Journal of graduate medical education最新文献

Background In 2017, the Accreditation Council for Graduate Medical Education (ACGME) updated select US residency duty hour requirements to improve continuity of care and resident education. It is unknown if this policy change affected hospital quality of care and patient experience. Objective To evaluate the association of the 2017 duty hour policy change with hospital quality and patient experience in teaching vs nonteaching hospitals. Methods In this observational difference-in-differences (DiD) study, hospital quality (patient outcomes) and patient experience metrics were obtained from Centers for Medicare & Medicaid Services Care Compare data from before (July 1, 2014-June 30, 2016) and after (July 1, 2017-June 30, 2019) the 2017 policy change in teaching and nonteaching hospitals. Primary outcomes include hospital quality (five 30-day readmission indicator rates, five 30-day mortality rates, 8 patient safety indicators), and patient experience (5 measures from Hospital Consumer Assessment of Healthcare Providers and Systems survey). Results A total of 2935 hospitals (250 teaching; 2685 nonteaching) were included. When comparing before and after the 2017 policy change, teaching hospitals had greater reductions in hospital-wide readmission (DiD coefficient -0.26; 95% CI, -0.34 to -0.18; P<.001), heart failure readmission (DiD coefficient -0.48; 95% CI, -0.78 to -0.19; P<.002), and stroke mortality rates (DiD coefficient -0.56; 95% CI, -0.94 to -0.19; P<.01) than did nonteaching hospitals. There were no significant differences between teaching and nonteaching hospitals in other outcomes before vs after policy change. Conclusions After the 2017 duty hour policy change, there was no evidence of worsening of hospital quality or patient experience in teaching hospitals, compared to nonteaching hospitals.

Background Despite undergraduate training in geriatric care, gaps persist throughout residency, highlighting limitations of current assessment methods in evaluating medical expertise across geriatric dimensions. Objective We developed a case-based assessment using the geriatric 5Ms framework (Mind, Mobility, Medications, Multicomplexity, Matters Most), aligned with undergraduate objectives and North American internal medicine milestones. We present feasibility data and preliminary validity evidence of using the geriatric 5Ms framework to evaluate residents' geriatric medical expertise. Methods During a 2023 mandatory academic session at a single site, 68 first- to third-year internal medicine residents were randomly assigned to complete assessment and management plans for 3 of 6 geriatric cases within 1 hour. Two blinded educators rated performance on 5Ms dimensions and non-geriatric medical expertise using a 3-level rating scale (0 to 2). We collected feasibility data (logistical integration, participation rates, time to design cases, rate responses) and validity evidence, based on Messick's framework, in part through a post-assessment questionnaire. Results Sixty-five residents completed 3 cases each, and 3 residents completed 2 cases each, resulting in 201 total cases, each integrating all 5Ms dimensions. Scores across the 5Ms dimensions ranged from 0.8 to 1.3, indicating partial assessment and management. All 5Ms dimensions (mean=1.1, SD=0.3) scored significantly lower than non-geriatric medical expertise (mean=1.5; SD=0.3; t(64)=9.58; P<.001). Interrater reliability was moderate to strong (ICC=0.67-0.85, P<.001). Most residents rated the cases (59 of 67, 88%; mean=4.4; SD=0.7) and the assessment (56 of 67, 84%; mean=4.1; SD=0.7) as representative of clinical practice. Conclusions A case-based assessment using the geriatric 5Ms framework demonstrated feasibility and preliminary validity for evaluating residents' geriatric medical expertise.