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1.
Stud Health Technol Inform ; 264: 1121-1125, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438099

RESUMO

Increasing attention is paid to the Handoff Process and EHR- integrated tools to enhance the Handoff Process and aid in creating Handoff Notes are becoming more prevalent. In this study, we attempted to determine the ideal content of the Handoff Note based on the preferences of the resident physicians for whom the tool was being constructed. This commenced with an initial semi-structured interview and culminated in a large-scale survey. Overall, 315 resident physicians completed the survey. Plan of Care, Illness Severity, and Patient Summary were the most important content elements to resident physicians. The importance and trustworthiness of other content elements, as well as their preferred display and level of granularity within the Handoff Note, varied considerably. Subjective assessment by a colleague of a patient's hospital course and plan of care, rather than any single piece of objective data, are preferred as ideal content for Handoff Note composition by resident physicians.


Assuntos
Registros Eletrônicos de Saúde , Transferência da Responsabilidade pelo Paciente , Humanos , Internato e Residência
3.
Am Surg ; 85(7): 747-751, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405421

RESUMO

The ACGME work hour restrictions facilitated increased utilization of service-based advanced practice providers (APPs) to offset reduced general surgery resident work hours. Information regarding attending surgeon perceptions of APP impact is limited. The aim of this survey was to gauge these perceptions with respect to workload, length of stay (LOS), safety, best practice, level of function, and clinical judgment. Attending surgeons on surgical teams that employ service-based APPs at an urban tertiary referral center responded to a survey at the completion of academic year 2016. Perceptions regarding APP impact on workload, LOS, safety, best practice, level of function, and clinical judgment were examined. Twenty-two attending surgeons (40%) responded. Respondents agreed that APPs always/usually decrease their workload (77%), decrease LOS (64%), improve safety (68%), contribute to best practice (82%), and decrease near misses (71%). They also agreed that APPs decrease resident workload (87%), but fewer agreed that APPs contribute to resident education (68%). The majority perceived APPs function at the PGY1/2 (43%) or PGY3 (39%) level and always/usually trust their clinical judgment (72%), and felt there was variability in level of function among APPs (56%). This single-center study illustrates that attending surgeons perceive a positive impact on patient care by service-based APPs.


Assuntos
Atitude do Pessoal de Saúde , Internato e Residência , Admissão e Escalonamento de Pessoal/organização & administração , Adulto , Feminino , Cirurgia Geral/educação , Pesquisas sobre Serviços de Saúde , Humanos , Tempo de Internação , Masculino , Profissionais de Enfermagem , Segurança do Paciente/normas , Qualidade da Assistência à Saúde , Carga de Trabalho
4.
Am Surg ; 85(7): 761-763, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405424

RESUMO

The operative experience of present-day surgical residency training has evolved as a result of the contributions of laparoscopic surgery. Some traditional open procedures are now more descriptive and less of a familiarity to many general surgery residents (GSRs). The aim of this study was to investigate how open operative experience compares with laparoscopy for GSRs. A retrospective, multicenter, consecutive cohort study of all patients undergoing surgical intervention involving the appendix and gallbladder identified from the ACS-NSQIP database over a 2.5-year period. All GSR postgraduate year-level operative experience was recorded. Of 777 procedures, 13 laparoscopic appendectomy conversions to open (4.3%) by Rocky-Davis (15%) or lower midline (84.6%) incisions were performed versus 285 that remained laparoscopic (95.6%). Fifty (10.4%) open cholecystectomies (38 open + 10 conversions + 2 common bile duct (CBD) exploration), 27 (5.6%) laparoscopic cholecystectomies with cholangiogram, and 402 (83.9%) laparoscopic cholecystectomies were performed. Twenty-nine different GSRs participated in procedures. Eighty-five (10.9%) operations were performed with multi-postgraduate year levels. Surgical residents have an unequal operative experience for case-specific open procedures. A competency-based system to demonstrate a resident's hands-on surgical skills is fundamental to residency training and should be considered for specific types of low-volume open surgical cases.


