Survey Of Internal Medicine Residents Research Articles

Assessment of Gaps in Hematology Education in Canadian Internal Medicine Residency Programs

Background Across Canadian Internal Medicine residency programs, a resident's clinical exposure to hematologic disorders is highly heterogeneous depending on the residency program's curriculum, ethnic diversity of the local patient population, and access to resources. Despite this variability in clinical exposure to hematology, there is a paucity of data assessing Internal Medicine residents' competence in the various subspecialties of hematology and whether they are fulfilling the Royal College of Physicians and Surgeons' expected competencies by the end of residency 1. Through this study, our primary aim was to assess Canadian Internal Medicine residents' perceptions of their hematology training to identify gaps in hematology education in residency curricula. Methods We administered a cross-sectional survey using REDCap to all Internal Medicine residents (PGY1 to PGY5) from participating sites across Canada. The survey was distributed to residents electronically by email. To increase response rates, the survey was distributed three times (every 2 weeks) over a 6-week period. An incentive ($10 Starbucks gift card) was provided to improve response rates. The survey questions were designed based on the Royal College objectives which outline expected competencies by the end of Internal Medicine residency (Table 1). It consisted of 16 questions assessing 4 domains: respondent demographics, competence in diagnosis and management of specific hematologic disorders, competence in management of hematologic emergencies, and resident perceptions on hematology education in their program. Survey responses were anonymous and consisted of a combination of dichotomous (yes/no) and ordinal variables (Likert scale). The study was approved by the University of Toronto Research and Ethics Board (REB). Generalized linear regression analysis was used to compare survey questions between residents in different subgroups. p<0.05 was considered statistically significant. Least square mean (LSM) difference (with standard error SE) and 95% confidence intervals (CI) were calculated, with positive LSM indicating a higher Likert score. Results Of the 17 Internal Medicine programs that were invited to participate, 13 programs participated in the survey. 208 residents responded, with 92.31% (192/208) complete responses and 7.69% (16/208) incomplete responses. The overall response rate was 15.02% (208/1,385), with breakdown as follows: 31.5% (436/1,385) PGY1s, 30.5% (423/1,385) PGY2s, 30.9% (428/1,385) PGY3s, 4.5% (62/1,385) PGY4s, and 1.6% (22/1,385) PGY5s. 84.46% (163/208) of residents felt that there was a need for more hematology education in their residency program (Table 2). Specifically, residents felt that there was a need for more education in thrombosis (62.5%, 120/208), hemostasis (75.5%, 145/208), apheresis (75.0%, 144/208), sickle cell disease (79.2%, 152/208), transfusion medicine (84.4%, 162/208), and malignant hematology (78.7%, 151/208). A simulation/workshop was rated to be the most beneficial intervention (mean score of 4.25 +/- 0.80 on Likert scale) for learning. Conclusion Based on a cross-national survey of Internal Medicine residents in Canada, there are significant gaps in hematology education in Canadian Internal Medicine residency programs, most pronounced in transfusion medicine, sickle cell disease, and hemostasis. Interventions targeting these gaps should be designed to improve competence in the diagnosis and management of hematologic disorders and emergencies.

A Survey of Internal Medicine Residents Comparing Virtual Academic Half Day to Traditional Academic Half Day Model

A Survey of Internal Medicine Residents Comparing Virtual Academic Half Day to Traditional Academic Half Day Model

S1612 Rates of Unnecessary Proton Pump Inhibitor Use in Patients With Liver Cirrhosis and a Survey of Internal Medicine Residents: A Quality Improvement Project

S1612 Rates of Unnecessary Proton Pump Inhibitor Use in Patients With Liver Cirrhosis and a Survey of Internal Medicine Residents: A Quality Improvement Project

Fitness app for resident wellness during COVID-19.

