Internal Medicine Residents Research Articles

Assessment tool items for addressing physician-patient communication and reducing healthcare risk factors across multiple enterprise risk management domains.

Expertise in physician-patient communication is a primary outcome measure for physicians. We evaluated residents' communication behaviors with clinic patients following an educational intervention as measured by the Communication Assessment Tool (CAT). Thirty-five internal medicine residents were assessed by patients using the CAT for 3 months before and after the educational intervention. The intervention included a simulated, videotaped patient encounter, mock CAT, and preceptor coaching during video review. The primary outcome was the percentage of CAT items receiving an "excellent" rating from patients before and after the intervention. Research results were compared to previously published CAT studies. Within-resident improvement in the percentage of excellent ratings was small with median changes between 0 and 3 percentage points. Compared to previously published studies, similar results were found for the highest and lowest-scored communication items. Many clinical encounters are time-limited, and physicians do not pursue time-consuming conversations that could reduce health care risk. This data and other published studies suggest seven communication items taking the most time to complete (i.e., shared decision-making) were items demonstrating little or no improvement. This study identified clinical performance risk factors applicable to the Enterprise Risk Management Framework that could impact complication and readmission rates if addressed by changes in physician- patient communication.

What/Why/When/Where/How Framework and Faculty Development Workshop to Improve the Utility of Narrative Evaluations for Assessing Internal Medicine Residents.

Clinical competency committees (CCCs) rely on narrative evaluations to assess resident competency. Despite the emphasis on these evaluations, their utility is frequently hindered by lack of sufficient detail for use by CCCs. Prior resources have sought to improve specificity of comments and use of evaluations by residents but not their utility for CCCs in assessing trainee performance. We developed a 1-hour faculty development workshop focused on a newly devised framework for Department of Medicine faculty supervising internal medicine residents. The what/why/when/where/how framework highlighted key features of useful narrative evaluations: behaviors of strength and growth, contextualized observations, improvement over time, and actionable next steps. Workshop sessions were implemented at a large multisite internal medicine residency program. We assessed the workshop by measuring attendee confidence and skill in writing narrative evaluations useful for CCCs. Skill was assessed through a rubric adapted from literature on the utility of narrative evaluations. Fifty-four participants started the presurvey, and 33 completed the workshop, for a response rate of 61%. Participant confidence improved pre-, post-, and 3 months postworkshop. Total utility scores improved in mock evaluations from 12.4 to 15.5 and in real evaluations from 13.7 to 15.0, but only some subcomponent scores improved, with fewer improving in the real evaluations. A short workshop focusing on our framework improves confidence and utility of narrative evaluations of internal medicine residents for use by CCCs. Next steps should include developing more challenging components of narrative evaluations for continued improvement in trainee performance and faculty assessment.

Validation of the Instructional Materials Motivation Survey among Medicine Resident Physicians

Purpose The Instructional Materials Motivation Survey (IMMS) was developed to measure motivational characteristics of a learning activity, building on Keller's Attention, Relevance, Confidence, Satisfaction (ARCS) motivation model. We aimed to validate IMMS scores using validity evidence of internal structure and relations with other variables. Methods Participants were internal medicine and family medicine residents who completed the IMMS following an online module on outpatient medicine, from 2005 to 2009. We used confirmatory factor analysis (CFA) to examine model fit using half the data (split-sample approach). Finding suboptimal fit, we conducted exploratory factor analysis (EFA) and developed a revised instrument. We evaluated this instrument with CFA using the remaining data. Associations were evaluated between IMMS scores and knowledge and other measures of motivation (Motivated Strategies for Learning Questionnaire, MSLQ). All analyses accounted for repeated measures on subjects. Results There were 242 participants. Although internal consistency reliabilities were good (Cronbach alpha ≥0.70), CFA of the original 36-item, 4-domain instrument revealed poor model fit for data sample 1. EFA found that reverse-scored items clustered strongly together. Further EFA using data sample 1, followed by CFA using data sample 2, found good fit for a 13-item, 4-domain model that omitted reverse-scored items (standardized root mean square residual 0.045, root mean square error of approximation 0.066, comparative fit index 0.96). Linear regression confirmed positive, statistically significant associations for most hypothesized relationships, including IMMS total with knowledge (r=0.19) and MSLQ total (r=0.53; both p<.001). Examination of reverse-scored items suggested participant inattention but not acquiescence. Conclusions IMMS scores show good reliability and relations with other variables. However, the hypothesized and empirical factor structures do not align, and reverse-scored items show particularly poor fit. A 13-item, 4-domain scale omitting reverse-scored items showed good model fit.

