Internal Medicine Residents Research Articles

Gamification approach to addiction education for internal medicine residents

Background: People with a substance use disorder (SUD) outnumber the trained provider workforce. The Accreditation Council for Graduate Medical Education (ACGME) recognized this gap in 2022 and now requires addiction education for internal medicine (IM) residents. However, traditional lecture formats struggle to deliver education on this stigmatized condition with meaningful retention and changes in attitudes. Gamification is an evidence-based educational strategy with positive outcomes in graduate medical education, but to our knowledge, has not been used for an entire addiction curriculum. Intervention: This six session IM-focused, stigma-free, interactive curriculum used published physician competencies for content selection. Games were matched to topics based on complexity and need for skill practice. Each hourly session included 10 minutes on introduction, 45 minutes on gameplay, and 5 minutes on feedback. This addiction curriculum was incorporated into existing didactics for IM residents where participants’ comfort, psychological safety, and learning expectations were pre-established. Methods: Sixteen IM residents participated in the curriculum. Curriculum evaluation was conducted using Kirkpatrick’s four levels of evaluation. Resident feedback was obtained via online survey software at the conclusion of each session and behavior impact through an anonymous single question prompt. We used descriptive statistics and summative content analysis to evaluate findings, respectively. Results: All residents were highly satisfied with the curriculum design and use of gamification. Residents reported high levels of engagement and learning, despite use of various games. Findings support an increase in medication prescribing and utilization of harm reduction strategies following curriculum implementation. Conclusion: Gamification may be a preferred educational strategy for addiction curriculum for IM residents. We plan to distribute our curriculum widely for further evaluation in health professions’ programs.

A Curriculum on Advanced Topics in Hypertension for Internal Medicine Residents.

Hypertension (HTN) affects nearly half of US adults. Our multi-institutional survey revealed that Internal Medicine residents lack proficiency in advanced HTN topics. We developed a curriculum to address knowledge gaps in these topics and aimed to assess the effects of the curriculum on residents' confidence, desire for future training, and knowledge in advanced HTN topics. HTN experts taught four advanced topics in HTN: conducting a workup for secondary HTN, managing HTN in chronic kidney disease, managing HTN in patients who are or may become pregnant, and managing hypertensive urgency (severe asymptomatic HTN) in the outpatient setting. The setting of the curriculum was an ambulatory educational half-day, during which residents rotated through small-group sessions dedicated to each HTN topic. We developed pre-, immediate post-, and 8 weeks postcurriculum surveys assessing residents' confidence and desire for future training in the four topics (4-point Likert scales), and multiple-choice quizzes to assess changes in knowledge. We used repeated-measures analysis of variance to compare means between time points for surveys and quizzes. A total of 112 Internal Medicine residents participated in the curriculum. The mean confidence scores for all four topics increased from 1.79 to 2.61 precurriculum to 2.90 to 3.45 immediately postcurriculum (all P < 0.001) and remained higher (2.53-3.18) than precurriculum at 8 weeks postcurriculum (all P < 0.02). The mean desire for future training scores decreased from 2.74 to 2.96 precurriculum to 2.06 to 2.36 immediately postcurriculum (all P < 0.001 except for managing HTN in patients who are or may become pregnant, which was P = 0.17) and remained lower (2.08-2.36) than precurriculum at 8 weeks postcurriculum (all P ≤ 0.003). The mean knowledge score increased from 48% precurriculum to 62% immediate postcurriculum (P < 0.001) and remained higher (55%) than precurriculum at 8 weeks postcurriculum (P = 0.015). A curriculum on advanced HTN topics produced durable gains in confidence and knowledge and partially satisfied the desire for future learning among Internal Medicine residents.

What Constitutes High Risk for Venous Thromboembolism? Comparing Approaches to Determining an Appropriate Threshold.