Residency training is known to be stressful, with an estimated 33% of Canadian internal medicine residents screening positive for depression and 15% for suicidal ideations.1 The current COVID-19 pandemic is expected to worsen these statistics due to the psychological, emotional and physical burdens it imposes on residents. A survey of internal medicine residents at McGill University (Montreal, Quebec, Canada) conducted during the second wave of the COVID-19 pandemic using the Maslach burnout inventory scale revealed that 25% of residents felt that residency training during the pandemic was hardening them emotionally with 28% feeling more callous when compared to the start of their training and 13% feeling unmotivated to create interpersonal relationship at work during this stressful time of isolation. The McGill Internal Medicine Residency Program launched a 3-week wellness challenge intended to increase physical fitness, interpersonal relatedness and overall wellbeing of residents while respecting the social isolation guidelines. This team-based health and fitness challenge was facilitated by a mobile app called Outbreak, a commercial app widely available on mobile app stores. The goal of each resident/attending physician was to run away from or combat virtual zombies to ensure their own character and team's survival. They did so through exercises synced to the game via wireless fitness devices such as Fitbit. One hundred fifty internal medicine residents (100% inclusion with no opt-out option) and thirty attending physicians (on a volunteer basis) participated in the challenge. Through pre-assigned teams, participants who usually work in different hospitals were given an opportunity to meet virtually, connect and work towards a common goal—that of combating zombies. In-game chat rooms created a platform for discussion, motivation and encouragement between the colleagues. A survey based on the Maslach burnout inventory scale conducted pre- and post-wellness challenge yielded some important differences in emotional exhaustion, physical accomplishment and depersonalisation. We summarised the changes in participant response to the sub-questions under each of the three Maslach burnout dimension. Approximately 8%–15% of residents felt less emotionally drained after participating in this challenge, indicating that they felt more energetic after the challenge. Also, 12.8%–22.3% had a greater feeling of personal accomplishment post wellness challenge, stating that they felt they could deal with emotional problems more calmly. Furthermore, 14%–19% felt more motivated to create interpersonal relationship with their peers and patients and 12%–13% felt more physically active post-challenge. While some engaged in fitness training (e.g., jogging and biking), many reported changes in lifestyle habits (e.g., taking stairs and walking/biking to work). We identified several elements that contributed to the overall positive effects of this challenge. The random team assignments allowed the formation of new relationships between junior residents, senior resident and attending physicians across different training sites, thereby enabling residents to feel connected with others despite physical isolation. Attendings' participation allowed residents to appreciate the non-medical side of their mentors. The challenge was a welcomed distraction and brought positivity into residents' daily routine strained by the pandemic. Major challenges encountered included lack of activity/interaction with teammates from approximately 20 out of 180 participants and occasional failed synchronisation with fitness devices. Digital and app-based platforms offer creative ways to enhance residents' physical fitness, relatedness and general wellbeing and have the unique advantage of supporting interpersonal connections across physical distances and over time. They should be considered for every residency program both within and beyond the context current pandemic and may be especially of value in larger programs with distributed training sites.

Sitting at the Bedside: Patient and Internal Medicine Trainee Perceptions

BackgroundSitting at the bedside may strengthen physician–patient communication and improve patient experience. Yet despite the potential benefits of sitting, hospital physicians, including resident physicians, may not regularly sit down while speaking with patients.ObjectiveTo examine the frequency of sitting by internal medicine residents (including first post-graduate year [PGY-1] and supervising [PGY-2/3] residents) during inpatient encounters and to assess the association between patient-reported sitting at the bedside and patients’ perceptions of other physician communication behaviors. We also assessed residents’ attitudes towards sitting.DesignIn-person survey of patients and email survey of internal medicine residents between August 2019 and January 2020.ParticipantsPatients admitted to general medicine teaching services and internal medicine residents at The Johns Hopkins Hospital.Main MeasuresPatient-reported frequency of sitting at the bedside, patients’ perceptions of other communication behaviors (e.g., checking for understanding); residents’ attitudes regarding sitting.Key ResultsOf 334 eligible patients, 256 (76%) completed a survey. Among these 256 respondents, 198 (77%) and 166 (65%) reported recognizing the PGY-1 and PGY-2/3 on their care team, respectively, for a total of 364 completed surveys. On most surveys (203/364, 56%), patients responded that residents “never” sat. Frequent sitting at the bedside (“every single time” or “most of the time,” together 48/364, 13%) was correlated with other positive behaviors, including spending enough time at the bedside, checking for understanding, and not seeming to be in a rush (p < 0.01 for all). Of 151 residents, 77 (51%) completed the resident survey; 28 of the 77 (36%) reported sitting frequently. The most commonly cited barrier to sitting was that chairs were not available (38 respondents, 49%).ConclusionsPatients perceived that residents sit infrequently. However, sitting was associated with other positive communication behaviors; this is compatible with the hypothesis that promoting sitting could improve overall patient perceptions of provider communication.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07231-4.