Enhancing point-of-care ultrasound (POCUS) utilization in primary care: A thyroid POCUS training course for internal medicine residents.

POCUS is valuable in primary care, yet outpatient-specific point-of-care ultrasound (POCUS) curriculum integration into internal medicine (IM) residency is limited. We addressed this gap by developing a thyroid POCUS workshop for IM residents. Develop and implement an educational curriculum to integrate thyroid POCUS into an IM residency program and evaluate the impact on resident knowledge, perceived skills, and attitudes. The study was conducted in a resident primary care clinic at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Residency Program in Internal Medicine at North Shore University Hospital and Long Island Jewish Medical Center. All 108 IM residents (PGY1-3) in one program participated in the study during their ambulatory clinic block. Residents participated in a 1-hour workshop involving a didactic session and two breakout groups: one for hands-on practice and another for case-based discussions with image review. Residents completed pre- and post-session surveys assessing knowledge, perceived skills, and attitudes toward thyroid POCUS. These data showed statistically significant increases in all assessed areas. Integrating thyroid POCUS into an IM residency curriculum significantly improved resident knowledge, attitudes, and perceived skills related to these exams. Residents valued this learning experience and expressed intentions to incorporate it into their future practice.

Retrospective, Longitudinal, One-Group Study on the Implementation of Continuous Glucose Monitoring To Improve Quality of Care for Patients With Type I or II Diabetes Mellitus in an Internal Medicine Residency Continuity Community Clinic.

In this three-year retrospective study, data from 51 patients with type 1 or type 2 diabetes mellitus (DM), receiving a minimum of 3-4 insulin injections per day and self-monitoring their blood glucose (SMBG) four times a day, were derived from our internal medicine residency primary care clinic. The patients were equipped with a continuous glucose monitoring (CGM) device that shared 24-hour glucose data with the clinic. They were assigned to members of our CGM team, which included internal medicine or transitional year medical residents who functioned under the supervision of a board-certified endocrinologist. The residents, in consultation with our endocrinologist, assessed the patients' glucose management data and adjusted their treatment regimens biweekly by calling the patients, and monthly by seeing the patients in the clinic. Significant results from the study include a reduction in HbA1c from 9.9% to 7.6%, an average blood glucose decrement from 242 mg/dL to 169 mg/dL, a reduction in the incidence of mild hypoglycemia from below 70 mg/dL to 54 mg/dL, from 4.68% to 0.76% per day, and a more pronounced hypoglycemia with glucose less than 54 mg/dL from 3.1% per day to 0.2% per day. We observed a significant increase in the time in the range of the blood glucose from 33% to 67% per day. Furthermore, 9.5% of the patients in this study eventually discontinued their daily insulin injections and continued treatment with oral diabetic medications with or without the use of injectable GLP-1 receptors once a week. Our study affirms that CGM devices significantly improve glycemic control compared to SMBG, supporting its efficacy in optimizing glycemic control in real-world clinical practice. The results imply that this can be accomplished in internal medicine residency clinics and not exclusively in specialized endocrine clinics. As far as we know, this is the first study of its kind in a residency clinic in the USA. This study confirms the benefits of widening the application of CGM in DM, along with the challenges that must be overcome to realize the evidence-based benefits of this technology. CGM needs to become a part of routine monitoring for type 1 and type 2 DM.

Internal Medicine and Internal Medicine-Pediatrics Residency Program Website Traffic Patterns Across Two Institutions and Five Electronic Residency Application Service (ERAS) Cycles.

