Amanda Bertram

Perceptions of division directors in general internal medicine about the importance of and support for scholarly work done by clinician-educators

Purpose To determine perceptions of general internal medicine (GIM) division directors of the importance of and support for clinician–educators’ (CEs’) scholarship. Method In 2010, the authors identified 127 accredited U.S. MD-granting medical schools with a GIM division, identified 144 GIM directors, and were able to survey 129 of them. Directors were asked to rate the importance of specific CE scholarly accomplishments for promotion from assistant to associate professor, to describe current research support for CEs, and to state how they would support the scholarly work of CEs if they had funding. Results Fifty-five directors (42.6%) from 52 institutions responded; there were no significant differences between responding and nonresponding schools. Curriculum development, presentations at national meetings and other institutions, review articles, and book chapters were rated as “most/very important” or “important/somewhat important” by over 90%. Approximately half rated published original peer-reviewed articles as “most/very important”; slightly less than half rated these “not important,” a difference associated with having a specific CE track. If

Learner feedback and educational outcomes with an internet-based ambulatory curriculum: a qualitative and quantitative analysis

100,000 per year were available to enhance the scholarly productivity of CEs, directors suggested spending it on faculty development, project coordination, protected time for CEs, and methodological and statistical support. Conclusions This nationwide survey of GIM division directors confirms that academic CEs in GIM are judged on a wide variety of scholarly activities, many of which are consistent across institutions. However, academic GIM CEs need to understand their institutions’ specific criteria, especially regarding the value placed on original, peer-reviewed publications.

How we developed the GIM clinician–educator mentoring and scholarship program to assist faculty with promotion and scholarly work

BackgroundOnline medical education curricula offer new tools to teach and evaluate learners. The effect on educational outcomes of using learner feedback to guide curricular revision for online learning is unknown.MethodsIn this study, qualitative analysis of learner feedback gathered from an online curriculum was used to identify themes of learner feedback, and changes to the online curriculum in response to this feedback were tracked. Learner satisfaction and knowledge gains were then compared from before and after implementation of learner feedback.Results37,755 learners from 122 internal medicine residency training programs were studied, including 9437 postgraduate year (PGY)1 residents (24.4 % of learners), 9864 PGY2 residents (25.5 %), 9653 PGY3 residents (25.0 %), and 6605 attending physicians (17.0 %). Qualitative analysis of learner feedback on how to improve the curriculum showed that learners commented most on the overall quality of the educational content, followed by specific comments on the content. When learner feedback was incorporated into curricular revision, learner satisfaction with the instructive value of the curriculum (1 = not instructive; 5 = highly instructive) increased from 3.8 to 4.1 (p < 0.001), and knowledge gains (i.e., post test scores minus pretest scores) increased from 17.0 % to 20.2 % (p < 0.001).ConclusionsLearners give more feedback on the factual content of a curriculum than on other areas such as interactivity or website design. Incorporating learner feedback into curricular revision was associated with improved educational outcomes. Online curricula should be designed to include a mechanism for learner feedback and that feedback should be used for future curricular revision.

Concurrent Validity Between a Shared Curriculum, the Internal Medicine In-Training Examination, and the American Board of Internal Medicine Certifying Examination

Abstract Clinician Educators’ (CEs) focus on patient care and teaching, yet many academic institutions require dissemination of scholarly work for advancement. This can be difficult for CEs. Our division developed the Clinician–Educator Mentoring and Scholarship Program (CEMSP) in an effort to assist CEs with scholarship, national reputation, recognition, promotion and job satisfaction. The key components are salary-supported director and co-director who coordinate the program and serve as overall mentors and link CEs and senior faculty, and a full-time Senior Research Coordinator to assist with all aspects of scholarship, a close relationship with the General Internal Medicine (GIM) Methods Core provides advanced statistical support. Funding for the program comes from GIM divisional resources. Perceived value was evaluated by assessing the number of manuscripts published, survey of faculty regarding usage and opinion of CEMSP, and a review of faculty promotions. Although impossible to attribute the contributions of an individual component, a program specifically aimed at helping GIM CE faculty publish scholarly projects, increase participation in national organizations and focus on career progression can have a positive impact.

