Resident Physician Attitudes Research Articles

Alignment Between Resident Medical Condition Regard Scale Scores and Desire to Treat Patients With Opioid Use Disorder.

To (1) evaluate attitudes of resident physicians towards patients with opioid use disorder (OUD) and (2) identify characteristics associated with residents' desire to treat patients with OUD. We administered the validated medical condition regard scale (MCRS), a question regarding desire to treat patients with OUD, and a demographic questionnaire to residents in multiple specialties at the University of New Mexico (family medicine, psychiatry, emergency medicine, internal medicine, anesthesiology, general surgery, obstetrics/gynecology). One hundred sixty-three of 307 residents (53%) responded to the survey; 146 provided complete responses to the "desire" and MCRS questions. Response rates, MCRS, and desire to care for patients with OUD varied between specialties ( P < 0.001); family medicine had highest MCRS and desire to care scores; surgery, anesthesiology had low scores. MCRS and resident "desire" scores were highly correlated on univariate analysis ( r = 0.73, P < 0.001); resident demographics were not. On logistic regression, resident desire to care for OUD increased with MCRS scores ( P < 0.001). The predicated probability of desire to care for OUD was ≥80% with MCRS >57; MCRS classification skill on receiver operator curve analysis was excellent (area under curve = 0.81 [95% confidence interval 0.74, 0.88], and specialty-adjusted MCRS area under curve = 0.85 [95% confidence interval 0.79, 0.91]). High resident regard for patients with OUD on MCRS was directly related to resident's desire to provide OUD care. MCRS may offer a tool to alter or individualize OUD education, potentially influencing the OUD workforce of the future.

An Analysis of the Involvement and Attitudes of Resident Physicians in Reporting Errors in Patient Care

An Analysis of the Involvement and Attitudes of Resident Physicians in Reporting Errors in Patient Care

Knowledge and Attitudes of Resident Physicians About Adverse Drug Reactions

Objective: WHO reported to all healthcare providers in its universal message that thousands of patients lives could be saved by reporting ADRs. In this study, we aimed to evaluate the knowledge levels and attitudes of the resident physicians about ADR and pharmacovigilance in our university hospital Method: This prospective study is performed by a questionnaire form consisted of 14 questions on 88 resident physicians who accepted to participate the study in Harran University Hospital. The study was started after gaining the approval of Harran University Faculty of Medicine Ethics Committee. The results of the questionnaire were evaluated by using SPSS 18.0 package program by frequency and percentage tests. Results: The exact definition of ADRs is correctly marked by 51.1% of doctors. Most of the physicians (69.3%) stated that they had never do ADR reporting. The rate of the participants who think that it is not the responsibility of the healthcare professionals to make ADR reporting is 9.1%. It was observed that only 6.8% of the physicians received professional information or training on ADR reporting. 72.7% of physicians think that, ADR is a serious problem in Turkey. Conclusion: This study showed that the level of knowledge and attitude of resident physicians working in our hospital about ADR reporting was not sufficient. We believe that it is important to raise awareness among the healthcare professionals about the ADRs reporting and the status can be improved by effective and periodical training methods.

Attitudes Toward Individuals With Mental Illness and Substance Use Disorders Among Resident Physicians.

