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Residency Training Programs (residency + training_program)
Selected AbstractsMonitoring stress levels in postgraduate medical trainingTHE LARYNGOSCOPE, Issue 1 2009Justin D. Hill MD Abstract Objectives: The Accreditation Council for Graduate Medical Education (ACGME) mandates that residency Program Directors (PD) monitor resident well-being, including stress. Burnout, as a measure of work-related stress, is defined by a high degree of emotional exhaustion and depersonalization, and a low degree of personal accomplishment using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). The purpose of this study is to describe the use of the MBI-HSS as a method of monitoring stress levels in an academic otolaryngology residency training program and introduce this survey as a tool for wider use in meeting ACGME requirements. Methods: The MBI-HSS was administered to residents in an academic otolaryngology residency training program on three separate occasions: at the beginning, middle, and end of different academic years. In addition, at the time of the third administration, the MBI-HSS was completed by faculty and staff in the same department. Surveys were completed and collected anonymously. Responses were scored against normative data from the MBI-HSS overall sample and the medicine subscale. Low, average, and high levels of burnout were identified for the individual categories of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA); average levels for each category were calculated. Results: Twenty-two residents completed the first survey, taken near the end of an academic year; 19 completed the second administration in the middle of the following academic year; and 24 completed the third survey at the beginning of the subsequent academic year. Thirteen faculty and 23 staff also completed the third survey. We found that three, one, and one residents reported high levels of burnout on the first, second, and third surveys, respectively. These figures compare to one faculty member and no staff members in the same department reporting high levels of burnout. Conclusions: The MBI-HSS is an established and validated tool for identifying burnout in resident physicians. Residency PDs may find the MBI-HSS useful as an aid in monitoring resident well-being and stress. In our own department, we found levels of burnout comparable to those previously reported for residents and faculty in this specialty. Laryngoscope, 119:75,78, 2009 [source] Are Internal Medicine Residency Programs Adequately Preparing Physicians to Care for the Baby Boomers?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2006A National Survey from the Association of Directors of Geriatric Academic Programs Status of Geriatrics Workforce Study Patients aged 65 and older account for 39% of ambulatory visits to internal medicine physicians. This article describes the progress made in training internal medicine residents to care for older Americans. Program directors in internal medicine residency programs accredited by the Accreditation Council for Graduate Medical Education were surveyed in the spring of 2005. Findings from this survey were compared with those from a similar 2002 survey to determine whether any changes had occurred. A 60% response rate was achieved (n=235). In these 3-year residency training programs, 20 programs (9%) required less than 2 weeks of clinical instruction that was specifically structured to teach geriatric care principles, 48 (21%) at least 2 weeks but less than 4 weeks, 144 (62%) at least 4 weeks but less than 6 weeks, and 21 (9%) required 6 or more weeks. As in 2002, internal medicine residency programs continue to depend on nursing home facilities, geriatric preceptors in nongeriatric clinical ambulatory settings, and outpatient geriatric assessment centers for their geriatrics training. Training was most often offered in a block format. The mean number of physician faculty per residency program dedicated to teaching geriatric medicine was 3.5 full-time equivalents (FTEs) (range 0,50), compared with a mean of 2.2 FTE faculty in 2002 (P,.001). Internal medicine educators are continuing to improve the training of residents so that, as they become practicing physicians, they will have the knowledge and skills in geriatric medicine to care for older adults. [source] The Columbia Cooperative Aging Program: An Interdisciplinary and Interdepartmental Approach to Geriatric Education for Medical InternsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2006Mathew S. Maurer MD Although there is a critical need to prepare physicians to care for the growing population of older adults, many academic medical centers lack the geriatric-trained faculty and dedicated resources needed to support comprehensive residency training programs in geriatrics. Because of this challenge at Columbia University, the Columbia Cooperative Aging Program was developed to foster geriatric training for medical interns. For approximately 60 interns each year completing their month-long geriatric rotations, an integral part of this training now involves conducting comprehensive assessments with "well" older people, supervised by an interdisciplinary team of preceptors from various disciplines, including cardiology, internal medicine, occupational therapy, geriatric nursing, psychiatry, education, public health, social work, and medical anthropology. Interns explore individual behaviors and social supports that promote health in older people; older people's strengths, vulnerabilities, and risk for functional decline; and strategies for maintaining quality of life and independence. In addition, a structured "narrative medicine" writing assignment is used to promote the interns' reflections on the assessment process, the data gathered, and their clinical reasoning throughout. Preliminary measures of the program's effect have shown significant improvements in attitudes toward, and knowledge of, older adults as patients, as well as in interns' self-assessed clinical