S206 Assessing Barriers for Inpatient Colonoscopy Preparation: A QI Project

Introduction: Inpatient colonoscopies tend to have poor quality. Poor communication, adherence, advanced patient age, and comorbidities may impact bowel preparation. Poor preparation can increase procedure times, lower pathology detection rates, and increase cancellations causing delays in care. We aimed to identify the practices and knowledge surrounding inpatient colonoscopies at our academic center. Methods: Our electronic health record was queried for inpatient colonoscopies scheduled between 1/1/2019-3/31/2019. Details about the procedure, demographics, and outcomes were recorded. A survey of internal medicine residents and hospitalists was conducted to assess physician knowledge and experiences. A separate survey was conducted among nursing to evaluate their knowledge and challenges with the inpatient protocol. Results: Between 1/1/2019-3/31/2019, a total of 133 inpatient colonoscopies were scheduled. Patients had a mean age of 63.5 ± 14.2 years, with 58.5% female (n=62). The most common indications were iron deficiency anemia 28.3% (n=30), hematochezia 27.4% (n=29), and abnormal CT of GI tract 8.4% (n=9). Of the 133 scheduled procedures, 20.3% (n=27) were rescheduled or cancelled. The most commonly cited reason was poor prep quality (n=8), although a reason was often not documented (n=17). Additional bowel prep was ordered 45.3% of the time. Seventy-two physicians participated in the first survey: 77.8% internal medicine residents and 22.2% hospitalists. Only 37.5% (n=27) reported knowing when to alert gastroenterology about a patient who has not prepped adequately. 51.4% (n=37) reported they were "never" or "rarely" notified by nursing of a patient's poor progression. Only 23.6% (n=17) felt "very familiar" and one "extremely familiar" with the protocol. The most commonly cited reasons for poor prep were patient non-adherence and poor communication. Fifty-nine nurses participated in the second survey. Nearly 25% (n=14) were not familiar with the current inpatient protocol. 54% (n=32) of nurses reporting experiencing delays in receiving bowel prep from the pharmacy. Patient counseling and nursing education were cited as the two most important targets for improvement. Conclusion: Our next steps are to develop a protocol to standardize inpatient colonoscopy preparation. We anticipate a three-prong approach focusing on enhancing patient knowledge using educational materials, improving provider education of the preparation protocol, and increasing the efficiency of preparation delivery via pharmacy.Figure 1.: Provider and Nursing Familiarity with Inpatient Colonoscopy Preparation Protocol.Table 1.: Characteristics of Scheduled Inpatient Colonoscopies.

A Survey of Internal Medicine Residents: Their Learning Environments, Bias and Discrimination Experiences, and Their Support Structures.

PurposeWhile there is an emerging body of literature that demonstrates how racism and bias negatively impact the experiences of physicians and trainees from underrepresented groups in medicine in the US, little is known about the experiences of internal medicine trainees and their learning environments. The purpose of this study was to examine these learning environments and explore trainees’ perceptions of race/ethnicity-related topics.MethodsA 35-item confidential electronic survey was disseminated to trainees from 11 internal medicine training programs in the US. A total of 142 trainees participated. Purposive sampling ensured alignment with 2018 IM trainee demographics by sex, race and ethnicity. Analyses were performed including chi-square, Fisher’s exact tests, and logistic regression.ResultsKey findings reveal 63% of respondents perceived disparities in the care provided to diverse patients. Two in three respondents were confident that their institution would respond to discrimination, but only 1/3 of respondents perceived appropriate reporting mechanisms. Black/African American trainees reported needing to minimize aspects of their race and were less likely to perceive their institutions as being supportive to people of color.ConclusionAccess to timely information about trainees’ experiences with discrimination and bias in graduate medical education is imperative to disrupt systemic racism and health inequities. Findings suggest a perceived difference in health care provided to minoritized groups, a gap in formal mechanisms for reporting racism and discrimination experienced by trainees, and environments that challenge a sense of belonging. Findings add to current literature exposing the experience of underrepresented trainees in the US.

