General Internal Medicine Residents Research Articles

A multi-method approach to drafting candidate entrustable professional activities for a general internal medicine residency programme.

Entrustable professional activities (EPAs) are units of concrete daily clinical tasks that trainee physicians should be able to handle with increasing autonomy during their postgraduate training. EPAs are gaining international recognition as an essential component of competency-based medical training programmes. The process of developing EPAs for a nationwide training programme is complex and requires an in-depth understanding of EPAs as a concept and good knowledge of appropriate development processes. This article provides a detailed description of the methodology and results of a multi-step approach for developing a list of candidate EPAs for Switzerland's postgraduate training programme in general internal medicine (GIM). We took a multi-step approach including a systematic review of international literature, four national focus groups, a national consensus process using a RAND appropriateness method, and a quality check of the selected candidate EPAs using EQual criteria. These steps generated a final list of 247 candidate EPAs in general internal medicine that were submitted for the national consensus process. After two rounds of rating, experts agreed on the appropriateness for general internal medicine postgraduate training of 225 candidate EPAs. Twenty-two were deemed inappropriate, and disagreement persisted only for two EPAs. This multi-step programme is one of the few describing in detail the process of developing a list of EPAs and providing evidence of validity at each step. The clinical breadth of our candidate EPAs, together with the detailed description of our methodology, could serve as a useful starting point from which medical education specialists or clinicians could develop or revise applicable lists of EPAs, particularly for postgraduate training programmes in either general internal medicine or family medicine.

Integration of Automated Office Blood Pressure Measurement Into a General Internal Medicine Residency Clinic.

Integration of Automated Office Blood Pressure Measurement Into a General Internal Medicine Residency Clinic.

An Online Educational Module to Improve General Internal Medicine Trainees’ Knowledge and Comfort in Managing Acute Complications of Sickle Cell Disease

BACKGROUND: Sickle cell disease (SCD) is a genetic disorder characterized by hemolytic anemia and vaso-occlusive episodes. Many adults with SCD require hospitalization for the management of acute manifestations. There appears to be a gap in the level of knowledge that general internal medicine (GIM) trainees possess regarding the treatment and management of SCD. METHODS: We created an online module that helps medical residents improve their knowledge about SCD. Participants were exposed to different scenarios related to SCD. A pre-and posttests were administered to detect improvement in knowledge and comfort when managing SCD and its acute complications. RESULTS: Thirty consecutive GIM residents participated. Of these, 20 completed the demographic survey, 17 completed the pretest, and 10 completed the posttest and usability survey. The median time to complete the module was 68 min. Fifty percent of participants were 1st-year postgraduation from medical school. Forty-five percent stated that they were uncomfortable managing patients with SCD 80% had cared for at least 1–5 patients with SCD. All reported having no SCD lectures in residency. The median pretest score was 12/20 (range, 8–15) and posttest score was 20.5/25 (range, 13–24). CONCLUSIONS: Residents agreed that the module was useful, helps understanding about SCD and its complication, and aids with clinical duties. This module demonstrated to be an effective educational tool that can support resident education during their internal medicine. Further strategies will be needed to improve the delivery of online modules to keep residents engaged with the module and attaint full benefit from these activities.

Improvement of mild and more serious hypoglycemia in patients with DM type 1 and type 2 after introduction of Continuous Glucose monitoring in Internal Medicine Residency Clinic

