First-year Internal Medicine Residents Research Articles

Design of a Social Justice Curriculum to Expand Critical Consciousness Among Resident Trainees.

Health equity curricula emphasizing critical pedagogy and centering perspectives of those with marginalized identities, both in curriculum design and execution, have yet to be described in interdisciplinary graduate medical education settings. The application of public health critical race praxis (PHCRP) in the redesign and evaluation of a social medicine immersion month (SMIM) curriculum. A mandatory, 4-week course within the Residency Program for Social Medicine in the Bronx, NY. First-year residents in internal medicine, family medicine, pediatrics, and clinical psychology fellows between 2019 and 2020. Residents and faculty underrepresented in medicine employed PHCRP to ground SMIM in critical pedagogy and structural competency with the goals of increasing critical consciousness, sensitizing trainees to structural barriers faced by patients, and promoting meaningful engagement in advocacy. SMIM was evaluated pre- and post-curriculum using a validated critical consciousness and intersectionality survey, with additional questions to assess competency and behaviors. Participants also provided course feedback. Participants demonstrated significant increases across all domains of the measure (Racism + 1.62 (p < .01), Classism + 1.62 (p < .05), Heterosexism + 1.06 (p < .05)). Participant feedback was positive. PHCRP is a valuable model for designing health equity curriculum. SMIM provides insights for incorporating this framework into GME curricula.

Feedback perceptions of first year medical residents: An intervention-based survey study.

Feedback in residency is a necessity for progression toward clinical competency and is included in The Accreditation Council for Graduate Medical Education (ACGME) milestones as an essential component for accreditation. Our study elucidates perceptions of feedback of first-year residents and aims to identify how these perceptions change after education on building expertise through deliberate practice. First-year internal medicine and neurology residents of a mid-sized university-affiliated residency program answered a five-question 5-point unipolar response scale questionnaire regarding feedback perceptions before and after attending a workshop about building expertise through effective feedback during residency orientation. Related-Samples Wilcoxon Signed Rank Test was applied for comparing pre- versus post-questionnaire data. Of 31 first-year residents, 29 completed the pre-questionnaire for a completion rate of 93.5%, while 24 of 31 completed the post-questionnaire for a completion rate of 77.4%. Of the five questions, three improved when comparing pre and post responses to, including the questions on confidence in the ability to procure feedback (p = <0.001), the effort put into procuring feedback (p = 0.001), and frequency of seeking feedback (p = 0.002). Interest in receiving feedback and the importance of feedback remained unchanged after workshop attendance. Residents should be educated on building expertise through deliberate practice and how to obtain high-quality feedback, given the emphasis and essentiality of feedback within the milestone assessment system and the core competencies of ACGME. In our study, education on these topics led to significant improvement in resident perceptions of confidence in the ability to procure feedback, effort put into procuring feedback, and frequency at which feedback would be sought.

Simulation training can improve internal medicine residents’ knowledge and comfort with cardiac point-of-care ultrasound to diagnose acute cardiovascular conditions

Few studies have examined the value of dedicated simulation-based point-of-care ultrasound (POCUS) training in improving Internal Medicine residents’ knowledge and comfort with cardiac POCUS to diagnose acute decompensated systolic heart failure and large pericardial effusion. This mixed-methods research included all 48 first-year Internal Medicine Residents receiving POCUS training at an urban academic centre. Participants were queried about their self-appraised cardiac POCUS knowledge, objectively tested on their cardiac POCUS knowledge, and surveyed about their comfort with cardiac POCUS tasks before and immediately after their training session, as well as 3 months later. Participants’ self-appraised knowledge regarding cardiac POCUS increased significantly from pre- to immediately post-intervention (31%–83%, Simulation-based training can be beneficial for teaching Internal Medicine residents the fundamental skills of cardiac POCUS as well as how to utilize the modality to diagnose acute decompensated systolic heart failure and large pericardial effusion.

Development and usability testing of a patient digital twin for critical care education: a mixed methods study.

