scholarly journals Simulation Improves Internal Medicine Resident Confidence With Defibrillation, Cardioversion, and Transcutaneous Pacemaker Use

Cureus ◽  
2021 ◽  
Author(s):  
Alexander W Smith ◽  
John O Elliott ◽  
Brad D Gable
Keyword(s):  
Internal Medicine ◽  
Internal Medicine Resident ◽  
Medicine Resident

Drug Alert Experience and Salience during Medical Residency at Two Healthcare Institutions

2021 ◽  
Vol 12 (02) ◽  
pp. 355-361
Author(s):  
Kinjal Gadhiya ◽  
Edgar Zamora ◽  
Salim M. Saiyed ◽  
David Friedlander ◽  
David C. Kaelber
Keyword(s):  
Internal Medicine ◽  
Residency Training ◽  
Medical Center ◽  
Internal Medicine Resident ◽  
Clinical Decision ◽  
University Of Pennsylvania ◽  
Teaching Hospitals ◽  
Medicine Resident ◽  
Internal Medicine Residents ◽  
The University

Abstract Background Drug alerts are clinical decision support tools intended to prevent medication misadministration. In teaching hospitals, residents encounter the majority of the drug alerts while learning under variable workloads and responsibilities that may have an impact on drug-alert response rates. Objectives This study was aimed to explore drug-alert experience and salience among postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2), and postgraduate year 3 (PGY-3) internal medicine resident physicians at two different institutions. Methods Drug-alert information was queried from the electronic health record (EHR) for 47 internal medicine residents at the University of Pennsylvania Medical Center (UPMC) Pinnacle in Pennsylvania, and 79 internal medicine residents at the MetroHealth System (MHS) in Ohio from December 2018 through February 2019. Salience was defined as the percentage of drug alerts resulting in removal or modification of the triggering order. Comparisons were made across institutions, residency training year, and alert burden. Results A total of 126 residents were exposed to 52,624 alerts over a 3-month period. UPMC Pinnacle had 15,574 alerts with 47 residents and MHS had 37,050 alerts with 79 residents. At MHS, salience was 8.6% which was lower than UPMC Pinnacle with 15%. The relatively lower salience (42% lower) at MHS corresponded to a greater number of alerts-per-resident (41% higher) compared with UPMC Pinnacle. Overall, salience was 11.6% for PGY-1, 10.5% for PGY-2, and 8.9% for PGY-3 residents. Conclusion Our results are suggestive of long-term drug-alert desensitization during progressive residency training. A higher number of alerts-per-resident correlating with a lower salience suggests alert fatigue; however, other factors should also be considered including differences in workload and culture.

scholarly journals Military Internal Medicine Resident Decision to Apply to Fellowship and Extend Military Commitment

2018 ◽  
Vol 183 (7-8) ◽  
pp. e299-e303 ◽  
Author(s):  
Alice E Barsoumian ◽  
Joshua D Hartzell ◽  
Erin M Bonura ◽  
Roseanne A Ressner ◽  
Timothy J Whitman ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Internal Medicine Resident ◽  
Medicine Resident

scholarly journals EMR-based handoff tool improves completeness of internal medicine residents’ handoffs

2018 ◽  
Vol 7 (3) ◽  
pp. e000188 ◽  
Author(s):  
Rebecca L Tisdale ◽  
Zac Eggers ◽  
Lisa Shieh
Keyword(s):  
Internal Medicine ◽  
Medical Center ◽  
Internal Medicine Resident ◽  
Objective Data ◽  
Code Status ◽  
Medicine Resident ◽  
Communication Breakdown ◽  
Internal Medicine Residents ◽  
Action List ◽  
Identical Fashion