Resident physicians frequently provide care for individuals diagnosed with mental illness and substance use disorders (SUDs). Clinicians-including psychiatrists and addiction professionals-have been shown to possess negative attitudes toward these individuals, which is concerning since negative attitudes may have an adverse impact on patient engagement, treatment, and outcomes. However, little is known about resident physicians' attitudes toward individuals with mental illness and SUDs. The objective of this study was to examine the attitudes of emergency medicine, internal medicine, and obstetrics-gynecology residents toward individuals with diagnoses of schizophrenia, multiple SUDs, co-occurring schizophrenia and SUDs, and major depressive disorder. A web-based questionnaire, including demographic information, level of training, and the 11-item Medical Condition Regard Scale (MCRS) for individuals with 4 different diagnoses, which assesses the degree to which clinicians find individuals with a given medical condition to be enjoyable, treatable, and worthy of medical resources, was sent to residents across the United States from May 2016 to April 2017. A total of 411 resident physicians completed the questionnaire. Respondents had more negative attitudes toward individuals with diagnoses of SUDs with and without schizophrenia than toward those individuals with diagnoses of schizophrenia or major depressive disorder alone. Senior residents possessed more negative attitudes toward individuals with SUDs than did junior residents. Emergency medicine residents had more negative attitudes than the other resident physician groups. The attitudes of resident physicians toward individuals with SUDs with and without schizophrenia were negative and were worse among emergency medicine residents and senior residents. Additional research and programmatic work are needed to understand the reasons for these negative attitudes and to develop interventions during residency training to improve them.

Attitudes of Resident Physicians Working in a University Hospital Towards Schizophrenia

Attitudes of Resident Physicians Working in a University Hospital Towards Schizophrenia

Assessing Origins of Quality Gaps in Discharge Summaries: A Survey of Resident Physician Attitudes.

Because little is known about attitudes of primary authors of discharge summaries in academic institutions, namely trainees and physician assistants (PAs), we sought to explore values, possible areas for improvement, and interest in formal discharge summary education. A survey composed of Likert scale analyses, dichotomous relationships, and open-ended questions was designed using focus groups and validated via expert committee review. Of 135 total residents (PGY 1-3), 79 residents and 10 PAs in a large academic hospital in New York City completed it. Of surveyed trainees, 77.2% reported that quality discharge summaries are useful in primary care. Interns had less outpatient experience with discharge summaries compared to PGY 2&3s (23.7% vs. 63.4%, p< 0.001) and were less comfortable authoring discharge summaries for patients who were not as familiar to them (47.4% vs. 24.4%, p=0.04). The majority (54.8%) of interns as well as all PAs reported never receiving feedback on discharge summaries. Finally, 63.2% of interns and 90% of PAs responded that formal teaching would be helpful. Interns' greater discomfort may speak to their poor understanding of core components of a useful discharge summary, which teaching sessions may improve. Alternatively, shifting the authorship responsibility from interns to seniors could be explored as a quality improvement initiative.

Resident physician's knowledge and attitudes toward biostatistics and research methods concepts.

Objectives:To assess the knowledge and attitudes of resident physicians toward biostatistics and research methodology concepts.Methods:We conducted a cross-sectional study between November 2014 and October 2014 at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. A self-administered questionnaire was distributed to all participants. The response rate was 90%.Results:One hundred sixty-two resident completed the questionnaire. Most residents were well-informed in basic concepts, such as, “P” values, study power, and case control studies; more than half had confidence in interpreting the results of scientific papers. Conversely, more than 67% of the residents were not knowledgeable on more sophisticated terms in biostatistics. Residents with previous training in evidence-based medicine (EBM) (p=0.05) and non-specialist residents (p=0.003) were more likely to have better knowledge scores. Females (p=0.003), and those with previous training in biostatistics and epidemiology had positive attitude toward biostatistics (p<0.001 in both cases). Residents who read medical journals scored lower than those who never read journals (p=0.001).Conclusion:Prior courses in EBM, as well as male gender were associated with knowledge scores. Reinforcing training after graduation from medical school with special focus on integrating biostatistics with epidemiology and research methods is needed.