Digital twins are computerized patient replicas that allow clinical interventions testing in silico to minimize preventable patient harm. Our group has developed a novel application software utilizing a digital twin patient model based on electronic health record (EHR) variables to simulate clinical trajectories during the initial 6 h of critical illness. This study aimed to assess the usability, workload, and acceptance of the digital twin application as an educational tool in critical care. A mixed methods study was conducted during seven user testing sessions of the digital twin application with thirty-five first-year internal medicine residents. Qualitative data were collected using a think-aloud and semi-structured interview format, while quantitative measurements included the System Usability Scale (SUS), NASA Task Load Index (NASA-TLX), and a short survey. Median SUS scores and NASA-TLX were 70 (IQR 62.5-82.5) and 29.2 (IQR 22.5-34.2), consistent with good software usability and low to moderate workload, respectively. Residents expressed interest in using the digital twin application for ICU rotations and identified five themes for software improvement: clinical fidelity, interface organization, learning experience, serious gaming, and implementation strategies. A digital twin application based on EHR clinical variables showed good usability and high acceptance for critical care education.

Explicit Training in Systematic Communication Strategies: A Pilot Study Exploring the Incorporation of Communication Tools by First-Year Residents in Simulation and in Clinical Practice.

Educational approaches for training physicians in clinical communications vary, and whether physicians apply the communication skills they learn or find them useful in the clinic is not well known. The aim of this study was to determine how first-year residents who received explicit instruction in 7 communication strategies would apply them in a simulation exercise and in clinical practice. First-year Internal Medicine residents at an urban teaching hospital received instruction in 7 systematic communication strategies: Ask-Tell-Ask, Teach-back, open-ended questioning, NURSE, open body language, pausing, and plain language. Residents were evaluated on their use of specific communication behaviors associated with the 7 strategies during a simulation exercise of disclosing a medical error to a standardized patient. Control group residents who did the simulation before attending the training program and training group residents who did the simulation after the training were compared. Residents were queried 6 months after the training program on their use of communication strategies during clinical practice. A total of 27 residents participated (n = 13 control group; n = 14 training group). The training group performed behaviors for "establishing patient understanding" significantly more often than the control group. Both groups used non-verbal communication and behaviors for addressing patient emotions at similar levels. Of the 24 residents who responded to the 6-month follow-up questionnaire, 24 (100%) reported using Ask-Tell-Ask, open-ended questioning, and Teach-back, and 22 (92%) reported using NURSE statements and non-verbal communication. Most respondents reported using the strategies in clinical practice often or very often (79%) and found the strategies useful or very useful (96%). Providing explicit instruction in systematic communication strategies, particularly those focused on establishing patient understanding, may be an efficient approach for helping early career physicians develop effective communication skills that can be readily implemented during clinical training and practice.

Evaluation of a Remote Curriculum to Improve Internal Medicine Resident Knowledge and Confidence in Oncologic Emergency Identification and Management

