Chaperone use by residents during pelvic, breast, testicular, and rectal exams.
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We designed a questionnaire survey to study internal medicine residents' plans to use a chaperone during the pelvic, breast, rectal, and testicular examinations. We found chaperone use by male and female residents differed markedly, and neither group planned to use chaperones universally. When examining female patients, male residents overall were very likely to use a chaperone during a pelvic exam, but less likely for the breast exam and rectal exam. For the female resident, there was a significantly lower likelihood of using chaperones during the pelvic, breast, or rectal exams. There was a much lower rate of chaperone use during the sensitive portions of the male physical examination compared with the female examination, with somewhat higher use by female residents. We concluded that male and female residents differ significantly in their patterns of chaperone use. It would be valuable to develop guidelines for chaperone use to help residents understand the issues involved in the choices, and to protect the residents from the possible medico-legal consequences of forgoing chaperones. (+info)
A needs assessment of surgical residents as teachers.
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OBJECTIVE: To determine the needs of surgical residents as teachers of clinical clerks. DESIGN: A needs assessment survey. SETTING: Department of Surgery, University of Toronto. PARTICIPANTS: Clinical clerks and surgical residents and staff surgeons. METHODS: Three stakeholder groups were defined: staff surgeons, surgical residents and clinical clerks. Focus-group sessions using the nominal group technique identified key issues from the perspectives of clerks and residents. Resulting information was used to develop needs assessment surveys, which were administered to 170 clinical clerks and 190 surgical residents. Faculty viewpoints were assessed with semi-structured interviews. Triangulation of these 3 data sources provided a balanced approach to identifying the needs of surgical residents as teachers. RESULTS: Response rates were 64% for clinical clerks and 66% for surgical residents. Five staff surgeons were interviewed. Consensus was noted among the stakeholder groups regarding the importance of staff surgeon role modelling and feedback, resident attitude, time management, knowledge of clerks' formal learning objectives, and appropriate times and locations for teaching. Discrepancies included a significant difference in opinion regarding the residents' capacity to address clerks' individual learning needs and to foster good team relationships. Residents indicated that they did not receive regular feedback regarding their teaching and that staff did not place an emphasis on their teaching role. CONCLUSIONS: This study has, from a multi-source perspective, assessed the needs of surgical residents as teachers. These needs include enhancing residents' education regarding how and what to teach medical students on a surgical rotation, and a need for staff surgeons to increase feedback to residents regarding their teaching. (+info)
Training tomorrow's clinicians today--managed care essentials: a process for curriculum development.
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OBJECTIVE: To develop a managed care curriculum for primary care residents. DESIGN: This article outlines a 4-stage curriculum development process focusing on concepts of managed care organization and finance. The stages consist of: (1) identifying the curriculum development work group and framing the scope of the curriculum, (2) identifying stakeholder buy-in and expectations, (3) choosing curricular topics and delivery mechanisms, and (4) outlining the evaluation process. Key elements of building a curriculum development team, content objectives of the curriculum, the rationale for using problem-based learning, and finally, lessons learned from the partnership among the stakeholders are reviewed. RESULTS: The curriculum was delivered to an entering group of postgraduate-year 1 primary care residents. Attitudes among residents toward managed care remained relatively negative and stable over the yearlong curriculum, especially over issues relating to finance, quality of care, control and autonomy of practitioners, time spent with patients, and managed care's impact on the doctor-patient relationship. Residents' baseline knowledge of core concepts about managed care organization and finance improved during the year that the curriculum was delivered. Satisfaction with a problem-based learning approach was high. CONCLUSION: Problem-based learning, using real-life clinical examples, is a successful approach to resident instruction about managed care. (+info)
Practice factors that influence antibiotic prescribing in general practice in Tayside.
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A cohort design was used to evaluate antibiotic prescribing in relation to patient and general practice characteristics. The study included prescribing to all subjects resident in Tayside, from January to December 1994 and found 215217 antibiotic prescriptions dispensed to 118596 people. Training status of general practitioners (GPs) was found to be the characteristic most associated with prescribing. Adjusting for other GP characteristics had little effect on these results. Training practice status was the dominant factor associated with significant differences in rates of antibiotic prescribing, in class of antibiotic prescribed and in performance indicators of antibiotic prescribing. (+info)
Effects of a structured curriculum in osteopathic manipulative treatment (OMT) on osteopathic structural examinations and use of OMT for hospitalized patients.
