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Search results for "Residents and Fellows"

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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. 2018 Dec 26; [Epub ahead of print].

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.

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 deadline for submitting applications is February 15, 2019.

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 > 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
  • CE/MOC
  • 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. 2018 Oct 11; [Epub ahead of print].

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.

Journal Article > Study

The relationship between the learning and patient safety climates of clinical departments and residents' patient safety behaviors.

Silkens MEWM, Arah OA, Wagner C, Scherpbier AJJA, Heineman MJ, Lombarts KMJMH. Acad Med. 2018;93:1374-1380.

Patient safety is an increasing area of focus within graduate medical education. Using data on residency educational climate, patient safety climate, and residents' self-reported patient safety behaviors from 31 teaching hospitals in the Netherlands, researchers found an association between safety climate and self-reported patient safety behavior.

Journal Article > Study

Using patient safety reporting systems to understand the clinical learning environment: a content analysis.

Sellers MM, Berger I, Myers JS, Shea JA, Morris JB, Kelz RR. J Surg Educ. 2018;75:e168-e177.

This qualitative study examined incident reports about surgical patients, comparing trainee reports to those submitted by attending surgeons and nurses. Trainees were more likely to enter reports anonymously and completed more elements for each report, but they also used more blame language and submitted fewer reports overall. The results suggest that encouraging trainee reporting may shed light on surgical safety.

Web Resource > Course Material/Curriculum

HMS Fellowship in Patient Safety and Quality.

Harvard Medical School.

This postgraduate fellowship program invites physicians from within Harvard institutions to engage with local and international experts to develop leadership and patient safety skills. Fellows will be assigned a mentor to work on frontline improvement activities to develop patient safety competencies. The process for submitting an application for the 2019 program is now closed.

Journal Article > Commentary

Curriculum development and implementation of a national interprofessional fellowship in patient safety.

Watts BV, Williams L, Mills PD, et al. J Patient Saf. 2018;14:127-132.

This commentary describes the deployment of a interprofessional fellowship program designed to develop patient safety competencies through experiential learning in the Veterans Affairs health system. The authors highlight the content and results of the curriculum.

Journal Article > Study

Evaluation of reasons why surgical residents exceeded 2011 duty hour requirements when offered flexibility.

Blay E Jr, Engelhardt KE, Hewitt DB, Dahlke AR, Yang AD, Bilimoria KY. JAMA Surg. 2018;153:860-862.

This secondary analysis of a prior randomized trial of flexible versus mandated duty hours for trainee physicians examined reasons for staying past the end of a 24-hour call. Most trainees reported voluntarily staying longer, though a significant proportion reported that program, attending, or senior resident expectations to stay longer influenced them. Reports of coercion to remain were less common, and the authors urge programs to ensure that trainees are not being coerced to exceed duty hours.

Journal Article > Study

Effect of increased inpatient attending physician supervision on medical errors, patient safety, and resident education: a randomized clinical trial.

  • Classic

Finn KM, Metlay JP, Chang Y, et al. JAMA Intern Med. 2018;178:952-959.

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.

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