Improved dental student clinical skills performance through an integrated dental and medical student curriculum.

PURPOSE/OBJECTIVES: In light of a movement to eliminate the historical separation of dentistry and medicine to produce more collaborative and knowledgeable clinicians and to improve care, integrated education models are vital. This study aimed to demonstrate the effectiveness of an integrated medical and dental student curriculum at the University of Connecticut. It was hypothesized that a medical and dental student doctoring course within an already combined biomedical curriculum would result in statistically significantly increases in dental student clinical skills performance. METHODS: Analysis of variance (ANOVA) was utilized for an overall test of scores from 2016 to 2019. When ANOVA indicated significant differences, post hoc pairwise comparisons using Tukey's adjustment classified pairs that differed significantly. Lastly, a contrast was constructed to test the difference before and after the course's introduction. A two-sided α of 0.05 was used. RESULTS: Dental students were assessed on three cases for history taking and master interview rating scale (MIRS) criteria. The mean averages in history taking and MIRS criteria after the implementation of this course increased by 7.81 (SE = 1.83, p < 0.0001) and 11.95 (SE = 1.34, p < 0.0001) for a toothache case, 11.37 (SE = 1.98, p < 0.0001) and 9.84 (SE = 1.35, p < 0.0001) for a loose bridge case, and 12.47 (SE = 1.75, p < 0.0001) and 10.07 (SE = 1.28, p < 0.0001) for a sensitive tooth case. CONCLUSION: An integrated doctoring course within a combined curriculum at the University of Connecticut Schools of Medicine and Dental Medicine resulted in a statistically significant increase in dental student clinical skills assessment scores, demonstrating this model's utility.

An Interprofessional Approach to Teaching Nutrition Counseling to Medical Students.

Introduction: Many physicians do not feel competent providing nutritional counseling to patients. A minimum of 25 hours dedicated to nutrition is recommended in preclinical years, but only 40% of U.S. medical schools achieve this goal. Nutrition counseling is best done when physicians work collaboratively with registered dietitians (RDs). We sought to introduce this interprofessional approach in our preclinical curriculum. Methods: In our first-year doctoring course, students viewed a nutrition lecture from a physician and RD. Teams of two to three medical students and one dietetics student were formed. The medical students took a history and performed nutrition counseling on the dietetics student role-playing a patient. The RD student provided feedback and reviewed clinical questions pertaining to the nutrition case. Medical students presented answers to their assigned case to the whole group. Medical students completed pre-/postsurveys assessing satisfaction and perceived confidence with nutrition counseling and were formally assessed using a standardized patient. The scores were compared to students from the year before who received the lecture but not the RD student activity. Results: Eighty-one medical students participated. After the activity, there was an increase in confidence with nutrition counseling (p < .001), and 74% found working with dietetics students to be helpful or extremely helpful. The nutrition counseling mean score increased from 68% (historical control, n = 76) to 84% (n = 75; p < .001) on the standardized patient assessment. Discussion: This format is an effective method of teaching nutrition counseling and promoting interprofessional behavior among rising physicians and RDs.

Separating Residents' Inpatient and Outpatient Responsibilities: Improving Patient Safety, Learning Environments, and Relationships With Continuity Patients.

PROBLEM: Current regulations for internal medicine residency programs require scheduling that minimizes conflict between inpatient and outpatient responsibilities. To meet these regulations, the internal medicine residency program at Beth Israel Deaconess Medical Center implemented a unique scheduling model--the Alternating Call and Elective Scheduling (ACES) model-in July 2009. APPROACH: Beginning in academic year 2009-2010, the authors restructured schedules for their 95 postgraduate year 2 and 3 internal medicine residents using the ACES model. They report pre- and postimplementation housestaff responses from end-of-year program evaluation and culture-of-safety surveys, as well as residents' pre- and postintervention schedule and patient visit data. OUTCOMES: Prior to the intervention, 13/83 (16%) residents agreed that the structure of residency training minimized conflict between inpatient and outpatient responsibilities; after the intervention, 82/84 (98%) agreed with this statement. Before the intervention, 23/83 (28%) residents felt that the schedule promoted inpatient safety, compared with 83/84 (99%) after the intervention. Agreement that the schedule promoted outpatient safety went from 28/83 (34%) preintervention to 73/84 (87%) postintervention. Before the intervention, 45/84 (54%) residents felt that the schedule promoted a continuous healing relationship with continuity patients, compared with 67/84 (80%) after the intervention. After implementation, residents' continuity visits with their own patients increased by 14%, and total annual patient visits increased by 16%. NEXT STEPS: Separating residents' inpatient and outpatient responsibilities may improve patient safety, the learning environment, and resident-patient relationships. Future innovations might focus on improving patient safety and decreasing stress in the outpatient environment.

The revolving door of resident continuity practice: identifying gaps in transitions of care.

BACKGROUND: It is well documented that transitions of care pose a risk to patient safety. Every year, graduating residents transfer their patient panels to incoming interns, yet in our practice we consistently find that approximately 50% of patients do not return for follow-up care within a year of their resident leaving. OBJECTIVE: To examine the implications of this lapse of care with respect to chronic disease management, follow-up of abnormal test results, and adherence with routine health care maintenance. DESIGN: Retrospective chart review SUBJECTS: We studied a subset of patients cared for by 46 senior internal medicine residents who graduated in the spring of 2008. 300 patients had been identified as high priority requiring follow-up within a year. We examined the records of the 130 of these patients who did not return for care. MAIN MEASURES: We tabulated unaddressed abnormal test results, missed health care screening opportunities and unmonitored chronic medical conditions. We also attempted to call these patients to identify barriers to follow-up. KEY RESULTS: These patients had a total of 185 chronic medical conditions. They missed a total of 106 screening opportunities including mammogram (24), Pap smear (60) and colon cancer screening (22). Thirty-two abnormal pathology, imaging and laboratory test results were not followed-up as the graduating senior intended. Among a small sample of patients who were reached by phone, barriers to follow-up included a lack of knowledge about the need to see a physician, distance between home and our office, difficulties with insurance, and transportation. CONCLUSIONS: This study demonstrates the high-risk nature of patient handoffs in the ambulatory setting when residents graduate. We discuss changes that might improve the panel transfer process.