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Attitudes of Radiology Program Directors Toward MD-PhD Trainees, Resident Research Productivity, and Dedicated Research Time.
Cogswell PM, Deitte LA, Donnelly EF, Morgan VL, Omary RA
(2018) Acad Radiol 25: 733-738
MeSH Terms: Attitude of Health Personnel, Biomedical Research, Clinical Competence, Efficiency, Humans, Internship and Residency, Physician Executives, Radiology, Surveys and Questionnaires, Time Factors
Show Abstract · Added March 16, 2018
RATIONALE AND OBJECTIVES - The percentage of clinical scientists in radiology has historically been low. Increasing the pipeline of trainees interested in research could occur by recruiting MD-PhD trainees and providing protected research time during residency. The purpose of this work is to assess the attitudes of radiology program directors toward MD-PhD trainees, resident research productivity, and dedicated research time.
METHODS - An online survey was sent to residency program directors of all diagnostic radiology departments that received National Institutes of Health (NIH) awards in 2014 (n = 63). Survey questions included program size; perception of overall performance, clinical performance, and research productivity of MD-PhD residents compared to non-PhD residents; and presence of dedicated research time. Responses comparing MD-PhD residents to non-PhD residents were reported as a five-point Likert scale. Student t test was used to assess for significance (alpha = 0.05).
RESULTS - Response rate was 37%. Clinical performance of MD-PhD residents was judged inferior (P < .05) to non-PhD residents, although that of all residents engaged in research trended toward superiority compared to those not involved in research. Dedicated research time is offered by 61% of programs in years R1-R3 and all programs in year R4. Research productivity during residency was judged to be similar (P = .5) between MD-PhD and non-PhD residents.
CONCLUSIONS - Survey results suggest that clinical performance during residency and research involvement is often individually based and difficult to generalize based on prior PhD training. All programs offered dedicated research time, and the vast majority of residents were reported to engage in research during residency, which may increase the pipeline of trainees interested in an academic career.
Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
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10 MeSH Terms
Interventional Pulmonology Fellowship Accreditation Standards: Executive Summary of the Multisociety Interventional Pulmonology Fellowship Accreditation Committee.
Mullon JJ, Burkart KM, Silvestri G, Hogarth DK, Almeida F, Berkowitz D, Eapen GA, Feller-Kopman D, Fessler HE, Folch E, Gillespie C, Haas A, Islam SU, Lamb C, Levine SM, Majid A, Maldonado F, Musani AI, Piquette C, Ray C, Reddy CB, Rickman O, Simoff M, Wahidi MM, Lee H
(2017) Chest 151: 1114-1121
MeSH Terms: Accreditation, Bronchoscopy, Clinical Competence, Curriculum, Education, Medical, Graduate, Faculty, Medical, Fellowships and Scholarships, Humans, Pulmonary Medicine, Societies, Medical, Thoracoscopy, Time Factors
Show Abstract · Added April 3, 2017
Interventional pulmonology (IP) is a rapidly evolving subspecialty of pulmonary medicine. In the last 10 years, formal IP fellowships have increased substantially in number from five to now > 30. The vast majority of IP fellowship trainees are selected through the National Resident Matching Program, and validated in-service and certification examinations for IP exist. Practice standards and training guidelines for IP fellowship programs have been published; however, considerable variability in the environment, curriculum, and experience offered by the various fellowship programs remains, and there is currently no formal accreditation process in place to standardize IP fellowship training. Recognizing the need for more uniform training across the various fellowship programs, a multisociety accreditation committee was formed with the intent to establish common accreditation standards for all IP fellowship programs in the United States. This article provides a summary of those standards and can serve as an accreditation template for training programs and their offices of graduate medical education as they move through the accreditation process.
Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
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12 MeSH Terms
Rural Trauma Team Development Course decreases time to transfer for trauma patients.
