Resident-led Initiative Research Articles

Implementation of an education session on buprenorphine induction in the emergency department, a resident-led initiative

IntroductionMany physicians including emergency medicine physicians report insufficient training and education on prescribing buprenorphine for opioid use disorder. As emergency departments implement buprenorphine induction protocols, educational sessions can provide physicians with further familiarity with the treatment of opioid use disorder. This quality improvement project aimed to address the barrier of physician education in the implementation of buprenorphine initiation in the emergency department and presents a model for resident-led education sessions of emergency medicine physicians.MethodsThe project was a resident-led educational quality improvement project on educating members of the Department of Emergency Medicine on buprenorphine induction. The thirty-minute educational session included a pre-test survey, lecture, practice case workshop, questions, post-test survey, and a discussion. The survey questions were designed for physicians including residents and faculty, but medical students were invited to complete the session.ResultsPhysicians including faculty and resident physicians responded positively to the educational survey, with an increase from 42.5 to 100% responding that they understood the risks and benefits of prescribing buprenorphine in the emergency department pre and post-survey respectively. Based on post-survey results, 88.5% of physicians responded that they planned to prescribe buprenorphine in the emergency department for patients meeting clinical criteria after completing the educational session.ConclusionThe results suggest that a resident-led training session can encourage peer involvement in buprenorphine induction to treat opioid use disorder in the emergency department.

A Resident-led Initiative To Improve Heart Failure Readmission Rate By Targeting Factors Of Social Vulnerability

A Resident-led Initiative To Improve Heart Failure Readmission Rate By Targeting Factors Of Social Vulnerability

Virtual orientation for international medical graduates: A resident-led initiative.

Virtual orientation for international medical graduates: A resident-led initiative.

Speak Up! A Resident-Led Initiative to Increase Safety Event Reporting in Psychiatry.

Speak Up! A Resident-Led Initiative to Increase Safety Event Reporting in Psychiatry.

A Resident-Led Initiative to Advance Diversity, Equity, Inclusion, and Antiracism in a Pediatrics Residency Program.

A racially and ethnically diverse physician workforce is critical to meeting the needs of the United States' increasingly diverse patient population. Unfortunately, Black, Latinx, American Indian, and Alaska Native communities remain underrepresented in medicine. The disproportionate impact of the COVID-19 pandemic by race/ethnicity and increased public attention to anti-Black and anti-Asian racism have inspired a growing national discourse on addressing systemic racism. Within academic medicine, there has been a call for the fundamental incorporation of antiracism into medical training and professional competency. From the perspective of a group primarily led by residents who are women of color, we describe our 6 years of experience leading a Diversity Committee that catalyzed sustained and systemic efforts to advance diversity, equity, inclusion (DEI), and antiracism at a large urban pediatrics residency program. We outline the implementation and key outcomes of the Diversity Committee's ongoing initiatives to increase resident diversity, foster an inclusive learning environment, develop a resident curriculum on DEI and antiracism, and center the needs and wisdom of the communities that our institution serves. Finally, we highlight challenges and lessons learned to inform other institutions striving to advance DEI and antiracism in academic medicine.

Contour Connections: Early Interest in a Program to Connect International Radiation Oncologists for Virtual Cloud-Based Contouring and Treatment Plan Evaluation

