Medicine Residency Curriculum Research Articles

Development and Evaluation of Resident-Championed Point-of-Care Ultrasound Curriculum for Internal Medicine Residents.

Introduction: Point-of-care ultrasound (POCUS) is a powerful clinical tool that has seen widespread adoption, including in Internal Medicine (IM), yet standardized curricula designed by trained faculty are scant. To address the demand for POCUS education at our institution, we created a resident-championed curriculum with support from skilled faculty across multiple specialties. Our objective was to teach postgraduate year (PGY)-3 IM residents the basics of POCUS for evaluation of the pulmonary, cardiac, and abdominal systems through resident-developed workshops. The goal of acquisition of these skills was for resident education and to inform decisions to pursue further patient testing. Methods: Three half-day workshops were created to teach residents how to obtain and interpret ultrasound images of the pulmonary, cardiac, and abdominal systems. Workshops were comprised of didactic teaching and practical ultrasound instruction with expert supervision of clinicians within and outside of IM. Residents were asked to complete a written survey before and after each workshop to assess confidence, knowledge, and likelihood of future POCUS use. Results: Across the three workshops (pulmonary, cardiac, and abdominal), 66 sets of pre- and post-workshop surveys (32 pulmonary, 25 cardiac, and 9 abdominal) were obtained and analyzed. Confidence in and knowledge regarding POCUS use increased significantly across all three workshops. Likelihood of future use increased in the cardiac workshop. Conclusions: We implemented a resident-championed POCUS curriculum that led to improved attitudes and increased knowledge of POCUS for PGY-3 IM residents.

Evaluation of One Program's Use of the Society for Adolescent Health and Medicine Resident Curriculum

PurposeThe publicly available Society for Adolescent Health and Medicine (SAHM) Resident Curriculum provides resources for blended learning. This report presents a formal evaluation of this blended learning curriculum. MethodsWe adapted the SAHM curriculum for a required four-week rotation for pediatricians in training. We selected webinars, videos, articles, and Web sites from the SAHM curriculum to complement the local clinical context. We evaluated the effectiveness of our curriculum using resident pre- and post-self-assessments, weekly knowledge quizzes, and a standardized patient encounter. ResultsResident self-assessment improved in all domains except managing urologic conditions. Residents scored 85% or higher on knowledge quizzes. Standardized patients rated residents a mean of 90.2 out of 100 on adolescent communication and 89.0 out of 100 on parent communication. ConclusionsA blended learning curriculum consisting of SAHM online materials and local clinical experiences improved resident self-assessment, knowledge, and communication skills.

Healing Through History: a qualitative evaluation of a social medicine consultation curriculum for internal medicine residents

BackgroundSocial context guides care; stories sustain meaning; neither is routinely prioritized in residency training. Healing Through History (HTH) is a social medicine consultation curriculum integrating social determinants of health narrative into clinical care for medically and socially complex patients. The curriculum is part of an internal medicine (IM) residency outpatient clinical rotation at a Veterans Health Administration hospital. Our aim was to explore how in-depth social medicine consultations may impact resident clinical practice and foster meaning in work.MethodsFrom 2017 to 2019, 49 categorical and preliminary residents in their first year of IM training were given two half-day sessions to identify and interview a patient; develop a co-produced social medicine narrative; review it with patient and faculty; and share it in the electronic health record (EHR). Medical anthropologists conducted separate 90-min focus groups of first- and second-year IM residents in 2019, 1–15 months from the experience.Results46 (94%) completed HTH consultations, of which 40 (87%) were approved by patients and published in the EHR. 12 (46%) categorical IM residents participated in focus groups; 6 PGY1, and 6 PGY2. Qualitative analysis yielded 3 themes: patient connection, insight, and clinical impact; clinical skill development; and structural barriers to the practice of social medicine.ConclusionsHTH offers a model for teaching co-production through social and narrative medicine consultation in complex clinical care, while fostering meaning in work. Integration throughout training may further enhance impact.

