Housestaff Knowledge Research Articles

Assessing pediatric senior residents' training in resuscitation: fund of knowledge, technical skills, and perception of confidence.

To describe pediatric housestaff knowledge, experience, confidence in pediatric resuscitations and their ability to perform important resuscitation procedures during the usual training experience. Cohort study of PGY-3 level residents in a ACGME accredited pediatric residency training program at a large, tertiary care children's hospital. Fund of knowledge was assessed by administering the standardized test from the Pediatric Advanced Life Support (PALS) Course in addition to a supplemental short answer test requiring clinical problem-solving skills. Procedural skills were evaluated through observation of the resident performing four procedures during a skills workshop using a weighted step-wise grading sheet. Resident experience and confidence was quantified using an anonymous survey. Ninety-seven percent of residents participated. Residents achieved high scores on the standardized PALS test (93.2%+/-5.5), but performed less well when answering more complicated questions (60.0%+/-9.9) on the short answer test. No resident was able to successfully perform both basic and advanced airway skills, and only 11% successfully completed both vascular skills. Although residents were overall confident in their resuscitation skills, performance in the skill workshop revealed significant deficits. For example, only 18% performed ancillary airway maneuvers properly. None of the residents performed all four skills correctly. Experience in both real and mock resuscitations was infrequent. Residents reported receiving feedback on their performance less than half of the time. Over 89% of them felt that resuscitation knowledge and skill were important for their future chosen career. Pediatric residents infrequently lead or participate in real or mock resuscitations. Although confident in performing many of the necessary resuscitation skills, few residents performed critical components of these skills correctly. Current pediatric residency training may not provide sufficient experience to develop adequate skills, fund of knowledge, or confidence needed for resuscitation.

An assessment of house staff's knowledge of alcohol and substance abuse utilizing standardized patients

Utilizing standardized patients (SPs), house staff knowledge of alcohol and substance abuse was assessed in residents just prior to their starting their first graduate year of training. A total of 345 residents from 13 different residencies in eight institutions participated in this program. Each resident was assigned four SP cases. The reliability of these encounters ranged from 0.63 to 0.74. Of the participating residents, 22% were United States medical graduates (USMGs) and 78% were international medical graduates (IMGs). A considerable proportion of both USMGs and IMGs failed to ask appropriate questions concerning alcohol and drug use or identify the presence of risk factors associated with such use. Residents’ scores on cases primarily dealing with general medical issues, as compared to those dealing with substance abuse, were consistently higher. Knowledge of basic information concerning substance abuse and opioids was deficient in over 50% of those tested. These findings suggest that residents about to start their clinical training are not sufficiently prepared to address patients presenting with alcohol and other drug problems.

Training Pediatric Residents in Evidence-Based Ethics: An Exploratory Clinical Trial ♦ 161

Background: There is an increasing need to train physicians to make sophisticated ethical decisions based on a critical assessment of patient prognosis. Physicians often have an overly pessimistic view of the outcome of premature infants and a limited ability to evaluate neonatal and follow-up studies. Purpose: We assessed whether a brief educational intervention would increase housestaff knowledge, ethical sophistication, and epidemiologic skills needed to address treatment decisions for marginally viable newborns. Hypotheses: A brief educational intervention for pediatric housestaff prior to their neonatal intensive care unit (NICU) rotation will: a) augment their knowledge base as assessed by the number of housestaff who substantially overestimate rates of death and cerebral palsy among extremely premature infants; b) augment the ethical sophistication of housestaff as assessed by the number of specific ethical issues considered in recommending whether to provide intensive care to marginally viable infants; and c) augment the epidemiologic skills of housestaff as assessed by the methodologic criteria used to evaluate the quality of follow-up studies. Methods: A clinical trial involving 64 pediatric housestaff was performed with alternating control and intervention housestaff rotations in the NICU. A 45-60 min discussion involving neonatal case studies and literature review was provided to intervention housestaff before their Parkland NICU rotation. Intervention and control groups were evaluated at the end of their rotation, using an 8-item questionnaire scored by two faculty members blinded to treatment group. Results: Intervention housestaff were less likely than controls to substantially overestimate mortality (23% vs 55%) and morbidity (46% vs 74%) for extremely premature infants in our center;(p<0.05). Intervention housestaff tended to cite more methodologic criteria to evaluate follow-up studies than did controls; (p=0.052). The intervention did not increase the range of ethical criteria considered in treatment recommendations for marginally viable infants. Cerebral palsy rates (as compared to those reported in the methodologically strongest follow-up studies) were substantially overestimated by a high percentage of both intervention and control housestaff (70% vs 87%); (p=0.123). Conclusions: Our intervention had limited success. A more intensive intervention may be required to have a large impact on housestaff skills in addressing difficult ethical issues for marginally viable infants.

