Outpatient Clinic Experience Research Articles

Intersection of Care: Navigating Patient-Hospital Relationships in Neurosurgery

This study explores the vital elements of patient satisfaction in hospital settings, with an emphasis on the aspects of service quality and patient-hospital interaction. It looks at how patients perceive several aspects of service quality, such as assurance, tangibility, empathy, responsiveness, and consistency. A descriptive cross-sectional study was conducted among 80 Neurosurgery in-patients at the Pakistan Institute of Medical Sciences (PIMS), using convenience sampling. Data collection was done after obtaining consent from each patient. A self-administered questionnaire was used to collect demographic data, and patient satisfaction with the outpatient clinic experience. Data were entered and analyzed in Statistical Package for the Social Sciences, version 25. A chi-square test was used to examine associations between outcome variables and factors related to patient satisfaction. The majority of the patients were males, 46 (57.5%). The mean age of the patients was 48.73 ± 18.428 years. The waiting time at the hospital also varies, with 77.5% of patients experiencing 0-hour wait time, and the mean waiting time being 38.44 minutes. A positive correlation was found between the following variables: travel time in minutes (χ2 = 0.012, p > 0.05) ; gender (χ2 = 0.037, p < 0.05) ; and the number of hospital visits per month (χ2 = 0.016, p > 0.05) and patient interaction in a health care setting. The study emphasizes the value of excellent patient-hospital interactions and the importance of communication, empathy, and trust-building in promoting these outcomes.

Preemptive Outpatient Clinic Experience: Holistic Approach vs. Standard of Care

Preemptive Outpatient Clinic Experience: Holistic Approach vs. Standard of Care

Physical medicine and rehabilitation clinical experiences: A narrative review of curricula and educational interventions.

Physical medicine and rehabilitation (PM&R) is a specialty of medicine that focuses on function and the care of people with disabilities. Many medical schools offer PM&R content by means of PM&R clerkships for career development purposes with varying curricula and assessments; however, there is limited information regarding the optimal way to teach clinical skills relating to the field of PM&R. This narrative review study was performed to evaluate PM&R specific clinical curricular interventions. The review included a PubMed search that yielded 63 articles and a Cumulated Index to Nursing and Allied Health Literature (CINAHL) search of 175 articles. A total of 14 articles were selected for review. PM&R clerkships were found to have a variety of educational interventions, including inpatient and outpatient clinical experiences, lectures, Objective Structured Clinical Examinations (OSCEs), case discussions, written examinations, physical examination sessions, cadaver sessions, small group discussions, and virtual education. PM&R rotations can improve neurologic and musculoskeletal physical examination skills, PM&R specific knowledge, and confidence in PM&R skills. More research is needed to determine the optimal methods to teach and assess PM&R knowledge and skills in the clinical setting to drive future PM&R curriculum development and educational innovations.

Revolutionising outpatient clinic experience (RevOCE): the future of chronic kidney disease care and associated multimorbidity

Revolutionising outpatient clinic experience (RevOCE): the future of chronic kidney disease care and associated multimorbidity

Factors Influencing Primary Care Career Choice: A Multi-Institutional Cross-sectional Survey of Internal Medicine Primary Care Residency Graduates.

Although primary care is associated with population health benefits, the supply of primary care physicians continues to decline. Internal medicine (IM) primary care residency programs have produced graduates that pursue primary care; however, it is uncertain what characteristics and training factors most affect primary care career choice. To assess factors that influenced IM primary care residents to pursue a career in primary care versus a non-primary care career. Multi-institutional cross-sectional study. IM primary care residency graduates from seven residency programs from 2014 to 2019. Descriptive analyses of respondent characteristics, residency training experiences, and graduate outcomes were performed. Bivariate logistic regression analyses were used to assess associations between primary care career choice with both graduate characteristics and training experiences. There were 256/314 (82%) residents completing the survey. Sixty-six percent of respondents (n = 169) practiced primary care or primary care with a specialized focus such as geriatrics, HIV primary care, or women's health. Respondents who pursued a primary care career were more likely to report the following as positive influences on their career choice: resident continuity clinic experience, nature of the PCP-patient relationship, ability to care for a broad spectrum of patient pathology, breadth of knowledge and skills, relationship with primary care mentors during residency training, relationship with fellow primary care residents during training, and lifestyle/work hours (all p < 0.05). Respondents who did not pursue a primary care career were more likely to agree that the following factors detracted them from a primary care career: excessive administrative burden, demanding clinical work, and concern about burnout in a primary care career (all p < 0.05). Efforts to optimize the outpatient continuity clinic experience for residents, cultivate a supportive learning community of primary care mentors and residents, and decrease administrative burden in primary care may promote primary care career choice.

