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1.
Wenli Ouyang Monica M. Cuddy David B. Swanson 《Journal of general internal medicine》2015,30(9):1307-1312
BACKGROUND
Prior to graduation, US medical students are required to complete clinical clerkship rotations, most commonly in the specialty areas of family medicine, internal medicine, obstetrics and gynecology (ob/gyn), pediatrics, psychiatry, and surgery. Within a school, the sequence in which students complete these clerkships varies. In addition, the length of these rotations varies, both within a school for different clerkships and between schools for the same clerkship.OBJECTIVE
The present study investigated the effects of clerkship sequence and length on performance on the National Board of Medical Examiner’s subject examination in internal medicine.PARTICIPANTS
The study sample included 16,091 students from 67 US Liaison Committee on Medical Education (LCME)-accredited medical schools who graduated in 2012 or 2013.MAIN MEASURES
Student-level measures included first-attempt internal medicine subject examination scores, first-attempt USMLE Step 1 scores, and five dichotomous variables capturing whether or not students completed rotations in family medicine, ob/gyn, pediatrics, psychiatry, and surgery prior to taking the internal medicine rotation. School-level measures included clerkship length and average Step 1 score.DESIGN
Multilevel models with students nested in schools were estimated with internal medicine subject examination scores as the dependent measure. Step 1 scores and the five dichotomous variables were treated as student-level predictors. Internal medicine clerkship length and average Step 1 score were used to predict school-to-school variation in average internal medicine subject examination scores.KEY RESULTS
Completion of rotations in surgery, pediatrics and family medicine prior to taking the internal medicine examination significantly improved scores, with the largest benefit observed for surgery (coefficient = 1.58 points; p value < 0.01); completion of rotations in ob/gyn and psychiatry were unrelated to internal medicine subject examination performance. At the school level, longer internal medicine clerkships were associated with higher scores on the internal medicine examination (coefficient = 0.23 points/week; p value < 0.01).CONCLUSIONS
The order in which students complete clinical clerkships and the length of the internal medicine clerkship are associated with their internal medicine subject examination scores. Findings may have implications for curriculum re-design.KEY WORDS: clinical education, internal medicine clerkship performance, clerkship sequence, clerkship length, NBME subject examinations 相似文献2.
S. Beth Bierer Elaine F. Dannefer John E. Tetzlaff 《Journal of general internal medicine》2015,30(9):1339-1343
BACKGROUND
Remediation in the era of competency-based assessment demands a model that empowers students to improve performance.AIM
To examine a remediation model where students, rather than faculty, develop remedial plans to improve performance.SETTING/PARTICIPANTS
Private medical school, 177 medical students.PROGRAM DESCRIPTION
A promotion committee uses student-generated portfolios and faculty referrals to identify struggling students, and has them develop formal remediation plans with personal reflections, improvement strategies, and performance evidence. Students submit reports to document progress until formally released from remediation by the promotion committee.PROGRAM EVALUATION
Participants included 177 students from six classes (2009–2014). Twenty-six were placed in remediation, with more referrals occurring during Years 1 or 2 (n = 20, 76 %). Unprofessional behavior represented the most common reason for referral in Years 3–5. Remedial students did not differ from classmates (n = 151) on baseline characteristics (Age, Gender, US citizenship, MCAT) or willingness to recommend their medical school to future students (p < 0.05). Two remedial students did not graduate and three did not pass USLME licensure exams on first attempt. Most remedial students (92 %) generated appropriate plans to address performance deficits.DISCUSSION
Students can successfully design remedial interventions. This learner-driven remediation model promotes greater autonomy and reinforces self-regulated learning.Electronic supplementary material
The online version of this article (doi:10.1007/s11606-015-3343-1) contains supplementary material, which is available to authorized users. 相似文献3.
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5.
