Journal of graduate medical education最新文献

Background Academic institutions in the United States continue to struggle with increasing the rate of patient safety event reporting by trainees. Objective To describe the development and implementation of 2 escape room cases with the goal of improving resident reporting of adverse events, reporting participant teamwork and communication skills, and describing feasibility and acceptability data. Methods We developed 2 high-fidelity medical simulation cases via group consensus from an interprofessional team as part of a required quality improvement curriculum for all graduate medical education learners. Senior residents and fellows from all training programs at a single university were recruited to participate. We utilized the New World Kirkpatrick Model levels 1-2 as our program evaluation framework to analyze data from participants between 2022 and 2023. Surveys were collected via an online survey tool immediately prior to and following the event. Results Over 2 years, 130 learners participated in the escape room event (78 residents [60%] and 52 fellows [40%] across 15 specialties/subspecialties). One hundred twenty-four (95%) completed the post-event survey. Eighty-four percent (104 of 124) reported they had never submitted a patient safety event report prior to this activity. All strongly agreed or agreed this educational activity had clear goals and was organized, 94% (117 of 124) felt the escape error room was relevant to their needs as a physician in training, and 83% (103 of 124) reported greater likelihood of submitting an event report in the future. Cost was $6 per learner. Conclusions This educational modality demonstrated feasibility and acceptability and improved overall willingness to submit future patient safety event reports.

Background Cross-cover is a cognitively complex, understudied aspect of graduate medical education. Understanding it through cognitive load theory can reveal areas of excessive cognitive load that can hinder reasoning and learning. Objective To characterize perceived cross-cover challenges by residents using a cognitive load lens. Methods An anonymous electronic survey was sent to 329 residents in internal medicine, internal medicine-pediatrics, pediatrics, general surgery, and neurology at a single academic institution in 2023. They were asked to characterize the frequency and perceived likelihood of associated adverse events of cross-cover challenges on 5-point Likert scales. These challenges were categorized by cognitive load type (intrinsic, extraneous, or germane). An impact score (range 1 to 25) was calculated by multiplying the frequency rating by the perceived likelihood of an adverse event. Differences between intern (postgraduate year [PGY] 1) and senior (PGY-2+) residents were examined. Results Response rate was 48% (n=158). Challenges related to extraneous load were the most impactful barrier to cross-cover care, including (average [±SD]): hospital short staffed (13.5 [±5.7]), receiving unnecessary notifications (12.9 [6.4]), and competing responsibilities (12.1 [5.6]). The impact of challenges characterized by intrinsic and germane loads varied between resident level, with higher impact for PGY-1 residents. These include lack of medical knowledge, lack of knowledge of hospital processes, delay calling attending overnight, and delay calling consultants overnight. Conclusions Cross-cover challenges related to extraneous load emerged as the most impactful barrier to effective cross-cover care, with PGY-1 residents experiencing a higher burden from intrinsic and germane loads than PGY-2+ residents.

Background Transitions in care between resident physician teams represent a vulnerable time for hospitalized patients and are prone to increased adverse patient outcomes. Objective This prospective study evaluated whether a pragmatic, time-efficient intervention could decrease adverse patient outcomes during end-of-week transitions of care between inpatient resident teams. Methods From September 2022 to May 2024, following their first week of inpatient service, resident teams performed an unstructured written handoff to the next team (control group). At the end of their second inpatient week, the team performed a structured verbal handoff utilizing the I-PASS system (intervention group). Two days prior to their verbal handoff, residents received a 5- to 10-minute teaching session on the appropriate use of the I-PASS system. On switch days, 4 adverse patient events (primary composite endpoint) were collected including delays in patient discharge, delays in scheduled procedures, incomplete patient-to-physician communications, and major adverse patient events. Results A total of 3744 patients were evaluated: 2000 in the control group and 1744 in the intervention group. The composite endpoint incidence was 6.35% (127 of 2000) in the control group and 3.61% (63 of 1744) in the intervention group (X²=13.9, P=.002). This represented an absolute risk reduction of 2.74% (95% CI, 1.3-4.1) and a number needed to treat of 37 (95% CI, 24-75). Conclusions The implementation of a time-efficient structured verbal I-PASS handoff, when compared to an unstructured handoff, was associated with a decrease in number of adverse patient outcomes during end-of-week transitions of care.

Background It can be challenging to successfully identify and prioritize wellness resources for residency programs within financially strained or smaller hospital systems. As part of COMPADRE (California Oregon Medical Partnership to Address Disparities in Rural Education and Health), trainee well-being was identified as a key priority due to the significant challenges graduate medical education (GME) programs face in supporting residents. Objective To develop a portable collaborative wellness programming model for GME leaders to use in support of trainee well-being. Methods The wellness model was developed in 2020 following an initial needs assessment with 31 GME programs, including rural sites in Oregon and Northern California and 2 urban academic medical centers. During the final year of the grant, a focus group was conducted to evaluate the impact of the model and included well-being faculty and staff leaders from multiple GME programs who consistently participated in our wellness programs. Results In response to the initial needs assessment, a wellness collaborative model was created, which included a wellness curriculum, peer support training, and a wellness community of practice (CoP). On average, 10 of the 31 GME programs participated in each of these offerings. Four modules were created in the following wellness domains: narrative reflection, belonging, mental health, and sense of purpose. During the final year of the grant, a semistructured focus group was conducted to evaluate the peer support trainings and CoP. A final needs assessment done by grant leadership revealed sustaining the program beyond the grant was a priority for most participants. Conclusions An adaptable collaborative wellness model was developed and met the wellness needs of GME programs by providing a wellness curriculum, peer support training, and a community of practice.

Background What does skilled coaching look like when learners discuss diverse racial or ethnic identities, or when such diversity occurs within the coach-coachee dyad? Medical education literature is sparse, and the extensive business and wellness coaching literature does not account for physician identity formation or the inherent hierarchies in graduate medical education. Objective To understand best practices for coaching racially and ethnically diverse learners through qualitative sampling of a range of expert perspectives. Methods Using constructivist grounded theory, 2 groups, expert coaches outside of medicine and leaders of academic coaching programs within medicine, underwent sequential semistructured interviews using snowball sampling. Topics included the role of coach and coachee identity in coaching, whether racial or ethnic dyad diversity influences coaching, and errors a coach may make through inquiry or lack thereof. Using iterative inductive coding, final themes were identified, and a conceptual map was created. Results In 2023, 16 subjects were interviewed (10 and 6 in each group). Five themes emerged from Group 1: (1) Contextually managing relationships; (2) Leveraging coaching competencies, in particular to create a trusted relationship; (3) Ongoing self-development; (4) Seeing the whole person; and (5) Selecting a coach with similar identity. Group 2 responses demonstrated 4 themes: (1) Intentionally building connection and rapport; (2) Navigating power differentials; (3) Acknowledging the lived experience; and (4) Exercising self-awareness. Conclusions This qualitative study of coaching experts provides themes and best practices related to how identity, particularly underrepresented racial/ethnic identity, can be addressed skillfully in the graduate medical education coaching relationship.