Influence of physician factors on the effectiveness of a continuing medical education intervention. (33/108)

BACKGROUND AND OBJECTIVES: Continuing medical education (CME) is essential for improving the quality of care in primary health care settings. This study's objective was to determine how the characteristics of family physicians influenced the effectiveness of a multifaceted CME intervention to improve the management of acute respiratory infection (ARI) or type 2 diabetes (DM2). METHODS: A secondary analysis was conducted based on data from 121 family physicians, who participated in the educational intervention study. The outcome variable was positive change in physician's performance for treatment of ARI or DM2. The exposure variable was multifaceted CME intervention. Independent variables were professional physicians and organizational characteristics. Analysis included log binomial regression modeling. RESULTS: Factors influencing positive change included, for ARI, participation in the CME intervention and medical director interested in that condition and for DM2, participation in the CME intervention, medical director interested in DM2, and being a teacher. CONCLUSIONS: Physicians' characteristics and organizational environment influence the effectiveness of educational intervention and are therefore relevant to the implementation of CME strategies.  (+info)

Pediatric residency duty hours before and after limitations. (34/108)

OBJECTIVES: The goals were to examine pediatric resident and program director experiences implementing the Accreditation Council for Graduate Medical Education work hour limits and to compare duty hours, moonlighting, and fatigue before and after the limits became effective. METHODS: National random samples of 500 pediatric residents who graduated in 2002 and in 2004 were surveyed to compare resident duty hours and fatigue before and after the Accreditation Council for Graduate Medical Education limits were implemented. In addition, all US pediatric residency program directors were surveyed at the end of the 2003/2004 academic year, to provide a complementary retrospective examination of limit implementation. RESULTS: Totals of 65%, 61%, and 83% of 2002 residents, 2004 residents, and program directors, respectively, responded. The proportion of residents who reported working >80 hours per week declined from 49% for NICU/PICU rotations before the limits to 18% after limit implementation. Resident well-being was the factor identified most often by both residents and program directors as being improved since the limitations. Multivariate modeling also showed reductions in the proportions of residents who reported falling asleep while driving from work or making errors in patient care because of fatigue. Overall, 89% of pediatric residents and program directors reported that the current system is effective in ensuring appropriate working hours. CONCLUSIONS: Since the Accreditation Council for Graduate Medical Education duty hour limits went into effect, pediatric residents report working fewer hours and making fewer patient care errors because of fatigue. Although room for additional improvement remains, the experiences of residents and program directors suggest that implementation of the Accreditation Council for Graduate Medical Education limits in pediatric residency programs is improving resident well-being.  (+info)

General practice research and research skill needs--attitudes of GP supervisors. (35/108)

BACKGROUND: General practice research is an important learning area in general practice registrar training. General practitioner supervisors have a central role in registrar training. Registrar training in Tasmania has the added component of a research project. Little is known about supervisors' research attitudes, confidence to support registrar research projects, and research skill needs. METHOD: A postal survey was sent to all 40 GP supervisors with General Practice Training Tasmania. RESULTS: Response rate was 90% (n=36): 33% were interested in becoming involved in general practice research; 53% wanted to improve their research skills; and 55% did not feel confident supporting a registrar with a research project. Those supervisors who were confident were more likely to have previous research involvement. DISCUSSION: There is potential for increasing research capacity in GP supervisors. It is important to build the confidence of supervisors in their support of general practice registrars engaged in research projects.  (+info)

The value of internship in graduate medical education: survey of emergency medicine residents and program directors. (36/108)

OBJECTIVE: To assess the opinions of emergency medicine (EM) residents and program directors about the value of completing a nonrequired 1-year internship before entering an EM residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME). METHODS: An eight-question, self-administered online survey was e-mailed to EM residents who had completed a nonrequired internship before entering ACGME-accredited residency programs. A separate, six-question survey was e-mailed to program directors of ACGME-accredited programs that do not require an internship who had ever had a resident who had completed a nonrequired internship. RESULTS: Forty-six (27 [59%] osteopathic, 19 [41%] allopathic) of 113 residents and 40 of 124 program directors responded to the survey questions. Less than 4% of residents completed a separate nonrequired 1-year internship. The most common reason for completing a nonrequired internship was to obtain licensure by the American Osteopathic Association (19 [41%]). Most residents believed that they were more proficient with history-taking and physical examinations (38 [83%]) and procedures (34 [74%]) during the first year of residency than their colleagues who did not complete an internship, but this percentage decreased over time. The program directors had similar opinions. Most osteopathic residents who completed the internship for osteopathic licensure would not have done so if it were not required. Most (39 of 40) program directors would not recommend taking a nonrequired internship. CONCLUSION: Completing a 1-year internship before entering an EM residency program may better prepare physicians for their first year of residency in terms of basic clinical competancy, but further study is needed in this area.  (+info)

