Career Plans of Internal Medicine Residents From 2019 to 2021.

This survey study examines career choices of internal medicine residents from 2019 to 2021 and compares them with findings from a decade earlier.

Polycystic Ovarian Syndrome.

Polycystic ovarian syndrome (PCOS) is a complex, familial, polygenetic metabolic condition. The Rotterdam criteria are commonly used to diagnose PCOS. Lifestyle changes are the first-line treatment of PCOS. Treatment options for menstrual irregularities and hirsutism are based on the clinical goals and preferences of the patient. Along with treating the symptoms of PCOS, it is essential to screen and treat the comorbid conditions commonly associated with PCOS, including type 2 diabetes mellitus, obesity, nonalcoholic fatty liver disease, hyperlipidemia, obstructive sleep apnea, anxiety, depression, infertility, and vitamin D deficiency.

Review of the Medical Student Performance Evaluation: analysis of the end-users' perspective across the specialties.

The Medical Student Performance Evaluation (MSPE) is an important tool of communication used by program directors to make decisions in the residency application process. To understand the perspective and usage of the MSPE across multiple medical specialties now and in anticipation of the planned changes in USMLE Step 1 score-reporting. A survey instrument including quantitative and qualitative measures was developed and piloted. The final survey was distributed to residency programs across 28 specialties in 2020 via the main contact on the ACGME listserv. Of the 28 specialties surveyed, at least one response was received from 26 (93%). Eight percent of all programs (364/4675) responded to the survey, with most respondents being program directors. Usage of the MSPE varied among specialties. Approximately 1/3 of end-users stated that the MSPE is very or extremely influential in their initial screening process. Slightly less than half agreed or strongly agreed that they trust the information to be an accurate representation of applicants, though slightly more than half agree that the MSPE will become more influential once USMLE Step 1 becomes pass/fail. Professionalism was rated as the most important component and noteworthy characteristics among the least important in the decision-making process. Performance in the internal medicine clerkship was rated as the most influential while neurology and psychiatry performances were rated as less influential. Overwhelmingly, respondents suggested that including comparative performance and/or class rank would make the MSPE more useful once USMLE Step 1 becomes pass/fail. MSPE end-users across a variety of specialties utilize this complex document in different ways and value it differentially in their decision-making processes. Despite this, continued mistrust of the MSPE persists. A better understanding of end-users' perceptions of the MSPE offers the UME community an opportunity to transform the MSPE into a highly valued, trusted document of communication.

Lack of Diversity in Simulation Technology: An Educational Limitation?

STATEMENT: Despite increased attention on diversity in medicine and healthcare, heterogeneity in simulation technology has been slow to follow suit. In a nonsystematic review of simulation technology available in 2018 with respect to skin tone, age and sex, we found limited diversity in these offerings, suggesting limitations to educators' abilities to represent the full array of patients, conditions, and scenarios encountered in medicine and training. We highlight these limitations and propose basic strategies by which educators can increase awareness of and incorporate diversity into the simulation arena.

The Revised Medical School Performance Evaluation: Does It Meet the Needs of Its Readers?

BACKGROUND: The Medical School Performance Evaluation (MSPE) is an important factor for application to residency programs. Many medical schools are incorporating recent recommendations from the Association of American Medical Colleges MSPE Task Force into their letters. To date, there has been no feedback from the graduate medical education community on the impact of this effort. OBJECTIVE: We surveyed individuals involved in residency candidate selection for internal medicine programs to understand their perceptions on the new MSPE format. METHODS: A survey was distributed in March and April 2018 using the Association of Program Directors in Internal Medicine listserv, which comprises 4220 individuals from 439 residency programs. Responses were analyzed, and themes were extracted from open-ended questions. RESULTS: A total of 140 individuals, predominantly program directors and associate program directors, from across the United States completed the survey. Most were aware of the existence of the MSPE Task Force. Respondents read a median of 200 to 299 letters each recruitment season. The majority reported observing evidence of adoption of the new format in more than one quarter of all medical schools. Among respondents, nearly half reported the new format made the MSPE more important in decision-making about a candidate. Within the MSPE, respondents recognized the following areas as most influential: academic progress, summary paragraph, graphic representation of class performance, academic history, and overall adjective of performance indicator (rank). CONCLUSIONS: The internal medicine graduate medical education community finds value in many components of the new MSPE format, while recognizing there are further opportunities for improvement.

Measurement of resident fatigue using rapid number naming.