RESIDENT PHYSICIAN ATTITUDES TOWARD ANTICOAGULATION FOR STROKE PREVENTION IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia. It is associated with an increased risk of ischemic strokes. Stroke prevention is the mainstay of management. Novel oral anticoagulants (NOACs) are part of the current therapeutic arsenal and resident physicians should be familiar with their use. The aim of this study was to identify practice patterns of Canadian resident physicians with respect to stroke prevention in patients with nonvalvular AF. METHODS: This was a cross-sectional survey, inviting internal, family, emergency medicine and adult cardiology residents from 8 academic centres across Canada. A web-based survey consisting of 13 multiple-choice questions was distributed. Questions focused on identifying risks of stroke and bleeding and selecting appropriate therapy in clinical scenarios involving patients with CHADS2 scores of 3. RESULTS: There were 704 respondents, of which 393 were internal, 196 family, 84 emergency medicine, and 31 adult cardiology residents. When determining the risk of stroke, 85% used CHADS2 and 70% used CHA2DS2-VASc scores. Assessment of bleeding risk was determined using theHAS-BLED score by 82% and 43% used clinical impression as an adjunct. When recommending one or more agents for a patient with no contraindications to anticoagulation, warfarin was chosen by 83% followed by rivaroxaban (55%), dabigatran (51%) and apixaban (48%). In a patient who had a history of gastrointestinal bleeding on acetylsalicylic acid (ASA) 1 year prior, 76% recommended warfarin, 34% apixaban, 29% rivaroxaban, 23% dabigatran and 13% ASA. For a patient on warfarin with labile INRs, 31% continued warfarin and provided more education, while 52% switched to a NOAC.When deciding on who should prescribe anticoagulation for a patient with a new diagnosis of AF in the emergency department, 46% chose family doctor, 32% emergency physician and 13%would consult internal medicine. If a reversal agent were to become available for theNOACs, 64% indicated theywould no longer prescribe warfarin for stroke prevention in most patients. CONCLUSION: This study revealed that, across a wide sampling of disciplines and centres, resident physician attitudes toward anticoagulation in patients with nonvalvular AF differ significantly from the current Canadian Cardiovascular Society guidelines. Lack of familiarity, fear of adverse events and absence of a reversal agent were identified as potential barriers to the use of NOACs. This study highlights the need for further education of Canadian resident physicians in the use of anticoagulants for stroke prevention in patients with nonvalvular AF.

Effects of a graduate-level interprofessional education program on adult nurse practitioner student and internal medicine resident physician attitudes towards interprofessional care

This article describes the development, implementation and evaluation of a longitudinal interprofessional education (IPE) experience for adult nurse practitioner students and internal medicine residents. This experience focused on providing care for complex community based patients during clinic and home visits, preceded by didactic learning that emphasized understanding one another’s professional roles and education, teamwork and conflict management. Evaluation demonstrated significant improvements in attitudes and beliefs associated with professional role, respect among health professions’ disciplines and conflict management. Results with regards to attitudes towards IPE and interprofessional practice, and valuing teamwork training were mixed. In particular, the curricular intervention did not change participants’self-reported skill in communication and did not affect attitudes and beliefs towards effects of interprofessional education on patient outcomes.

Suicídio: um tema pouco conhecido na formação médica

Esta pesquisa foi realizada em instituição federal pública universitária com o objetivo de melhor conhecer visões, valores e atitudes dos médicos residentes em clínica médica em relação ao suicídio. Trabalhou-se com o conceito de representação social (Moscovici) e a metodologia qualiquantitativa do discurso do sujeito coletivo (DSC) (Lefèvre e Lefèvre). Os discursos revelaram que os médicos residentes se apresentam sensibilizados com a questão do suicídio, entretanto não familiarizados com a bibliografia especializada e nem com os procedimentos de atendimento normatizados pelo Ministério da Saúde e pela OMS. Os pesquisados revelaram dificuldades para identificar e prestar atendimento a pacientes em risco de suicídio. Conclui-se que parece faltar à formação médica (graduação e residência) maior atenção ao tema suicídio.

Residents' attitudes and behaviors regarding care for underserved patients: a multi-institutional survey.