Impact of a 360-degree Professionalism Assessment on Faculty Comfort and Skills in Feedback Delivery 下载免费PDF全文
Background
Professionalism is identified as a competency of resident education. Best approaches to teaching and evaluating professionalism are unknown, but feedback about professionalism is necessary to change practice and behavior. Faculty discomfort with professionalism may limit their delivery of feedback to residents.Objectives
A pilot program to implement a 360-degree evaluation of observable professionalism behaviors and determine how its use impacts faculty feedback to residents.Design
Internal Medicine (IM) residents were evaluated during ambulatory rotations using a 360-degree assessment of professional behaviors developed by the National Board of Medical Examiners®. Faculty used evaluation results to provide individual feedback to residents.Patients/Participants
Fifteen faculty members.Measurements and Main Results
Faculty completed pre- and post-intervention surveys. Using a 7-point Likert scale, faculty reported increased skill in giving general feedback (4.85 vs 4.36, p < .05) and feedback about professionalism (4.71 vs 3.57, p < .01) after the implementation of the 360-degree evaluation. They reported increased comfort giving feedback about professionalism (5.07 vs 4.35, p < .05) but not about giving feedback in general (5.43 vs 5.50).Conclusions
A 360-degree professionalism evaluation instrument used to guide feedback to residents improves faculty comfort and self-assessed skill in giving feedback about professionalism.KEY WORDS: professionalism, feedback, 360-degree evaluation, internship, residency 相似文献6.
7.
Adeyinka O. Laiyemo Chyke Doubeni Paul F. Pinsky V. Paul Doria-Rose Robert Bresalier Thomas Hickey Thomas Riley Tim R. Church Joel Weissfeld Robert E. Schoen Pamela M. Marcus Philip C. Prorok 《Journal of general internal medicine》2015,30(10):1447-1453
BACKGROUND
It is unclear whether the higher rate of colorectal cancer (CRC) among non-Hispanic blacks (blacks) is due to lower rates of CRC screening or greater biologic risk.OBJECTIVE
We aimed to evaluate whether blacks are more likely than non-Hispanic whites (whites) to develop distal colon neoplasia (adenoma and/or cancer) after negative flexible sigmoidoscopy (FSG).DESIGN
We analyzed data of participants with negative FSGs at baseline in the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial who underwent repeat FSGs 3 or 5 years later. Subjects with polyps or masses were referred to their physicians for diagnostic colonoscopy. We collected and reviewed the records of diagnostic evaluations.PARTICIPANTS
Our analytic cohort consisted of 21,550 whites and 975 blacks.MAIN MEASURES
We did a comparison by race (whites vs. blacks) in the findings of polyps or masses at repeat FSG, the follow-up of abnormal test results and the detection of colorectal neoplasia at diagnostic colonoscopy.KEY RESULTS
At the follow-up FSG examination, 304 blacks (31.2 %) and 4183 whites (19.4 %) had abnormal FSG, [adjusted relative risk (RR) = 1.00; 95 % confidence interval (CI), 0.90–1.10]. However, blacks were less likely to undergo diagnostic colonoscopy (76.6 % vs. 83.1 %; RR = 0.90; 95 % CI, 0.84–0.96). Among all included patients, blacks had similar risk of any distal adenoma (RR = 0.86; 95 % CI, 0.65–1.14) and distal advanced adenoma (RR = 1.01; 95 % CI, 0.60–1.68). Similar results were obtained when we restricted our analysis to compliant subjects who underwent diagnostic colonoscopy (RR = 1.01; 95 % CI, 0.80–1.29) for any distal adenoma and (RR = 1.18; 95 % CI, 0.73–1.92) for distal advanced adenoma.CONCLUSIONS
We did not find any differences between blacks and whites in the risk of distal colorectal adenoma 3–5 years after negative FSG. However, follow-up evaluations were lower among blacks.KEY WORDS: PLCO, colorectal cancer disparities, adenomatous polyps, flexible sigmoidoscopy, screening 相似文献8.