Background Oncologic emergencies (OEs) are life-threatening complications of malignancy that can present in multiple clinical settings and necessitate early recognition and intervention. Most medical resident training is experiential, but variability in exposure can yield gaps in medical knowledge that could result in delayed patient care. Remote curricula are commonly used to fill these gaps and reduce classroom burden on trainees. Given their time-sensitive nature, OEs are a prime target to augment clinical experience with a supplementary curriculum to prepare residents for new scenarios. This study evaluates whether an original, remote curriculum improves internal medicine resident knowledge of and confidence in recognition and management of OEs. Methods With expert faculty input, we developed a remote curriculum for first-year internal medicine residents at a tertiary care academic medical center. The curriculum includes 6 OEs: tumor lysis syndrome (TLS), hypercalcemia (hyperCa), neutropenic fever (NF), hyperviscosity syndrome and leukostasis (HVS/LS), superior vena cava (SVC) syndrome, and malignant spinal cord compression (CC). OEs were selected based upon prominence in the literature, morbidity and mortality, need for urgent management, and association with malignancy. We created an online lesson in Qualtrics for each OE. Each lesson was designed to be completed in 15 minutes via computer or smartphone. Lessons were delivered by email every 10 days, with reminders every 5 days. Learning objectives for each OE lesson were to 1) identify concerning signs and symptoms, 2) order appropriate workup, and 3) provide prompt management in the appropriate clinical setting. Lessons included clinical questions and evidence-based information delivery contextualized by case presentations. We evaluated the curriculum's efficacy with a randomized, controlled study. First-year residents were randomly assigned to two groups (“Intern A” and “Intern B”). We built assessments of knowledge and confidence with expert faculty input. Confidence in identifying and managing each OE was assessed by Likert scale (“1 - completely confident,” “5 - not at all confident”). Knowledge was evaluated with 3 multiple choice questions per OE, for a maximum knowledge score of 18. After both groups completed the pre-test, Intern A received the curriculum. After curriculum completion, both groups completed the post-test. All interns were required to complete the curriculum, but research participation was optional. Residents consented to participation prior to each test administration. All lessons and research activities were anonymous. Analysis was completed in GraphPad Prism 9 using the unpaired t-test or one-way ANOVA with post-hoc testing, as appropriate. Results Thirty-nine internal medicine residents completed the curriculum. Twenty were assigned to Intern A and 19 to Intern B. Intern A had 10 pre-test respondents (50.0%) with a mean knowledge score of 9.13 (50.7% correct), and Intern B had 13 pre-test respondents (68.4%) with a mean knowledge score of 9.35 (51.9% correct). There were no differences by OE-specific score. Baseline confidence was similar between groups (Table 1). Comparison of mean knowledge scores is shown in Figure 1. Intern A and B had 9 (45.0%) and 10 (52.6%) post-test respondents, respectively. Both Intern A (mean 14.2; 95% CI, 12.8 to 15.7; 78.9% correct) and Intern B (mean 12.2; 95% CI, 10.5 to 13.9; 67.8% correct) significantly improved their knowledge scores compared to prior, though Intern A had a more marked effect size (Intern A mean difference 5.02; 95% CI, 2.84 to 7.21; P&amp;lt;0.0001; Intern B mean difference 2.66; 95% CI, 0.660 to 4.66; P=0.006). Intern A confidence significantly improved from the pre-test in both the identification and management of HVS/LS and SVC syndrome. Intern A confidence was significantly better than Intern B confidence in management of SVC syndrome at the time of the post-test (Table 1). Conclusions Baseline intern OE knowledge scores were sub-optimal. Intern participation in a remote OE curriculum improved knowledge acquisition to a greater degree than experiential learning alone. Confidence in identification and management of OEs with low pre-existing confidence, such as HVS/LS and SVC syndrome, improved in the remote curriculum. Further study should evaluate knowledge retention over time, resident clinical performance, and patient outcomes.

Bacterial Contamination on The First-Year Internal Medicine Residents’ Scrubs at H. Adam Malik Medan General Hospital

Background: The doctor’s white coat was known to be a source of nosocomial infection. Despite many studies’ results have shown the presence of bacterial contamination on the doctor's white coat, there was little research about bacterial contamination on the doctor's scrub. This study aims to investigate bacterial contamination on the scrubs of first-year residents of the Internal Medicine Department worn for one shift (17 hours). Method: This is a descriptive study on the first-year residents' scrubs which was conducted in January - February 2021 at H. Adam Malik Medan General Hospital. Samples were taken from the sleeves and pockets of the scrubs and programmed software was used to identify the amount, percentage of bacterial contamination, and bacterial species. Data were analyzed using the SPPS version 21. Result: Of the 31 first-year residents' scrubs that met the inclusion criteria, 79 colonies (50,6%) of bacterial contamination was found on the sleeves and 77 colonies (49,4%) in the pockets of the scrubs. Bacteria found on the scrubs are coagulase-negative Staphylococcus, Bacillus sp., Staphylococcus aureus, Acinetobacter Iwoffli, Pantoea sp., Acinetobacter baumanii, Klebsiella pneumaniae, Oligella ureolytica, and Pseudomonas stutzeri with the most common bacterial colonies found both in sleeves and pockets were coagulase- negative Staphylococcus (220.935 ± 180.56 and 289.09 ± 181.57). Conclusion: Bacterial contamination was found mainly on the sleeves of the scrubs with coagulase-negative Staphylococcus as the most contaminating bacteria and this should be taken into consideration as this strain could cause severe infection, especially in immunocompromised patients.

