Association Of Program Directors In Internal Medicine Research Articles

Management of the Electronic Health Record Inbox: Results From a National Survey of Internal Medicine Program Directors.

Background Internal medicine (IM) resident physicians spend a considerable amount of time managing their inbox as part of their longitudinal continuity clinic experience. There are no standardized guidelines for how programs should train, monitor, or supervise residents in this type of patient care. Objective To understand how IM residency programs educate, monitor, and supervise resident electronic health record (EHR) inbox management as part of their longitudinal continuity clinic and determine whether patient safety events have occurred due to EHR inbox-related patient care decisions made by unsupervised resident physicians. Methods In August 2021, 439 program directors at accredited US IM residency programs who were members of the Association of Program Directors in Internal Medicine (APDIM) were asked 12 questions developed by the study authors and APDIM survey committee members regarding resident EHR inbox management as part of the annual APDIM survey. Results Two hundred and sixty-seven (61%) PDs responded. The majority (224 of 267, 84%) of programs provided guidelines for expected message response times; less than half (115, 43%) monitored timeliness metrics. Only half (135; 51%) of programs required faculty supervision of inbox messages for all residents; 28% (76) did not require supervision for any residents. Twenty-one percent of PDs (56) reported awareness of a patient safety event occurring due to an unsupervised resident inbox-related patient care decision. Conclusions Substantial variability exists in how IM residency programs train, monitor, supervise, and provide coverage for resident inbox work. Program directors are aware of patient safety events resulting from unsupervised resident inbox management.

Characterization of Internal Medicine Chief Resident Administrative, Educational, and Clinical Experiences

The internal medicine (IM) chief residency is a position of leadership and honor common in IM programs, but the goals, responsibilities, and experiences of those who undertake it can be highly variable. Studies assessing the experience and impressions of the chief resident (CR) position from the viewpoint of the IM CRs are lacking. To describe the structure, responsibilities, and perceptions of the IM CR role across IM residency programs. A cross-sectional, simple descriptive electronic survey for current CRs was administered between April and June 2018 across US IM residency programs accredited by US Accreditation Council for Graduate Medical Education. A 2-step nonrandom sampling approach was used: first, snowball sampling was performed using the authors' professional networks, and second, the survey was sent to the Association of Program Directors in Internal Medicine (APDIM) CR listserv. Data analysis was performed from June 2020 to August 2020. Participation as a CR for an IM residency program in the 2017 to 2018 academic year. Descriptive CR personal and program characteristics and CR perceptions of administrative, clinical, and leadership experiences. Among 169 unique responses, 77 participants (46%) were female and 89 (53%) were White. The response rate was 57% (70 of 122 surveys) in the snowball sample and 12% (99 of 842 surveys) in the APDIM listserv. The 2 sampled groups were combined for analysis. Most respondents (125 CRs [74%]) were from academic or university-based programs. Common across CR responses was responsibility for administrative tasks, clinical work, and educational efforts. Most CRs (111 of 157 respondents [71%]) reported being the primary schedulers for the residency program. Clinical work differed widely across respondents. Only 70 of 156 respondents (45%) reported having an academic title associated with the CR role. CRs reported inconsistent evaluation throughout the year, with high percentages reporting never receiving feedback on teaching (34 respondents [23%]), clinical abilities (67 respondents [45%]), or leadership abilities (60 respondents [40%]). Most CRs (107 respondents [69%]) agreed that they find work as a CR fulfilling and 117 (74%) agreed they would do chief residency again. Despite its ubiquity in training programs across the US, the IM CR experience is very different across programs. Recommendations are provided to consider for improvement of the CR experience, including structured feedback opportunities, maximizing educational and clinical experiences, and standardizing policies.

Virtual Recruitment: Experiences and Perspectives of Internal Medicine Program Directors

Virtual Recruitment: Experiences and Perspectives of Internal Medicine Program Directors

The New Internal Medicine Subinternship Curriculum Guide: a Report from the Alliance for Academic Internal Medicine.

The internal medicine (IM) subinternship has been a long-established clinical experience in the final phase of medical school deemed by key stakeholders as a crucial rotation to prepare senior medical students for internship. Medical education has changed greatly since the first national curriculum for this course was developed in 2002 by the Clerkship Directors in Internal Medicine (CDIM). Most notably, competency-based medical education (CBME) has become a fixture in graduate medical education and has gradually expanded into medical school curricula. Still, residency program directors and empirical studies have identified gaps and inconsistencies in knowledge and skills among new interns. Recognizing these gaps, the Association of Program Directors in Internal Medicine (APDIM) surveyed its members in 2010 and identified four core skills essential for intern readiness. The Association of American Medical Colleges (AAMC) also published 13 core entrustable professional activities (EPAs) for entering residency to be expected of all medical school graduates. Results from the APDIM survey along with the widespread adoption of CBME informed this redesign of the IM subinternship curriculum. The authors provide an overview of this new guide developed by the Alliance for Academic Internal Medicine (AAIM) Medical Student-to-Resident Interface Committee (MSRIC).