Tyler N. A. Winkelman Lisa Soleymani Lehmann Navjyot K. Vidwan Meredith Niess Cynthia S. Davey Derek Donovan Joseph Cofrancesco Jr. Mia Mallory Sandi Moutsios Ryan M. Antiel John Y. Song 《Journal of general internal medicine》2015,30(7):1018-1024
BACKGROUND
It is not known whether medical students support the Affordable Care Act (ACA) or possess the knowledge or will to engage in its implementation as part of their professional obligations.OBJECTIVE
To characterize medical students’ views and knowledge of the ACA and to assess correlates of these views.DESIGN
Cross-sectional email survey.PARTICIPANTS
All 5,340 medical students enrolled at eight geographically diverse U.S. medical schools (overall response rate 52 % [2,761/5,340]).MAIN MEASURES
Level of agreement with four questions regarding views of the ACA and responses to nine knowledge-based questions.KEY RESULTS
The majority of respondents indicated an understanding of (75.3 %) and support for (62.8 %) the ACA and a professional obligation to assist with its implementation (56.1 %). The mean knowledge score from nine knowledge-based questions was 6.9 ± 1.3. Students anticipating a surgical specialty or procedural specialty compared to those anticipating a medical specialty were less likely to support the legislation (OR = 0.6 [0.4–0.7], OR = 0.4 [0.3–0.6], respectively), less likely to indicate a professional obligation to implement the ACA (OR = 0.7 [0.6–0.9], OR = 0.7 [0.5–0.96], respectively), and more likely to have negative expectations (OR = 1.9 [1.5–2.6], OR = 2.3 [1.6–3.5], respectively). Moderates, liberals, and those with an above-average knowledge score were more likely to indicate support for the ACA (OR = 5.7 [4.1–7.9], OR = 35.1 [25.4–48.5], OR = 1.7 [1.4–2.1], respectively) and a professional obligation toward its implementation (OR = 1.9 [1.4–2.5], OR = 4.7 [3.6–6.0], OR = 1.2 [1.02–1.5], respectively).CONCLUSIONS
The majority of students in our sample support the ACA. Support was highest among students who anticipate a medical specialty, self-identify as political moderates or liberals, and have an above-average knowledge score. Support of the ACA by future physicians suggests that they are willing to engage with health care reform measures that increase access to care.KEY WORDS: Medical students, Health care reform, Affordable Care Act, Survey 相似文献9.
Molly B. Conroy Kathleen L. Sward Kathleen C. Spadaro Dana Tudorascu Irina Karpov Bobby L. Jones Andrea M. Kriska Wishwa N. Kapoor 《Journal of general internal medicine》2015,30(2):207-213
BACKGROUND
Physical inactivity is a significant risk factor for cardiovascular disease and remains highly prevalent in middle-aged women.OBJECTIVE
We hypothesized that an interventionist-led (IL), primary-care–based physical activity (PA) and weight loss intervention would increase PA levels and decrease weight to a greater degree than a self-guided (SG) program.DESIGN
We conducted a randomized trial.PARTICIPANTS
Ninety-nine inactive women aged 45–65 years and with BMI ≥ 25 kg/m2 were recruited from three primary care clinics.INTERVENTIONS
The interventionist-led (IL) group (n = 49) had 12 weekly sessions of 30 min discussions with 30 min of moderate-intensity PA. The self-guided (SG) group (n = 50) received a manual for independent use.MAIN MEASURES
Assessments were conducted at 0, 3, and 12 months; PA and weight were primary outcomes. Weight was measured with a standardized protocol. Leisure PA levels were assessed using the Modifiable Activity Questionnaire. Differences in changes by group were analyzed with a t-test or Wilcoxon rank-sum test. Mixed models were used to analyze differences in changes of outcomes by group, using an intention-to-treat principle.KEY RESULTS
Data from 98 women were available for analysis. At baseline, mean (SD) age was 53.9 (5.4) years and 37 % were black. Mean weight was 92.3 (17.7) kg and mean BMI was 34.7 (5.9) kg/m2. Median PA level was 2.8 metabolic equivalent hours per week (MET-hour/week) (IQR 0.0, 12.0). At 3 months, IL women had a significantly greater increase in PA levels (7.5 vs. 1.9 MET-hour/week; p = 0.02) than SG women; there was no significant difference in weight change. At 12 months, the difference between groups was no longer significant (4.7 vs. 0.7 MET-hour/week; p = 0.38). Mixed model analysis showed a significant (p = 0.048) difference in PA change between groups at 3 months only.CONCLUSIONS
The IL intervention was successful in increasing the physical activity levels of obese, inactive middle-aged women in the short-term. No significant changes in weight were observed.Electronic supplementary material
The online version of this article (doi:10.1007/s11606-014-3077-5) contains supplementary material, which is available to authorized users.KEY WORDS: physical activity, exercise, clinical trial, intervention 相似文献10.
