Medical Education Experience Research Articles

Authentic early experience in Medical Education: a socio-cultural analysis identifying important variables in learning interactions within workplaces

This paper addresses the question 'what are the variables influencing social interactions and learning during Authentic Early Experience (AEE)?' AEE is a complex educational intervention for new medical students. Following critique of the existing literature, multiple qualitative methods were used to create a study framework conceptually orientated to a socio-cultural perspective. Study participants were recruited from three groups at one UK medical school: students, workplace supervisors, and medical school faculty. A series of intersecting spectra identified in the data describe dyadic variables that make explicit the parameters within which social interactions are conducted in this setting. Four of the spectra describe social processes related to being in workplaces and developing the ability to manage interactions during authentic early experiences. These are: (1) legitimacy expressed through invited participation or exclusion; (2) finding a role-a spectrum from student identity to doctor mindset; (3) personal perspectives and discomfort in transition from lay to medical; and, (4) taking responsibility for 'risk'-moving from aversion to management through graded progression of responsibility. Four further spectra describe educational consequences of social interactions. These spectra identify how the reality of learning is shaped through social interactions and are (1) generic-specific objectives, (2) parallel-integrated-learning, (3) context specific-transferable learning and (4) performing or simulating-reality. Attention to these variables is important if educators are to maximise constructive learning from AEE. Application of each of the spectra could assist workplace supervisors to maximise the positive learning potential of specific workplaces.

Sleep Deprivation in Resident Physicians, Work Hour Limitations, and Related Outcomes: A Systematic Review of the Literature

Extended work hours, interrupted sleep, and shift work are integral parts of medical training among all specialties. The need for 24-hour patient care coverage and economic factors have resulted in prolonged work hours for resident physicians. This has traditionally been thought to enhance medical educational experience. These long and erratic work hours lead to acute and chronic sleep deprivation and poor sleep quality, resulting in numerous adverse consequences. Impairments may occur in several domains, including attention, cognition, motor skills, and mood. Resident performance, professionalism, safety, and well–being are affected by sleep deprivation, causing potentially adverse implications for patient care. Studies have shown adverse health consequences, motor vehicle accidents, increased alcohol and medication use, and serious medical errors to occur in association with both sleep deprivation and shift work. Resident work hour limitations have been mandated by the Accreditation Council for Graduate Medical Education in response to patient safety concerns. Studies evaluating the impact of these regulations on resident physicians have generated conflicting reports on patient outcomes, demonstrating only a modest increase in sleep duration for resident physicians, along with negative perceptions regarding their education. This literature review summarizes research on the effects of sleep deprivation and shift work, and examines current literature on the impact of recent work hour limitations on resident physicians and patient–related outcomes.

“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 ...

Teaching Empathy through Movies: Reaching Learners’ Affective Domain in Medical Education

We live in an era where outcomes, guidelines, and clinical trials are at the forefront of medical training. However, to care implies having an understanding of the human being and build reflective practitioners impregnated of a humanistic perspective of doctoring. Although technical knowledge and skills can be acquired through training with little reflective process, it is impossible to refine attitudes, acquire virtues, and incorporate values without reflection. Empathy, which is required for a deep understanding of the human condition, could bridge the gap between patient-centered medicine and evidence-based medicine therefore representing a profound therapeutic potential. The challenge is how to teach empathy, an important issue in medical education, hard to teach and to measure. The authors’ broad experience in medical education using movies points out an innovative methodology to promote empathy because it reaches the learners’ affective domain. A description of the cinematic teaching methodology is provided and an extensive list of movie scenes are included so faculty and educators can try it in their own teaching scenario.

Daily Written Reflections Improve Medical Student Learning during a Third-Year Child Neurology Rotation (P07.245)

Objective: To measure medical student reports of how an assignment of daily written reflections changed their learning on a clinical child neurology rotation. Background Reflection is a key component to learning from experience. Despite the importance of learning from experience in medical education, little effort is made to facilitate and utilize reflection during clinical rotations. Design/Methods: A required daily reflections assignment was incorporated into the Washington University School of Medicine third-year child neurology rotation in October 2010. Students were required to write at least a paragraph every day analyzing their performance and experiences. A 33-question survey was developed to measure student reports of how the daily reflections affected their learning during the rotation. Twenty-nine third-year medical students participated in the daily reflections assignment between October 2010 and June 2011 and were invited to participate in the survey in September 2011. Results: Ninety percent of eligible students completed the survey (n=26). Eighty-four percent of students felt that the daily reflections improved their learning from experience, with 19% reporting that it majorly improved their learning. Seventy-seven percent reported that the daily reflections increased their awareness of their own thoughts and actions during the rotation. Fifty-four percent felt that the reflections changed their performance. Interestingly, 77% reported that the reflections improved what they were able to recall from the rotation. Sixty-nine percent felt that the daily reflections assignment should be continued as part of the rotation. Conclusions: A program of daily written reflections appears to have enhanced third-year medical student experiential learning during a clinical child neurology rotation. The majority of students reported that reflections increased their awareness of their own thoughts and actions, changed their performance, and increased their recall of experiences from the rotation. Educators should design clinical rotations to include written reflections on experience. Disclosure: Dr. Larsen has nothing to disclose.

