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Search results for "Residents and Fellows"

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Journal Article > Study

A multidisciplinary model for reviewing severe maternal morbidity cases and teaching residents patient safety principles.

Ogunyemi D, Hage N, Kim SK, Friedman P. Jt Comm J Qual Patient Saf. 2019 Mar 20; [Epub ahead of print].

The rise in maternal morbidity and mortality is one of the most pressing patient safety issues in the United States. Formal debriefing after adverse events is an important method for analyzing and improving safety. In this study, an academic hospital adopted a systems-based morbidity and mortality conference model to review cases of serious maternal harm and implemented several safety measures (including teamwork training) to address issues that were identified through structured review.

Journal Article > Study

Patient safety outcomes under flexible and standard resident duty-hour rules.

Silber JH, Bellini LM, Shea JA, et al; iCOMPARE Research Group. N Engl J Med. 2019;380:905-914.

Duty hour reform for resident physicians was implemented as a patient safety measure, but it remains controversial. The iCOMPARE study is a cluster-randomized noninferiority trial in which 63 internal medicine programs were assigned either to follow the 2011 duty hour rules or to maintain flexible resident schedules. Researchers found no significant differences in 30-day mortality or AHRQ patient safety indicators among programs with fixed versus flexible resident schedules, similar to a recent study of surgical trainees. Programs with flexible schedules had slightly higher 30-day readmission rates and higher incidence of prolonged length of stay. Overall, the authors conclude that local flexibility in resident schedules did not adversely affect patient safety. An accompanying editorial calls for eliciting patient perspectives about trainee duty hours and the therapeutic relationship between rotating physicians and the hospitalized patient. A previous PSNet interview discussed the FIRST trial, which examined how less restrictive duty hours affected patient outcomes and resident satisfaction.

Journal Article > Study

Sleep and alertness in a duty-hour flexibility trial in internal medicine.

Basner M, Asch DA, Shea JA, et al; iCOMPARE Research Group. N Engl J Med. 2019;380:915-923.

This cluster-randomized trial compared an internal medicine residency schedule that adhered to 2011 duty hour regulations to a flexible schedule that maintained an overall 80-hour work week. Self-reported sleepiness and measured sleep duration did not differ by group, but residents in the flexible programs performed worse on psychomotor vigilance testing, a measure of alertness. The authors recommend implementing fatigue-management training during residency.

Journal Article > Commentary

The Swiss Cheese Conference: integrating and aligning quality improvement education with hospital patient safety initiatives.

Durstenfeld MS, Statman S, Dikman A, et al. Am J Med Qual. 2019 Jan 18; [Epub ahead of print].

Academic medical centers are working to increase resident engagement in patient safety work. Building on Reason's system failure investigation model, this commentary describes the integration of monthly educational opportunities into actual improvement efforts. Core elements of the program rely on effective case selection, root cause analysis, and resident-led discussion.

Book/Report

Utilizing a Systems and Design Thinking Approach for Improving Well-Being Within Health Professional Education and Health Care.

Kreitzer MJ, Carter K, Coffey DS, et al. NAM Perspectives. Washington, DC: National Academy of Medicine; 2019.

Burnout can diminish the safety of clinicians, students, health care workers, and patients. This report suggests institutions apply design thinking and systems thinking methods to develop interventions to reduce burnout and stress. A past Annual Perspective covered the impact of burnout on patient safety.

Journal Article > Study

Identification of warning signs during selection of surgical trainees.

Hagelsteen K, Johansson BM, Bergenfelz A, Mathieu C. J Surg Educ. 2019;76:684-693.

This educational study used a survey followed by semi-structured individual interviews with experienced surgeons to examine behaviors early in training that constitute a risk for future unprofessional behavior, a known safety concern. Researchers found that respondents consistently believed that such warning signs could be identified early in training. The authors constructed an interview guide for surgical residency admission to surface behavioral concerns.

Journal Article > Study

Data omission by physician trainees on ICU rounds.

Artis KA, Bordley J, Mohan V, Gold JA. Crit Care Med. 2019;47:403-409.

Reporting complete patient information during clinical rounds is important for achieving an accurate diagnosis and informing clinical management. Prior research has shown that data is sometimes omitted or inaccurately communicated on rounds. This observational study compared patient data shared by trainees and medical students on ICU rounds to that contained within the electronic health record. Researchers analyzed photocopies of trainee and student notes as well as audio recordings of their oral presentations. For the 157 patient presentations included in the study, they found all contained data omissions and that other team members on rounds supplemented a minimal amount of data missing from student and trainee presentations. The authors recommend additional oversight and education of trainees with regard to data presented on rounds.

Award

Lucian Leape Patient Safety Fellowship Award.

International Society for Quality in Health Care.

Inspired by the work and leadership of Dr. Lucian Leape, this award is a mentoring program to develop physicians and leaders seeking to translate patient safety theory, clinical practice improvements, and implementation science to health care environments in developing countries. The current application is now closed.

Journal Article > Study

Improving resident and fellow engagement in patient safety through a graduate medical education incentive program.

Turner DA, Bae J, Cheely G, Milne J, Owens TA, Kuhn CM. J Grad Med Educ. 2018;10:671-675.

Voluntary reporting of safety events is a widespread patient safety practice, but safety events are known to be underreported, especially by physicians. This uncontrolled intervention study aimed to increase error reporting by residents and fellows by providing a financial incentive of about $200 to report at least two safety events per year. More than half of eligible trainee physicians received the incentive, and the resultant increase in safety reports was sustained over 3 years. One related commentary suggests providing team-based incentives instead of the individual payments, and another commentary questions whether increased safety reporting translates to safer care and urges caution in incentivizing event reporting. A past PSNet perspective discussed the effect of financial incentives on patient safety.