Comparing the effectiveness of asynchronous e-modules and didactic lectures to teach electrocardiogram interpretation to first year US medical students

BackgroundMedical students are expected to be competent in interpreting electrocardiograms (ECGs) by the time they graduate, but many are unable to master this skill. Studies suggest that e-modules are an effective way to teach ECG interpretation, however they are typically evaluated for use during clinical clerkships. We sought to determine if an e-module could replace a didactic lecture to teach ECG interpretation during a preclinical cardiology course.MethodsWe developed an asynchronous, interactive e-module that consisted of narrated videos, pop-up questions and quizzes with feedback. Participants were first year medical students who were either taught ECG interpretation during a 2-hour didactic lecture (control group) or were given unlimited access to the e-module (e-module group). First-year internal medicine residents (PGY1 group) were included to benchmark where ECG interpretation skills should be at graduation. At three time-points (pre-course, post-course, and 1-year follow-up), participants were evaluated for ECG knowledge and confidence. A mixed-ANOVA was used to compare groups over time. Students were also asked to describe what additional resources they used to learn ECG interpretation throughout the study.ResultsData was available for 73 (54%) students in the control group, 112 (81%) in the e-module group and 47 (71%) in the PGY1 group. Pre-course scores did not differ between the control and e-module groups (39% vs. 38%, respectively). However, the e-module group performed significantly better than the control group on the post-course test (78% vs. 66%). In a subsample with 1-year follow-up data, the e-module group’s performance decreased, and the control group remained the same. The PGY1 groups’ knowledge scores were stable over time. Confidence in both medical student groups increased by the end of the course, however only pre-course knowledge and confidence were significantly correlated. Most students relied on textbooks and course materials for learning ECG, however online resources were also utilized.ConclusionsAn asynchronous, interactive e-module was more effective than a didactic lecture for teaching ECG interpretation, however continued practice is needed regardless of how students learn to interpret ECGs. Various ECG resources are available to students to support their self-regulated learning.

Times Constraints, Lack of Confidence in Treatment, Stigma, and Confidentiality Concerns: Barriers to Care Among First-year Internal Medicine Residents During the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has presented unprecedented challenges for frontline health care workers. First-year medical residents have been at high risk of psychological distress given these challenges as well as those related to transitioning to a provider role. Virtual peer discussion groups were organized for first-year residents (N=47) at a large, American academic medical center to process the emotional impacts from the pandemic and provide support. Residents completed an anonymous survey before the initiation of the discussion groups to assess their level of psychological distress, perceived sources of stress, impact of the pandemic on their mental health, and attitudes toward seeking mental health services. Results from the survey identified time constraints as the greatest barrier to accessing mental health care, followed by lack of confidence in treatment, stigma, and concerns about confidentiality. We discuss potential ways to address some of these barriers to improve access and acceptability of mental health support for this specific population during a pandemic.

An Advanced, Risk-Driven Sexual Health Curriculum for First-Year Internal Medicine Residents.