<h3>Purpose/Objective(s)</h3> Barriers to international collaborative learning within radiation oncology include the relatively small size of the field, travel limitations, and scarce resources for local mentorship in some settings. Contour Connections is a recently established resident-led initiative that seeks to connect residents and attending physicians globally using a virtual cloud-based contouring platform. In the process of developing a sustainable program, several efforts have been undertaken to garner interest, support, and participation in this program. <h3>Materials/Methods</h3> Contour Connections pursued a two-pronged approach for recruitment over the course of three months. In the United States (US), the initiative was presented at monthly meetings for the Association of Residents in Radiation Oncology (ARRO) Global Health Subcommittee, and select radiation oncologists with interest or prior experience in global health were personally contacted. Internationally, the opportunity was selectively shared by the nonprofit organization Rayos Contra Cancer (RCC) among clinicians and clinics who had expressed interest in peer-to-peer support. <h3>Results</h3> 26 individuals were reached through ARRO and RCC group meetings. 100% (n = 10) of US-based volunteers and 100% (n = 11) of international radiation oncologists who were personally contacted expressed interest in participating. 16 (80%) of recruited and matched participants completed the pre-program survey required to proceed with the program. Several key factors were necessary for robust recruitment to this new program including 1) access to a network of US-based residents and radiation oncologists with experience or interest in global radiation oncology, 2) access to a network of non-U.S. centers with a strong desire to improve skills and knowledge in contouring and treatment planning, 3) individual relationships to facilitate new connections, and 4) word-of-mouth referrals from previous participants. Preliminary post-program results show that 100% (n = 4) participants rated the Contour Connections experience "excellent" and "very helpful" with contouring and plan evaluation, and 100% (n = 4) expressed they were "very likely" to participate again and recommend the program to their colleagues. <h3>Conclusion</h3> There exists a growing interest in addressing global oncology disparities through peer-to-peer international connections among radiation oncologists. Contour Connections seeks to address this demand by actively recruiting individuals to utilize a virtual cloud-based platform to review contours and treatment plans with each other. This study demonstrates that recruitment is readily feasible within the global radiation oncology community, with early results showing a favorable participant experience.

Remote Contouring and Virtual Review during the COVID-19 Pandemic (RECOVR-COVID19): Results of a Quality Improvement Initiative for Virtual Resident Training in Radiation Oncology.

The need to minimize in-person interactions during the COVID-19 pandemic has led to fewer clinical learning opportunities for trainees. With ongoing utilization of virtual platforms for resident education, efforts to maximize their value are essential. Herein we describe a resident-led quality improvement initiative to optimize remote contouring and virtual contour review. From April to June 2020, radiation oncology (RO) residents at our institution were assigned modified duties. We implemented a program to source and assign cases to residents for remote contouring and to promote and optimize virtual contour review. Resident-perceived educational value was prospectively collected and analyzed. All nine RO residents at our institution (PGY1–5) participated, and 97 cases were contoured during the evaluation period. Introduction of the Remote Contouring and Virtual Review (RECOVR) program coincided with a significant increase in mean cases contoured per week, from 5.5 to 17.3 (p = 0.015), and an increased proportion of cases receiving virtual review, from 14.8% to 58.6% (p < 0.001). Residents reported that the value of immediate feedback during virtual review was similar to that of in-person review (4.6 ± 0.1 vs. 4.5 ± 0.2, p = 0.803) and significantly higher than feedback received post hoc (e.g., email; 3.6 ± 0.2, p < 0.001). The implementation of a remote process for contour review led to significant increases in contouring, and virtual contour review was rated as highly as in-person interactions. Our findings provide a data-driven rationale and framework for integrating remote contouring and virtual review into competency-based medical education.

Urine Trouble: Reducing Midstream Clean Catch Urine Contamination Among Children 3-17 Years Old.

Children, caregivers, and clinicians often prefer midstream clean catch technique to urethral catheterization for obtaining urine cultures. However, contamination is common, potentially resulting in unnecessary medical intervention and cost. With this resident-led initiative, we aimed to reduce pediatric midstream clean catch urine culture contamination over 6 months. A bundled intervention was implemented in the emergency department, inpatient units, and outpatient clinics at our institution. Baseline contamination rates were collected April 2016 to September 2017; the intervention was introduced October 2017 to March 2018 and evaluated April 2018 to September 2018. Sustainability was measured October 2018 to September 2020. Balancing measures included rates of repeat urine cultures, positive cultures, and contaminated cultures by urethral catheterization. Rates of midstream clean catch urine culture contamination were 45.3% preintervention and 30.9% postintervention, a 14.7% (95% confidence interval: 8.0% to 21.5%) absolute decrease. Before and after intervention, girls and patients 16 to 17 years old had the highest rates of midstream clean catch contamination. Six months postintervention, the rate of repeat urine culture decreased from 4.9% to 0.9% with no change in positive culture results or contaminated cultures by urethral catheterization. Over the subsequent 2 years, the impact of the intervention decreased (rate of contamination over 30 months postintervention: 38.4%, a 7.3% [95% confidence interval: 2.9% to 11.6%] absolute decrease; rate of repeat urine culture: 3.2%). An intervention to improve midstream clean catch urine culture collection was associated with a clinically meaningful decrease in contamination. Impact of the resident-led intervention decreased over time.