We are describing our experience of introducing Continuous Glucose Monitoring (CGM) for the first time as far as we know not in specialized endocrine clinic, but in Internal Medicine Residency Clinic in USA. The 25- patients we included in the trial were with type 2 Diabetes Mellitus (DM 2) -85% and Type 1 DM (DM1)-15%. They were treated with multiple injections of Insulin per day and were self-Monitoring their blood glucose (SMBG) 4 times a day. Their HbA1c was in the beginning of the trial was 9.5-to 14%. Before the introduction of the CGM the patients were spending 1 hour and 14 minutes a day having mild hypoglycemia- between 69-54 mg/dl-4.75% and more significant hypoglycemia- less than 54 mg/dl 29 min a day-3.01%. The CGM was started in the Clinic by the CGM team. In the CGM team were actively participating a10- Internal medicine and Transitional Year Residents under the supervision of board-Certified Endocrinologist who was a member of the clinic also. The CGM used was Dexcom G6. The goal of the project was to show that not only in specialized centers, but in General Internal Medicine Residency clinic we can not only improve the control of DM type 1 and type 2 in those 25- patients but most importantly reduce the time they had hypoglycemia. The Internal Medicine and Transitional year Residents were actively involved in the project. They were educating the patients before starting the CGM on their die and how to adjust their Insulin at home based on written instruction materials and treat their low blood sugar. The patients were called at least once a week by Internal Medicine Clinic representative of the CGM team with instructions how to adjust their Insulin, treat their hypoglycemia and to counsel them about their diet and physical activity. The patients had scheduled appointment to the clinic once a month. After the glucotoxicity from the initial high blood sugar was overcomed by using the appropriate dose of Insulin the control of the diabetes was achieved with reduction of HbA1c to 7.04% mean from 11.21% before the introduction of the CGM. With the help of the CGM the time spent by the patients with BS less than 70 mg/dl decreased from 1 hour and 14 minutes per day-4.75% to 11 minutes per day-0.78% and the time spend with blood sugar less than 54 mg/dl per day decreased from 29 minutes-3.01% to 3 minute per day-0.25%. Both values after the introduction of CGM were within the American Diabetic Association (ADA) standards- mild hypoglycemia goal of less than 4 % and more significant hypoglycemia goal of less than 1 % per day. Four of the patients were able to have excellent control of their DM 2 without any low blood glucose only on per oral antidiabetic medications and or GLP1-RAG. Our experience showed that introduction of CGM instead of SMBG in General Internal Medicine residency Clinic can help a lot of patients with DM type 1 and type 2 on multiple injections of insulin per day to reduce mild and more serious hypoglycemia and improve their blood sugar control with Insulin. Also, we showed that this can be done safely in General Internal Residency clinic and not only in specialized endocrine clinics which can be adopted in other Internal Medicine residency Clinics in USA. This also significantly improves the education and experience with the CGM devise of our Internal Medicine and Transitional Year Medical Residents.

Case report about treatment of the patient with DM Type 2 on multiple injections of insulin who with the help of continuous glucose monitoring (CGM) improved and was controlled only on anti-diabetic pills and GLP1 - RAG

We would like to describe a patient who was treated for decompensated Diabetes Mellitus Type 2(DM type 2) with Multiple Injections of Insulin per day. His HbA1c while when he visited our clinic was above 14 %. He was self-monitoring his Blood sugar at home (SMBG) 4- times a day. He was treated only with Metformin ER in the past. The CGM was started in Internal Medicine Residency Clinic. The patient start sharing his CGM data with the clinic through Dexcom G6 CGM and compatible I phone. The patient was educated on diet, how to adjust his insulin at home based on written instruction material. Moreover, the patient was called at least once a week by the Medicine Clinic professional how to adjust his insulin and to counsel him about his diet and physical activity. The patient had scheduled appointment to the clinic at least once a month. After the glucotoxicity from the initial high blood sugar was managed by using the appropriate dose of insulin, the insulin dosages started to decrease in our patient. DM type 2 was well controlled with GMI less than 7% after starting the CGM. During the clinic visits, the morning fasting C- peptide of the patient was increased which we attribute due to his morbid obesity. These gave us the opportunity to start the patients on per oral antidiabetic medications and injectable GLP-1 receptor agonists (GLP-1-RAG). The patient’s DM type 2 control was maintained 3-6 months after stopping the insulin with Glucose management index (GMI) which approximates HbA1c less than 7%. Our experience with this patient showed that introduction of CGM instead of SMBG in the General Internal Medicine Residency Clinic can help patients with DM type 2 to improve their blood sugar control with Insulin and eventually stop the Insulin and start therapy with oral antidiabetic agents and or injectable GLP-1 -RAG. Also, we showed that this can be done safely in General Internal Medicine Residency clinic and not only in specialized clinics.

