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1.
A Pilot Study Using Nominal Group Technique to Assess Residents’ Perceptions of Successful Attending Rounds 下载免费PDF全文
Castiglioni A Shewchuk RM Willett LL Heudebert GR Centor RM 《Journal of general internal medicine》2008,23(7):1060-1065
BACKGROUND Ward attending rounds are fundamental for internal medicine residency training. An improved understanding of interns’ and
residents’ perceptions of attending rounds should inform training programs and attending physicians.
OBJECTIVES The aim of this study was to assess residents’ perceptions of successful attending rounds.
DESIGN We convened two groups of interns and two groups of residents, to elicit their perceptions on attending rounds.
SUBJECTS Participants were recruited by e-mail and conference announcements from the 49 interns and 80 residents in the internal medicine
and medicine-pediatrics residency programs.
MEASUREMENTS The nominal group technique (NGT) uses a structured group process to elicit and prioritize answers to a carefully articulated
question.
MAIN RESULTS Seven interns (14%) identified 27 success factors and ranked attending approachability and enthusiasm and high quality teaching
as most important. A second group of six (12%) interns identified 40 detractors and ranked having “mean attendings,” receiving
disrespectful comments, and too long or too short rounds as the most significant detractors. Nine (11%) residents identified
32 success factors and ranked attention to length of rounds, house staff autonomy, and establishing goals/expectations as
the most important success factors. A second group of six (8%) residents identified 34 detractors and ranked very long rounds,
interruptions and time constraints, and poor rapport between team members as the most significant detractors).
CONCLUSIONS Although there was some overlap in interns’ and residents’ perceptions of attending rounds, interns identified interpersonal
factors as the most important factors; whereas residents viewed structural factors as most important. These findings should
assist attending physicians improve the way they conduct rounds targeting both interns and residents needs.
Presented in part at the Southern Regional Meeting of the Society of General Internal Medicine in New Orleans, LA, in February
2005 and the Society of General Internal Medicine Annual Meeting in New Orleans, LA, in May 2005. 相似文献
2.
Dr. Rodney A. Hayward MD Brent C. Williams MD MPH Larry D. Gruppen PhD David Rosenbaum BA 《Journal of general internal medicine》1995,10(9):504-510
OBJECTIVE: To determine which aspects of outpatient attending physician performance (e.g., clinical ability, teaching ability, interpersonal
conduct) were measurable and separable by resident report.
DESIGN: Self-administered evaluation form.
SETTING: University internal medicine resident continuity clinic.
PARTICIPANTS: All residents with their continuity clinic at the university hospital evaluated the two attendings who staffed their clinic
for the academic years of 1990–1991, 1991–1992, and 1992–1993 (average of 85 total residents per year). The overall response
rate was 74%.
ANALYSIS: Exploratory analyses were conducted on a preliminary evaluation form in the first two years of the study (236 evaluations
of 20 different clinic attendings) and confirmatory analyses using factor analysis and generalizability analysis were performed
on the third year’s data (142 evaluations of 15 different clinic attendings). Analysis of variance was used to evaluate factors
associated with evaluation scores.
RESULTS: Analyses demonstrated that the residents did not distinguish between the attendings’ clinical and teaching abilities, resulting
in a single four-item scale that was named the Clinical/Teaching Excellence Scale, measured on a five-point scale from poor
to outstanding (Cronbach’s alpha=0.92). A large amount of the variance for this scale score was associated with attending
identity (adjusted R2=46%). However, two alternative approaches to evaluating the performance of the attending (preference for him or her to the
“average” attending and perceived impact of the attending on residents’ clinical skills) did not provide useful information
independent of the Clinical/Teaching Excellence Scale. The ratings of three separate conduct scales [availability in clinic
(Availability Scale), treating residents and patients with respect (Respect Scale), and time efficiency in staffing cases
(Slow Staffing Scale)] were separable from each other and from the rating of clinical/teaching excellence. For the Clinical/Teaching
Excellent Scale, as few as four evaluations produced good interrater reliability and eight evaluations produced excellent
reliability (reliability coefficients were 0.70 and 0.84, respectively).