Background Since the start of the COVID-19 pandemic in Spring 2020, medical residency program recruitment has become increasingly web-based due to the transition to virtual interviews. Although social media use by residency programs has soared during this time, applicant surveys show that official program websites remain the most used online resource. According to survey-based studies, the content that applicants favor on program websites tends to mirror their priorities in choosing programs. However, it is unclear whether applicant-reported priorities in program choice and website content truly drive program website traffic. In this analysis, we will elucidate website traffic patterns from two Internal Medicine residency programs and two Internal Medicine-Pediatrics programs, both in terms of the thematic content of high-traffic pages and changes in traffic patterns throughout the Electronic Residency Application Service (ERAS) application cycle. We will provide novel, data-driven guidance to residency program leadership regarding website content. Methodology For each of the four programs included in the analysis, total pageviews on a monthly basis were obtained for the annual ERAS application cycles taking place from 2017 through 2022. For one Internal Medicine program, data was only available for its current website from 2020 to 2022. The mean monthly pageviews were calculated for each page within each website. The total site traffic trends across each year and within high-traffic months were totaled as well. Results As expected, the highest traffic period for all programs in all years was the days before the application deadline, with a secondary, smaller spike in traffic around Match Day. In general, the most popular pages for all four programs were thematically in line with the top five applicant priorities in the 2022 National Resident Matching Program applicant survey, namely, geographic location, goodness of fit, program reputation, work/life balance, and current program residents. Three of the websites featured unique content that unexpectedly proved to be as popular as the top survey-reported topics, such as pages related to a new major clinical site, a new integrated subspecialty pathway, and, most profoundly, a pipeline program for certain applicants from groups that are underrepresented in medicine. Alumni career content was also heavily trafficked across all four programs. Conclusions Program directors should plan twice-yearly updates to residency program websites, timed to be finished by the start of the ERAS cycle in the fall, and again just before Match Day in March. Program directors should include specific, up-to-date information about unique program features. Future research should incorporate a more diverse variety of programs, software-based page content analysis, and traffic source data.

Supporting Care Transformation Through a Comprehensive Graduate Medical Education Curricular Program in a Department of Internal Medicine.

The imperative to train physicians in skills required to lead care transformation is increasingly recognized, yet few Graduate Medical Education (GME) programs exist to meet this need. Describe the development, outcomes, and lessons learned from a novel GME care transformation curricular program. Department of Internal Medicine (IM) at Dell Medical School at The University of Texas, Austin. Between 2020 and 2023, 33 IM residents and fellows completed training with participation in the Care Transformation program. Department leadership developed a comprehensive educational and experiential program that included (1) Dell Medical School-wide Distinction in Care Transformation curriculum; (2) Primary Care Residency track with care transformation projects; (3) participation in the national Veterans Affairs Chief Resident in Quality and Safety program; and (4) Hospital Medicine Fellowship in Quality and Safety. Each trainee led a care transformation project spanning a variety of topics and settings. Graduates who responded to a follow-up survey (22 of 33 graduates) reported they used skills learned through the program in their current roles and these experiences better prepared them for fellowship and/or faculty positions. The Care Transformation program provides real-world experiences and skillsets that are increasingly valuable in modern healthcare delivery.

Rotation X: An Innovative Quality Improvement Focused Curriculum Built Into an Internal Medicine Residency

Background: The Accreditation Council for Graduate Medical Education (ACGME) states that resident physicians must participate in quality improvement (QI) and patient safety (PS) initiatives during their training. Furthermore, once residents enter the workforce as attending physicians, their performance is often based on metrics related to the quality of care provided and the patient’s experience while in the hospital. However, many internal medicine residency programs have a variation of curriculum that is focused on QI and PS. Methods: At our institution, we sought to incorporate education in QI and PS in a longitudinal and structures fashion throughout a resident’s three years of training. Hence, Rotation X was created as both a collaborative and innovative one-week long curriculum with targeted teaching across the continuum of residency training. Rotation X was implemented as a mandatory rotation for all post graduate year (PGY) 1 and 3 trainees in our internal medicine program. During this rotation, learners meet with the clinical documentation improvement (CDI) team, learn about the process of completing a root cause analysis, and review a case with the quality improvement team. Learners also participate in multidisciplinary meetings including a nursing-physician series, focused on improving communication in the hospital, and met with patients nearing discharge to learn about their unique perspective during inpatient hospital stay. Results: All residents participating in Rotation X were surveyed over the course of a year to ascertain their perspective on the rotation. We collated responses from the PGY-1s (interns) and PGY-3s (senior residents). Of the PGY-3 class, at least 80% found the heart failure/pharmacy session, RN-MD session, root cause analysis (RCA) session, CDI session, and catheter associated urinary tract infection (CAUTI) rounds either very or extremely useful. Of the intern class, more than 75% found all session at least somewhat useful with at least half finding the sessions very or extremely useful to their training. Conclusions: With the growing landscape of QI and PS in medicine, we sought out to seamlessly integrate a focused curriculum into our internal medicine residency program. Rotation X, a one-week long rotation embedded with collaborative sessions, was curated to engage our learners in these domains. We found that the curriculum was well received by both our interns and senior residents. Our curriculum is easily adaptable and can be integrated into existing programs, with the capacity to tailor Rotation X sessions to a program’s goals and focus points in the domain of quality improvement.

