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1.
MedEdPORTAL ; 17: 11106, 2021 03 02.
Artículo en Inglés | MEDLINE | ID: mdl-33768143

RESUMEN

Introduction: During the COVID-19 pandemic, third-year medical students were temporarily unable to participate in onsite clinical activities. We identified the curricular components of an internal medicine (IM) clerkship that would be compromised if students learned solely from online didactics, case studies, and simulations (i.e., prerounding, oral presentations, diagnostic reasoning, and medical management discussions). Using these guiding principles, we created a virtual rounds (VR) curriculum to provide IM clerkship students with clinical exposure during a virtual learning period. Methods: Held three times a week for 2 weeks, VR consisted of three curricular components. First, clerkship students prerounded on an assigned hospitalized patient by remotely accessing the electronic health record and calling into hospital rounds. Second, each student prepared an oral presentation on their assigned patient. Third, using videoconferencing, students delivered these oral presentations to telemedicine VR small groups consisting of three to four students and three tele-instructors. Tele-instructors then provided feedback on oral presentations and taught clinical concepts. We assessed the effectiveness of VR by anonymously surveying students and tele-instructors. Results: Twenty-nine students and 34 volunteer tele-instructors participated in VR over four blocks. A majority of students felt VR improved their prerounding abilities (86%), oral presentation abilities (93%), and clinical reasoning skills (62%). All students found small group to be useful. Discussion: VR allowed students to practice rounding skills in a supportive team-based setting. The lessons learned from its implementation could facilitate education during future pandemics and could also supplement in-person clerkship education.


Asunto(s)
Prácticas Clínicas/métodos , Educación a Distancia/métodos , Educación de Pregrado en Medicina/métodos , Medicina Interna/educación , Rondas de Enseñanza/métodos , /epidemiología , Competencia Clínica , Curriculum , Medicina Hospitalar/educación , Medicina Hospitalar/tendencias , Humanos , Satisfacción Personal , Estudiantes de Medicina/psicología , Telemedicina/métodos
5.
South Med J ; 114(2): 116-122, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33537794

RESUMEN

OBJECTIVES: National guidelines and the American Board of Internal Medicine have highlighted critical areas of women's health (WH) that are important to the training of Internal Medicine (IM) residents. Our objective was to assess and improve WH education in a large academic community-based IM residency program. METHODS: An anonymous online survey was sent to IM residents to assess their perceived comfort, knowledge, and importance, and exposure to 34 WH topics identified as critical to the training of an internist. To meet the critical learning needs of our residents, a new longitudinal WH curriculum was designed using active instructional methods. Retrospective pre-post surveys were conducted after interactive education workshops to measure their effectiveness. RESULTS: IM residents identified 13 of 34 WH topics that were critically important to their training. Of these, residents believed they had insufficient clinical exposure to prescribing contraceptives, evaluating breast symptoms, managing menopause, performing Papanicolaou tests and pelvic examinations, and polycystic ovary syndrome. Residents identified osteoporosis as their single greatest learning need. There was a strong and statistically significant correlation between residents' knowledge, comfort, and clinical exposure to WH topics. In response to these findings, the curricular methods we developed, such as problem-based learning workshops, multidisciplinary case conferences, and small-group case discussions, were found to be effective. CONCLUSIONS: Our study highlighted significant gaps in our WH curriculum. Based on our findings, we redesigned our educational and experiential WH curriculum to augment knowledge, comfort, perceived importance of, and exposure to areas of need. Enhancing education and increasing clinical exposure to fundamental WH issues will promote higher quality care for women patients.


Asunto(s)
Curriculum , Medicina Interna/educación , Internado y Residencia/métodos , Estudiantes de Medicina/psicología , Salud de la Mujer , Adulto , Competencia Clínica , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Aprendizaje Basado en Problemas , Encuestas y Cuestionarios
6.
South Med J ; 114(2): 111-115, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33537793

RESUMEN

OBJECTIVES: Physicians in training may be particularly vulnerable to the negative effects of discrimination and inappropriate behaviors by patients. We sought to determine the frequency of inappropriate behaviors by patients toward Internal Medicine (IM) residents, residents' confidence to manage the behaviors, and differences among demographic characteristics, including race, sex, and level of clinical experience. METHODS: We developed a curricular session to equip IM residents and faculty to respond to discrimination or inappropriate behaviors by patients. Before the session, we surveyed residents about their experiences with macroaggressions, microaggressions, and other inappropriate behaviors using a 16-question survey instrument. We used descriptive statistics to summarize the participants' characteristics and the χ2 or Fisher exact test for comparison between groups. RESULTS: Eighty-two percent (27 of 33) of residents who attended the workshop completed the survey. We found that the majority of residents experienced patient macro- and microaggressions. More than 50% had a personal experience or witnessed experience with a macroaggression related to race (56%) or gender (59%). Seventy percent of residents personally experienced a microaggression by a patient. Women and residents of color are more likely to experience these types of encounters, which become more common in residents with higher postgraduate year level. Confidence in how to appropriately respond to such encounters is low. CONCLUSIONS: Our study highlights that macro- and microaggressions by patients toward IM residents are common. Curricula are needed to equip trainees with tools to appropriately respond during such encounters.


