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2.
South Med J ; 114(3): 129-132, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33655304

RESUMO

OBJECTIVES: This project was developed because residents need to gain knowledge and experience in promptly recognizing patients with suicidal ideation. Our study allowed pediatric interns the opportunity to manage a simulated 16-year-old actively suicidal patient in the resident continuity clinic for a well-child visit. METHODS: During their first year, each resident receives simulation training. The simulation scenario for this study involves the use of a standardized patient (SP). Sessions take place in the pediatric simulation center and are recorded for observation and review. The scenario was scripted and piloted to ensure standardization in educational intervention. Postscenario, participants have a nonjudgmental debriefing with the attending physician and the SP. An anonymous survey is completed after training. Enrollment was June 2016-September 2019, with two to three 1-hour cases monthly. RESULTS: Seventy-one postgraduate year-1 residents participated. Sixty-one residents left the suicidal patient alone/unobserved. Fifteen participants never learned of the intent of suicide during their initial intake with the patient but believed that she was depressed. The mean time to ask about suicidal ideation, when applicable, was 8:32 minutes (standard deviation 4:10 minutes, range 2:15-24:48 minutes). Common learning themes included realistic exposure to an actively suicidal patient and simulation debriefing/direct feedback from the SP. CONCLUSIONS: Practicing this crucial but somewhat rare primary care mental health emergency for all interns was possible when structured monthly. Feedback was extremely positive, with learners' feeling more prepared postsimulation. Our simulation experience also allows supervisors to assess intern's individual abilities to communicate in a difficult patient scenario which is an important physician competency as defined by the Accreditation Council for Graduate Medical Education.


Assuntos
Internato e Residência/métodos , Questionário de Saúde do Paciente , Pediatria/educação , Treinamento por Simulação , Ideação Suicida , Adolescente , Adulto , Competência Clínica , Feminino , Humanos , Masculino , Simulação de Paciente , Atenção Primária à Saúde
3.
South Med J ; 114(3): 133-138, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33655305

RESUMO

ABSTRACT: Racial minorities will account for >50% of the United States population by 2045, yet race and ethnicity persist as leading predictors of morbidity. Although minorities achieve better outcomes when treated by racially concordant providers, the number of minority physicians is disproportionately low compared with the rapidly growing minority population. This imbalance creates a cultural gap between many minority patients and their healthcare providers. Research suggests that educational initiatives addressing health inequity through a historical lens can help providers better understand the root causes of disparities; however, extensive clinical demands severely limit the time providers can dedicate to non-medical learning. OBJECTIVES: To address this gap, the University of Miami/Jackson Memorial Hospital System developed and piloted a short film about the history of Black people in South Florida, highlighting significant events that shaped the health-seeking behaviors of this population. METHODS: A 20-minute documentary exploring the sociocultural history of Black communities in Miami-Dade County was presented to 188 first-year postgraduate residents in June 2017. Residents completed pre-post surveys to measure changes in knowledge and care delivery intentions. RESULTS: Analyses performed between March and July 2018 revealed moderate improvements in the knowledge and awareness of the socioeconomic history of Miami's Black communities. Before watching the video, a majority indicated that increasing awareness of the sociocultural history of their patient population was a valuable learning activity. CONCLUSIONS: These findings suggest that brief videos focused on the history of culturally distinct populations may be a successful pedagogical strategy to introduce physicians to the communities they serve and improve provider knowledge.


Assuntos
Competência Clínica , Competência Cultural/educação , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência/métodos , Filmes Cinematográficos , Adulto , Afro-Americanos/história , Diversidade Cultural , Assistência à Saúde Culturalmente Competente , Feminino , Florida , Disparidades em Assistência à Saúde/etnologia , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Masculino , Faculdades de Medicina
5.
Ann Glob Health ; 87(1): 24, 2021 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-33747799

RESUMO

Integrating global health (GH) training in medical education has become prevalent in the United States over the last two decades. Many medical school graduates participate in some type of international learning experience during their undergraduate/graduate training, with plans to make this a part of their life-long learning experiences. Recognizing this trend, many pediatric national organizations, such as the American Academy of Pediatrics, the Association of Pediatric Program Directors, and the American Board of Pediatrics, have developed initiatives integrating GH education into existing curricula. We report our experience with using virtual learning on a cloud-based platform to remain connected with our GH training partners, and utilize this opportunity to further strengthen our existing relationships during the ongoing COVID-19 pandemic. Overall, our experience thus far shows that this is an effective way to maintain communication even when international travel is not possible. It allows for the ongoing exchange of ideas and the development of long-term sustainable relationships. There are many important lessons our trainees can learn from such partnerships.