Despite recommendations for annual chlamydia screening for young, sexually active females, chlamydia rates continue to increase nationally. Medical school students often receive limited training in obtaining comprehensive, risk-based sexual histories, leading to less screening for sexually transmitted illnesses (STIs). Consequently, many internal medicine (IM) residents feel unprepared for advanced sexual history taking and site-specific STI testing based on sexual practices. We developed a case-based interactive didactic session for IM and med/peds residents. We focused on more advanced topics, such as comprehensive sexual history taking, secondary site testing for STIs, and patient counseling. Based on pre- and postcurriculum surveys, interns reported increases in comfort (scale: 1 = very low comfort, 5 = very high comfort) with counseling after positive STI results (Ms: pre = 2.9, post = 3.5, p < .01) and providing education on safe sex practices (Ms: pre = 3.0, post = 3.6, p < .01) and modest improvement in comfort with expedited partner therapy (EPT; Ms: pre = 2.1, post = 2.5, p = .06). An increase in self-reported confidence with collecting site-specific testing (composite Ms: pre = 2.7, post = 3.5, p < .01) was also seen. Percentage correct on knowledge questions increased from 48% to 78% postcurriculum (p = .01). This curriculum demonstrated improvement in knowledge and comfort with sexual history taking, STI screening, and counseling. Comfort also improved with EPT counseling, but not significantly, which could be addressed in future iterations of the curriculum.

Development and Implementation of a Novel Case-Based Gun Violence Prevention Training Program for First-Year Residents.

Gun violence results in approximately 40,000 deaths in the United States each year, yet physicians rarely discuss gun access and firearm safety with patients. Lack of education about how to have these conversations is an important barrier, particularly among trainees. A 2-part training curriculum was developed for first-year residents. It included (1) a didactic presentation outlining a framework to understand types of firearm-related violence, describing institutional resources, and reviewing strategies for approaching discussions about firearms with patients, and (2) interactive case scenarios, adjusted for clinical disciplines, with standardized patients. Before and after the training, participants completed surveys on the training's relevance, efficacy, and benefit. Standardized patients provided real-time feedback to participants and completed assessments based on prespecified learning objectives. In June-August 2019, 148 first-year residents in internal medicine (n = 74), general surgery (n = 12), emergency medicine (n = 15), pediatrics (n = 22), psychiatry (n = 16), and OB/GYN (n = 9) completed the training. Most (70%, n = 104) reported having no prior exposure to gun violence prevention education. Knowledge about available resources increased among participants from 3% (n = 5) pretraining to 97% (n = 143) post-training. Awareness about relevant laws, such as Extreme Risk Protection Orders, and their appropriate use increased from 3% (n = 4) pretraining to 98% (n = 145) post-training. Comfort discussing access to guns and gun safety with patients increased from a median of 5 pretraining to 8 post-training (on a scale of 1-10, with higher scores indicating more comfort). Delivery of a case-based gun violence prevention training program was effective and feasible in a single institution. Next steps include expanding the training to other learners (across undergraduate and graduate medical education) and institutions and assessing how the program changes practice over time.

The Important Factors Applicants Consider When Choosing a Residency: A Survey Study.

While medical school graduates compete to get matched into the best residency programs, programs also compete to attract the best applicants. The applicant's decision to rank their programs of interest is determined by several factors, many of which are not always apparent. This study aimed to evaluate significant factors involved in an applicant's residency program selection. A 12-question survey was sent between June 2020 and September 2020 to all first-year internal medicine residents in the United States (US) through an online national database of residencies using the Survey Monkey platform. We asked them to rank the most significant factors that enticed or deterred them from choosing a specific program. We also compared domestic with international medical graduate (IMG) average ranked responses wherein differences were evaluated using an independent two mean samples t-test. The association between outcomes and predictors was analyzed using Pearson's correlation and chi-square analysis. Out of 9,127 residents, 102 responded to the survey, which equaled a 1.11% response rate. The findings showed that the location, culture, and organization of a program are high-value factors for applicants. Salary, the number of cases seen, and friends near the residency location were not.There are statistically significant differences between graduates of US medical schools and IMG applicants, with the former placing higher importance on the quality of life during residency. Male and female residents also have different priorities with the latter emphasizing program culture and work environment improvement.Residents who chose programs based on academic competitiveness also placed significance on the prestige of the program (r = 0.418, P < .001), program organization/structure (r = 0.3, P = .006), fellowship match rate (r = 0.307, P = .006) and word of mouth (r = 0.520, P < .001). Residents who chose programs based on program culture also put an emphasis on the perceived happiness of the residents (r = 0.450, P = 0.001), and work-life balance (r = 0.359, P = .004). Programs can attract stronger applicants if they emphasize modifiable factors that are important to potential residents.