Dennis BM, Vella MA, Gunter OL, Smith MD, Wilson CS, Patel MB, Nunez TC, Guillamondegui OD
(2016) J Trauma Acute Care Surg 81: 632-7
MeSH Terms: Adult, Aged, Clinical Competence, Emergency Service, Hospital, Female, Hospital Mortality, Hospitals, Rural, Humans, Length of Stay, Male, Middle Aged, Patient Care Team, Patient Transfer, Tennessee, Tomography, X-Ray Computed, Trauma Centers, Traumatology, Wounds and Injuries
Show Abstract · Added June 26, 2018
BACKGROUND - The Rural Trauma Team Development Course (RTTDC) is designed to teach knowledge and skills for the initial assessment and stabilization of trauma patients in resource-limited environments. The effect of RTTDC training on transfers from nontrauma centers to definitive care has not been studied. We hypothesized that RTTDC training would decrease referring hospital emergency department (ED) length of stay (LOS), time to call for transfer, pretransfer computed tomography (CT) imaging rate, and mortality rate.
METHODS - We conducted a pre/post analysis of trauma patients who were transferred from rural, nontrauma hospitals from 2012 to 2014. Patients from six rural hospitals that participated in an RTTDC course were compared with a control group of similar centers that did not participate in the course. Primary outcome evaluated was referring hospital ED LOS, which was estimated using a difference-in-differences regression model. Secondary outcomes were time to transfer call, pretransfer CT imaging rates, and mortality.
RESULTS - Two hundred fifty-three patients were available for study (RTTDC group, n = 130; control group, n = 123). Demographics, CT imaging, and mortality rates were similar between the two groups. In the primary outcome, the RTTDC group experienced an overall 61-minute reduction in referring hospital LOS (p = 0.02) compared with the control group. The RTTDC group also showed a 41-minute reduction (p = 0.03) in time to call for transfer compared with controls. There were no differences in the secondary outcomes of pretransfer CT scanning rates or mortality.
CONCLUSIONS - Rural Trauma Team Development Course training shortens ED LOS at rural, nontrauma hospitals by more than 1 hour without increasing mortality. Future educational and research efforts should focus on decreasing unnecessary imaging prior to transfer as well as opportunities to improve mortality rates. This study suggests an important role for RTTDC training in the care of rural trauma patients and may allow trauma centers to recapture the "golden hour" for transferred trauma patients.
LEVEL OF EVIDENCE - Therapeutic/care management study, level III.
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Provider Knowledge, Attitudes, and Practices Surrounding Conservative Management for Patients with Advanced CKD.
Parvez S, Abdel-Kader K, Pankratz VS, Song MK, Unruh M
(2016) Clin J Am Soc Nephrol 11: 812-20
MeSH Terms: Adult, Aged, Attitude of Health Personnel, Clinical Competence, Conservative Treatment, Female, Health Care Surveys, Health Knowledge, Attitudes, Practice, Humans, Kidney Failure, Chronic, Male, Middle Aged, Nephrology, Patient Participation, Practice Patterns, Physicians', Primary Health Care, United States, Young Adult
Show Abstract · Added November 29, 2018
BACKGROUND AND OBJECTIVES - Despite the potential benefits of conservative management, providers rarely discuss it as a viable treatment option for patients with advanced CKD. This survey was to describe the knowledge, attitudes, and practices of nephrologists and primary care providers regarding conservative management for patients with advanced CKD in the United States.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS - We developed a questionnaire on the basis of a literature review to include items assessing knowledge, attitudes, and self-reported practices of conservative management for patients with advanced CKD. Potential participants were identified using the American Medical Association Physician Masterfile. We then conducted a web-based survey between April and May of 2015.