Program Directors' Selection Criteria for General Surgery and Internal Medicine Residency Programs: A Cross-Sectional Study.

Background and aims General surgery is a specialty that calls for a variety of abilities such as strong hand-eye coordination, the ability to function well under pressure, and the ability to make quick, informed decisions. On the other hand, internal medicine focuses on diagnosing, treating, and preventing adult non-surgical disorders. The present study aims to investigate the commonly used selection criteria employed by program directors (PDs) for general surgery and internal medicine residency programs. It also identifies how PDs value those criteria in the western and central regions of Saudi Arabia. Methods A retrospective cross-sectional study was conducted using a questionnaire adopted from the literature and modified following expert opinion. It was distributed to PDs in both the central and the western regions of Saudi Arabia. Results In total, 34 PDs completed the questionnaire, of which 32 (94.1%) were men. The mean age of participants was 42.53 ± 5.05 years; 21 (61.8%) PDs were general surgeons, and 47.1% were from the Jeddah region. Conclusion The study showed that the most selected criterion for both specialties was communication skills followed by clinical rotation in the same hospital; leadership skills were also highly considered by PDs.

Sitting at the Bedside: Patient and Internal Medicine Trainee Perceptions

BackgroundSitting at the bedside may strengthen physician–patient communication and improve patient experience. Yet despite the potential benefits of sitting, hospital physicians, including resident physicians, may not regularly sit down while speaking with patients.ObjectiveTo examine the frequency of sitting by internal medicine residents (including first post-graduate year [PGY-1] and supervising [PGY-2/3] residents) during inpatient encounters and to assess the association between patient-reported sitting at the bedside and patients’ perceptions of other physician communication behaviors. We also assessed residents’ attitudes towards sitting.DesignIn-person survey of patients and email survey of internal medicine residents between August 2019 and January 2020.ParticipantsPatients admitted to general medicine teaching services and internal medicine residents at The Johns Hopkins Hospital.Main MeasuresPatient-reported frequency of sitting at the bedside, patients’ perceptions of other communication behaviors (e.g., checking for understanding); residents’ attitudes regarding sitting.Key ResultsOf 334 eligible patients, 256 (76%) completed a survey. Among these 256 respondents, 198 (77%) and 166 (65%) reported recognizing the PGY-1 and PGY-2/3 on their care team, respectively, for a total of 364 completed surveys. On most surveys (203/364, 56%), patients responded that residents “never” sat. Frequent sitting at the bedside (“every single time” or “most of the time,” together 48/364, 13%) was correlated with other positive behaviors, including spending enough time at the bedside, checking for understanding, and not seeming to be in a rush (p < 0.01 for all). Of 151 residents, 77 (51%) completed the resident survey; 28 of the 77 (36%) reported sitting frequently. The most commonly cited barrier to sitting was that chairs were not available (38 respondents, 49%).ConclusionsPatients perceived that residents sit infrequently. However, sitting was associated with other positive communication behaviors; this is compatible with the hypothesis that promoting sitting could improve overall patient perceptions of provider communication.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07231-4.

Canadian general internal medicine residents' perception of a pedagogical tool of online cases in obstetric medicine.

Sufficient exposure to rarer medical problems around pregnancy is a challenge during short rotations in obstetric medicine (OM). A Canadian research group created online clinical cases, the CanCOM cases, to overcome this. We conducted an exploratory study to document the use and perceived utility of the CanCOM cases. 77 residents doing an OM rotation participated in our study. We used a survey to document their perception of CanCOM cases (12 items, 7-point scale), clinical exposure to several conditions (pre and post rotation; 41 items, 7-point scale) and use of the educational tool (1 item, 4-option scale). CanCOM cases was perceived as an accessible and useful tool. Participants completed a median of 6/20 cases (range 1-20), and highly recommended the cases (6.48 ± 0.73 SD on a 7-point Likert scale). Despite some technical limitations, CanCOM cases was shown to contribute to clinical exposure to rare but essential medical conditions.