“Get the DNR”: residents’ perceptions of goals of care conversations before and after an e-learning module

BackgroundResidents frequently lead goals of care (GoC) conversations with patients and families to explore patient values and preferences and to establish patient-centered care plans. However, previous work has shown that the hidden curriculum may promote physician-driven agendas and poor communication in these discussions. We previously developed an online learning (e-learning) module that teaches a patient-centered approach to GoC conversations. We sought to explore residents’ experiences and how the module might counteract the impact of the hidden curriculum on residents’ perceptions and approaches to GoC conversations.MethodsEleven first-year internal medicine residents from the University of Toronto underwent semi-structured interviews before and after completing the module. Themes were identified using principles of constructivist grounded theory.ResultsPrior to module completion, residents described institutional and hierarchical pressures to “get the DNR” (Do-Not-Resuscitate), leading to physician-centered GoC conversations focused on code status, documentation, and efficiency. Tensions between formal and hidden curricula led to emotional dissonance and distress. However, after module completion, residents described new patient-centered conceptualizations and approaches to GoC conversations, feeling empowered to challenge physician-driven agendas. This shift was driven by greater alignment of the new approach with their internalized ethical values, greater tolerance of uncertainty and complexity in GoC decisions, and improved clinical encounters in practice.ConclusionAn e-learning module focused on teaching an evidence-based, patient-centered approach to GoC conversations appeared to promote a shift in residents’ perspectives and approaches that may indirectly mitigate the influence of the hidden curriculum, with the potential to improve quality of communication and care.

Teaching Telehealth During a Pandemic and Beyond: an Intern's Survival Guide for Virtual Medicine.

BackgroundThe rapid transition to telemedicine at the onset of the COVID-19 pandemic required many providers to learn telemedicine “on the fly.” As virtual care will likely remain a mainstay of outpatient medicine, it is imperative that telemedicine training be incorporated into graduate medical education.AimDesign a telemedicine curriculum for internal medicine residents based on principles of experiential learning.SettingVA-based internal medicine primary care clinic.ParticipantsSixteen first-year internal medicine residents participated in the curriculum.Program DescriptionThe curriculum included a didactic session followed by four simulated patient encounters focused on troubleshooting technical issues, performing the virtual physical exam, coordinating team-based care, and tackling emergencies.Program EvaluationParticipants reported minimal previous experience with telemedicine. After completing the training, resident confidence in conducting video visits increased from an average score of four to seven (on a 10-point scale). Residents were more likely to agree that video visits would allow them to build bonds and effectively address their patients’ needs. This increased confidence persisted at 3 months after training.DiscussionUsing experiential learning, we identified strategies which increased the confidence of internal medicine trainees in conducting telemedicine visits. Further research is needed to validate our findings across different practice settings.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07009-8.

Telehealth Attitudes, Training, and Preparedness Among First-Year Internal Medicine Residents in the COVID-19 Era.

Introduction: Telehealth, especially the use of real-time video and phone visits in ambulatory care, is increasingly important in the wake of the COVID-19 pandemic. The current state of internal medicine (IM) interns' telehealth training at the start of residency is unknown. Objective: To characterize the attitudes, training, and preparedness of IM interns regarding the use of telehealth video and phone visits in ambulatory care. Materials and Methods: We conducted a cross-sectional survey of IM interns at four IM residency programs in the United States in 2020. Results: One hundred fifty-six surveys were analyzed (response rate 82%). Seventy-five percent of interns rated training in the use of real-time video and phone visits for ambulatory care as important or very important. The vast majority received no training (74%) or clinical experience (90% no prior video visits, 81% no prior phone visits) during medical school. More interns believed that primary care may be effectively delivered via video visits compared with phone visits (77% vs. 35%). Most interns (69%) missed clinical time during medical school due to the COVID-19 pandemic; 41% felt that the pandemic negatively affected their ambulatory care preparation. Overall, the majority of interns (58%) felt prepared for primary care; only 12% felt prepared to deliver primary care using either video or phone visits. Conclusions: Although IM interns had favorable attitudes toward video and phone visits, few had training or clinical experience; most felt unprepared. Residency programs may need to close training gaps for current interns in conducting telehealth video and phone visits.

