Graduate medical education scholarly activities initiatives: a systematic review and meta-analysis.

BACKGROUND: According to the Accreditation Council for Graduate Medical Education residents "should participate in scholarly activity." The development of a sustainable, successful resident scholarship program is a difficult task faced by graduate medical education leadership. METHODS: A medical librarian conducted a systematic literature search for English language articles published on scholarly activities initiatives in Graduate Medical Education (GME) between January 2003 and March 31 2017. Inclusion criteria included implementing a graduate medical education research curriculum or initiative designed to enhance intern, resident, or fellow scholarly activities using a control or comparison group. We defined major outcomes as increases in publications or presentations. Random effects meta-analysis was used to compare the rate of publications before and after implementation of curriculum or initiative. RESULTS: We identified 32 relevant articles. Twenty-nine (91%) reported on resident publications, with 35% (10/29) reporting statistically significant increases. Fifteen articles (47%) reported on regional, national, or international presentations, with only 13% (2/15) reporting a statistically significant increase in productivity. Nineteen studies were eligible for inclusion in the meta-analysis; for these studies, the post-initiative publication rate was estimated to be 2.6 times the pre-intervention rate (95% CI: 1.6 to 4.3; p < 0.001). CONCLUSIONS: Our systematic review identified 32 articles describing curricula and initiatives used by GME programs to increase scholarly activity. The three most frequently reported initiatives were mentors (88%), curriculum (59%), and protected time (59%). Although no specific strategy was identified as paramount to improved productivity, meta-analysis revealed that the publication rate was significantly higher following the implementation of an initiative. Thus, we conclude that a culture of emphasis on resident scholarship is the most important step. We call for well-designed research studies with control or comparison groups and a power analysis focused on identifying best practices for future scholarly activities curricula and initiatives.

Geospatial Visualization of Mobile Stroke Unit Dispatches: A Method to Optimize Service Performance.

BACKGROUND: Timely treatment of acute ischemic stroke is crucial to optimize outcomes. Mobile stroke units (MSU) have demonstrated ultrafast treatment compared to standard emergency care. Geospatial analysis of the distribution of MSU cases to optimize service delivery has not been reported. METHODS: We aggregated all first-year MSU dispatch occurrences and all cases classified by clinical teams as true stroke by zip code and calculated dispatch and true stroke incidence rates. We mapped dispatch and stroke cases and symbolized incidence rates by standard deviation. We confirmed visual impressions of clusters from map inspection by local Moran's I, boxplot inspection, and t test. We calculated service areas using drive times to meet dispatch and true stroke need. RESULTS: A significant cluster of high dispatch incident rate was confirmed around our MSU base in urban Memphis within a 5-min driving area supporting the initial placement of the MSU based on 911 activation. A significant cluster of high true stroke rate was confirmed to the east of our MSU base in suburban Memphis within a 10-min driving area. Mean incident longitude of cases of true stroke versus disregarded status was significantly eastward (p = 0.001785). CONCLUSION: Our findings will facilitate determination of socio-spatial antecedents of neighborhood overutilization of 911 and MSU services in our urban neighborhoods and service delivery optimization to reach neighborhoods with true stroke burden.