CONCLUSIONS: Although this evaluation instrument for measuring clinic attending performance must be considered preliminary, this study
suggests that relatively few attending evaluations are required to reliably profile an individual attending’s performance,
that attending identity is associated with a large amount of the scale score variation, and that special issues of attending
performance more relevant to the outpatient setting than the inpatient setting (availability in clinic and sensitivity to
time efficiency) should be considered when evaluating clinic attending performance.
Presented in part at the annual meeting of the Society of General Internal Medicine, Washington, DC, April 29, 1994. 相似文献
3.
Joseph Conigliaro MD Dr. William H. Frishman MD Eliot J. Lazar MD Lila Croen MA 《Journal of general internal medicine》1993,8(9):502-507
Objectives: To assess the attitudes of internal medicine housestaff and their attending physicians regarding the impact of the reduction
in on-call working hours and increased supervision mandated in New York by a revision of the State Health Code (Section 405).
Design: Survey of senior medical housestaff and attendings two years after the adoption of the mandated changes.
Setting: Two independent medicine housestaff training programs of the Albert Einstein College of Medicine in the Bronx, New York.
Participants: Fifty-three percent of third- and fourth-year residents (n=79) and 60% of voluntary and full-time attendings (n=266) responded.
Measurements: A factor analysis of 13 variables that appeared on both versions of the survey identified two interpretable factors. A multivariate
analysis of variance compared responses to each factor by group and by campus, and Bonferroni post-hoc comparisons analyzed
the items within factors. Chi-square analyses compared responses of residents and attendings to the open-ended questions.
Results: Significant differences between the housestaff and attendings groups were found for all fixed-response items (minimum p<0.05
for all analyses), but both groups agreed that the regulations had a positive impact on resident attitudes regarding the demands
on their time. Both groups were also uncertain whether the new regulations had a beneficial effect on the choice of internal
medicine as a career, the quality of resident supervision, and residents’ intellectual interest in challenging medical problems.
Whereas residents agreed that the regulations diminished their fatigue, had no impact on their ability to observe the full
impact of interventions on patients, and resulted in better patient care, attendings were uncertain or disagreed. While attendings
agreed that the regulations had caused a shift-work mentality among residents, housestaff were uncertain.
Conclusions: Housestaff had more positive attitudes about the impact of the mandated changes in working conditions for residents than
did attending physicians in the same institutions. The major benefits seen by residents were less fatigue and more spare time.
There was no consensus about whether these changes had a positive impact on internal medicine practice and clinical supervision.
There was some concern that a shift-work mentality is developing among residents and that continuity of patient care has suffered.
Thus, despite some substantial benefits, Section 405 may not be achieving its goals of improving resident supervision and
the quality of patient care by houseofficers.
Received from the Departments of Medicine and Epidemiology and Social Medicine, and the Office of Educational Research and
Evaluation, the Albert Einstein College of Medicine, Bronx, New York.
An abstract of this paper was presented at the Research in Medical Education Conference, Association of American Medical Colleges,
New Orleans, Louisiana, November 10–11, 1992. 相似文献
4.
Jed D. Gonzalo MD Cynthia H. Chuang MD MSc Grace Huang MD Christopher Smith MD 《Journal of general internal medicine》2010,25(8):792-798
Background
Bedside rounds have decreased in frequency on teaching services. Perceived barriers toward bedside rounds are inefficiency and patient and house staff lack of preference for this mode of rounding.Objectives
To evaluate the impact of a bedside rounding intervention on the frequency of bedside rounding, duration of patient encounters and rounding sessions, and patient and resident attitudes toward bedside rounds.Design
A pre- and postintervention design, with a bedside rounding workshop midway through two consecutive internal medicine rotations, with daily resident interviews, patient surveys, and an end-of-the-year survey given to all Medicine house staff.Participants
Medicine house staff and medicine patients.Measures
Frequency of bedside rounds, duration of new patient encounters and rounding sessions, and patient and house staff attitudes regarding bedside rounds.Results
Forty-four residents completed the bedside rounding workshop. Comparing the preintervention and postintervention phases, bedside rounds increased from <1% to 41% (p < 0.001). The average duration of walk rounding encounters was 16 min, and average duration of bedside rounding encounters was 15 min (p = 0.42). Duration of rounds was 95 and 98 min, respectively (p = 0.52). Patients receiving bedside rounds preferred bedside rounds (99% vs. 83%, p = 0.03) and perceived more time spent at the bedside by their team (p < 0.001). One hundred twelve house staff (71%) responded, with 73% reporting that bedside rounds are better for patient care. House staff performing bedside rounds were less likely to believe that bedside rounds were more educational (53% vs. 78%, p = 0.01).Conclusions
Bedside rounding increased after an educational intervention, and the time to complete bedside rounding encounters was similar to alternative forms of rounding. Patients preferred bedside rounds and perceived more time spent at the bedside when receiving bedside rounds. Medicine residents performing bedside rounds were less likely to believe bedside rounds were more educational, but all house staff valued the importance of bedside rounding for the delivery of patient care.KEY WORDS: bedside rounds, medical education, patient care 相似文献5.
