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dical schools whose goals include training a more diverse physician workforce towards addressing racial health disparities require a new playbook.
Panel management (PM) curricula in internal medicine (IM) residency programs often assign performance measures which may not address the varied interests or needs of resident-learners.
To evaluate a self-directed learning (SDL)-based PM curriculum.
University-based primary care practice in Burlington, Vermont.
Thirty-five internal medicine residents participated.
Residents completed a PM curriculum that integrated SDL, electronic health record (EHR)-driven performance feedback, mentorship, and autonomy to set learning and patient care goals.
Pre/post-curricular surveys assessed EHR tool acceptability, weekly curricular surveys and post-curricular focus groups assessed resident perceptions and goals, and an interrupted time series analysis of care gap closure rates was used to compare the pre-intervention and intervention periods. Majority of residents (28-32 or 80-91%) completed the surveys and focus groups. Residents found the EHR tools acceptable and valued protected time, mentorship, and autonomy to set goals. A total of 13,313 patient visits were analyzed. There were no significant differences between rates between the pre-intervention period and the first intervention period (p=0.44).
A longitudinal PM curriculum that incorporated SDL and goal setting with EHR-driven performance feedback was well-received by residents, however did not significantly impact the rate of care gap closure.
A longitudinal PM curriculum that incorporated SDL and goal setting with EHR-driven performance feedback was well-received by residents, however did not significantly impact the rate of care gap closure.Psychological safety is the perception that an environment is safe for interpersonal risk taking, exposing vulnerability, and contributing perspectives without fear of being shamed, blamed, or ignored. The presence of psychological safety has been associated with improved team learning and innovation, leader inclusivity, and team members' sense of belonging. In medical education, psychological safety has additional benefits it allows learners to be present in the moment and to focus on the tasks at hand, and reduces trainee focus on image. Several key features of psychologically safe environments have already been described, including the presence of high-quality relationships, the absence of social positioning, a learner-driven and flexible learning agenda, the lack of formal assessment, and time for debriefing. However, many of the structures and cultural traditions in medical education are in clear opposition to these features. This paper describes the current barriers to psychological safety in medical education, and sets out an agenda for change. In accordance with benefits seen in other sectors, we anticipate that an emphasis on relationships and psychological safety will support the learning, inclusion, and success of medical trainees.
Internal medicine (IM) residents are underprepared in women's health. Lack of properly trained faculty and clinic culture limits the ability to provide bedside teaching.
Assess the impact of a primary care-based, women's clinic on residents' quality of care for females.
Large academic, urban primary care clinic with resident and faculty practices PARTICIPANTS PGY-2 IM and Med-Peds (MP) residents PROGRAM DESCRIPTION A weekly half-day, women's clinic to provide expanded women's healthcare to primary care group patients. Residents rotate through the clinic to receive bedside teaching.
Chart review was performed for a representative sample of reproductive-aged women seen in primary care before and after the establishment of the women's clinic. A total of 666 charts were reviewed (314 pre, 352 post). Improvement was seen in residents' rate of sexual histories (54% vs 75%, p< 0.01) with a significant decrease in women not asked about contraception (15% vs 3%, p<0.01). Overall there was a decrease in gynecology referrals (18 to 11%, p=0.02).
After implementing the women's health clinic, more women were asked about sexual health needs, and fewer were referred to gynecology, suggesting increased women's healthcare provided by residents.
After implementing the women's health clinic, more women were asked about sexual health needs, and fewer were referred to gynecology, suggesting increased women's healthcare provided by residents.
The temporal progression and workload-related causal contributors to physician burnout are not well-understood.
To characterize burnout's time course and evaluate the effect of time-varying workload on burnout and medical errors.
Six-month longitudinal cohort study with measurements of burnout, workload, and wrong-patient orders every 4 weeks.
Seventy-five intern physicians in internal medicine, pediatrics, and anesthesiology at a large academic medical center.
Burnout was measured using the Professional Fulfillment Index survey. Selleckchem Calcium folinate Workload was collected from electronic health record (EHR) audit logs and summarized as follows total time spent on the EHR, after-hours EHR time, patient load, inbox time, chart review time, note-writing time, and number of orders. Wrong-patient orders were assessed using retract-and-reorder events.
Seventy-five of 104 interns enrolled (72.1%) in the study. A total of 337 surveys and 8,863,318 EHR-based actions were analyzed. Median burnout score across the cohort acrosso mitigate sustained elevations of work responsibilities.
Burnout and recovery were associated with recent clinical workload for a cohort of physician trainees, highlighting the elastic nature of burnout. Wellness interventions should focus on strategies to mitigate sustained elevations of work responsibilities.