Some Perceptions Differ, Match Outcomes Do Not: A Multisite Retrospective Cross-Sectional Comparison of Virtual vs. In-Person Recruitment.

Virtual interviewing for residency provides considerable savings. Its impact on match outcomes remains unclear. Evaluate the impact of virtual residency recruitment on program and applicant assessment and match outcomes. Cross-sectional survey, September 2020-July 2021 PARTICIPANTS: Faculty interviewers and 2019 and 2020 PGY-1 classes at three academic internal medicine residencies. Survey items rating effectiveness of interview format, preference for future interview format, and perceived impact on diversity. A total of 247/436 faculty (57%) interviewers responded. Faculty perceived that in-person interviews enhanced applicant assessment (3.23 ± 0.38, p < 0.01) and recruitment of the most qualified applicants (p < 0.01) but did not impact recruitment of a racially or gender diverse class (3.03 ± 0.99, p = 0.95 and 3.09 ± 0.76, p = 0.14 respectively). They also did not demonstrate a preference for future interview formats. A total of 259/364 matched applicants responded, corresponding to a 76% response rate in the in-person cohort and a 66% response rate for virtual. Trainees were equally likely to match at their top choice when interviewing virtually vs. in-person (p = 0.56), and racial/ethnic and gender composition of the incoming class also did not differ (p = 0.81 and p = 0.19 respectively). Trainees perceived many aspects of the institution were better assessed in-person, though the impact varied according to assessment domain. Trainees who interviewed in-person preferred in-person formats. Of those who interviewed virtually, 47% preferred virtual and 54% preferred in-person. There were no predictors of virtual preference for future interview formats. Faculty and applicants who experienced virtual recruitment had no preference for future recruitment format. Virtual recruitment had no impact on the racial/gender diversity of matched classes or on applicants matching at their top-ranked institution. Institutions should consider the potential non-inferiority of virtual interviews with financial and other benefits when making decisions about future interview formats.

Addressing the Health Needs of LGBTQ Persons in Medical Curricula: A Review of Educational Programs.

Given the vulnerability of and the importance of caring for the specific health care needs of the growing lesbian, gay, bisexual, transgender, and queer (LGBTQ) population, the authors attempted to identify all educational interventions in psychiatric settings with quantitative outcomes targeting medical students, residents, and physicians in postgraduate settings. To gain insight from other disciplines that have published research in this area, a second objective was to review studies in teaching in those other disciplines. The authors sought to describe the methods of selected studies. The authors searched the published English-language literature indexed in PubMed, EMBASE, and PsycINFO using key terms for health care education concerning LGBTQ populations. The authors described and critically appraised studies with quantitative outcomes designed to enhance knowledge, skills, and attitudes in treating the LGBTQ community. Of the 15 trials identified, 10 included medical students, 4 included internal medicine residents or medical school faculty, and 1 included oncologists. We did not find any randomized controlled trials or controlled nonrandomized trials of curricula dedicated to teaching learners in psychiatry. All of the studies included a presurvey, followed by an educational intervention and then a postsurvey assessment. The educational interventions, outcome measures, and quality of studies varied widely. Four studies enrolled self-identified members of the LGBTQ community as trainers and facilitators of the educational interventions. The lack of high-quality controlled studies indicates the need to develop evidence-based curricula to support the education of the psychiatric workforce to provide for the special needs of LGBTQ persons.

Improving Early Sepsis &amp; Severe Sepsis Identification and Management on Internal Medicine service at the Detroit John D. Dingell VA Medical Center