Guidelines recommend pharmacological venous thromboembolism (VTE) prophylaxis only for high-risk patients, but the probability of VTE considered "high-risk" is not specified. Our objective was to define an appropriate probability threshold (or range) for VTE risk stratification and corresponding prophylaxis in medical inpatients. Patients were adults admitted to any of 10 Cleveland Clinic Health System hospitals between December 2020 and August 2021 (N = 41,036). Hospital medicine physicians and internal medicine residents from included hospitals were surveyed between June and November 2023 (N = 214). We compared five approaches to determining a threshold: decision analysis, maximizing the sensitivity and specificity of a logistic regression model, deriving a probability from a point-based model, surveying physicians' understanding of VTE risk, and deriving a probability from physician behavior. For each approach, we determined the probability threshold above which a patient would be considered high-risk for VTE. We applied each threshold to the Cleveland Clinic VTE risk assessment model (CCM) and calculated the percentage of the 41,036 patients in our cohort who would be considered eligible for prophylaxis due to their high-risk status. We compared these hypothetical prophylaxis rates with physicians' observed prophylaxis rates. The different approaches yielded thresholds ranging from 0.3% to 5.4%, corresponding inversely with hypothetical prophylaxis rates of 0.2% to 75%. Multiple thresholds clustered between 0.52% to 0.55%, suggesting an average hypothetical prophylaxis rate of approximately 30%, whereas physicians' observed prophylaxis rates ranged from 48% to 76%. Multiple approaches to determining a probability threshold for VTE prophylaxis converged to suggest an optimal threshold of approximately 0.5%. Other approaches yielded extreme thresholds that are unrealistic for clinical practice. Physicians prescribed prophylaxis much more frequently than the suggested rate of 30%, indicating opportunity to reduce unnecessary prophylaxis. To aid in these efforts, guidelines should explicitly quantify high-risk.

Empowering Internal Medicine Residents Through Health Policy: A Simple Approach to Inspire and Teach Action.

Background Most physicians receivelittle or no teaching about health policy during residency, despite accreditation organizations emphasizing the need to do so. Lack of time, expert faculty, and institutional financial support can be barriers to implementing a health policy experience. Aim Our goal was to educate internal medicine residents about the legislative process, improve their ability to engage with lawmakersand inspire them to effect policy change in their role as physicians. We aimed to impart a basic knowledge of how health policy decisions are made and give residents hands-on experience in speaking to lawmakers without requiring significant faculty or resident time. Settings Residents attended an hour-long classroom presentation at our medical school. A portion of them attended a lobby day with the Texas Medical Association (TMA). This consisted of introductory training at the TMA building and then a meeting with individual legislators at the Capitol. Participants Sixty-three internal medicine residents received the classroom presentation. Thirteen residents attended the lobby day, ten of whom were in the primary care track, and three were residents in the categorical program who expressed interest and had scheduled availability. Three Dell Medical School faculty members also attended the lobby day. Program description Residents attended a one-hour classroom presentation about the legislative process, current health policy proposals, and local organizations and their policy priorities. Residents then participated in a lobby day with the Texas Medical Association (TMA) in the spring of 2023, which consisted of an introductory session with an issue briefing and training sessions. Residents were then separated into groups based on their zip code, guided in how to speak on behalf of their experiences, and met with their local lawmakers. Program evaluation We administered a pre- and post-experience survey. Only 16.7% had ever met with a lawmaker, but they highly rated the importance of engaging in health policy (mean±SD, 4.42±0.79). The experience significantly increased from pre- to post-experience their ability to contact their lawmaker (2.75 to 3.89), confidence in their ability to discuss policy with a lawmaker (2.33 to 3.56), and their sense of empowerment that they have a voice that can influence policy (2.92 to 4.22). Discussion Internal medicine residents view engagement with health policy as an important experience during training. By utilizing existing resources in our institution combined with an existing lobbying opportunity, we were able to improve resident confidence and abilities to engage in policymaking without substantial financial or time costs.

Crafting the Future Doctor: Mentorship in the First Year of Medical School.

Background: The Clinically Reimagined Apprenticeship For Physician Training (CRAFT) program is a volunteer, student-run, clinical mentorship program that started in 2015 at an academic medical center in the Mid-Atlantic region. Clinical exposure during the first year of medical school may influence a student's decision to pursue internal medicine for their residency program of choice.Methods: A retrospective chart analysis of CRAFT program volunteers was conducted. First-year medical school students at an academic medical center in the Mid-Atlantic region (first-year classes of 2020 to 2022) who participated in the CRAFT program (N=77) were followed from first year until their medical school graduation. Information regarding first year mentor's specialty and student's match list data were collected.Results: Students (51%) who participated in CRAFT matched into the same specialty of medicine as their CRAFT program mentors (P=0.765, Chi Square Test). The top specialties represented included emergency medicine, internal medicine, obstetrics/gynecology, and surgery. Of students (23%) who chose mentors in internal medicine, 50% matched into internal medicine residency programs (P<0.0001, Chi Square Test).Conclusion: Clinical mentorship programs during the first year of medical school may be important for choosing future residency programs, leading to successful career goals. Timely engagement with mentors can be crucial in influencing career choices in the field of internal medicine.

