New ACGME Clinician Educator Milestones as a Roadmap for Faculty Development: a Position Paper from the Society of General Internal Medicine Education Committee.

Traditionally, clinician educators are tasked with the responsibility of training future physician workforce. However, there is limited identification of skills required to fulfill this responsibility and a lack of consensus on effective faculty development for career growth as a clinician educator. The newly released Accreditation Council of Graduate Medical Education (ACGME) Clinician Educator (CE) Milestones framework outlines important skills for clinician educators and provides the opportunity to create robust faculty development. In this paper, members of the Society of General Internal Medicine Education Committee discuss the importance of these CE Milestones, outline the novel themes highlighted in the project, and provide recommendations for proper application on both the individual and institutional levels to optimize faculty development. The paper discusses strategies for how to apply the CE Milestones as a tool to create a culture of professional growth and self-directed learning. Using a reflective approach, CE faculty and mentors can identify areas of proficiency and opportunities for growth, thereby creating individualized professional development plans for career success. Institutions should use aggregate CE Milestones data as a needs assessment of their faculty "population" to create targeted faculty development. Most importantly, institutions should not use CE Milestones for high-stakes assessments but rather encourage reflection by CE faculty and create subsequent robust faculty development programs. The ACGME CE Milestones present an exciting opportunity and lay an important foundation for future CE faculty development.

Current status of clinician-educator tracks in internal medicine residency programmes.

BACKGROUND: Residents in internal medicine programmes lack formal training in leadership, curriculum development and clinical teaching. Residency programmes created clinician-educator tracks (CETs) to formally teach residents to become effective educators and to involve them in the science of medical education. However, the curricula in these tracks are often locally developed and remain at the discretion of the individual programmes. METHODS: This survey evaluates the frequency of CETs in internal medicine residency programmes in the USA and descriptively analyses their logistical and curricular content. During the academic year 2017-2018, directors of all Accreditation Council for Graduate Medical Education (ACGME) accredited internal medicine residency programmes in the USA were invited to participate in this survey (n=420). We developed a web-based 22-question survey to assess the logistics and curricular content of CET programmes. RESULTS: A total of 150 programmes responded to the survey invitation (response rate=35.7%). Only 24% (n=36) of programmes offered a CET, the majority of which have been available for only 5 years or less. The track is most frequently offered to postgraduate year (PGY)-2 and PGY-3 residents. Only a minority of participating faculty (27.8%) have protected time to fulfil their CET role. Bedside teaching, feedback, small group teaching and curriculum development are the most commonly taught topics, and faculty mentorship and small group teaching methods are the most commonly used types of instruction. CONCLUSIONS: CETs are offered in only 24% of internal medicine residency programmes in the USA. The curricula of these tracks vary across programmes, and their success is often countered by logistic and financial challenges.

A systematic review of the use and effectiveness of the Objective Structured Teaching Encounter.

BACKGROUND: The Objective Structured Teaching Encounter (OSTE) has been proposed as a means of promoting and assessing the teaching skills of medical faculty. AIMS: To describe the uses of the OSTE and the evidence supporting its effectiveness. METHOD: MEDLINE (January 1966 through February 2010) was searched for English-language studies detailing the use of an OSTE for any educational purpose. Reference lists from relevant review articles and identified studies were also searched. Of the 354 papers initially identified, 22 were included in the review. RESULTS: The OSTE has been used to assess and improve teaching performance and to assess the impact of other means of faculty development. Although qualitative results have been generally positive, there is little quantitative data to support using the OSTE as a means of improving teaching performance. There is moderate evidence suggesting the OSTE is a reliable and valid means of assessing teaching, although few ratings instruments have been adequately studied. CONCLUSIONS: The OSTE is a promising innovation with potential application to assessing and promoting the teaching skills of medical faculty. Further study is required to determine the most effective OSTE design.

An Interactive Mock Paging Curriculum to Prepare New Internal Medicine Interns for Inpatient Wards.

Introduction: The July effect refers to an increase in adverse outcomes during periods of physician trainee turnover in teaching hospitals. We created an interactive resident-led curriculum to train new internal medicine interns for routine encounters on inpatient wards by role-playing through mock paging scenarios and focusing on practical information relevant to intern year. Methods: A formal assessment of the academic year 2018 intern boot camp curriculum revealed that interns preferred sessions that involved active learning strategies and covered common issues. In the first week of academic year 2019, interns participated in two 1-hour small-group sessions involving mock paging scenarios. Interns were divided into small groups with one facilitator who was a senior medicine resident. Within these groups, facilitators acted as the nurse and provided pages. Interns took turns answering these mock pages based on a sign-out of patients. The facilitator emphasized desired learner actions and teaching points using a provided guide. Results: Twenty interns participated in the curriculum. Interns rated the curriculum highly and felt that the sessions improved their knowledge, comfort, and skills in managing routine inpatient encounters. On a 2-week follow-up knowledge test to determine if they retained the information from the curriculum, interns scored an average of 85% (response rate: 60%, N = 12), indicating that they could apply the knowledge/skills learned to new scenarios. Discussion: This curriculum prepares medicine interns to manage common inpatient issues at the beginning of their residency. After completing the curriculum, interns reported increased confidence in handling these issues.

