Telehealth Attitudes, Training, and Preparedness Among First-Year Internal Medicine Residents in the COVID-19 Era.

Introduction: Telehealth, especially the use of real-time video and phone visits in ambulatory care, is increasingly important in the wake of the COVID-19 pandemic. The current state of internal medicine (IM) interns' telehealth training at the start of residency is unknown. Objective: To characterize the attitudes, training, and preparedness of IM interns regarding the use of telehealth video and phone visits in ambulatory care. Materials and Methods: We conducted a cross-sectional survey of IM interns at four IM residency programs in the United States in 2020. Results: One hundred fifty-six surveys were analyzed (response rate 82%). Seventy-five percent of interns rated training in the use of real-time video and phone visits for ambulatory care as important or very important. The vast majority received no training (74%) or clinical experience (90% no prior video visits, 81% no prior phone visits) during medical school. More interns believed that primary care may be effectively delivered via video visits compared with phone visits (77% vs. 35%). Most interns (69%) missed clinical time during medical school due to the COVID-19 pandemic; 41% felt that the pandemic negatively affected their ambulatory care preparation. Overall, the majority of interns (58%) felt prepared for primary care; only 12% felt prepared to deliver primary care using either video or phone visits. Conclusions: Although IM interns had favorable attitudes toward video and phone visits, few had training or clinical experience; most felt unprepared. Residency programs may need to close training gaps for current interns in conducting telehealth video and phone visits.

Time for Clinic: Fourth-Year Primary Care Exposure and Clinic Preparedness Among Internal Medicine Interns.

BACKGROUND: Internal medicine (IM) residency graduates consistently report being less prepared for outpatient practice than inpatient medicine. Although an initial study suggested interns arriving for IM residency reported low levels of preparedness for continuity clinic, the impact of education and experience during the undergraduate medical education to graduate medical education transition on ambulatory training is unclear. OBJECTIVE: To describe end of medical school primary care exposure among entering IM interns and its association with self-assessed preparedness for residency continuity clinic. DESIGN: Cross-sectional survey of 161 entering IM interns in 2019. PARTICIPANTS: Entering interns at four geographically diverse IM residency programs (University of Chicago, University of North Carolina, University of Pennsylvania, and University of Washington), representing 81 US medical schools. RESULTS: A total of 139 interns (86%) responded to the survey. Surveyed interns reported a median of zero days of general internal medicine (GIM) clinic (interquartile range [IQR]: 0-20 days) and 2.5 days of multispecialty adult primary care (IQR: 0-26.5 days) during fourth year of medical school. The median last exposure to primary care was 13 months prior to internship (IQR: 7-18 months). Interns who rated themselves as prepared for primary care clinic reported a median of twenty more multispecialty adult primary care days (20 vs. 0 days; p < 0.01) and fourteen more GIM clinic days (14 vs. 0 days; p < 0.01) than their unprepared counterparts. The experiences were also more recent, with six fewer months between their last multispecialty adult primary care exposure and the start of internship (9 vs. 15 months; p < 0.01). CONCLUSIONS: The majority of incoming IM interns had no primary care training during the fourth year of medical school. At the start of residency, IM interns who felt more prepared for their primary care clinic reported more recent and more numerous primary care experiences.

A Curriculum to Teach Resilience Skills to Medical Students During Clinical Training.

Introduction: Burnout in medical students is extensive and a critical issue. It is associated with increased rates of depression, suicide, and poor perception of the educational environment. Enhancing resilience, the ability to adapt well in the face of adversity, is a potential tool to mitigate burnout and improve medical student wellness. Methods: Our resilience curriculum consisted of facilitated workshops to cultivate resilience in medical students during their core clerkship rotations. This curriculum served as an introduction to the concept of resilience and taught skills to cultivate resilience and promote wellness. The sessions allowed for identification of and reflection on stressors in the clinical learning environment, including straining team dynamics, disappointment, and uncertainty. Educational sessions included resilience skill-building exercises for managing expectations, letting go of negative emotions, dealing with setbacks, and finding meaning in daily work. Associated materials included lesson plans for small-group facilitators, learner pre- and postcurriculum surveys, and a social media activity guide. Results: This curriculum was delivered to 144 clerkship students at two academic institutions over the 2017-2018 academic year. Sessions were well received by medical students, with the majority of students stating that the sessions should continue. The majority of attendees found the sessions valuable and learned new ways to approach challenges. Discussion: Students valued connecting with peers and feeling less alone through their participation. A challenge was constructing a setting conducive to comfortable reflection for all learners. Not all students found these sessions necessary. Sessions may have improved resilience levels.

