A Curriculum for Teaching Clinical Efficiency Focusing on Specific Communication Skills While Maximizing the Electronic Health Record.

Introduction: All physicians must learn comprehensive patient care delivery within the electronic health record (EHR). No studies have considered EHR communication training with an emphasis on clinical efficiency. This curriculum provides a method of teaching clinic efficiency while practicing effective patient communication in any EHR clinical situation. The target audience is resident physicians, fellow physicians, faculty physicians, and physician extenders practicing in a primary care setting where the EHR is present. Methods: This curriculum of four separate workshops provides a structured EHR approach while addressing communication strategies for preclinical preparation, rapport building, encounter initiation, agenda setting, and visit closure. The curriculum contains interactive presentations, tools, and an evaluation survey. Presenting efficiency issues with the EHR using the ATTEND mnemonic and agenda setting allows documentation while practicing communication techniques that maximize efficiency. Results: Postworkshop surveys revealed that participants felt the workshops were helpful (84%). One measurement of efficiency revealed improvement through decreased number of days to note completion after workshop participation. At the Program Directors Workshop, curriculum value was demonstrated by high attendance, with 94% feeling the workshops provided easily utilizable strategies. Discussion: The curriculum utilized only the EPIC EHR but would be generalizable. Future directions could include measurement of effective communication and visit efficiency through direct observation and expanded EHR timing data.

Back to the future: reflections on the history of the future of family medicine.

These are historic times for family medicine. The profession is moving beyond the visionary blueprint of the Future of Family Medicine (FFM) report while working to harness the momentum created by the FFM movement. Preparing for, and leading through, the next transformative wave of change (FFM version 2.0) will require the engagement of multigenerational and multidisciplinary visionaries who bring wisdom from diverse experiences. Active group reflection on the past will potentiate the collective work being done to best chart the future. Historical competency is critically important for family medicine's future. This article describes the historical context of the development and launch of the FFM report, emphasizing the professional activism that preceded and followed it. This article is intended to spark intergenerational dialog by providing a multigenerational reflection on the history of FFM and the evolution that has occurred in family medicine over the past decade. Such intergenerational conversations enable our elders to share wisdom with our youth, while allowing our discipline to visualize history through the eyes of future generations.

Early intervention to promote medical student interest in surgery and the surgical subspecialties.

OBJECTIVE: Concerns about projected workforce shortages are growing, and attrition rates among surgical residents remain high. Early exposure of medical students to the surgical profession may promote interest in surgery and allow students more time to make informed career decisions. The objective of this study was to evaluate the impact of a simple, easily reproducible intervention aimed at increasing first- and second-year medical student interest in surgery. DESIGN: Surgery Saturday (SS) is a student-organized half-day intervention of four faculty-led workshops that introduce suturing, knot tying, open instrument identification, operating room etiquette, and basic laparoscopic skills. Medical students who attended SS were administered pre-/post-surveys that gauged change in surgical interest levels and provided a self-assessment (1-5 Likert-type items) of knowledge and skills acquisition. PARTICIPANTS: First- and second-year medical students. OUTCOME MEASURES: Change in interest in the surgical field as well as perceived knowledge and skills acquisition. RESULTS: Thirty-three first- and second-year medical students attended SS and completed pre-/post-surveys. Before SS, 14 (42%) students planned to pursue a surgical residency, 4 (12%) did not plan to pursue a surgical residency, and 15 (46%) were undecided. At the conclusion, 29 (88%) students indicated an increased interested in surgery, including 87% (13/15) who were initially undecided. Additionally, attendees reported a significantly (p < 0.05) higher comfort level in the following: suturing, knot tying, open instrument identification, operating room etiquette, and laparoscopic instrument identification and manipulation. CONCLUSIONS: SS is a low resource, high impact half-day intervention that can significantly promote early medical student interest in surgery. As it is easily replicable, adoption by other medical schools is encouraged.

La nefrectomía laparoscópica asistida para donante: es realizable sin causar daños transitorios al riñon / The Laparoscopic nephroctomy assisted to donor is realizable without cause lors transiet of kidney

La nefrectomía laparoscópica asistida para el donante (NLA) ha evolucionado y es hoy en día un procedimiento realizable con un margen adecuado de seguridad. Los estudios han mostrado que si la presión intraabdominal es mayor de 15 mmHg o se prolonga el neumoperitoneo, causa trastornos renales transitorios manifestados por una reducción del volumen urinario (VU). La adecuada administración de líquidos en el intraoperatorio es importante para asegurar al máximo la perfusión renal previa a la extracción del riñon. Para esta relativamente nueva técnica, hay una escasez de datos relacionados con el volumen de orina esperado durante el procedimiento. El propósito de este informe es proporcionar un rango de "normales" asociado con unos buenos resultados en el rreceptor que pueden ser usados como referencias durante los procedimientos y determinar la viabilidad de operar laparoscópicamente con baja presión de insuflación. Método: En 25 pacientes consecutivos sometidos a NLA, la tensión arterial (TA), volumen urinario (VU), el volumen de líquidos intravenosos infundidos y la respuesta a la administración de diuréticos se registró a intervalos igules o cuando ocurría un evento importante a lo largo del procedimiento y postoperatoriamente. Un caso se convirtió debido a lesión de la arterial renal, y fue excluido. La TA fue supervisada continuamente por una ínea arterial . El VU se registró cada 30 min. Estos intervals y su correlación con la administración de diuréticos; mannitol en 2 dosis de 12.5 g. Se dió al comienzo de la disección de la vena renal y la arteria respectivamente. La furosemida fue administrada cuando el cirujano avisó que la extracción del riñon ocurriría dentro de una hora para aumentar al máximo VU. Resultados: 56 por ciento de los pacientes fueron del sexo femenino; edad media 35 años (18-61); el peso promedio: 84 Kg (54-130). La nefrectomía izquierda se realizó en 80 por ciento. TA sistólica promedio = 120 mmHG, diastólica promedio = 72 mmHg, no se observó ningún cambio al comienzo del neumoperitoneo. La presión media de CO2 en los primeros 13 pacientes fue de 9 mmHg. Todos los pacientes subsecuentes se operaron a 8 mmHg. El promedio del total de líquidos administrados en el intraoperatorio fue: 6000 ml; VU total promedio: 2300 ml.