A resident-led initiative to improve patient safety event reporting in an internal medicine residency program

ABSTRACT Background Despite the Clinical Learning Environment Review’s recommendations of their use, patient safety event reporting systems are underutilized by residents. Objective We aimed to identify perceived barriers to event reporting amongst internal medicine residents and implement a targeted quality improvement initiative to address the identified barriers and increase overall resident event report rates. Methods A total of 94 Internal Medicine (IM) residents participated in the educational intervention in 2018. We measured residents’ perception of barriers to event reporting and employed the results of the questionnaire to create a skill-based educational workshop. We conducted the plan-do-study-act model to test a structured educational intervention and its effectiveness on pre-post IM residents’ event report rates and compared it to report rates of Non-Internal Medicine (Non-IM) residents. Additionally, we assessed pre-post intervention knowledge, skills, and attitudes in event reporting. Results 94/94 (100%) of IM residents had a significantly higher median percent of patient safety event reporting when compared to pre-intervention (23.6% compared to 5.88%, p-value = 0.0030) and when compared to Non-IM residents (23.6% compared to 5.31%, p-value = 0.0002). Residents performed better on the post-test compared to the pre-test (90% compared to 30%, p-value = 0.0001) for knowledge. 100% of the critical action items were completed and 90% of participants reported their perception of the event reporting process improved. Conclusions By elucidating common reasons why residents are not reporting patient safety events, a specific intervention can be created to target the identified impediments and improve resident event reporting. Abbreviations IM: Internal Medicine IM; Non-IM: Non-Internal Medicine; IOM: Institute of Medicine I; ACGME CLER: Accreditation Council for Graduate Medical Education Clinical Learning Environment Review; GME: Graduate Medical Education; IRB: Institutional Review Board; PDSA: Plan, Do, Study, Act

Diabetic Nephropathy Screening in a Residency Clinic: Improvements Also Reveal Limits of Healthcare Effectiveness Data and Information Set (HEDIS) Metric.

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc., and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a resident-led initiative that improved diabetic nephropathy screening in a primary care clinic. It also highlights the challenges of complex metrics, as well as the potential unintended consequences of emphasizing one dimension of a care process over another.

A resident-led clinic that promotes the health of refugee women through advocacy and partnership

Implication StatementLongitudinal global health experiences promote cultural competency and a commitment to caring for underserved populations beyond residency. This paper describes a longitudinal, co-curricular local global health experience. Obstetrics and gynaecology residents have partnered with the Family Medicine-led Halifax Newcomer Health Clinic to provide education and clinical well woman care to refugee women. This resident-led initiative meets the care needs of an underserved population while promoting resident engagement in health advocacy.

Collaborative Data Work Towards a Caring Democracy

Researchers in human-centered computing have surfaced a feminist ethic of care in interaction with technologies, in data collection, and in data work. Drawing on two years of ethnographic fieldwork, we consider how democratic caring might be enacted and sustained through collaborative data work. We employ philosopher Joan Tronto's theory of caring democracy to structure our analysis of a resident-led initiative that uses data to organize and address issues of neglect and abandonment in their neighborhood. Adding to the CSCW literature on sociotechnical systems of care, we look particularly at Tronto's concept of caring democracy where caring needs and the ways in which they are met are an ongoing and inclusive process of assigning and reassigning caring responsibilities, characterized by both equality of voice and freedom from domination. This work develops grounded insight into the practice of democratic caring and how collaborative data work is relevant to this caring practice. We discuss opportunities and challenges for a data-supported caring democracy and address how caring democracy technologies are different from other modern civic technology practices. We conclude with a call to researchers to identify and enact democratic caring experiments in the small.