Mitesh S. Patel Darcy A. Reed Cynthia Smith Vineet M. Arora 《Journal of general internal medicine》2015,30(9):1294-1298
BACKGROUND
Little is known about how well faculty at teaching hospitals role-model behaviors consistent with cost-conscious care.OBJECTIVE
We aimed to evaluate whether residents and program directors report that faculty at their program consistently role-model cost-conscious care, and whether the presence of a formal residency curriculum in cost-conscious care impacted responses.DESIGN
Cost-conscious care surveys were administered to internal medicine residents during the 2012 Internal Medicine In-Training Examination and to program directors during the 2012 Association of Program Directors in Internal Medicine Annual Survey. Respondents stated whether or not they agreed that faculty in their program consistently role-model cost-conscious care. To evaluate a more comprehensive assessment of faculty behaviors, resident responses were matched with those of the director of their residency program. A multivariate logistic regression model was fit to the outcome variable, to identify predictors of responses that faculty do consistently role-model cost-conscious care from residency program, resident, and program director characteristics.PARTICIPANTS
Responses from 12,623 residents (58.4 % of total sample) and 253 program directors (68.4 %) from internal medicine residency programs in the United States were included.MAIN MEASURES
The primary outcome measure was responses to questionnaires on faculty role-modeling cost-conscious care.KEY RESULTS
Among all responses in the final sample, 6,816 (54.0 %) residents and 121 (47.8 %) program directors reported that faculty in their program consistently role-model cost-conscious care. Among paired responses of residents and their program director, the proportion that both reported that faculty do consistently role-modeled cost-conscious care was 23.0 % for programs with a formal residency curriculum in cost-conscious care, 26.3 % for programs working on a curriculum, and 23.7 % for programs without a curriculum. In the adjusted model, the presence of a formal curriculum in cost-conscious care did not have a significant impact on survey responses (odds ratio [OR], 1.04; 95 % Confidence Interval [CI], 0.52–2.06; p value [p] = 0.91).CONCLUSIONS
Responses from residents and program directors indicate that faculty at US teaching hospitals were not consistently role-modeling cost-conscious care. The presence of a formal residency curriculum in cost-conscious care did not impact responses. Future efforts should focus on placing more emphasis on faculty development and on combining curricular improvements with institutional interventions to adapt the training environment.KEY WORDS: cost-conscious care, high-value , role-modeling, resident, program director, residency program, teaching hospitals, faculty, medical education 相似文献11.
