Colleen Y. Colbert

Nurses' perceptions of simulation-based interprofessional training program for rapid response and code blue events.

Following completion of an interprofessional simulation program for rapid response and code blue events, we explored hospital unit nurses perspectives of the training, through a mixed-methods analysis. The results of this study advocate for the use of simulation training in preparing nurses and promoting communication among team members, effective teamwork, and early recognition of clinically deteriorating patients. This study provides support for the implementation and continued use of simulation interprofessional programs in hospital settings.

A Review of Portfolio Use in Residency Programs and Considerations before Implementation

Background: Portfolios, often described as collections of evidence, are discussed as a means of teaching or assessing the Accreditation Council for Graduate Medical Education competencies. Yet, it is unclear how many residency programs utilize portfolios. The purpose of this article is to (a) review the literature on portfolio use in graduate medical education; (b) examine efficacy of portfolio use, based upon studies in the field; and (c) offer a discussion of considerations for implementing portfolios. Summary: Two searches of PubMed, OVID, JSTOR, SCOPUS, and FirstSearch Wilson Select were conducted between October 2006 and April 2007 to identify studies and articles related to portfolio usage. Thirty-nine articles met criteria and were reviewed. Conclusions: There is wide variation in how portfolios are utilized within U.S. residency programs. The challenge for graduate medical education is to create consensus on the definition and purpose of portfolios, such that best practices in portfolio implementation and assessment can be achieved.

Clinical Competency Committees and Assessment: Changing the Conversation in Graduate Medical Education.

The Accreditation Council for Graduate Medical Educations (ACGME) new accreditation system has introduced a significantly different world of assessment with its language of milestones and centralized oversight of trainee performance by Clinical Competency Committees (CCCs). Just as the shift to competency-based education and assessment required a culture shift for graduate medical education programs across the United States,1 so, too, does the shift to using CCCs to determine trainee progression on milestones. In this article, we offer our perspectives on the role of the CCC and discuss challenges and opportunities for graduate medical education programs as they enter this new world of assessment.

How to interpret surveys in medical research: a practical approach.

Surveys are being used increasingly in health-care research to answer questions that may be difficult to answer using other methods. While surveys depend on data that may be influenced by self-report bias, they can be powerful tools as physicians seek to enhance the quality of care delivered or the health care systems they work in. The purpose of this article is to provide readers with a basic framework for understanding survey research, with a goal of creating well-informed consumers. The importance of validation, including pretesting surveys before launch, will be discussed. Highlights from published surveys are offered as supplementary material. Was the survey well designed? Was the sample appropriate and the response rate adequate? And do the data support the conclusions?

Patients' attention to and understanding of adverse drug reaction warnings

Correspondence: Tresa Muir McNeal Scott & white Hospital, Dept of Internal Medicine, 2401 South 31st St, Temple, TX 76508, USA email tmcneal@swmail.sw.org Introduction: Medications are critical to the management of patient conditions, and they can have significant effects on the success or failure of medical interventions. Patient perceptions of drug warnings play an important role in medication compliance and ultimately disease management. Several factors may affect patients’ understanding of drug warnings and drug labeling, including health literacy and interactions with physicians and pharmacists. Purpose: The purpose of this article is to provide a review of the literature related to patient perceptions of drug warnings and drug labeling. Descriptive articles and studies regarding patient perceptions and knowledge of adverse drug reaction warnings were reviewed. Methods: The following databases were utilized to search the literature related to patient perceptions of drug warnings: PubMed, Academic Search Premiere, CINAHL, Medline, Psych Info, Business Source Complete, Alternative Healthwatch, Health Source (both Nursing/Academic and Consumer additions), JSTOR, and Master File Premiere. For the purpose of this review, any peer-reviewed article was eligible. Exclusionary criteria included: articles published in languages other than English, articles/studies on patient perceptions of vaccines and chemotherapy, and articles related to perceptions of medications administered in the inpatient setting. Forty-six articles were included in the review. Results: Health literacy has been shown to have a major impact on patients’ ability to understand potential adverse reactions and instructions on correct dosing of medications. Direct communication with physicians and pharmacists is one of the most important and effective variables in promoting understanding of drug warnings. Appropriateness of written medical information that is informative and timely can improve patients’ perceptions of drug warnings and hopefully disease management. Conclusion: As patients increasingly assume more personal responsibility as informed consumers of health care, it is even more important to address patient perceptions of drug warnings considering how this fits in the context of their overall care.

Enhancing competency in professionalism: targeting resident advance directive education.