Outpatient management of Post-COVID syndrome – single center experience

BackgroundCOVID patients continue to experience unremitting symptoms that extend far beyond the initial illness. While there is rapid accumulation of data on acute COVID treatment in hospitalized patients, little is known regarding post-COVID management. ObjectivesTo describe our center's experience treating post-COVID sub-syndromes encountered in Post-COVID Lung Clinic. MethodsWe retrospectively reviewed data on 98 post-COVID patients evaluated in our clinic between 07/01/2020–12/31/2022. We encountered three distinct post-COVID subtypes: 1) respiratory complaints associated with increased O2 requirements and abnormal CT findings (post-COVID interstitial lung disease [ILD]), 2) respiratory complaints associated with tachycardia (post-COVID dyspnea-tachycardia syndrome [DTS]). Post-COVID ILD patients (n = 28) received steroids in combination with cell cycle inhibitor (mycophenolate mofetil-MMF). Post-COVID DTS patients (n = 16) were treated with metoprolol. 3) A third, undifferentiated group presented with mild respiratory complaints and normal spirometry (n = 17) and was followed in clinic without initiation of a specific treatment. ResultsIn treated post-COVID ILD patients, mean oxygen requirements at rest (1.96 ± 1.79 L/NC) decreased to 0.89 ± 1.29 L/NC at 6 months follow-up, p = 0.005. In patients with post-COVID DTS, mean heart rate at rest decreased (98 ± 15 bpm to 79 ± 11 bpm) at 6 months follow-up, p = 0.023. 60 % of patients reported an improvement in exertional dyspnea. ConclusionsOur descriptive study presents a single center outpatient COVID-19 clinic experience. We encountered 3 post-COVID sub-syndromes and describe their treatments: post-COVID interstitial lung disease [ILD] treated with a novel regimen of MMF and steroids, post COVID dyspnea-tachycardia syndrome [DTS] treated with metoprolol, and a third subgroup with mild undifferentiated symptoms without specific treatment.

Lipoprotein (a) concentration and cardiovascular disease in a group of patients with hyperlipidemia – A lipid outpatient clinic experience

Lipoprotein (a) concentration and cardiovascular disease in a group of patients with hyperlipidemia – A lipid outpatient clinic experience

The European TeleCheck-AF project on remote app-based management of atrial fibrillation: ablation outpatient clinic experience

Abstract Funding Acknowledgements Type of funding sources: None. Background TeleCheck-AF is a multicentre international project initiated to implement remote care delivery for patients with atrial fibrillation (AF) through teleconsultations supported by an on-demand photoplethysmography (PPG)-based heart rate/rhythm monitoring app. Purpose The current sub-study of the TeleCheck-AF project aimed to provide the first real-world dataset on feasibility and patient experience of this standardized mobile health (mHealth) infrastructure in the clinical setting of follow-up after catheter ablation. Methods This sub-study included consecutive patients in each centre who have undergone catheter ablation. In the post-ablation period, at the 3-, 6- or 12-month visit, patients were provided with the app and were instructed to perform 60-second heart rate/rhythm recordings three times daily and in case of symptoms for seven consecutive days prior to teleconsultation. Recurrences of AF were documented by PPG-based app (FibriCheck®). Motivation was defined as number of days in which the expected number of measurements (≥three/day) were performed per number of days over the entire prescription period. Adherence was defined as number of performed measurements per number of expected measurements over the entire prescription period. Patients’ experience was based on a survey sent to each patient via e-mail. Results Data from 588 patients (median age 63 [56-70] years, 39% female) from eight centres from six European countries were analysed. Patients with both optimal motivation (100%) and adherence (≥100%) constituted 158 (29%) of the study population and had more often previously undergone an ablation for AF (77% vs 62%), P=0.005) and had a higher number of AF PPG recordings (mean 1.9 vs 0.8, P=0.017). The app gave patients a safe feeling (70%) and automated reminders were useful (68%). Patients agreed that the app was easy to use (97%), easy to install (89%) and that they would like to use the app in the future (70%). In 95 (16%) patients, AF was detected by the app. There was no statistically significant difference between patients with (vs without) app-based detected AF, except a higher prevalence of prescribed three or more cardiovascular drugs (65% vs 53%, P=0.032) and beta-blockers (64% vs 52%, P=0.033). Patients with (vs without) app-based detected AF had higher optimal adherence (66% vs 41%, P&amp;lt;0.001). Conclusion The TeleCheck-AF approach is feasible and associated with high adherence as well as motivation to use the app and with optimal patient experience. Whether this approach can replace conventional rhythm follow-up after catheter ablation required further study.