Audrey L. Jones Susan D. Cochran Arleen Leibowitz Kenneth B. Wells Gerald Kominski Vickie M. Mays 《Journal of general internal medicine》2015,30(12):1828-1836
BACKGROUND
The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders.OBJECTIVE
To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS).DESIGN
Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics.PARTICIPANTS
A total of 2,358 adults, aged 18–64 years, met the criteria for serious psychological distress and reported on their usual provider and practice characteristics.MAIN MEASURES
We defined “usual provider” as a primary care provider/practice, and “PCMH provider” as a usual provider that delivered accessible, comprehensive, patient-centered care as determined by patient self-reporting. The dependent variable, MHS, included self-reported mental health visits to a primary care provider or mental health specialist, counseling, and psychiatric medication treatment over a period of 1 year.RESULTS
Participants with a usual provider were significantly more likely than those with no usual provider to have experienced a primary care mental health visit (marginal effect [ME] = 8.5, 95 % CI = 3.2–13.8) and to have received psychiatric medication (ME = 15.5, 95 % CI = 9.4–21.5). Participants with a PCMH were additionally more likely than those with no usual provider to visit a mental health specialist (ME = 7.6, 95 % CI = 0.7–14.4) and receive mental health counseling (ME = 8.5, 95 % CI = 1.5–15.6). Among those who reported having had any type of mental health visit, participants with a PCMH were more likely to have received mental health counseling than those with only a usual provider (ME = 10.0, 95 % CI = 1.0–19.0).CONCLUSIONS
Access to a usual provider is associated with increased receipt of needed MHS. Patients who have a usual provider with PCMH qualities are more likely to receive mental health counseling.KEY WORDS: patient-centered medical home, primary care, mental health services, Affordable Care Act, race 相似文献12.
Prabhu P. Gounder Tiffany G. Harris Holly Anger Lisa Trieu Jeanne Sullivan Meissner Betsy L. Cadwell Elena Shashkina Shama D. Ahuja 《Journal of general internal medicine》2015,30(6):742-748
Background
Patients with prior positive tuberculin skin test (TST) results may benefit from prophylaxis after repeat exposure to infectious tuberculosis (TB).Objective
To evaluate factors associated with active TB disease among persons with prior positive TST results named as contacts of persons with infectious TB.Design
Population-based retrospective cohort study.Participants
A total of 2,933 contacts with prior positive TST results recently exposed to infectious TB identified in New York City’s TB registry during the period from January 1, 1997 through December 31, 2003.Main Measurements
Contacts developing active TB disease ≤ 4 years after exposure were identified and compared with those who did not, using Poisson regression analysis. Genotyping was performed on selected Mycobacterium tuberculosis-positive isolates.Key Results
Among contacts with prior positive TST results, 39 (1.3 %) developed active TB disease ≤ 4 years after exposure (≤2 years: 34). Risk factors for contacts that were independently associated with TB were age < 5 years (adjusted prevalence ratio [aPR] = 19.48; 95 % confidence interval [CI] = 7.15–53.09), household exposure (aPR = 2.60;CI = 1.30–5.21), exposure to infectious patients (i.e., cavities on chest radiograph, acid-fast bacilli on sputum smear; aPR = 1.9 3;CI = 1.01–3.71), and exposure to a U.S.-born index patient (aPR = 4.04; CI = 1.95–8.38). Receipt of more than1 month of treatment for latent TB infection following the current contact investigation was found to be protective (aPR = 0.27; CI = 0.08–0.93). Genotype results were concordant with the index patients among 14 of 15 contacts who developed active TB disease and had genotyping results available.Conclusions
Concordant genotype results and a high proportion of contacts developing active TB disease within 2 years of exposure indicate that those with prior positive TST results likely developed active TB disease from recent rather than remote infection. Healthcare providers should consider prophylaxis for contacts with prior TB infection, especially young children and close contacts of TB patients (e.g., those with household exposure).KEY WORDS: contact tracing, tuberculosis infection, prevention and control, epidemiology 相似文献13.
