What Is Implementation Science and What Forces Are Driving a Change in Medical Education?

Evidence-based interventions to improve health care and medical education face multiple complex barriers to adoption and success. Implementation science focuses on the period following research dissemination, which is necessary but insufficient to address important gaps in clinician performance and patient outcomes. This article describes the forces on health care institutions, medical schools, physician clinicians, and trainees that have created the imperative to design educational interventions to address the gap between evidence and practice. These forces include accreditation, certification, licensure, and regulatory and research funding initiatives focused on improving the quality of health professions education and clinical practice. Medical educators must expand their focus on "what to change" to include "how to change" in order to prepare health care professionals and institutions to effectively adopt new evidence-based practices to improve patient, and ultimately population, outcomes.

Live tweeting in medicine: 'Tweeting the meeting'.

Medical conferences create an opportunity for lifelong learning for healthcare practitioners. The use of Twitter at such conferences continues to expand. This article focuses on how Twitter can be used by physicians and other healthcare providers at regional, national and international conferences, and also at local conferences, such as grand rounds. It also addresses the potential utility of Twitter chats and journal clubs in the promotion of lifelong learning. The impact of Twitter use in healthcare in general, and specifically at conferences, and how it can be measured, is discussed.

Social media, evidence-based tweeting, and JCEHP.

Medical practice and medical journals must adapt to a constantly changing environment, in which social media plays an ever-increasing role. Social media platforms such as Twitter can provide an opportunity to disseminate information in innovative ways. The concept of evidence-based tweeting is introduced, especially as "tweeting the meeting" continues to expand within medical conferences and other venues important for continuing education for health care providers. Future social media strategies for the journal are outlined.

Educational Conference Scheduling, Patient Discharge Time, and Resident Satisfaction.

BACKGROUND: Limits on resident duty hours instituted in 2003 and 2011 have compressed medical resident daily workload. Despite this compression, residents must gain competence to practice medicine without supervision. OBJECTIVE: We sought to determine whether moving the time our educational conference is scheduled affects the time when patient discharges are completed on an internal medicine teaching service. METHODS: The study was conducted at a county hospital within a large internal medicine residency program. During the 4-month study period, the morning report conference for internal medicine residents was shifted from 8:30 am to 2 pm. Patient discharge times, defined as the time the discharge order set was signed, were obtained for the service via the electronic health record. The outcomes measured were patient discharge time variation and internal medicine resident preference for conference time. RESULTS: Survey response rate was 82% (42 of 51). Of the residents who responded, 64% (27 of 42) preferred the 8:30 am report time, and 74% (31 of 42) felt the 8:30 am time was also better for education and timing of teaching rounds. There was no difference in discharge times for 2999 patients on the medicine teaching service, whether educational case conference morning report occurred at 8:30 am or at 2 pm. CONCLUSIONS: Medical patient average discharge time was not influenced by time of educational conference. Factors other than the timing of educational conference appear to influence hospital discharge times on an inpatient internal medicine service.

The influence of the residency application process on the online social networking behavior of medical students: a single institutional study.

PURPOSE: To evaluate medical students' behavior regarding online social networks (OSNs) in preparation for the residency matching process. The specific aims were to quantify the use of OSNs by students to determine whether and how these students were changing OSN profiles in preparation for the residency application process, and to determine attitudes toward residency directors using OSNs as a screening method to evaluate potential candidates. METHOD: An e-mail survey was sent to 618 third- and fourth-year medical students at Indiana University School of Medicine over a three-week period in 2012. Statistical analysis was completed using nonparametric statistical tests. RESULTS: Of the 30.1% (183/608) who responded to the survey, 98.9% (181/183) of students reported using OSNs. More than half, or 60.1% (110/183), reported that they would (or did) alter their OSN profile before residency matching. Respondents' opinions regarding the appropriateness of OSN screening by residency directors were mixed; however, most respondents did not feel that their online OSN profiles should be used in the residency application process. CONCLUSIONS: The majority of respondents planned to (or did) alter their OSN profile in preparation for the residency match process. The majority believed that residency directors are screening OSN profiles during the matching process, although most did not believe their OSN profiles should be used in the residency application process. This study implies that the more medical students perceive that residency directors use social media in application screening processes, the more they will alter their online profiles to adapt to protect their professional persona.

Practice-based learning and improvement: a curriculum in continuous quality improvement for surgery residents.