Assuntos
/epidemiologia , Currículo/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência/métodos , Pandemias , Saúde Global , Humanos
7.
J Public Health Manag Pract ; 27(Suppl 3): S139-S145, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33785685

RESUMO

CONTEXT: Preventive medicine residents must train in population medicine (including analytics and population health) and clinical preventive medicine (including screening, behavioral counseling, and chemoprophylaxis). Yet, opportunities to perform both functions concurrently for the same population are scarce. Residents must also master the art of preventive medicine, but they often lack an established community of practice that provides a continuous forum to do so. This project explored Population Health Rounds as a novel vehicle to optimize preventive medicine residency training. PROGRAM DESCRIPTION: Modeled after traditional medical rounds, Population Health Rounds consist of a 1-hour weekly meeting engaging preventive medicine residents and supervising attendings at Stony Brook Medicine in both population medicine and clinical preventive medicine concurrently, including patient case discussions and targeted population health analytics. EVALUATION AND RESULTS: Because of the pandemic, the rounds have predominantly focused on COVID-19 and its effects on the hospital employee population. In addition to providing direct patient care to COVID-19-positive and exposed employees, residents have analyzed data on this population and made recommendations to hospital leadership based on COVID-19's institutional epidemiology, including incidence, prevalence, and predictive factors. A formative qualitative survey of resident perceptions offers insights on the value and learning outcomes of this new model. DISCUSSION AND CONCLUSION: Factors that may impact the implementation, sustainability, and feasibility of this model are discussed. The preventive medicine residency program is commissioned to address gaps in clinical preventive services for the patient-centered medical home tied to the sponsoring institution's family medicine practice. Additional plans are underway to expand the rounds to other clinical contexts, such as lifestyle medicine in the occupational setting, and for targeted populations, such as the underserved. Replication of the Population Health Rounds model is recommended to determine its effectiveness.


Assuntos
Internato e Residência/métodos , Saúde da População , Medicina Preventiva/educação , Visitas com Preceptor/métodos , Humanos , New York
8.
Arthroscopy ; 37(3): 1008-1010, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33673956

RESUMO

Simulation-based training has been widely adopted by surgical educators and is now an essential component of the modern resident's skills acquisition pathway and career progression. The challenges faced by residents because of lack of exposure as a result of working-time directives-and now the COVID-19 (coronavirus disease 2019) pandemic limiting nonurgent and elective operating-reinforce the need for evidence-based simulation training. Although a wide range of training platforms have been developed, very few have shown transfer of skills. Simulation is thought to enhance the initial phase of the procedural learning curve; however, this hypothesis is yet to be tested in a high-quality study. Nevertheless, in light of the current evidence, simulation-based procedural curricula should be developed using the strengths of multiple different training platforms while incorporating the essential concept of nontechnical skills.


Assuntos
Competência Clínica , Currículo , Internato e Residência/métodos , Procedimentos Ortopédicos/educação , Treinamento por Simulação/métodos , /epidemiologia , Comorbidade , Humanos , Pandemias
9.
Am J Surg ; 221(2): 331-335, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33729917

RESUMO

BACKGROUND: The regulatory focus theory (RFT) posits that people can pursue goals with a promotion or prevention focus. Greater alignment of RFT motivational styles between faculty and residents may enhance resident operative autonomy. This study establishes a set of faculty behaviors residents can identify to infer faculty motivational styles. METHODS: 10 behaviors associated with promotion and prevention motivational styles were identified. General surgery residents rated faculty on how strongly they exhibit these behaviors. Faculty conducted a self-assessment of how strongly they exhibit these behaviors. RESULTS: There is a positive correlation between resident and faculty ratings for the promotion-associated behaviors of "works quickly," "high energy," and "mostly provides broad oversight," and for the prevention-associated behaviors of "works slowly and deliberately," "quiet and calm," and "preference for vigilant strategies." CONCLUSION: Residents can observe faculty operative behaviors to infer faculty motivational styles. Residents may use this knowledge to adjust to faculty motivational styles and enhance operative interactions.