Abstract P315: Using Home Blood Pressure Monitors in the Office Setting as an Alternative to Automated Office Blood Pressure: A Quality Improvement Project

Background: Accurate blood pressure (BP) measurement is key to the diagnosis and effective treatment of hypertension (HTN). The U.S. HTN guideline recommends having patients rest for 5 minutes before measuring BP and obtaining at least two measurements 1-2 minutes apart. This is difficult to achieve in a busy primary care practice, and while automated office BP (AOBP) has been advanced as a solution, the required device may be cost-prohibitive. As home BP monitors are much less expensive, a protocol employing them in the office setting could prove to be an attractive alternative to AOBP. Objective: To promote the recording of multiple BP readings in primary care visits by using home BP monitors for measurement. Methods: Our primary care practice hosts 110 internal medicine residents and completes more than 35,000 patient visits annually. Prior to the intervention, medical assistants (MAs) obtained vital signs (VS) at every visit using a VS cart. In the first version of the new protocol, MAs measured all VS except BP using the VS cart, then measured BP once using an Omron 5 series BP monitor and recorded that reading in the chart. MAs left the cuff on the patient’s arm and instructed him/her to rest quietly for 5 minutes before taking a second BP reading him/herself while waiting for the provider after the MA exited the room. The patient took a third reading 1-2 minutes after the second. The provider recorded the second and third readings in the chart. Results: We implemented the new protocol in November 2023. In February 2024, we met with MAs to solicit feedback. They found the protocol easy to follow overall but had two concerns: (1) It was cumbersome to use two different devices to obtain a full set of VS; and (2) since many patients had normal BP, it did not seem worthwhile to obtain multiple BP measurements for all patients. After this meeting, we began measuring heart rate and oxygen saturation with a portable pulse oximeter instead of the VS cart, which is now only used in special circumstances. We also modified the protocol so that patients with systolic BP &lt; 120 mm Hg and diastolic BP &lt; 80 mm Hg are not required to obtain any repeat BP measurements. Conclusions: A new BP measurement protocol using home BP monitors to obtain multiple readings at each visit was feasible in our large academic primary care practice. We plan to investigate its effect on frequency of repeat BP measurement and likelihood of intensifying therapy for uncontrolled HTN.

Evaluating the Impact of Gender, Race, and Training Year on Internal Medicine Residents' Experiences Across the United States.

Prior studies have highlighted experiences of bias within resident training based on trainees' gender and race and high rates of burnout. However, few studies have addressed the intersection between bias and wellness for residents in internal medicine (IM) programs. This study explores how race, gender, and training year affect IM residents' bias experiences and well-being. An anonymous survey with questions evaluating demographics and resident experiences of bias and perceptions of wellness and self-efficacy was distributed to 596 IM programs across the United States. Sixty-nine programs sent out the survey to their IM residents. Respondents to the survey included 176 residents. Descriptive analyses and χ2 tests were performed. Responses demonstrated that gender and race impacted residents' experiences with bias and misidentification. Eighty-eight percent of women compared to 1% of men, and 89% of Black residents compared to 3% of White residents reported being misidentified as a nonphysician due to gender and race, respectively. Degrees to which residents felt they were thriving in residency, experiencing burnout, and utilizing their strengths varied significantly by gender. Residents' self-perceived burnout levels were associated with being misidentified as not being a physician due to race. Experiences with bias also increased significantly with training year. This study provides important insights into the impact of gender, race/ethnicity, and training year on IM residents' experiences with bias and self-perception. The findings emphasize the need for structural changes within IM residency programs to reduce experiences of bias and to better cultivate the wellness of residents.

Teaching and Evaluating the Virtual Physical Exam in Telemedicine.