\u201cWhat do you think about nephrology?\u201d A national survey of internal medicine residents

BackgroundInterest in nephrology has been declining among internal medicine residents but the reasons behind this observation are not well characterized. Our objective was to evaluate factors influencing residents’ choice of subspecialty.MethodsThis is a mixed-method QUAL-QUAN design study that used the results of our previously published qualitative analysis on residents’ perception of nephrology to create and pilot a questionnaire of 60 questions. The final questionnaire was distributed to 26 programs across the United States and a total of 1992 residents. We calculated response rates and tabulated participant characteristics and percentage of participant responses. We categorized choice of fellowship into 2 medical categories (Highly Sought After vs. Less Sought After) and fitted a logistic regression model of choosing a highly vs. less sought after fellowship.ResultsFour hundred fifteen out of 1992 (21%) US residents responded to the survey. Of the 268 residents planning to pursue fellowship training, 67 (25%) selected a less sought after fellowship. Female sex was associated with significantly higher odds of selecting a less sought after fellowship (OR = 2.64, 95% CI: 1.47, 4.74). Major factors deterring residents from pursuing nephrology were perception of inadequate financial compensation, broad scope of clinical practice and complexity of patient population. We observed a decline in exposure to nephrology during the clinical years of medical school with only 35.4% of respondents rotating in nephrology versus 76.8% in residency. The quality of nephrology education was rated less positively during clinical medical school years (median of 50 on a 0–100 point scale) compared to the pre-clinical years (median 60) and residency (median 75).ConclusionOur study attempts to explain the declining interest in nephrology. Results suggest potential targets for improvement: diversified trainee exposure, sub-specialization of nephrology, and increased involvement of nephrologists in the education of trainees.

The Price of Fear: An Ethical Dilemma Underscored in a Virtual Residency Interview Season.

The Price of Fear: An Ethical Dilemma Underscored in a Virtual Residency Interview Season.

A Cross-Sectional Survey of Internal Medicine Residents’ Knowledge, Attitudes, and Current Practices Regarding Patient Transitions to Post-Acute Care

ObjectivesPrior studies have found suboptimal knowledge about post-acute care (PAC) among inpatient providers and poor communication at discharge that can lead to unsafe discharge transitions, but little is known about residents and the PAC transition. The aim of this study is to assess internal medicine residents’ knowledge, attitudes, and current practice regarding patient transitions to PAC. DesignA multisite, cross-sectional 36-question survey. Setting and ParticipantsInternal Medicine and Medicine-Pediatrics residents at 3 university-based Internal Medicine training programs in the United States. Methods: Survey delivered electronically to residents in 2018 and 2019. Survey responses were described by collapsing 4-point Likert responses into dichotomous variables, and thematic content analysis was used to evaluate free text responses. Results: Of 482 residents surveyed, 236 responded (49%). Despite high reported confidence in their ability to transition patients to PAC, only 31% of residents knew how often patients received skilled therapies at skilled nursing facilities (SNFs) and 23% knew how frequently nursing services are provided. The majority of residents (79%) identified the discharge summary as the main way they communicated care instructions to the SNF, but only 55% reported always completing it prior to discharge. Upper-level residents were more likely to know how much therapy patients received at a SNF, but resident knowledge about PAC did not vary by residency year in other domains. Residents who experienced a clinical rotation at a SNF had higher levels of knowledge compared to residents who did not. ConclusionsThis national survey of internal medicine residents identified common knowledge gaps regarding PAC. These knowledge gaps did not improve throughout residency without deliberate exposure to PAC environments. This suggests a need for dedicated curriculum development as discharges to PAC continue to rise exponentially.

Who is Responsible for Discharge Education of Patients? A Multi-Institutional Survey of Internal Medicine Residents.