HYPOTHESIS: Surgery residents can learn continuous quality improvement (CQI) principles within a structured curriculum and propose quality improvement projects. DESIGN: Curriculum within a surgical residency program. SETTING: A university surgical residency program with multiple hospital training sites. PARTICIPANTS: Fifteen surgical residents during the dedicated research year. INTERVENTION: A curriculum in CQI that focuses on devising a quality improvement project. MAIN OUTCOME MEASURES: Resident self-reported attitudes about quality improvement and implementation of resident-initiated quality improvement projects. RESULTS: Resident survey data demonstrated an improvement in knowledge, self-efficacy, and experiences within CQI. Fifteen individual residents, within smaller teams, created 4 quality improvement projects worthy of implementation. CONCLUSIONS: A structured CQI curriculum can be successfully integrated into a general surgery residency program. Residents can learn the skill of constructing CQI project ideas within the framework of the plan-do-study-act cycle. Residents are eager to make improvements in their local system of residency. By giving them the tools to critically investigate systems improvement and a much needed ear to hear their concerns and suggestions for improvement, we found ways to potentially enhance patient care and developed ideas to improve the education of future surgeons. In doing so, we provided the residents with "buy-in" into their residency program, while addressing the competency of practice-based learning and improvement required by the Accreditation Council for Graduate Medical Education for resident education.

A continuous quality improvement curriculum for residents: addressing core competency, improving systems.

PURPOSE: To describe the development, implementation, and evaluation of a residency continuous quality improvement (CQI) curriculum. METHOD: Forty-four medicine and pediatrics residents participated in a CQI curriculum. Resident-designed projects were scored for CQI construct skills using a grading tool. Pre- and post-tests evaluated knowledge, perceived knowledge, interest, and self-efficacy. RESULTS: Differences between pre- and post-test perceived knowledge and self-efficacy were highly significant (p <.001). The mean project score was 81.7% (SD 8.3%). Higher knowledge was associated with higher ratings of self-efficacy. There was no correlation of measured knowledge with project score or interest. CONCLUSIONS: Resident education and learning in CQI served to produce innovative and creative improvement projects that demonstrated individual residents' competency in practice-based learning and improvement.

Teaching medical residents about teenagers: an introductory curriculum in adolescent medicine.

OBJECTIVE: Adolescents in the United States have high morbidity rates, which are attributable to injuries, behavioral disorders, sexually transmitted diseases, and unplanned pregnancies. This has led to a call to action for health care educators to better prepare future practitioners to meet adolescent health care needs. Although pediatrics residency programs have required one-month curricula dedicated to adolescent medicine, many internal medicine (IM) residency programs do not have such requirements despite an American College of Physicians position paper recognizing the importance of internists' providing health care to adolescents. Thus, an introductory curriculum in adolescent medicine was developed for a community hospital IM residency program. The curriculum was designed to train IM residents to effectively interview, provide preventive care for, and evaluate common medical problems of older adolescents (ages 16-21) in an outpatient setting. DESCRIPTION: The curriculum was based on the results of an extensive needs assessment, which included surveys sent to practicing internists and current IM residents. It included three units, each a series of one-hour lessons delivered via morning report or grand rounds sessions. The first unit was interviewing, which covered specific interviewing questions, communication methods, and confidentiality issues. The second unit was preventive medicine care, which addressed immunizations, injury prevention, and adolescent drug and alcohol use. The third unit was diagnosis and management of common problems, which focused on topics frequently encountered during adolescent outpatient visits, including acne, sexually transmitted diseases, reproductive health care needs, and menstrual abnormalities. Other topics pertinent to the care of adolescents, notably depression, eating disorders, and sports medicine, were covered by previously established curricula, and thus omitted. This curriculum was created through the support of the Michigan State University Primary Care Faculty Development Fellowship Program, and was reviewed by curricular and adolescent medicine content experts. The residency program director supported its implementation over the course of two academic years. The pilot unit interviewing was conducted in February 2001, during two one-hour morning report sessions. In the first session, a short lecture outlining interviewing concepts and principles was given, followed by several case-based studies describing office presentations of adolescent patients. In the second session, an actual office visit was simulated; the residents observed adolescent volunteers being interviewed, and were then given an opportunity to ask the patients further questions. Residents completed a brief quiz and evaluation survey at the end of the pilot unit. DISCUSSION: Twenty-one of 40 residents participated in the pilot unit. Evaluations were overall very positive. Quiz scores confirmed that the residents achieved the desired learning objectives. Given these results from the pilot unit, the remaining two units of the curriculum have been integrated into the residency curriculum. Additional faculty members have been selected to deliver future sessions and support this important educational activity. The adolescent medicine curriculum can be used as an model by other IM residency programs for teaching adolescent health care, with an emphasis on both the knowledge base of adolescent issues and awareness of the unique skills necessary for the establishment of a physician-patient relationship between internists and older adolescents.