hours of consultation occurred in 330 (17.1%) patients: 221 (11.4%) major operations, 69 (3.6%) external ventricular drains, and 40 (2.1%) intracranial pressure monitors. This is the first study to quantify the workload and educational experience of a typical neurosurgical junior resident while “on-call” (ie, carrying the pager) for 2 consecutive years. It is our hope that these findings are considered by neurosurgical educators when refining resident education.

Frozen Section and the Surgical Pathologist: A Point of View

2009 ◽  
Vol 133 (7) ◽  
pp. 1135-1138 ◽  
Author(s):  
Jerome B. Taxy
Keyword(s):  
Resident Education ◽  
Frozen Section ◽  
Definitive Diagnosis ◽  
Organ System ◽  
Point Of View ◽  
Clinical Knowledge ◽  
Frozen Sections ◽  
Intraoperative Management ◽  
Tissue Disposition ◽  
Point Of Intersection

Abstract Frozen section is a prominent point of intersection between surgeons and pathologists. It is regarded as the most definitive—but not the sole—form of intraoperative consultation. Its role in tissue triage, diagnosis, and intraoperative management should not be misconstrued as a shortcut to a definitive diagnosis. Although the pathologist remains in control of the tissue disposition, frozen sections are ideally requested and executed as a collaborative effort. Frivolous requests with no direct consequences for the conduct of a given procedure should not be honored. Frozen section plays a material role in resident education and may be the last vestige of general surgical pathology in an era of organ system specialization. Frozen section will retain its relevance only in the context of broad clinical knowledge by the pathologist and judicious utilization by the surgeon, both in the ultimate service of the patient.

scholarly journals Quality frameworks for telephone triage

2008 ◽  
Vol 32 (4) ◽  
pp. 786 ◽  
Author(s):  
Alicia C McGrath ◽  
Christine R Macdonald
Keyword(s):  
Review Process ◽  
Service Providers ◽  
Critical Evaluation ◽  
System Level ◽  
Telephone Triage ◽  
Quality Review ◽  
Quality Framework ◽  
After Hours ◽  
Evidenced Based ◽  
The Individual

The establishment of the Grampians After-Hours Service has led to the development of a quality framework for nurse telephone triage. The service providers believe this framework is the basis for the service?s success. While quality frameworks including critical evaluation and peer review are not new to the health industry, the development of organisational systems to improve quality in afterhours services is innovative. The framework developed is comprehensive, evidenced-based and emphasises training, protocols and documentation. It also involves a continuous and nonpunitive quality review process that operates at the individual, small group, organisation and whole-system level. The framework will continue to improve and at this time provides a foundation for discussion and further application in the pursuit of quality improvement in rural after-hours health services.

The Effects of Restricted Work Hours on Clinical Training

2006 ◽  
Vol 72 (1) ◽  
pp. 19-21 ◽  
Author(s):  
Raffy L. Karamanoukian ◽  
Joseph K. Ku ◽  
Jacob Delarosa ◽  
Hratch L. Karamanoukian ◽  
Gregory R.D. Evans
Keyword(s):  
Patient Care ◽  
Clinical Training ◽  
Resident Education ◽  
Training Programs ◽  
Potential Effect ◽  
Work Hours ◽  
Affected Patient ◽  
Clinical Exposure ◽  
The Past ◽  
Work Hour

Resident education has changed dramatically over the past 10 years. With the implementation of restricted work hours on clinical training, questions have arisen whether these restricted hours will affect clinical competency. This manuscript attempts to answer this question through a survey performed to assess the perception of residents about duty-hour restrictions and the potential effect on residents’ clinical exposure. In this study, a majority of the respondents did believe that work-week restrictions significantly affected patient care and clinical exposure. However, few respondents were willing to accept an additional year of training to compensate for the loss of this clinical exposure. Regardless, work-hour restrictions are here to stay and will probably be further limited in the future. Training programs will have to adjust to provide the necessary clinical exposure while complying with these new ACGME guidelines.

scholarly journals Compulsory community service for dentists - Opportunity for meaningful reform

2021 ◽  
Vol 76 (04) ◽  
pp. 201-206
Author(s):  
Motimedi L Machete ◽  
Nokukhanya L Makwakwa ◽  
Pusetso D Moipolai ◽  
Pagollang D Motloba
Keyword(s):  
Community Service ◽  
Clinical Skills ◽  
Quality Care ◽  
Clinical Work ◽  
Cross Sectional Study ◽  
Independent Practice ◽  
Cross Sectional ◽  
Clinical Exposure ◽  
Dental Procedures ◽  
Provide Quality Care

Previous studies indicate that the delivery of the compulsory community service (CS) programme was far from the intended objectives. It is plausible that the intended vision of the programme for the young graduates to“…develop skills, acquire knowledge, behaviour patterns and critical thinking that would help in their professional development and future careers.” may not be realizable. This study evaluated the extent to which CS programme nenabled CS dentists to develop clinical skills. A national cross-sectional study was undertaken on CS dentists. Adapted visual analogue scale (VAS) assessed the frequency of work performed and levels of skills or competency acquired. A total of 217/235 dentists participated, (response rate of 92.34%). The clinical work undertaken and skills/competence acquired were positively correlated; [Mean (SD)= 1.10 (0.326), 1.10 (0.359); r =0.945, p=<0.000, n = 217] respectively. This finding validates the associated loss of skills and competence because of lack of clinical exposure during CS. Specialised dental procedures were never or rarely performed during CS (89.5%). Similarly the level of skills acquired during CS was minimal. CS in its present form disrupts continuing education and the development of learning and clinical skills. These cohorts of dentists have entered independent practice less prepared; may fail to provide quality care to the public. The CS programme is regressive, and requires urgent review and reform.