Background: Sepsis is a life-threatening organ dysfunction due to infection, with an incidence of nearly 50 million people each year, causing about 11 million in mortality worldwide. Adhering to Sepsis protocols is a quality metric monitored by both the Centers for Medicare &amp; Medicaid Services (CMS) via the SEP 1 measure and the VA Healthcare System through SEP 90, which consists of an all-or-nothing score comprised of individual metrics. These metrics include specific actions such as early management bundle utilization, lactate monitoring, timely fluid resuscitation, and vasopressor administration, all within defined timeframes. Based on FY 2023 Data, the John D. Dingell VAMC performed nationally in the last quintile with &gt; 72% fallouts. Given that the vast majority of our Sepsis patients are treated and managed by the inpatient Internal Medicine resident service, we initiated a Quality Improvement project to educate them and thereby decrease our number of fallouts. We aim to improve Sepsis, severe Sepsis, &amp; Septic shock Identification and Management by 50% over the course of 8 months on the internal medicine service. Methods: Internal medicine residents are central to the identification and management of early Sepsis and Severe Sepsis at the Detroit VA. Given the monthly turnover of resident teams, we focused on our model for improvement on interventions at the start of each month with targeted educational sessions to define Sepsis, severe Sepsis, and septic shock (and their management). We have also implemented targeted EMR training on utilizing a recently developed “Sepsis Bundle order set” for patients who have been identified as Sepsis. Sepsis Menu data usage was collected based on health factor tags on patients with Sepsis as their ICD-10 code on discharge from the internal medicine service. Results: Internal Medicine Resident educational sessions and EMR training commenced on July 1st, 2024. Sepsis Bundle was implemented in the EMR late 2022 due to rising fallouts of Sepsis and severe sepsis cases. However, its usage remained minimal, as depicted in Figure One, when compared to the number of discharged patients. Following the educational sessions and EMR training, both the identification and management of Sepsis have increased. Prior to intervention, from October 2022 to June 2023, a mean sepsis bundle usage rate of 10% was observed for identified sepsis patients, whereas post-intervention, from July 2023 to March 2024, the mean has increased to 30%. Conclusion/Discussion: Based on the early data, we can confidently note that our monthly education sessions, paired with our process measure (Sepsis bundle use), have been effective. Ongoing opportunities for improvement are improved coordination and handoff between ER and IM/MICU. We continue to see the need for ongoing resident education on identification and appropriate documentation of Sepsis severity along with obtaining labs within a certain time frame.

Procedures Group Chat: A Resident-Driven Approach to Increase Procedural Competency

Introduction: In 2007, the American Board of Internal Medicine (ABIM) shifted away from requiring completion of procedures during residency training and towards emphasizing common procedural indications, contraindications, and complications. As a result, many procedures are now referred to consulting services such as critical care and interventional radiology (IR). Our aim was to address this training gap through a resident-driven initiative that provided daily opportunities to collaborate on procedures in a supervised clinical setting. Methodology: In January 2023, we created a secure group chat and invited Internal Medicine (IM) residents to voluntarily join if they were interested in learning or teaching bedside procedures such as thoracenteses, paracenteses, lumbar punctures, and line placement. Residents who identified a need for a non-emergent bedside procedure would reach out in the group chat to see if a resident certified to perform and supervise that procedure would be available and could subsequently coordinate availability. A two-question survey was sent to the entire residency program asking residents whether they were a part of the group chat and whether they found the chat helpful in advancing their medical knowledge. The impact of the initiative was measured through procedures logged in to New Innovations, a website used by graduate medical education to log completed procedures. We chose five procedures (paracenteses, thoracenteses, central lines, arterial lines, and lumbar punctures) to compare changes in procedure volume performed by IM residents one year before and after the group chat was set up. Results: 64 out of 108 residents responded to the survey (59% response rate). 90% of respondents stated that they were part of the group chat and 76.6% responded they “agree/strongly agree” that the procedures group chat has been helpful. Objective measures of the group chat’s impact revealed a 93% increase in the number of procedures performed by residents. IM Residents logged 122 procedures in 2022, the year prior to the initiation of the group chat, compared to 235 procedures logged in 2023, the year after. There was a 96% increase in paracentesis and 387% change in thoracenteses completed after the group chat was established. Conclusions: The procedures group chat nearly doubled the number of procedures completed and logged by residents. This group chat has fostered enthusiasm for patient care by helping us overcome some of the barriers and delays in health care due to factors out of our control, such as limited resources or staffing. Due to the inexpensive nature of this initiative, it can be easily replicated at other IM programs across the country, especially those without resources such as simulation centers. Future goals include creating formal teaching sessions including cadaver lab simulations and a proceduralist elective for procedures to be taught and supervised by certified residents, attendings, and subspeciality services for a multidisciplinary education.

Burnout and Health Scores Among Residency Programs as an Indicator of Wellness.

