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1.
J Hosp Med ; 14(12): 754-757, 2019 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-31339841

RESUMEN

Despite rapidly growing interest in Hospital Medicine (HM), no prior research has examined the factors that may be most beneficial or detrimental to candidates during the HM hiring process. We developed a survey instrument to assess how those involved in the HM hiring process assess HM candidate attributes, skills and behaviors. The survey was distributed electronically to nontrainee physician Society of Hospital Medicine members. Respondents ranked the top five qualifications of HM candidates and the top five qualities an HM candidate should demonstrate on interview day to be considered for hiring. In thematic analysis of free-response questions, several themes emerged relating to interview techniques and recruitment strategies, including heterogeneous approaches to long-term versus short-term applicants. These findings represent the first published assessment in the area of HM hiring and should inform HM candidates and their mentors.

2.
J Hosp Med ; 14(1): 38-41, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30667409

RESUMEN

We created Sleep for Inpatients: Empowering Staff to Act (SIESTA), which combines electronic "nudges" to forgo nocturnal vitals and medications with interprofessional education on improving patient sleep. In one "SIESTAenhanced unit," nurses received coaching and integrated SIESTA into daily huddles; a standard unit did not. Six months pre- and post-SIESTA, sleep-friendly orders rose in both units (foregoing vital signs: SIESTA unit, 4% to 34%; standard, 3% to 22%, P < .001 both; sleeppromoting VTE prophylaxis: SIESTA, 15% to 42%; standard, 12% to 28%, P < .001 both). In the SIESTAenhanced unit, nighttime room entries dropped by 44% (-6.3 disruptions/room, P < .001), and patients were more likely to report no disruptions for nighttime vital signs (70% vs 41%, P = .05) or medications (84% vs 57%, P = .031) than those in the standard unit. The standard unit was not changed. Although sleep-friendly orders were adopted in both units, a unit-based nursing empowerment approach was associated with fewer nighttime room entries and improved patient experience.

4.
Acad Med ; 93(12): 1814-1820, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29923893

RESUMEN

PROBLEM: Formal education in requesting consultations is inconsistent in medical education. To address this gap, the authors developed the Consultation Observed Simulated Clinical Experience (COSCE), a simulation-based curriculum for interns using Kessler and colleagues' 5Cs of Consultation model to teach and assess consultation communication skills. APPROACH: In June 2016, 127 interns entering 12 University of Chicago Medicine residency programs participated in the COSCE pilot. The COSCE featured an online training module on the 5Cs and an in-person simulated consultation. Using specialty-specific patient cases, interns requested telephone consultations from faculty, who evaluated their performance using validated checklists. Interns were surveyed on their preparedness to request consultations before and after the module and after the simulation. Subspecialty fellows serving as consultants were surveyed regarding consultation quality before and after the COSCE. OUTCOMES: After completing the online module, 84% of interns (103/122) were prepared to request consultations compared with 52% (63/122) at baseline (P < .01). After the COSCE, 96% (122/127) were prepared to request consultations (P < .01). Neither preparedness nor simulation performance differed by prior experience or training. Over 90% (115/127) indicated they would recommend the COSCE for future interns. More consultants described residents as prepared to request consultations after the COSCE (54%; 21/39) than before (27%; 11/41, P = .01). NEXT STEPS: The COSCE was well received and effective for preparing entering interns with varying experience and training to request consultations. Future work will emphasize consultation communication specific to training environments and evaluate skills via direct observation of clinical performance.


Asunto(s)
Curriculum , Evaluación Educacional/métodos , Internado y Residencia/métodos , Entrenamiento Simulado/métodos , Adulto , Competencia Clínica , Comunicación , Retroalimentación , Femenino , Humanos , Masculino , Derivación y Consulta
5.
J Med Libr Assoc ; 106(2): 175-183, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29632440

RESUMEN

Objective: The investigation sought to determine the effects of a clinical librarian (CL) on inpatient team clinical questioning quality and quantity, learner self-reported literature searching skills, and use of evidence-based medicine (EBM). Methods: Clinical questioning was observed over 50 days of inpatient pediatric and internal medicine attending rounds. A CL was present for 25 days and absent for 25 days. Questioning was compared between groups. Question quality was assessed by a blinded evaluator, who used a rubric adapted from the Fresno Test of Competence in Evidence-Based Medicine. Team members were surveyed to assess perceived impacts of the CL on rounds. Results: Rounds with a CL (CLR) were associated with significantly increased median number of questions asked (5 questions CLR vs. 3 NCLR; p<0.01) and answered (3 CLR vs. 2 NCLR; p<0.01) compared to rounds without a CL (NCLR). CLR were also associated with increased mean time spent asking (1.39 minutes CLR vs. 0.52 NCLR; p<0.01) and answering (2.15 minutes CLR vs. 1.05 NCLR; p=0.02) questions. Rounding time per patient was not significantly different between CLR and NCLR. Questions during CLR were 2 times higher in adapted Fresno Test quality than during NCLR (p<0.01). Select participants described how the CL's presence improved their EBM skills and care decisions. Conclusions: Inpatient CLR were associated with more and improved clinical questioning and subjectively perceived to improve clinicians' EBM skills. CLs may directly affect patient care; further study is required to assess this. CLs on inpatient rounds may be an effective means for clinicians to learn and use EBM skills.