What do attending physicians contribute in a house officer-based ambulatory continuity clinic? 下载免费PDF全文
Cyran EM Albertson G Schilling LM Lin CT Ware L Steiner JF Anderson RJ 《Journal of general internal medicine》2006,21(5):435-439
OBJECTIVE: To study the educational contributions of attending physicians in an internal medicine house staff ambulatory clinic. DESIGN: Cross-sectional, self-administered survey. SETTING: University-affiliated general internal medicine practice. PATIENTS/PARTICIPANTS: Internal medicine residents and attendings. MEASUREMENTS AND MAIN RESULTS: Attending and resident perceptions of whether attendings made contributions to teaching points, diagnosis (DX), therapy (RX), and health care maintenance (HCM) were assessed in 428 patient encounters. Resident assessments significantly exceeded attending self-assessments of contributions to teaching points (82% vs 74%, P=.001), DX (44% vs 34%, P=.001), RX (61% vs 55%, P=.02), and HCM (19% vs 15%, P=.04). Both residents and attendings perceived that contributions declined progressively with increasing resident year (P<.05). Primary care and categorical residents assessed attending contributions comparably. However, attendings perceived contributing more to RX and HCM for categorical residents than primary care (P<.05). Male and female residents assessed attending contributions comparably. However, attendings perceived contributing generally more to DX in male residents than female (P=.003). In 8% of encounters, either residents or attendings felt that patient evaluation by the attending was needed. In these encounters with personal patient evaluation by attendings, both residents and attendings felt that attendings made more contributions to DX (P=.001) and teaching points than in other encounters. CONCLUSIONS: Attending physicians consistently underestimate their perceived contributions to house officer ambulatory teaching. Their personal patient evaluation increases assistance with DX and teaching points. Given perceived declining contributions by training year, attendings may need to identify other teaching strategies for interactions with senior residents. 相似文献
6.
7.
Kulaga ME Charney P O'Mahony SP Cleary JP McClung TM Schildkamp DE Mazur EM 《Journal of general internal medicine》2004,19(4):293-301
OBJECTIVE: Although hospitalists have been shown to improve both financial and educational outcomes, their ability to manage dual roles as clinicians and educators has been infrequently demonstrated, particularly in the community setting where large numbers of residents train. We evaluated the impact of hospitalists on financial and educational outcomes at a mid-sized community teaching hospital 1 year after implementation. DESIGN: Two hospitalist clinician educators (HCEs) were hired to provide inpatient medical care while participating in resident education. Length of stay and cost per case data were calculated for all patients admitted to the hospitalist service during their first year and compared with patients admitted to private physicians. The hospitalists' top 11 discharge diagnoses were individually assessed. For the same time period, categorical medicine residents (N = 36) were given an anonymous written survey to assess the HCEs' impact on resident education and service. RESULTS: Resource consumption: length of stay was reduced by 20.8% and total cost per case was reduced by 18.4% comparing the HCEs with community-based physicians. Reductions in both length of stay and cost per case were noted for 8 of the 11 most common discharge diagnoses. Resident survey: over 75% of residents responded, with all noting improvement in the quality of attending rounds, bedside teaching, and the overall inpatient experience. Residents' roles as teachers and team leaders were largely unchanged. CONCLUSION: Hospitalist clinician educators as inpatient teaching attendings effectively reduce length of stay and resource utilization while improving resident education at community-based teaching hospitals. 相似文献
8.