Impact of Medical Residency on Knowledge of Asthma

BACKGROUND A core objective of residency education is to facilitate learning, and programs need more curricula and assessment tools with demonstrated validity evidence. OBJECTIVE We sought to demonstrate concurrent validity between performance on a widely shared, ambulatory curriculum (the Johns Hopkins Internal Medicine Curriculum), the Internal Medicine In-Training Examination (IM-ITE), and the American Board of Internal Medicine Certifying Examination (ABIM-CE). METHODS A cohort study of 443 postgraduate year (PGY)-3 residents at 22 academic and community hospital internal medicine residency programs using the curriculum through the Johns Hopkins Internet Learning Center (ILC). Total and percentile rank scores on ILC didactic modules were compared with total and percentile rank scores on the IM-ITE and total scores on the ABIM-CE. RESULTS The average score on didactic modules was 80.1%; the percentile rank was 53.8. The average IM-ITE score was 64.1% with a percentile rank of 54.8. The average score on the ABIM-CE was 464. Scores on the didactic modules, IM-ITE, and ABIM-CE correlated with each other (P < .05). Residents completing greater numbers of didactic modules, regardless of scores, had higher IM-ITE total and percentile rank scores (P < .05). Resident performance on modules covering back pain, hypertension, preoperative evaluation, and upper respiratory tract infection was associated with IM-ITE percentile rank. CONCLUSIONS Performance on a widely shared ambulatory curriculum is associated with performance on the IM-ITE and the ABIM-CE.

Are Anesthesia Providers Ready for Hypnosis? Anesthesia Providers’ Attitudes Toward Hypnotherapy

Objectives. To assess resident physician knowledge of pathophysiology, diagnosis, and management of asthma and to assess the impact of an interactive curriculum on that knowledge. Participants. A total of 720 resident and attending physicians at 15 internal medicine residency programs. Methods. An educational module and two multiple choice tests were developed using established methods of curriculum development and knowledge assessment, then disseminated online to 15 internal medicine residency programs. Baseline and post-intervention knowledge was analyzed according to year of training using Chi square to detect differences in group performance. Results. Baseline knowledge on asthma was poor. The average baseline score on all questions was 54.2%, and was worst on questions on diagnosis of asthma (47.5% correct) and questions on management of asthma (54.8% correct). Baseline knowledge was best on questions on the pathophysiology of asthma (71.5% correct). On specific concepts, only 41.9% correctly knew which pharmacotherapeutic agents were used as controller agents, and only 43.5% were able to correctly diagnose asthma severity. Knowledge on questions on diagnosis of asthma was no better in post-graduate year (PGY) 3 residents than in PGY1 residents (p = 0.054), but PGY3 residents performed better on questions about management of asthma than did PGY1 residents (p < 0.001). Knowledge improved for all concepts and at all levels of training after completion of an interactive module on asthma guidelines (p < 0.001). Conclusion. Resident physician knowledge of asthma guidelines is poor and can be improved by an interactive curriculum.

Use of an internet-based curriculum to teach internal medicine residents about addiction.

This study sought to measure current attitudes toward hypnosis among anesthesia providers using an in-person survey distributed at a single grand rounds at a single academic teaching hospital. One hundred twenty-six anesthesia providers (anesthesiologists and nurse anesthetists) were included in this study. A 10-question Institutional Review Board (IRB)-approved questionnaire was developed. One hundred twenty-six (73% of providers at the meeting) anesthesia providers completed the survey. Of the respondents, 54 (43%) were anesthesiologists, 42 (33%) were trainees (interns/residents/fellows) in anesthesia, and 30 (24%) were nurse anesthetists. Over 70% of providers, at each level of training, rated their knowledge of hypnosis as either below average or having no knowledge. Fifty-two (42%) providers agreed or strongly agreed that hypnotherapy has a place in the clinical practice of anesthesia, while 103 (83%) believed that positive suggestion has a place in the clinical practice of anesthesia (p < .0001). Common reasons cited against using hypnosis were that it is too time consuming (41%) and requires special training (34%). Only three respondents (2%) believed that there were no reasons for using hypnosis in their practice. These data suggest that there is a self-reported lack of knowledge about hypnosis among anesthesia providers, although many anesthesia providers are open to the use of hypnosis in their clinical practice. Anesthesia providers are more likely to support the use of positive suggestion in their practice than hypnosis. Practical concerns should be addressed if hypnosis and therapeutic verbal techniques are to gain more widespread use.

