RESUMEN
BACKGROUND AND OBJECTIVE: Medical students are often unprepared for social challenges in caring for safety net patients. We aim to evaluate and chronicle the evolution of a pre-clinical elective alongside medical disparities curriculum. DESIGN AND METHODS: Medical students designed the course to supplement clinical training on care of vulnerable patients. From 2011-2015, there have been 80 first-year medical student participants, five cohorts of second-year course leaders, and two supporting faculty advisors for this 10-12 session evening elective. RESULTS: Students (n=67) rated the course extremely highly (ranging from 4.4-4.6 on a five-point Likert scale). Medical students reported having significantly more knowledge of underserved populations after taking the course (difference=0.72, SE=0.16, P <0.001). Career interests and attitudes toward health disparities remained strong after taking the course. CONCLUSIONS: This student-created elective equipped participants with improved knowledge in caring for underserved patients and contributed to the incorporation of health disparities in medical curriculum. [Full article available at http://rimed.org/rimedicaljournal-2016-10.asp].
Asunto(s)
Educación Médica/métodos , Conocimientos, Actitudes y Práctica en Salud , Disparidades en Atención de Salud/normas , Estudiantes de Medicina , Poblaciones Vulnerables , Humanos , Rhode Island , Facultades de Medicina , Encuestas y CuestionariosRESUMEN
BACKGROUND: Difficult patient encounters in the primary care office are frequent and are associated with physician burnout. However, their relationship to patient care outcomes is not known. OBJECTIVE: To determine the effect of difficult encounters on patient health outcomes and the role of physician dissatisfaction and burnout as mediators of this effect. DESIGN: A total of 422 physicians were sorted into 3 clusters based on perceived frequency of difficult patient encounters in their practices. Patient charts were audited to assess the quality of hypertension and diabetes management and preventive care based on national guidelines. Summary measures of quality and errors were compared among the 3 physician clusters. RESULTS: Of the 1384 patients, 359 were cared for by high-cluster physicians (those who had a high frequency of difficult encounters), 871 by medium-cluster physicians, and 154 by low-cluster physicians. Dissatisfaction and burnout were higher among physicians reporting higher frequencies of difficult encounters. However, quality of patient care and management errors were similar across all 3 groups. CONCLUSIONS: Physician perception of frequent difficult encounters was not associated with worse patient care quality or more medical errors. Future studies should investigate whether other patient outcomes, including acute care and patient satisfaction, are affected by difficult encounters.
Asunto(s)
Agotamiento Profesional/epidemiología , Satisfacción en el Trabajo , Relaciones Médico-Paciente , Calidad de la Atención de Salud , Adulto , Anciano , Anciano de 80 o más Años , Auditoría Clínica , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Medicina Familiar y Comunitaria , Femenino , Adhesión a Directriz/estadística & datos numéricos , Humanos , Hipertensión/epidemiología , Hipertensión/terapia , Medicina Interna , Masculino , Errores Médicos/estadística & datos numéricos , Persona de Mediana Edad , Medio Oeste de Estados Unidos , Ciudad de Nueva York , Atención Primaria de Salud , Prevención Primaria/estadística & datos numéricosRESUMEN
CONTEXT: Little is known about the influence of the primary care workplace on patient care. Assessing physician opinion through focus groups can elucidate factors related to safety and error in this setting. METHOD: During phase 1 of the Minimizing Error, Maximizing Outcome (MEMO) Study, 9 focus groups were conducted with 32 family physicians and general internists from 5 areas in the upper Midwest and New York City. RESULTS: The physicians described challenging settings with rapidly changing conditions. Patients are medically and psychosocially complex and often underinsured. Communication is complicated by multiple languages, time pressure, and inadequate information systems. Complex processes of care have missing elements including medication lists and test results. Physicians are pressed to be more productive, and key administrative decisions are made without their input. Targeted areas to improve safety and reduce error included teamwork, aligned leadership values, diversity, collegiality, and respect. CONCLUSIONS: Primary care physicians clearly described positive and negative workplace factors related to safety and error. The themes suggest that systems of care and their dynamic nature warrant attention. Enhancing positive and ameliorating negative cultures and processes of care could bring real benefits to patients, physicians, and ambulatory office settings.
Asunto(s)
Atención Ambulatoria/normas , Conocimientos, Actitudes y Práctica en Salud , Errores Médicos/prevención & control , Pacientes Ambulatorios , Médicos de Familia/psicología , Atención Primaria de Salud , Garantía de la Calidad de Atención de Salud , Femenino , Grupos Focales , Humanos , Masculino , Estados UnidosAsunto(s)
Agotamiento Profesional/psicología , Medicina Familiar y Comunitaria/estadística & datos numéricos , Medicina Interna/estadística & datos numéricos , Visita a Consultorio Médico , Evaluación de Procesos y Resultados en Atención de Salud , Relaciones Médico-Paciente , Médicos/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Estrés Psicológico/etiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Chicago , Análisis por Conglomerados , Factores de Confusión Epidemiológicos , Femenino , Humanos , Satisfacción en el Trabajo , Modelos Logísticos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Oportunidad Relativa , Médicos/psicología , Proyectos de Investigación , Factores Sexuales , Estrés Psicológico/complicaciones , Encuestas y Cuestionarios , WisconsinRESUMEN
We describe a specific mentoring approach in an academic general internal medicine setting by audiotaping and transcribing all mentoring sessions in the year. In advance, the mentor recorded his model. During the year, the mentee kept a process journal. Qualitative analysis revealed development of an intimate relationship based on empathy, trust, and honesty. The mentor's model was explicitly intended to develop independence, initiative, improved thinking, skills, and self-reflection. The mentor's methods included extensive and varied use of questioning, active listening, standard setting, and frequent feedback. During the mentoring, the mentee evolved as a teacher, enhanced the creativity in his teaching, and matured as a person. Specific accomplishments included a national workshop on professional writing, an innovative approach to inpatient attending, a new teaching skills curriculum for a residency program, and this study. A mentoring model stressing safety, intimacy, honesty, setting of high standards, praxis, and detailed planning and feedback was associated with mentee excitement, personal and professional growth and development, concrete accomplishments, and a commitment to teaching.