Dr. Kelley M. Skeff MD PhD Georgette Stratos PhD Marilyn Campbell PhD Molly Cooke MD Henry W. Jones III MD 《Journal of general internal medicine》1986,1(5):315-322
The effects of a seminar method to improve the teaching of ward attending physicians were evaluated. Forty-six attending physicians
from four institutions were randomly assigned to experimental and control groups. The method was evaluated to assess its effects
on attending physicians’ performances and attitudes, and impact on learners. Evaluation methods included ratings of videotapes
of ward rounds, teachers’ subjective assessments of both their teaching performances and their experiences in the study, and
trainee ratings. Videotape ratings, the teachers’ own assessments, and the trainees’ assessments of the attending physicians’
impact on learning were significantly different, favoring the experimental group (p<0.05). It is concluded that the seminar
method can provide the basis for effective and feasible approaches for improving clinical teaching by attending physicians.
Received from Stanford University Medical Center and Palo Alto Veterans Administration Medical Center.
Supported by the National Fund for Medical Education, the Veterans Administration, and the Kaiser Foundation Research Institute. 相似文献
9.
Martha Miller Bill Johnson MD Dr. Harry L. Greene MD Monika Baier MS Scott Nowlin MD 《Journal of general internal medicine》1992,7(6):646-648
The authors conducted an observational study of attending rounds to determine the current status of this form of clinical
teaching in a university-based internal medicine department. Using two forms of measurement, questionnaires and timed observations,
we found that 63% of attending physician time was spent in the conference room, 26% in hallways, and only 11% at the bedside.
Significant differences were found between estimated and actual times, particularly in discussing previously admitted patients,
patient interactions, data reviews, topic presentations, and the category of “other” activities. These results provide a framework
for appraising attending rounds and identifying areas that may be improved with a teaching workshop intervention.
Presented at the Mountain West Regional Meeting of the Society of General Internal Medicine, Sante Fe, New Mexico, March 6,
1992.
Supported by the Biomedical Research Support Grant Committee, Grant No.BRSG (2S07 RR05675-22). 相似文献
10.
Dr. Risa Beth Burns MD MPH Karen M. Freund MD MPH Arlene Ash PhD Michael Shwarfz PhD Lisa Antab MPH Ruth Hall RD MSc 《Journal of general internal medicine》1995,10(9):520-522
To determine rates of, and explore physician factors associated with, repeat mammography, administrative data for 791 women
aged 50 years and older were examined. Three-fourths of the women (73%) received repeat mammography (i.e., a second mammogram
was obtained within six to 18 months of the first). Provider factors associated with higher repeat mammography rates were:
being a woman, practicing in the women’s health group rather than the general internal medicine service, and being a fellow
or an attending physician (p-values <0.01). Patients of women attendings/fellows had higher repeat mammography rates than
did those of men attendings/fellows, men residents, and women residents. Characteristics (gender, level of training) of providers
strongly influence their patients’ screening behavior.
Presented at the annual meeting of the Association for Health Services Research, Washington, DC, June 27–29. 1993.
Supported by American Cancer Society Individual Institutional Research Grant, #IRG-97P. 相似文献
11.
Dr. William S. Yancy Jr. MD MHS David S. Macpherson MD MPH Barbara H. Hanusa PhD Galen E. Switzer PhD Robert M. Arnold MD Raquel A. Buranosky MD Wishwa N. Kapoor MD MPH 《Journal of general internal medicine》2001,16(11):755-762
OBJECTIVE: To measure and compare patient satisfaction with care in resident and attending physician internal medicine ambulatory care clinics. DESIGN: A cross-sectional survey using a questionnaire derived from the Visit-Specific Satisfaction Questionnaire (VSQ) and Patient Satisfaction Index (PSI) distributed from March 1998 to May 1998. SETTING: Four clinics based at a university teaching hospital and the associated Veterans' Affairs (VA) hospital. PARTICIPANTS: Two hundred eighty-eight patients of 76 resident and 25 attending physicians. RESULTS: Patients of resident physicians at the university site were more likely to be African American, male, have lower socioeconomic status and have lower physical and mental health scores on the Short Form-12 than patients of university attendings. Patients of resident and attending physicians at the VA site were similar. In multivariate analyses, patients of university attending physicians were more likely to be highly satisfied than patients of university residents on the VSQ-Physician (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.6 to 7.8) and the PSI-Physician (OR, 10.1; 95% CI, 3.7 to 27.4) summary scores. Differences were not seen on the summary scores at the VA site. Two individual items displayed significant differences between residents and attendings at both sites: "personal manner (courtesy, respect, sensitivity, friendliness) of the doctor" (P 相似文献
12.