Barriers to providing palliative care in long-term care facilities. (37/108)

OBJECTIVE: To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors. DESIGN: Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses. SETTING: All licensed LTC facilities in Ontario with designated medical directors. PARTICIPANTS: Medical directors in the facilities. MAIN OUTCOME MEASURES: Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received. RESULTS: Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff's capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice guidelines related to assessing and managing palliative care patients (67.8%). CONCLUSION: Medical directors in our study reported that their LTC facilities were inadequately staffed and lacked equipment. The study also highlighted the specialized role of medical directors, who identified continuing medical education as a key strategy for improving provision of palliative care.  (+info)

Choosing a career in combined internal medicine-pediatrics: insights from interns. (38/108)

BACKGROUND: Combined internal medicine-pediatrics (med-peds) programs may be competing for the same students who would have otherwise chosen family medicine. The degree to which this is happening is not known. METHODS: We sent an eight-item questionnaire to new med-peds interns to assess their career plans at different stages of their decision making. Questionnaires were mailed to the directors of all US med-peds programs in 2002. RESULTS: A total of 288/333 (87%) responded. The med-peds interns were more likely to be interested in internal medicine or pediatrics than they were in family medicine. If med-peds were not available, only 52/286 (18%) would have chosen family medicine as an alternative. A total of 55/288 (19%) anticipated practicing in rural areas. CONCLUSIONS: The majority of med-peds interns would have chosen internal medicine or pediatrics if med-peds was not available. A small percentage would have chosen family medicine, thus having a minor impact on recruitment. An even smaller proportion would have chosen a non-primary care specialty. A sizable number anticipate practicing in rural areas.  (+info)

Reaching and teaching preceptors: limited success from a multifaceted faculty development program. (39/108)

We conducted a six-pronged preceptor faculty development program that included a listserve and interactive Web-based teaching scenarios. A total of 144 preceptors in a required preceptorship program were offered traditional continuing medical education (CME), a preceptor listserve, an electronic clinical teaching discussion group, an orientation videotape, a CD-ROM on teaching skills, and technology support. On Web-based evaluation, 31% of participants responded. Eighty percent of preceptors allowed us to subscribe them to the listserve, and most agreed it was useful. One third of preceptors responded to an electronic clinical teaching case discussion, most rating it useful to their precepting. The listserve and electronic teaching cases hold promise for preceptor faculty development.  (+info)

Effect of intensive care unit organizational model and structure on outcomes in patients with acute lung injury. (40/108)

RATIONALE: Prior studies supported an association between intensive care unit (ICU) organizational model or staffing patterns and outcome in critically ill patients. OBJECTIVES: To examine the association of closed versus open models with patient mortality across adult ICUs in King County (WA). METHODS: Cohort study of patients with acute lung injury (ALI). MEASUREMENTS AND MAIN RESULTS: ICU structure, organization, and patient care practices were assessed using self-administered mail questionnaires completed by the medical director and nurse manager. We defined closed ICUs as units that required patient transfer to or mandatory patient comanagement by an intensivist and open ICUs as those relying on other organizational models. Outcomes were obtained from the King County Lung Injury Project, a population-based cohort of patients with ALI. The main endpoint was hospital mortality. Of 24 eligible ICUs, 13 ICUs were designated closed and 11 open. Complete survey data were available for 23 (96%) ICUs. Higher physician and nurse availability was reported in closed versus open ICUs. A total of 684 of 1,075 (63%) of patients with ALI were cared for in closed ICUs. After adjusting for potential confounders, patients with ALI cared for in closed ICUs had reduced hospital mortality (adjusted odds ratio, 0.68; 95% confidence interval, 0.53, 0.89; P = 0.004). Consultation by a pulmonologist in open ICUs was not associated with improved mortality (adjusted odds ratio, 0.94; 95% confidence interval, 0.74, 1.20; P = 0.62). These findings were robust for varying assumptions about the study population definition. CONCLUSIONS: Patients with ALI cared for in a closed-model ICU have reduced mortality. These data support recommendations to implement structured intensive care in the United States.  (+info)