Impacts of computerized physician documentation in a teaching hospital: perceptions of faculty and resident physicians.
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OBJECTIVE: Computerized physician documentation (CPD) has been implemented throughout the nation's Veterans Affairs Medical Centers (VAMCs) and is likely to increasingly replace handwritten documentation in other institutions. The use of this technology may affect educational and clinical activities, yet little has been reported in this regard. The authors conducted a qualitative study to determine the perceived impacts of CPD among faculty and housestaff in a VAMC. DESIGN: A cross-sectional study was conducted using semistructured interviews with faculty (n = 10) and a group interview with residents (n = 10) at a VAMC teaching hospital. MEASUREMENTS: Content analysis of field notes and taped transcripts were done by two independent reviewers using a grounded theory approach. Findings were validated using member checking and peer debriefing. RESULTS: Four major themes were identified: (1) improved availability of documentation; (2) changes in work processes and communication; (3) alterations in document structure and content; and (4) mistakes, concerns, and decreased confidence in the data. With a few exceptions, subjects felt documentation was more available, with benefits for education and patient care. Other impacts of CPD were largely seen as detrimental to aspects of clinical practice and education, including documentation quality, workflow, professional communication, and patient care. CONCLUSION: CPD is perceived to have substantial positive and negative impacts on clinical and educational activities and environments. Care should be taken when designing, implementing, and using such systems to avoid or minimize any harmful impacts. More research is needed to assess the extent of the impacts identified and to determine the best strategies to effectively deal with them. (+info)
Medical faculty's use of print and electronic journals: changes over time and in comparison with scientists.
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OBJECTIVES: The objectives are to determine how medical faculty members use scholarly journals, whether print or electronic journals are read more, whether there is a pattern among types of users, and what similarities and differences there are between the use of journals by medical faculty and faculty in other disciplines. METHODS: Medical faculty of the University of Tennessee Health Science Center (UTHSC) multi-campus system were surveyed, and their responses estimated using critical incident technique to characterize the different aspects of their use of print and electronic journals. RESULTS: Medical faculty read a great deal, especially compared to scientists. The most frequently reported principal purpose of reading is to support their primary research (30% of reading). The majority of reading comes from recently published articles, mostly from personal subscriptions. Medical faculty continue to rely on print journals (approximately 70% of readings) versus electronic journals. Age of faculty does not appear to influence the choice of print or electronic format. Medical faculty read more articles than others on average and need information digested and verified in a way to save them time. Convenience and currency are highly valued attributes. CONCLUSIONS: It can be asserted that librarians and publishers must find ways to provide the attributes of convenience and currency and match the portability of personal subscriptions in an electronic journal format for medical faculty. (+info)
Cultural consensus analysis as a tool for clinic improvements.
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Some problems in clinic function recur because of unexpected value differences between patients, faculty, and residents. Cultural consensus analysis (CCA) is a method used by anthropologists to identify groups with shared values. After conducting an ethnographic study and using focus groups, we developed and validated a CCA tool for use in clinics. Using this instrument, we identified distinct groups with 6 important value differences between those groups. An analysis of these value differences suggested specific and pragmatic interventions to improve clinic functioning. The instrument has also performed well in preliminary tests at another clinic. (+info)
A primary care musculoskeletal clinic for residents: success and sustainability.
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Musculoskeletal complaints are common, but are often underemphasized in residency training. We evaluated the experience of residents (12) in 4 sessions of an innovative concentrated ambulatory, community-based musculoskeletal (MS) clinic precepted by general internists with additional training in teaching MS medicine. Compared with the year long longitudinal house staff (HS) clinic experience, the mean number of musculoskeletal diagnoses per resident seen in MS clinic was higher (13.9 [standard deviation 4.0] vs 5.4 [standard deviation 4.0]; P <.01). Common diagnoses in MS clinic included shoulder, hip, and knee tendonitis/bursitis, and the majority of diagnoses in HS clinic were nonspecific arthralgia (66%). Fifty-two injections were performed in MS clinic over the year, compared with one in HS clinic. (+info)
Clinician-teachers' self-assessments versus learners' perceptions.
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Understanding how clinician-teachers' self-assessments compare to learners' impressions can serve to help educators place each of these evaluations in the appropriate context. Past participants of the Johns Hopkins Faculty Development Program and other physician-teachers were surveyed in 2002 regarding their teaching skills and behaviors. We surveyed their learners to compare teacher and learner assessments of teaching proficiency, behaviors, enjoyment, and career satisfaction. In each area, learners' ratings were statistically significantly higher than their teachers' self-ratings. Though it is unclear whether teachers' or learners' assessments are a more accurate reflection of the truth, the more positive learner ratings should promote self-confidence in clinician-educators regarding their teaching abilities. (+info)
Getting funded. Career development awards for aspiring clinical investigators.
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For aspiring clinical investigators, career development awards provide a primary mechanism for "getting funded." The objective of this article is to provide information that will facilitate a successful application for a research career development award. Specifically, we discuss important issues that cut across the diverse array of awards, and we highlight the most common sources of funding, including the unique opportunities that are available for underrepresented minorities. The target audience includes junior faculty and fellows who are pursuing or considering a research career in academic medicine, as well as their mentors and program directors. (+info)
Implementation of integrated medical curriculum in Japanese medical schools.
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Recently, various integrated medical curricula, which can be defined as courses with subject matter classified by organ systems rather than according to departments such as surgery and internal medicine, are beginning to be introduced to bedside-learning in Japan. For example, in such an integrated medical curriculum, lectures in the course on neurological diseases would be given by a team that would include neurosurgeons, neurologists, and pathologists. Using medical education on neurological diseases as an example of an integrated medical curriculum, we analyzed the factors related to the neurological disease course as an example of an integrated medical curriculum in the clinical medicine course at our school. We also compared our course with those of all private medical schools in Japan, using the syllabuses of these private medical schools for the comparison, and considered elements that measured interdisciplinary participation in presenting the curriculum. For an integrated medical curriculum to gain interdisciplinary acceptance, the curriculum should be constituted using all medical disciplines related to the specific organ involved in the disease process under study, including both basic medicine and clinical medicine. In addition, teachers should be informed of the rationale for such a curriculum to promote their participation and a textbook on the integrated medical curriculum is needed. A curriculum committee should play an important role in promoting this type of medical education. (+info)
Conducting interdisciplinary research to promote healthy and safe employment in health care: promises and pitfalls.
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Due to the complexity of human health, emphasis is increasingly being placed on the need for and conduct of multidisciplinary and/or interdisciplinary health research. Yet many academic and research organizations--and the discipline-specific associations and journals--may not yet be prepared to adopt changes necessary to optimally support interdisciplinary work. This article presents an ongoing interdisciplinary research project's efforts to investigate mechanisms and pathways that lead to occupational health disparities among healthcare workers. It describes the promises and pitfalls encountered during the research,and outlines effective strategies that emerged as a result. Lessons learned include: conflict resolution regarding theoretical and methodological differences; establishing a sense of intellectual ownership of the research, as well as guidelines for multiple authorship; and development and utilization of protocols, communication systems, and tools. This experience suggests a need for the establishment of supportive structures and processes to promote successful interdisciplinary research. (+info)