With the rapid adoption of telemedicine since the COVID-19 pandemic, it has become imperative to teach and evaluate health professional trainees on skills important to conducting effective virtual visits. We developed a simulation-based workshop with (1) readings, (2) a lecture covering online communication and the virtual head and neck exam, (3) a telemedicine simulation with a standardized patient observed by faculty, (4) personalized feedback from faculty, and (5) a group debrief session. We created an evaluation rubric based on three of 20 Association of American Medical Colleges (AAMC) telemedicine competencies to assess learner performance during the simulations. Students (medical and physician assistant students; n = 50), and internal medicine residents (n = 20) completed this workshop in 2023. At least 90% of trainees across the two groups were rated as approaching entrustment or entrustable in each competency. This workshop is an example of a scalable telemedicine curriculum that can be used to teach and evaluate learners in the virtual physical exam across the training continuum.

Closing the Gaps in Hepatitis C Knowledge Among Internal Medicine Residents in the United States

BackgroundThe introduction of direct-acting antivirals (DAA) has revolutionized hepatitis C virus (HCV) treatment but has not translated into an appreciable decline in HCV prevalence, which is estimated to be 2.4 million in the United States. Efforts are thought to be limited by the lack of experience among nonspecialist providers in managing HCV. However, there have been no comprehensive surveys assessing HCV knowledge among medical trainees to determine if trends have shifted since the discovery of DAAs. MethodsWe performed a retrospective observational study of internal medicine (IM) residents in the United States (n = 1763) who completed the Physician Education and Assessment Center HCV learning module between 2021 and 2022. Participant pre- and post-test performance was compared with further stratified analysis by training year, geography, training program type, and local HCV prevalence using ANOVA and Chi-squared tests of proportions, respectively. ResultsIM residents universally lacked baseline HCV knowledge (average score ± standard deviation, 43% ± 19%); less than 50% of participants answered correctly in the majority of tested domains. There were no consistent trends in performance regardless of resident characteristic used to stratify the participants. Knowledge gaps improved after completing an online educational training module (P < .001). ConclusionsHCV knowledge remains limited among IM residents despite expansion of treatment options. Addressing these gaps during clinical training may substantially increase the availability of HCV treatment in the community, and online modules may be one means by which to integrate these efforts into medical training.

Patched but Still Leaky: An Update on the Pipeline for Women in Gastroenterology.

Women remain underrepresented in gastroenterology (GI). Studies have identified that a lack of formal mentorship for women contributes to this underrepresentation. While many GI divisions have adopted models for supporting GI fellows and faculty, there is a gap in our knowledge regarding mentorship options for internal medicine (IM) residents interested in GI. To evaluate representation of women at each level of their career (resident, fellow, and attending) and examine trends in representation of women in GI compared to other IM subspecialties. We analyzed AAMC Physician Specialty Data Reports to compare gender representation and growth of women representation across all IM subspecialties and residencies from 2007 to 2021. In 2021, 44.3% of IM residents, 37.8% of GI fellows, and 19.7% of actively practicing attending gastroenterologists were women. Since 2007, GI comprised significantly lower proportions of women attendings except for cardiology, and lower representation in fellows, except for cardiology and nephrology, than other IM subspecialties (p < 0.001). There was a consistently higher proportion of women GI fellows than attendings over the past 14years (p < 0.01). GI has among the lowest representation of women at each career level compared to other IM subspecialties. Given the previously reported preference of gender congruent mentoring, the underrepresentation of senior academic gastroenterologists who are women may be a contributing factor to lower proportions of women trainees choosing to pursue GI.

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.