Education Research: Appraisal of Outpatient Clinical Experience During Neurology Residency.

Outpatient clinical experience is a key component of neurology residency. Understanding the educational environment for residents in the outpatient setting can inform educators to maximize teaching and learning opportunities, enhance resident exposure to subspecialty diagnoses and management, and deliver quality care. We studied the continuity clinic experience of 5 neurology residents over the course of their residency to determine the breadth of their ambulatory experience. We used administrative health data from new and return patient visits scheduled with 5 neurology residents of the same class over 3 years of continuity clinic. International classification of disease codes pertaining to neurologic diagnoses and symptoms associated with these visits were analyzed. Frequency and proportions of the most commonly evaluated diagnoses and symptoms were tabulated. These were compared with previously published data about resident experience during training. We also analyzed resident experience over time. Five neurology residents evaluated 948 patients (mean 189.6; range 180-202; 59.2% female) during 2,699 clinic visits (mean 539.8; range 510-576) over 3 years in their continuity clinics. There were 6,555 international classification of disease codes associated with these visits (2,948 [44.9%] neurologic diagnoses, 2,249 [34.3%] neurologic symptoms, and 1,358 [20.8%] comorbidities). The most common neurologic diagnoses were as follows: headache disorders (24.5%), neuromuscular disorders (17.3%), movement disorders (12.1%), cerebrovascular disorders (11.5%), and epilepsy (7.5%). The most common neurologic symptoms evaluated by residents were as follows: seizure-like events (16.5%), sensory symptoms (12.4%), pain (10.3%), headache (9.7%), and motor symptoms (8.1%). The clinical experience of residents in the continuity clinic was diverse, but it was skewed toward headache, neuromuscular, and movement disorders, which constituted 54% of the workload. When compared with previous studies, the range of resident's outpatient clinical experience differed from that of inpatient experience. Based on the results of this study, we made changes to our outpatient curriculum by adding 2-month-long rotations in subspecialty clinics from postgraduate year 2 to 4 with the aim of boosting resident exposure to neurologic disorders in the outpatient setting.

Efficacy and Safety of Nirmatrelvir/Ritonavir, Molnupiravir, and Remdesivir in a Real-World Cohort of Outpatients with COVID-19 at High Risk of Progression: The PISA Outpatient Clinic Experience.

Different antivirals are available for the treatment of outpatients with COVID-19. Our aim was to describe a real-world experience of outpatient management of COVID-19 subjects at high risk of progression. This prospective observational study conducted in the University Hospital of Pisa (January 2022-July 2022) included consecutive COVID-19 outpatients with at least one risk factor for disease progression. Patients received nirmatrelvir/ritonavir, molnupiravir, or 3-day remdesivir, according to the Italian Medicines Agency (AIFA) indications. All patients were followed up until 30days from the first positive nasopharyngeal swab. The primary endpoint was a composite of death or hospitalization. Secondary endpoints were occurrence of adverse events and a negative test within 10days from the first positive test. Multivariable analysis was performed to identify factors associated with death or hospitalization. Overall, 562 outpatients were included: 114 (20.3%) received molnupiravir, 252 (44.8%) nirmatrelvir/ritonavir, and 196 (34.9%) 3-day remdesivir. The composite endpoint occurred in 2.5% of patients and was more frequent in patients treated with remdesivir (5.1%) compared with molnupiravir (1.8%) or nirmatrelvir/ritonavir (0.8%, ANOVA among groups p = 0.012). On multivariable Cox regression analysis, presence of ≥ 3 comorbidities, hematological disease, gastrointestinal symptoms, and each-day increment from symptoms onset were factors associated with death or hospitalization, while antiviral treatment was not a predictor. Adverse events occurred more frequently in the nirmatrelvir/ritonavir group (49.2%). Nirmatrelvir/ritonavir compared with remdesivir was associated with a higher probability of having a negative test within 10days from the first positive one. Death or hospitalization did not differ among high-risk COVID-19 outpatients treated with currently available antivirals. Safety and time to a negative test differed among the three drugs.