Asunto(s)
Medicina Interna , Bibliotecólogos , Rol Profesional , Rondas de Enseñanza , Centros Médicos Académicos , Humanos , Pacientes Internos , Encuestas y Cuestionarios
6.
Acad Med ; 93(2): 214-219, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-28678096

RESUMEN

PROBLEM: Residency clinician-educator tracks have been created; however, they have generally been limited to a single discipline or program and experienced some challenges. The Graduate Medical Education Scholars Track (GMEST), an embedded longitudinal, multimodal, multidisciplinary clinician-educator track for residents, was piloted at the Pritzker School of Medicine, University of Chicago, in academic year 2014-2015. APPROACH: The GMEST is a two-year experience completed during residency training. The goal is to prepare trainees for academic careers as clinician-educators with a focus on medical education scholarship. This track is designed for residents from diverse training programs with variable clinical schedules and blends a live interactive program, asynchronous instruction and discussion, and overarching multimodal mentorship in medical education. Participants are expected to complete a capstone medical education project and submit it to institutional, regional, and/or national venues. OUTCOMES: Data gathered from the 2014-2016 and 2015-2017 cohorts demonstrated that 21/22 (95%) participants were satisfied with the GMEST curriculum, felt it was important to their development as future clinician-educators, and felt it would positively influence their ability to work in medical education. Further, 18/22 (82%) participants wished to pursue a career as a clinician-educator and in medical education leadership and/or scholarship. NEXT STEPS: The authors will longitudinally track graduates' future career positions, projects, publications, and awards, and cross-match and compare GMEST graduates with non-GMEST residents interested in medical education. Faculty mentors, program directors, and the Medical Education, Research, Innovation, Teaching, and Scholarship community will be asked for feedback on the GMEST.


Asunto(s)
Curriculum , Educación de Postgrado en Medicina/métodos , Docentes Médicos/educación , Internado y Residencia , Anestesiología/educación , Medicina de Emergencia/educación , Cirugía General/educación , Humanos , Estudios Interdisciplinarios , Medicina Interna/educación , Liderazgo , Pediatría/educación , Desarrollo de Programa
7.
J Grad Med Educ ; 9(6): 706-713, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29270258

RESUMEN

Background : Advances in information technology have increased remote access to the electronic health record (EHR). Concurrently, standards defining appropriate resident supervision have evolved. How often and under what circumstances inpatient attending physicians remotely access the EHR for resident supervision is unknown. Objective : We described a model of attending remote EHR use for resident supervision, and quantified the frequency and magnitude of use. Methods : Using a mixed methods approach, general medicine inpatient attendings were surveyed and interviewed about their remote EHR use. Frequency of use and supervisory actions were quantitatively examined via survey. Transcripts from semistructured interviews were analyzed using grounded theory to identify codes and themes. Results : A total of 83% (59 of 71) of attendings participated. Fifty-seven (97%) reported using the EHR remotely, with 54 (92%) reporting they discovered new clinical information not relayed by residents via remote EHR use. A majority (93%, 55 of 59) reported that this resulted in management changes, and 54% (32 of 59) reported making immediate changes by contacting cross-covering teams. Six major factors around remote EHR use emerged: resident, clinical, educational, personal, technical, and administrative. Attendings described resident and clinical factors as facilitating "backstage" supervision via remote EHR use. Conclusions : In our study to assess attending remote EHR use for resident supervision, attendings reported frequent remote use with resulting supervisory actions, describing a previously uncharacterized form of "backstage" oversight supervision. Future work should explore best practices in remote EHR use to provide effective supervision and ultimately improve patient safety.


