The craft of writing: a physician-writer's workshop for resident physicians.

INTRODUCTION: How can residency programs help trainees address conflicting emotions about their professional roles and cultivate a curiosity about their patients' lives beyond their diseases? We drew on the medical humanities to address these challenges by creating an intensive writing workshop for internal medicine residents. AIM: To help participants become better physicians by reflecting on their experiences and on what gives meaning to work and life. This paper describes the workshop and how residents were affected by the focus on the craft of writing. SETTING: A group of 15 residents from 3 training programs affiliated with 1 institution. PROGRAM DESCRIPTION: We engaged the expertise of physician-writer Abraham Verghese in planning and facilitating the 2 and one-half day workshop. Residents' submissions were discussed with a focus on the effectiveness of the writing. We also conducted a focus group with participants to evaluate the workshop. PROGRAM EVALUATION: Themes in the writing included dysphoria, impotence of the physician, and the healing power of compassion. Our focus group data suggested that this workshop served as a creative outlet from the rigors of medicine, created a sense of community among participants, enhanced both self-awareness and awareness of their patients' lives, and increased intra-institutional and extra-institutional interest in writing and the residency program. DISCUSSION: Teaching creative writing to residents in an intensive workshop may deepen interactions with peers and patients, improve writing skills, and increase interest in writing and the residency program.

Preventing communication errors in telephone medicine.

Errors in telephone communication can result in outcomes ranging from inconvenience and anxiety to serious compromises in patient safety. Although 25% of interactions between physicians and patients take place on the telephone, little has been written about telephone communication and medical mishaps. Similarly, training in telephone medicine skills is limited; only 6% of residency programs teach any aspect of telephone medicine. Increasing familiarity with common telephone challenges with patients may help physicians decrease the likelihood of negative outcomes. We use case vignettes to highlight communication errors in common telephone scenarios. These scenarios include giving sensitive test results, requests for narcotics, managing ill patients who are not sick enough for the emergency room, dealing with late-night calls, communicating with unintelligible patients, and handling calls from family members. We provide management strategies to minimize the occurrence of these errors.

A novel program to increase the number of women patients seen by residents in a VA hospital.

A recent requirement from the Accreditation Council for Graduate Medical Education that internal medicine residents must provide care for a minimum of 25% of female patients in their longitudinal clinics has posed difficulties for Internal Medicine programs that utilize Department of Veterans Affairs (VA) hospitals for outpatient training. The authors report an innovative program developed at a Connecticut VA hospital for internal medicine residents at the Yale University School of Medicine. Residents participate in the clinic at the VA Women's Health Center every fourth week instead of attending their usual VA primary care clinic. To increase the numbers of patients being seen by residents, the "Sharing Program" was initiated in 2001 so that wives of veterans could be seen in the VA women's clinic. Sharing Program patients are billed for their care by the Yale University Medical Group and the VA is reimbursed by the University Medical Group for the cost of providing care to these patients. As a result of the Sharing Program, the mean proportion of female patients assigned to residents has reached 25%. Surveys showed high levels of patient and resident satisfaction, and that residents perceived an improvement in their education in the outpatient care of women.

Gender differences in the ability to identify a mentor at morning report: a multi-institutional survey.

BACKGROUND: Prior studies have shown that mentors are very important for career development of physicians, and that many female physicians have not had a mentor during their training. However, little is known about the availability of mentors for residents. PURPOSE: To identify resident and program characteristics that were associated with the ability to identify a potential mentor at resident morning report. METHOD: We performed a cross-sectional survey of 356 internal medicine residents at a convenience sample of 13 residency programs. The instrument included questions about demographic characteristics, subspecialty fellowship plans, and ability to identify a potential mentor at morning report during the previous 6 months. RESULTS: Seventy-three percent were able to identify a potential mentor at morning report within the previous 6 months (63% of women vs. 79% of men). Among residents planning on entering general internal medicine, women were less likely than men to be able to identify a potential mentor (55% vs. 77%). The likelihood of identifying a mentor varied between the different programs, with a range from 27% to 89%. CONCLUSION: Many residents could identify a potential mentor at morning report, although there was a wide variability between programs. Female residents who were going into general internal medicine were less likely than their male colleagues to find a potential mentor. Medical educators should ensure that all residents have exposure to potential generalist mentors.