A Curriculum to Enhance Resilience in Internal Medicine Interns.

BACKGROUND: Burnout is a serious concern in graduate medical education. While enhancing resilience in trainees is considered beneficial, there are few studies showing successful interventions. OBJECTIVE: We developed and implemented a curriculum to teach resilience skills to internal medicine (IM) residents. METHODS: Our resilience curriculum focused on 4 small group skill-building workshops: setting realistic goals, managing expectations, letting go after stressful clinical events, and finding gratitude. All sessions were delivered by a chief resident during dedicated teaching time, and combined lectures, group discussions, reflection, and simulated skill-building exercises. Participants were assessed before and after the curriculum using the Connor-Davidson Resilience Scale. RESULTS: Over a period of 2 years, 81 interns participated; 75% (61 of 81) responded prior to participating in the curriculum, and 79% (64 of 81) responded after participation. The majority thought sessions should continue the following year (75%, 48 of 64). Postsession, participants were more comfortable talking about stress and burnout (70%, 44 of 63), were more comfortable talking about medical errors (73%, 46 of 63), and had learned new ways to approach challenges (64%, 41 of 64). Mean resilience scores were lower after the curriculum (72.54 ± 10.18 versus 68.65 ± 10.14, P = .034). Feedback from participants indicated that the sessions fostered a sense of togetherness among peers and provided them with an additional support system. CONCLUSIONS: Small group resilience workshops were feasible over 2 years and well received by IM interns, who noted gaining new skills to approach challenges. There was no improvement in resilience scores after the sessions.

Building Team Resilience and Debriefing After Difficult Clinical Events: A Resilience Curriculum for Team Leaders.

INTRODUCTION: Burnout is prevalent among medical trainees and faculty. Resilience, the ability to cope well with stress and thrive during challenges, has been a focus of initiatives to combat burnout. However, curricula teaching resilience skills are needed. Since residents experience challenging and stressful clinical events often, and would like to discuss these events with their teams, resilience skills may help trainees cope after such events. Additionally, resilience skills may help trainees address other challenges they face as team leaders. Leadership training is an important component of physician professional development. METHODS: This advanced resilience training curriculum consists of two interactive workshops that include didactics, skills practice, and reflection. The first workshop focuses on applying resilience skills to team leadership, while the second focuses on structured team debriefing after difficult clinical events. This curriculum is intended for learners who are health care team leaders, such as senior residents, fellows, or faculty. It may be used with learners who have completed introductory resilience training or with those without prior training. RESULTS: The curriculum was rated highly by senior residents, who reported feeling more comfortable leading their teams after difficult clinical events and talking about these events following this curriculum. The majority of residents thought the workshops should be continued. DISCUSSION: This novel curriculum teaches learners to apply resilience skills during team leadership and difficult clinical scenarios. It was well received by senior residents and may be used with a variety of learners across health professions and training levels.

A Curriculum to Foster Resident Resilience.