Beyond opioid prescribing: Evaluation of a substance use disorder curriculum for OBGYN residents.

Amidst the current opioid crisis, there is a need for better integration of substance use disorder screening and treatment across specialties. However, there is no consensus regarding how to best instruct OBGYN trainees in the clinical skills related to opioid and other substance use disorders (SUD). Study objectives were (1) to assess the effectiveness a SUD curriculum to improve self-reported competence among OBGYN residents and (2) to explore its effectiveness to improve attending evaluations of residents' clinical skills as well as its feasibility and acceptability from the resident perspective. A pilot 3-session curriculum was developed and adapted to SUD screening and treatment which included readings, didactics, and supervised outpatient clinical experiences for OBGYN post-graduate year 1 (PGY-1) residents rotating through an integrated OBGYN-SUD clinic. Eighteen residents completed pre and post clinical skills self-assessments (SUD screening, counseling, referring, Motivational Interviewing) using an adapted Zwisch Rating Scale (range 1-5). Scores were compared between time points using paired t-tests. Sub-samples also (a) were evaluated by the attending on three relevant Accreditation Council for Graduate Medical Education Milestones (ACGME) milestone sets using the web-based feedback program, myTIPreport (n = 10) and (b) completed a qualitative interview (n = 4). All PGY-1s (18/18) across three academic years completed the 3-session SUD curriculum. Clinical skill self-assessments improved significantly in all areas [SUD Screening (2.44 (0.98) vs 3.56 (0.62), p = <0.01); Counseling (1.81 (0.71) vs 3.56 (0.51), p = < .01; Referring (2.03 (0.74) vs 3.17 (0.71), p = < .01; Motivational Interviewing (1.94 (1.06) vs 3.33 (0.69), p = < .01)]. Milestone set levels assigned by attending evaluations (n = 10) also improved. Qualitative data (n = 4) revealed high acceptability; all curriculum components were viewed positively, and feedback was provided (e.g., desire for more patient exposures). A pilot SUD curriculum tailored for OBGYN PGY-1 residents that goes beyond opioid prescribing to encompass SUD management is feasible, acceptable and likely effective at improving SUD core clinical skills.

Impact of nutrition service attributes on patient satisfaction: evidence from an outpatient clinic at a Lebanese-Middle Eastern hospital

PurposeThe purpose of this paper is to explore the existing literature on the relationship between different service attributes and patient satisfaction at outpatient nutrition clinics to propose and test a culture-specific conceptual model interlinking the drivers of patient satisfaction.Design/methodology/approachOver a 7-week period in Fall 2019 (November 2–December 19), 600 patients from a Lebanese-Middle Eastern hospital (396 females and 204 males) completed an anonymous-designed survey with closed questions (n = 30). Statements were considered to represent specific attributes of nutrition services. In order to measure the existence and degree of significant relationships between different research variables, Pearson correlation coefficients and Fisher's Z test were employed to analyze the collected data, before and while joining the clinic, during and after the appointment. Means of scores and frequencies were calculated.FindingsThe results show that the nutrition service attributes with reference to “after the appointment” may improve the patients' satisfaction level more than attributes with reference to “while joining the clinic” and “during the appointment”. Most patients were satisfied with their overall outpatient clinic experience. The patient experience is a direct result of positive interactions with the entire services offered.Practical implicationsThe conceptual model sets the foundations for testing and for further research to develop. Moreover, the findings of this study are important for assessing the quality of nutrition service attributes and for reporting on the ability of this service to meet the needs and preferences of patients in the health care sector.Originality/valueThis study attempts to fill the gap in knowledge on nutrition service quality as indicators for overall patient satisfaction, while opening clear research avenues for further studies to follow. It is the basis for the development of clinical practice guidelines and other quality enhancement tools.