Disparities in objective assessments in graduate medical education such as the In-Training Examination (ITE) that disadvantage women and those self-identifying with race/ethnicities underrepresented in medicine (URiM) are of concern.
Examine ITE trends longitudinally across post-graduate year (PGY) with gender and race/ethnicity.
Longitudinal analysis of resident ITE metrics at 7 internal medicine residency programs, 2014-2019. ITE trends across PGY of women and URiM residents compared to non-URiM men assessed via ANOVA. Those with ITE scores associated with less than 90% probability of passing the American Board of Internal Medicine certification exam (ABIM-CE) were identified and odds of being identified as at-risk between groups were assessed with chi square.
A total of 689 IM residents, including 330 women and URiM residents (48%).
ITE score KEY RESULTS There was a significant difference in ITE score across PGY for women and URiM residents compared to non-URiM men (F
4.46, p=0.011). Adjusting lly being seen as at-risk for not passing the ABIM-CE. Differences in ITE over training may reflect differences in experiences of women and URiM residents during training and may lead to further disparities.Researchers studying cystic fibrosis (CF) pathogens have produced numerous RNA-seq datasets which are available in the gene expression omnibus (GEO). Although these studies are publicly available, substantial computational expertise and manual effort are required to compare similar studies, visualize gene expression patterns within studies, and use published data to generate new experimental hypotheses. Furthermore, it is difficult to filter available studies by domain-relevant attributes such as strain, treatment, or media, or for a researcher to assess how a specific gene responds to various experimental conditions across studies. To reduce these barriers to data re-analysis, we have developed an R Shiny application called CF-Seq, which works with a compendium of 128 studies and 1,322 individual samples from 13 clinically relevant CF pathogens. The application allows users to filter studies by experimental factors and to view complex differential gene expression analyses at the click of a button. Here we present a series of use cases that demonstrate the application is a useful and efficient tool for new hypothesis generation. (CF-Seq http//scangeo.dartmouth.edu/CFSeq/ ).As a unique geographical transition zone, the estuary is considered as a model environment to decipher the diversity, functions and ecological processes of microbial communities, which play important roles in the global biogeochemical cycle. Here we used surface water metagenomic sequencing datasets to construct metagenome-assembled genomes (MAGs) from 30 subtropical estuaries at a large scale along South China. In total, 500 dereplicated MAGs with completeness ≥ 50% and contamination ≤ 10% were obtained, among which more than one-thirds (n = 207 MAGs) have a completeness ≥ 70%. These MAGs are dominated by taxa assigned to the phylum Proteobacteria (n = 182 MAGs), Bacteroidota (n = 110) and Actinobacteriota (n = 104). These draft genomes can be used to study the diversity, phylogenetic history and metabolic potential of microbiota in the estuary, which should help improve our understanding of the structure and function of these microorganisms and how they evolved and adapted to extreme conditions in the estuarine ecosystem.
The classification of acetabular fractures remains a challenge for the junior radiologist, although he is the first line of diagnosis in Emergency Department. The advantages of three-dimensional reconstructions have yet to be evaluated on a large scale.
A total of 212 fractures were classified according to Letournel and Judet by a senior orthopaedic surgeon, a senior radiologist, and a resident radiologist. The CT scans were first analysed in 2D and then a second time using 2D + 3D reconstructions of the acetabulum excluding the femoral head.
3D reconstructions improved correct classification not only for the radiologist resident (+ 5%) but also for senior radiologist and orthopaedist (+ 2 and + 3%). 3D reconstructions also more significantly improved the diagnoses of complex fractures (+ 8.3%) compared to simple fractures (+ 0.4%).
3D reconstructions have improved the routine diagnosis of acetabular fractures, especially for junior radiologist or in cases of complex fractures.
3D reconstructions have improved the routine diagnosis of acetabular fractures, especially for junior radiologist or in cases of complex fractures.Colonoscopy is one of the most commonly performed endoscopic procedures and remains the most commonly used screening modality method for colorectal cancer (CRC) screening in the USA. Although serious complications of fiberoptic colonoscopy are uncommon due to technical advances, due to increasing number of colonoscopy procedures, post-procedural complications are not uncommonly encountered in the routine clinical practice. Also, as some of the post-colonoscopy complications are life threatening, it is important to diagnose them early so that timely treatment measures can be taken to decrease mortality and morbidity. In this review, we present a case-based illustration of the utility of CT to detect complications of colonoscopy including bowel perforation, hemorrhage, splenic injury, and postpolypectomy syndrome.