BACKGROUNDnEducation about advance directives typically is incorporated into medical school curricula and is not commonly offered in residency. Residents experiences with advance directives are generally random, nonstandardized, and difficult to assess. In 2008, an advance directive curriculum was developed by the Scott & White/Texas A&M University System Health Science Center College of Medicine (S&W/Texas A&M) internal medicine residency program and the hospitals legal department. A pilot study examining residents attitudes and experiences regarding advance directives was carried out at 2 medical schools.nnnMETHODSnIn 2009, 59 internal medicine and family medicine residents (postgraduate year 2-3 [PGY-2, 3]) completed questionnaires at S&W/Texas A&M (n u200a=u200a 32) and The University of Texas Medical School at Houston (n u200a=u200a 27) during a validation study of knowledge about advance directives. The questionnaire contained Likert-response items assessing attitudes and practices surrounding advance directives. Our analysis included descriptive statistics and analysis of variance (ANOVA) to compare responses across categories.nnnRESULTSnWhile 53% of residents agreed/strongly agreed they had sufficient knowledge of advance directives, given my years of training, 47% disagreed/strongly disagreed with that statement. Most (93%) agreed/strongly agreed that didactic sessions on advance directives should be offered by my hospital, residency program, or medical school. A test of responses across residency years with ANOVA showed a significant difference between ratings by PGY-2 and PGY-3 residents on 3 items: Advance directives should only be discussed with patients over 60, I have sufficient knowledge of advance directives, given my years of training, and I believe my experience with advance directives is adequate for the situations I routinely encounter.nnnCONCLUSIONnOur study highlighted the continuing need for advance directive resident curricula. Medical school curricula alone do not appear to be sufficient for residents needs in this area.

An Alternative Practice Model: Residents Transform Continuity Clinic and Become Systems Thinkers

BACKGROUNDnA changing health care environment has created a need for physicians trained in health system improvement. Residency programs have struggled to teach and assess practice-based learning and improvement and systems-based practice competencies, particularly within ambulatory settings.nnnINTERVENTIONnWe describe a resident-created and resident-led quality and practice-improvement council in an internal medicine continuity clinic. We conducted focus groups and report on residents perspectives on council membership, practice management experiences, quality improvement projects, and resident satisfaction.nnnMETHODnFocus groups were held from May 2009 to March 2010 with internal medicine residents (Nu2009u200a=u200au20095/focus group) who participated in the Continuity Clinic Ownership in Resident Education (CCORE) council. Data were analyzed with a grounded theory approach.nnnRESULTSnDURING THE FOCUS GROUPS, RESIDENTS RESPONDED TO THE QUESTION: Do you have any new insights into delivering quality patient care in an outpatient clinic as a result of this experience (CCORE membership)? The qualitative analysis resulted in 6 themes: systems thinking and systems-based care skills; improving quality of patient care; improved clinic efficiency; ownership of patients; need for improved communication of practice changes; and a springboard for research.nnnCONCLUSIONSnCCORE residents participated in system changes and acquired leadership skills while working on practice-based and system problems in a clinic microsystem. We believe this model can be implemented by other residency programs to promote the development of systems thinking in residents, increase their ownership of continuity clinic, and empower them to implement system changes.

Tool for Diagnosing Gaps Within a Competency-Based Assessment System

Tool for Diagnosing Gaps Within a Competency-Based Assessment System S. Bierer;Colleen Colbert;Cecile Foshee;Judith French;Lily Pien; Academic Medicine

Comparison of documentation and evidence-based medicine use for non-ST-segment elevation myocardial infarction among cardiology, teaching, and nonteaching teams.

Non-ST-segment elevation myocardial infarctions (NSTEMI) are common and cause significant morbidity and mortality. Following evidence-based medicine (EBM) guidelines is one way to ensure that these patients are cared for appropriately. This pilot study examined data from patients with NSTEMI to assess both documentation quality and use of EBM across multiple teams. Medical records were reviewed for significant differences in documentation quality in areas including history and physical exam, treatment, and inpatient mortality. While total documentation quality and mortality were not significantly different between groups, cardiology teams adhered to evidence-based recommendations more often than other teams.

Factors Associated with Performance in an Internal Medicine Clerkship

The purpose of this retrospective study was to examine the relationship between demographic and educational variables and student performance on an internal medicine (IM) clerkship in order to target areas for educational intervention and potential early remediation. This study examined data associated with third-year medical student performance (N = 505) during the IM clerkship at Baylor Scott & White, Temple/Texas A&M Health Science Center College of Medicine from 2005 to 2011. Multiple regression analysis (N = 341) showed that a model containing the following variables was significantly associated with scores on the National Board of Medical Examiners (NBME) subject exam, accounting for 46.5% of the variance: Objective Structured Clinical Exam (OSCE), Medical College Admissions Test (MCAT), US Medical Licensing Exam (USMLE) Step 1, second-year grade point average (GPA), and clinical evaluation. A model containing USMLE Step 1, clinical evaluation, and NBME was significantly associated with OSCE score, accounting for 30% of the variance. Additionally, a model containing age, MCAT score, undergraduate GPA, NBME subject exam score, and OSCE was significantly associated with clinical evaluation score, accounting for 22% of score variance. Age accounted for the most unique variance in clinical evaluation score. Gender and IM interest group were not significantly associated with any outcome variable. In conclusion, in contrast to previous studies in the field, we did not find a significant association between undergraduate GPA and NBME score. Our findings supply further evidence that the OSCE, typically believed to be a clinical performance exam, actually assesses a broader set of domains. Interest group membership did not confer any academic benefit to medical students in IM clerkships in our study.