Asunto(s)
Acceso a la Información , Registros Electrónicos de Salud/estadística & datos numéricos , Medicina Interna/educación , Internado y Residencia , Cuerpo Médico de Hospitales , Modelos Educacionales , Adulto , Educación de Postgrado en Medicina , Femenino , Humanos , Entrevistas como Asunto , Masculino , Encuestas y Cuestionarios
10.
MedEdPORTAL ; 12: 10454, 2016 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-31008232

RESUMEN

Introduction: A common career aspiration among residents is to become a clinician-educator, though standard postgraduate training may not prepare trainees for the academic and scholarly requirements of this career. To address this need, we designed and implemented an asynchronous, interactive webinar series detailing a systematic approach to medical education research and scholarship. The series was piloted as part of a new track at the University of Chicago for residents interested in additional training and completing an educational learning project in medical education. Methods: We aimed to use this series to introduce relevant frameworks in curriculum development, program evaluation, and learning theory. Materials associated with this publication include six webinars and corresponding summary reference handouts, discussion assignments, and answer keys. Additional materials include a faculty course director packet and sample feedback for discussion assignments. Each webinar is an 8- to 20-minute narrated presentation with goals and objectives, an overview of each session's content, and example vignettes. Residents viewed presentations and completed a two-part discussion assignment for each webinar, which included reflection on the educational material and vignettes, faculty feedback on this reflection, and application of webinar material and faculty feedback to their own experiences in medical education. Results: All residents in the pilot completed the webinars and assignments. Residents' reactions to the webinar series have been positive, and residents have commented that self-paced learning with directed faculty feedback is a desirable instructional method for this material. Discussion: This series is well suited to introduce fundamental concepts in medical education scholarship and inspire self-directed study for motivated learners.

11.
J Grad Med Educ ; 7(2): 238-41, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26221442

RESUMEN

BACKGROUND: Written communication skills are integral to patient care handoffs. Residency programs require feasible assessment tools that provide timely formative and summative feedback, ideally linked to the Accreditation Council for Graduate Medical Education Milestones. OBJECTIVE: We describe the use of 1 such tool-UPDATED-to assess written handoff communication skills in internal medicine interns. METHODS: During 2012-2013, the authors piloted a structured practice audit at 1 academic institution to audit written sign-outs completed by 45 interns, using the UPDATED tool, which scores 7 aspects of sign-out communication linked to milestones. Intern sign-outs were audited by trained faculty members throughout the year. Results were incorporated into intern performance reviews and Clinical Competency Committees. RESULTS: A total of 136 sign-outs were audited (averaging 3.1 audits per intern). In the first trimester, 14 interns (31%) had satisfactory audit results. Five interns (11%) had critical deficiencies and received immediate feedback, and the remaining 26 (58%) were assigned future audits due to missing audits or unsatisfactory scores. In the second trimester, 21 interns (68%) had satisfactory results, 1 had critical deficiencies, and 9 (29%) required future audits. Nine of the 10 remaining interns in the final trimester had satisfactory audits. Faculty time was estimated at 10 to 15 minutes per sign-out audited. CONCLUSIONS: The UPDATED audit is a milestone-based tool that can be used to assess written sign-out communication skills in internal medicine residency programs. Future work is planned to adapt the tool for use by senior supervisory residents to appraise sign-outs in real time.


Asunto(s)
Evaluación Educacional/métodos , Medicina Interna/educación , Internado y Residencia/métodos , Pase de Guardia/normas , Escritura , Auditoría Clínica , Competencia Clínica , Retroalimentación , Humanos , Medicina Interna/normas , Internado y Residencia/normas
13.
J Hosp Med ; 8(7): 409-13, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23757149

RESUMEN

Changes in the clinical learning environment under resident duty hours restrictions have introduced a number of challenges on today's wards. Additionally, the current group of medical trainees is largely represented by the Millennial Generation, a generation characterized by an affinity for technology, interaction, and group-based learning. Special attention must be paid to take into account the learning needs of a generation that has only ever known life with duty hours. A mnemonic for strategies to augment teaching rounds for hospitalists was created using an approach that considers time limitations due to duty hours as well as the preferences of Millennial learners. These strategies to enhance learning during teaching rounds are Flipping the Wards, Using Documentation to Teach, Technology-Enabled Teaching, Using Guerilla Teaching Tactics, Rainy Day Teaching, and Embedding Teaching Moments into Rounds (FUTURE). Hospitalists serving as teaching attendings should consider these possible strategies as ways to enhance teaching in the post-duty hours era. These techniques appeal to the preferences of today's learners in an environment often limited by time constraints. Hospitalists are well positioned to champion innovative approaches to teaching in a dynamic and evolving clinical learning environment.