Resident physicians often encounter underprivileged patients before other providers, yet little is known about residents' attitudes and behaviors regarding these patients. To measure US resident physician attitudes regarding topics relevant to medically underserved patients, their behaviors (volunteerism) with underserved patients, and the association between attitudes and behaviors. In 2007 and 2008, 956 surveys on resident attitudes and behaviors about underserved patients were distributed to 18 residency programs in the United States. Survey content was based on existing literature and an expert needs assessment. The attitude assessment had 15 items with 3-point scales (range 0-1). The behavior assessment evaluated volunteering for underserved patients in the past, present, and future. A total of 498 surveys (response rate = 52%) were completed. Attitudes regarding underserved patients were generally positive and more favorable for women than men (overall attitude score 0.83 versus 0.74; P = < .001). Rates of volunteering for underserved patients were high in medical school (N = 375, 76%) and anticipated future practice (N = 409, 84%), yet low during residency (N = 95, 19%). Respondents who volunteered regularly had more favorable attitudes than those who did not volunteer (overall average attitude score of 0.81 versus 0.73; P = <.001). Relationships between hours volunteered per-week and favorable attitudes about topics related to the underserved were significant across all 15 items in medical school and anticipated future practice (P value range of .035 to <.0001). This survey revealed that US residents' attitudes towards topics regarding medically underserved populations are generally favorable. Rates of volunteerism for underserved patients were higher in medical school than during residency, and resident's anticipated rates of volunteerism in future practice volunteerism were approximately the same as rates of volunteerism in medical school. Resident attitudes are strongly correlated with volunteerism.

Are Doctors Who Have Been Ill More Compassionate? Attitudes of Resident Physicians Regarding Personal Health Issues and the Expression of Compassion in Clinical Care

Compassion is an attribute central to professionalism and modern clinical care, yet little is known about how compassion is acquired and preserved in medical training. We sought to understand whether personal illness experiences are thought by residents to foster compassion. The authors surveyed 155 (71% response rate) second- and third-year residents at the University of New Mexico School of Medicine regarding their views of the relationship of personal life experience with illness to compassion and empathy for patients. Residents believe that experience with personal health issues enhances physician compassion for patients. Residents who report more personal health concerns, such as physical or mental health problems and family health problems, endorse the connection between direct experience with illness and empathy. Health care trainees' own illness experiences may increase compassionate patient care practices and foster empathy.

To lie or not to lie: resident physician attitudes about the use of deception in clinical practice

BackgroundPhysicians face competing values of truth-telling and beneficence when deception may be employed in patient care. The purposes of this study were to assess resident physicians' attitudes towards lying, explore...

An Assessment of an Educational Intervention on Resident Physician Attitudes, Knowledge, and Skills Related to Adverse Event Reporting

Reporting and learning from events linked to patient harm and unsafe conditions is critical to improving patient safety. Programs that engage resident physicians in adverse event reporting can enhance patient safety and simultaneously address all 6 Accreditation Council for Graduate Medical Education competencies. Yet fewer than 60% of physicians know how to report adverse events and near misses, and fewer than 40% know what to report. Our study evaluated the effect of an educational intervention on anesthesiology residents' attitudes, knowledge, and skills related to adverse event reporting and the associated follow-up. In a prospective study, anesthesiology residents participated in a training program focused on the importance of reporting methods and on reporting adverse events for patient safety. Quarterly adverse event reports were analyzed retrospectively for 2years before the intervention and prospectively for 7 quarters after the intervention. Residents also completed a survey, before and 1year after the intervention, that evaluated their attitudes, experience, and knowledge regarding adverse event reporting. After the intervention, the number of adverse event reports increased from 0 per quarter to almost 30 per quarter. We identified several categories of harm events, near misses, and unsafe conditions, including reports of disruptive providers. Of the harm events associated with invasive procedures, more than half were associated with lack of attending physician supervision. We also observed significant progress in the residents' ability to appropriately file a report, improved attitudes regarding the value of reporting and available emotional support, and a reduction in the perceived impediments to reporting. An educational intervention increased the number of adverse event reports submitted by anesthesiology residents, improved their attitudes about the importance of reporting, and produced a source for learning opportunities and process improvements in the delivery of anesthesia care.