RESULTS - In total, 431 (67.6% nephrologists and 32.4% primary care providers) providers completed the survey for a crude response rate of 2.7%. The respondents were generally white, men, and in their 30s and 40s. Most primary care provider (83.5%) and nephrology (78.2%) respondents reported that they were likely to discuss conservative management with their older patients with advanced CKD. Self-reported number of patients managed conservatively was >11 patients for 30.6% of nephrologists and 49.2% of primary care providers. Nephrologists were more likely to endorse difficulty determining whether a patient with CKD would benefit from conservative management (52.8% versus 36.2% of primary care providers), whereas primary care providers were more likely to endorse limited information on effectiveness (49.6% versus 24.5% of nephrologists) and difficulty determining eligibility for conservative management (42.5% versus 14.3% of nephrologists). There were also significant differences in knowledge between the groups, with primary care providers reporting more uncertainty about relative survival rates with conservative management compared with different patient groups.
CONCLUSIONS - Both nephrologists and primary care providers reported being comfortable with discussing conservative management with their patients. However, both provider groups identified lack of United States data on outcomes of conservative management and characteristics of patients who would benefit from conservative management as barriers to recommending conservative management in practice.
Copyright © 2016 by the American Society of Nephrology.
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Using Coworker Observations to Promote Accountability for Disrespectful and Unsafe Behaviors by Physicians and Advanced Practice Professionals.
Webb LE, Dmochowski RR, Moore IN, Pichert JW, Catron TF, Troyer M, Martinez W, Cooper WO, Hickson GB
(2016) Jt Comm J Qual Patient Saf 42: 149-64
MeSH Terms: Clinical Competence, Communication, Documentation, Humans, Inservice Training, Leadership, Medical Staff, Patient Care Team, Patient Safety, Personnel, Hospital
Show Abstract · Added May 13, 2016
BACKGROUND - Health care team members are well positioned to observe disrespectful and unsafe conduct-behaviors known to undermine team function. Based on experience in sharing patient complaints with physicians who subsequently achieved decreased complaints and malpractice risk, Vanderbilt University Medical Center developed and assessed the feasibility of the Co-Worker Observation Reporting System(SM) (CORS (SM)) for addressing coworkers' reported concerns.
METHODS - VUMC leaders used a "Project Bundle" readiness assessment, which entailed identification and development of key people, organizational supports, and systems. Methods involved gaining leadership buy-in, recruiting and training key individuals, aligning the project with organizational values and policies, promoting reporting, monitoring reports, and employing a tiered intervention process to address reported coworker concerns.
RESULTS - Peer messengers shared coworker reports with the physicians and advanced practice professionals associated with at least one report 84% of the time. Since CORS inception, 3% of the medical staff was associated with a pattern of CORS reports, and 71% of recipients of pattern-related interventions were not named in any subsequent reports in a one-year follow-up period.
CONCLUSIONS - Systematic monitoring of documented co-worker observations about unprofessional conduct and sharing that information with involved professionals are feasible. Feasibility requires organizationwide implementation; co-workers willing and able to share respectful, nonjudgmental, timely feedback designed initially to encourage self-reflection; and leadership committed to be more directive if needed. Follow-up surveillance indicates that the majority of professionals "self-regulate" after receiving CORS data.
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Automated Case Cancellation Review System Improves Systems-Based Practice.
Starnes JR, McEvoy MD, Ehrenfeld JM, Sandberg WS, Wanderer JP
(2015) J Med Syst 39: 134
MeSH Terms: Accreditation, Anesthesiology, Clinical Competence, Efficiency, Organizational, Health Knowledge, Attitudes, Practice, Humans, Information Systems, Internship and Residency, Interpersonal Relations, Preoperative Period, Problem-Based Learning, Professionalism, Time Factors
Show Abstract · Added October 17, 2015
BACKGROUND - Accreditation Council for Graduate Medical Education (ACGME) core competencies of systems-based practice and practice-based learning and improvement are difficult to assess, as they are often not directly measurable or observable. Reviewing day-of-surgery cancellations could provide resident learning opportunities in these areas.