Leslie R. M. Hausmann Maria Mor Barbara H. Hanusa Susan Zickmund Peter Z. Cohen Richard Grant Denise M. Kresevic Howard S. Gordon Bruce S. Ling C. Kent Kwoh Said A. Ibrahim 《Journal of general internal medicine》2010,25(9):982-988
BACKGROUND
The extent to which treatment recommendations in the orthopedic setting contribute to well-established racial disparities in the utilization of total joint replacement (TJR) in the treatment of advanced knee/hip osteoarthritis has not been explored.OBJECTIVE
To examine whether orthopedic surgeons are less likely to recommend TJR to African-American patients compared to white patients with similar clinical indications, and whether there are racial differences in the receipt of TJR within six months of study enrollment.DESIGN
Prospective, observational study.PARTICIPANTS
African-American (AA; n = 120) and white (n = 337) patients seeking treatment for knee or hip osteoarthritis in Veterans Affairs orthopedic clinics.MAIN MEASURES
Patients completed surveys that assessed socio-demographic and clinical variables that could influence osteoarthritis treatment. Orthopedic surgeons’ notes were reviewed to determine whether patients had been recommended for TJR and whether they underwent the procedure within 6 months of study enrollment.RESULTS
Rate of TJR recommendation was 19.5%. Odds of receiving a TJR recommendation were lower for AA than white patients of similar age and disease severity (OR = 0.46, 95% CI = 0.26–0.83; P = 0.01). However, this difference was not significant after adjusting for patient preference for TJR (OR = 0.69, 95% CI = 0.36–1.31, P = 0.25). Overall, 10.3% of patients underwent TJR within 6 months. TJR was less likely for AA patients than for white patients of similar age and disease severity (OR = 0.41, 95% CI = 0.16–1.05, P = 0.06), but this difference was reduced after adjusting for whether patients had received a recommendation for the procedure at the index visit (OR = 0.57, 95% CI = 0.21–1.54, P = 0.27).CONCLUSIONS
In this study, race differences in patient preferences for TJR appeared to underlie race differences in TJR recommendations, which led to race differences in utilization of the procedure. Our findings suggest that patient treatment preferences play an important role in racial disparities in TJR utilization in the orthopedic setting.KEY WORDS: healthcare disparities, total joint replacement, orthopedic surgery, osteoarthritis, patient preference 相似文献14.
James E. Aikens Ranak Trivedi Alicia Heapy Paul N. Pfeiffer John D. Piette 《Journal of general internal medicine》2015,30(6):797-803
Background
Although telephone care management improves depression outcomes, its implementation as a standalone strategy is often not feasible in resource-constrained settings. Moreover, little research has examined the potential role of self-management support from patients’ trusted confidants.Objective
To investigate the potential benefits of integrating a patient-selected support person into automated mobile health (mHealth) for depression.Design
Patient preference trial.Participants
Depressed primary care patients who were at risk for antidepressant nonadherence (i.e., Morisky Medication Adherence Scale total score > 1).Intervention
Patients received weekly interactive voice response (IVR) telephone calls for depression that included self-management guidance. They could opt to designate a lay support person from outside their home to receive guidance on supporting their self-management. Patients’ clinicians were automatically notified of urgent patient issues.Main Measures
Each week over a period of 6 months, we used IVR calls to monitor depression with the Patient Health Questionnaire-9 (PHQ-9; with total < 5 classified as remission), adherence (single item reflecting perfect adherence over the past week), and functional impairment (any bed days due to mental health).Key Results
Of 221 at-risk patients, 61% participated with a support person. Analyses were adjusted for race, medical comorbidity, and baseline levels of symptom severity and adherence. Significant interaction effects indicated that during the initial phase of the program, only patients who participated with a support person improved significantly in their likelihood of either adhering to antidepressant medication (AOR = 1.31, 95% CI: 1.16–1.47, p < 0.001) or achieving remission of depression symptoms (AOR = 1.24, 95% CI: 1.14–1.34, p < 0.001). These benefits were maintained throughout the 6-month observation period.Conclusions
Incorporating the “human factor” of a patient-selected support person into automated mHealth for depression self-management may yield sustained improvements in antidepressant adherence and depression symptom remission. However, this needs to be confirmed in a subsequent randomized controlled trial.KEY WORDS: depression, mHealth, self-management, caregiving, social support 相似文献15.