Investigating a Rural Immersion Experience in Medical Education Utilizing Narrative Inquiry

Lack of access to health care coupled with a severe shortage of physicians is on the forefront of much debate nationally and internationally. Rural areas often suffer the most. Innovations in medical education, such as the creation of rural immersion rotations, are attempting to solve this health crisis. The purpose of this study was to investigate and analyze the narrative writings of 36 fourth-year medical students and primary care residents that participated in a rural immersion rotation in the Mississippi Delta. A grounded theory data analysis led to the emergence of four central themes: Positive reflections of the experience, community health, limited access to health care, and alteration of prior perceptions. The findings of this research provide rich data from the perspective of the medical student and resident. This study concluded that the use of narrative inquiry was beneficial within the rural immersion experience, and the experience positively influenced and impacted medical students and residents.

Transformative Learning

Short-term medical missions are common in medical educational settings and could possibly affect student learning. Little research has been conducted about the potential of these missions on students' transformative learning, in particular as it relates to empathy and multicultural awareness. Eight podiatric medical students who participated in short-term medical missions in 2008 and 2009 completed an electronic survey to investigate the effect of their experience as it relates to their learning. The empathy and multicultural awareness impact of the mission experience was emphasized. Qualitative questions in the survey were coded, themed, and triangulated with the quantitative responses. Six students (75%) "strongly agreed" that participating in the medical mission was a significant positive experience in their podiatric medical training. Six students felt that their experiences in serving these communities increased their personal awareness of multicultural/diversity needs in general. All of the students agreed that they will become better podiatric physicians because of their experiences in the medical missions. The qualitative data also indicate that the experience had an effect on the students' views of health care and increased empathy toward their patients. Short-term medical missions could play a significant role in the transformative learning experience in podiatric medical education. This could affect the empathy and multicultural awareness of podiatric medical students. Further and more extensive evaluations of the potential impact of short-term medical missions in podiatric medical education should be explored because it could influence curriculum and global health in the field of podiatric medicine.

Global health education for medical students: New learning opportunities and strategies

Background: A new course was offered to introduce basic global health concepts to all first year Johns Hopkins medical students, that took advantage of new distance learning capacity to connect medical students in Baltimore with students and faculty in Uganda, Ethiopia, Pakistan and India.Aims: Lessons learned from the launch of this new course will optimize the conduct of future global health courses at JHUSOM and may be of value to other institutions.Methods: Feedback from the Hopkins students was obtained through an on-line structured course evaluation questionnaire. Unstructured student and faculty feedback from partners institutions was solicited via email.Results: Students reported high levels of satisfaction with the course content and format, as well as achievement of course competencies and objectives.Conclusions: Distance learning can support unique, high-quality medical educational experiences that leverage technology and global connectivity, but also the power of group learning and “South-to-North” capacity building.

Modified teaching approach for an enhanced medical physics graduate education experience.

Lecture-based teaching promotes a passive interaction with students. Opportunities to modify this format are available to enhance the overall learning experience for both students and instructors. The description for a discussion-based learning format is presented as it applies to a graduate curriculum with technical (formal mathematical derivation) topics. The presented hybrid method involves several techniques, including problem-based learning, modeling, and online lectures, eliminating didactic lectures. The results from an end-of-course evaluation show that the students appear to prefer the modified format over the more traditional methodology of “lecture only” contact time. These results are motivation for further refinement and continued implementation of the described methodology in the current course and potentially other courses within the department graduate curriculum.