Effects of Structured Encounter Forms on Pediatric House Staff Knowledge, Parent Satisfaction, and Quality of Care

To evaluate the effects of health supervision structured encounter forms on pediatric house staff knowledge, parent satisfaction, and quality of care. Randomized, controlled trial. Pediatric house staff continuity clinic in a university-based children's hospital. 53 pediatric house officers and 153 parents. House staff were randomized to use structured encounter forms focused on developmental milestones (group 1) or anticipatory guidance/preventive care (group 2) during health supervision visits. Changes in house staff knowledge were assessed with pretests and posttests. Parent satisfaction was assessed with surveys. Quality of care, defined as compliance with recommended guidelines for age-specific health supervision, was assessed by audiotaping visits. Group 1 demonstrated greater but not significantly different improvement in knowledge of developmental milestones than group 2, while group 2 improved more than group 1 in knowledge of anticipatory guidance/ preventive care. Parent satisfaction with developmental screening was significantly greater for group 1 visits than for group 2 visits (P < .001). Group 1 demonstrated significantly greater compliance than group 2 with recommended standards of developmental screening (P = .001). The use of structured encounter forms for health supervision in pediatric house staff continuity clinics may increase house staff knowledge of developmental milestones and anticipatory guidance/preventive care, increases parent satisfaction with developmental assessment during health supervision, and improves compliance with recommended guidelines for developmental assessment.

Housestaff's knowledge of their patients' social histories.

To assess the extent to which house officers know the social histories of their hospital patients, and to examine the factors that influence social history knowledge. In October-November 1992, all 31 internal medicine housestaff rotating on the hospital inpatient services at the University of Kentucky A. B. Chandler Medical Center completed questionnaires regarding the social histories of up to three of their patients. Responses were analyzed using simultaneous multiple linear regression analysis. Standard questions about social history were answered correctly only 29% of the time (two of seven items). The overall knowledge of patients' social histories was significantly less for supervising residents than for interns (p = .03) and, independently, for housestaff with greater patient loads (p = .04). Knowledge of a patient's social history was not related to the particular inpatient service, time the patient was admitted, or other characteristics of the patients or residents. The internal medicine residents' knowledge of their hospital patients' social histories was limited, particularly when the residents had relatively heavy patient loads or supervisory roles in patient care. The data suggest that patients' social histories may have been underemphasized during the residents' training.

A study of pediatric house staff's knowledge of pulse oximetry : Rodriguez LR, Kotin N, Lowenthal D, et al. Pediat 93:810, 1994

A study of pediatric house staff's knowledge of pulse oximetry : Rodriguez LR, Kotin N, Lowenthal D, et al. Pediat 93:810, 1994

Barriers to immunization--an examination of factors that influence the application of pneumococcal vaccine by house staff.

