Implementation, Reach, and Effectiveness of the Direct Observation of Residents in Clinic Program.

BACKGROUND: Direct observation is important, yet medical residents are rarely observed. We implemented and evaluated a direct observation program in resident clinics to increase the frequency of observation and feedback and improve perceptions about direct observation. METHODS: We assigned faculty as observers in our resident clinics between June 2019 and February 2020. We surveyed residents and faculty before and after the program. Faculty completed a form for each observation performed. We analyzed surveys to examine changes in barriers, frequency and type of observations and feedback, and attitudes toward observation. The analytical sample included 38 and 37 pre- and postresident surveys, respectively, and 20 and 25 pre- and postfaculty surveys, respectively. RESULTS: Resident survey response rates were 32.3% (40/124) pre- and 30.7% (39/127) postintervention. Most residents (76% [pre], 86% [post], P = 0.258) reported being observed in at least one of the four areas: history, examination, counseling, or wrap-up. We received observation tracking forms on 68% of eligible residents. Observed history taking increased from 30% to 79% after the program (P = 0.0010). Survey response rates for faculty were 64.7% (22/34) pre- and 67.5% (25/37) postintervention. Fewer faculty reported time (80% [pre], 52% [post], P = 0.051) and competing demands (65% [pre], 52% [post], P = 0.380) as barriers postintervention. Fewer faculty postintervention viewed observation as a valuable teaching tool (100% [pre], 79% [post], P = 0.0534). All faculty who did not view observation as valuable were the least experienced. DISCUSSION: Assigning faculty as observers can increase observation, especially in history taking, though data suggest an increase in negative perceptions of observation by faculty.

How to Build It So They'll Come: Faculty Opinion on Faculty Development.

BACKGROUND: Residents report low satisfaction with faculty evaluation and feedback. To improve skills, successful faculty development interventions must be accessible and acceptable. METHODS: A faculty development survey was admin- istered to 145 specialty and non-specialty Internal Medicine faculty at the Warren Alpert Medical School of Brown University, Providence, RI. Analyses assessed demographics, opinion regarding evaluation and feedback and interest in faculty development. RESULTS: Only 70% of faculty were satisfied with their evaluation ability and only 59% were satisfied with their feedback skills. Despite this, 32% had limited interest in faculty development. Non-specialty faculty were more interested than subspecialty faculty, p-value=0.02. Faculty preferred short electronic audio slideshows and 38% reported participation barriers. CONCLUSIONS: Although faculty report evaluation and feedback are important skills, not all were satisfied with their abilities. Subspecialty faculty were less interested than non-specialty in faculty development. Our findings suggest that more effective ways to engage faculty in the process of faculty development are needed.

The Great Imposter: A Confusing Case of a Rare Renal Cell Carcinoma.

We report a 61-year-old male with sarcomatoid renal cell carcinoma (sRCC) in the context of multiple paraneoplastic syndromes, including thrombocytosis, leukemoid reaction, and paraneoplastic hepatopathy (Stauffer syndrome). The patient's clinical course was complicated by multiple medical challenges, extensive metastases, and persistent infection. This confusing presentation of a rare subtype of renal cell carcinoma (RCC) highlights the diverse and often misleading manifestations of this aggressive malignancy. Clinicians should be aware of the association between RCC, multiple paraneoplastic syndromes, and its propensity to present with systemic, non-renal symptoms.

Improving the Perception of Outpatient Practice: A Second Continuity Experience for Internal Medicine Residents.

BACKGROUND: The challenges trainees experience in the traditional medical clinic are felt to be one deterrent to choosing a primary care career. OBJECTIVE: We examined whether participation in a second outpatient continuity experience (Second Site) affects trainee perception of primary care practice. METHODS: 241 current and former graduates of the Brown Alpert Medical School Internal Medicine training programs were surveyed about their experiences with Second Site. RESULTS: Of the 232 potential responders, 160 completed the survey. Although most did not feel that the experience altered their chosen career path, a positive perception of outpatient practice was noted by 97% of the primary care respondents and 92% of the subspecialty respondents. CONCLUSION: Second Site improved the perception of outpatient practice. A large number of our residents enter primary care, thus, few residents' careers were influenced by Second Site. Despite this, Second Site might enhance interest in primary care careers at other institutions. [Full article available at http://rimed.org/rimedicaljournal-2017-04.asp].