Implementing a Residents as Teachers Program for Interns in Residencies in Community Hospitals

Federal Bills Raise Cap on Medicare-Funded Residency Positions and Modify Graduate Medical Education Policies.

CMS Finalizes Rules for Distribution of 1000 New Medicare-Funded Residency Positions and Changes to Rural Training Track Programs.

Objective Patients in Sweden’s rural community hospitals have not been clinically characterised. We compared characteristics of patients in general practitioner-led community hospitals in northern Sweden with those admitted to general hospitals. Design Retrospective register study. Setting Community and general hospitals in Västerbotten and Norrbotten counties, Sweden. Patients Patients enrolled at community hospitals and hospitalised in community and general hospitals between 1 January 2010 and 31 December 2014. Outcome measures Age, sex, number of admissions, main, secondary and total number of diagnoses. Results We recorded 16,133 admissions to community hospitals and 60,704 admissions to general hospitals. Mean age was 76.8 and 61.2 years for community and general hospital patients (p < .001). Women were more likely than men to be admitted to a community hospital after age adjustment (odds ratio (OR): 1.11; 95% confidence interval (CI): 1.09–1.17). The most common diagnoses in community hospital were heart failure (6%) and pneumonia (5%). Patients with these diagnoses were more likely to be admitted to a community than a general hospital (OR: 2.36; 95% CI: 2.15–2.59; vs. OR: 3.32: 95% CI: 2.77–3.98, respectively, adjusted for age and sex). In both community and general hospitals, doctors assigned more diagnoses to men than to women (both p<.001). Conclusions Patients at community hospitals were predominantly older and women, while men were assigned more diagnoses. The most common diagnoses were heart failure and pneumonia. Our observed differences should be further explored to define the optimal care for patients in community and general hospitals. Key points The patient characteristics at Swedish general practitioner-led rural community hospitals have not yet been reported. This study characterises inpatients in community hospitals compared to those referred to general hospitals. • Patients at community hospitals were predominantly older, with various medical conditions that would have led to a referral to general hospitals elsewhere in Sweden. • Compared to men, women were more likely to be admitted to community hospitals than to general hospitals, even after adjustment for age. To the best of our knowledge, this pattern has not been reported in other countries with community hospitals. • In both community hospitals and general hospitals, doctors assigned more diagnoses to men than to women.

Rural Hospital Disparities in Goals of Care Documentation.

College of Medicine, University of Saskatchewan.

University of Missouri—Kansas City School of Medicine

Nurse staffing levels in American hospitals: A 2001 report

University of Cincinnati College of Medicine

Availability of anesthesia personnel in rural Washington and Montana.

Rural Residency Training as a Strategy to Address Rural Health Disparities: Barriers to Expansion and Possible Solutions.

Internal Medicine Residency Training on Topics in Ambulatory Care: A Status Report

Veterans Health Administration (VHA) enrollees may use community hospitals for inpatient care and sometimes require transfer to larger community or VHA hospitals. Little is known about interhospital transfer patterns among veterans using community and VHA hospitals or how coronavirus disease 2019 (COVID-19) case surges affected transfer. Retrospective cohort study among veterans age 65+ admitted to community and VHA hospitals for acute myocardial infarction (AMI) or acute ischemic stroke (AIS) during 2018-2021. We examined associations between COVID-19 case density in regional hospital referral networks and the likelihood of transfer. A total of 8373 (23.6%) veterans with AMI and 4630 (13.1%) with AIS were transferred in the prepandemic period. Transfer was especially common for rural veterans (36% with AMI, 20% with AIS). Most transfers (88%) were between community hospitals and 6% from community to VHA. Among AMI patients, transfer was less likely among patients age >90 (relative to age 65-69), those with non-White race/ethnicity, and females. Transfer was more common among patients initially seen in rural hospitals (AMI, odds ratio [OR] = 2.73, 95% confidence interval [CI], 2.90-3.74; AIS, OR = 2.43; 95% CI, 2.24-2.65). During 2020-2021, transfer among AMI patients was less likely during COVID-19 case density surges affecting the admitting hospital's referral network (OR = 0.86; 95% CI, 0.78-0.96 for highest compared with lowest quartile of COVID-19 cases). Interhospital transfer was common for veterans with AMI and AIS, especially among rural veterans. Few transfers were to VHA hospitals. COVID-19 case surges were associated with decreased transfer for veterans with AMI, potentially limiting access to needed care.

To assess the perspectives of internal medicine (IM) residency directors on issues that might determine the feasibility of consortia for IM graduate medical education (GME). A self-administered questionnaire was mailed to all 413 U.S. IM program directors in June 1994. Of the 413 IM programs, 215 were located in community hospitals; 123 in university hospitals; and 75 in municipal, Veterans Administration, or military hospitals, or hospitals associated with multispecialty clinics ("other"). The questionnaire elicited responses concerning (1) perspectives on the quality of academic affiliations, (2) experience with formal institutional collaboration on GME issues and projection of consortium success, and (3) possible barriers to the success of consortia. Data were analyzed by comparing responses from the three program categories. In all, 330 (80%) program directors responded. Two-thirds reported ongoing academic affiliations. A larger percentage of university program directors considered these ties to be strong and advantageous than did their colleagues in community or other hospitals, who also considered their affiliations to be less equitable and less mutually trusting. Only 31% of community and university programs and 40% of other programs reported any prior experience with institutional collaboration on GME issues. A high percentage of those respondents considered these collaborative experiences to be successful and were optimistic about the projected success of consortia. Of seven possible barriers to consortium success, competition, governance, bureaucracy, and mistrust were most often perceived as major barriers. The data appear to indicate some optimism for the prospects of GME consortia, thereby supporting their feasibility for IM GME. Although many respondents perceived barriers to success, such perceptions were less common among program directors who had had direct experience with previous collaborative efforts. Nevertheless, these barriers may require attention if consortia are to succeed in achieving their many possible advantages.

Robotic telerounding is effective from the standpoint of patients' satisfaction and patients' care in teaching and community hospitals. However, the impact of robotic telerounding by the intensivist rounding remotely in the surgical intensive care unit (SICU), on patients' outcome and on the education of medical students physician assistants and surgical residents, as well as on nurses' satisfaction has not been studied. Prospective evaluation of robotic telerounding (RT) using a Likert Scale measuring tool to assess whether it can replace conventional rounding (CR) from the standpoint of patients' care and outcome, nursing satisfaction, and educational effectiveness. RT did not have a negative impact on patients' outcome during the study interval: mortality 5/42 (12 %) versus 6/37 (16 %), RT versus CR, respectively, p = 0.747. The intensivists rounding in the SICU were satisfied with their ability to deliver the same patients' care remotely (Likert score 4.4 ± 0.2). The educational experience of medical students, physicia assistants, and surgical residents was not affected by RT (average Likert score 4.5 ± 0.2, 3.9 ± 0.4, and 4.4 ± 0.4 for surgical residents, medical students and PAs, respectively, p > 0.05). However, as shown by a Likert score of 3.5 ± 1.0, RT did not meet nurses' expectations from several standpoints. Intensivists regard robotic telerounding as an effective alternative to conventional rounding from the standpoint of patients' care and teaching. Medical students, physician assistants (PA's), and surgical residents do not believe that RT compromises their education. Despite similar patients' outcome, nurses have a less favorable opinion of RT; they believe that the physical presence of the intensivist is favorable at all times.

A Role for Live-Animal Models in Undergraduate Surgical Education During the Cadaver Shortage.