OBJECTIVE - An automated system to facilitate anesthesiology resident review of cancelled cases was implemented on the Preoperative Evaluation Clinic (PEC) rotation at the authors' institution. This study aims to evaluate its impact on resident education.
METHODS - Residents on the PEC rotation during the 6 months preceding (n = 22) and following (n = 13) implementation in 2014 were surveyed about their experience performing cancelled case reviews in order to ascertain the effect of the intervention on their training.
RESULTS - Significant changes were reported in the number of cases reviewed by each resident (p < 0.0001), perceived importance of review (p = 0.03), and ease of review (p = 0.03) after system implementation. There was also an increase in the proportion of cancelled cases reviewed from 17.3% (34 of 196) to 95.6% (194 of 203) (p < 0.0001). Non-significant trends were seen in perceived rotation effect on ACGME competencies, including systems-based practice. Several specific improvements to our clinical practice, including the creation of standardized guidelines, arose from these case reviews.
CONCLUSION - Implementation of automated systems can improve compliance with educational goals by clarifying priorities and simplifying workflow. This system increased the number of cases reviewed by residents and the perceived importance of this review as a part of their educational experience.
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13 MeSH Terms
Using natural language processing to provide personalized learning opportunities from trainee clinical notes.
Denny JC, Spickard A, Speltz PJ, Porier R, Rosenstiel DE, Powers JS
(2015) J Biomed Inform 56: 292-9
MeSH Terms: Academic Medical Centers, Advance Directives, Aged, Algorithms, Automation, Clinical Clerkship, Clinical Competence, Education, Medical, Educational Measurement, Electronic Health Records, Geriatrics, Hospitals, Veterans, Humans, Learning, Mental Disorders, Middle Aged, Natural Language Processing, Outcome Assessment (Health Care), Reproducibility of Results, Software, Students, Medical, Tennessee, User-Computer Interface
Show Abstract · Added March 14, 2018
OBJECTIVE - Assessment of medical trainee learning through pre-defined competencies is now commonplace in schools of medicine. We describe a novel electronic advisor system using natural language processing (NLP) to identify two geriatric medicine competencies from medical student clinical notes in the electronic medical record: advance directives (AD) and altered mental status (AMS).
MATERIALS AND METHODS - Clinical notes from third year medical students were processed using a general-purpose NLP system to identify biomedical concepts and their section context. The system analyzed these notes for relevance to AD or AMS and generated custom email alerts to students with embedded supplemental learning material customized to their notes. Recall and precision of the two advisors were evaluated by physician review. Students were given pre and post multiple choice question tests broadly covering geriatrics.
RESULTS - Of 102 students approached, 66 students consented and enrolled. The system sent 393 email alerts to 54 students (82%), including 270 for AD and 123 for AMS. Precision was 100% for AD and 93% for AMS. Recall was 69% for AD and 100% for AMS. Students mentioned ADs for 43 patients, with all mentions occurring after first having received an AD reminder. Students accessed educational links 34 times from the 393 email alerts. There was no difference in pre (mean 62%) and post (mean 60%) test scores.
CONCLUSIONS - The system effectively identified two educational opportunities using NLP applied to clinical notes and demonstrated a small change in student behavior. Use of electronic advisors such as these may provide a scalable model to assess specific competency elements and deliver educational opportunities.
Copyright © 2015 Elsevier Inc. All rights reserved.
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23 MeSH Terms
Automated Assessment of Medical Students' Clinical Exposures according to AAMC Geriatric Competencies.
