Abstract

Background

New approaches to enhance access in primary care necessitate change in the model for residency education.

Purpose

To describe instrument design, development and testing, and data collection strategies for residency programs, continuity clinics, residents, and program graduates participating in the Preparing the Personal Physician for Practice (P⁴) project.

Methods

We developed and pilot-tested surveys to assess demographic characteristics of residents, clinical and operational features of the continuity clinics and educational programs, and attitudes about and implementation status of Patient Centered Medical Home (PCMH) characteristics. Surveys were administered annually to P⁴ residency programs since the project started in 2007. Descriptive statistics were used to profile data from the P⁴ baseline year.

Results

Most P⁴ residents were non-Hispanic white women (60.7%), married or partnered, attended medical school in the United States and were the first physicians in their families to attend medical school. Nearly 85% of residency continuity clinics were family health centers, and about 8% were federally qualified health centers. The most likely PCMH features in continuity clinics were having an electronic health record and having fully secure remote access available; both of which were found in more than 50% of continuity clinics. Approximately one-half of continuity clinics used the electronic health record for safety projects, and nearly 60% used it for quality-improvement projects.

Conclusions

We created a collaborative evaluation model in all 14 P⁴ residencies. Successful implementation of new surveys revealed important baseline features of residencies and residents that are pertinent to studying the effects of new training models for the PCMH.

Abstract

Background

Paracentesis is a commonly performed bedside procedure that has the potential for serious complications. Therefore, simulation-based education for paracentesis is valuable for clinicians.

Objective

To assess internal medicine residents' procedural skills before and after simulation-based mastery learning on a paracentesis simulator.

Methods

A team with expertise in simulation and procedural skills developed and created a high fidelity, ultrasound-compatible paracentesis simulator. Fifty-eight first-year internal medicine residents completed a mastery learning-based intervention using the paracentesis simulator. Residents underwent baseline skill assessment (pretest) using a 25-item checklist. Residents completed a posttest after a 3-hour education session featuring a demonstration of the procedure, deliberate practice, ultrasound training, and feedback. All residents were expected to meet or exceed a minimum passing score (MPS) at posttest, the key feature of mastery learning. We compared pretest and posttest checklist scores to evaluate the effect of the educational intervention. Residents rated the training sessions.

Results

Residents' paracentesis skills improved from an average pretest score of 33.0% (SD = 15.2%) to 92.7% (SD = 5.4%) at posttest (P < .001). After the training intervention, all residents met or exceeded the MPS. The training sessions and realism of the simulation were rated highly by learners.

Conclusion

This study demonstrates the ability of a paracentesis simulator to significantly improve procedural competence.

Abstract

Background

Transitional Year (TY) programs meet an important need by preparing residents for specialties that accept individuals after an initial preparatory year. To our knowledge, no surveys to date have been conducted to identify attributes of TY programs and concerns of TY program directors.

Purpose

The purpose of this study was to review TY program characteristics and identify critical issues and concerns of TY program directors (TYPDs).

Methods

A web-based, 22-question survey was sent to all 114 TYPDs of programs accredited by the Accreditation Council for Graduate Medical Education between January and April 2011. The survey included open-formatted and closed-formatted questions addressing program and institution demographics, program director time, administrative support, satisfaction, and future plans.

Results

The survey response rate was 86%. The median age of TY programs was 28 years, with few new programs. More than 80% of TY programs were conducted at community hospitals and university-affiliated community hospitals. Of the responding TYPDs, 17% had served less than 2 years, and 32% had served 10 years or more. Common sponsoring TY programs included internal medicine (88%), general surgery (42%), family medicine (25%), emergency medicine (24%), and pediatrics (18%). Overall, TYPDs were satisfied with their positions. They expressed concerns about inadequate time to complete duties, salary support, and administrative duties assigned to program coordinators. Forty-nine percent of TYPDs reported they planned to leave the position within the next 5 years.

Conclusions

Our survey provides useful information to assist institutions and the graduate medical education community in meeting the needs of TYPDs and strengthening TY programs.

The Challenge

Maintaining an environment of scholarly inquiry is highlighted in the Accreditation Council for Graduate Medical Education's (ACGME) common program requirements. Faculty and trainees are expected to participate in scholarly activities,1 and present those findings to peers for review.2 Faculty and residents/fellows often lack a conceptual yet practical framework for guiding scholarly activities when they occur in the context of health care systems, clinical practice, quality improvement, education, or community partnerships.

The Journal of Graduate Medical Education is deeply grateful to the individuals who served as reviewers and provided critiques and helpful suggestions to authors for the 4 issues published in 2011. Reviewers shown bolded reviewed a significant number of articles, and the Journal greatly appreciates the contribution of their time, energy, and expertise.

Ralitsa Akins, MD, PhD

Amer Aldeen, MD

Douglas Ander, MD

Kathryn Andolsek, MD, MPH

Keith Armitage, MD

Joshua H. Atkins, MD, PhD

C. Maria Bacchus, MD

Glen Bandiera, MD

Pippa Bark

Mathias Basner, MD, MS, MSc

Ellen Bass, MD

Brent Beasley, MD, FACP

Tomer