Grit Does Not Predict Burnout among First-Year Internal Medicine Residents.

Grit, defined as passion and perseverance for long-term goals, has been associated with the avoidance of burnout among residents in a number of specialties. We aimed to evaluate the relationship between grit and burnout among first-year Internal Medicine residents. During the 2018-2019 academic year, the authors recruited 75 first-year Internal Medicine residents within a large academic program to complete the Short Grit Scale (Grit-S) and the Maslach Burnout Inventory General Survey (MBI-GS) at baseline and after 6 and 12 months. The primary outcome was the association between baseline Grit-S and MBI-GS scores within the domains of emotional exhaustion (EE) or cynicism (CYN) over time using linear mixed models. Secondary outcomes included the association between grit and high burnout at 6 or 12 months, grit and persistently high burnout, and the association of baseline high burnout with later high scores at 6 and 12 months using logistic regression models and trends in grit over time using repeated-measures analysis of variance. A total of 53 of 75 (71%) first-year residents completed the Grit-S and MBI-GS at baseline and at least one other time point. There was no association between grit and EE (P = 0.44) or CYN (P = 0.61) burnout domain scores. High baseline EE and high baseline CYN significantly increased the odds of later high burnout scores within each domain (EE odds ratio 9.66, 95% confidence interval 1.16-80.83; CYN odds ratio 13.37, 95% confidence interval 1.52-117.75). Grit scores and professional efficacy scores remained stable throughout the year (P = 0.15 and 0.46, respectively), while EE and CYN significantly increased (both P < 0.01). In this single-center study, grit was not associated with burnout among first-year Internal Medicine residents; however, our findings highlight the value of baseline burnout scores in helping to identify first-year residents who may be at higher risk of later burnout.

Internal Medicine Residents' Views About Care Transitions: Results of an Educational Intervention.

Problem:Suboptimal care transitions can lead to re-hospitalizations.Intervention:We developed a 2-week “Transitions of Care Curriculum” to train first-year internal medicine residents to improve their knowledge and skills to deliver optimal transitional care. Our objective was to use reflective writing essays to evaluate the impact of the curriculum on the residents.Methods:The rotation included: Transition of Care Teaching modules, Transition Audit, Transitional Care Site Visits, and Transition of Care Conference. Residents performed the above elements of care transitions during the curriculum and wrote reflective essays about their experiences. These essays were analyzed to assess for the overall impact of the curriculum on the residents.Qualitative analysis of reflective essays was used to evaluate the impact of the curriculum. Of the 20 residents who completed the rotation, 18 reflective essays were available for qualitative analysis.Results:Five major themes identified in the reflective essays for improvement were: discharge planning, patient-centered care, continuity of care, goals of care discussions, and patient safety. The most discussed theme was continuity of care, with following subthemes: fragmentation of the healthcare system, disjointed care to the patients, patient specific factors contributing to lack of continuity of care, lack of primary care provider role as a coordinator of care, and challenges during discharge process. Residents also identified system-based gaps and suggested solutions to overcome these gaps.Conclusions:This experiential learning and use of reflective writing enhanced the residents’ self-identified awareness of gaps in care transitions and prompted them to generate ideas for systems improvement and personal actions to improve their practice during care transitions.

A Mixed-Methods Evaluation of Medical Residents' Attitudes Towards Interprofessional Learning and Stereotypes Following Sonography Student-Led Point-of-Care Ultrasound Training.