Chen Y, Wrenn J, Xu H, Spickard A, Habermann R, Powers J, Denny JC
(2014) AMIA Annu Symp Proc 2014: 375-84
MeSH Terms: Area Under Curve, Artificial Intelligence, Clinical Competence, Education, Medical, Undergraduate, Educational Measurement, Geriatrics, Humans, Natural Language Processing, Students, Medical, Tennessee
Show Abstract · Added March 14, 2018
Competence is essential for health care professionals. Current methods to assess competency, however, do not efficiently capture medical students' experience. In this preliminary study, we used machine learning and natural language processing (NLP) to identify geriatric competency exposures from students' clinical notes. The system applied NLP to generate the concepts and related features from notes. We extracted a refined list of concepts associated with corresponding competencies. This system was evaluated through 10-fold cross validation for six geriatric competency domains: "medication management (MedMgmt)", "cognitive and behavioral disorders (CBD)", "falls, balance, gait disorders (Falls)", "self-care capacity (SCC)", "palliative care (PC)", "hospital care for elders (HCE)" - each an American Association of Medical Colleges competency for medical students. The systems could accurately assess MedMgmt, SCC, HCE, and Falls competencies with F-measures of 0.94, 0.86, 0.85, and 0.84, respectively, but did not attain good performance for PC and CBD (0.69 and 0.62 in F-measure, respectively).
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SCCT curriculum guidelines for general (level 1) cardiovascular CT training.
Maroules CD, Cheezum MK, Joshi PH, Williams M, Simprini LA, Nelson KH, Bittencourt MS, Carr JJ, Weigold WG, Cury RC, Blankstein R, Abbara S
(2015) J Cardiovasc Comput Tomogr 9: 81-8
MeSH Terms: Cardiac Imaging Techniques, Cardiovascular Diseases, Clinical Competence, Curriculum, Education, Medical, Graduate, Female, Guidelines as Topic, Humans, Internship and Residency, Male, Radiology, Societies, Medical, Tomography, X-Ray Computed, United States
Show Abstract · Added August 24, 2015
The Society of Cardiovascular Computed Tomography has developed general (level 1) cardiovascular CT (CCT) training guidelines for radiology resident and cardiology fellow education. As CCT use has expanded over the past decade, it is essential to incorporate such training in both diagnostic radiology residency programs and cardiology fellowship programs. This curriculum will ensure residents and fellows-in-training obtain a fundamental understanding of CCT to stay current in the evolving landscape of cardiovascular imaging and know how and when to use CCT. The curriculum will also help narrow the present knowledge and training gap that exists for CCT between different programs and may encourage trainees to pursue additional training in advanced cardiovascular imaging.
Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
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14 MeSH Terms
Nutrition competencies in health professionals' education and training: a new paradigm.
Kris-Etherton PM, Akabas SR, Douglas P, Kohlmeier M, Laur C, Lenders CM, Levy MD, Nowson C, Ray S, Pratt CA, Seidner DL, Saltzman E
(2015) Adv Nutr 6: 83-7
MeSH Terms: Australia, Clinical Competence, Disease Management, Education, Medical, Health Personnel, Humans, Nutrition Therapy, Nutritional Sciences, United Kingdom, United States
Show Abstract · Added September 30, 2015
Most health care professionals are not adequately trained to address diet and nutrition-related issues with their patients, thus missing important opportunities to ameliorate chronic diseases and improve outcomes in acute illness. In this symposium, the speakers reviewed the status of nutrition education for health care professionals in the United States, United Kingdom, and Australia. Nutrition education is not required for educating and training physicians in many countries. Nutrition education for the spectrum of health care professionals is uncoordinated, which runs contrary to the current theme of interprofessional education. The central role of competencies in guiding medical education was emphasized and the urgent need to establish competencies in nutrition-related patient care was presented. The importance of additional strategies to improve nutrition education of health care professionals was highlighted. Public health legislation such as the Patient Protection and Affordable Care Act recognizes the role of nutrition, however, to capitalize on this increasing momentum, health care professionals must be trained to deliver needed services. Thus, there is a pressing need to garner support from stakeholders to achieve this goal. Promoting a research agenda that provides outcome-based evidence on individual and public health levels is needed to improve and sustain effective interprofessional nutrition education.
© 2015 American Society for Nutrition.
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