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Osteopathic manipulative treatment (OMT) is a defining feature of osteopathic medicine; however, use of OMT by osteopathic physicians is declining. Recent studies reveal that many osteopathic physicians are abandoning use of OMT as early as medical school. Current national efforts are aimed at reversing this trend by standardizing osteopathic medical records and clinical training in OMT. The authors found that a structured clinical curriculum in OMT taught to house staff significantly increased the percentage of patients who received osteopathic structural examinations and the percentage of patients who received OMT as part of their hospital care. (+info)
Use of an open-ended question to supplement a patient satisfaction questionnaire in a medical residents' clinic.
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OBJECTIVES: To determine (1) the proportion of responses to an open-ended question related to patient satisfaction that could be categorized into 1 or more of 9 previously developed domains of out-patient care and (2) whether any other important aspects of care could be identified by adding the open-ended question to a satisfaction questionnaire. STUDY DESIGN: A 3-month observational study was done at the internal medicine clinic of an urban teaching hospital. PATIENTS AND METHODS: As part of a patient satisfaction study, 511 visitors were asked after their visit, "What are the 1 or 2 things that are most important to you when you see a doctor?" The responses were categorized independently by 2 raters into 1 or more of the 9 domains. When these 2 raters disagreed, the responses were read to a third rater. When either all 3 raters disagreed, or at least 1 rater thought a new domain was mentioned, those responses were categorized by consensus. Interobserver reliability between raters 1 and 2 was calculated by using Cohen's kappa statistic. RESULTS: The 355 responses were categorized as follows: 303 (85.4%) identified one or more domains that were part of the previously developed taxonomy, 9 (2.5%) identified a new domain, 11 (3.1%) identified both old and new domains, and 32 (9.0%) could not be categorized. Cohen's kappa was 0.57 (P < .001). Cultural sensitivity and physician honesty were the additional domains identified, by 1.1% and 4.5% of respondents, respectively. CONCLUSIONS: The previously developed taxonomy of domains can be used in this setting to categorize the large majority of open-ended responses. Such responses can identify important aspects of care that were either previously unidentified or were already identified but given low ratings. This information then can help improve quality of care. (+info)
Design and analysis of a Web-based guideline tutorial system that emphasizes clinical trial evidence.
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OBJECTIVE: To describe a Web-based guideline tutorial system and evaluate its features. METHODS: A Web-based tutorial system called SAGE (Self-study Acceleration with Graphic Evidence) was constructed to teach knowledge important for care after myocardial infarction. SAGE features a pretest, followed by an overview that coordinates studying resources for a set of learning objectives. Resources include pretest answers, guideline passages, and graphical presentations of clinical trial results. Data on the use of SAGE was obtained from 79 residents participating in a larger trial. Linear regression was used to correlate the amount learned with resource-use, and resource-use with user characteristics. RESULTS: On average, users accessed less than half of the guideline passages and very little of the graphic evidence. Greater use of guideline passages was correlated with greater immediate learning, but use of graphic evidence was not. CONCLUSIONS: Further research is needed to motivate more thorough self-study and to integrate clinical trial evidence with guideline-based education. (+info)
A study of communication in the Cardiac Surgery Intensive Care Unit and its implications for automated briefing.
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We present a study of the information transferred among caregivers in the context of cardiac surgery and use the study to evaluate a system, MAGIC, that we are developing for automated generation of briefings. Our framework integrates cognitive and quantitative evaluation methods and features three standards that reflect current practice in the Cardiothoracic Intensive Care Unit (CTICU). Using experimental design to compare human-generated and machine-generated briefings, we show that MAGIC's current level of performance is useful. Moreover, MAGIC could help improve information flow in the CTICU by providing a consistent set of information earlier than in current practice. The separate standards are also consistent in suggesting specific modifications that may be necessary for iterative design and further system development. (+info)