Assuntos
Apendicectomia/métodos , Colecistectomia Laparoscópica/estatística & dados numéricos , Colecistectomia/métodos , Laparoscopia/educação , Colecistectomia Laparoscópica/educação , Competência Clínica , Humanos , Internato e Residência/estatística & dados numéricos , Estudos Retrospectivos
6.
Nurs Educ Perspect ; 40(5): 306-308, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31436695

RESUMO

Global experiential learning using clinical internships and microsemesters is expanding in nursing as an alternative to full-semester study abroad. When incorporated into the curriculum, students have a broader perspective on global health care issues. For example, students learn historic and cultural concepts that are uniquely Australian while studying diversity in a condensed two-week microsemester. We describe the development and incorporation of global internships and alternative global experiences for undergraduate nursing students.


Assuntos
Educação em Enfermagem/organização & administração , Saúde Global/educação , Intercâmbio Educacional Internacional , Estudantes de Enfermagem/psicologia , Austrália , Currículo , Humanos , Internato e Residência , Inovação Organizacional
7.
9.
J Dent Educ ; 83(8): 865-877, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31371427

RESUMO

With increasing recognition of the important relationship between oral and systemic health, non-dental health professions schools and programs are now teaching their students about oral health in various ways. This study built on surveys of medical schools, primary care residency and fellowship programs, and other health professions programs conducted by the authors in 2017, which found some had made significant progress in integrating oral health into primary care training, while others lagged behind. The aim of the current study was to better understand the characteristics and climate of oral health education in non-dental health professions schools by conducting interviews with leaders of programs who had self-identified in the surveys as having a robust oral health curriculum. Hour-long interviews were conducted between October 2017 and March 2018 with 31 program directors or deans of medical specialty and allied health professions programs using a semi-structured interview guide. These interviewees were from 13 health disciplines. The coding of interview transcripts identified seven major themes: motivations to develop an oral health curriculum; rationale for curriculum topics covered; best aspects of the curriculum; evaluation and assessment strategies; relationships with dental providers and residents and dental hygienists; barriers and challenges; and advice and lessons learned. The interviewees reported a strong belief that oral health is an important health topic. Key elements that interviewees identified as helping them build robust oral health programs in their primary care curricula were the following: having an oral health champion; having some funding; building relationships with dental professionals; using local, state, and national resources; using curricular materials from existing sources; incorporating skills-based sessions; taking an IPE approach; and making oral health part of what the program already does. These findings should be useful for primary care schools and programs that are beginning to add oral health to their curricula and those seeking to improve their existing oral health education for their students.


Assuntos
Saúde Bucal/educação , Atenção Primária à Saúde , Avaliação de Programas e Projetos de Saúde , Faculdades de Odontologia/normas , Faculdades de Medicina/normas , Adulto , Currículo/normas , Higienistas Dentários/educação , Educação em Odontologia , Ocupações em Saúde , Humanos , Internato e Residência , Pessoa de Meia-Idade , Desenvolvimento de Programas , Pesquisa Qualitativa , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
13.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(7): 849-853, 2019 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-31357810

RESUMO

Objective: To understand the internship of students majoring in preventive medicine in 6 colleges and universities in China, and provide reference suggestions for the improvement of internship arrangement. Methods: By using the method of combined clustering and convenient sampling, the fifth grades students majoring in preventive medicine in six universities in the eastern, central and western China were surveyed by using questionnaires to collect the information of their attitudes (to) and suggestions for clinical and public health internships. Results: A total of 596 students were surveyed. In terms of the benefits of clinical internship and public health internship, students who thought that the internship was fruitful accounted for >88%, and more students thought that reform is needed in clinical internship compared with public health internship. In clinical internship, the students through that the time arrangement was not appropriate enough (95, 39.58%), the content should be more detailed and in-depth (73, 30.42%) and the content did not conform to the professional direction (54, 22.50%). In public health internship, the students thought that the time arrangement was not appropriate (77, 45.56%), the content should be more detailed and standardized (65, 38.46%) and the types of internship bases should be more diversified (20, 11.83%). Conclusions: The undergraduates majoring in preventive medicine felt to be benefited from clinical practice and public health internships and thought they are of necessity. At the same time, there are still many problems which needs to be improved in the two types of internships. It is necessary to make joint efforts from students, teachers, colleges and practice bases to promote the continuous improvement of undergraduate internship.