Asunto(s)
Curriculum , Medicina Interna/educación , Internado y Residencia/métodos , Cuerpo Médico de Hospitales/educación , Relaciones Médico-Paciente , Adulto , Agresión , Femenino , Acoso no Sexual , Humanos , Masculino , Cuerpo Médico de Hospitales/psicología , Pacientes/psicología , Discriminación Social
7.
Medicine (Baltimore) ; 100(5): e23680, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592827

RESUMEN

BACKGROUND: Healthcare professionals have negative implicit biases toward minority and poor patients. Few communication skills interventions target implicit bias as a factor contributing to disparities in health outcomes. We report the protocol from the COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP), a trial evaluating a novel educational and training intervention targeting graduate medical and nursing trainees that is designed to mitigate the effects of implicit bias in clinical encounters. The CONSULT-BP intervention combines knowledge acquisition, bias awareness, and practice of bias mitigating skills in simulation-based communication encounters with racially/ethnically diverse standardized patients. The trial evaluates the effect of this 3-part program on patient BP outcomes, self-reported patient medication adherence, patient-reported quality of provider communication, and trainee bias awareness. METHODS: We are conducting a cluster randomized trial of the intervention among cohorts of internal medicine (IM), family medicine (FM), and nurse practitioner (NP) trainees at a single academic medical center. We are enrolling entire specialty cohorts of IM, FM, and NP trainees over a 3-year period, with each academic year constituting an intervention cycle. There are 3 cycles of implementation corresponding to 3 sequential academic years. Within each academic year, we randomize training times to 1 of 5 start dates using a stepped wedge design. The stepped wedge design compares outcomes within training clusters before and after the intervention, as well as across exposed and unexposed clusters. Primary outcome of blood pressure control is measured at the patient-level for patients clustered within trainees. Eligible patients for outcomes analysis are: English-speaking; non-White racial/ethnic minority; Medicaid recipient (regardless of race/ethnicity); hypertension; not have pregnancy, dementia, schizophrenia, bipolar illness, or other serious comorbidities that would interfere with hypertension self-control; not enrolled in hospice. Secondary outcomes include trainee bias awareness. A unique feature of this trial is the engagement of academic and community stakeholders to design, pilot test and implement a training program addressing healthcare. DISCUSSION: Equipping clinicians with skills to mitigate implicit bias in clinical encounters is crucial to addressing persistent disparities in healthcare outcomes. Our novel, integrated approach may improve patient outcomes. TRIAL REGISTRATION: NCT03375918. PROTOCOL VERSION: 1.0 (November 10, 2020).


Asunto(s)
Educación de Postgrado en Medicina/organización & administración , Educación en Enfermería/organización & administración , Hipertensión/etnología , Grupos Minoritarios , Enfermeras Practicantes , Simulación de Paciente , Presión Sanguínea , Competencia Cultural , Medicina General/educación , Conocimientos, Actitudes y Práctica en Salud , Humanos , Medicina Interna/educación , Medicaid , Enfermeras Practicantes/educación , Estados Unidos
10.
Med Educ Online ; 26(1): 1847755, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33222656

RESUMEN

Background: The opioid epidemic is a growing problem in the USA. Use of medication-assisted treatment (MAT) has been effective in treating patients with opioid use disorders (OUD) and maintaining sobriety; however, there is a significant shortage of physicians formally trained in MAT. Objective: Wayne State University School of Medicine integrated the 8-hour MAT waiver training into its Internal Medicine clerkship curriculum. The objectives of integrating this into the curriculum were to (1) introduce opioid use education during students' Internal Medicine clerkship and (2) assess whether the curriculum prepares students to feel more comfortable evaluating and treating patients with OUD. Design: MAT training specifically for medical students was provided free online by the Providers Clinical Support System (PCSS). All students on the Internal Medicine clerkship were required to complete the training. A 7-question pre-survey and post-survey assessed students' comfort in evaluating and treating OUD. Significant changes were assessed with a paired McNemar Bowker Test. Results: Medical students (n = 141) completed the pre-survey and post-survey. After the MAT training, students' perspective of their clinical knowledge about OUD, familiarity with MAT, and likelihood to utilize MAT for their patients significantly differed, with increased proportions of medical students in agreement across 6 of 7 pre-post survey items (p <.0001). Conclusions: Online MAT waiver training is a low-cost (free) way to introduce MAT education into the undergraduate clinical curriculum. Upon completing of the training, medical students self-reported improvements in their knowledge and attitudes about OUD and the different treatment options. Our hope is that MAT waiver training will allow for graduation of medical students who are ready to care for patients with OUD during residency and as practitioners upon completion of their residency.