Safely and effectively discharging a patient from the hospital requires working within a multidisciplinary team. However, little is known about how perceptions of responsibility among the team impact discharge communication practices. Our study attempts to understand residents' perceptions of who is primarily responsible for discharge education, how these perceptions affect their own reported communication with patients, and how residents envision improving multidisciplinary communication around discharges. A multi-institutional cross-sectional survey. Internal medicine (IM) residents from seven US residency programs at academic medical centers were invited to participate between March and May 2019, via email of an electronic link to the survey. Data collected included resident perception of who on the multidisciplinary team is primarily responsible for discharge communication, their own reported discharge communication practices, and open-ended comments on ways discharge multidisciplinary team communication could be improved. Of the 613 resident responses (63% response rate), 35% reported they were unsure which member of the multidisciplinary team is primarily responsible for discharge education. Residents who believed it was either the intern's or the resident's primary responsibility had 4.28 (95% CI, 2.51-7.30) and 3.01 (95% CI, 1.66-5.71) times the odds, respectively, of reporting doing discharge communication practices frequently compared to those who were not sure who was primarily responsible. To improve multidisciplinary discharge communication, residents called for the following among team members: (1) clarifying roles and responsibilities for communication with patients, (2) setting expectations for communication among multidisciplinary team members, and (3) redefining culture around discharges. Residents report a lack of understanding of who is responsible for discharge education. This diffusion of ownership impacts how much residents invest in patient education, with more perceived responsibility associated with more frequent discharge communication.

Barriers to Accessing Nighttime Supervisors: a National Survey of Internal Medicine Residents.

Single-center studies have reported residents experience barriers to accessing supervising physicians overnight, but no national dataset has described barriers perceived by residents or the association between supervision models and perceived barriers. To explore residents' perception of barriers to accessing overnight supervision. Questions about overnight supervision and barriers to accessing it were included on the American College of Physicians Internal Medicine In-Training Examination® (IM-ITE®) Resident Survey in Fall 2017. All US-based internal medicine residents who completed the 2017 IM-ITE®. Responses from 20,744 residents (84%) were analyzed. For our main outcome, we calculated percentages of responses for eight barriers and tested for association with the presence or absence of nocturnists. For our secondary outcome, we categorized free-text responses enumerating barriers from all residents into the five Systems Engineering Initiative for Patient Safety (SEIPS) categories to elucidate future areas for study or intervention. Internal medicine residents working in hospitals without nocturnists more commonly reported having at least one barrier to accessing a supervising physician "always" or "most of the time" (5075/9842, 51.6%) compared to residents in hospitals with nocturnists (3074/10,902, 28.2%, p < 0.001). Among residents in hospitals without nocturnists, the most frequently reported barrier to accessing attending supervision was attendings not being present in the hospital (30.4% "always" or "most of the time"); residents in hospitals with nocturnists most frequently reported desire to make their own decisions as a barrier to contacting attendings (15.7% "always" or "most of the time"). Free-text responses from residents with and without nocturnists most commonly revealed organization (47%) barriers to accessing supervision; 28% cited person barriers, and 23% cited tools/technology barriers. Presence of nocturnists is associated with fewer reported barriers to contacting supervising physicians overnight. Organizational culture, work schedules, desire for independence, interpersonal interactions, and technology may present important barriers.

Discharge Communication: A Multi-Institutional Survey of Internal Medicine Residents' Education and Practices.

To characterize residents' practices around hospital discharge communication and their exposure to transitions-of-care instruction in graduate medical education (GME). In 2019, internal medicine residents at 7 academic medical centers completed a cross-sectional survey reporting the types of transitions-of-care instruction they experienced during GME training and the frequency with which they performed 6 key discharge communication practices. The authors calculated a mean discharge communication score for each resident, and, using multiple logistic regression, they analyzed the relationship between exposure to types of educational experiences and discharge communication practices residents reported they performed frequently (> 60% of time). The authors used content analysis to explore factors that motivated residents to change their discharge practices. The response rate was 63.5% (613/966). Resident discharge communication practices varied. Notably, only 17.0% (n = 104) reported routinely asking patients to "teach-back" or explain their understanding of the discharge plans. The odds of frequently performing key discharge communication practices were greater if residents received instruction based on observation of and feedback regarding their communication (adjusted odds ratio 1.73; 95% confidence interval [CI], 1.07-2.81) or if they received explicit on-rounds teaching (adjusted OR 1.46; 95% CI, 1.04-2.23). In open-ended comments, residents reported that experiencing adverse patient events at some point in the postdischarge continuum was a major impetus for practice change. This study exposes gaps in hospital discharge communication with patients, highlights the benefits of workplace-based instruction on discharge communication skills, and reveals the influence of adverse events as a source of hidden curricula. The results suggest that developing faculty to incorporate transitions-of-care instruction in their rounds teaching and integrating experiences across the postdischarge continuum into residents' education may foster physicians-in-training who are champions of effective transitions of care within the fragmented health care system.