OBJECTIVE: Sleep deprivation has a negative effect on neurocognitive performance. The King-Devick test (KDT), which tests speed and accuracy of number-reading, requires integrity of saccades, visual processing, and cognition. This study investigated effects of sleep deprivation in on-call residents using KDT. METHODS: A prospective cohort study was conducted among 80 residents. KDT was performed at the beginning and end of an overnight call shift for the residents in the experimental group. A control group was tested at the beginning of 2 consecutive day shifts. Estimates of hours of sleep, Karolinska Sleepiness Scale (KSS)(1 = extremely alert, 9 = extremely sleepy), and time and accuracy of KDT were recorded. RESULTS: 42 residents were tested before and after overnight call shifts and 38 served as controls. Change in test time differed between the groups, with the experimental group performing 0.54(SD = 4.0) seconds slower after their night on call and the control group performing 2.32(SD = 3.0) seconds faster on the second day, p < 0.001. This difference was larger in surgical compared to medical residents. CONCLUSIONS: Sleep deprivation was inversely correlated with neurocognitive performance as measured by KDT, with more effect on surgical than medical residents. Further research could investigate whether this test could help determine fatigue level and ability to continue working after a long shift.

A Curriculum for Lumbar Puncture Training in Internal Medicine Residency.

This article was migrated. The article was not marked as recommended. Background: Lumbar puncture (LP), although not mandatory for internal medicine (IM) residents to perform, remains a vital procedure for hospitalized patients. The optimal method for training residents in LP is not established. Objective: We implemented, and evaluated a curriculum (online video, post-video quiz, group discussion, checklist, simulation training) for training PGY-2 IM residents in performing LPs. Methods: We surveyed residents after completion of the curriculum and compared LP logs for the cohort who participated in this training to the prior year of residents without the curriculum. Results: Overall survey response rate was 65%. 98% of residents found the pre-course materials useful; 92% agreed or strongly agreed that the in-person training session helped them to correctly perform an LP. 90% of residents found simulation training useful and 84% responded that the training session increased their confidence to perform an LP. However, compared to the prior residency class who did not have LP training, the initial class that underwent training did not perform more LPs during their residency: median 2 (inter-quartile range 0-5) vs. 2 (inter-quartile range 0-4.25), respectively (p = 0.98). Conclusion: Despite not leading to an increase in LP rates, our curriculum was very well received by PGY-2 IM residents.

Inspiring the next generation of academic physicians: the academic health careers program.

There is growing evidence in the medical education literature for the aggressive need to recruit and retain the next generation of academic physicians. In 2008, the University of Kentucky College of Medicine (UK COM) developed an academic health careers (AHCs) program for preclinical medical students as an introduction into the practice of academic medicine. The goals of this elective experience included (1) highly customized training and mentorship experiences in research, teaching, and other aspects of academic medicine; (2) information and perspectives to assist students in making informed career choices, including options for academic careers; (3) access to academic career mentors and role models related to individual faculty research interests and teaching responsibilities; and (4) opportunities to network with UK COM administrators. This short communication provides a detailed overview of the AHC experience - along with preliminary findings from a 2016-17 follow-up of program graduates exploring the program's role in their career aspirations and decisions.

Duly noted: Lessons from a two-site intervention to assess and improve the quality of clinical documentation in the electronic health record.

BACKGROUND: Communication errors are identified as a root cause contributing to a majority of sentinel events. The clinical note is a cornerstone of physician communication, yet there are few published interventions on teaching note writing in the electronic health record (EHR). This is a prospective, two-site, quality improvement project to assess and improve the quality of clinical documentation in the EHR using a validated assessment tool. METHODS: Internal Medicine (IM) residents at the University of Kentucky College of Medicine (UK) and Montefiore Medical Center/Albert Einstein College of Medicine (MMC) received one of two interventions during an inpatient ward month: either a lecture, or a lecture and individual feedback on progress notes. A third group of residents in each program served as control. Notes were evaluated with the Physician Documentation Quality Instrument 9 (PDQI-9). RESULTS: Due to a significant difference in baseline PDQI-9 scores at MMC, the sites were not combined. Of 75 residents at the UK site, 22 were eligible, 20 (91%) enrolled, 76 notes in total were scored. Of 156 residents at MMC, 22 were eligible, 18 (82%) enrolled, 40 notes in total were scored. Note quality did not improve as measured by the PDQI-9. CONCLUSION: This educational quality improvement project did not improve the quality of clinical documentation as measured by the PDQI-9. This project underscores the difficulty in improving note quality. Further efforts should explore more effective educational tools to improve the quality of clinical documentation in the EHR.

Does gender moderate medical students' assessments of unprofessional behavior?

BACKGROUND: Despite widespread acceptance of professionalism as a clinical competency, the role of certain contextual factors in assessing certain behaviors remains unknown. OBJECTIVE: To examine the potential moderating role of gender in assessing unprofessional behaviors during undergraduate medical training. DESIGN: Randomized, anonymous, self-administered questionnaire. PARTICIPANTS: Ninety seven (97) third-year students from a southeastern U.S. medical school (participation rate=95.1 %). MAIN MEASURES: Using a 4-point Likert-type scale, subjects reviewed two subsets of randomly administered, equally weighted hypothetical vignettes depicting potentially unprofessional behaviors that could occur during medical students' clinical training. Ratings were categorized from 1 -"Not a Problem" to 4 -"A Severe Problem", based on the perceived degree of unprofessionalism. In each written scenario, trainee gender was systematically varied. KEY RESULTS: Across all scenario subsets, male and female students' mean ratings of hypothetical behaviors did not differ significantly. Further, male and female students tended, on average, to rate behaviors similarly regardless of the trainee's gender. CONCLUSION: Study findings suggest that: (1) neither students' gender nor that of the hypothetical "actor" moderates the assessment of unprofessional behaviors; and (2) male and female students assign roughly the same overall rankings to potentially unprofessional behaviors.