Perceptions of resident physicians about management of inpatient hyperglycemia in an urban hospital

Information regarding practitioner beliefs about inpatient diabetes care is limited. To assess resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal glycemic control in an urban hospital setting. A previously developed questionnaire was modified and administered. Residents were asked about the importance of inpatient glucose control, desirable glucose ranges, and problems encountered when managing hyperglycemia. Urban teaching hospital. Of 85 resident physicians, 66 completed the survey (mean age, 31 years; 47% men; 33% in first residency year). Most respondents categorized glucose control as "very important" in critically-ill and perioperative patients but only "somewhat important" in non-critically-ill patients. Most residents said they would target a therapeutic glucose range within the recommended levels. Most residents (88%) also said they felt "very comfortable" or "somewhat comfortable" using subcutaneous insulin therapy, whereas some were "not at all comfortable" with either subcutaneous (11%) or intravenous (18%) administration. In general, respondents were not very familiar with existing institutional policies and preprinted order sets. The most commonly reported barrier to management of inpatient hyperglycemia was lack of knowledge about appropriate insulin regimens and their use. Anxiety about hypoglycemia was only the third most frequent concern. Most residents acknowledged the importance of good glucose control in hospitalized patients and chose target glucose ranges consistent with existing guidelines. Lack of knowledge about insulin treatment options was the most commonly cited barrier to ideal management. Educational programs should emphasize inpatient treatment strategies for glycemic control.

Resident Physician Attitudes and Competence About Obesity Treatment: Need for Improved Education

Background: Obesity is a common problem in primary care, but little is known about Internal Medicine residents’ attitudes towards obesity treatment.Objective: To describe resident attitudes about obesity treatment.Methods: Cross-sectional survey of 101 Internal Medicine residents in Philadelphia, PA, and Bronx, NY. Responses to 18 items on a Likert scale assessed resident attitudes. Weight loss goals were assessed with open-ended questions to a clinical scenario. ANOVA with trend analysis compared questionnaire responses to resident postgraduate year (PGY) level. Associations between clinic site, PGY level, and dichotomized Likert responses were tested with chi-square analysis.Results: 19% of residents felt competent in prescribing weight loss programs. Few residents (18%) considered the current recommendations of a 5-10% reduction in body weight to be successful in an obese hypothetical patient. Third-year residents reported greater feelings of negativity towards obese patients than first- and second year residents (p < .05)Conclusions: Resident physicians do not feel competent in treating obesity and have unrealistic weight loss goals; third-year residents had more negative attitudes about obese patients compared to residents in their 1st or 2nd year of training. These areas are targets for further resident education about obesity management.

Change in Residents’ Perceptions of Teaching: Following a One Day “Residents as Teachers” (RasT) Workshop

The objective of this study was to assess the perceptions and attitudes of resident physicians toward teaching before and after participation in a mandatory "Residents as Teachers" (RasT) workshop in four domains: (1) setting goals and expectations, (2) use of clinical microskills in teaching, (3) evaluation and feedback, and (4) enthusiasm and preparedness toward teaching. Pre- and postintervention questionnaires were utilized. Data were analyzed for all respondents. Subgroup analyses were performed for each academic year and for primary care versus nonprimary care specialties. Over a 5-year period, 15 RasT workshops were presented to 276 residents from 10 different residency programs. Eighty-six percent completed the questionnaire before participation in the workshop, and 88% completed the questionnaire immediately after participation. The difference between the mean post-RasT and pre-RasT ratings on each item was used to measure the change in that item resulting from participation in the workshop. Overall, residents' self-assessed ratings of their attitudes toward teaching were positively impacted by participation in a RasT workshop. Further subanalysis showed that residents in primary care specialties showed a significantly greater increase in their ratings than residents in nonprimary care specialties.