John M. Thomas MD John R. O’Leary MA Terri R. Fried MD 《Journal of general internal medicine》2014,29(7):1048-1054
Background
Little is known about the differences between physicians in training and post training in their willingness to comply with patient requests at the end of life.Objective
To compare the attitudes of attendings and residents regarding a range of patient requests at the end of lifeDesign
Written, cross-sectional surveyParticipants
The cohort included 191 attendings randomly selected across the state of Connecticut and 240 residents from 2 university-affiliated Internal Medicine programs.Main Measures
We surveyed attendings and residents about their willingness to honor the requests of the same decisionally capable elderly patient in five scenarios involving different requests regarding end-of-life treatment.Results
While a large majority of both attendings and residents were willing to comply with each of the requests to withhold intubation (100 % and 94 %, respectively), to extubate (92 % and 77 %), and to give increasingly higher doses of narcotics (94 % and 71 %), a significantly larger proportion of attendings versus residents was willing to comply with each of these requests. Small proportions of attendings and residents were willing to prescribe a lethal amount of sleeping pills (3 % and 5 %, respectively) and to give a lethal injection in its current illegal state (1 % and 4 %). A significantly larger proportion of residents (32 %) compared to attendings (19 %) was willing to give a lethal injection if legal. Adjusting for sociodemographic factors, attending status was independently associated with willingness to extubate [adjusted odds ratio (AOR)?=?3.0, 95 % CI?=?1.6-5.7] and to give a lethal injection if legal (AOR?=?0.5, 95 % CI?=?0.3-0.8). The proportion of physicians willing to extubate increased across years since graduation, with the greatest differences occurring across the residency years (69 % to 86 %).Conclusions and Relevance
Clinical experience was an important determinant of physicians’ willingness to perform multiple patient requests at the end of life, with substantial changes in attitudes occurring during residency training. More research is needed to determine whether dedicated clinical exposure for physicians in training influences attitudes. 相似文献13.
CONTEXT: The impact of residents on hospital finance has been studied; there are no data describing the economic effect of residents on attending physicians. OBJECTIVE: In a community teaching hospital, we compared allowable inpatient visit codes and payments (based on documentation in the daily progress notes) between a general medicine teaching unit and nonteaching general medicine units. DESIGN: Retrospective chart review, matched cohort study. SETTING: Six hundred fifty-bed community teaching hospital. PATIENTS: Patients were discharged July 1998 through February 1999 from Saint Barnabas Medical Center. We randomly selected 200 patients in quartets. Each quartet consisted of a pair of patients cared for by residents and a pair cared for only by an attending physician. In each pair, 1 of the patients was under the care of an attending physician who usually admitted to the teaching service, and 1 was under the care of a usually nonteaching attending. Within each quartet, patients were matched for diagnosis-related group, length of stay, and discharge date. MAIN OUTCOME MEASURES: We assigned the highest daily visit code justifiable by resident and attending chart documentation, determining relative value units (RVUs) and reimbursements allowed by each patient's insurance company. RESULTS: Although more seriously ill, teaching-unit patients generated a mean 1.75 RVUs daily, compared with 1.84 among patients discharged from nonteaching units (P =.3). Median reimbursement, daily and per hospitalization, was similar on teaching and nonteaching units. Nonteaching attendings documented higher mean daily RVUs than teaching attendings (1.83 vs 1.76, P =.2). Median allowable reimbursements were $267 per case ($53 daily) among teaching attendings compared with $294 per case ($58 daily) among nonteaching attendings (Z = 1.54, P =.1). When only the resident note was considered, mean daily RVUs increased 39% and median allowable dollars per day 27% (Z = 4.21, P <.001). CONCLUSIONS: Nonteaching attendings appear to document their visits more carefully from a billing perspective than do teaching attendings. Properly counter-documented, resident notes could substantially increase payments to attending physicians. 相似文献
14.