Point-of-care ultrasound (POCUS) training is growing across internal medicine graduate medical education, but lack of trained faculty is a barrier to many programs. Interprofessional education (IPE) may offer a solution but must overcome potential biases of trainees. To evaluate the impact of an interprofessional POCUS training on residents' attitudes towards interprofessional learning and stereotypes. Midwestern health sciences university. Diagnostic medical sonography (DMS) students (n = 13) served as teachers for first-year internal medicine residents (IMR) (n = 49). DMS students participated in a train-the-trainer session to learn teaching strategies via case-based simulation, then coached IMR to acquire images of the kidneys, bladder, and aorta on live models. Mixed-methods evaluation, including pre-/post-surveys and focus group interviews. The survey response rate was 100% (49/49 IMR). Composite survey scores evaluating residents' attitudes towards IPE and stereotyping of sonographers improved significantly following the intervention. Qualitative analysis of focus group interviews yielded four themes: enhanced respect for other disciplines, implications for future practice, increased confidence of DMS students, and interest in future IPE opportunities. Interprofessional POCUS education can improve residents' perceptions towards IPE, increase their level of respect for sonographers, and motivate interest in future interprofessional collaboration.

A Novel Intimate Partner Violence Curriculum for Internal Medicine Residents: Development, Implementation, and Evaluation.

IntroductionIntimate partner violence (IPV) is a prevalent problem with profound health consequences. Research suggests that internal medicine (IM) residents are unprepared to screen for and address IPV. We designed a curriculum to improve IM residents’ knowledge, attitudes, and practices in caring for IPV survivors.MethodsThe curriculum was delivered to first-year IM residents from 2016 to 2017 at Johns Hopkins Bayview. Part 1 was 60 minutes long, with a video, evidence-based didactic teaching, and case-based discussion. Part 2 was 90 minutes long, with evidence-based didactic teaching, role-play of patient-provider conversations about IPV, and debriefing about strategies for discussing IPV. We evaluated knowledge, confidence, and self-reported behaviors pre- and postintervention using two-tailed paired t tests.ResultsThirty-two residents received IPV training. In comparing precurriculum (n = 29, 91% of total participants) and postcurriculum (n = 28, 88% of total participants) surveys, there was significant improvement in knowledge about IPV (p < .001). Postcurriculum, learners reported greater confidence in detecting IPV (p < .001), documenting IPV (p < .001), and referring to resources (p < .001). Participants reported increased comfort with managing difficult emotions about IPV in patients (p < .01) and themselves (p < .001) and increased comfort in discussing IPV with female (p < .001) and male (p < .001) patients. Postcurriculum, all respondents felt they were more skillful in discussing IPV and would be more likely to screen for IPV.DiscussionOur curriculum improved residents’ knowledge, confidence, comfort, and preparedness in screening for and discussing IPV.

Resident Perceptions of Assessment and Feedback in Competency-Based Medical Education: A Focus Group Study of One Internal Medicine Residency Program.

As key participants in the assessment dyad, residents must be engaged with the process. However, residents' experiences with competency-based medical education (CBME), and specifically with entrustable professional activity (EPA)-based assessments, have not been well studied. The authors explored junior residents' perceptions regarding the implementation of EPA assessment and feedback initiatives in an internal medicine program. From May to November 2018, 5 focus groups were conducted with 28 first-year internal medicine residents from the University of Toronto, exploring their experiences with facilitators and barriers to EPA-based assessments in the first years of the CBME initiative. Residents were exposed to EPA-based feedback tools from early in residency. Themes were identified using constructivist grounded theory to develop a framework to understand the resident perception of EPA assessment and feedback initiatives. Residents' discussions reflected a growth mindset orientation, as they valued the idea of meaningful feedback through multiple low-stakes assessments. However, in practice, feedback seeking was onerous. While the quantity of feedback had increased, the quality had not; some residents felt it had worsened, by reducing it to a form-filling exercise. The assessments were felt to have increased daily workload with consequent disrupted workflow and to have blurred the lines between formative and summative assessment. Residents embraced the driving principles behind CBME, but their experience suggested that changes are needed for CBME in the study site program to meet its goals. Efforts may be needed to reconcile the tension between assessment and feedback and to effectively embed meaningful feedback into CBME learning environments.