Does admission order form design really matter? A reduction in urea blood test ordering

IntroductionLaboratory blood testing is one of the most high-volume medical procedures and continues to increase steadily with instances of inappropriate testing resulting in significant financial implications. Studies have suggested that...

Innovative educational approaches to house calls in the time of COVID-19.

Innovative educational approaches to house calls in the time of COVID-19.

Impact of an internal medicine nocturnist service on care of patients with cancer at a large Canadian teaching hospital: a quality-improvement study.

Background:Nocturnists (overnight hospitalists) are commonly implemented in US teaching hospitals to adhere to per-resident patient caps and improve care but are rare in Canada, where patient caps and duty hours are comparatively flexible. Our objective was to assess the impact of a newly implemented nocturnist program on perceived quality of care, code status documentation and patient outcomes.Methods:Nocturnists were phased in between June 2018 and December 2019 at Toronto General Hospital, a large academic teaching hospital in Toronto, Ontario. We performed a quality-improvement study comparing rates of code status entry into the electronic health record at admission, in-hospital mortality, the 30-day readmission rate and hospital length of stay for patients with cancer admitted by nocturnists and by residents. Surveys were administered in June 2019 to general internal medicine faculty and residents to assess their perceptions of the impact of the nocturnist program.Results:From July 2018 to June 2019, 30 nocturnists were on duty for 241/364 nights (66.5%), reducing the mean maximum overnight per-resident patient census from 40 (standard deviation [SD] 4) to 25 (SD 5) (p < 0.001). The rate of admission code status entry was 35.3% among patients admitted by residents (n = 133) and 54.9% among those admitted by nocturnists (n = 339) (p < 0.001). The mortality rate was 10.5% among patients admitted by residents and 5.6% among those admitted by nocturnists (p = 0.06), the 30-day readmission rate was 8.3% and 5.9%, respectively (p = 0.4), and the mean acute length of stay was 7.2 (SD 7.0) days and 6.4 (SD 7.8) days, respectively (p = 0.3). Surveys were completed by 15/24 faculty (response rate 62%), who perceived improvements in patient safety, efficiency and trainee education; however, only 30/102 residents (response rate 29.4%) completed the survey.Interpretation:Although implementation of a nocturnist program did not affect patient outcomes, it reduced residents’ overnight patient census, and improved faculty perceptions of quality of care and education, as well as documentation of code status. Our results support nocturnist implementation in Canadian teaching hospitals.

Entrustability levels of general internal medicine residents

BackgroundEntrustable professional activities (EPAs) are those activities that a health professional can perform without direct supervision in a defined environment. Bridging the gap between competencies and learning objectives, EPAs have made assessing the performances of health professional more realistic. The main objective of the present study was developing and customizing EPAs for Iranian Internal Medicine Residency Programs.ResultsAfter reviewing the publications, residency curricula and logbooks, and collecting experts’ ideas, the initial list of EPAs was developed. Then, in a focus group, the list was refined, the entrustability level of each residency year was determined, and finally, the EPA-competency cross-tab was established, and in the next step, through a one- round Delphi, the results were validated. Twenty-eight EPAs were developed. Some of them were definitely suitable for the higher levels of residency, such that they had to be accomplished under direct supervision until the end of the program. On the other hand, some of EPAs were those that residents, even from the first year, are expected to perform independently or under indirect supervision. Most of the EPAs cover a wide range of competencies.ConclusionDetermining the entrustability level of each residency year in each EPA as well as the competency- EPA matrix has crucial effect on the quality of the graduates. It seems that our findings are applicable in developing countries like Iran.

Resident Mental Health Care: a Timely and Necessary Resource.

Residency training is associated with stress and burnout that can contribute to poor mental health, yet many residents do not get the help needed. While some healthcare institutions provide mental health services specifically for residents, literature has documented few examples. The objective of this study was to investigate the utilization and patient characteristics of a resident mental health program. The authors conducted a retrospective records analysis of residents who utilized outpatient mental health services through the Thomas Jefferson University Hospital Emotional Health and Wellness Program for House Staff from 2010 to 2018. A total of 158 resident patient charts were reviewed. Utilization was highest for females, first years, and general internal medicine residents. Initial help-seeking was most common for summer, winter, and intern year. The most frequent diagnoses were adjustment, depressive, and anxiety disorders. Of residents who completed screening tools, 43% screened positive for moderate to severe depression, 11% screened positive for hazardous alcohol consumption, and 15% endorsed thoughts of death or suicide. Resident physicians manifest psychiatric symptoms, mental disorders, and suicidal ideation that require treatment and intervention. Yet, a minority of residents make use of services. This data emphasizes the need to promote help-seeking behaviors among residents and ensure timely access to comprehensive mental health services.