Assuntos
Cirurgia Geral/educação , Internato e Residência/métodos , Salas Cirúrgicas/métodos , Cirurgiões/psicologia , Competência Clínica/normas , Docentes de Medicina/psicologia , Feminino , Cirurgia Geral/métodos , Humanos , Masculino , Motivação , Autonomia Profissional , Autocontrole , Inquéritos e Questionários , Confiança
11.
J Public Health Manag Pract ; 27(Suppl 3): S123-S128, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33605672

RESUMO

The 2020 SARS-CoV-2 pandemic created a unique opportunity for Public Health/General Preventive Medicine (PH/GPM) and Occupational and Environmental Medicine (OM) residents to contribute to pandemic public health response activities. We surveyed all 18 Health Resources and Services Administration (HRSA)-funded PH/GPM and OM residency program directors to evaluate program and resident involvement in pandemic response activities from January 1 through June 30, 2020. Of 116 residents, 110 (95%) participated at some level in the response activities including screening/testing, contact tracing, surveillance, data analysis, incident command, provider support, reopening, direct patient care, education, and risk communication. Residents' response activities were in multiple settings, such as state, local, and federal health agencies; hospital systems; long-term care facilities; academic centers; local businesses and labor unions; Federally Qualified Health Centers; homeless shelters; and clinics. Residents' participation was facilitated by their training in public health, epidemiology, the care of patients and populations, and emergency preparedness. Programs should continue to promote these experiences and key roles that PH/GPM and OM residents can play, as this leadership is a necessity for the successful navigation of future major public health events. As the pandemic continues, evaluation of residents' experiences will help guide longer-term changes to program curriculum and partnerships. Many trainees' contributions and expertise met both educational and service goals and therefore should be integrated into ongoing pandemic response work in PH/GPM and OM programs.


Assuntos
/prevenção & controle , Internato e Residência/métodos , Medicina Preventiva/educação , /diagnóstico , Humanos , Internato e Residência/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos , United States Health Resources and Services Administration/organização & administração
12.
South Med J ; 114(2): 116-122, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33537794

RESUMO

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.


Assuntos
Currículo , Medicina Interna/educação , Internato e Residência/métodos , Estudantes de Medicina/psicologia , Saúde da Mulher , Adulto , Competência Clínica , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Aprendizagem Baseada em Problemas , Inquéritos e Questionários
14.
South Med J ; 114(2): 111-115, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33537793

RESUMO

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.


Assuntos
Currículo , Medicina Interna/educação , Internato e Residência/métodos , Corpo Clínico Hospitalar/educação , Relações Médico-Paciente , Adulto , Agressão , Feminino , Assédio não Sexual , Humanos , Masculino , Corpo Clínico Hospitalar/psicologia , Pacientes/psicologia , Discriminação Social
17.
South Med J ; 114(1): 8-12, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33398353

RESUMO

OBJECTIVES: There are many factors that influence medical students' (MS) decisions when choosing a career. Some prominent factors include life-work balance, indebtedness, and flexibility of work hours. Whereas the expression of empathy has many positive correlates with a trusting and meaningful physician-patient interaction, only a few studies have analyzed the association of MS empathy expression and primary care residency selection. The results of these studies about the relationship of MS expression of empathy and their selection of primary care specialties have been conflicting, depending on the empathy instrument used. In addition, there have been other variables that have affected career decision making in more recent years not previously encountered. The objectives of our study were to analyze the association of The George Washington University School of Medicine and Health Sciences (GWU) MS Interpersonal Reactivity Index (IRI) scores and their residency selection, to compare our results with previous studies to determine whether the IRI provided more definitive relationships between empathy and career choice, and to assess whether our results confirmed the theoretical construct linking empathy with primary care physicians. METHODS: GWU third-year MS (MS3s), representing the classes of 2008-2011, completed the perspective taking and empathy subscales of the IRI, which measure cognitive and affective empathy, respectively. MS empathy scores for individual specialty were compared to those scores in internal medicine (IM) using a linear regression model. Empathy scores for patient-oriented versus technology-oriented specialties and primary versus surgical specialties were compared using the independent t test. RESULTS: A total of 593 (77.5%) MS3s had mean IRI scores of 45.1 (standard error 4.8), higher than a recent study involving MS. There were no significant differences between patient- and technology-oriented specialties (-0.65 to 0.88), primary care versus surgical residencies (-0.87 to 1.4), and women versus men (-0.20 to 1.4). Our study did not clarify previous conflicting studies in the literature. CONCLUSIONS: There are no significant differences in expression of empathy in GWU students who chose patient- versus technology-oriented and primary care versus surgical residencies. The authors can only speculate why students' high expression of empathy was not associated with selecting primary care residencies, namely, women are outnumbering men entering medicine and are selecting technology-related specialties previously identified predominantly with men, and millennials have specific traits inherent in their generation that can affect their specialty choice. The results of our study shed doubt that the theoretical construct linking MS high empathy expression and choice of primary care careers is valid today.