Crowdsourced Feedback to Improve Resident Physician Error Disclosure Skills

Residents must prepare for effective communication with patients after medical errors. The video-based communication assessment (VCA) is software that plays video of a patient scenario, asks the physician to record what they would say, engages crowdsourced laypeople to rate audio recordings of physician responses, and presents feedback to physicians. To evaluate the effectiveness of VCA feedback in resident error disclosure skill training. This single-blinded, randomized clinical trial was conducted from July 2022 to May 2023 at 7 US internal medicine and family medicine residencies (10 total sites). Participants were second-year residents attending required teaching conferences. Data analysis was performed from July to December 2023. Residents completed 2 VCA cases at time 1 and were randomized to the intervention, an individual feedback report provided in the VCA application after 2 weeks, or to control, in which feedback was not provided until after time 2. Residents completed 2 additional VCA cases after 4 weeks (time 2). Panels of crowdsourced laypeople rated recordings of residents disclosing simulated medical errors to create scores on a 5-point scale. Reports included learning points derived from layperson comments. Mean time 2 ratings were compared to test the hypothesis that residents who had access to feedback on their time 1 performance would score higher at time 2 than those without feedback access. Residents were surveyed about demographic characteristics, disclosure experience, and feedback use. The intervention's effect was examined using analysis of covariance. A total of 146 residents (87 [60.0%] aged 25-29 years; 60 female [41.0%]) completed the time 1 VCA, and 103 (70.5%) completed the time 2 VCA (53 randomized to intervention and 50 randomized to control); of those, 28 (54.9%) reported reviewing their feedback. Analysis of covariance found a significant main effect of feedback between intervention and control groups at time 2 (mean [SD] score, 3.26 [0.45] vs 3.14 [0.39]; difference, 0.12; 95% CI, 0.08-0.48; P = .01). In post hoc comparisons restricted to residents without prior disclosure experience, intervention residents scored higher than those in the control group at time 2 (mean [SD] score, 3.33 [0.43] vs 3.09 [0.44]; difference, 0.24; 95% CI, 0.01-0.48; P = .007). Worse performance at time 1 was associated with increased likelihood of dropping out before time 2 (odds ratio, 2.89; 95% CI, 1.06-7.84; P = .04). In this randomized clinical trial, self-directed review of crowdsourced feedback was associated with higher ratings of internal medicine and family medicine residents' error disclosure skill, particularly for those without real-life error disclosure experience, suggesting that such feedback may be an effective way for residency programs to address their requirement to prepare trainees for communicating with patients after medical harm. ClinicalTrials.gov Identifier: NCT06234085.

Team-Based Learning as a Feasible, Acceptable, and Effective Educational Method for Internal Medicine Trainees - A Multi-phase Intervention and Cohort Comparison.

Team-based learning (TBL) is an active learning strategy gaining traction in medical education. However, studies demonstrating successful incorporation into Graduate Medical Education (GME) curricula are limited. To assess the feasibility, acceptability and efficacy of Infectious Disease (ID) TBL sessions within an Internal Medicine (IM) residency curriculum as part of a traditional 60-minute conference. We conducted a prospective cohort study of TBL implementation assessing acceptability and feasibility (Phase 1), and efficacy (Phase 2). Phase 1 included 101 IM residents and eight TBL naïve faculty. Phase 2 included aggregate cohort IM In-Training Exam (ITE) data before (2008-2013) and after (2014-2019) TBL implementation. Eight TBL sessions were delivered once or twice weekly during 60-minute noon conferences. We assessed feasibility by measuring individual Readiness Assurance Test (iRAT) completion rates and inclusion of TBL elements in each session; acceptability through attendance, perceived effectiveness rating and attitudes about TBL; efficacy by comparing ITE data for the overall ID content and specific TBL associated learning objectives. Seventy-five of 93 (80%) residents attended at least one session. All TBL elements were successfully incorporated each session. Of those surveyed, 86% rated the TBL sessions as facilitating their learning "very (4)" or "extremely (5)" well on a 5-point Likert scale (p<0.001). ITE mean percent correct scores of total ID content as well as TBL associated learning objective performance were both significantly higher for the post-TBL cohort among PGY-2 (76.2 vs 62.3; 76.2 vs 62.6) and PGY-3 (73 vs 64.5; 76.2 vs 64.5) IM residents (p<0.05; p<0.001 respectively). Implementing a complete TBL pedagogy within the traditional noontime conference hour in GME is feasible, acceptable to residents and faculty, and associated with improved learning efficacy demonstrated through improved ITE scores.

Toward precision medical education: Characterizing individual residents' clinical experiences throughout training.

Despite the central role of experiential learning in residency training, the actual clinical experiences residents participate in are not well characterized. A better understanding of the type, volume, and variation in residents' clinical experiences is essential to support precision medical education strategies. We sought to characterize the entirety of the clinical experiences had by individual internal medicine residents throughout their time in training. We evaluated the clinical experiences of medicine residents (n = 51) who completed training at NYU Grossman School of Medicine's Brooklyn campus between 2020 and 2023. Residents' inpatient and outpatient experiences were identified using notes written, orders placed, and care team sign-ins; principal ICD-10 codes for each encounter were converted into medical content categories using a previously described crosswalk tool. Of 152,426 clinical encounters with available ICD-10 codes, 132,284 were mapped to medical content categories (94.5% capture). Residents' clinical experiences were particularly enriched in infectious and cardiovascular disease; most had very little exposure to allergy, dermatology, oncology, or rheumatology. Some trainees saw twice as many cases in a given content area as did others. There was little concordance between actual frequency of clinical experience and expected content frequency on the ABIM certification exam. Individual residents' clinical experiences in training vary widely, both in number and in type. Characterizing these experiences paves the way for exploration of the relationships between clinical exposure and educational outcomes, and for the implementation of precision education strategies that could fill residents' experiential gaps and complement strengths with targeted educational interventions.