Implementation of an educational intervention pilot for residents on acute care general internal medicine wards around the ‘comfort measures strategy’ for end of life care

Purpose This multi-component educational intervention was aimed at General Internal Medicine residents’ perceived self-efficacy in providing end of life care. This study also measured the uptake of the Comfort Measures Order Set. Methods This non-randomized study was conducted over nine 4-week rotations on one General Internal Medicine ward. The intervention consisted of: 1) a didactic module, 2) presence of the Palliative Care Consult Team at General Internal Medicine rounds and, 3) provision of end of life care educational materials. Twenty learners completed a pre/post Self-Efficacy in Palliative Care Scale. Data/Results Data revealed improved self-efficacy ratings on the overall scale, and on all three subscales of the Self-Efficacy in Palliative Care Scale. The Comfort Measures Order Set was implemented in 62% of patient deaths in the intervention group, and 51% of patient deaths in the control group, demonstrating no statistical difference between these groups. Conclusion The uptake of the order set in both the intervention and control groups demonstrated utility in providing a clinical framework for delivering end of life care and highlighted the need for on-going education and enhancement of clinicians' self-efficacy in end of life care.

The well-being of Swiss general internal medicine residents.

Physician well-being has an impact on productivity and quality of care. Residency training is a particularly stressful period. To assess the well-being of general internal medicine (GIM) residents and its association with personal and work-related factors. We conducted an anonymous electronic survey among GIM residents from 13 Swiss teaching hospitals. We explored the association between a reduced well-being (&ge;5 points based on the Physician Well-Being Index [PWBI]) and personal and work-related factors using multivariable mixed-effects logistic regression. The response rate was 54% (472/880). Overall, 19% of residents had a reduced well-being, 60% felt burned out (emotional exhaustion), 47% were worried that their work was hardening them emotionally (depersonalisation), and 21% had career choice regret. Age (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.05&ndash;1.34), working hours per week (OR 1.04 per hour, 95% CI 1.01&ndash;1.07) and &lt;2.5 rewarding work hours per day (OR 3.73, 95% CI 2.01&ndash;6.92) were associated with reduced well-being. Administrative workload and satisfaction with the electronic medical record were not. We found significant correlations between PWBI score and job satisfaction (rs = -0.54, p&lt;0.001), medical errors (rs = 0.18, p&lt;0.001), suicidal ideation (rs = 0.12, p = 0.009) and the intention to leave clinical practice (rs = 0.38, p &lt;0.001) CONCLUSIONS: Approximately 20% of Swiss GIM residents appear to have a reduced well-being and many show signs of distress or have career choice regret. Having few hours of rewarding work and a high number of working hours were the most important modifiable predictors of reduced well-being. Healthcare organisations have an ethical responsibility to implement interventions to improve physician well-being.

Fundamentals of Anorectal Technical Skills: A Concise Surgical Skills Course.