Workplace Violence: Experiences of Internal Medicine Trainees at an Academic Medical Center.

Healthcare professionals are at higher risk for workplace violence (WPV) than workers in other sectors. This elevated risk exists despite the vast underreporting of WPV in the medical setting. The challenge of responding to this risk is compounded by limited empirical research on medical training environments. Understanding trainees' experience and educating them on workplace safety, WPV reporting, and awareness of resources are shared goals of educational and institutional leadership. In our setting, clear understanding and education were urgent after the enactment of a statewide "constitutional carry" law affording individuals a right to carry concealed firearms in all state-owned universities and hospitals, beginning in July 2017. We sought to examine the incidence of WPV affecting Internal Medicine trainees to understand the types of violence encountered, reporting rates, and the factors that influence reporting. We conducted a cross-sectional online survey of Internal Medicine residents and fellows in practice for the previous 12 months. Survey items included both forced choice and open-ended questions. Descriptive statistics were calculated and used to summarize the study variables. χ2 tests were performed to examine whether sex differences existed for each of the survey questions. Qualitative responses were content analyzed and organized thematically. Of 186 trainees, 88 completed the survey. Forty-seven percent of respondents experienced WPV, with >90% of cases involving a patient, a patient's family member, or a patient's friend. Verbal assault was the most common type of incident encountered. Trainees formally reported fewer than half of the violent incidents disclosed in the survey. Major factors that influenced reporting included the severity of the incident, condition of the patient, and clarity of the reporting mechanism. Previous research indicates similar amounts and types of WPV. Likewise, a large percentage of the incidents are not reported. Addressing the key factors related to why physicians underreport can inform institutions on how to make systematic changes to reduce WPV and its negative impact. Future research is needed to examine whether specific interventions can be implemented to improve reporting and reduce the incidence of WPV.

Comparing the communication habits between residents and consultant fellows: recommendations for curriculum development

ABSTRACTBackgroundInterprofessional communication, in conjunction with coordination of care between teams, is critical for high-value care in hospital-based units. The consultation process is often the first step in coordinating communication between different groups of physicians.ObjectiveWe sought to investigate the current practice patterns of internal medicine residents and subspecialty medicine fellow consultants, as well as how perceptions regarding the consultation process differ between groups.MethodsWe used a cross-sectional survey of internal medicine residents and subspecialty medicine fellow consultants at two academic medical centers and one community medical center. Differences between the responses of residents and consultant fellows regarding the consult process were compared. Descriptive and nonparametric comparisons were used.ResultsOf 228 residents from the three sites, 139 responded (61%). Of 192 consultant fellows sent surveys, 118 responded (61%). Both residents and fellows agreed that consult question was the most important aspect of the consultation. Residents considered information including the medical record number, history of present illness and physical exam to be more important than did fellows. The residents’ confidence in their own ability to convey a consult question was statistically different than the consultants’ perceptions about the abilities of these same residents (4.21 vs. 3.14, P < 0.01). Both felt that their interactions during the consultation process were educationally rewarding (3.81 vs. 3.64, P = 0.07).ConclusionsOur research sheds light on the current communication habits of residents and consultant fellows. Hospital dynamics, workflow and patient length of stay could be negatively affected. Further work, including the development of formal curricula, will lead to improvements in consultation communication.

Knowledge of HIV Testing Guidelines Among US Internal Medicine Residents: A Decade After the Centers for Disease Control and Prevention's Routine HIV Testing Recommendations.

Ten years after the Centers for Disease Control and Prevention recommended universal HIV screening, rates remain low. Internal medicine residents are the front-line medical providers for large groups of patients. We evaluated the knowledge of internal medicine residents about HIV testing guidelines and examined adherence to universal HIV testing in an outpatient setting. A cross-sectional survey of internal medicine residents at four residency programs in Chicago was conducted from January to March 2016. Aggregate data on HIV screening were collected from 35 federally qualified community health centers in the Chicago area after inclusion of an HIV testing best practice alert in patients' electronic medical records. Of the 192 residents surveyed, 130 (68%) completed the survey. Only 58% were aware of universal HIV screening and 49% were aware that Illinois law allows for an opt-out HIV testing strategy. Most of the residents (64%) ordered no more than 10 HIV tests in 6 months. The most frequently reported barriers to HIV testing were deferral because of urgent care issues, lack of time, and the perception that patients were uncomfortable discussing HIV testing. From July 2015 to February 2016, the average HIV testing adherence rate in the 35 health centers was 18.2%. More effort is needed to change HIV testing practices among internal medicine residents so that they will adopt this approach in their future clinical practice. Improving knowledge about HIV testing and addressing other HIV testing barriers are essential for such a successful change.