"Life with Diabetes": A Pilot Study on an Experiential Continuous Glucose Monitoring Curriculum for Resident Physicians.

The use of technology in diabetes mellitus (DM) management has been growing. The indications and coverage for continuous glucose monitoring (CGM) have increased. Primary care (PC) clinics, including resident continuity clinics, are the frontline for DM management; however, they struggle to adopt CGM. To implement a CGM curriculum to resident physicians to improve knowledge and confidence. An internal medicine (IM) resident PC clinic in an urban academic medical institution. Twenty-four IM residents. We designed a curriculum that included a lecture about CGM indications, interpretation, ordering, and insurance consideration; and a voluntary, experiential learning module in which the residents wore a CGM. We conducted a retrospective pre-post survey with a 4-point Likert scale. Average self-reported scores in knowledge increased for CGM (1) indications from 1.85 to 3.45, (2) ordering from 1.35 to 3.05, (3) functioning from 2.20 to 3.50, and (4) data interpretation from 1.85 to 3.25 (all p < 0.0001). Confidence for "describing CGM monitoring" and "fielding questions about CGM" increased from 2.25 to 3.65 (p < 0.0001) and 1.90 to 3.30 (p < 0.0001). Given the demand for DM management in the PC setting, this targeted CGM curriculum has promise to help residents adopt CGM into their practice.

Breaking the Cycle: A Qualitative Study of Factors That Mitigate Impostor Phenomenon Among Internal Medicine Residents.

Background Impostor phenomenon (IP) describes feelings of inadequacy often experienced by individuals struggling to internalize success despite evidence to the contrary. IP is common in medicine and can be experienced as a cycle following exposure to an achievement-focused task, leading to fear of being found out as an impostor. Prior research describes IP characteristics, yet few studies have identified factors that mitigate IP among medical residents. Objective To understand factors that moderate IP among internal medicine (IM) residents. Methods We conducted a qualitative study using one-on-one semistructured interviews with 28 IM residents at a single academic health center from May to June 2020. To ascertain the prevalence of IP, informants completed a 20-item Clance Impostor Phenomenon Scale (CIPS) questionnaire. Using a constructivist thematic approach investigators independently coded transcripts to identify factors mitigating IP. Results Twenty-eight of 53 (53%) eligible residents participated in the study. Most informants were female (21 of 28, 75%) and in their second postgraduate year of training (12 of 28, 43%). The mean CIPS score was 63. When faced with an achievement-focused task, informants describe feelings of inadequacy, avoidance behaviors, distortion of feedback, and attribution beliefs. Internal factors found to moderate IP include (1) reframing attribution beliefs; (2) accepting feedback; and (3) acknowledging strengths. External factors include (1) mentors, coaches, and role models; (2) formal opportunities to share IP experiences; and (3) growth-oriented learning environments. Conclusions This qualitative study describes internal and external factors that potentially mitigate impostor feelings, thereby interrupting the cyclical nature of IP among IM residents.

Peer review for handoff education in a transition to residency course: A prospective cohort study.