Anorectal diseases, among the most common surgical conditions, are underrepresented in medical training. The Fundamentals of Anorectal Technical Skills course was developed to provide cost-effective formal training in diagnosis of common anorectal conditions and in commonly performed anorectal procedures using the theories of deliberative practice and perceptual and adaptive learning. First- through third-year general surgery and internal medicine residents and third- and fourth-year medical students participated in a course consisting of didactic instruction and hands on skills stations. The course covered common anorectal conditions, including internal and external hemorrhoids, fissures, condylomata, abscesses, fistula-in-ano, rectal prolapse, pilonidal disease, pruritis ani, and anal and rectal cancer, as well as common procedures such as anoscopy, excision of thrombosed external hemorrhoids, banding of internal hemorrhoids, rigid proctoscopy, incision and drainage of an abscess, administration of local anesthesia, and reduction of rectal prolapse. Before the course, participants completed a questionnaire consisting of demographics; previous anorectal experience, as measured by procedural case volume; confidence diagnosing and treating anorectal conditions; and a clinical knowledge multiple-choice quiz. Immediately following the course, participants took an additional survey reassessing their confidence and testing their clinical knowledge. This study was granted an educational exception by the Institutional Review Board at Walter Reed National Military Medical Center. Forty-three learners participated in this course. Forty-six percent of participants had not participated in any anorectal cases, 26% had participated in 1 to 5 cases, 17% had participated in 6 to 10 cases, 6% had been involved with 11 to15 cases, and 6% had been involved with more than 15 cases. For learners who had no prior experience, 1 to 5 prior cases, or 6 to 10 cases, there were statistically and educationally significant increases in confidence for all diagnoses and procedures. Additionally, there were statistically and educationally significant increases between pre-course and post-course quiz scores for learners who had no prior experience (7.8±2.0 vs. 11.8±2.5, P<0.01, Cohen's d=1.8) and for those who had only participated in 1 to 5 cases (11.0±3.7 vs. 14.2±2.0, P=0.04, Cohen's d=1.1). The changes in quiz scores for learners who previously had been involved with six or more cases were not statistically significant. This course provides a cost-effective training that significantly boosts learners' confidence in diagnosis of common anorectal procedures and confidence in performance of common anorectal procedures, in addition to improving objectively measured anorectal clinical knowledge.

Providing quality feedback to general internal medicine residents in a competency-based assessment environment

Construct: Competence Based Medical Education (CBME) is designed to use workplace-based assessment (WBA) tools to provide observed assessment and feedback on resident competence. Moreover, WBAs are expected to provide evidence beyond that of more traditional mid- or end-of-rotation assessments [e.g., In Training Evaluation Records (ITERs)]. In this study we investigate competence in General Internal Medicine (GIM), by contrasting WBA and ITER assessment tools.Background: WBAs are hypothesized to improve and differentiate written and numerical feedback to support the development and documentation of competence. In this study we investigate residents’ and faculty members’ perceptions of WBA validity, usability, and reliability and the extent to which WBAs differentiate residents’ performance when compared to ITERs. Approach: We used a mixed methods approach over a three-year period, including perspectives gathered from focus groups, interviews, along with numerical and narrative comparisons between WBA and ITERs in one GIM program.Results: Residents indicated that the narrative component of feedback was more constructive and effective than numerical scores. They perceived the focus on specific workplace-based feedback was more effective than ITERs. However, quantitative analysis showed that overall rates of actionable feedback, including both ITERs and WBAs, were low (26%), with only 9% providing an improvement strategy. The provision of quality feedback was not statistically significantly different between tools; although WBAs provided more actionable feedback, ITERs provided more strategies. Statistical analyses showed that more than half of all assessments came from 11 core faculty.Conclusions: Participants in this study viewed narrative, actionable and specific feedback as essential, and an overall preference was found for written feedback over numerical assessments. However, quantitative analyses showed that specific actionable feedback was rarely documented, despite qualitative emphasis from both groups of its importance for developing competency. Neither formative WBAs or summative ITERs clearly provided better feedback, and both may still have a role in overall resident evaluation. Participant views differed in roles and responsibilities, with residents stating that faculty should be responsible for initiating assessments and vice-versa. These results reveal a disconnect between resident and faculty perceptions and practice around giving feedback and emphasize opportunities for programs adopting and implementing CBME to address how best to support residents and frontline clinical teachers.