Medical education in sub-Saharan Africa: a literature review

This review synthesises research published in the traditional and 'grey' literature to promote a broader understanding of the history and current status of medical education in sub-Saharan Africa (SSA). We performed an extensive review and analysis of existing literature on medical education in SSA. Relevant literature was identified through searches of five traditional medical databases and three non-traditional or grey literature databases featuring many African journals not indexed by the traditional databases. We focused our inquiry upon three themes of importance to educators and policymakers: innovation; capacity building, and workforce retention. Despite the tremendous heterogeneity of languages and institutions in the region, the available literature is published predominantly in English in journals based in South Africa, the UK and the USA. In addition, first authors usually come from those countries. Several topics are thoroughly described in this literature: (i) human resources planning priorities; (ii) curricular innovations such as problem-based and community-based learning, and (iii) the 'brain drain' and internal drain. Other important topics are largely neglected, including: (i) solution implementation; (ii) programme outcomes, and (iii) the development of medical education as a specialised field of inquiry. Medical education in SSA has undergone dramatic changes over the last 50 years, which are recorded within both the traditionally indexed literature and the non-traditional, grey literature. Greater diversity in perspectives and experiences in medical education, as well as focused inquiry into neglected topics, is needed to advance medical education in the region. Lessons learned from this review may be relevant to other regions afflicted by doctor shortages and inequities in health care resulting from inadequate capacity in medical education; the findings from this study might be used to inform specific efforts to address these issues.

Return from the Darkside–Sleep Medicine Fellowship Training: Past, Present and Future

At the time this editorial comes to press, I will be nearing completion of my 6½ years of service on the Internal Medicine Residency Review Committee (IMRRC) of the Accreditation Council of Graduate Medical Education (ACGME). Six and a half years is a long time to serve on any committee, and the IMRRC is no exception. I will not miss the hours of hard work, time away from home or the sometimes heated debate, but I always will cherish the camaraderie among fellow educators and the privilege of representing the sleep medicine community on this important body. The IMRRC a frequently misunderstood committee. I have been told by some that serving on the IMRRC is analogous “going over to the dark side,” and that the IMRRC and the ACGME are the “enemy.” This cannot be further from the truth. Although the IMRRC does sanction Sleep Medicine and other training programs that are non compliant with its requirements, the IMRRC in virtually every instance tries to improve the medical educational experience at the programs it accredits. With respect to Sleep Medicine, it is not commonly appreciated that accredited training and American Board of Medical Specialties (ABMS) board certification would not be possible today without the action taken by the ACGME. For years, organized Sleep Medicine had petitioned the ABMS for a certification examination, but had been consistently rebuffed. However, the ACGME, under the leadership of the late Dr. Marvin Dunn, agreed that Sleep Medicine was an emergent medical specialty and ACGME accredited Sleep Medicine training was born.1 Because the ABMS generally does not wish to have accredited training without a parallel examination process, ABMS board certification in Sleep Medicine became possible. Thus, during my service on the IMRRC, I have witnessed and participated in the development of the training requirements for Sleep Medicine fellowships and observed the accreditation of 71 Sleep Medicine fellowships.2 These events would not have been possible without the understanding and assistance of the IMRRC which solicited input from our community in the developing policy and program requirements. What then is the immediate future for Sleep Medicine training? In July 2012, in parallel with implementation of new program requirements for Internal Medicine subspecialties, there will be new program requirements for Sleep Medicine. Although the format of the program requirements will be different and will include the new ACGME common requirements with their focus on duty hours, core educational content related to Sleep Medicine will not be markedly different. There will be greater flexibility for training programs that emphasize pediatrics and a requirement for all key clinical faculty including the program director to be certified in Sleep Medicine by an ABMS member board. It also is likely that a provision to allow residents trained in Anesthesiology to enter Sleep Medicine training will be added to be consistent with their eligibility to take the ABMS certification exam. Moreover, the IMRRC will continue review all Sleep Medicine programs irrespective of their sponsoring specialty. However, the greatest changes will occur in assessment of fellows' meeting the six ACGME competencies: Medical Knowledge, Patient Care, Practice-based Learning, Communications, Professionalism and Systems-Based Practice. Evaluation methods will now require direct observation of these skills, solicitation of opinions from patients and staff and objective assessment tools. In general, the leadership of the ACGME is attempting to move to a less proscriptive and more outcomes-based accreditation process with longer accreditation cycles for programs in good standing. In the long-term, Sleep Medicine training will reflect the practice of Sleep Medicine. The IMRRC never makes changes in training program requirements without input from its constituent specialty communities. Thus, as the practice of Sleep Medicine evolves more toward ambulatory testing, and emphasizing the cognitive value of a Sleep Medicine specialist in the evaluation and treatment of all sleep disorders, not just sleep disordered breathing, fellowship training will need to mirror these changes in practice. It will be important for Sleep Medicine educators to provide input to the IMRRC for these changes to occur. Finally, as I return unscathed from the dark side, remember, the IMRRC is not your enemy, and in most cases it wants to be your friend.