Effects of the COVID-19 pandemic on obstetrics and gynecology residency training in Turkey

Objective:This study aimed to evaluate the effect of the coronavirus disease-19 (COVID-19) pandemic on obstetrics and gynecology residency in Turkey.Materials and Methods:A 40-item questionnaire was prepared by the European Network of Trainees in Obstetrics and Gynecology. The survey included four parts, namely, workload, training aspects, trainees’ health and safety, and women’s and maternal health, conducted between April 2020 and September 2020. The submission of the questionnaire was voluntary.Results:A total of 103 trainees from 28 cities responded to the survey. The mean duration of training was 2.5 years, and first- to fifth-year residents were included. In this study, 66 trainees (65.3%) were deployed in COVID-19 units, and the number of working hours was 84 hours per week. Moreover, 67% of the trainees reported insufficient outpatient clinic experience to meet education targets. Almost all trainees (101 of 103) trainees reported that the number of surgeries and/or elective surgeries decreased or were canceled. In addition, 63% and 68% of the trainees reported that their surgical skills were hindered by the reduced number of surgeries and dissatisfaction by not achieving a sufficient number of surgeries, respectively. Overall, 71% (n=73) were worried about their training. Only 45 trainees (43.6%) have raised their concerns to their program coordinators. Trainees in Turkey experienced a decrease in the workload during the first COVID-19 wave by 62% (n=64). In average, trainees worked nearly 30 h less than their usual workweek. Only 5% of the trainees (n=5) worked from home. Trainees claimed to have used sufficient personal protective equipment, and 66% (n=68) could keep their social distance in the hospital. The availability of health care was different between departments, and the family planning and reproductive medicine departments were the most affected.Conclusion:The obstetrics and gynecology training in Turkey has significantly been affected by the COVID-19 pandemic.

Influence of “RAP” experiences on nursing students' career choices in aging: A qualitative exploration

BackgroundHealthcare professions are ever challenged to meet the demands of a global aging society. Educators across the helping professions continuously explore ways to motivate students' interest in caring for older adults. Given new undergraduate nursing curriculum changes, increased demand for creative outpatient educational opportunities for clinical gerontological experiences has put tremendous urgency on all healthcare stakeholders. ObjectiveTo analyze students' perceptions of clinical experiences at the Robust Aging Program clinic, a community wellness outpatient senior center. DesignQualitative study using semi-structured interviews, exploring students' perspectives on whether they would consider gerontology/geriatrics-related careers. SettingUniversity extension senior clinic, serving Osher Lifelong Learning Center members who attend the Robust Aging Program, a School of Nursing community service. MethodIRB-approved semi-structured interviews were conducted by phone and Zoom within a year of clinic experience. Preset questions centered on students' clinic experiences. Trained research assistants working under the guidance of a qualitative researcher collected and analyzed and categorized common and emergent themes. Participants13 undergraduate nursing students who volunteered in the clinic in current or previous semesters. Students were about to graduate or new alumni; working nurses came from different specialties, including pediatrics. ResultsClinical immersion in a nurse-led senior wellness clinic that entailed close interactions with robustly aging adults increased students' knowledge and skills and their willingness to work with the aged. Mentorship was noted as a key emergent theme. ConclusionsExposure to community outpatient clinical experiences can spark interest in working with older adults. This is especially true of advanced practice nurse-led wellness clinics where students receive mentorship and are empowered to exercise holistic care. Further research is needed to determine educators', clinicians', and administrators' roles in sustaining students' interest in gerontology-related careers.

