A randomized controlled trial of behavior change counseling education for medical students.

BACKGROUND: Educating medical students about how to effectively counsel patients with negative health behaviors (i.e., lack of exercise, smoking) is vitally important. Behavior change counseling is a promising method that can be used by physicians to encourage positive changes in health behaviors. PURPOSE: To examine the effectiveness of a 2 h workshop in behavior change counseling for medical students. METHODS: This study used a pre-post control group design with 35 second-year medical students who were randomly assigned to participate in a behavior change counseling intervention or wait-list control group. Student knowledge and attitudes were assessed using multiple choice items and open-ended question prompts. Student skills were assessed via performance in a standardized patient encounter rated using the Behavior Change Counseling Index (BECCI). RESULTS: Student attitudes toward behavior change counseling were positive at both pre- and post-test assessment in both groups. Knowledge scores and BECCI total scores showed significantly greater improvement in the intervention group compared to the wait-list control group. CONCLUSIONS: This study found that a brief educational intervention had a positive impact on medical students' knowledge and skills in behavior change counseling, and that student attitudes about the counseling method were very positive.

Who did the case? Perceptions on resident operative participation.

BACKGROUND: The ACGME case log is one of the primary metrics used to determine resident competency; it is unclear if this is an accurate reflection of the residents' role and participation. METHODS: Residents and faculty were independently administered 16-question surveys following each case over a three-week period. The main outcome was agreement between resident and faculty on resident role and percent of the case performed by the resident. RESULTS: Matched responses were collected for 87 cases. Agreement on percent performed occurred in 61% of cases, on role in 63%, and on both in 47%. Disagreement was more often due to resident perception they performed more of the case. Faculty with <10 years experience were more likely to have disagreement compared to faculty with ≥10 years (p = 0.009). CONCLUSIONS: There was a high degree of disagreement between faculty and residents regarding percent of the case performed and role. Accurate understanding of participation and competency is vital for accrediting institutions and for resident self-assessment meriting further study of the causes for this disagreement to improve training and evaluation.

It depends on your perspective: Resident satisfaction with operative experience.

INTRODUCTION: Resident satisfaction is a key performance metric for surgery programs; we studied factors influencing resident satisfaction in operative cases, and the concordance of faculty and resident perceptions on these factors. METHODS: Resident and faculty were separately queried on satisfaction immediately following operative cases. Statistical significance of the associations between resident and faculty satisfaction and case-related factors were tested by Chi-square or Fisher's exact test. RESULTS: Residents and faculty were very satisfied in 56/87 (64%) and 36/87 (41%) of cases respectively. Resident satisfaction was associated with their perceived role as surgeon (p < 0.04), performing >50% of the case (p < 0.01), autonomy (p < 0.03), and PGY year 4-5(p < 0.02). Faculty taking over the case was associated with both resident and faculty dissatisfaction. Faculty satisfaction was associated with resident preparation (p < 0.01), faculty perception of resident autonomy (p < 0.01), and faculty familiarity with resident's skills (p < 0.01). CONCLUSIONS: Resident and faculty satisfaction are associated with the resident's competent performance of the case, suggesting interventions to optimize resident preparation for a case or faculty's ability to facilitate resident autonomy will improve satisfaction with OR experience.

Defining family-centered rounds.

BACKGROUND: Physicians are required to provide safe, effective, and high-quality care that is patient-centered. Continuing to meet the educational needs of residents and medical students in the setting of patient-centered care will require developing new models for hospital "work rounds." Family-centered rounds is a model of communicating and learning between the patient, family, medical professionals, and students on an academic, inpatient ward setting. Unfortunately, in the medical literature, there is no consensus on the definition of family-centered rounds. SUMMARY: Despite the increased utilization of hospitalists and the recognition that bedside teaching has many benefits, bedside rounds are underutilized. In this article, we present a description of family-centered rounds that is supported by a review of the literature on bedside teaching, family-centered care, and interdisciplinary care. The key difference between family-centered rounds and traditional bedside teaching is the active participation of the patient and family in the discussion. Interdisciplinary care implies that professionals from a variety of disciplines work collaboratively to develop a unified care plan. Family-centered rounding provides an interface between families and medical professionals that allows education of medical students and residents as well as the development of a unified care plan. CONCLUSIONS: Family-centered rounds hold potential to create a patient-centered environment, enhance medical education, and improve patient outcomes. The model is a planned, purposeful interaction that requires the permission of patients and families as well as the cooperation of physicians, nurses, and ancillary staff.

A Graduate Medical Education Initiative to Promote Professional Excellence Among Residency Program Coordinators.

BACKGROUND: The authors describe the scope and impact of a professional development program for residency and fellowship program coordinators (PCs) at the University of Arkansas for Medical Sciences (UAMS) College of Medicine. PCs are vital in the success of their residency programs, yet few articles to date have addressed their increasingly complex roles. PURPOSE: This exploratory study examines PCs' professional characteristics, perceptions that influence professional development meeting attendance, and the impact of the Program Coordinators' Organization (PCO). METHODS: All 44 PCs serving 53 residency and fellowship programs at UAMS were surveyed about their perceptions of the PCO in January 2006. RESULTS: The majority of respondents agreed that the PCO has improved their abilities and interactions with their supervisors, colleagues, and residents and that the PCO has made an institution-wide impact on residency education. CONCLUSIONS: Sponsoring a PCO may be an effective tool for organizations to enhance the role of PCs and their graduate medical education programs.