INTRODUCTION: Burnout in medical trainees is extensive and a critical issue. It is associated with increased rates of depression, suicide, and poor clinical performance. Enhancing resilience, the ability to adapt well in the face of adversity, is a potential tool to mitigate burnout and improve professional development. Our resilience curriculum consists of novel skill-building workshops to help programs cultivate resilience in their trainees. METHODS: This curriculum serves as an introduction for medical trainees and educators to the concept of resilience and teaches skills to help cultivate resilience and promote wellness. The sessions allow for identification of and reflection on stressful clinical events and consist of resilience-enhancing exercises, including setting realistic goals, managing expectations, letting go after medical errors, and finding gratitude. Through small-group reflection, the sessions also help participants discuss challenges with peers. This curriculum is intended for use with intern, junior, and/or senior residents and allows residency programs to address Accreditation Council for Graduate Medical Education milestones in the areas of professionalism, identification of system error, and advocating for system improvement. Materials include an introduction to resilience topics, guidelines for small-group facilitators, a learner precurriculum survey, and an evaluation form. RESULTS: Sessions were well received by interns. The majority of attendees felt more comfortable talking about burnout and medical errors and learned new ways to approach challenges. DISCUSSION: This resilience curriculum has been continued in the intern curriculum and has been presented at a national conference. Resilience training is an effective educational intervention to help trainees manage feelings of distress during residency training.

Preparing for the primary care clinic: an ambulatory boot camp for internal medicine interns.

INTRODUCTION: Internal medicine (IM) interns start continuity clinic with variable ambulatory training. Multiple other specialties have utilized a boot camp style curriculum to improve surgical and procedural skills, but boot camps have not been used to improve interns' ambulatory knowledge and confidence. The authors implemented and assessed the impact of an intern ambulatory boot camp pilot on primary care knowledge, confidence, and curricular satisfaction. METHODS: During July 2014, IM interns attended ambulatory boot camp. It included clinically focused case-based didactic sessions on common ambulatory topics as well as orientation to the clinic and electronic medical records. Interns anonymously completed a 15-question pre-test on topics covered in the boot camp as well as an identical post-test after the boot camp. The interns were surveyed regarding their confidence and satisfaction. RESULTS: Thirty-eight interns participated in the boot camp. Prior to the boot camp, few interns reported confidence managing common outpatient conditions. The average pre-test knowledge score was 46.3%. The average post-test knowledge score significantly improved to 76.1% (p<0.001). All interns reported that the boot camp was good preparation for clinics and 97% felt that the boot camp boosted their confidence. CONCLUSIONS: The ambulatory boot camp pilot improved primary care knowledge, and interns thought it was good preparation for clinic. The ambulatory boot camp was well received and may be an effective way to improve the preparation of interns for primary care clinic. Further assessment of clinical performance and expansion to other programs and specialties should be considered.

Resident Use of Text Messaging for Patient Care: Ease of Use or Breach of Privacy?

BACKGROUND: Short message service (SMS) text messaging is an efficient form of communication and pervasive in health care, but may not securely protect patient information. It is unclear if resident providers are aware of the security concerns of SMS text messaging when communicating about patient care. OBJECTIVE: We sought to compare residents' preferences for SMS text messaging compared with other forms of in-hospital communication when considering security versus ease of use. METHODS: This study was a cross-sectional multi-institutional survey of internal medicine residents. Residents ranked different communication modalities based on efficiency, ease of use, and security using a Likert scale. Communication options included telephone, email, hospital paging, and SMS text messaging. Respondents also reported whether they had received confidential patient identifiers through any of these modalities. RESULTS: SMS text messaging was preferred by 71.7% (94/131) of respondents because of its efficiency and by 79.8% (103/129) of respondents because of its ease of use. For security, 82.5% (104/126) of respondents preferred the hospital paging system, whereas only 20.6% (26/126) of respondents preferred SMS text messaging for secure communication. In all, 70.9% (93/131) of respondents reported having received patient identifiers (first and/or last name), 81.7% (107/131) reported receiving patient initials, and 50.4% (66/131) reported receiving a patient's medical record number through SMS text messages. CONCLUSIONS: Residents prefer in-hospital communication through SMS text messaging because of its ease of use and efficiency. Despite security concerns, the majority of residents reported receiving confidential patient information through SMS text messaging. For providers, it is possible that the benefits of improved in-hospital communication with SMS text messaging and the presumed improvement in the coordination and delivery of patient care outweigh security concerns they may have. The tension between the security and convenience of SMS text messaging may represent an educational opportunity to ensure the compliance of mobile technology in the health care setting.