The impact of gown-use requirement on hand hygiene compliance.

BACKGROUND: Hand hygiene compliance remains low, despite its effectiveness in preventing infections. Gowns are routinely used to reduce dissemination of organisms within hospitals. Use of gowns is time consuming and costly, and their effectiveness, compared with that of hand hygiene alone, is debated. Among the arguments supporting a gown-use requirement is the potential to boost awareness of infection control, leading to improved hand hygiene compliance. METHODS: Hand hygiene compliance was recorded in a 14-month crossover trial comparing compliance at 2 intensive care units during periods with and without a gown-use requirement. RESULTS: During 170 h of observation, 1619 hand hygiene opportunities were recorded. Compliance was 10% before care was given and 36% after care was given. Compliance with glove and gown use was 62% and 63%, respectively. After-care hand hygiene compliance for nurses, physicians, and therapists was 40%, 38%, and 22%, respectively. Compliance after patient contact, body fluid contact, and other in-room activity was 42%, 48%, and 22%, respectively. For periods with and without a gown-use requirement, overall after-care compliance (37% vs. 34%) and rates by personnel and activity type were similar. In the subgroup of patients on contact precautions, hand hygiene compliance during the period with a gown-use requirement versus the period without a gown-use requirement was 11% versus 10% (P=.85) before care was given and 45% versus 39% (P=.09) after care was given. In this subgroup, after adjustment for type of in-room activity, medical personnel, intensive care unit, and observer, the predicted after-care hand hygiene compliance during periods with and without a gown-use requirement was 48% versus 41% (P=.02). CONCLUSIONS: The hypothesis that a gown-use requirement might improve hand hygiene compliance in the intensive care unit could not be confirmed. In the subgroup of patients on contact precautions, improvement in hand hygiene compliance associated with the gown-use requirement was small and did not affect precare rates.

Feedback based on observation of work rounds improves residents' self-reported teaching skills.

INTRODUCTION: Residents provide a significant amount of bedside teaching to medical students and more junior colleagues, but often do not receive feedback that is tailored to this aspect of their professional performance. OBJECTIVE: To assess residents' self-reported improvement in teaching skills after feedback based on direct observation of work rounds. METHOD: The authors initiated a program of direct observation of residents' teaching during work rounds during the academic year 2007-2008. Eleven interested faculty volunteers, including chief residents, observed teaching on work rounds by 18 second-year residents in internal medicine during 35 total encounters. Within 24 hours, the faculty observers provided individualized feedback to the resident teachers regarding the quantity and quality of their teaching based on the data collected with the Teaching on Work Rounds observation form. At the end of the year, a survey was conducted to assess the residents' receptivity to this program. RESULTS: Each observation averaged 92 minutes per observer, for 81.5 recorded hours of observations. Eighty percent of the residents felt that they were better teachers because of the feedback they received, and 87% subsequently reported having made conscious changes in their teaching during work rounds. DISCUSSION: A direct observation program of residents' teaching on work rounds improved residents' interest in teaching while motivating them to make conscious changes in their teaching based on the individualized feedback they received.

Voluntary electronic reporting of laboratory errors: an analysis of 37,532 laboratory event reports from 30 health care organizations.

Laboratory testing is essential for diagnosis, evaluation, and management. The objective was to describe the type of laboratory events reported in hospitals using a voluntary electronic error reporting system (e-ERS) via a cross-sectional analysis of reported laboratory events from 30 health organizations throughout the United States (January 1, 2000, to December 31, 2005). A total of 37,532 laboratory-related events were reported, accounting for 14.1% of all reported quality events. Preanalytic laboratory events were the most common (81.1%); the top 3 were specimen not labeled (18.7%), specimen mislabeled (16.3%), and improper collection (13.2%). A small number (0.08%) of laboratory events caused permanent harm or death; 8% caused temporary harm. Most laboratory events (55%) did not cause harm. Laboratory errors constitute 1 of 7 quality events. Laboratory errors often are caused by events that precede specimen arrival in the lab and should be preventable with a better labeling processes and education. Most laboratory errors do not lead to patient harm.