A Recipe for Medical Schools to Produce Primary Care Physicians

U.S. health care reform will add to the growing demand for primary care physicians. The recent launching of new allopathic medical schools provides an opportunity to redesign the medical education experience to foster student selection of primary care careers.

Almost Internists: Analysis of Students Who Considered Internal Medicine but Chose Other Fields

Medical students' career choices affect health care. To understand how to increase the number of students who choose careers in internal medicine (IM), students who seriously considered IM but chose another field ("Switchers") and those who rejected IM ("Never Considered") were compared with those who chose IM ("Choosers"). Fourth-year medical students from 11 U.S. institutions were surveyed about demographics, medical school educational experiences, and aspects of the specialty of IM. Univariate analysis and multivariate logistic regression models examined associations between student characteristics and classification as Switchers, Choosers, and Never Considered. A total of 1,177 students completed the survey (82% response rate). There were 274 (23%) Choosers, 398 (34%) Switchers, and 499 (43%) Never Considered. The authors' models explained over 80% of variance in these three career choice classification groups. For most responses, an increasingly favorable gradient from Never Considered to Choosers was observed. Multivariate analysis revealed six items that were associated with higher probability of choosing IM: types of patients internists see, timing of career decision, interest groups, intellectual challenge, satisfaction among internists, and the core IM clerkship. Several potentially modifiable educational experiences and aspects of IM distinguished Switchers from the other two groups. The percentage of variance explained by group suggests that these findings identify important underpinnings of career decisions. These items also suggest ways that educational experiences and aspects of the specialty could be redesigned by academicians and policy makers to improve the attractiveness of IM careers.

Teaching Tobacco Cessation Skills to Uruguayan Physicians Using Information and Communication Technologies

Since 2004, with the ratification of the Framework Convention on Tobacco Control, Uruguay has implemented a wide range of legal restrictions designed to reduce the devastating impacts of tobacco. This legal process generated an increase in demand for tobacco cessation treatment, which led to the need to train a large number of physicians. Information and Communication Technologies (ICTs) are evolving constantly, creating new opportunities to make online education more interactive. The evolution of ICTs presents an opportunity to develop innovative continuing medical education (CME) experiences to meet the increasing demand for this topic. A blended-learning course on tobacco cessation was developed and implemented, combining face-to-face and online activities. Educational strategy focused on (1) facilitating interaction among generalists and between generalists and experts, and (2) providing high impact CME incorporating multifaceted interventions with wiki-type collaborative construction of practical knowledge. Multiple-choice tests and commitments-to-change were used for evaluation. Three hundred thirty-five health professionals participated in the course. Of these, 145 (43.3%) attended the on-site workshop, 216 (64.5%) participated in the online activities, and 109 (32.5%) completed both phases. Fifty of the 105 (47.6%) participants completing the pretest had a passing score, while 78.1% received a passing score on the final test (p < .001). Differences between mean pretest and posttest scores among those who completed both phases compared with those who only did the online phase were statistically significant (p = .003 and p = .009, respectively). The need to train physicians on tobacco cessation skills can be addressed via ICTs and educational activities that include participant interaction.

Cardiothoracic Surgery League from University of São Paulo Medical School: twelve years in medical education experience

Academic Leagues (Academic Interest Group) are entities that belong to medical schools and their hospitals. Their goals are research, medical education and health care. The cardiothoracic Surgery League (Liga de Cirurgia Cardiotorácica--LCCT), University of São Paulo Medical School, was founded 12 years ago, aimed at providing undergraduate medical students an opportunity to expand knowledge in cardiothoracic surgery and to take part in scientific studies in the field. To evaluate the experience gained through LCCT implementation. Current students and former members of LCCT were submitted to a specific evaluation form, delivered personally or by email, which provided data on the general opinion regarding LCCT's activities, the reasons for answers provided and choice of medical specialties. Furthermore, LCCT's total scientific production was evaluated. Most undergraduate medical students 51/65 (78.5%) and former members 94/121 (77.7%) completed the form. The interest in Cardiothoracic Surgery was the most common reason for joining LCCT 44/161 (27.3%). Most students 32/51 (62.7%)--reported their initial expectations were partially met. Almost every member would recommend a fellow medical student to join LCCT 50/51 (98%) and 25/51 (49%) of them participated in a scientific project linked to LCCT. In total, 47 scientific papers were published having LCCT's medical students as authors or co-authors during the existence of the league. Of the former members who chose a surgical career, 7/52 (13.4%) chose thoracic or cardiovascular surgery. LCCT has met its goals, since most current and former members recognized its role in their medical training, besides it is a good way to produce scientific initiation.