A Patient-Centered Medical Home (PCMH) Rotation Prepares Residentsfor Practicing in Today’s Culture of Quality and Teamwork

Residency programs today face new challenges in training physicians for the rapidly changing culture of quality and teamwork in medical practice. New curricular initiatives must address accreditation standards for resident education in quality improvement (QI), teamwork, and patient data review. The objective of this study was to evaluate a new curriculum for internal medicine residents which introduced the concept of a patient-centered medical home (PCMH). We piloted a rotation for residents to experience PCMH practices in the community. The curriculum utilized experiential, didactic, and reflective sessions training residents in the PCMH tenets, QI, and interdisciplinary teamwork. We evaluated resident knowledge, attitudes, and behaviors using a single retrospective pre-post survey. Post rotation, residents felt better able to identify PCMH initiatives (47% before vs. 93% after, p < 0.01), PCMH team members in their primary care clinics (30% before vs. 83% after, p < 0.01), and expressed enhanced understanding of PCMH team members’ roles (30% before vs. 87% after, p < 0.01). Residents reported being more likely to utilize PCMH resources (52% before vs. 93% after, p < 0.01) and use patient data to improve their practice (37% before vs. 80% after, p < 0.01) after this intervention. This curricular model increased resident self-reported knowledge and identification of PCMH team members in their own continuity practice. This model, which embeds trainees in an experienced PCMH practice, can be used by residency programs to prepare residents for participation in team-based, quality-driven care in other PCMH sites in which they are likely to practice in their future careers.

The Curriculum Development Process for an International Emergency Medicine Rotation

Background: Completion of electives abroad is not a new phenomenon for physicians in training. Benefits to the physician and the host country's population have been sufficiently described in the literature; however, many academic residency programs lack an international health curriculum that incorporates both the Accreditation Council for Graduate Medical Education's core and specialty-specific competencies. Description: The goal of this project was to develop a curriculum for emergency medicine residents completing International Emergency Medicine (IEM) rotations. Evaluation: A literature search was conducted to review available international rotation curricula and the curriculum development process. A committee was formed to create an IEM rotation, borrowing philosophical premises from the educational literature, particularly experientialism. Conclusions: The resulting article describes the curriculum development process and provides a curriculum template for medical specialties to utilize when sending residents abroad.

Family Medicine Residents’ Perspectives on “Worldview Thinking in Patient Care

Background: To engage in worldview thinking in patient care is for physicians to acknowledge both the patient’s and their own life perspectives. Learner-centered development of worldview thinking curriculum for family medicine residents has not been reported. Purposes: This qualitative research project, which studied the perspectives of family medicine residents, was a necessary preamble to such curriculum development. Methods: Eight residents were interviewed on a voluntary, confidential basis using an open-ended format, structured around core questions. Recurring themes were identified and sorted. A focus group of study participants verified the analysis. Results: The residents valued worldview thinking in patient care. Their own worldviews were formed in earlier years by distinctive family influences and life experiences. They did not support mandatory worldview thinking residency curriculum. For themselves, they preferred curricula involving real-life patient interactions. Conclusions: Qualitative research methods are useful in initiating learnercentered worldview curriculum development. These residents’ views invite exploration of innovative ways to teach this aspect of professionalism.

Resident Field Response in an Emergency Medicine Prehospital Care Rotation

Background. Emergency medical services (EMS) is an important component of emergency medicine residency curricula. For over 20 years, residents at a university-affiliated program have staffed a physician response vehicle and responded to selected calls in an urban EMS system with online faculty backup. Objectives. To describe the prehospital educational experience and patient care provided through this unique program and to assess residents’ perceptions. Methods. This was a three-year retrospective study of patient care records for all prehospital resident responses. Information obtained included complaint, disposition, procedures performed, and medications administered. The number of EMS radio consultations provided by residents during this rotation was also sought. We surveyed 43 current and recently graduated residents to assess their perceptions of this experience. Results. Residents treated 1,434 patients during 1,381 scene responses (16.7 field patient contacts per resident-year). Complaints included cardiac arrest (788, 55.0%) and neurologic (230, 16.0%), traumatic (194, 13.5%), respiratory (144, 10.0%), and other cardiac (40, 2.8%) emergencies. Most patients (1,022; 71.3%) were transported to the hospital, including 82 of 143 patients (57.3%) who initially refused EMS transport. Residents performed procedures on 546 responses (39.5%), including 123 successful intubations, 115 central lines, 43 peripheral (IV) lines, and 10 intraosseous lines. EMS radio consultation records were available for only the second half of the study period. Residents provided 11,583 consultations during this one-and-a-half-year period (264 radio consultations per resident-year). Of the 40 returned surveys (93.0%), autonomy (n = 21), medical decision making (n = 10), and management of high-acuity patients (n = 7) were the most important perceived benefits of this program. Conclusion. Our prehospital training program incorporates emergency medicine residents as in-field physicians and allows hands-on opportunity to provide patient care for a variety of conditions in the EMS environment, as well as extensive experience in online medical direction. The trainees believed it had a strong positive impact on their acquisition of important emergency medicine abilities.

