Residents as teachers: Survey of Canadian family medicine residents

Objective

To examine Canadian family medicine residents’ perspectives surrounding teaching opportunities and mentorship in teaching.

Design

A 16-question online survey.

Setting

Canadian family medicine residency programs.

Participants

Between May and June 2011, all first- and second-year family medicine residents registered in 1 of the 17 Canadian residency programs as of September 2010 were invited to participate. A total of 568 of 2266 residents responded.

Main outcome measures

Demographic characteristics, teaching opportunities during residency, and resident perceptions about teaching.

Results

A total of 77.7% of family medicine residents indicated that they were either interested or highly interested in teaching as part of their future careers, and 78.9% of family medicine residents had had opportunities to teach in various settings. However, only 60.1% of respondents were aware of programs within residency intended to support residents as teachers, and 33.0% of residents had been observed during teaching encounters.

Conclusion

It appears that most Canadian family medicine residents have the opportunity to teach during their residency training. Many are interested in integrating teaching as part of their future career goals. Family medicine residencies should strongly consider programs to support and further develop resident teaching skills.     

Simulation-based training of internal medicine residents in advanced cardiac life support protocols: a randomized trial

Background: Internal medicine residents must be competent in Advanced Cardiac Life Support (ACLS) for board certification. Purpose: The purpose was to use a medical simulator to assess baseline proficiency in ACLS and determine the impact of an intervention on skill development. Method: This was a randomized trial with wait-list controls. After baseline evaluation in all residents, the intervention group received 4 education sessions using a medical simulator. All residents were then retested. After crossover, the wait-list group received the intervention, and residents were tested again. Performance was assessed by comparison to American Heart Association guidelines for treatment of ACLS conditions with interrater and internal consistency reliability estimates. Results: Performance improved significantly after simulator training. No improvement was detected as a function of clinical experience alone. The educational program was rated highly.     

Evidence-based medicine in internal medicine clerkships: a national survey

BACKGROUND: Although evidence-based medicine (EBM) has become widely accepted, the extent of its implementation during clinical clerkships is not well described. This study was done to characterize the implementation of formal EBM curricula in internal medicine clerkships. METHODS: In 1999, the Clerkship Directors in Internal Medicine surveyed its membership from 123 medical schools. The EBM section of the four-part survey addressed implementation, teaching and evaluation techniques, and barriers to implementing EBM. RESULTS: Survey response was 89%. Of 109 respondents, 38.5% reported having a formal EBM curriculum at some time during the third year and/or fourth year. Variability existed in curricular materials and evaluation tools used. The most common barriers to implementing EBM were lack of time and inadequately trained faculty. CONCLUSIONS: Evidence-based medicine has been formally incorporated into relatively few internal medicine clerkships. Faculty development programs in conjunction with innovative teaching methods may help overcome these barriers.     

Changes in internal medicine residents' attitudes about resuscitation after cardiac arrest over a decade

Background

Resident physicians' beliefs about cardiopulmonary resuscitation (CPR) may impact their communication with patients about end-of-life care. We sought to understand how these perceptions and experiences have changed in the past decade because both medical education and American society have focused more on this domain.

Method

We surveyed 2 internal medicine resident cohorts at a large academic medical center in 1995 and 2005. Residents were asked of their beliefs about survival after CPR, perceived patient understanding, and regret after attempted resuscitation. Residents in 2005 reported more numerical experience with CPR. Current internal medicine residents are more optimistic than the 1995 cohort about survival after an inpatient cardiac arrest. They believe that far fewer patients and families understand resuscitation but report less regret about attempting to resuscitate patients.

Conclusions

These pilot data reveal potential changes in the attitudes of resident physicians toward CPR. The perceived poor understanding among decision makers calls into question the standard of informed consent. Despite this, residents report less regret leading one to ask what factors may underlie this response.     

综合性医院内科门诊病人神经症性症状调查

国外资料显示,21%～26%的内科门诊病人有心理问题[1],20世纪90年代上海市综合性医院的调查显示,内科门诊病人精神障碍的患病率为9.7%[2],与国外资料相差甚大.这些伴有心理问题的病人长期就诊于各内科门诊,得不到专科的诊断与治疗,造成身心痛苦,给其物力财力带来损失,同时给国家的医疗资源造成浪费.为此,对综合性医院门诊病人普遍存在的心理问题进行调查研究,并研究此类病人的医院满意度.现介绍如下.……     

综合性医院内科门诊病人神经症性症状调查

国外资料显示，21％～26％的内科门诊病人有心理问题，20世纪90年代上海市综合性医院的调查显示，内科门诊病人精神障碍的患病率为9．7％，与国外资料相差甚大。这些伴有心理问题的病人长期就诊于各内科门诊，得不到专科的诊断与治疗，造成身心痛苦，给其物力财力带来损失，同时给国家的医疗资源造成浪费。为此，对综合性医院门诊病人普遍存在的心理问题进行调查研究，并研究此类病人的医院满意度。现介绍如下。     