Assuntos
Atitude , Internato e Residência , Medicina Preventiva/educação , Estudantes de Ciências da Saúde/psicologia , China , Humanos , Inquéritos e Questionários , Universidades
14.
J Laryngol Otol ; 133(8): 700-703, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31317846

RESUMO

OBJECTIVE: The completion of a laser safety course remains a core surgical curriculum requirement for otolaryngologists training in the UK. This project aimed to develop a comprehensive laser safety course utilising both technical and non-technical skills simulation. METHODS: Otolaryngology trainees and consultants from the West of Scotland Deanery attended a 1-day course comprising lectures, two high-fidelity simulation scenarios and a technical simulation of safe laser use in practice. RESULTS: The course, and in particular the use of simulation training, received excellent feedback from otolaryngology trainees and consultants who participated. Both simulation scenarios were validated for future use in laser simulation. CONCLUSION: The course has been recognised as a laser safety course sufficient for the otolaryngology Certificate of Completion of Training. To the authors' knowledge, this article represents the first description of using in situ non-technical skills simulation training for teaching laser use in otolaryngology.


Assuntos
Lasers/efeitos adversos , Otolaringologia/educação , Treinamento por Simulação/métodos , Competência Clínica , Simulação por Computador , Educação Médica Continuada , Humanos , Internato e Residência , Reino Unido
15.
BMJ ; 366: l4134, 2019 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-31292124

RESUMO

OBJECTIVE: To determine whether 30 day mortality, 30 day readmissions, and inpatient spending vary according to whether physicians were exposed to work hour reforms during their residency. DESIGN: Retrospective observational study. SETTING: US Medicare. PARTICIPANTS: 20% random sample (n=485 685) of Medicare beneficiaries aged 65 years or more admitted to hospital and treated by a general internist during 2000-12. MAIN OUTCOME MEASURES: 30 day mortality, 30 day readmissions, and inpatient Medicare Part B spending among patients treated by first year internists who were fully exposed to the 2003 Accreditation Council for Graduate Medical Education (ACGME) work hour reforms during their residency (completed residency after 2006) compared with first year internists with partial or no exposure to reforms (completed residency before 2006). Senior internists not exposed to reforms during their residency served as a control group (10th year internists) for general trends in hospital care: a difference-in-difference analysis. RESULTS: Exposure of physicians to work hour reforms during their residency was not associated with statistically significant differences in 30 day mortality, 30 day readmissions, or inpatient spending. Among 485 685 hospital admissions, 30 day mortality rates during 2000-06 and 2007-12 for patients of first year internists were 10.6% (12 567 deaths/118 014 hospital admissions) and 9.6% (13 521/140 529), respectively, and for 10th year internists were 11.2% (11 018/98 811) and 10.6% (13 602/128 331), for an adjusted difference-in-difference effect of -0.1 percentage points (95% confidence interval -0.8% to 0.6%, P=0.68). 30 day readmission rates for first year internists during 2000-06 and 2007-12 were 20.4% (24 074/118 014) and 20.4% (28 689/140 529), respectively, and for 10th year internists were 20.1% (19 840/98 811) and 20.5% (26 277/128 331), for an adjusted difference-in-difference effect of 0.1 percentage points (-0.9% to 1.1%, P=0.87). Medicare Part B inpatient spending for first year internists during 2000-06 and 2007-12 was $1161 (£911; €1024) and $1267 per hospital admission, respectively, and for 10th year internists was $1331 and $1599, for an adjusted difference-in-difference effect of -$46 (95% confidence interval -$94 to $2, P=0.06). CONCLUSIONS: Exposure of internists to work hour reforms during their residency was not associated with post-training differences in patient mortality, readmissions, or costs of care.