30: Characteristics of Emergency Medicine Residency Curricula That Affect Board Performance

30: Characteristics of Emergency Medicine Residency Curricula That Affect Board Performance

A simulation-based biodefense and disaster preparedness curriculum for internal medicine residents

Aims: Disaster and bioterrorism preparedness is poorly integrated into the curricula of internal medicine residency programs. Given that victims may present to a variety of healthcare venues, including primary care practices, inpatient hospital wards, and intensive care units, we developed a curriculum to address this need.Methods: The curriculum consisted of four didactic sessions with supplemental readings covering biologic, chemical, and radiologic agents, as well as public health infrastructure. All 30 internal medicine resident participants also underwent a four hour training seminar at a high fidelity human simulation center. Instruction included the use of personal protective equipment (PPE) and participation in simulated scenarios utilizing technologically sophisticated mannequins with monitoring and interactive capability. Sessions were videotaped, reviewed with participants, and followed by self-evaluation and constructive feedback.Results: Compared to a control group of residents who did not undergo training, the participants’ level of knowledge was significantly better, with mean objective test scores of 66.8% ;± ;11.8% SD vs. 50% ;± ;13.1% SD, p ;< ;0.0001. Although there was a trend toward increasing knowledge with increasing level of training in the control group, this difference was not significant. Subjective preparedness was also significantly better in the intervention group (p ;< ;0.0001). Objective improvements were not maintained after one year.Conclusions: In this pilot study, a disaster-preparedness curriculum including simulation-based training had a positive effect on residents’ knowledge base and ability to respond to disaster. However, this effect had diminished after one year, indicating the need for reinforcement at regular intervals.

Use of Emergency Bedside Ultrasound by Emergency Medicine Physician Assistants: A New Training Concept

INTRODUCTION Over the past two decades, the application of ultrasound by physicians in the emergency department has become common practice. The adoption of ultrasound skills by emergency physicians resulted from the unique practice environment of emergency medicine, which requires the ability to make timely diagnoses of life-threatening conditions at all hours of the day.1 Ultrasonography is uniquely suited to emergency medicine application. When performed at the patient’s bedside by the treating physician it can provide real-time diagnostic information in many time-sensitive, life-threatening conditions without the delay associated with waiting for an ultrasound technician, who is often not available in the hospital during off hours. Using ultrasound also eliminates the risk associated with requiring potentially unstable patients to leave the emergency department to have tests performed. This need has been recognized by the American College of Emergency Physicians (ACEP). In 1991, the ACEP Board of Directors approved a position statement that for the first time formally supported the use of ultrasound technology by emergency physicians.2 The Society for Academic Emergency Medicine (SAEM) endorsed the ACEP position and published a model curriculum in 1994.3 In 1997 ACEP created a more comprehensive statement, which was updated in 2001. Along with defining specific types of examinations that are considered to be within the domain of the emergency physician, it stated that: “Training in performing and interpreting ultrasound imaging studies should be included in emergency medicine residency curricula.”4 In 1999, the American Medical Association (AMA) Resolution 802 stated that ultrasound use was within the scope of practice of appropriately trained physicians and that credentialing criteria should be developed by each specialty.5 In 2001, ACEP published Marc L. Daymude, MD, FACEP, is medical director and Leonard Gruppo, PA-C, is program director of the Emergency Medicine Physician Assistant Residency at San Antonio Uniformed Services Health Education Consortium; Sumeru Mehta, MD, is director of the Emergency Medicine Ultrasound Program at San Antonio Uniformed Services Health Education Consortium, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas.

Ethics curriculum for internal medicine residents.

Ethics curriculum for internal medicine residents.

Balanced experiential curriculum for internal medicine residents at a municipal hospital

Balanced experiential curriculum for internal medicine residents at a municipal hospital

Evaluation of a rural-oriented primary care curriculum for internal medicine residents

Evaluation of a rural-oriented primary care curriculum for internal medicine residents

A microcomputer application curriculum for emergency medicine residents using computer-assisted instruction

A microcomputer application curriculum using computer-assisted instruction was developed for emergency medicine residents. Other than introductory comments, the course was composed entirely of disk-based tutorials. No faculty time was necessary. Subjects covered included introduction to microcomputers, the disk operating system; word processing, data bases, and spread sheets. The entire course, including the tutorial floppy disks, was contained in one loose-leaf notebook. Residents who took the course were surveyed. The course took an average of three to six hours to complete. All found the course to be helpful, with word processing being the most useful module. The majority of residents thought that the course was so valuable that it should be given earlier in the residency. Thus, we have moved the course to the first postgraduate year, and the data base and spread-sheet modules have been made optional. The course is easily assembled, requires minimal faculty time, and can be modified to accommodate different hardware and software.