Assessing the quality of clinical teaching: a preliminary study.

OBJECTIVES: Evaluations in the clinical arena are fraught with problems. Current assessments of clinical teaching typically measure attributes of clinical teachers in overly broad terms, are often subjective and often succumb to the halo effect. This is in contradistinction to measurements of lectures, workshops or online educational content, which can more readily be assessed using objective criteria. As a result, clinical evaluations are often insufficient to provide focused feedback, guide faculty development or identify specific areas for clinical teachers to implement change and improvement. The aim of our study was to offset these limitations. METHODS: We developed a structured, 15-item objective structured clinical examination (OSCE)-type checklist of discrete teaching behaviours intended to be: (i) observable; (ii) applicable to multiple disciplines, and (iii) reliably identifiable. Our goal was to test and utilise this checklist as an objective assessment of clinical teaching across a range of in-patient teaching rounds experiences. During 2007-2008, pairs of external raters on two separate occasions observed nine attending physicians during actual in-patient paediatrics and internal medicine ward rounds at a large, academic medical centre. Observers documented the extent to which specific teaching behaviours did or did not occur. RESULTS: The internal consistency of the 15-item checklist was good (alpha = 0.85). A two-facet, partially nested G study found the generalisability of ratings to be generally acceptable, but inter-rater reliability varied greatly between occasions and across individual checklist items. CONCLUSIONS: Despite attempts to identify discrete and observable target behaviours, placing observers on rounds to detect these behaviours may not be as straightforward as it would seem. Clinical teaching may be a more inherently subjective process, based on different teaching styles of faculty staff. However, a set of objective checklist items to be completed by trained observers on teaching rounds holds promise as a potentially viable means of identifying strengths and weaknesses of clinical instruction. Further research is needed to define what constitutes quality clinical teaching, as well as the most reliable method for assessing it.

Professionalism in residency training: is there a generation gap?

BACKGROUND: Teaching and evaluating professionalism is part of the Accreditation Council for Graduate Medical Education's training requirements for postgraduate education. Defining what constitutes professional behavior is the first step in this endeavor. Difficulty in teaching and evaluating professionalism may stem from generational differences between teachers and trainees in their definition of professional behavior. PURPOSE: We sought to explore the magnitude of generational differences by asking faculty and residents to evaluate behaviors along a continuum of professionalism. METHODS: A questionnaire composed of 16 vignettes describing unprofessional behaviors was distributed to a sample of internal medicine trainees and faculty. For each specific behavior described, participants were asked to rate the severity of the infraction on a 4-point scale. RESULTS: Within each group, responses were distributed across severity categories for most vignettes. There were no significant differences in the responses of trainees versus faculty for any of the vignettes except two. CONCLUSION: There is little consensus for determining the severity of unprofessional behaviors among faculty and trainees at one urban university training program. However, this lack of consensus does not appear to have a generational basis. Attributing difficulties in teaching and assessing professionalism cannot be blamed on differences between the generations.

An innovative program to provide adequate women's health education to residents with VA-based ambulatory care experiences.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) requires internal medicine residents to spend 25% continuity clinic time seeing patients of each gender. This requirement is a challenge for programs that use a Veterans Administration Hospital (VA) as the sole site for residents' continuity clinic, because of its predominately a male patient population. PURPOSE: To ensure VA- clinic-based residents meet the ACGME requirement regarding gender care and receive adequate training in women's-health issues and to assess and evaluate a novel program designed to fulfill these needs.. METHODS: We developed a program that allows VA-based residents to spend 75% continuity practice time in VA clinic and 25% in a university-based clinic. We surveyed program participants annually regarding their experiences and in post graduate years (PGY) 1 and 3 assessed all residents' knowledge of women's health (WH). RESULTS: Thirty-five residents were paired with faculty preceptors over 3 years. In annual program surveys, program residents reported seeing a gender mix of patients and feeling more comfortable with women's health. In knowledge surveys, mean score of all residents improved from 46% to 54% (p=.002). Factors associated with improvement were female resident gender (p=.004), having VA continuity clinic(p=.001), having specialized women's health preceptors (p=.006), and seeing at least 30% female patients (p=.01). In the multivariable model, resident gender and having a VA continuity clinic remained significant. CONCLUSIONS: Our program provides a novel, effective method to ensure VA-based internal medicine residents receive adequate educational experiences in gender-specific care.