Developing Residents as Medical Educators via the McMaster Multidisciplinary Academic Day Planning Committee.

BackgroundResidents are being asked to perform educator roles such as curriculum design and learner assessment with minimal professional development in leadership or medical education. The Multidisciplinary Academic Day (MAD) planning committee is a resident-led initiative responsible for delivering combined educational half-day sessions and workshops for all residents at McMaster University.ObjectiveWe sought to determine the impact participation in MAD planning committee had on residents' professional development and career goals. MethodsWe conducted a program evaluation survey of 19 of 30 (63.3%) current and former committee members to determine how the MAD planning committee’s alumni perceived its usefulness, and how participation affected their professional development. ResultsResidents cited a desire to gain medical education experience, learn about event planning and management, and improve resident education as reasons for joining the committee; 89.5% of respondents felt they had met these goals. Experience on the committee included skills related to curriculum design, developing needs assessments and programmatic evaluation. Many residents felt it helped them acquire leadership skills such as decision-making, idea generation, delegation, and public speaking. Several noted that it had sparked an interest in medical education as part of an academic career, and one former member subsequently pursued a Master’s of Education. The majority of the respondents (78.9%) felt it was helpful for their careers and 94.7% would recommend this experience to others interested in leadership and medical education. ConclusionInvolvement in the MAD planning committee is a highly useful way for residents to acquire leadership skills, develop an interest in medical education and work in a multidisciplinary team.

A Resident-Led Initiative to Increase Documentation of Surrogate Decision Makers for Hospitalized Patients.

Identification of surrogate decision makers (SDMs) is an important part of advance care planning for hospitalized patients. Despite its importance, the best methods for engaging residents to sustainably improve SDM documentation have not been identified. We implemented a hospital-wide quality improvement initiative to increase identification and documentation of SDMs in the electronic health record (EHR) for hospitalized patients, utilizing a Housestaff Quality and Safety Council (HQSC). EHR documentation of SDMs for all adult patients admitted to a tertiary academic hospital, excluding psychiatry, were tracked and grouped by specialty in a weekly run chart during the intervention period (July 2015 through April 2016). This also continued postintervention. Interventions included educational outreach for residents, monthly plan-do-study-act cycles based on performance feedback, and a financial incentive of a one-time payment of 0.75% of a resident's salary put into the retirement account of each resident, contingent on meeting an SDM documentation target. Comparisons were made using statistical process control and chi-square tests. At baseline, SDMs were documented for 11.1% of hospitalized adults. The intervention period included 9146 eligible admissions. Hospital-wide SDM documentation increased significantly and peaked near the financial incentive deadline at 48% (196 of 407 admissions, P < 001). Postintervention, hospital-wide SDM documentation declined to 30% (134 of 446 admissions, P < .001), but remained stable. This resident-led intervention sustainably increased documentation of SDMs, despite a decline from peak rates after the financial incentive period and notable differences in performance patterns by specialty admitting service.

Boundary work: understanding enactments of ‘community’ in an area-based, empowerment initiative

Engaging the community in initiatives to improve health and inequalities is a prominent feature of contemporary public health approaches. Yet, how ‘community’ might be differently interpreted and experienced through mechanisms of engagement is little understood, with potential implications for how the pathways of effect of such initiatives, and their impacts on health inequalities, might be evaluated. This study sought to explore how community was enacted through the delivery of an area-based, empowerment initiative underway in disadvantaged areas of England. An ethnographic approach was used to identify enactments of community arising around the core activities and decision-making processes of the resident-led initiative in two sites. Enactments comprised ‘boundary work’: the ongoing assertion and negotiation of boundaries around who or what was, and was not, eligible to contribute to decision-making, and / or benefit from the initiative. Boundary work arose around practices of connecting with and consulting residents, protecting locally defined interests and autonomy, negotiating different sets of interests, and navigating representation. The multiple, shifting enactments of community and its boundaries highlight implications for understanding processes of inclusion and exclusion inherent to community engagement, and for interpreting pathways between collective empowerment and improved health. The study also raises questions for evaluating similar complex, community initiatives, where community cannot be taken as a fixed analytical unit, but something continually in process through the interplay between the initiative and the wider context. This must inform interpretations of how, and for whom, community engagement might – or might not – improve health.