A survey of the in-hospital response to cardiac arrest on general wards in the hospitals of Rome

OBJECTIVE: To investigate the response to cardiac arrest in general wards. METHODS: Direct interview with the cardiac arrest team (CAT) members in 32 hospitals in Rome, Italy. RESULTS: The majority of CATs are activated by telephone but only two (6%) hospitals have a dedicated telephone number for emergency calls. The CAT always includes a physician, who is usually an anaesthesiologist (30 hospitals, 94%), and usually includes one or two other members (23 hospitals, 72%). In 21 hospitals (65%) there is less than one defibrillator per floor but in only six hospitals (19%), CATs are equipped with defibrillators. Resuscitation guidelines are adopted by 15 teams (47%). The Utstein style of data collection is used in only one hospital. The most common problems reported by the CATs are: insufficient training of ward personnel (29 hospitals, 91%), insufficient staff (19 hospitals, 59%) and insufficient equipment (18 hospitals, 56%). Average maximum arrival time for the CAT to arrive is 220 s, but varies significantly between single-building and the multiple-building hospitals (88 vs. 390 s; P<0.001). CONCLUSIONS: The majority of the cardiac arrest teams have acceptable response times, but their efficiency may be impaired by the lack of staff, equipment and co-ordination with the ward personnel. CAT members identified a strong need for BLS training of ward personnel. More widespread introduction of standard protocols for resuscitation and reporting of cardiac arrest are necessary to evaluate aspects that may need improvement.     

Identifying non-technical skills and barriers for improvement of teamwork in cardiac arrest teams

Background

The application of non-technical skills (NTSs) in health care has previously been described in other health-care educational programmes. NTSs are behavioural principles such as leadership, task distribution and communication. The aim of this study was to identify NTSs suitable for improving team performance in multi-professional cardiac arrest teams, and to describe barriers to the use and implementation of such NTSs by using a qualitative method.

Methods

Individual semi-structured interviews were conducted with 11 Danish Advanced Life Support instructors during the period April 2006 to November 2006. Interviews were focussed on barriers and recommendations for teamwork in the cardiac arrest team, optimal policy for improvement of resuscitation training and clinical practice, use of cognitive aids and adoption of European Resuscitation Council (ERC) Guidelines 2005. Interviews and data analysis were supported by a template describing 25 NTSs derived from other educational programmes in health care.

Results

A framework with five categories relating to NTSs was identified: leadership, communication, mutual performance monitoring, maintenance of standards and guidelines and task management. Important barriers that were identified were inexperienced team leaders, task overload and hierarchic structure in the teams’ inability to maintain focus on chest compressions.

Conclusion

Interview participants pointed out that NTSs of teams could improve the treatment of cardiac arrest, but several barriers to this exist. Improving resuscitation training should include considerations regarding team leader experience, structured communication, mandatory use of cognitive aids, avoidance of task overload and mutual performance monitoring to avoid unnecessary interruptions in chest compressions.     

The use of intravenous cholangiography in teaching hospitals: A survey

Thirty academic radiology departments active in biliary imaging were surveyed to document how frequently intravenous cholangiography (IVC) was being performed. Over a 10-year period the number of examinations has decreased precipitously from approximately 1728 in 1976 to 8 in 1986. This coincides with the increased availability of alternative procedures. The availability of new contrast agents with improved diagnostic yield and decreased toxicity suggests that its use may have been prematurely abandoned.     

中医医院建立中医护理内部培训师队伍的思考

培训师队伍的建设、培养与管理是提高护理人员在职培训质量的关键环节。该文在分析中医护理在职培训师资现状的基础上,提出建立中医护理内部培训师队伍可使培训内容更具针对性和有效性,培训体系更具可持续性,并为护理人员开辟实现自我价值及职业生涯发展的平台。同时,提出构建与管理中医护理内部培训师队伍应完善选拔聘任及激励管理机制,加强培养管理及绩效考评管理等建议。     

Residents with disabilities: a national survey of directors of emergency medicine residency programs

BACKGROUND: The Americans With Disabilities Act (ADA) has been in effect since 1990. The present study shows response to this act for emergency medicine (EM) residents nationwide. METHODS: A total of 121 surveys were mailed to the directors of American College of Graduate Medical Education (ACGME)-approved residency programs. A definition of disability was provided, and a second mailing was sent to those not replying. RESULTS: Ninety-two program directors (76%) responded, representing 4,644 residents. Of these, 62 residents (1.3%) were reported as having a documented disability. Programs with a known disabled resident were significantly more likely to have available resources for assistance. Forty-seven (52%) of the program directors suspected a resident might have an undiagnosed disability, and 40 (85%) of these recommended testing or referral. CONCLUSIONS: There is a wide array of disabilities among EM residents. Available assistance varies. This may apply to other residencies as well.