With long hours, significant responsibilities, and a heavy workload, residency can be an incredibly stressful experience. The aim of our study was to assess the impact of residency on mental health and wellness. A secondary aim was to determine if the post-graduate year (PGY) of the different residents impacted their mental health or ability to cope with the stressors of residency. Residents in anesthesiology, family medicine, internal medicine, and surgery were invited to complete a survey. The first portion of the survey had residents rank their mental health on a scale from 1 to 5. There was also a short-form answer portion, which collected suggestions on how to improve wellness. An analysis of variance was used to compare the means of 2 continuous outcome variables-Patient Health Questionnaire (PHQ) and burnout scores compared across specialties and post-graduate years. Burnout scores were measured using the Oldenburg Burnout Inventory. This survey was created and validated by psychology researchers to assess burnout based on the strongest indicators of burnout-emotional exhaustion and disengagement from work. The PHQ9 survey was chosen as it has a specificity of 91-94% and is a reliable method to screen for depression, a common companion to burnout. PHQ9 scores were highest among surgery residents (7.2 ± 7.07), followed by anesthesia (6.59 ± 6.64), emergency medicine (5.57 ± 4.09), and internal medicine (4.82 ± 3.68). Scoring was also higher among PGY4-6 residents. Burnout scores were highest among surgery (37.8 ± 8.69) and anesthesia (38.17 ± 7.09) residents and among PGY4-6 residents. PGY4-6 residents had a mean burnout score of 38.55 ± 7.67 compared to 36.17 ± 8.69 among first-year residents. Similarly, the P value noted no significant difference among burnout scores across either specialty or year: .5930 and .8061. There was no significant difference among specialties or years in training among their subjective ratings of depression.

A Resident Led Newsletter Is a Powerful Communication Tool.

Communication with stakeholders for a graduate medical education (GME) program depends on shared visual and written content. Residency training programs are embracing social media as a communication channel. However, curated information that may only be viewed by subscribers or followers is difficult to archive and may appear overwhelming to novice users. An electronic, printable newsletter may be a unique communication tool for training programs to share information among residents, faculty, and hospital administration. We published a monthly electronic newsletter sent to all residents, teaching faculty, and additional stakeholders in our internal medicine residency program. We conducted an electronic anonymous survey and sent it to all residents in February 2023 and January 2024. The survey consisted of 5 questions to assess the satisfaction level of the newsletter. Sixty of 232 (25.9%) residents completed the survey. Of those, 44 (73.3%) residents were very satisfied regarding overall satisfaction, 39 (65.0%) residents were very satisfied with the overall content, and 42 (70.0%) residents were very satisfied with the timeliness of the information presented. Thirty-six (60%) residents reported the importance of having a resident-led newsletter. We found an overall high satisfaction level in a resident-led newsletter based on a survey completed by residents within our program. Most survey respondents deemed resident leadership crucial for the newsletter. We also received strong positive feedback from key stakeholders ranging from hospital administration to residency applicants.

PICC Your Poison: Resident Beliefs and Attitudes Regarding Discharge Parenteral Antibiotics for Patients Who Inject Drugs.

Serious injection-related infections (SIRIs) in people who inject drugs often lead to prolonged hospitalizations or premature discharges. This may be in part due to provider reluctance to place peripherally inserted central catheters (PICCs) for outpatient parenteral antibiotic therapy in this population. Because internal medicine (IM) residents are often frontline providers in academic centers, understanding their perspectives on SIRI care is important to improve outcomes. We surveyed IM residents in a large urban multicenter hospital system about SIRI care with a novel case-based survey that elicited preferences, comfort, experience, and stigma. The survey was developed using expert review, cognitive interviewing, and pilot testing. Results are reported with descriptive statistics and linear regression. Of 116 respondents (response rate 34%), most (73%) were uncomfortable discharging a patient with active substance use home with a PICC, but comfortable (87%) with discharge to postacute facilities. Many (∼40%) endorsed high levels of concern for PICC misuse or secondary line infections, but larger numbers cited concerns about home environment (50%) or loss to follow-up (68%). While overall rates were low, higher stigma was associated with more concerns around PICC use (r = -0.3, P = .002). A majority (58%) believed hospital policies against PICC use in SIRI may act as a barrier to discharge, and 74% felt initiation of medications for opioid use disorder (MOUD) would increase their comfort discharging with a PICC. Most IM residents endorsed high levels of concern about PICC use for SIRI, related to patient outcomes and perceived institutional barriers, but identified MOUD as a mitigating factor.