Geographically Localized Medicine House-Staff Teams and Patient Satisfaction:

Objectives:Addiction is an important and common health problem. Many internal medicine training programs do not offer structured training in addiction; as a result, residents often report feeling unprepared in caring for patients with this problem. We developed an Internet-based curriculum to teach internal medicine residents about evaluating and treating patients with substance use disorders. Methods:Three educational modules on addiction were developed and posted on an established Web site that provides an internal medicine curriculum for training programs throughout the United States. Baseline and posttest questions were tested and validated by having house officers and addiction medicine faculty members complete the tests. We compared baseline pretest scores between first (PGY-1) and third year (PGY-3) residents to assess baseline knowledge and pretest and posttest scores for the entire cohort to assess the impact of the modules. Results:Each module was completed by over 1200 residents at 86 different training programs. Although overall baseline pretest scores were better among PGY-3 than PGY-1 residents (mean 58% vs 55%; P < 0.05), the difference between the 2 groups for individual modules was not significant. The mean baseline pretest score was 56.4% and posttest score was 74.8%, a difference that was statistically significant (P < 0.001). When asked to rate the educational value of the program, the residents gave it a mean score of 4.2 on a 5-point Likert scale (1 = not instructive; 5 = highly instructive). Conclusions:Internet-based curricula can be an effective tool to disseminate knowledge on addiction to trainees. Learners show an improvement in testing scores and rate these programs highly.

Patient Perceptions of Readmission Risk: An Exploratory Survey

Background: Geographically localized care teams may demonstrate improved communication between team members and patients, potentially enhancing coordination of care. However, the impact of geographically localized team on patient experience scores is not well understood. Objective: To compare experience scores of patients on resident teams home clinical units with patients assigned to them off of their home units over a 10-year period. Participants: Patients admitted to any of the 4 chief resident staffed internal medicine inpatient service were included. Patients admitted to the house-staff teams’ home clinical unit comprised the exposure group and their patients off of their home units comprised the control patients. Measurement: Top-box experience scores calculated from the physician Hospital Consumer Assessment of Healthcare and Provider Systems (HCAHPS) and Press Ganey patient satisfaction surveys. Results: There were 3012 patients included in the study. There were no significant differences in experience scores with physician communication, nursing communication, pain, or discharge planning between the 2 groups. Patients did not report satisfaction more often with the time physicians spent with them on localized teams (48.6% vs 47.5%; P = .54) or that staff were better at working together (63.2% vs 61.3%; P = .29). This did not change during a 45-month period when the proportion of patients on home units exceeded 75% and multidisciplinary rounds were started. Conclusion: Patients cared for by geographically localized teams did not have better patient experience. Other factors such as physician communication skills or limited time spent in direct care may overshadow the impact of having localized teams. Further research is needed to better understand organizational, team, and individual factors impacting patient experience.

Does Patient Experience Predict 30-Day Readmission? A Patient-Level Analysis of HCAHPS Data

Interventions to prevent readmissions often rely upon patient participation to be successful. We surveyed 895 general medicine patients slated for hospital discharge to (1) assess patient attitudes surrounding readmission, (2) ascertain whether these attitudes were associated with actual readmission, and (3) determine whether patients can estimate their own readmission risk. Actual readmissions and other clinical variables were captured from administrative data and linked to individual survey responses. We found that actual readmissions were not correlated with patients’ interest in preventing readmission, sense of control over readmission, or intent to follow discharge instructions. However, patients were able to predict their own readmissions (P = .005) even after adjusting for predicted readmission rate, race, sex, age, and payer. Reassuringly, over 80% of respondents reported that they would be frustrated or disappointed to be readmitted and almost 90% indicated that they planned to follow all of their discharge instructions. Whether assessing patient-perceived readmission risk might help to target preventive interventions warrants further study.