University of Virginia School of Medicine

University of Virginia School of Medicine

The understanding and experience of students, tutors and educators regarding reflection in medical education: a qualitative study

Objectives: This exploratory study was designed to investigate the understanding and experience of students, tutors and medical educators with respect to reflection in medical education during the MBChB medical degree programme. Methods: A qualitative approach was employed using semistructure interviews. Seven medical students, eleven tutors and eight medical educators participated in the study. An inductive thematic analysis was used to accomplish the aim of this study. Results: The results indicate that students, tutors and educators have an incomplete understanding of reflection. The cause exists at several points, not only at curriculum level but also at the level of the educator, tutor and the student. Whilst the study presents information regarding curriculum deficits and individual needs it also signifies that policy documents are not clearly understood. Assumptions were made by participants regarding the teaching, learning and assessment of reflection indicating a need for a review of student and tutor preparation. Conclusions: The importance of reflection is frequently noted in the literature as an essential characteristic for professional competence. This research has highlighted the need for a much greater emphasis on reflection in or through teaching, learning and assessment. Suggestions to overcome these are offered.

Comparison of academic viewpoints between Yun Tie-qiao and Lu Yuan-lei

Both Yun Tie-qiao and Lu Yuan-lei are medical professionals coming from the literary field with versatile and in-depth knowledge and extensive experience in medical education and clinical practice, all closely related to modern TCM development. Yun, the elder, insisted on reforming TCM and was early to advocate the academic idea of amalgamating western and traditional Chinese medicine; while Lu, the younger, insisted on the idea of "scientizing TCM" and was the representative of amalgamating western and traditional Chinese medicine in the later stage. They shared many common viewpoints, including venerating Zhang Zhongjing, stressing exogenous cold pathogens, advocating reformation and amalgamation of western medicine and TCM and objecting to the abolishment of TCM. However, there were discrepancies between them, including the relationship between the Inner Canon and the Essay on Exogenous Cold Diseases, warm disease theory, pulse theory, titles of TCM diseases and Japanese Kampo medicine. A comparison of them and noting their valuable contributions will be beneficial for the promotion of the development of TCM.

Management of Female Sexual Problems: Perceived Barriers, Practice Patterns, and Confidence among Primary Care Physicians and Gynecologists

Although approximately 40% of women report female sexual problems--and particularly sexual desire disorders, there are numerous practical, professional, and personal barriers to their diagnosis and management by treating clinicians. To identify practice patterns, perceptions, and barriers to the diagnosis and management of female sexual problems among U.S. practicing primary care physicians (PCPs) and obstetrician/gynecologists (OB/GYNs). A random sample of practicing U.S. PCPs and OB/GYNs were sent a case-vignette survey by e-mail and fax. Response to the survey was considered consent. A regression model was analyzed to assess predictors of confidence. Frequency and variability in diagnostic tests ordered and treatment recommendations provided for a patient with diminished sexual desire. Percent of physicians who reported they were confident in treating hypoactive sexual desire disorder (HSDD) and percent who reported significant barriers to initiating a dialogue about sexual health with female patients. A total of 505 responses were analyzed (8.8% response rate). Of respondents, 21% of OB/GYNs and 38% of PCPs stated they were not at all confident in treating HSDD. The majority of physicians would order a thyroid panel (PCP = 63%, OB/GYN = 53%) to assess a patient's diminished desire and recommended counseling and stress management to treat a patient with sexual complaints (PCP = 48%, OB/GYN = 54%). Regression results identified time constraints, the perceived lack of effective therapies, perceptions regarding patient-physician gender discordance, years in practice, number of patients seen per week, and perceptions regarding continuing medical education and practice experience as significant and independent predictors of confidence in treating HSDD patients.

Improving quality and patient satisfaction in a pediatric resident continuity clinic through advanced access scheduling.

To evaluate the impact of advanced access scheduling in a pediatric residency clinic on resident and patient satisfaction, medical education, practice quality, and efficiency. Residents were assigned to either the advanced access template (10 appointments available to patients and 2 physician overbooks) or the prior template (5 available and 8 overbooks). Outcomes included resident and patient satisfaction, appointment availability, and continuity of care and clinic costs. Patient satisfaction improved in 7 areas (P < .001). Residents in either template did not report an impact on medical education experiences. Significant increases were realized with appointment availability and the number of patients seen. Continuity also increased as the overflow/acute visits decreased (P < .001). Overall costs per visit decreased 22%. Because of the significant improvements in access, continuity, and efficiency, all residents were switched to the advanced access template after completion of the study. Improvement in access to the primary physician has a significant impact on patient satisfaction with health care delivery. This model optimizes the limited time that residents have in continuity clinic, and it has implications for health care delivery quality improvement.