Saima I. Chaudhry MD MSHS Sandy Balwan MD Karen A. Friedman MD FACP Suzanne Sunday PhD Basit Chaudhry MD PhD Deborah DiMisa Alice Fornari EdD 《Journal of general internal medicine》2013,28(8):1100-1104
BACKGROUND
Traditional ambulatory training models have limitations in important domains, including opportunities for residents to learn, fragmentation of care delivery experience, and satisfaction with ambulatory experiences. New models of ambulatory training are needed.AIM
To compare the impact of a traditional ambulatory training model with a templated 4 + 1 model.SETTING
A large university-based internal medicine residency using three different training sites: a patient-centered medical home, a hospital-based ambulatory clinic, and community private practices.PARTICIPANTS
Residents, faculty, and administrative staff.PROGRAM DESCRIPTION
Development of a templated 4 + 1 model of residency where trainees do not attend to inpatient and outpatient responsibilities simultaneously.PROGRAM EVALUATION
A mixed-methods analysis of survey and nominal group data measuring three primary outcomes: 1) Perception of learning opportunities and quality of faculty teaching; 2) Reported fragmentation of care delivery experience; 3) Satisfaction with ambulatory experiences. Self-reported empanelment was a secondary outcome. Residents’ learning opportunities increased (p = 0.007) but quality of faculty teaching was unchanged. Participants reported less fragmentation in the care residents provide patients in the inpatient and outpatient setting (p < 0.0001). Satisfaction with ambulatory training improved (p < 0.0001). Self-reported empanelment also increased (p < 0.0001). Results held true for residents, faculty, and staff at all three ambulatory training sites (p < 0.0001).DISCUSSION
A 4 + 1 model increased resident time in ambulatory continuity clinic, enhanced learning opportunities, reduced fragmentation of care residents provide, and improved satisfaction with ambulatory experiences. More studies of similar models are needed to evaluate effects on additional trainee and patient outcomes.Electronic supplementary material
The online version of this article (doi:10.1007/s11606-013-2387-3) contains supplementary material, which is available to authorized users.KEY WORDS: ambulatory training, 4 + 1 model 相似文献16.
17.
Objective:
The purpose of this study was to examine whether baseline sleep duration predicts weight loss outcomes in a randomized controlled trial examining a behavioral weight loss (BWL) intervention among overweight and obese (OW/OB) women with urinary incontinence; and whether participation in the BWL intervention is associated with changes in sleep duration.Design:
Longitudinal, clinical intervention study of a 6-month BWL program.Subjects:
Three hundred sixteen OW/OB women, with urinary incontinence (age: 30–81 years, body mass index (BMI; 25–50 kg m−2) enrolled from July 2004–April 2006.Measurements:
Measured height and weight, self-report measures of demographics, sleep and physical activity.Results:
Neither self-reported total sleep time (TST) nor time in bed (TIB) at baseline significantly predicted weight loss outcomes among OW/OB women in a BWL treatment. BWL treatment was successful regardless of how much subjects reported sleeping at baseline, with an average weight loss of 8.19 kg for OW/OB women receiving BWL treatment, versus a weight loss of 1.44 kg in the control condition. Similarly, changes in weight, BMI and incontinence episodes did not significantly predict changes in sleep duration or TIB across the treatment period.Conclusion:
Although epidemiological and cross-sectional studies support a relationship between short sleep and increased BMI, the present study found no significant relationship between TST or TIB and weight loss for OW/OB women participating in a BWL treatment. 相似文献18.