Assuntos
Empatia , Internato e Residência/métodos , Atenção Primária à Saúde/métodos , Estudantes de Medicina/psicologia , Adulto , District of Columbia , Feminino , Humanos , Internato e Residência/estatística & dados numéricos , Modelos Lineares , Masculino , Atenção Primária à Saúde/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários
18.
Indian J Ophthalmol ; 69(2): 410-416, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33463600

RESUMO

Wet labs are an extremely important training tool, especially in times of a global COVID-19 pandemic, where surgical training can be minimal. They help the trainee learn and practice in a risk-free environment, without an imminent of a complication or failure, also allowing them the chance to execute the steps of a surgery repeatedly. We summarize all the key ingredients required from setting up a wet lab to improve the surgical skill of the trainees. The review also discusses various eyeball fixating devices, preparation of the eye for various types of ocular surgeries, and the role of simulation-based training in today's scenario.


Assuntos
/epidemiologia , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência/métodos , Procedimentos Cirúrgicos Oftalmológicos/educação , Oftalmologia/educação , Pandemias , Competência Clínica , Comorbidade , Oftalmopatias/epidemiologia , Oftalmopatias/cirurgia , Humanos
19.
Artigo em Inglês | MEDLINE | ID: mdl-33512967

RESUMO

BACKGROUND: The COVID-19 pandemic has rapidly affected all facets of everyday life including the practice of medicine. Hospital systems and medical practices have evolved to protect patients, physicians, and staff and conserve personal protective equipment and resources. Orthopaedic practices have been specifically affected by social distancing and stay at home guidelines, limiting in-office practice and elective surgery restrictions. This, in turn, has had an effect on resident education. Previous literature has been published regarding how academic programs have adjusted to these changes. However, the effects on smaller orthopaedic residencies with nonacademic faculty has not been discussed. The orthopaedic residency at Baylor University Medical Center of Dallas is a fifteen-resident program with a combination of hospital employed and private practice faculty. We adjusted our resident education in mid-March 2020 to keep residents safe while trying to maximize surgical and clinical education and outside research. GOALS: Our goals were to come up with a plan allowed for continuing high-level patient care and resident education while protecting residents and limiting burnout. MODEL: We devised a four-team system with five-day call periods. Interactions between teams were strictly minimized. We also moved to a web-based academic curriculum and devised a system for safe resident participation in surgical cases. The model has been adjusted based on attending and resident feedback. CONCLUSION: Until we develop effective treatments or vaccination for COVID-19, there is a possibility that it will be an ongoing threat. Resident education must also adapt to the changing environment while continuing to provide residents safe opportunities for patient care, didactic education, and research. We believe we have come up with a sustainable, adaptable model for resident education during this challenging time.


Assuntos
/epidemiologia , Currículo , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência/métodos , Ortopedia/educação , Pandemias , Humanos
20.
J Drugs Dermatol ; 20(1): 112-113, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33400409

RESUMO

The coronavirus disease 2019 pandemic has quickly and abruptly altered workflow and education across medical specialties. As the health crisis persists in the United States, change will be the norm for the foreseeable future. Dermatology residents report high levels of anxiety, with concerns ranging from redeployment to career prospects.1.


Assuntos
Ansiedade/prevenção & controle , Competência Clínica , Dermatologia/educação , Dermatologia/métodos , Educação a Distância/métodos , Internato e Residência/métodos , Ansiedade/psicologia , Competência Clínica/normas , Dermatologia/normas , Humanos , Internato e Residência/normas
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