Postinterview Communication: Strategies for a New Generation of Residency Applicants.

Postinterview Communication: Strategies for a New Generation of Residency Applicants.

Awareness of Bullying in Residency: Results of a National Survey of Internal Medicine Program Directors.

Bullying of medical trainees is believed to occur more frequently in medical education than once thought. We conducted a survey to understand internal medicine program director (PD) perspectives and awareness about bullying in their residency programs. The 2015 Association of Program Directors in Internal Medicine (APDIM) annual survey was e-mailed to 368 of 396 PDs with APDIM membership, representing 93% of internal medicine residency programs. Questions about bullying were embedded within the survey. Bivariate analyses were performed on PD and program characteristics. Of a total of 368 PD APDIM members, 227 PDs (62%) responded to the survey. Less than one-third of respondents (71 of 227, 31%) reported being aware of bullying in their residency programs during the previous year. There were no significant differences in program or PD characteristics between respondents who reported bullying in their programs and those who did not (gender, tenure as PD, geographic location, or specialty, all P > .05). Those who acknowledged bullying in their program were more likely to agree it was a problem in graduate medical education (P < .0001), and it had a significant negative impact on the learning environment (P < .0001). The majority of reported events entailed verbal disparagements, directed toward interns and women, and involved attending physicians, other residents, and nurses. This national survey of internal medicine PDs reveals that a minority of PDs acknowledged recent bullying in their training programs, and reportedly saw it as a problem in the learning environment.

The Internal Medicine Subinternship--Now More Important than Ever: A Joint CDIM-APDIM Position Paper.

For decades, the internal medicine (IM) subinternship has served as a critical interface between undergraduate and graduate medical education. As such, the vast majority of U.S. medical schools offer this rotation to help students prepare for post-graduate training. Historically an experiential rotation, a formal curriculum with specific learning objectives was eventually developed for this course in 2002. Since then, graduate medical education (GME) has changed significantly with the regulation of duty hours, adoption of competency-based education, and development of training milestones and entrustable professional activities. In response to these and many other changes to residency training and medical practice, in 2010, the Association of Program Directors in Internal Medicine (APDIM) surveyed its members-with input from the Clerkship Directors in Internal Medicine (CDIM) Subinternship Task Force-to determine which core skills program directors expected from new medical school graduates. The results of that survey helped to inform a joint CDIM-APDIM committee's decision to re-evaluate the goals of the IM subinternship in an effort to enhance the transition from medical school to residency. This joint committee defined the minimum expectations of what constitutes an IM subinternship rotation, proposed recommended skills for IM subinterns, and discussed challenges and future directions for this crucial course.

Burnout and Distress Among Internal Medicine Program Directors: Results of A National Survey

Physician burnout and distress has been described in national studies of practicing physicians, internal medicine (IM) residents, IM clerkship directors, and medical school deans. However, no comparable national data exist for IM residency program directors. To assess burnout and distress among IM residency program directors, and to evaluate relationships of distress with personal and program characteristics and perceptions regarding implementation and consequences of Accreditation Council for Graduate Medical Education (ACGME) regulations. The 2010 Association of Program Directors in Internal Medicine (APDIM) Annual Survey, developed by the APDIM Survey Committee, was sent in August 2010 to the 377 program directors with APDIM membership, representing 99.0 % of the 381 United States categorical IM residency programs. The 2010 APDIM Annual Survey included validated items on well-being and distress, including questions addressing quality of life, satisfaction with work-life balance, and burnout. Questions addressing personal and program characteristics and perceptions regarding implementation and consequences of ACGME regulations were also included. Of 377 eligible program directors, 282 (74.8 %) completed surveys. Among respondents, 12.4 % and 28.8 % rated their quality of life and satisfaction with work-life balance negatively, respectively. Also, 27.0 % reported emotional exhaustion, 10.4 % reported depersonalization, and 28.7 % reported overall burnout. These rates were lower than those reported previously in national studies of medical students, IM residents, practicing physicians, IM clerkship directors, and medical school deans. Aspects of distress were more common among younger program directors, women, and those reporting greater weekly work hours. Work-home conflicts were common and associated with all domains of distress, especially if not resolved in a manner effectively balancing work and home responsibilities. Associations with program characteristics such as program size and American Board of Internal Medicine (ABIM) pass rates were not found apart from higher rates of depersonalization among directors of community-based programs (23.5 % vs. 8.6 %, p = 0.01). We did not observe any consistent associations between distress and perceptions of implementation and consequences of program regulations. The well-being of IM program directors across domains, including quality of life, satisfaction with work-life balance, and burnout, appears generally superior to that of medical trainees, practicing physicians, and other medical educators nationally. Additionally, it is reassuring that program directors' perceptions of their ability to respond to current regulatory requirements are not adversely associated with distress. However, the increased distress levels among younger program directors, women, and those at community-based training programs reported in this study are important concerns worthy of further study.