Journal Article > Study

Case-based simulation empowering pediatric residents to communicate about diagnostic uncertainty.

Olson ME, Borman-Shoap E, Mathias K, Barnes TL, Olson APJ. Diagnosis (Berl). 2018;5:243-248.

Uncertainty is common in the diagnostic process due to complexity in clinical scenarios. This study describes a simulation-based educational intervention to develop resident skills in discussing clinical uncertainty with patients and families. The results of the program illustrate the strong potential of simulation as a method to enhance communication skills.

Journal Article > Study

Adjusting to duty hour reforms: residents' perception of the safety climate in interdisciplinary night-float rotations.

Lafleur A, Harvey A, Simard C. Can Med Educ J. 2018;9:e111-e119.

Investigators implemented a night-float rotation in acute-care settings in order to adhere to duty hours restrictions for trainees. Safety culture, as measured by the Safety Attitudes Questionnaire, remained strong following implementation of the cross-coverage system. The authors conclude that a night-float system is logistically feasible and did not negatively impact safety.

Journal Article > Review

Comfort with uncertainty: reframing our conceptions of how clinicians navigate complex clinical situations.

Ilgen JS, Eva KW, de Bruin A, Cook DA, Regehr G. Adv Health Sci Educ Theory Pract. 2018 Nov 2; [Epub ahead of print].

Uncertainty in complex care situations is a common experience for both trainees and experienced practitioners. This review explores the concept of comfort with uncertainty in medicine and suggests that individual awareness of uncertainty is required to respond to the condition as it occurs. The authors advocate for educational and research strategies to further manage uncertainty in health care.

Cases & Commentaries

Supervision and Entrustment in Clinical Training: Protecting Patients, Protecting Trainees

  • Spotlight Case
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  • Web M&M

Olle ten Cate, PhD; November 2018

An ICU patient with head and spine trauma was sent for an MRI. Due his critical condition, hospital policy required a physician and nurse to accompany the patient to the MRI scanner. The ICU attending assigned a new intern, who felt unprepared to handle any crises that might arise, to transport the patient along with the nurse. While in a holding area awaiting the MRI, the patient's heart rate fell below 20 beats per minute, and the experienced ICU nurse administered atropine to recover his heart rate and blood pressure. The intern worried he had placed the patient's life at risk because of his inexperience, but he also felt uncomfortable speaking up.

Journal Article > Study

Association between surgical trainee daytime sleepiness and intraoperative technical skill when performing septoplasty.

Tseng YW, Vedula SS, Malpani A, et al. JAMA Facial Plast Surg. 2019;21:104-109.

This prospective cohort study examined the association between self-rated daytime sleepiness among trainee surgeons and attending surgeon–rated intraoperative technical skill. Higher ratings of sleepiness were associated with worse technical skills, echoing concerns about procedures performed by sleep-deprived surgeons.

Journal Article > Study

Factors underlying suboptimal diagnostic performance in physicians under time pressure.

ALQahtani DA, Rotgans JI, Mamede S, Mahzari MM, Al-Ghamdi GA, Schmidt HG. Med Educ. 2018;52:1288-1298.

In this educational study, internal medicine resident physicians were randomized to solve standardized cases with and without time pressure. The time-pressured group performed worse, and they reported more stress and generated fewer possible diagnoses.

Journal Article > Study

"Closing the loop": a mixed-methods study about resident learning from outcome feedback after patient handoffs.

Shenvi EC, Feupe SF, Yang H, El-Kareh R. Diagnosis (Berl). 2018;5:235-242.

Seeking feedback on patient outcomes after a patient handoff takes place may provide useful learning for the provider who initially cared for the patient and inform future clinical decision-making. In this mixed-methods study, residents identified both a lack of time and inadequate systems for tracking patients as significant barriers to learning from the outcomes of patients they had handed over to other teams.

Journal Article > Study

Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians.

Dyrbye LN, Burke SE, Hardeman RR, et al. JAMA. 2018;320:1114-1130.

Physician burnout threatens the well-being and sustainability of the health care workforce. This large prospective cohort study found that 45% of resident physicians experienced burnout. Higher burnout rates were detected in urology, general surgery, emergency medicine, and neurology. Those who were burned out were more likely to regret their decision to become a physician. An Annual Perspective explored how burnout impacts patient safety.

Journal Article > Study

Education and reporting of diagnostic errors among physicians in internal medicine training programs.

Wijesekera TP, Sanders L, Windish DM. JAMA Intern Med. 2018;178:1548-1549.

This survey of internal medicine attending and resident physicians found that few received instruction on reporting diagnostic errors or discussing diagnostic errors with patients. The authors recommend improving training in order to enhance reporting and communication about diagnostic errors.

Journal Article > Study

About politeness, face, and feedback: exploring resident and faculty perceptions of how institutional feedback culture influences feedback practices.

Ramani S, Könings KD, Mann KV, Pisarski EE, van der Vleuten CPM. Acad Med. 2018;93:1348-1358.

Constructive feedback is a pillar of strong safety culture. Through resident and attending physicians focus groups at a single institution, investigators found that cultural emphasis on politeness and excellence hindered all parties' ability to provide honest feedback. The authors advocate for transitioning to a culture of growth, which would shift their institution toward a more just culture.

Journal Article > Commentary

Leveraging the continuum: a novel approach to meeting quality improvement and patient safety competency requirements across a large department of medicine.

Myers JS, Bellini LM. Acad Med. 2018;93:1321-1325.

Although patient safety competency development is increasingly a goal of graduate medical education, skills to teach them are lacking. This project report describes the development, implementation, and outcomes of a curriculum developed to meet quality improvement and patient safety educational requirements. The approach included activities such as event reporting, root cause analysis, and disclosure simulation.

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