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1.
J Gen Intern Med ; 2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-34729698

RESUMO

BACKGROUND: Training future clinicians in safe opioid prescribing (SOP) and treatment of opioid use disorder (OUD) is critical to address the opioid epidemic. The Accreditation Council on Graduate Medical Education requires all programs to provide instruction and experience in pain management and will mandate addiction medicine clinical experiences for internal medicine trainees. OBJECTIVE: Assess residents' training in SOP and treatment of OUD and identify training barriers. DESIGN: Cross-sectional nationally representative survey was emailed in 2019. PARTICIPANTS: Four hundred twenty-two Association of Program Directors in Internal Medicine members in US internal medicine residency programs. MAIN MEASURES: Program opportunities and challenges to developing or implementing training in SOP, treatment of OUD, and buprenorphine waiver training, and perceived curricular effectiveness. KEY RESULTS: The response rate was 69.4% (293/422). Most programs required didactics in SOP (94.2%) and treatment of OUD (71.7%). Few programs required clinical experiences including addiction medicine clinics (28/240, 11.7%), inpatient consult services (11/240, 4.6%), or offsite treatment rotations (8/240, 3.3%). Lack of trained faculty limited developing or implementing curricula (61.5%). Few respondents reported that their program was "very effective" in teaching SOP (80/285, 28.1%) or treatment of OUD (43/282, 15.3%). Some programs offered buprenorphine waiver training to residents (83/286, 29.0%) and faculty (94/286, 32.9%) with few mandating training (11.7% (28/240) and 5.4% (13/240) respectively). Only 60 of 19,466 (0.3%) residents completed buprenorphine waiver training. Primary care programs/tracks were more likely to offer waiver training to residents (odds ratio [OR], 3.07; 95% CI, 1.68-5.60; P < 0.001) and faculty (OR, 1.08; 95% CI, 1.01-3.22; P = 0.05). CONCLUSIONS: In this nationally representative survey, few internal medicine residency programs provided clinical training in SOP and treatment of OUD, and training was not viewed as very effective. Lack of effective training may have adverse implications for patients, clinicians, and society.

4.
MedEdPORTAL ; 17: 11187, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34651070

RESUMO

Introduction: Clinician-educators often need to produce scholarship for academic promotion. While some programs exist to help with faculty development skills, few provide adequate statistical training to help educators evaluate their work. Methods: From January 2020 through January 2021, faculty at three academic centers attended one of five in-person or virtual seminars with dedicated statistical training for medical education interventions. These 90-minute seminars included a 45-minute PowerPoint presentation of common statistical tests used for educational interventions followed by small breakout groups to help attendees work on additional practice examples. After each seminar, surveys were distributed in person or virtually to obtain feedback. Results: Forty-three faculty attended the five seminars, with a range of surgical and nonsurgical specialties represented. Of these attendees, 38 (88%) completed session evaluations. The majority of respondents (n = 34, 90%) rated the session as extremely useful in helping them know how to use statistics in their scholarly work. Most participants agreed or strongly agreed they had adequate time to practice skills (n = 30, 79%). Self-rated confidence in using statistics was significantly higher after the session compared to before (3.00 post vs. 1.97 pre, p < .0001). Most participants (n = 32, 84%) rated the session as excellent and the small-group practice as most useful (n = 16, 42%), but many (n = 26, 69%) wanted more skills practice. Discussion: This intervention shows that dedicated training on biostatistics used in educational interventions can help clinician-educators improve self-rated confidence and knowledge in choosing statistical tests in educational scholarship.


Assuntos
Educação Médica , Currículo , Docentes , Bolsas de Estudo , Humanos , Desenvolvimento de Pessoal
5.
Yale J Biol Med ; 93(3): 403-410, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32874145

RESUMO

Background: Competency-based assessment is an important but challenging aspect of residency education but determines trainees' progression towards the ultimate goal of graduation. Entrustment decision making has been proposed as a supplementary metric to assess trainee competence. This study explores the process by which Program Directors (PDs) make entrustment decisions in Internal Medicine (IM) training programs. Study Design: Purposive sampling was used to recruit PDs from ACGME-accredited IM training programs to participate in a semi-structured interview. We analyzed interviews using an iterative, grounded theory-based approach to allow identification of themes that define the process of trainee entrustment. Results: Sixteen PDs were interviewed. Qualitative analysis showed that PDs use a dynamic process to understand trainee entrustability and progression towards competence, including construction of assessment networks, comparing performance to expected trajectory of trainee competence development, and bidirectional filtering and weighing of assessment data. Conclusions: PDs serve as a central processor by which assessment data on trainees is filtered, weighted, and compared an expected trajectory, all to gain understanding of trainee performance. Assessment networks are crucial to understanding trainee competence. While expected trajectory is an important tool to determine how trainees are progressing, its continued use may inject bias into the assessment process and slow transition to true competency-based assessment.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Medicina , Medicina Interna/educação , Internato e Residência , Adulto , Tomada de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Confiança
8.
J Gen Intern Med ; 34(7): 1348-1351, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30993631