Changes in the National Residency Matching Program Policy: Are Internal Medicine Program Directors “All-In”?

Michael Adams, MD, FACP, is Program Director of Medicine at Georgetown University; Thomas B. Morrison, MD, is Fellow in Cardiovascular Medicine at Vanderbilt University; Stephanie Call, MD, is Program Director of Medicine at Virginia Commonwealth University; Andrew J. Halvorsen, MS, is Biostatistician and Project and Data Manager in the Internal Medicine Residency Office of Educational Innovations at Mayo Clinic; Jared Moore, MD, is Chief Medical Resident in Internal Medicine at Ohio State University; Maria Lucarelli, MD, is Associate Program Director in Internal Medicine at Ohio State University; Steven Angus, MD, is Program Director of Medicine at the University of Connecticut Health Center; and Furman S. McDonald, MD, MPH, is Program Director of Internal Medicine Residency Office of Educational Innovations at the Mayo Clinic. Funding: This study was supported in part by the Mayo Clinic Internal Medicine Residency Office of Educational Innovations as part of the ACGME Educational Innovations Project. The Mayo Clinic Survey Research Center provided assistance with the survey design and data collection. We are grateful for the support of the Association of Program Directors of Internal Medicine and the members of the Survey Committee and to the residency program directors who completed the Association of Program Directors in Internal Medicine (APDIM) survey. While we are reporting the results of the APDIM Survey Committee, we are not presuming to speak for the organization and our paper does not constitute an official policy statement of APDIM, the APDIM Council, or any other organzation with which any of the authors may be affiliated.

“MiPLAN” to Teach With the Assistance of Our Patients

OPEN ACCESSMay 17, 2012“MiPLAN” to Teach With the Assistance of Our Patients Chad Stickrath, MD, Melver Anderson, MD, Eva Aagaard, MD Chad Stickrath, MD Denver VA Medical Center Google Scholar More articles by this author , Melver Anderson, MD Denver VA Medical Center Google Scholar More articles by this author , Eva Aagaard, MD University of Colorado Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9173 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractEducators espouse the benefits of bedside teaching, that is, teaching in the presence of the patient, and faculty and trainees report they would like to see this method of education increase. However, studies show that the proportion of teaching that occurs in the presence of the patient continues to diminish. Furthermore, faculty feel inadequately prepared to teach in this setting. We developed a model for clinical teaching based upon these principles of learning and derived from decades of collective medical education experience. The aim was to deconstruct the highly complex activities of effective clinical teachers and repackage them in a manner that would be memorable and helpful for other teachers. In particular, we hope that this method will promote more and higher-quality teaching with the patient present. This model, named MiPLAN, encourages teachers to meet their learners before engaging in shared clinical and educational activities (the M) and to focus on five areas as the learner presents in the presence of the patient (the i's: introductions, interruptions, in the moment, inspection, and independent thought); the model then provides an algorithm for teaching after the presentation (the PLAN: patient care-centered, learner-centered, attending-centered, and next steps). This resource teaches the MiPLAN model in a workshop session lasting 90–120 minutes. The workshop utilizes a PowerPoint presentation.We have implemented this faculty development workshop on five occasions: once at the Association of Program Directors in Internal Medicine (APDIM) Chief Residents Annual Meeting, three times at the local school of medicine, and once at a local chief resident teaching retreat. Evaluations collected from the APDIM workshop were very positive. The presentation scored an average 6.44 out of 7 and the content a 6.31 out of 7 from 59 respondents. Comments included “Excellent session,” “Great incorporation of videos,” “The best session I attended,” and “Very useful tools.” Evaluations collected from the local sessions have also been very positive, with averages of 3.67-3.89 out of 4 for ratings on the organization, usefulness, and quality of the content and presentation. Educational Objectives By the end of this session, learners will be able to: Explain the rationale for teaching in the presence of the patient.Recognize the barriers to teaching and learning in the presence of the patient.Discuss strategies and techniques to enhance their abilities to teach effectively in the presence of the patient.Employ the MiPLAN model to make teaching in the presence of the patient fun, effective, and simple. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Bedside Teaching MedEdPORTAL.ppt MiPLAN MedEdPORTAL Eval.doc MiPLAN MedEdPORTAL Teachers outline.docx MiPLAN Overcoming Obstacles.doc MiPLAN Worksheet Teacher Edition.doc MiPLAN Worksheet.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationStickrath C, Anderson M, Aagaard E. “MiPLAN” to Teach With the Assistance of Our Patients. MedEdPORTAL. 2012;8:9173. https://doi.org/10.15766/mep_2374-8265.9173 Copyright & Permissions© 2012 Stickrath et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.KeywordsMiPLANBedside Instruction Disclosures None to report. Funding/Support None to report. Loading ...