Development and Implementation of a Multidisciplinary, Resident-Led Advocacy Initiative Addressing Poverty Within a Free-Standing Children’s Hospital (Descriptive Abstract)

Development and Implementation of a Multidisciplinary, Resident-Led Advocacy Initiative Addressing Poverty Within a Free-Standing Children’s Hospital (Descriptive Abstract)

CORR Insights®: A Resident-led Initiative Improves Screening and Treatment for Vitamin D Deficiency in Patients with Hip Fractures.

CORR Insights®: A Resident-led Initiative Improves Screening and Treatment for Vitamin D Deficiency in Patients with Hip Fractures.

A Resident-led Initiative Improves Screening and Treatment for Vitamin D Deficiency in Patients with Hip Fractures.

Acute hip fractures carry a high risk of morbidity and are associated with low vitamin D levels. Improvements in screening and treating low vitamin D levels may lead to lower fall rates and a lower likelihood of additional fragility fractures. However, patients with low vitamin D levels often remain unassessed and untreated, even after they experience these fractures. We wished to determine whether a resident-led initiative can improve (1) screening for and (2) treatment of vitamin D deficiency in patients with acute hip fractures. Our department initiated a housestaff-led, quality improvement project focused on screening and treating vitamin D deficiency in patients with acute hip fractures. Screening encompassed checking serum 25-hydroxyvitamin D level during the acute hospitalization, and treating was defined as starting supplementation before discharge when the serum 25-hydroxyvitamin D level was less than 30 ng/mL. To evaluate the efficacy of this program, an administrative database identified 283 patients treated surgically for an acute hip fracture between July 2010 and June 2014. This period included 2 years before program initiation (Year 1, n = 65 patients; Year 2, n = 61 patients), the initial program year (Year 3, n = 66 patients), and the subsequent program year (Year 4, n = 91 patients). Followup was extended to 6 weeks after treatment with 9.2% (26/282) of patients lost to followup. Eight patients were excluded owing to documented intolerance of vitamin D supplementation. There were no differences regarding patient demographics, fracture type, or treatment rendered across these 4 years. The primary endpoints were the proportion of patients screened and treated for vitamin D deficiency. The secondary endpoint was the continuation of vitamin D supplementation at the patient's 6 week followup, according to the patient's medication list at that visit. This analysis included all patients, assuming those lost to followup had not continued supplementation. ANOVA and chi-square tests were used to evaluate the differences in demographic data and in screening and treating rates. Screening for vitamin D deficiency improved after initiation of the resident-led quality improvement program, with screening performed for 31% of patients in Year 1 (20/65; odds ratio [OR], 0.44; 95% CI, 0.26-0.75), 20% of patients in Year 2 (12/61; OR, 0.24; 95% CI, 0.13-0.46), 46% of patients in Year 3 (30/66; OR, 0.83; 95% CI, 0.51-1.35), and 88% of patients in Year 4 (80/91; OR, 7.27; 95% CI, 3.87-13.7) (p < 0.001). Vitamin D supplementation was initiated for 33% of patients in Year 1 (21/63; OR, 0.5; 95% CI, 0.30-0.84), 28% in Year 2 (17/61; OR, 0.39; 95% CI, 0.22-0.68), 50% in Year 3 (32/64; OR,1.00; 95% CI, 0.61-1.63), and 76% in Year 4 (65/86; OR, 3.10; 95% CI, 1.89-5.06) (p < 0.001). At early postoperative followup, we saw substantial improvement in the proportion of patients who continued receiving vitamin D supplementation: Year 1, 12% (8/64; OR, 0.14; 95% CI, 0.07-0.30); Year 2, 15% (9/61; OR, 0.17; 95% CI, 0.09-0.35); Year 3, 26% (16/64; OR, 0.33; 95% CI, 0.19-0.59); and Year 4, 46% (40/86; OR, 0.87; 95% CI, 0.57-1.33) (p < 0.001). Implementation of a resident-led quality improvement program resulted in higher rates of screening and treating vitamin D deficiency for patients with acute hip fractures. Housestaff-based initiatives may be an effective way to improve care processes that target improvements in bone health.