RESUMO

Disseminating scholarly work as a clinician educator is critical to furthering new knowledge in medical education, creating an evidence base for new practices, and increasing the likelihood of promotion. Knowing how to initiate scholarship and develop habits to support it, however, may not be clear. This perspective is designed to help readers choose and narrow their focus of scholarly interest, garner mentors, find potential project funding, and identify outside support through involvement with national organizations, collaborators, and faculty development programs. By incorporating these suggestions into their daily work, educators can find ways to connect their clinical and educational interests and make their daily work count toward scholarship.


Assuntos
Educação Médica/normas , Docentes de Medicina/normas , Bolsas de Estudo/normas , Faculdades de Medicina/normas , Desenvolvimento de Pessoal/normas , Educação Médica/métodos , Bolsas de Estudo/métodos , Humanos , Desenvolvimento de Pessoal/métodos
12.
J Gen Intern Med ; 32(8): 948-952, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28409434

RESUMO

BACKGROUND: Demand for faculty with teaching expertise is increasing as medical education is becoming well established as a career pathway. Junior faculty may be expected to take on teaching responsibilities with minimal training in teaching skills. AIM: To address the faculty development needs of junior clinician-educators with teaching responsibilities and those changing their career focus to include teaching. SETTING: Sessions at two Society of General Internal Medicine (SGIM) annual meetings combined with local coaching and online learning during the intervening year. PARTICIPANTS: Eighty-nine faculty scholars in four consecutive annual cohorts from 2013 to 2016. PROGRAM DESCRIPTION: Scholars participate in a full-day core teaching course as well as selective workshops at the annual meetings. Between meetings they receive direct observation and feedback on their teaching from a local coach and participate in an online discussion group. PROGRAM EVALUATION: Sessions were evaluated using a post-session survey. Overall content rating was 4.48 (out of 5). Eighty-nine percent of participants completed all requirements. Of these, 100% agreed that they had gained valuable knowledge and skills. DISCUSSION: The TEACH certificate program provides inexperienced faculty teachers an opportunity to develop core skills. Satisfaction is high. Future research should focus on the impact that this and similar programs have on teaching skills.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Educação Médica/organização & administração , Docentes de Medicina/educação , Medicina Interna/educação , Avaliação de Programas e Projetos de Saúde/métodos , Ensino/organização & administração , Adulto , Feminino , Humanos , Masculino , Faculdades de Medicina , Estados Unidos , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-26201403

RESUMO

PURPOSE: This study aimed to determine the correlation of burnout syndrome with specific coping strategies, behaviors, and spiritual attitudes among interns in internal medicine, primary care, and internal medicine/pediatrics residency programs at two institutions. METHODS: Intern physicians completed anonymous voluntary surveys prior to starting the internship in June 2009 and in the middle of the internship in February 2010. Three validated survey instruments were used to explore burnout, coping, and spiritual attitudes: the Maslach Burnout Inventory, the COPE Inventory, and the Hatch Spiritual Involvement and Beliefs Scale. The interns were in programs at the Yale University School of Medicine and a Yale-affiliated community hospital, New Haven, Connecticut, USA. RESULTS: The prevalence of self-identified burnout prior to starting the internship was 1/66 (1.5%) in June 2009, increasing to 10/53 (18.9%) in February 2010 (P<0.0001). From June 2009 to February 2010, the prevalence of high emotional exhaustion increased from 30/66 (45.5%) to 45/53 (84.9%) (P<0.0001), and that of high depersonalization increased from 42/66 (63.6%) to 45/53 (84.9%) (P=0.01). Interns who employed the strategies of acceptance and active coping were less likely to experience emotional exhaustion and depersonalization (P<0.05). Perceptions of high personal accomplishment was 75.5% and was positively correlated with total scores on the Hatch Spiritual Involvement and Beliefs Scale, as well as the internal/fluid and existential/meditative domains of that instrument. Specific behaviors did not impact burnout. CONCLUSION: Burnout increased during the intern year. Acceptance, active coping, and spirituality were correlated with less burnout. Specific behaviors were not correlated with burnout domains.