Major Concerns About Internal Medicine: Insights from Program Directors

To better understand and characterize the challenges facing internal medicine from the perspective of internal medicine residency program directors. In 2007, internal medicine program directors were surveyed by the Association of Program Directors in Internal Medicine (APDIM). An open-ended question asked: "What are your major concerns regarding internal medicine?" Responses to this question were independently coded by two investigators and compared for agreement. Content analysis identified several major themes related to their concerns. Of the 236 program directors completing the survey, 186 (79%) answered the question and explained their concerns. Approximately one half of the informants were general internists. There was a fairly even distribution among assistant, associate, and professor ranking. All regions of the country were represented. Five themes emerged as the program directors' major concerns about internal medicine: waning interest in internal medicine, especially primary care; onerous regulatory oversight; economic pressures; the eighty-hour work week; and fragmentation within internal medicine. By virtue of their role, internal medicine residency directors gain a unique understanding about the core elements that contribute to declining interest in careers in internal medicine, which is particularly relevant given the current primary care workforce crisis. Collaboration among stakeholders that can influence healthcare policy to address these concerns about internal medicine will be necessary to revive interest in the field.

Origins of JCHIMP

With this, the first issue of the Journal of Community Hospital Internal Medicine Perspectives ( www.jchimp.org ), volume 1, the efforts of many individuals are no longer a concept but a reality. The journal’s origins can be traced back to 2007 at the Association of Program Directors in Internal Medicine (APDIM) semi-annual meeting in Minneapolis, Minnesota. Prior to that meeting, the Department of Medicine at Union Memorial Hospital in Baltimore, Maryland had conducted a very successful research survey of internal medicine program directors in Pennsylvania, Maryland, and the District of Columbia. Using this regional success as a model, a national network was organized in Minneapolis. (Published: 9 May 2011) Citation: Journal of Community Hospital Internal Medicine Perspectives 2011, 1 : 6328 - DOI: 10.3402/jchimp.v1i1.6328

Jumpstarting Academic Careers with a Novel Intern Research Rotation: the AIMS Rotation

The Accreditation Council for Graduate Medical Education (ACGME). requirements for residency education in internal medicine specifically state that the program must advance residents’ knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care.1 Further, residents should participate in scholarly activity and the sponsoring institution and program should allocate adequate educational resources to facilitate resident involvement in scholarly activities.1 The scholarly activity requirement may be satisfied with projects other than research, including journal clubs, presentation at grand rounds, and quality improvement projects. Some programs have developed structured research training experiences that prepare residents to present their research at professional or scientific meetings, write manuscripts in peer reviewed journals, and publish review articles or book chapters.2 Dedicated research activities advance the core competencies and are often highly rated aspects of residency training.3–5 In fact, most residents feel research should be required.6 A recent article suggests that residency program enhancements in patient care, education, community service, and research improve departments of internal medicine and teaching hospitals.7 Finally, research experiences may encourage some residents to consider a career in clinical investigation.8 Despite these potential benefits, implementing a structured research curriculum in a busy residency program remains a logistical challenge. In a meta-analysis, Hebert and colleagues9 identified four features of successful resident research programs: exposure to and guidance from mentors, training in basic research methods, protected time, and an environment supportive of research. The vast majority of internal medicine programs offer one to two months of protected research time during postgraduate year (PGY) two or three. An informal email survey of the Association of Program Directors in Internal Medicine (APDIM) listserver participants showed that 121 of 143 programs, or 85%, offered at least four weeks for research. However, successful resident research projects require much greater commitment of time, interest, and resources. Pursuit of research interests is often displaced by patient care demands.10 We previously described resident research as a three-year continuum of preparation, investigation, and synthesis phases in which early preparation is critical.11 Delaying bona fide research experiences to PGY-2 and compressing them into a one-month block, along with an often ad hoc search for mentors, limits the resident’s chances for success. Such frustrating research experiences may even deter residents from careers in clinical investigation. We recently implemented the four-week Academic Internal Medicine Scholarship (AIMS) rotation, which introduces all interns to the process of organized inquiry and research. Each intern designs a feasible, scientifically sound research project to be completed over the course of residency. They learn research methodology, cultivate mentoring relationships, and develop interdisciplinary collaborations. Since 2005, all interns in the categorical internal medicine residency program at University of California, Davis, School of Medicine (UC Davis) have completed this rotation. We describe the early success of this novel research curriculum. This project has been approved by the UC Davis Institutional Review Board (IRB).