Assuntos
Custos de Cuidados de Saúde/normas , Mortalidade Hospitalar , Hospitalização/economia , Internato e Residência , Readmissão do Paciente/economia , Garantia da Qualidade dos Cuidados de Saúde , Jornada de Trabalho em Turnos , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/tendências , Humanos , Internato e Residência/normas , Masculino , Medicare/economia , Readmissão do Paciente/normas , Readmissão do Paciente/tendências , Estudos Retrospectivos , Estados Unidos
17.
Am Surg ; 85(6): 579-586, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267897

RESUMO

We aim to investigate the prevalence of posttraumatic stress disorder (PTSD), physician burnout (PBO), and work-life balance (WLB) among surgical residents, fellows, and attendings to illustrate the trends in surgeon wellness. A cross-sectional national survey of surgical residents, fellows, and attendings was conducted screening for PTSD, PBO, and WLB. The prevalence of screening positive for PTSD was more than two times that of the general population at all levels of experience, and more than half have an unhealthy WLB. The prevalence of PTSD, PBO, and unhealthy WLB declined with increasing level of experience (P < 0.001). One deviation in this trend was a lower prevalence of PBO among surgical fellows compared with residents and attendings (P < 0.001). Surgeon wellness improved with increasing level of experience. The incorporation of wellness programs into surgical residencies is essential to the professional development of young surgeons to cultivate healthy lasting habits for a well-balanced career and life.


Assuntos
Esgotamento Profissional/epidemiologia , Promoção da Saúde/organização & administração , Satisfação no Emprego , Satisfação Pessoal , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Cirurgiões/psicologia , Adulto , Esgotamento Profissional/psicologia , Estudos Transversais , Bolsas de Estudo/tendências , Feminino , Humanos , Internato e Residência/tendências , Masculino , Corpo Clínico Hospitalar/tendências , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Cirurgiões/educação , Estados Unidos , Adulto Jovem
18.
Am Surg ; 85(6): 606-610, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267901

RESUMO

The objective of this study was to assess the results of a structured remediation program for surgical residents scoring poorly on the American Board of Surgery In-Training Examination®. Residents scoring below the threshold (<20th percentile) were placed in a remediation program consisting of textbook-based review and mandatory weekly quizzes overseen by the program director. The effects of the program were assessed over a five-year period (2014-2018). Of 168 tests taken, 23 (13.7%) instances of scoring below the threshold occurred (average percentile 11, range 1-19). Postremediation scores in the subsequent year improved with a median (IQR) percentile increase of 29 [23.5, 46] (P < 0.001). Two residents scored below the threshold twice; all others continued to score above the threshold. Participation in a structured remediation program results in dramatic improvement in American Board of Surgery In-Training Examination® performance, and a single occurrence of poor performance does not necessarily lead to a permanent handicap in academic performance.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Medicina/organização & administração , Cirurgia Geral/educação , Internato e Residência/organização & administração , Ensino de Recuperação/organização & administração , Adulto , Currículo , Bases de Dados Factuais , Avaliação Educacional , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Inquéritos e Questionários , Estados Unidos
19.
Am Surg ; 85(6): 663-670, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267909

RESUMO

Ineffective communication between surgical trainees and attending surgeons is a significant contributor to patient harm. The aim of this study was to evaluate a tool to improve resident-to-attending communication regarding changes in patient clinical status. Ten critical patient events were compiled into a list of triggers for direct attending surgeon notification at a single academic institution. Residents and faculty were surveyed to assess communication before and after implementation of the list. Institution of the triggers list was associated with a nonstatistically significant increase in resident-to-attending notification regarding 7 of 10 critical patient events. There was no reported change in frequency of calls associated with the list's implementation. Most residents felt that the list improved patient care and increased their comfort with calling attending surgeons. Comments were generally positive; however, both groups expressed concern that the list could negatively impact resident autonomy and supervision. Implementing a list of triggers for attending notification of critical patient events subjectively improved resident-to-attending communication in an environment with high baseline levels of communication.


Assuntos
Internato e Residência/organização & administração , Corpo Clínico Hospitalar/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Melhoria de Qualidade , Inquéritos e Questionários , Centros Médicos Acadêmicos , Adulto , Educação de Pós-Graduação em Medicina/organização & administração , Feminino , Humanos , Comunicação Interdisciplinar , Relações Interprofissionais , Masculino , Erros Médicos/prevenção & controle , Pessoa de Meia-Idade , Ohio
20.
Lancet ; 393(10191): 2582-2583, 2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31258120
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