Dr. Carol M. Ashton MD MPH Nelda P. Wray MD MPH Joan A. Friedland MD MPH Anthony J. Zollo MD James W. Scheurich MD 《Journal of general internal medicine》1994,9(4):208-212
Objective: To determine whether the manner in which residents conduct work rounds is associated with the adequacy of their care processes
and the outcomes of their patients.
Methods: Two types of data were collected: time and motion data for residents (n=12) during work rounds, and clinical and outcome data for the patients they cared for during the observation period (n=211). Five residents were classified as data gatherers because they spent twice as much time gathering clinical data about
their patients as they spent engaging in other activities. Three physicians blinded to the resident’s identity rated the quality
of the care process and assessed the frequency of undesirable events occurring during the stay and after discharge.
Results: A data-gathering style was associated with higher quality of care as judged by both process and outcomes. The data gatherers
were more likely to comply with the “stability of medications before discharge” criterion (86% of the data gatherers’ cases
vs 73% of others’, p=0.07), and their patients were less likely to have unanticipated problems, in that fewer required calls
from nurses (20% vs 37%, p<0.01) and visits by on-call housestaff (33% vs 50%, p=0.01). The data gatherers’ patients were
less likely to be readmitted within 30 days (14% vs 38%, p<0.01).
Conclusions: A data-gathering work-rounds style is associated with better process and outcome. Residency programs should provide formal
instruction to trainees in the conduct of work rounds.
Received from the General Medicine Section, Veterans Affairs Medical Center, and Baylor College of Medicine, Houston, Texas.
Presented in poster form at the annual meeting of the Society of General Internal Medicine, Arlington, Virginia, April 28–30,
1993.
Supported in part by the Houston Center for Quality of Care and Utilization Studies, a Veterans Affairs Health Services Research
and Development Field Program. 相似文献
15.
16.
Bedside case presentations 总被引:1,自引:2,他引:1
Dr. Rebekah M. Wang-Cheng MD Gary P. Barnas MD Peter Sigmann MD Pamela A. Riendl RN MSN Mark J. Young MD 《Journal of general internal medicine》1989,4(4):284-287
STUDY OBJECTIVE: To determine current attitudes of patients, medical students, housestaff, and clinical faculty toward bedside case presentations. DESIGN: Survey using multiple-choice questionnaire and open comments for students, housestaff, and faculty, and a structured interview of patients. SETTING: Major teaching hospitals on the campus of a midwestern medical school, staffed by full-time faculty. PARTICIPANTS: 136 medical students, 58 housestaff, 66 faculty, and 73 patients. MEASUREMENTS AND MAIN RESULTS: 85% of patients liked the case presentation discussion at the bedside, but 95% of both students and housestaff felt more comfortable with such discussion away from the patient. Attending faculty were about evenly divided in preference, with the younger staff preferring the conference room setting. Most patients (88%) opposed rounds in the hallway. Duration of rounds of one to two hours was felt desirable by most, but 50% of students preferred a duration of less than one hour. For length of new patient case presentation, 60% of learners again favored brevity, less than 5 minutes. CONCLUSIONS: Bedside rounds are an opportunity to sharpen diagnostic skills and to demonstrate the art of medicine. They are undervalued by learners and younger faculty but appreciated by patients. The authors recommend that faculty improve bedside rounds by assessing team members' educational needs, by cultivating sensitivity and respect for the needs of all parties, and by assuring pertinence and brevity of bedside discussion. 相似文献
17.
18.
D Nerenz H Rosman C Newcomb M B Bolton G Heudebert T Simmer S Goldstein 《Archives of internal medicine》1990,150(11):2294-2297
As part of an effort to examine the structure and content of our residency program in internal medicine, we assessed interns' activities on call to identify problems with workload scheduling, supervision, or learning. Eleven interns were observed continuously during a 34-hour on-call period. Interns averaged 5.6 hours at the bedside, with 57 minutes of that time under direct supervision of a resident or attending physician. Nearly half of new patient examinations continued after midnight despite a special night admission team that evaluated all patients admitted after 11 pm. The interns averaged 21 beeps per 30 hours. They slept an average of 2.5 hours with two interruptions. They read about their patients an average of 4 minutes during the 34-hour period. Most supervision was away from the bedside (82/139 minutes). Bedside supervision occurred predominantly during rounds (45/57 minutes). Attending physicians averaged only 12 minutes of bedside interaction with the intern. Many of these findings were unanticipated. Structural defects in the training program were defined and are being addressed. Other training programs should consider similar analyses before making fundamental changes. 相似文献
19.