Demographic and work-life study of chief residents: a survey of the program directors in internal medicine residency programs in the United States.

Chief residents play a crucial role in internal medicine residency programs in administration, academics, team building, and coordination between residents and faculty. The work-life and demographic characteristics of chief residents has not been documented. To delineate the demographics and day-to-day activities of chief residents. The Survey Committee of the Association of Program Directors in Internal Medicine (APDIM) developed a Web-based questionnaire. A link was sent in November 2006 by e-mail to 381 member programs (98%). Data collection ended in April 2007. Data collected include the number of chief residents per residency, the ratio of chief residents per resident, demographics, and information on salary/benefits, training and mentoring, and work life. The response rate was 62% (N = 236). There was a mean of 2.5 chief residents per program, and on average there was 1 chief resident for 17.3 residents. Of the chief residents, 40% were women, 38% international medical graduates, and 11% minorities. Community-based programs had a higher percentage of postgraduate year 3 (PGY-3)-level chief residents compared to university-based programs (22% versus 8%; P = .02). Mean annual salary was $60 000, and the added value of benefits was $21 000. Chief residents frequently supplement their salaries through moonlighting. The majority of formal training occurs by attending APDIM meetings. Forty-one percent of programs assign academic rank to chief residents. Most programs have at least 2 chief residents and expect them to perform administrative functions, such as organizing conferences. Most programs evaluate chief residents regularly in administration, teaching, and clinical skills.

A Commentary on the Use of the Internal Medicine In-Training Examination

The Internal Medicine In-Training Examination (IM-ITE) was developed by the American College of Physicians (ACP), the Association of Program Directors in Internal Medicine (APDIM), and the Association of Professors of Medicine (APM).1 The current test has 340 questions in 11 content areas and a 7-hour time limit, and is administered annually in the fall. The test is designed to evaluate the knowledge base of postgraduate year (PGY)-2 residents; however, most internal medicine residency programs administer the test to residents at all levels.

Redesigning Training for Internal Medicine

Letters5 December 2006Redesigning Training for Internal MedicineJohn P. Fitzgibbons, MD and Frederick J. Meyers, MDJohn P. Fitzgibbons, MDFrom Alliance for Academic Internal Medicine Education Redesign Task Force, Washington, DC.Search for more papers by this author and Frederick J. Meyers, MDFrom Alliance for Academic Internal Medicine Education Redesign Task Force, Washington, DC.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-145-11-200612050-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: The internal medicine community is beginning to reach consensus on how to strengthen graduate medical education. In the ACP position paper by Weinberger and colleagues (1) and the Association of Program Directors in Internal Medicine (APDIM) position paper by Fitzgibbons and colleagues (2), the discussions continue.For 2 years, the Alliance for Academic Internal Medicine (AAIM) Education Redesign Task Force, which includes representatives from the 5 associations in the AAIM, as well as the ACP and the American Board of Internal Medicine (ABIM), has been working 1) to define a core competency in internal medicine and 2) ...

Roles of various organizations in internal medicine curriculum reform.

The curriculum in internal medicine for medical students and residents is being driven increasingly by the service demands of our teaching hospitals and is badly in need of fundamental reform. In reasserting the primacy of education as the driving force for the curriculum, numerous tasks must be done to achieve successful reform. These tasks are well within the scope of the several organizations that command leadership positions in the discipline of internal medicine and that represent the spectrum of activities required to discharge the specialty's public responsibility. These organizations include the Association of Professors of Medicine (APM), the Association of Program Directors in Internal Medicine (APDIM), the Society of General Internal Medicine (SGIM), The Residency Review Committee for Internal Medicine (RRC-IM), the American Board of Internal Medicine (ABIM), the American College of Physicians (ACP), the American Society of Internal Medicine (ASIM), and the Federated Council of Internal Medicine (FCIM). The challenge posed by the need for curriculum reform is to rouse these organizations to concerted action. Each of the seven organizations must assume a specific role and a unique set of responsibilities in the epic reforms envisioned.