Abstract

Background

Motivational interviewing (MI) is a patient-centered method of behavior change counseling. It has shown promise in enabling patients to identify and improve problem health behaviors. Incorporating MI education into residency training may be beneficial.

Objective

To review the current evidence regarding the impact of MI education in graduate medical education.

Results

Of the 9 studies of MI education in graduate medical education training, most noted favorable outcomes after MI education. Outcomes included improvements in residents' view of MI, MI skill use and competency, and resident satisfaction with MI interventions. Of the 5 studies that looked at residents' views of MI, 3 found improvements in resident assessments of the importance of and confidence in using MI. Of the 4 studies of MI skills, 3 reported improvements in residents' use of and competency in the MI skill. The quality of MI education in the graduate medical education literature is limited by overreliance on preintervention and postintervention analysis as a study design, the variable intensity of educational interventions, and limited use of validated assessment tools and quantitative outcome measures.

Conclusions

Review of the literature shows that MI education can be successfully implemented within the residency education environment. The intensity of MI interventions, coupled with experiential learning and feedback, correlated with favorable outcomes in terms of resident use of MI skills and resident satisfaction. Further study is needed to determine which MI skills are most effectively taught to residents, the impact of MI training on resident behavior in clinical settings, and the impact on clinical outcomes.

Abstract

Background

Teaching residents how to teach is a critical part of resident education because residents are often the major teachers of medical students. The importance of formal residents-as-teachers (RAT) curricula has been emphasized throughout the literature, yet not all residency programs have such a curriculum in place.

Objective

The purpose of our study was to (1) review the medical education literature for established RAT curricula, (2) assess published curricula's reproducibility, (3) evaluate the type of outcomes achieved using the Kirkpatrick model of evaluation, and (4) identify curricula that training programs could feasibly adopt.

Methods

We performed a literature review using PubMed, Medline, Scopus, PsycINFO, ERIC, and Embase. Key search words included residents, residents as teachers, teaching, internship and residency, and curriculum. In addition, a search of MedEdPORTAL was performed using the same key terms. Articles were evaluated based on the reproducibility of curricula and the assessment tools. Evaluation of educational outcomes was performed using the Kirkpatrick model.

Results

Thirty-nine articles were deemed appropriate for review. Interventions and evaluation techniques varied greatly. Only 1 article from the literature was deemed to have both curricula and assessments that would be fully reproducible by other programs.

Conclusions

A literature review on RAT curricula found few articles that would be easily reproduced for residency programs that want to start or improve their own RAT curricula. It also demonstrated the difficulty and lack of rigorous outcome measurements for most curricula.

Abstract

Background

Internal medicine programs are redesigning ambulatory training to improve the resident experience and answer the challenges of conflicting clinical responsibilities. However, little is known about the effect of clinic redesign on residents' satisfaction.

Objective

We assessed residents' satisfaction with different resident continuity clinic models in programs participating in the Educational Innovations Project Ambulatory Collaborative (EPAC).

Methods

A total of 713 internal medicine residents from 12 institutions in the EPAC participated in this cross-sectional study. Each program completed a detailed curriculum questionnaire and tracked practice metrics for participating residents. Residents completed a 3-part satisfaction survey based on the Veterans Affairs Learners' Perception Survey, with additional questions addressing residents' perceptions of the continuous healing relationship and conflicting duties across care settings.

Results

Three clinic models were identified: traditional weekly experience, combination model with weekly experience plus concentrated ambulatory rotations, and a block model with distinct inpatient and ambulatory blocks. The satisfaction survey showed block models had less conflict between inpatient and outpatient duties than traditional and combination models. Residents' perceptions of the continuous healing relationship was higher in combination models. In secondary analyses, the continuity for physician measure was correlated with residents' perceptions of the continuous healing relationship. Panel size and workload did not have an effect on residents' overall personal experience.

Conclusions

Block models successfully minimize conflict across care settings without sacrificing overall resident satisfaction or resident perception of the continuous healing relationship. However, resident perception of the continuous healing relationship was higher in combination models.

Setting and Problem

Government agencies, insurance companies, health systems, and accreditors have developed numerous outcome measures that providers should consider and achieve. However, effective outcomes measurement faces barriers in teaching settings. In ambulatory practice, measurement tends to emphasize individual physician performance. This is problematic in ambulatory training practices, as residents are frequently absent for significant periods of time. In addition, measures selected are often chosen from outside the practice, and buy-in can suffer. This environment can lead to trainees and allied health providers accepting measures without critically analyzing what should be measured and why.

Intervention

University of Cincinnati internal medicine

Setting and Problem

Nuclear medicine (NM) faces significant challenges as a specialty. Fewer physicians are choosing to enter NM, and employment prospects for graduates are increasingly limited. Additional challenges include declining reimbursement, “turf” battles with specialties that have assumed some of the areas previously the domain of NM, and difficulties with implementation of translational research. Rapidly proliferating technology and hybrid imaging are significantly changing the scope of knowledge, requiring greater understanding of 3-dimensional anatomy, cross-sectional imaging techniques, physics, and clinical applications. NM residency alone may not be adequate preparation, and NM programs are having difficulty attracting top candidates.

In addition