skills. For academic medical centers, where certified geriatric providers are scarce, this approach may be an effective model for fostering residency geriatric education among interns. [source] Service Versus Education: Finding the Right Balance: A Consensus Statement from the Council of Emergency Medicine Residency Directors 2009 Academic Assembly "Question 19" Working GroupACADEMIC EMERGENCY MEDICINE, Issue 2009Antonia Quinn DO Abstract Many emergency medicine (EM) residency programs have recently received citations for their residents' responses to Question 19 of the Accreditation Council on Graduate Medical Education annual survey, which asks residents to rate their program's emphasis on clinical education over service obligations. To the best of our knowledge, no prior investigations or consensus statements exist that specifically address the appropriate balance between educational activity and clinical service in EM residency training. The objective of this project was to create a consensus statement based on the shared insights of academic faculty and educators in EM, with specific recommendations to improve the integration of education with clinical service in EM residency training programs. More than 80 EM program directors (PDs), associate and assistant PDs, and other academic EM faculty attending an annual conference of EM educators met to address this issue in a discussion session and working group. Participants examined the current literature on resident service and education and shared with the conference at large their collective insight and experience and possible solutions to this challenge. A consensus statement of specific recommendations and effective educational techniques aimed at balancing service and education requirements was created, based on the contributions of a diverse group of academic emergency physicians. Recommendations included identifying the teachable moment in all clinical service; promoting resident understanding of program goals and expectations from the beginning; educating residents about the ACGME resident survey; and engaging hospitals, institutional graduate medical education departments, and residents in finding solutions. [source] Teaching Across the Generation Gap: A Consensus from the Council of Emergency Medicine Residency Directors 2009 Academic AssemblyACADEMIC EMERGENCY MEDICINE, Issue 2009Lisa Moreno-Walton MD Abstract Background:, Four distinct generations of physicians currently coexist within the emergency medicine (EM) workforce, each with its own unique life experience, perspective, attitude, and expectation of work and education. To the best of our knowledge, no investigations or consensus statements exist that specifically address the effect of intergenerational differences on undergraduate and graduate medical education in EM. Objectives:, To review the existing literature on generational differences as they pertain to workforce expectations, educational philosophy, and learning styles and to create a consensus statement based on the shared insights of experienced educators in EM, with specific recommendations to improve the effectiveness of EM residency training programs. Methods:, A group of approximately one hundred EM program directors (PDs), assistant PDs, and other academic faculty attending an annual conference of emergency physician (EP) educators gathered at a breakout session and working group to examine the literature on intergenerational differences, to share insights and discuss interventions tailored to address these stylistic differences, and to formulate consensus recommendations. Results:, A set of specific recommendations, including effective educational techniques, was created based on literature from other professions and medical disciplines, as well as the contributions of a diverse group of EP educators. Conclusions:, Recommendations included early establishment of clear expectations and consequences, emphasis on timely feedback and individualized guidance during training, explicit reinforcement of a patient-centered care model, use of peer modeling and support, and emphasis on more interactive and small-group learning techniques. [source] Resident Training in Emergency Ultrasound: Consensus Recommendations from the 2008 Council of Emergency Medicine Residency Directors ConferenceACADEMIC EMERGENCY MEDICINE, Issue 2009Saadia Akhtar MD Abstract Over the past 25 years, research performed by emergency physicians (EPs) demonstrates that bedside ultrasound (US) can improve the care of emergency department (ED) patients. At the request of the Council of Emergency Medicine Residency Directors (CORD), leaders in the field of emergency medicine (EM) US met to delineate in consensus fashion the model "US curriculum" for EM residency training programs. The goal of this article is to provide a framework for providing US education to EM residents. These guidelines should serve as a foundation for the growth of resident education in EM US. The intent of these guidelines is to provide minimum education standards for all EM residency programs to refer to when establishing an EUS training program. The document focuses on US curriculum, US education, and competency assessment. The use of US in the management of critically ill patients will improve patient care and thus should be viewed as a required skill set for all future graduating EM residents. The authors consider EUS skills critical to the development of an emergency physician, and a minimum skill set should be mandatory for all graduating EM residents. The US education provided to EM residents should be structured to allow residents to incorporate US into daily clinical practice. Image acquisition and interpretation alone are insufficient. The ability to integrate findings with patient care and apply them in a busy clinical environment should be stressed. [source] Conference Attendance Does Not Correlate With Emergency Medicine Residency In-Training Examination ScoresACADEMIC EMERGENCY MEDICINE, Issue 2009H. Gene Hern Jr MD Abstract