Nancy C. Dolan Vanessa Ramirez-Zohfeld Alfred W. Rademaker M. Rosario Ferreira William L. Galanter Jonathan Radosta Milton “Mickey” Eder Kenzie A. Cameron 《Journal of general internal medicine》2015,30(12):1780-1787
BACKGROUND
Physician recommendation of colorectal cancer (CRC) screening is a critical facilitator of screening completion. Providing patients a choice of screening options may increase CRC screening completion, particularly among racial and ethnic minorities.OBJECTIVE
Our purpose was to assess the effectiveness of physician-only and physician–patient interventions on increasing rates of CRC screening discussions as compared to usual care.DESIGN
This study was quasi-experimental. Clinics were allocated to intervention or usual care; patients in intervention clinics were randomized to receipt of patient intervention.PARTICIPANTS
Patients aged 50 to 75 years, due for CRC screening, receiving care at either a federally qualified health care center or an academic health center participated in the study.INTERVENTION
Intervention physicians received continuous quality improvement and communication skills training. Intervention patients watched an educational video immediately before their appointment.MAIN MEASURES
Rates of patient-reported 1) CRC screening discussions, and 2) discussions of more than one screening test.KEY RESULTS
The physician–patient intervention (n = 167) resulted in higher rates of CRC screening discussions compared to both physician-only intervention (n = 183; 61.1 % vs.50.3 %, p = 0.008) and usual care (n = 153; 61.1 % vs. 34.0 % p = 0.03). More discussions of specific CRC screening tests and discussions of more than one test occurred in the intervention arms than in usual care (44.6 % vs. 22.9 %,p = 0.03) and (5.1 % vs. 2.0 %, p = 0.036), respectively, but discussion of more than one test was uncommon. Across all arms, 143 patients (28.4 %) reported discussion of colonoscopy only; 21 (4.2 %) reported discussion of both colonoscopy and stool tests.CONCLUSIONS
Compared to usual care and a physician-only intervention, a physician–patient intervention increased rates of CRC screening discussions, yet discussions overwhelmingly focused solely on colonoscopy. In underserved patient populations where access to colonoscopy may be limited, interventions encouraging discussions of both stool tests and colonoscopy may be needed.KEY WORDS: colorectal cancer screening, health literacy, randomized trial, physician communication of preventive care 相似文献19.
William T. Branch Jr. MD Calvin L. Chou MD PhD Neil J. Farber MD David Hatem MD Craig Keenan MD Gregory Makoul PhD Mariah Quinn MD William Salazar MD Jane Sillman MD Margaret Stuber MD LuAnn Wilkerson Ed.D George Mathew MD Michael Fost MS 《Journal of general internal medicine》2014,29(9):1250-1255
Background
There is increased emphasis on practicing humanism in medicine but explicit methods for faculty development in humanism are rare.Objective
We sought to demonstrate improved faculty teaching and role modeling of humanistic and professional values by participants in a multi-institutional faculty development program as rated by their learners in clinical settings compared to contemporaneous controls.Design
Blinded learners in clinical settings rated their clinical teachers, either participants or controls, on the previously validated 10-item Humanistic Teaching Practices Effectiveness (HTPE) questionnaire.Participants
Groups of 7-9 participants at 8 academic medical centers completed an 18-month faculty development program. Participating faculty were chosen by program facilitators at each institution on the basis of being promising teachers, willing to participate in the longitudinal faculty development program.Intervention
Our 18-month curriculum combined experiential learning of teaching skills with critical reflection using appreciative inquiry narratives about their experiences as teachers and other reflective discussions.Main Measures
The main outcome was the aggregate score of the ten items on the questionnaire at all institutions.Key Results
The aggregate score favored participants over controls (P = 0.019) independently of gender, experience on faculty, specialty area, and/or overall teaching skills.Conclusions
Longitudinal, intensive faculty development that employs experiential learning and critical reflection likely enhances humanistic teaching and role modeling. Almost all participants completed the program. Results are generalizable to other schools.KEY WORDS: faculty development, attitudes and values, professionalism 相似文献20.
P D Chandler J B Scott B F Drake K Ng A T Chan B W Hollis K M Emmons E L Giovannucci C S Fuchs G G Bennett 《Nutrition & diabetes》2015,5(1):e147