15.
J Healthc Qual ; 37(6): 363-73, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26042748

RESUMO

This study assesses whether geographic localization of housestaff patients contributes to improved patient knowledge of diagnosis, patient satisfaction, provider satisfaction, and workplace culture of safety. Due to national changes to graduate medical education, housestaff patients were localized to a single general medicine ward. Ninety-three patients prelocalization, 64 patients postlocalization, 26 localized physicians, and 10 localized nurses were surveyed. Validated questionnaires assessed patients' experiences during hospitalization, and physician and nurse job satisfaction. Fifty-seven percent of patients knew their diagnosis prior to localization, compared to 80% postlocalization (p < .0001). Prior to localization, 39% of patients who reported experiencing anxieties or fears during hospitalization felt physicians frequently discussed these emotions with them compared to 85% after localization (p < .0001). Before localization, 51% of patients stated that doctors spent 4 min or more daily with them discussing care, compared to 91% after localization (p < .0001). Both physician and nurse opinion significantly improved regarding some but not all aspects of collaboration, teamwork, patient safety, appropriate handling of errors, and culture of safety. The average length of stay was unchanged and the change in 30-day readmission rate was not statistically significant. Localization of patients to a single inpatient ward improved patient knowledge and satisfaction, and some aspects of interprofessional communication and workplace culture of safety.


Assuntos
Comunicação , Pacientes Internados/psicologia , Internato e Residência/organização & administração , Satisfação no Emprego , Recursos Humanos de Enfermagem no Hospital/psicologia , Segurança do Paciente , Satisfação do Paciente/estatística & dados numéricos , Médicos/psicologia , Adolescente , Adulto , Idoso , Connecticut , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
16.
J Gen Intern Med ; 29(8): 1166-76, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24733301

RESUMO

BACKGROUND: Patient activation interventions (PAIs) engage patients in care by promoting increased knowledge, confidence, and/or skills for disease self-management. However, little is known about the impact of these interventions on a wide range of outcomes for adults with type 2 diabetes (DM2), or which of these interventions, if any, have the greatest impact on glycemic control. METHODS: Electronic databases were searched from inception through November 2011. Of 16,290 citations, two independent reviewers identified 138 randomized trials comparing PAIs to usual care/control groups in adults with DM2 that reported intermediate or long-term outcomes or harms. For meta-analyses of continuous outcomes, we used a random-effects model to derive pooled weighted mean differences (WMD). For all-cause mortality, we calculated the pooled odds ratio (OR) using Peto's method. We assessed statistical heterogeneity using the I (2) statistic and conducted meta-regression using a random-effects model when I (2) > 50 %. A priori meta-regression primary variables included: intervention strategies, intervention leader, baseline outcome value, quality, and study duration. RESULTS: PAIs modestly reduced intermediate outcomes [A1c: WMD 0.37 %, CI 0.28-0.45 %, I (2) 83 %; SBP: WMD 2.2 mmHg, CI 1.0-3.5 mmHg, I (2) 72 %; body weight: WMD 2.3 lbs, CI 1.3-3.2 lbs, I (2) 64 %; and LDL-c: WMD 4.2 mg/dL, CI 1.5-6.9 mg/dL, I (2) 64 %]. The evidence was moderate for A1c, low/very low for other intermediate outcomes, low for long-term mortality and very low for complications. Interventions had no effect on hypoglycemia (evidence: low) or short-term mortality (evidence: moderate). Higher baseline A1c, pharmacist-led interventions, and longer follow-up were associated with larger A1c improvements. No intervention strategy outperformed any other in adjusted meta-regression. CONCLUSIONS: PAIs modestly improve A1c in adults with DM2 without increasing short-term mortality. These results support integration of these interventions into primary care for adults with uncontrolled glycemia, and provide evidence to insurers who do not yet cover these programs.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Intervenção Médica Precoce/métodos , Participação do Paciente/métodos , Segurança do Paciente , Autocuidado/métodos , Adulto , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Resultado do Tratamento
17.
J Grad Med Educ ; 5(2): 257-61, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24404269

RESUMO

BACKGROUND: Burnout in physicians is common, and studies show a prevalence of 30% to 78%. Identifying constructive coping strategies and personal characteristics that protect residents against burnout may be helpful for reducing errors and improving physician satisfaction. OBJECTIVE: We explored the complex relationships between burnout, behaviors, emotional coping, and spirituality among internal medicine and internal medicine-pediatrics residents. METHODS: We anonymously surveyed 173 internal medicine and medicine-pediatrics residents to explore burnout, coping, and spiritual attitudes. We used 3 validated survey instruments: the Maslach Burnout Inventory, the Carver Coping Orientation to Problems Experienced (COPE) Inventory, and the Hatch Spiritual Involvement and Beliefs Scale (SIBS). RESULTS: A total of 108 (63%) residents participated, with 31 (28%) reporting burnout. Residents who employed strategies of acceptance, active coping, and positive reframing had lower emotional exhaustion and depersonalization (all, P < .03). Residents who reported denial or disengagement had higher emotional exhaustion and depersonalization scores. Personal accomplishment was positively correlated with the SIBS total score (r  =  +.28, P  =  .003), as well as the internal/fluid domain (r  =  +.32, P  =  .001), existential axes (r  =  +.32, P  =  .001), and humility/personal application domain (r  =  +.23, P  =  .02). The humility/personal application domain also was negatively correlated with emotional exhaustion (r  =  -.20, P  =  .04) and depersonalization (r  =  -.25, P  =  .009). No activity or demographic factor affected any burnout domain. CONCLUSIONS: Burnout is a heterogeneous syndrome that affects many residents. We identified a range of emotional and spiritual coping strategies that may have protective benefit.