Evaluating the Impact of Coaching Through the Transition to Residency.

Coaching has been proposed to support the transition to residency. Clarifying its impact will help define its value and best use. To explore the experiences of residents working with coaches through the residency transition. A cohort comparison survey compared experiences of a coached resident cohort with coaches to the prior, uncoached cohort. Post-graduate year (PGY)-2 residents in internal medicine, obstetrics and gynecology, emergency medicine, and pathology at a single academic center. Faculty trained as coaches had semi-structured meetings with graduating medical students and residents throughout the PGY-1year. An online anonymous survey assessed effects of coaching on measures of self-directed learning, professional development, program support and impact of coaching using existing scales (2-item Maslach Burnout Inventory, Brief Resilient Coping Scale, 2-item Connor-Davidson Resilience Scale, Stanford Professional Fulfillment Inventory), and novel measures adapted for this survey. Bivariate analyses (t-tests and chi-square tests) compared cohort responses. MANOVA assessed the effects of coaching, burnout and their interactions on the survey domains. Of 156 PGY2 residents, 86 (55%) completed the survey. More residents in the "un-coached" cohort reported burnout (69%) than the "coached" cohort (51%). Burnout was significantly and negatively associated (F = 3.97 (df 7, 75); p < .001) with the learning and professional development outcomes, while being coached was significantly and positively associated with those outcomes (F = 5.54 (df 9, 75); p < .001). Significant interaction effects were found for goal-setting attitudes, professional fulfillment, and perceived program career support such that the positive differences in these outcomes between coached and un-coached residents were greater among burned out residents. Coached residents reported a positive impact of coaching across many domains. Residents experiencing coaching reported better professional fulfillment and development outcomes, with more pronounced differences in trainees experiencing burnout. Coaching is a promising tool to support a fraught professional transition.

Gender Disparities in Electronic Health Record Usage and Inbasket Burden for Internal Medicine Residents.

Studies have demonstrated patients hold different expectations for female physicians compared to male physicians, including higher expectations for patient-centered communication and addressing socioeconomic or emotional needs. Recent evidence indicates this gender disparity extends to the electronic health record (EHR). Similar studies have not been conducted with resident physicians. This study seeks to characterize differences in EHR workload for female resident physicians compared to male resident physicians. This study evaluated 12months of 156 Mayo Clinic internal medicine residents' inbasket data from July 2020 to June 2021 using Epic's Signal and Physician Efficiency Profile (PEP) data. Excel, BlueSky Statistics, and SAS analytical software were used for analysis. Paired t-tests and analysis of variance were used to compare PEP data by gender and postgraduate year (PGY). "Male" and "female" were used in substitute for "gender" as is precedent in the literature. Mayo Clinic internal medicine residents. Total time spent in EHR per day; time in inbasket and notes per day; time in notes per appointment; number of patient advice requests made through the portal; message turnaround time. Female residents received more patient advice requests per year (p = 0.004) with an average of 86.7 compared to 68, resulting in 34% more patient advice requests per day worked(p < 0.001). Female residents spent more time in inbasket per day (p = 0.002), in notes per day (p < 0.001), and in notes per appointment (p = 0.001). Resident panel comparisons revealed equivocal sizes with significantly more female patients on female (n = 55) vs male (n = 34) resident panels (p < 0.001).There was no difference in message turnaround time, total messages, or number of results received. Female resident physicians experience significantly more patient-initiated messages and EHR workload despite equivalent number of results and panel size. Gender differences in inbasket burden may disproportionally impact the resident educational experience.

Assessing the prevalence of workplace telepressure on resident and attending physicians: A validated scale

BackgroundPhysician wellbeing and burnout are significant threats to the healthcare workforce. Mobile electronic medical record access and smartphones allow for efficient communication in healthcare but may lead to workplace telepressure (WPT). MethodsAn IRB-approved survey related to five domains of burnout [WPT, smartphone usage, boundary control, and psychologic detachment] was circulated. Internal medicine and general surgery faculty and residents were surveyed between 3/2021 and 6/2021. Survey results were analyzed for internal consistency with a Cronbach alpha coefficient and validation against a known physician burnout scale. ResultsThe domains were internally valid with a Cronbach alpha of 0.888. Validation against the physician burnout scale was significantly correlated with WPT domains but was overall positively correlated across domains. Surgical trainees reported the highest burnout rate related to every domain. ConclusionSurvey-based WPT burnout scales provide insight into the daily pressures on physicians. Targeted interventions to limit WPT are needed to improve physician wellbeing.