Association of American Medical Colleges (AAMC) and Accreditation Council for Graduate Medical Education (ACGME) mandate training in handoff delivery for students and residents. Communication errors, including errors during handoffs of patient care, account for over 2/3 of sentinel events. This study aims to assess the effectiveness of peer-assisted learning (PAL) in handoff education within a longitudinal framework. This study involved the analysis of fourth-year medical students (n = 67) enrolled in a transition to residency program designed to reinforce skills essential for success in internal medicine residencies. We modified the I-PASS handoff rubric for a single-encounter evaluation. Before attending the transitions of care workshop, students submitted one written handoff report. During high-fidelity simulation sessions, peers evaluated the written document as well as verbal handoffs, while faculty evaluated a recorded verbal version. The primary outcome measured was improvement in handoff quality and accuracy over time and secondary outcomes compared peer- and self-evaluations to faculty assessments. Overall, students demonstrated a statistically significant improvement in handoff quality and accuracy across all scoring criteria after completing the peer evaluation process. Peer evaluations did not demonstrate statistically significant differences in scores for quality or accuracy questions as compared to faculty. Peer evaluators effectively assessed handoff reports using the modified I-PASS checklist yielding outcomes similar to faculty while providing feedback. These findings provide exciting evidence that should prompt training programs to consider incorporating standardized peer review into handoff education for medical students and, potentially, residents. The detailed evaluation of individual handoff events fosters feedback skills essential for ongoing professional growth and clinical excellence.

Critical Care Exposure and Preparedness Among Internal Medicine Residents: Results from the American College of Physicians In-Training Exam Survey

Critical Care Exposure and Preparedness Among Internal Medicine Residents: Results from the American College of Physicians In-Training Exam Survey

Sending a Signal: Evaluating the Impact of Program and Geographic Preference Signaling on the Internal Medicine Residency Match.

Background For over a decade, the number of residency applications has surged, a trend known as "application inflation." COVID-19 further intensified this trend, leading the Association of American Medical Colleges (AAMC) to addressthe issue by introducing a supplemental application in the 2021-2022 cycle, allowing programs to identify applicants with a connection to their program or geographic region. For the 2022-2023 cycle, the number of program signals increased from five to seven. The impact of the supplemental application and the increase in signals on the likelihood of an applicant matching with a programhas yet to be evaluated. Methods This retrospective cohort study evaluated the impact of program signaling and geographic preference on the matching likelihood in our internal medicine residency program. Data from MyERAS® and the Supplemental Application for 640 applicants who applied to our large, urban, university-based program in the Southeastern United States during the 2020-2021 and 2022-2023 application cycles were included. Using univariate and multivariate analysis, we examined the correlation between program signal, geographic preference, and final match location. Results Applicants who sent a program signal had nearly three-foldhigher odds of matching with our program. Geographic preference was numerically but not statistically associated with higher odds of matching. Both signaling a preference for matching with a program in an urban environment and couples matching correlated with decreased odds of matching with our program. Geography was an important predictor of match location as residing in our AAMC geographic region, our four-state area, and our specific state had increased odds of matching with our program. Conclusions Signaling our program was associated with increased odds of matching with our program. Geographic preferences were less predictive of a match with our program; however, they did predict the likelihood of a match at a program within that region. Future studies are needed to ensure external validity.

Streamlining Communication: "Resident Huddle" on General Medicine Wards at a Veterans Affairs Hospital.

Background Orienting medical trainees to new practice environments is essential. Huddles have been shown to improve communication and safety outcomes. However, their use in orienting trainees to systems processes and changes on inpatient general medicine (GM) wards remains unexplored. Objective Implement a weekly inpatient huddle between residents and hospital leaders to improve dissemination of information around health system operations. Methods In 2019, we established "Resident Huddle," a weekly 20-minute huddle for senior internal medicine residents rotating on GM wards at a US Department of Veterans Affairs Hospital led by the site leads. Resident Huddle content included system updates, rotation updates, process reminders, performance feedback, and systems and patient safety concerns raised by trainees. Reactions to the huddle were assessed via survey. Behavioral change was assessed by rates of complete trainee admission medication reconciliation documentation before and after huddle implementation. Results Resident Huddle started in October 2019 and continues to this day. Between October 2019 and June 2022, 136 of 205 participants completed surveys (66% response rate). Respondents agreed or strongly agreed that the huddle provided useful information for care delivery (94%, 128 of 136), improved work engagement (73%, 99 of 136), provided feedback on practice patterns (90%, 121 of 135), and that issues they experienced were acknowledged and acted upon (86%, 114 of 133). Retrospective medical record analysis demonstrated improvement in admission medication reconciliation completion rate by trainees from pre-intervention (32%, 19 of 60) to post-intervention (73%, 44 of 60). Conclusions A weekly huddle between hospital leaders and residents strengthened communication and equipped trainees with operational health systems knowledge to enhance patient care outcomes while fostering a greater sense of engagement with their work environment.