Asunto(s)
Prácticas Clínicas/organización & administración , Medicina Interna/educación , Tratamiento de Sustitución de Opiáceos/métodos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Adulto , Curriculum , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Adulto Joven
11.
GMS J Med Educ ; 37(7): Doc84, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33364363

RESUMEN

Objective: The contact restrictions caused by the Covid-19 pandemic fundamentally limit patient-centered teaching. To realize a patient-oriented education in the block training "Internal Medicine" at the University Hospital Halle (Saale) despite the challenges, the already established teaching module "Interprofessional Teleconsultation" was adapted. The short article outlines the interprofessional teaching module including first evaluation results and describes the adapted block training. Method: In the "Internal Medicine" block training, students in a lecture hall navigated a telepresence system, which was accompanied by a physician across the ward and conducted an anamnesis via video and audio transmission without actual patient contact. Results: Students, physicians, and patients were open-minded about this form of communication during the Covid-19 pandemic and quickly got accustomed to the use of the telepresence system. To be able to react to technical challenges (e.g. unstable connection between the communication partners), a careful preparation of the lecturers is necessary. Conclusion: In using a telepresence system, patient-oriented teaching of students in the block training "Internal Medicine" can be ensured with low-threshold technical effort during the Covid-19 pandemic. The telepresence system allows for the involvement of patients into teaching while adhering to the necessary hygiene measures. Despite technical challenges, the teaching format based on telepresence is suitable as an alternative to face-to-face teaching if actual patient contact is not possible.


Asunto(s)
/epidemiología , Educación a Distancia/organización & administración , Educación Médica/organización & administración , Medicina Interna/educación , Telemedicina/organización & administración , Comunicación , Humanos , Educación Interprofesional/organización & administración , Pandemias
12.
Rev. cuba. med ; 59(4): e1398, oct.-dic. 2020. tab
Artículo en Español | LILACS, CUMED | ID: biblio-1144503

RESUMEN

Introducción: La evaluación de graduación constituye el examen de culminación de los estudios de la especialización, correspondiente a la enseñanza de posgrado. Objetivo: Proponer y fundamentar la realización de modificaciones en la evaluación de graduación de la especialidad Medicina Interna, en nuestro contexto. Método: Investigación sustentada en el análisis de documentos metodológicos y en una reflexión crítica de la praxis, para la construcción teórica de la propuesta de modificaciones. Resultados: A partir de la identificación de puntos de mejoría y guiados por una serie de principios, se proponen los siguientes cambios: 1) readecuación en la secuencia de los ejercicios teóricos y prácticos que conforman el examen estatal, 2) mayor peso de las actividades prácticas en la evaluación, tanto por aumento del número de actividades como por el tiempo destinado a las ejecuciones, 3) representación más amplia de la diversidad de habilidades y competencias objetivo de aprendizaje en la residencia, y 4) una mirada más exigente y valorizada de las competencias investigativas en general, y del trabajo de terminación de la especialidad en particular. Conclusiones: Mediante los cambios que se proponen se logra una certificación más real y objetiva de las competencias profesionales de los educandos para el cumplimiento del encargo social, y contribuye al mejoramiento de la calidad del profesional egresado, al estimular un proceso formativo dirigido a garantizar la aplicación de los conocimientos(AU)


Introduction: The graduation evaluation constitute the final assessment of the specializing studies, corresponding to postgraduate education. Objective: To propose and to substantiate the conduction of modifications in the graduation evaluation of Internal Medicine specialty, in our context. Method: A research based on the analysis of methodological documents and on praxis critical reflection was carried out for the theoretical construction of the proposed modifications. Results: From the identification of çimprovement points and guided by a series of principles, the following changes are proposed: 1) Readjusting the sequence of theoretical and practical exercises that make up the state exams, 2) Providing greater importance of practical activities in the assessment, both due to the increase in the number of activities and the time allocated to performing, 3) Bringing broader representation of the diversity of skills and competencies which are learning objective in the residence, and 4) Demanding and measuring more the research competences in general, and of the completion paper of the specialty in particular. Conclusions: These proposed changes result in more real and objective certification of the professional competences of the students for achieving the fulfillment of the social mandate. These changes improve the quality of the professional, by stimulating a training process aimed at guaranteeing the application of knowledge(AU)