The application of electron microscopy to diagnosis in gynecologic neoplasms and tumor-like conditions

1984 ◽  
Vol 42 ◽  
pp. 102-105
Author(s):  
Lawrence M. Roth
Keyword(s):  
Electron Microscopy ◽  
Reproductive Tract ◽  
Malignant Tumors ◽  
Frozen Section ◽  
Cost Effective ◽  
Female Reproductive Tract ◽  
Ultrastructural Examination ◽  
Specific Diagnosis ◽  
Potential Value ◽  
Gynecologic Neoplasms

The female reproductive tract may be the site of a wide variety of benign and malignant tumors, as well as non-neoplastic tumor-like conditions, most of which can be diagnosed by light microscopic examination including special stains and more recently immunoperoxidase techniques. Nevertheless there are situations where ultrastructural examination can contribute substantially to an accurate and specific diagnosis. It is my opinion that electron microscopy can be of greatest benefit and is most cost effective when applied in conjunction with other methodologies. Thus, I have developed an approach which has proved useful for me and may have benefit for others. In cases where it is deemed of potential value, glutaraldehyde-fixed material is obtained at the time of frozen section or otherwise at operation. Coordination with the gynecologic oncologist is required in the latter situation. This material is processed and blocked and is available if a future need arises.

Ultrastructure of Cryptorchidism and Seminoma

1981 ◽  
Vol 39 ◽  
pp. 540-541
Author(s):  
Shirley Siew ◽  
Susan C. James
Keyword(s):  
Malignant Tumors ◽  
Frozen Section ◽  
Malignant Potential ◽  
Genetic Influences ◽  
Endocrine Gland ◽  
Medial Aspect ◽  
Left Testis ◽  
Bilateral Orchiectomy

Testicular maldescent is the most common endocrine gland abnormality, as 2.7% of mature neonates are cryptorchid. The significant complications are that there is a disturbance of normal maturation which results in diminished fertility and there is an increase in the malignant potential which is 35 times greater in the undescended than the descended testis. It is considered that genetic influences may be of etiological importance and recurrence has been described in some families. It is of interest, that the case reported here has 2 siblings who have also presented with cryptorchidism and malignant tumors.The propositus is 14 years old. He is well developed (described by some as obese) and shows normal secondary male characteristics except for an immature scrotum. Laparotomy showed both testes to be intraabdominal. A hard nodule (0.5cm) was palpated on the medial aspect of the left testis. Frozen section showed the presence of seminoma and bilateral orchiectomy was performed.

Nuclear Reactions in Deuterium Titanium

1990 ◽  
Vol 48 (2) ◽  
pp. 134-135
Author(s):  
D.M. Vanderwalker
Keyword(s):  
Nuclear Reactions ◽  
Ion Beam ◽  
Exothermic Reaction ◽  
Pure Titanium ◽  
Fundamental Interest ◽  
Transmission Electron ◽  
Iodide Titanium ◽  
A Cell ◽  
After Hours ◽  
Quantity Of Heat

There is a fundamental interest in electrochemical fusion of deuterium in palladium and titanium since its supposed discovery by Fleischmann and Pons. Their calorimetric experiments reveal that a large quantity of heat is released by Pd after hours in a cell, suggesting fusion occurs. They cannot explain fusion by force arguments, nor can it be an exothermic reaction on the formation of deuterides because a smaller quantity of heat is released. This study examines reactions of deuterium in titanium.Both iodide titanium and 99% pure titanium samples were encapsulated in vacuum tubes, annealed for 2h at 800 °C. The Ti foils were charged with deuterium in a D2SO4 D2O solution at a potential of .45V with respect to a calomel reference junction. Samples were ion beam thinned for transmission electron microscopy. The TEM was performed on the JEOL 200CX.The structure of D charged titanium is α-Ti with hexagonal and fee deuterides.

AEM of reaction-bonded SiC

1992 ◽  
Vol 50 (1) ◽  
pp. 344-345
Author(s):  
K Das Chowdhury ◽  
R. W. Carpenter ◽  
W. Braue
Keyword(s):  
Mechanical Properties ◽  
Phase Transformation ◽  
High Temperature ◽  
Epitaxial Growth ◽  
Liquid Silicon ◽  
Structural Ceramic ◽  
Few Data

Research on reaction-bonded SiC (RBSiC) is aimed at developing a reliable structural ceramic with improved mechanical properties. The starting materials for RBSiC were Si,C and α-SiC powder. The formation of the complex microstructure of RBSiC involves (i) solution of carbon in liquid silicon, (ii) nucleation and epitaxial growth of secondary β-SiC on the original α-SiC grains followed by (iii) β>α-SiC phase transformation of newly formed SiC. Due to their coherent nature, epitaxial SiC/SiC interfaces are considered to be segregation-free and “strong” with respect to their effect on the mechanical properties of RBSiC. But the “weak” Si/SiC interface limits its use in high temperature situations. However, few data exist on the structure and chemistry of these interfaces. Microanalytical results obtained by parallel EELS and HREM imaging are reported here.

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