Objectives:, The residency review committee for emergency medicine (EM) requires residents to have greater than 70% attendance of educational conferences during residency training, but it is unknown whether attendance improves clinical competence or scores on the American Board of Emergency Medicine (ABEM) in-training examination (ITE). This study examined the relationship between conference attendance and ITE scores. The hypothesis was that greater attendance would correlate to a higher examination score. Methods:, This was a multi-center retrospective cohort study using conference attendance data and examination results from residents in four large county EM residency training programs. Longitudinal multi-level models, adjusting for training site, U.S. Medical Licensing Examination (USMLE) Step 1 score, and sex were used to explore the relationship between conference attendance and in-training examination scores according to year of training. Each year of training was studied, as well as the overall effect of mean attendance as it related to examination score. Results:, Four training sites reported data on 405 residents during 2002 to 2008; 386 residents had sufficient data to analyze. In the multi-level longitudinal models, attendance at conference was not a significant predictor of in-training percentile score (coefficient = 0.005, 95% confidence interval [CI] = ,0.053 to 0.063, p = 0.87). Score on the USMLE Step 1 examination was a strong predictor of ITE score (coefficient = 0.186, 95% CI = 0.155 to 0.217; p < 0.001), as was female sex (coefficient = 2.117, 95% CI = 0.987 to 3.25; p < 0.001). Conclusions:, Greater conference attendance does not correlate with performance on an individual's ITE scores. Conference attendance may represent an important part of EM residency training but perhaps not of ITE performance. [source] Simulation in Graduate Medical Education 2008: A Review for Emergency MedicineACADEMIC EMERGENCY MEDICINE, Issue 11 2008Steve McLaughlin MD Abstract Health care simulation includes a variety of educational techniques used to complement actual patient experiences with realistic yet artificial exercises. This field is rapidly growing and is widely used in emergency medicine (EM) graduate medical education (GME) programs. We describe the state of simulation in EM resident education, including its role in learning and assessment. The use of medical simulation in GME is increasing for a number of reasons, including the limitations of the 80-hour resident work week, patient dissatisfaction with being "practiced on," a greater emphasis on patient safety, and the importance of early acquisition of complex clinical skills. Simulation-based assessment (SBA) is advancing to the point where it can revolutionize the way clinical competence is assessed in residency training programs. This article also discusses the design of simulation centers and the resources available for developing simulation programs in graduate EM education. The level of interest in these resources is evident by the numerous national EM organizations with internal working groups focusing on simulation. In the future, the health care system will likely follow the example of the airline industry, nuclear power plants, and the military, making rigorous simulation-based training and evaluation a routine part of education and practice. [source] Informed Consent for Research: Current Practices in Academic Emergency MedicineACADEMIC EMERGENCY MEDICINE, Issue 6 2008Edward Monico MD Abstract Background:, The emergency department (ED) environment presents unique barriers to the process of obtaining informed consent for research. Objectives:, The objective was to identify commonalities and differences in informed consent practices for research employed in academic EDs. Methods:, Between July 1, 2006, and June 30, 2007, an online survey was sent to the research directors of 142 academic emergency medicine (EM) residency training programs identified through the Accreditation Council for Graduate Medical Education (ACGME). Results:, Seventy-one (50%) responded. The average number of simultaneous clinical ED-based research projects reported was 7.3 (95% confidence interval [CI] = 5.53 to 9.07). Almost half (49.3%) of respondents reported that EM residents are responsible for obtaining consent. Twenty-nine (41.4%) participating institutions do not require documentation of an individual resident's knowledge of the specific research protocol and consent procedure before he or she is allowed to obtain consent from research subjects. Conclusions:, It is common practice in academic EDs for clinical investigators to rely on on-duty health care personnel to obtain research informed consent from potential research subjects. This practice raises questions regarding the sufficiency of the information received by research subjects, and further study is needed to determine the compliance of this consent process with federal guidelines. [source] Outcome Assessment in Emergency Medicine,A Beginning: Results of the Council of Emergency Medicine Residency Directors (CORD) Emergency Medicine Consensus Workgroup on Outcome AssessmentACADEMIC EMERGENCY MEDICINE, Issue 3 2008Cherri Hobgood MD Abstract This article is designed to serve as a guide for emergency medicine (EM) educators seeking to comply with the measurement and reporting requirements for Phase 3 of the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project. A consensus workshop held during the 2006 Council of Emergency Medicine Residency Directors (CORD) "Best Practices" conference identified specific measures for five of the six EM competencies,interpersonal communication skills, patient care, practice-based learning, professionalism, and systems-based practice (medical knowledge was excluded). The suggested measures described herein should allow for ease in data collection and applicability to multiple core competencies as program directors incorporate core competency outcome measurement into their EM residency training programs. [source] | ||||||||||