Pneumococcal infection is a leading cause of adult morbidity and mortality in the United States. Immunization against this infection is a valuable strategy in preventive medicine. An effective pneumococcal vaccine has been available in this country for over a decade, but it remains poorly utilized. The purpose of the present investigation was to analyse the factors that affect the use and administration of the pneumococcal vaccine and to identify barriers to use. Upper-level internal medicine residents (n = 33) from two medical clinics associated with an academic medical centre completed an explanatory survey. This explored the levels of house-staff knowledge, perception and attitudes regarding the vaccine and the existence of practical barriers against its utilization. chi 2 analyses and z tests were carried out to determine significance, where appropriate. The majority of the house staff (22, 66.7%) answered correctly regarding vaccine target groups, and all residents indicated that they generally obtain a vaccination history in adult patient evaluation. However, a sizeable number (14, 42.4%) did not indicate a time of the year when they routinely administered vaccines to patients. They were not confident about their knowledge regarding vaccine guidelines (23, 69.7%) and had an exaggerated fear of hypersensitivity reactions from immunization (20, 60.6%). Neither the expense of the vaccine nor adverse publicity were impediments to immunization (24, 72.7% and 28, 84.8%, respectively). Although most physicians knew of the usefulness of the vaccine (31, 93.9%), many failed to translate this knowledge into clinical practice (22, 66.7%). 'Pressing' clinical issues were viewed as barriers to vaccination (18, 54.5%) and placed the practice of preventive medicine in a subordinate position.(ABSTRACT TRUNCATED AT 250 WORDS)

Housestaff knowledge of prevention guidelines.

Since the mid-1970s, practice guidelines for preventive care have been published in the primary care and internal medicine literature. In 1978, the Institute of Medicine (IOM) issued a monograph titled Preventive Services for the Well Population. l A more thorough effort was made by the Canadian Task Force (CTF) the Periodic Health Examination in 1979. e This latter group reviewed the scientific evidence on the effectiveness of 78 preventive procedures and offered recommendations. The American Cancer Society (ACS) issued the ACS Report on the Cancer-Related Health Checkup in 19807 In 1987, the National Cancer Institute (NCI) approved the Working Guidelines for Early Cancer Detection. 4 Through the initiative of its Clinical Efficacy Assessment Project (CEAP),5 the American College of Physicians (ACP) has issued background papers, 11 of which have led to preventive practice recommendations. 6 In 1989, the American Medical Association (AMA) Council on Scientific Affairs published its recommendation for mammographic screening for, women aged 40 years and older. 7 Also in 1989, the American College of Obstetricians and Gynecologists (ACOG) released its report on routine cancer screening, s Finally, the American Academy of Family Physicians (AAFP) published Positions on the Clinical Aspects of Medical Practice in 1991. 9

Society of General Internal Medicine Symposium Teaching Occupational and Environmental Medicine in Primary Care Residency Training Programs: Experience Using Three Approaches During 1984–1991

There is a critical shortage of physicians trained to recognize and treat occupational and environmental health problems. We implemented several required teaching programs for internal medicine and family medicine residents that focus on providing primary care for these problems. Clinical experiences were developed using the university and medical center as an example of a workplace with chemical and physical hazards. On-site experiences were also provided at local industries, but when resident stipend support for this aspect was discontinued, that part of the program was suspended. Didactic programs were associated with a statistically significant improvement in house staff knowledge scores. These occupational and environmental health issues can be introduced during residency, resulting in increased expertise in this discipline.

House staff knowledge of blood component therapy: an evaluation.

It has been documented that most transfusion errors are either administrative or clerical. It is necessary to ascertain if those responsible for transfusing patients have the knowledge to do it properly. Since house staff are responsible for the proper administration of blood components at many teaching hospitals, a group of pediatric interns and residents were given a short examination to measure their knowledge of transfusion practices and to identify when, during their training, this knowledge is obtained. Transfusion techniques, inspection of blood bag labels, compatibility, and transfusion reactions were covered in the exam. It was found that the knowledge of transfusion therapy is learned by experience and that many house staff members have an adequate knowledge of present-day transfusion practices.