Medical students’ perceptions of the elements of effective inpatient teaching by attending physicians and housestaff 下载免费PDF全文
BACKGROUND: Most studies of effective inpatient teaching have focused on teaching by attending physicians. OBJECTIVE: To identify and compare medical students' perceptions of behaviors associated with teaching effectiveness of attending physicians and housestaff (residents and interns). DESIGN AND PARTICIPANTS: Third-year students who spent 4 weeks on a general internal medicine inpatient service during academic year 2003-2004 completed surveys using a 5-point Likert-type scale. Students evaluated numerous teaching behaviors of attendings and housestaff and then evaluated their overall teaching effectiveness. MEASUREMENTS: Each behavior was correlated with the perceived teaching effectiveness in univariate and regression analyses. RESULTS: Seventy-two students were taught by 23 attendings and 73 housestaff. Of 144 possible teaching evaluations, they completed 142 (98.6%) for attendings and 128 (88.9%) for housestaff. The mean rating for perceived teaching effectiveness was 4.48 (SD 0.82) for attendings and 4.39 (SD 0.80) for housestaff. For attending physicians, teaching effectiveness correlated most strongly with enthusiasm for teaching (R(2)=63.6%) but was also associated with inspiring confidence in knowledge and skills, providing feedback, and encouraging students to accept increasing responsibility. Housestaff teaching effectiveness correlated most strongly with providing a role model (R(2)=61.8%) but was also associated with being available to students, performing effective patient education, inspiring confidence in knowledge and skills, and showing enthusiasm for teaching. Regression models explained 79.7% and 73.6% of the variance in evaluations of attendings and housestaff, respectively. CONCLUSIONS: Students' perceptions of effective teaching behaviors differ for attending physicians and housestaff, possibly reflecting differences in teaching roles or methods. 相似文献
20.
Steven Guarisco MD Dr. Eugene Oddone MD MHS David Simel MD MHS 《Journal of general internal medicine》1994,9(5):272-277
Objective: To describe a novel method of time analysis for health care settings by quantifying internal medicine housestaff’s work
activities and contacts.
Design: Observational work sampling study based on random sampling technique.
Setting: General medicine service in a university hospital.
Participants: All housestaff (18 interns, 18 residents) rotating through the general medicine service during a 12-week period.
Main outcome measures: Proportion of time spent doing 22 work activities and proportion of time spent with 13 work contacts, reported separately
for interns and residents and for on-call days and off-call days.
Results: The authors sampled 6,599 unique time observations (3,533 from on-call days, 3,066 from off-call days) during 193 housestaff
workdays. The housestaff spent a majority of their time engaged in direct patient care activities (81% of the interns’ workdays,
and 64.5% of the residents’ workdays), primarily in patient evaluation and follow-up (48% of the interns’ and 39% of the residents’
workdays). Compared with the interns, the residents spent relatively more time in direct educational activities (conferences,
reading, teaching): 27% of the residents’ workdays versus 10% of the interns’ workdays. Analysis of work contacts showed that
the housestaff spent a large portion of the workday alone: 27% of the residents’ and 34% of the interns’ workdays. The housestaff
also spent a large portion of the workday with attending physicians: 23% of the residents’ and 11% of the interns’ workdays.
This translates into 21 hours/week of attending supervision for the residents and 10 hours/week for the interns.
Conclusions: Using random work sampling, the authors found that the vast majority of the houseofficer’s workday was spent in direct patient
care. This method of time analysis may be used to describe housestaff training and supervision, as well as to evaluate administrative
interventions designed to change housestaff work experience.
Presented at the annual meeting of the Society of General Internal Medicine, Washington, DC, April 29, 1993.
Supported in part by the A. W. Mellon Foundation. Dr. Oddone is supported by the VA Health Services Research career development
program. 相似文献