Asunto(s)
Competencia Clínica , Médicos Hospitalarios/tendencias , Internado y Residencia/métodos , Responsabilidad Social , Rondas de Enseñanza/métodos , Predicción , Humanos , Internado y Residencia/tendencias , Rondas de Enseñanza/tendencias , Tolerancia al Trabajo Programado
14.
J Hosp Med ; 8(6): 292-7, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23418143

RESUMEN

BACKGROUND: Graduated supervision is necessary for residents to progress to independence, but it is unclear what factors influence attendings' perception of housestaff autonomy. OBJECTIVE: To determine if attending characteristics and secular trends are associated with variation in attendings' perception of housestaff autonomy. DESIGN: Secondary data analysis of monthly survey data collected from 2001 to 2008. SETTING/PARTICIPANTS: Attending hospitalists and nonhospitalists on teaching internal medicine services at an academic tertiary care center. MEASUREMENTS: Attendings' perception of intern decision making and resident autonomy. RESULTS: Response rate was 70% (514/738). Compared with early-career attendings, experienced attendings perceived more intern involvement in decision making (odds ratio [OR]: 2.16, 95% confidence interval [CI]: 1.17-3.97, P=0.013). Hospitalists perceived less intern involvement in decision making (OR: 0.19, 95% CI: 0.06-0.58, P=0.004) and resident autonomy (OR: 0.27, 95% CI: 0.11-0.66, P=0.004) compared with nonhospitalists. A significant interaction existed between hospitalists and experience; experienced hospitalists perceived more intern decision making (OR: 7.36, 95% CI: 1.86-29.1, P=0.004) and resident autonomy (OR: 5.85, 95% CI: 1.75-19.6, P=0.004) compared with early-career hospitalists. With respect to secular trends, spring season of the academic year was associated with greater perception of intern decision making compared with other seasons (OR: 1.94, 95% CI: 1.18-3.19, P=0.009). The 2003 resident duty-hours restrictions were associated with decreased perception of intern decision making (OR: 0.51, 95% CI: 0.29-0.87, P=0.014) and resident autonomy (OR: 0.49, 95% CI: 0.28-0.86, P=0.012). CONCLUSIONS: Perception of housestaff autonomy varies with attending characteristics and time trends. Hospitalists perceive autonomy and clinical decision making differently, depending on their attending experience.


Asunto(s)
Actitud del Personal de Salud , Médicos Hospitalarios/normas , Internado y Residencia/normas , Cuerpo Médico de Hospitales/normas , Percepción , Autonomía Profesional , Competencia Clínica/normas , Recolección de Datos/métodos , Médicos Hospitalarios/tendencias , Humanos , Internado y Residencia/tendencias , Cuerpo Médico de Hospitales/tendencias , Factores de Tiempo
15.
16.
Int J Radiat Oncol Biol Phys ; 82(5): 1636-41, 2012 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-21489715

RESUMEN

PURPOSE: Prolonged delivery times during daily cone-beam computed tomography (CBCT)-guided lung stereotactic body radiotherapy (SBRT) introduce concerns regarding intrafraction variation (IFV) of the mean target position (MTP). The purpose of this study was to evaluate the magnitude of the IFV-MTP and to assess target margins required to compensate for IFV and postonline CBCT correction residuals. Patient, treatment, and tumor characteristics were analyzed with respect to their impact on IFV-MTP. METHODS AND MATERIALS: A total of 126 patients with 140 tumors underwent 659 fractions of lung SBRT. Dose prescribed was 48 or 60 Gy in 12 Gy fractions. Translational target position correction of the MTP was performed via onboard CBCT. IFV-MTP was measured as the difference in MTP between the postcorrection CBCT and the posttreatment CBCT excluding residual error. RESULTS: IFV-MTP was 0.2 ± 1.8 mm, 0.1 ± 1.9 mm, and 0.01 ± 1.5 mm in the craniocaudal, anteroposterior, and mediolateral dimensions and the IFV-MTP vector was 2.3 ± 2.1 mm. Treatment time and excursion were found to be significant predictors of IFV-MTP. An IFV-MTP vector greater than 2 and 5 mm was seen in 40.8% and 7.2% of fractions, respectively. IFV-MTP greater than 2 mm was seen in heavier patients with larger excursions and longer treatment times. Significant differences in IFV-MTP were seen between immobilization devices. The stereotactic frame immobilization device was found to be significantly less likely to have an IFV-MTP vector greater than 2 mm compared with the alpha cradle, BodyFIX, and hybrid immobilization devices. CONCLUSIONS: Treatment time and respiratory excursion are significantly associated with IFV-MTP. Significant differences in IFV-MTP were found between immobilization devices. Target margins for IFV-MTP plus post-correction residuals are dependent on immobilization device with 5-mm uniform margins being acceptable for the frame immobilization device.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/cirugía , Movimiento , Radiocirugia/métodos , Radioterapia Guiada por Imagen/métodos , Respiración , Anciano , Análisis de Varianza , Peso Corporal , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/patología , Tomografía Computarizada de Haz Cónico/métodos , Fraccionamiento de la Dosis de Radiación , Femenino , Tomografía Computarizada Cuatridimensional , Humanos , Inmovilización/instrumentación , Inmovilización/métodos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Masculino , Estudios Prospectivos , Radiocirugia/instrumentación , Planificación de la Radioterapia Asistida por Computador/métodos , Factores de Tiempo , Carga Tumoral
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