This article reports on results from a 2017 survey of internal medicine residency program directors’ support for flexible work hours introduced by the Accreditation Committee on Graduate Medical Education (ACGME) based on trial results. Although the majority of programs supported the ACGME work hour flexibility, only one quarter of programs introduced longer work hours.

… measure combining these two constructs. … Chatterjee S; Desai S; Manesh R; Junfeng S; Nundy S; Wright SM. … S. … S. … R. … S. … S. … SM … Chatterjee … Desai … Manesh … Junfeng … Nundy … Wright … S. Chatterjee … S. Desai … R. Manesh … S. Junfeng … S. Nundy … SM Wright …

… journal of the American College of Medical Quality … Am J Med Qual … Engaging trainees in quality improvement efforts …

Diagnostic errors have garnered increasing attention as a contributor to patient harm. This review explores reasons for underrecognition of diagnostic errors, including cognitive biases and large-scale system weaknesses. The authors suggest emphasis on education to enhance clinical knowledge, physical examination practice, and medical history-taking skills to improve diagnosis.

Over the past decade, with the goal of improving both the educational experience and patient safety, the Accreditation Council for Graduate Medical Education has introduced regulations restricting resident duty hours and requiring graded supervision by faculty physicians. While many studies have evaluated how duty hour restrictions influence safety outcomes, the impact of different supervisory strategies has been less studied. Conducted on an internal medicine teaching service, this randomized controlled trial examined the effect of two supervisory strategies on patient safety and the educational experience for housestaff. Increased direct supervision (faculty physician physically present for duration of morning rounds, including patient care discussions and encounters with newly admitted and existing patients) was compared to standard supervision (faculty directly supervised residents only for new admissions, meeting later in the day to discuss existing patients). The study used a rigorous, previously developed methodology to track adverse event rates and found no significant difference in safety outcomes between the two groups. Residents perceived that greater supervision led to decreased autonomy in decision-making. Although the study evaluated only direct, in-person supervision, its findings demonstrate that—like reducing duty hours—increasing direct supervision of trainees does not necessarily translate to improving patient safety. The relationship between clinical supervision, education, and patient safety is discussed in a PSNet perspective.

Research suggests that standardization, dedicated space, and supervision improve resident handoffs, but less is known about how these best practices are implemented. Investigators surveyed residency program directors and found significant variation in the implementation of recommended handoff practices and educational strategies.

In medical training, learners glean messages from the offhand comments, behaviors, and attitudes of their superiors, a phenomenon known as the hidden curriculum. Experts have described how the hidden curriculum often runs counter to a culture of safety and standards of equitable treatment. In this position statement, the American College of Physicians recommends that educators recognize and optimize the hidden curriculum in physician training through promoting an expectation of professionalism as a core value, empowering learners to raise concerns about safety, and modeling empathy, reflection, and discussion of positive and negative experiences in the training environment.

… journal of the American College of Medical Quality … Am J Med Qual … Organizational infrastructure is important to …

… The New England journal of medicine … N Engl J Med … The effect of resident work hours on patient safety …

… Journal of hospital medicine … J Hosp Med … The volume–outcome relationship—in which …

Examining whether medical school graduates are equipped to provide direct patient care in the beginning of their internships, this newspaper article reports how educators have collaborated to identify and integrate competencies, such as assertiveness and time management, to augment the safety of this transition.

Signs of burnout and fatigue were most often associated with being on a rotation that included shifts longer than 24 hours, in this survey of intern physicians at three internal medicine residency programs. The survey was performed immediately prior to implementing the 2011 duty hour restrictions, limiting intern shifts to 16 hours.

Conducted before implementation of the 2011 ACGME duty hour limits, this survey found that the majority of internal medicine and surgery program directors believed the new regulations would negatively affect the learning environment and continuity of care, as well as result in increased faculty workload and require changes in clinical services.

Hospitals whose residency programs provided formal training in handoffs had slightly lower pneumonia mortality rates; however, there were no other associations found between handoff training, resident workload, and other patient care outcomes.

The disturbingly high incidence of readmissions after hospital discharge remains a national policy priority, as many readmissions can be linked to adverse events after discharge. In this study, a nurse practitioner (NP) was assigned to a resident inpatient medical team at a tertiary care hospital, with the specific responsibility of facilitating the discharge process. The NP's responsibilities included arranging follow-up appointments, performing medication reconciliation, and following up on tests pending at discharge. Although NP discharge facilitation achieved improved patient satisfaction with the discharge process, higher rates of timely outpatient follow-up, and improved resident work efficiency, it did not result in fewer readmissions or emergency department visits in the post-discharge period. The complex nature of preventing readmissions is discussed in an AHRQ WebM&M interview with Dr. Eric Coleman.

This study found that residents’ reflections on improvement opportunities were stable over their 3-year training period, lower for systems reflections than for personal ones, and associated with the preventability of adverse events.

Widespread implementation of rapid response teams (RRTs) has been spurred by endorsements from prominent organizations and a Joint Commission National Patient Safety Goal. However, the evidence on effectiveness of such teams is mixed, although recent single-institution studies have shown impressive improvements in clinical outcomes. This study found that implementation of an RRT at an academic medical center did not improve clinical outcomes over a 6-month follow-up period. This study is one of the few to evaluate the effectiveness of teams led by resident physicians and nurses, in contrast with other studies evaluating RRTs led by critical care physicians.