Preventing Delays in First-Case Starts on the Neurosurgery Service: A Resident-Led Initiative at an Academic Institution

On-time starts for the first case of the day are critical to maintaining efficiency in operating rooms (ORs). We studied whether a resident-led initiative to ensure on-time site marking and documentation of surgical consent could lead to improved first-case start time. In a resident-led initiative at a large 600-bed academic hospital with 25 ORs, we aimed to complete site marking and surgical consents half an hour before the scheduled start time for all first-case neurosurgical patients. We monitored the occurrence of delayed first starts and the length of delay during our initiative, and compared these cases to neurosurgical cases 3 months before the implementation of the initiative and to first-start nonneurosurgical cases. In the year of the initiative, both site marking and surgical consents were completed 30 minutes before the case start in 97% of neurosurgical cases. The average delay across all first-case starts was reduced to 7.17 minutes (N = 1271), compared with 9.67 minutes before the intervention (N = 345). During the study period, non-neurosurgical cases were delayed on average 10.3 minutes (N = 3592). There was a significant difference in latencies between the study period and the period before the initiative (p < 0.001), and also between neurosurgical cases and nonneurosurgical cases (p < 0.001). There was no reduction in delay times seen on the non-neurosurgical services in the study period when compared to the case 3 months before. Considering its effect across 1271 cases, this initiative over 1 year resulted in a total reduction of 52 hours and 57 minutes in delays. Through a resident-led quality improvement program, neurosurgical trainees successfully reduced delays in first-case starts on a surgical service. Engaging physician trainees in quality improvement and enhancing OR efficiency can be successfully achieved and can have a significant clinical and financial effect.

PGM market report: outlook for palladium: supply & demand in 2016

On-time starts for the first case of the day are critical to maintaining efficiency in operating rooms (ORs). We studied whether a resident-led initiative to ensure on-time site marking and documentation of surgical consent could lead to improved first-case start time.In a resident-led initiative at a large 600-bed academic hospital with 25 ORs, we aimed to complete site marking and surgical consents half an hour before the scheduled start time for all first-case neurosurgical patients. We monitored the occurrence of delayed first starts and the length of delay during our initiative, and compared these cases to neurosurgical cases 3 months before the implementation of the initiative and to first-start nonneurosurgical cases.In the year of the initiative, both site marking and surgical consents were completed 30 minutes before the case start in 97% of neurosurgical cases. The average delay across all first-case starts was reduced to 7.17 minutes (N = 1271), compared with 9.67 minutes before the intervention (N = 345). During the study period, non-neurosurgical cases were delayed on average 10.3 minutes (N = 3592). There was a significant difference in latencies between the study period and the period before the initiative (p < 0.001), and also between neurosurgical cases and nonneurosurgical cases (p < 0.001). There was no reduction in delay times seen on the non-neurosurgical services in the study period when compared to the case 3 months before. Considering its effect across 1271 cases, this initiative over 1 year resulted in a total reduction of 52 hours and 57 minutes in delays.Through a resident-led quality improvement program, neurosurgical trainees successfully reduced delays in first-case starts on a surgical service. Engaging physician trainees in quality improvement and enhancing OR efficiency can be successfully achieved and can have a significant clinical and financial effect.