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Especialización/normas , Medicina Interna/educación , Competencia Profesional , Evaluación Educacional/métodos
15.
PLoS One ; 15(8): e0236952, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32780751

RESUMEN

Rotation schedules for residents must balance individual preferences, compliance with Accreditation Council for Graduate Medical Education guidelines, and institutional staffing requirements. Automation has the potential to improve the consistency and quality of schedules. We designed a novel rotation scheduling tool, the Automated Internal Medicine Scheduler (AIMS), and evaluated schedule quality and resident satisfaction and perceptions of fairness after implementation. We compared schedule uniformity, fulfillment of resident preferences, and conflicting shift assignments for the hand-made 2017-2018 schedule, and the AIMS-generated 2018-2019 schedule. Residents were surveyed in September 2018 to assess perception of schedule quality and fairness. With AIMS, 71/74 (96.0%) interns and 66/82 (80.5%) residents were assigned to their first-choice rotation, a significant increase from the 50/72 (69.4%) interns and 25/82 (30.5%) residents assigned their first-choice in the 2017-2018 academic year. AIMS also yielded significant improvements in the number of night shift/day shift conflicts at the time of rotation switches for interns, with a significant decrease to 0.3 conflicts per intern compared to 0.7 with the prior manual schedule. Twenty-two of 82 residents (27%) completed the survey, and average satisfaction and perception of fairness were 0.7 and 0.9 points higher on a 5-point Likert scale for the AIMS-generated schedule when compared to the non-AIMS schedule. There was no significant difference in the preference for assigned vacation blocks, or in variance for night or ICU rotations. Automated scheduling improved several metrics of schedule quality, as well as resident satisfaction. Future directions include evaluation of the tool in other residency programs and comparison with alternative scheduling algorithms.


Asunto(s)
Medicina Interna/educación , Internado y Residencia , Admisión y Programación de Personal , Automatización , Connecticut , Femenino , Humanos , Satisfacción en el Trabajo , Masculino , Admisión y Programación de Personal/normas , Admisión y Programación de Personal/estadística & datos numéricos , Horario de Trabajo por Turnos/normas , Horario de Trabajo por Turnos/estadística & datos numéricos , Programas Informáticos , Encuestas y Cuestionarios , Estados Unidos , Tolerancia al Trabajo Programado
16.
J Med Life ; 13(2): 183-186, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32742511

RESUMEN

Clinical reasoning is the cornerstone of medical practice, and achieving this competence depends on a large number of factors. Internal medicine departments provide junior doctors with plentiful and varied patients, offering a comprehensive basis for learning clinical reasoning. In order to evaluate the usefulness of an early rotation at internal medicine departments, we compared, via script concordance tests, the evolution of residents' clinical reasoning after an initial internal medicine rotation compared to rotations through other medical specialties. Twenty-two residents were tested after six months of their internal medicine rotation and compared to twenty-five residents that had the first rotation in another specialty (control). We showed a significant difference in the improvement of the script concordance tests scores (p=0.015) between the beginning and the end of their first rotation between the internal medicine and the control groups, and this implies the lower improvement of clinical reasoning skills and spontaneous learning slope of the junior doctors in other departments.


Asunto(s)
Medicina Interna/educación , Internado y Residencia , Aprendizaje , Competencia Clínica , Evaluación Educacional , Humanos
17.
Am J Med Sci ; 360(4): 357-362, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32631577

RESUMEN

BACKGROUND: The association between grit, defined as perseverance and passion for long-term goals, and professional burnout has not been studied in internal medicine residents. Our objective was to examine whether internal medicine residents' scores on a grit scale were associated with various measures of burnout. METHODS: All residents from a single internal medicine program were invited to participate in a study of grit and burnout. Grit and burnout were measured using the Short Grit Scale and modified Maslach Burnout Inventory, respectively. In addition, demographics, last In-Training Examination (ITE) score, and interest in a subspecialty were captured. RESULTS: A total of 139 of 168 eligible residents (83%) participated. Emotional exhaustion and depersonalization (i.e., burn out) were identified in 63% and 42% of residents, respectively. Endorsement of emotional exhaustion was higher for residents living with family members, postgraduate year (PGY)1 and PGY2 compared with PGY3 residents, and residents scoring above the 50th percentile on the last ITE. Grit scores were higher for residents not reporting emotional exhaustion. As grit score increases, the odds of reporting emotional exhaustion significantly decreased, after adjustments for demographics, ITE scores, type of medical school, PGY level, and interest in a subspecialty (odds ratio = 0.36, 95% CI 0.15-0.84). CONCLUSIONS: Grit appeared to be an independent predictor of burnout in internal medicine residents in this sample, with lower grit scores associated with higher burnout scores. By measuring grit early in residency, programs can potentially identify residents at risk for symptoms of burnout, specifically emotional exhaustion, and implement targeted interventions.