Changes in internal medicine residents' attitudes about resuscitation after cardiac arrest over a decade

Background Resident physicians' beliefs about cardiopulmonary resuscitation (CPR) may impact their communication with patients about end-of-life care. We sought to understand how these perceptions and experiences have changed in the past decade because both medical education and American society have focused more on this domain. Method We surveyed 2 internal medicine resident cohorts at a large academic medical center in 1995 and 2005. Residents were asked of their beliefs about survival after CPR, perceived patient understanding, and regret after attempted resuscitation. Residents in 2005 reported more numerical experience with CPR. Current internal medicine residents are more optimistic than the 1995 cohort about survival after an inpatient cardiac arrest. They believe that far fewer patients and families understand resuscitation but report less regret about attempting to resuscitate patients. Conclusions These pilot data reveal potential changes in the attitudes of resident physicians toward CPR. The perceived poor understanding among decision makers calls into question the standard of informed consent. Despite this, residents report less regret leading one to ask what factors may underlie this response.

Satisfaction with Telephonic Interpreters in Pediatric Care

To compare satisfaction among Spanish-speaking mothers who did and did not use telephonic interpreters during pediatric visits, and to examine resident physician attitudes about telephonic interpreter use. Anonymous surveys were administered to 98 mothers limited in English proficiency and presenting for well-baby visits in an urban university hospital-affiliated practice. Pediatric visits were performed by 24 non-Spanish-proficient pediatric residents. The first 46 women (baseline cohort) received routine services, including ad-hoc interpretation or no interpretation; the second 52 women (intervention cohort) used a dual-headset telephonic interpreter service. Mothers completed postvisit interviews assessing overall satisfaction, comfort and ease of communication. Pediatric residents completed self-administered questionnaires assessing attitudes about and experience with telephonic interpretation. The intervention cohort overwhelmingly rated telephonic interpretation as "very helpful" (94%), indicating the visit would have been "harder" without the service (98%). Significantly more intervention cohort mothers reported it was "very easy" to communicate with the physician (83% vs. 22%, P < 0.01), they understood "all" that the physician told them (97% vs. 80%, P < 0.05) and they were "very satisfied" with the clinic overall (85% vs. 57%, P < 0.05). Almost all intervention cohort mothers (96%) reported a preference to use telephonic interpretation at their subsequent visit; however, only one-third of residents believed their patients would prefer to use the telephonic interpreter in the future. Mothers who used telephonic interpretation reported significantly greater communication and overall satisfaction compared to mothers in routine care. Pediatric residents substantially underestimated their patients' desire to use telephonic interpreters.

Resident Physician Attitudes and Competence About Obesity Treatment: Need for Improved Education

Background:Obesity is a common problem in primary care, but little is known about Internal Medicine residents’ attitudes towards obesity treatment.Objective:To describe resident attitudes about obesity treatment.Methods:Cross-sectional survey of 101 Internal Medicine residents in Philadelphia, PA, and Bronx, NY. Responses to 18 items on a Likert scale assessed resident attitudes. Weight loss goals were assessed with open-ended questions to a clinical scenario. ANOVA with trend analysis compared questionnaire responses to resident postgraduate year (PGY) level. Associations between clinic site, PGY level, and dichotomized Likert responses were tested with chi-square analysis.Results:19% of residents felt competent in prescribing weight loss programs. Few residents (18%) considered the current recommendations of a 5-10% reduction in body weight to be successful in an obese hypothetical patient. Third-year residents reported greater feelings of negativity towards obese patients than first- and second year residents (p<.05)Conclusions:Resident physicians do not feel competent in treating obesity and have unrealistic weight loss goals; third-year residents had more negative attitudes about obese patients compared to residents in their 1st or 2nd year of training. These areas are targets for further resident education about obesity management.