Morganbeasley7955

Background Internal medicine residents face numerous career options after residency training. Little is known about when residents make their final career choice. Objective We assessed the timing and predictive factors of final career choices among internal medicine residents at graduation, including demographics, pre-residency career preferences, and rotation scheduling. Methods We conducted a retrospective study of graduates of an academic internal medicine residency program from 2014 to 2017. Main measures included demographics, rotation schedules, and self-reported career choices for residents at 5 time points recruitment day, immediately after Match Day, end of postgraduate year 1 (PGY-1), end of PGY-2, and at graduation. Results Of the 138 residents eligible for the study, 5 were excluded based on participation in a fast-track program for an Accreditation Council for Graduate Medical Education subspecialty fellowship. Among the remaining 133 residents, 48 (36%) pursued general internal medicine fields and 78 (59%) pursued fellowship training. Career choices from recruitment day, Match Day, and PGY-1 were only weakly predictive of the career choice. AG-14361 molecular weight Many choices demonstrated low concordance throughout training, and general medicine fields (primary care, hospital medicine) were frequently not decided until after PGY-2. Early clinical exposure to subspecialty rotations did not predict final career choice. Conclusions Early career choices before and during residency training may have low predictability toward final career choices upon graduation in internal medicine. These choices may continue to have low predictability beyond PGY-2 for many specialties. Early clinical exposure may not predict final career choice for subspecialties. Accreditation Council for Graduate Medical Education 2020.Background Clinical continuity is recognized as a driver of satisfaction for patients and physicians. Greater continuity may positively affect trainee decisions to enter primary care. Maintaining clinical continuity remains a challenge in residency clinics. Objective We determined whether enhanced scheduling support was associated with improvement in internal medicine resident continuity with patients. Methods This study was conducted from June 2017 to December 2018. In the intervention clinic, a single scheduling staff member (ratio of 10 residents to 1 scheduler) was colocated within the clinical space, allowing the scheduler to participate in clinical discussions and direct communication with physicians regarding future appointments. In the comparison clinic, scheduling staff (191 ratio) were located at a remote front desk area and relied on patient reports or electronic health record orders to identify appointment needs and arrange follow-up appointments. The main outcome of the intervention was resident continuity, calculated using the continuity for physician formula. Results During the study period, mean resident continuity was 23% (range 13%-37%) in the comparison clinic (57 residents) and 54% (range 38%-66%) in the intervention clinic (10 residents). Resident continuity was significantly higher in the intervention clinic compared with the traditional control clinic for every quarter measured (P  less then  .001 for all comparisons). Conclusions Enhancing scheduling support through colocation and a lower resident to scheduler ratios was associated with significantly higher rates of resident continuity compared with a traditional front desk model, with results sustained over 18 months. Accreditation Council for Graduate Medical Education 2020.Background Improved well-being is a focus for graduate medical education (GME) programs. Residents and fellows often express difficulty with visiting primary care physicians, and this issue has not been thoroughly investigated. Objective We reported implementation and utilization of a primary care concierge scheduling service and a primary care video visit service for GME trainees. Methods GME leaders collaborated with Duke Primary Care to offer trainees a concierge scheduling service and opportunity for primary care video visits. This quantitative evaluation included (1) analysis of the institutional GME survey results pre- and post-intervention, and (2) review of use of the concierge scheduling line. Results Comparison of the 2018 and 2019 internal GME surveys showed a decrease in perceived barriers accessing primary care (58% to 31%, P less then .0001), a decrease in perceived delays to access primary care (27% to 21%, P = .023), and an increase in respondents who reported needing health care services in the past year (37% to 62%, P less then .0001). Although increased need for health services was reported, there was no difference in the proportion reporting use of health services (63% and 65%, P = .43). Of the 142 concierge line calls reviewed, 127 (87%) callers requested clinic appointments, and 15 (10%) callers requested video appointments. Of callers requesting clinic appointments, 99 (80%) were scheduled. Conclusions Providing resources to connect trainees to primary care greatly reduces their perception of barriers to health care and may provide a convenient mechanism to schedule flexible primary care appointments. Accreditation Council for Graduate Medical Education 2020.Background Nonclinical skills (eg, self-regulation, team leadership, conflict resolution) are essential for success as a chief resident (CR). The literature on programs teaching these skills reports few if any effectiveness outcomes. Objective We reported the outcomes of a leadership course for CRs using participants' self-reported outcomes and assessments from their program directors (PDs). Methods A 2-day curriculum focused on emotional intelligence competencies, including self-awareness, self-management, social awareness, and relationship management. We used a logic model to align 2017-2018 curriculum with targeted outcomes. Questionnaires before and after the course assessed short-term and intermediate outcomes for the participants and PD interviews evaluated observed changes in CRs' performance attributable to the course. Results A total of 74 residents participated in the course, and 65% and 59% responded to the post-course and follow-up questionnaires, respectively. Over 95% of respondents indicated developing leadership knowledge and skills and connecting with new CRs in the post-course questionnaire.