BackgroundThe majority of adverse events in healthcare involve communication breakdown. Physician-to-physician handoffs are particularly prone to communication errors, yet have been shown to be more complete when systematised according to a standardised bundle. Interventions that improve thoroughness of handoffs have not been widely studied.AimTo measure the effect of an electronic medical record (EMR)-based handoff tool on handoff completeness.InterventionThis EMR-based handoff tool included a radio button prompting users to classify patients as stable, a ‘watcher’ or unstable. It automatically pulled in EMR data on the patient’s 24-hour vitals, common lab tests and code status. Finally, it provided text boxes labelled ‘Active Issues’, ‘Action List (To-Dos)’ and ‘If/Then’ to fill in.Implementation and evaluationWritten handoffs from general and specialty (haematology, oncology, cardiology) Internal Medicine resident-run inpatient wards were evaluated on a randomly chosen representative sample of days in April and May 2015 at Stanford University Medical Center, focusing on a predefined set of content elements. The intervention was then implemented in June 2015 with postintervention data collected in an identical fashion in August to September 2016.ResultsHandoff completeness improved significantly (p<0.0001). Improvement in inclusion of illness severity was notable for its magnitude and its importance in establishing a consistent mental model of a patient. Elements that automatically pulled in data and those prompting users to actively fill in data both improved.ConclusionA simple EMR-based handoff tool providing a mix of frameworks for completion and automatic pull-in of objective data improved handoff completeness. This suggests that EMR-based interventions may be effective at improving handoffs, possibly leading to fewer medical errors and better patient care.

scholarly journals Educational Conference Scheduling, Patient Discharge Time, and Resident Satisfaction

2014 ◽  
Vol 6 (3) ◽  
pp. 574-576 ◽  
Author(s):  
Steffanie Campbell ◽  
Matthew Campbell ◽  
Chirayu Shah ◽  
Alexander M. Djuricich
Keyword(s):  
Internal Medicine ◽  
Medical Patient ◽  
Patient Discharge ◽  
Internal Medicine Resident ◽  
Case Conference ◽  
Morning Report ◽  
Discharge Time ◽  
Medicine Resident ◽  
Medicine Service ◽  
Internal Medicine Residents

Abstract Background Limits on resident duty hours instituted in 2003 and 2011 have compressed medical resident daily workload. Despite this compression, residents must gain competence to practice medicine without supervision. Objective We sought to determine whether moving the time our educational conference is scheduled affects the time when patient discharges are completed on an internal medicine teaching service. Methods The study was conducted at a county hospital within a large internal medicine residency program. During the 4-month study period, the morning report conference for internal medicine residents was shifted from 8:30 am to 2 pm. Patient discharge times, defined as the time the discharge order set was signed, were obtained for the service via the electronic health record. The outcomes measured were patient discharge time variation and internal medicine resident preference for conference time. Results Survey response rate was 82% (42 of 51). Of the residents who responded, 64% (27 of 42) preferred the 8:30 am report time, and 74% (31 of 42) felt the 8:30 am time was also better for education and timing of teaching rounds. There was no difference in discharge times for 2999 patients on the medicine teaching service, whether educational case conference morning report occurred at 8:30 am or at 2 pm. Conclusions Medical patient average discharge time was not influenced by time of educational conference. Factors other than the timing of educational conference appear to influence hospital discharge times on an inpatient internal medicine service.

Warfarin Management Using Point-of-Care Testing in a University-Based Internal Medicine Resident Clinic

2012 ◽  
Vol 344 (4) ◽  
pp. 289-293 ◽  
Author(s):  
Marcus Smith ◽  
Sarah Grace ◽  
Michael S. Bronze ◽  
Rhett Jackson ◽  
Donald Harrison ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Point Of Care ◽  
Internal Medicine Resident ◽  
Point Of Care Testing ◽  
Medicine Resident

How do resident physicians prefer to seek help from burnout? A best-worst scaling survey of internal medicine resident physicians examining rank-ordered factors for help-seeking and barriers to utilizing mental health supports (Preprint)

2021 ◽  
Author(s):  
Andrew Wu ◽  
Varsha Radhakrishnan ◽  
Elizabeth Targan ◽  
Timothy P Scarella ◽  
John Torous ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Peer Support ◽  
Help Seeking ◽  
Latent Class ◽  
Internal Medicine Resident ◽  
Wellness Programs ◽  
Specific Information ◽  
Medicine Resident ◽  
Resident Physicians ◽  
Best Worst Scaling