19.
J Interpers Violence ; 26(12): 2335-52, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21712340

RESUMO

Contradictory data exist regarding optimal methods and instruments for intimate partner violence (IPV) screening in primary care settings. The purpose of this study was to determine the optimal method and screening instrument for IPV among men and women in a primary-care resident clinic. We conducted a cross-sectional study at an urban, academic, internal medicine residency continuity clinic in Connecticut among English or Spanish speaking adult patients. One group of patients ( n = 340) received a self-administered questionnaire (SAQ) containing the partner violence screen (PVS) and the Hurt, Insulted, Threatened or Screamed at Questionnaire (HITS). A second group (n = 126) was screened with PVS and HITS by their primary care providers during face-to-face (FTF) clinical encounters. Multivariable logistic regression models were used to determine the association between IPV prevalence and screening method (SAQ or FTF) after adjusting for socio-demographic effects. The overall IPV prevalence was 17.3% using the SAQ and 9.0% with FTF screening (p = .008). Patients receiving the SAQ were more likely to report IPV than those who were screened FTF (adjusted odds ratio [AOR]: 2.6, 95% confidence interval [CI]: 1.2-5.6). This effect persisted for women, who had a higher odds of IPV when screened through a SAQ than when screened FTF (AOR: 3.5, 95% CI: 1.4-8.6). Men did not differ in reporting IPV between methods: 11% with SAQ versus 9.4% FTF (p = .69). In internal medicine residency continuity clinics, a SAQ for IPV may result in higher disclosure and completion rates among female patients compared to FTF screening. Unique screening instruments and methods may be needed for men.


Assuntos
Anamnese/métodos , Delitos Sexuais/estatística & dados numéricos , Inquéritos e Questionários , Violência/estatística & dados numéricos , Centros Médicos Acadêmicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Connecticut , Estudos Transversais , Feminino , Humanos , Medicina Interna , Internato e Residência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Testes Psicológicos , População Urbana , Adulto Jovem
20.
J Gen Intern Med ; 26(5): 524-30, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21222047

RESUMO

BACKGROUND: In the United States, 1 in 6 women report a lifetime prevalence of sexual assault. Few population-based studies have examined the association between sexual assault victimization on health care utilization and unhealthy behaviors. OBJECTIVE: To assess the relationship between experiencing sexual assault and health care utilization and unhealthy behaviors among a state-wide representative sample of Connecticut adults. DESIGN AND PARTICIPANTS: Cross-sectional study of 4183 Connecticut residents who responded to sexual assault questions in the 2005 telephone-based Connecticut State Behavioral Risk Factor Surveillance System (CT-BRFSS). MAIN MEASURES: Health care utilization and unhealthy behaviors among residents reporting sexual assault. RESULTS: Approximately one out of eleven Connecticut adults (9.4%) experienced sexual assault at some point in their life. Among adults aged 65 years and older, 4.3% reported sexual assault compared to 11.2% of adults aged 18-34 years, (p < 0.001). Among men, 3.7% reported sexual assault victimization versus 14.6% of women, (p < 0.001). After controlling for sociodemographic factors, victims of forced sexual assault were less likely to have seen a physician in the previous 12 months for a routine checkup (Odds ratio [OR]: 1.49, 95%: 1.07-2.07) and more likely to report being unable to see a doctor because of cost (OR: 2.72, 95% CI: 1.70-4.34). Victims were more likely to currently smoke (OR: 2.01, 95% CI: 1.34-3.00) and drink heavily (OR: 3.30, 95% CI: 2.01-5.42) than those reporting no sexual assault. CONCLUSIONS: For Connecticut adults, sexual assault victimization was associated with infrequent usage of some primary care health services and higher risks of unhealthy behaviors. Increased community-level interventions and public health outreach programs are needed to provide health-care services to this high-risk group.


Assuntos
Vítimas de Crime/psicologia , Comportamentos Relacionados com a Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Vigilância da População , Delitos Sexuais/psicologia , Adolescente , Adulto , Idoso , Connecticut/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Fatores de Risco , Comportamento Sexual/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/etiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto Jovem
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