The relationship between dissociation symptoms, sleep disturbances, problematic internet use and online gaming in adolescents

ABSTRACT Some adolescents admitted to the child and adolescent psychiatry outpatient clinic experience dissociative symptoms, such as hearing strange sounds, temporary blackouts, seeing images, changes in body parts, and looking at themselves from outside themselves. Some may also have sleep disturbances and a history of spending a long time on the internet. This study investigated the relationship between dissociative symptoms and sleep disorders, problematic internet usage (PIU),aggression and digital game addiction in adolescents. Participants completed the State-Trait Anger Expression Inventory (STAXI), Problematic Internet Usage Scale (PIUS), Digital Game Addiction Scale (DGAS-7), Children’s Depression Inventory (CDI), Adolescent Dissociative Experiences Scale (A-DES), Pittsburgh Sleep Quality Index (PSQI), Screen for Child Anxiety Related Emotional Disorders Child Version (SCARED), and a sociodemographic form. Regression analyses were performed to identify associations. The sample consisted of 244 adolescents between 14 and 18 years of age (M = 15.93, SD = 0.90), of which 171 (70.1%) were girls and 73 (29.9%) were boys. Fifty-two (21.3%) were classified as having problematic online gaming (POG+), whereas 192 (78.7%) were classified as not having problematic online gaming (POG-). There was a difference between the two groups in all sub-dimensions of the PIUS, STAXI, CDI, and A-DES. Adolescents who had higher scores on the A-DES had a higher risk of sleep disorders and had higher scores on the PIU, CDI, and SCARED. The POG+ group dissociation scores were considerably higher than POG- group scores. Adolescents with high A-DES scores also had higher anger scores and weaker anger control skills. Consequently, sleep disorders, PIU, and POG may increase dissociative symptoms.

Trainee perspective of the causes of stress and burnout in surgical training: a qualitative study from Wales

ObjectivesStress and burn-out among surgical trainees has been reported most prevalent in core surgical trainees (CST) and female trainees in particular. This study aimed to identify factors perceived by CSTs...

Instilling Resiliency in Surgical Education: The Benefits of Longitudinal Medical Student Learning

The longitudinal clerkship has been recognized as an innovative, unique model in medical education that demonstrates significantly higher student and preceptor satisfaction with comparable long-term outcomes like performance on standardized examinations. At the center of this model is the student-preceptor relationship, which promotes effective student-directed learning and personal and professional relationships with established faculty mentors. The University of California, San Francisco (UCSF) has two clerkships models: a traditional or "block" model consisting of 2-month sequential clinical rotations in seven core clerkships, and a longitudinal model that integrates parallel out-patient clinical experiences over the entire year with one-on-one faculty preceptors from each core discipline with focused 2-week intensive inpatient rotations. In the setting of the Covid-19 pandemic beginning in Spring of 2020, this arrangement allowed for a natural experiment to evaluate the resiliency of the respective models in the face of unprecedented disruptions in education and healthcare delivery. As described in this perspective, both clerkships required rapid pivots; however, students enrolled in the longitudinal clerkship were more likely to develop stronger relationships with surgical faculty and felt more prepared for making career choices. Medical school curricula may benefit from incorporating longitudinal components, as this model provided flexibility and fostered greater faculty-student mentorship in the setting of disruption to medical education.

Attend anywhere clinic: A virtual outpatient clinic experience in otolaryngology during the COVID-19 pandemic.

IntroductionNumerous technological advances have been made during the COVID‐19 pandemic. There has been a growing body of evidence highlighting the value of virtual consultations as an adjunct to physical appointments. This study presents the virtual clinic experiences of one ENT department in the UK.MethodsRetrospective review of all virtual consultations undertaken at a single ENT department during the COVID‐19 pandemic.ResultsA total of 556 virtual consultations took place during the study period across all ENT sub‐specialties. Of which 27% of patients were converted to face‐to‐face follow‐up and over 30% were discharged following a virtual consultation. Out of 333 video consultation, 31% were converted to telephone due to patient preference or technological difficulties.ConclusionThis study highlights the benefits and lessons learnt from implementing a virtual clinic system in ENT. The authors recommend the introduction of video consultation as a useful adjunct to face‐to‐face appointments during the COVID‐19 pandemic and beyond.Level of Evidence4.

Lithium nephrotoxicity: when and why? Experience of nephrology and psychiatry outpatient clinics

Lithium nephrotoxicity: when and why? Experience of nephrology and psychiatry outpatient clinics

Surgical Outpatient Study: characterizing the educational experience of outpatient clinics for surgical trainees.

Surgical Outpatient Study: characterizing the educational experience of outpatient clinics for surgical trainees.