BACKGROUND Burnout interventions are limited by low utilization. Understanding resident physician preferences for burnout interventions may increase utilization and improve assessment of interventions. OBJECTIVE An econometric best-worst scaling (BWS) framework was used to survey internal medicine resident physicians to establish help-seeking preferences for burnout and barriers to utilizing wellness supports. METHODS Internal medicine resident physicians at our institution completed an anonymous online BWS survey during the 2020-2021 academic year. This cross-sectional study was analyzed with multinomial logistic regression and latent class modeling to determine relative rank-ordering of factors for seeking support for burnout and barriers to utilizing wellness supports. ANOVA with post-hoc Tukey HSD was used to analyze differences in mean utility scores representing choice for barriers and support options. RESULTS 77 residents completed the survey (47% response rate). Top-ranking factors for seeking wellness supports were seeking informal peer support (best: 71%/worst: 0.6%) and support from friends and family (best: 70%/worst: 1.6%). Top-ranking barriers to seeking counseling were time (best: 75%/worst: 5%) and money (best: 35%/worst: 21%). Latent class analysis identified two segments, a Formal Help-Seeking group (n=6) that preferred seeking therapy as their 2nd-ranking factor (best: 63%/worst: 0%), and an Open to Isolating group (n=20) that preferred to not seek support from others as their 3rd ranking factor (best: 14%/worst: 18%). CONCLUSIONS Overall, resident physicians reported high preference for informal peer support, though there exists a segment that prefer counseling services and a segment that prefers not to seek help at all. Time and cost are more significant barriers compared to stigma against utilizing wellness supports. Using BWS-informed studies are a promising and easy-to-administer methodology for clinician wellness programs to gather specific information on clinician preferences to determine best practices for wellness programs. CLINICALTRIAL N/A

Abstract P204: Home Blood Pressure Monitoring: A Missed Opportunity?

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Gin Den William Chang ◽  
Berta Shamuilova ◽  
Rebecca Mazurkiewicz ◽  
Arber Kodra
Keyword(s):  
Internal Medicine ◽  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Internal Medicine Resident ◽  
Home Blood Pressure ◽  
Home Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Medicine Resident ◽  
Progress Notes ◽  
Artery Disease

Introduction: The 2017 American College of Cardiology and American Heart Association hypertension guidelines recommend self-measured and home blood pressure (BP) monitoring to confirm the diagnosis of hypertension, to titrate anti-hypertensives and to assess adherence to treatment. However, it is unclear to what extent is home blood pressure monitoring being optimally utilized in everyday clinical practice. Hypothesis: We hypothesized that our Internal Medicine resident clinic underutilizes home BP monitoring as part of the diagnosis and continued management of hypertension. Methods: We performed a retrospective chart review of patients with a history of hypertension patients seen for at our Internal Medicine resident clinic in New York City between July 2019 and September 2019. We examined all progress notes in this time frame for documentation of home BP cuff measurements or prescriptions for home BP monitors as well as patient comorbidities such as tobacco use, coronary artery disease, diabetes and hyperlipidemia. The chi-square test was performed to evaluate and compare guideline adherence between groups. Statistical significance was considered at p < 0.05. Results: A total of 282 patients (mean age: 59) met inclusion criteria, of which, 114 (40.1%) had progress notes discussing home BP monitoring. Of those currently monitoring BP at home, 75/175 female patients (42%) and 68/107 male patients (63%) were not prescribed either a BP cuff or mention of a plan for home BP monitoring (p=0.0007). There was no significant correlation for BP cuff prescriptions or implementation of a BP diary in terms of resident year level, ethnicity, diabetes, coronary artery disease, hyperlipidemia, smoking history. Conclusion: There is a discrepancy in our current practice to incorporate home BP monitoring as part of the comprehensive care of hypertension particularly among males and females. There is a possibility that females are being targeted more for home blood pressure due to the preventive emphasis of cardiovascular morbidity in females. Current interventions including physician and patient clinic education as well as utilization of pamphlets to targeted patients are underway to improve this often overlooked component of hypertension management.

Sign in / Sign up

Export Citation Format

Share Document