Work Related Post Traumatic Stress Disorder in Medicine Residents.

This study sought to screen for the burden of work-related posttraumatic stress disorder (PTSD) symptoms in internal medicine residents. A cross-sectional survey of internal medicine residents from three academic institutions was conducted using the PCL-5 screening tool. Off all residents surveyed, 5.2% screened positive for PTSD symptoms (N = 194). 86.1% of all trainees identified stressors during training. Positive PTSD screens were significantly higher in PGY3 residents (X2 = 15.24, p = 0.0005). Of all PGY3 residents, 9.8% (N = 4) and 14.6% (N = 6) of residents screened positive for PTSD symptoms based on absolute and cluster score criteria, respectively. Verbal/physical assault by patients/families/colleagues were triggers for the most cases of positive screens. Self-reported stressors are highly prevalent in internal medicine trainees. Verbal/physical assault by patients and families appear to be the triggering event for most positive screens. These observations will help with future study designs to quantify the burden of work related PTSD in internal medicine trainee physicians so that appropriate supportive measures can be provided.

Trainee Satisfaction with Feedback provided using an Entrustment Scale: A Survey of Internal Medicine Residents

This article was migrated. The article was marked as recommended. Background: Numerous scales have been developed to evaluate medical learners, including entrustment scales. Little is known about resident satisfaction with entrustment scales. The objective of this study was to evaluate residents' perceptions of entrustment scales as a method of assessment in comparison to traditional evaluation methods. Methods: Residents (n=102) at the University of Pennsylvania Internal Medicine residency program were asked to participate in a survey in June 2016 regarding perceptions of an entrustment scale, which was incorporated into end-of-rotation resident clinical evaluations in 2014. The survey assessed the assessment utility in various domains, including overall perception of the scale, overall satisfaction, and preference in comparison with other rating scales. Qualitative comments were elicited via free-text to further clarify residents' perceptions. Results: Sixty of the 102 residents (59%) completed the survey. Most residents positively rated the usefulness of questions asked (n=54, 92%) and comments provided (n=48, 98%). Similarly, of those previously evaluated by numerical scales (n=29), numerical scales with behavioral anchors (n=26), and numerical scales with adjectives (n=35), 72%, 88%, and 83% found the entrustment scale to be equivocal or superior, respectively. Qualitative comments supporting the entrustment scale noted improved ease of interpretation, objectivity, and intuitiveness. Conclusions: Residents are satisfied with entrustment scales, noting the entrustment scale to be superior compared to traditional scale alternatives. Residents found entrustment scales provided a more objective assessment, allowed for easier interpretation, and were more intuitive than traditional scales.

Drivers of Application Inflation: A National Survey of Internal Medicine Residents

Drivers of Application Inflation: A National Survey of Internal Medicine Residents

Assessment of Knowledge, Attitudes, and Practices Regarding Chronic Hepatitis C Treatment and Its Challenges: A Survey of Internal Medicine Residents in a Community Hospital.

BackgroundDespite recent advances in chronic hepatitis C (CHC) treatment, only a small proportion of patients are connected with care and receive treatment. Internal medicine (IM) residents spend nearly one-third of their training in primary care settings and play a crucial role in diagnosing and counseling patients as well as linking patients with care and following up.MethodsIM residents in a community hospital completed an anonymous questionnaire regarding their knowledge, attitude, and practice associated with CHC treatment and its challenges.ResultsDescriptive analysis of the survey showed that there is a substantial gap in knowledge regarding the newer treatment of CHC between IM residents’ perceptions of patient awareness and IM residents.ConclusionUpdated education regarding CHC that is geared towards medical residents and focused on new modalities of treatment can narrow the gap and lead to considerable increases in the rates of diagnosis and treatment and decreases in morbidity and mortality.