A Case-Based Curriculum on Buprenorphine for Treatment of Opioid Use Disorder Among Internal Medicine Residents

Background: As the mandatory X-waiver requirements for prescribing buprenorphine have recently been lifted, general practitioners are being relied on to fill the treatment gap in prescribing medications for opioid use disorder (MOUD). However, insufficient clinician education remains a major barrier to prescribing MOUD in both inpatient and outpatient settings. Objective: To evaluate the impact of a new MOUD curriculum on internal medicine (IM) residents’ attitudes, comfort, and knowledge of buprenorphine in the inpatient and outpatient settings. Methods: All second-year IM residents (n = 46) participated in a 90-minute curricular session between July and October 2022 during scheduled mandatory didactic blocks. The curriculum was structured as a small group, case-based session focused on how to initiate sublingual buprenorphine (traditional and low-dose initiation). Residents completed identical and anonymous pre- and post-session surveys. A Wilcoxon signed rank test was used to analyze the data. Results: Thirty-nine (84.4%) second-year IM residents participated in the evaluation. Residents reported increased importance of independently initiating buprenorphine for hospitalized patients with opioid withdrawal ( P &lt; .001). Residents were significantly more likely to endorse confidence in discussing MOUD with patients ( P &lt; .001), initiating buprenorphine in inpatient and outpatient settings ( P &lt; .001), and identifying patients who would benefit from low-dose buprenorphine initiation ( P = .002). There was a significant increase in the correct number of knowledge-based questions after the session (before = 1.55/4 vs after = 3.33/4; P value &lt; .001). Conclusions: A 90-minute buprenorphine training improved residents’ attitudes toward, perceptions of competency, and knowledge of buprenorphine delivery to patients with OUD in the inpatient and outpatient setting.

(071) IMPROVING TRAINEE COMFORT IN ASSESSMENT AND MANAGEMENT OF FEMALE SEXUAL HEALTH AND MENOPAUSE THROUGH AN INTERACTIVE WORKSHOP

Abstract Introduction Concerns related to female sexual health and menopause are common in clinical practice, but these topics are often inadequately covered during training. Many medical schools and residency programs lack a formal curriculum, and trainees in internal medicine, family medicine, and obstetrics and gynecology often graduate feeling uncertain in their management of these conditions. Objective Improve resident comfort with assessment and management of female sexual health and menopause through an interactive workshop. Methods We created a 90-minute, interactive workshop focused on female sexual health and menopause. Residents in internal medicine at a large academic medical center were invited to participate. A multidisciplinary group including physicians, advanced practice providers, registered nurses and a certified sex therapist were recruited to lead the workshop. Results Participants rotate through three 30-minute sessions targeted to learning objectives. One session focuses on conducting a symptom-based pelvic exam. A 3-dimensional model is used to review the anatomy of the female pelvic floor and demonstrate physical exam techniques to evaluate vaginal and vulvar symptoms, pelvic pain, and dyspareunia. Diagnostic skills include vulvar inspection to assess for skin and mucosal changes, cotton swab test of the vestibule, and assessment of pelvic floor musculature. A second session focuses on the genitourinary syndrome of menopause (GSM). The pathophysiology, presentation and treatment of GSM is introduced. Next, registered nurses with expertise in female sexual health and menopause lead an interactive demonstration of vaginal moisturizers and lubricants. Advice for counseling patients on the proper use and application of vaginal estrogens is also reviewed. The final session focuses on sexual health counseling, including sexual history-taking skills. Participants are taught about the domains of sexual function, female sexual response cycle, types of desire, patient resources, and sexual aids. Feedback following the initial iteration of this workshop was very positive. All participants felt that the experience was an effective use of time, would recommend it to others, and were confident in their ability to apply skills to their clinical practice. Conclusions This interactive workshop led by a multidisciplinary group of providers aims to improve trainee comfort in evaluation and management of female sexual health and menopause. Given the commonplace nature of these topics in primary care and paucity of existing curricula, consideration could be given to the inclusion of a similar educational experience into internal medicine, family medicine and/or obstetrics and gynecology residency programs. Disclosure No.