Asunto(s)
Agotamiento Profesional/psicología , Medicina Interna/educación , Internado y Residencia/organización & administración , Satisfacción en el Trabajo , Estrés Psicológico , Estudiantes de Medicina/psicología , Estudios de Cohortes , Humanos , Encuestas y Cuestionarios
18.
Nutr Metab Cardiovasc Dis ; 30(9): 1520-1524, 2020 08 28.
Artículo en Inglés | MEDLINE | ID: mdl-32665208

RESUMEN

BACKGROUND AND AIMS: Despite evidence that pregnancy planning improves outcomes, in Italy, as in many other countries worldwide, <50% of women with diabetes prepare their pregnancy. The aim of this study was to document training and knowledge on diabetes and pregnancy (D&P) among diabetes professionals. METHODS AND RESULTS: We administered an anonymous online questionnaire, focused on diabetes and pregnancy planning, to diabetes team members. Between Nov-2017 and Jul-2018, n = 395 professionals (60% diabetes/endocrinology/internal medicine specialists, 28% fellows) completed the survey. Fifty-nine percent of the specialists, mainly (78%) those completing their fellowship after 2006, reported having received training on D&P during fellowship. Considering specialists reporting training, 43% correctly identified fetal risks of inadequate preconceptional glucose control and 55% maternal risks, 38% identified risks associated with overweight/obesity, and 39% would prescribe hormonal contraception to women with diabetes only if glucose control is good. CONCLUSIONS: The results of our survey suggest the need to improve training and awareness of professionals in the area of diabetes and pregnancy.


Asunto(s)
Endocrinólogos/psicología , Conocimientos, Actitudes y Práctica en Salud , Medicina Interna , Complicaciones del Embarazo/prevención & control , Embarazo en Diabéticas/terapia , Adulto , Anticoncepción , Educación de Postgrado en Medicina , Endocrinólogos/educación , Servicios de Planificación Familiar , Becas , Femenino , Humanos , Medicina Interna/educación , Internado y Residencia , Masculino , Salud Materna , Persona de Mediana Edad , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/fisiopatología , Resultado del Embarazo , Embarazo en Diabéticas/diagnóstico , Embarazo en Diabéticas/fisiopatología , Embarazo no Planeado , Medición de Riesgo , Factores de Riesgo , Especialización , Encuestas y Cuestionarios
20.
Am J Med Sci ; 360(4): 342-347, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32553748

RESUMEN

BACKGROUND: The academic half day (AHD) has emerged in recent years as an alternative to the traditional noon conference model of didactic teaching in graduate medical education. However, the effects of this change on learners are not fully understood. This study aimed to assess the effects of the AHD on attendance, satisfaction, perceived value and wellness of resident physicians. METHODS: A survey aimed to assess housestaff satisfaction, perceived value and relevance to medical literature of the core educational curriculum was developed and validated. This, along with a wellness assessment survey, was distributed to residents electronically prior to the implementation of the AHD and again at the end of the academic year. Attendance was tracked for all conferences. RESULTS: The survey was administered to residents before and after implementation of the AHD (response rates were 100% and 83%, respectively at these time points [n = 95]). Implementation of the AHD lead to a significant increase in average time spent in the core conference series per week (29.7 versus 64.8 minutes). It additionally led to a statistically significant improvement of resident satisfaction with the core curriculum, perceived value of the core conference series, understanding of medical literature and promotion of reading outside of work. CONCLUSIONS: The AHD significantly improved resident time in conference, resident satisfaction and perceived educational value of the core conference series compared to a noon conference model. While challenges will exist with any educational conference model, the AHD appears to be a highly attractive approach to medical resident education.


Asunto(s)
Curriculum , Medicina Interna/educación , Internado y Residencia/organización & administración , Satisfacción Personal , Carga de Trabajo , Adulto , Humanos , Admisión y Programación de Personal , Evaluación de Programas y Proyectos de Salud , Encuestas y Cuestionarios , Factores de Tiempo
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