Paging the Right Resident the First Time on General Internal Medicine: A Quality Improvement Project

Interprofessional hospital communication is vital for high-quality patient care. However, staff have reported that nursing pages are often sent to the wrong residents, leading to service delays, interruptions, and safety risks. The aim of this quality improvement project was to reduce day shift pages to general internal medicine (GIM) teams by 25% over 10 months by helping nurses page the right residents the first time. This study was conducted at a Canadian tertiary academic hospital and involved three GIM teams on seven inpatient wards. The Model for Improvement was used to explore root causes and redesign how nurses and switchboard operators contacted residents. Multiple change ideas were tested: posting daily resident assignments on digital monitors, redirecting switchboard pages to internal medicine residents, and forwarding pagers in learning sessions. The primary outcome was the average number of pages/team/week to GIM residents. Evaluation was conducted with statistical process control charts and qualitative feedback. A total of 19,925 pages were reviewed from 226 resident shifts over 39 weeks. Average pages/team/week (Monday to Friday, 08:00 to 17:00) decreased by 38.3% (133 to 82) postimplementation. More nurses reported often or always knowing which residents were assigned to patients, increasing from 0% to 38.1%. Fewer residents reported often or always receiving pages about another resident's patient, decreasing from 50.0% to 26.7%. Quality improvement methods were used to streamline the paging process on GIM wards, resulting in fewer pages and improved communication efficiency.

Education Research - GIM

Background&#x0D; Obstetric Medicine is an area of expertise within General Internal Medicine (GIM) in Canada. Essential content for clinical rotations for GIM residents was identified by subject-matter experts (N=204 items). However, this work did not address the perspective of curriculum stakeholders.&#x0D; Methods&#x0D; Members of the Canadian GIM Specialty Committee (GIMSC) were surveyed to obtain their perspective on essential content that GIM residents should acquire in Obstetric Medicine.&#x0D; Results&#x0D; GIMSC members (N=14) selected “core content” which reduced the initial content blueprint by 72%. Some sections of the blueprint were left largely unchanged (e.g., hypertensive disorders of pregnancy), whereas others were removed entirely (e.g., transplant medicine).&#x0D; Interpretation&#x0D; GIMSC were more selective than Canadian Obstetric Internists in choosing the essential content for GIM residents, with a moderate overall agreement of 78% (kappa coefficient of 0.53). Comparison of perspectives and content mapping may provide useful validity evidence for further work.&#x0D;

What makes internal medicine attractive for the millennial generation? A survey of residents in internal medicine in Switzerland.

A new generation of physicians, millennials (also known as Generation Y), are entering residency programmes in internal medicine, and these young men and women learn and work in ways that are different from those of past generations. The aim of the present study was to investigate aspects contributing to the attractiveness to young residents of a career in general internal medicine (GIM) compared with medical subspecialties (SUB). In a cross-sectional online survey, we included residents working in residency facilities in GIM in German-speaking Switzerland. A total of 1818 junior residents were eligible. We looked for personal preferences, characteristics, and criteria influencing the choice of a career in GIM or SUB. 392 out of 1818 (22%) residents participated in the survey (66% females); they had been in clinical training for 35.5 months on average. 87% of the respondents aspired to a title in GIM, and 29% of these to a SUB title as well. 71% of the women chose GIM and not a SUB vs 58% of the men (p &lt;0.019). GIM residents gave significantly higher ratings to &ldquo;broad range of expertise,&rdquo; &ldquo;flexible work hours&rdquo; (p = 0.007), &ldquo;work-life balance&rdquo;, and &ldquo;reconciliation of work, family and private life&rdquo; than residents aiming at a SUB. SUB residents evaluated career-related criteria as significantly more important (p &lt;0.0001). With regard to career motivation, GIM residents and female residents rated extraprofessional concerns significantly higher than SUB residents did (p = 0.019). In contrast, SUB residents showed significantly higher intrinsic motivation than GIM residents (p = 0.025). Only 28.2% of GIM residents had a mentor, compared to 49.6% of SUB residents (p &lt;0.0005). Concerning personal perceptions of the future within the next 5 years, GIM residents attached significantly more importance to part-time work (p = 0.001), whereas SUB residents attached more importance to getting a leading position as a main goal (p = 0.0001). There are considerable differences between GIM and SUB residents regarding career motivation and their views on working conditions and work-life balance. It is essential to understand the factors that motivate or deter the next generation in order to ensure the attractiveness of the profession of GIM. &nbsp.