“Teaching as a Competency”: Competencies for Medical Educators.
Acad Med. 2011 Aug 24;
Authors: Srinivasan M, Li ST, Meyers FJ, Pratt DD, Collins JB, Braddock C, Skeff KM, West DC, Henderson M, Hales RE, Hilty DM
Abstr…

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Art Rounds: Teaching Interprofessional Students Visual Thinking Strategies at One School.
Acad Med. 2011 Aug 24;
Authors: Klugman CM, Peel J, Beckmann-Mendez D
Abstract
PURPOSE: The Art Rounds program uses visu…

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The Incidence and Predictors of Job Burnout in First-Year Internal Medicine Residents: A Five-Institution Study.
Acad Med. 2011 Aug 24;
Authors: Ripp J, Babyatsky M, Fallar R, Bazari H, Bellini L, Kapadia C, Katz JT, Pecker M,…

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Difficult Issues in Mentoring: Recommendations on Making the “Undiscussable” Discussable.
Acad Med. 2011 Aug 24;
Authors: Bickel J, Rosenthal SL
Abstract
Many mentoring relationships do not reach fruition becau…

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Teachers as Learners: The Effect of Bedside Teaching on the Clinical Skills of Clinician-Teachers.
Acad Med. 2011 May 25;
Authors: Wenrich MD, Jackson MB, Ajam KS, Wolfhagen IH, Ramsey PG, Scherpbier AJ
PURPOSE: To ass…

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Commentary: is the glass half empty? Code blue training in the modern era.
Acad Med. 2011 Jun;86(6):680-3
Authors: Yang J, Howell MD
Skilled management of cardiopulmonary resuscitation, or responding to a “code blue,” …

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Reduced Resident “Code Blue” Experience in the Era of Quality Improvement: New Challenges in Physician Training.
Acad Med. 2011 Apr 20;
Authors: Mickelsen S, McNeil R, Parikh P, Persoff J
PURPOSE: Emergency resuscitati…

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Bayes’ Theorem and the Physical Examination: Probability Assessment and Diagnostic Decision Making.
Acad Med. 2011 Mar 23;
Authors: Herrle SR, Corbett EC, Fagan MJ, Moore CG, Elnicki DM
PURPOSE: To determine how examin…

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Shifting Indirect Patient Care Duties to After Hours in the Era of Work Hours Restrictions.
Acad Med. 2011 Mar 23;
Authors: Mourad M, Vidyarthi AR, Hollander H, Ranji SR
PURPOSE: Few data describe how often residents d…

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Lost in Transition: The Experience and Impact of Frequent Changes in the Inpatient Learning Environment.
Acad Med. 2011 Mar 23;
Authors: Bernabeo EC, Holtman MC, Ginsburg S, Rosenbaum JR, Holmboe ES
PURPOSE: The tradit…

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Use of simulated pages to prepare medical students for internship and improve patient safety.
Acad Med. 2011 Jan;86(1):77-84
Authors: Schwind CJ, Boehler ML, Markwell SJ, Williams RG, Brenner MJ
During the transition f…

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Perspective: Malpractice in an Academic Medical Center: A Frequently Overlooked Aspect of Professionalism Education.

Acad Med. 2011 Jan 18;

Authors: Hochberg MS, Seib CD, Berman RS, Kalet AL, Zabar SR, Pachter HL

Understanding how medical malpractice occurs and is resolved is important to improving patient safety and preserving the viability of a physician’s career in academic medicine. Every physician is likely to be sued by a patient, and how the physician responds can change his or her professional life. However, the principles of medical malpractice are rarely taught or addressed during residency training. In fact, many faculty at academic medical centers know little about malpractice.In this article, the authors propose that information about the inciting causes of malpractice claims and their resolution should be incorporated into residency professionalism curricula both to improve patient safety and to decrease physician anxiety about a crucial aspect of medicine that is not well understood. The authors provide information on national trends in malpractice litigation and residents’ understanding of malpractice, then share the results of their in-depth review of surgical malpractice claims filed during 2001-2008 against their academic medical center. The authors incorporated those data into an evidence-driven curriculum for residents, which they propose as a model for helping residents better understand the events that lead to malpractice litigation, as well as its process and prevention.

PMID: 21248606 [PubMed - as supplied by publisher]

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Checklists to Reduce Diagnostic Errors.

Acad Med. 2011 Jan 18;

Authors: Ely JW, Graber ML, Croskerry P

Diagnostic errors are common and can often be traced to physicians’ cognitive biases and failed heuristics (mental shortcuts). A great deal is known about how these faulty thinking processes lead to error, but little is known about how to prevent them. Faulty thinking plagues other high-risk, high-reliability professions, such as airline pilots and nuclear plant operators, but these professions have reduced errors by using checklists. Recently, checklists have gained acceptance in medical settings, such as operating rooms and intensive care units. This article extends the checklist concept to diagnosis and describes three types of checklists: (1) a general checklist that prompts physicians to optimize their cognitive approach, (2) a differential diagnosis checklist to help physicians avoid the most common cause of diagnostic error-failure to consider the correct diagnosis as a possibility, and (3) a checklist of common pitfalls and cognitive forcing functions to improve evaluation of selected diseases. These checklists were developed informally and have not been subjected to rigorous evaluation. The purpose of this article is to argue for the further investigation and revision of these initial attempts to apply checklists to the diagnostic process. The basic idea behind checklists is to provide an alternative to reliance on intuition and memory in clinical problem solving. This kind of solution is demanded by the complexity of diagnostic reasoning, which often involves sense-making under conditions of great uncertainty and limited time.

PMID: 21248608 [PubMed - as supplied by publisher]

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Commentary: lowly interns, more is merrier, and the casablanca strategy.

Acad Med. 2011 Jan;86(1):8-10

Authors: Croskerry P

Test ordering is an integral part of clinical decision making. Variation in test-ordering behavior appears to reflect uncertainty in the clinical reasoning and decision-making process. Among decision makers, novices function mostly in the analytic mode of reasoning, experiencing high levels of uncertainty and, therefore, account for the most variance. While less discriminate test ordering has both economical and clinical downsides, it nevertheless remains a rite of passage along the road toward expertise.In response to the article by Iwashyna and colleagues, the author of this commentary reflects on the implications of test-ordering behavior in the academic medicine setting. The process of ordering tests can serve purposes other than the obvious, not the least of which allows the decision maker additional time for reflection in the decision-making process, perhaps leading to a less mindless and more mindful approach.The author observes that test-ordering behavior of novitiates might be optimized through a variety of strategies that improve both active and passive learning in the clinical environment. In addition to specific education around costs, as well as Bayesian considerations, active learning importantly requires exposure to those processes that may subvert clinical reasoning, notably cognitive biases. Passive learning is enhanced in supportive environments. Throughout, those who supervise and teach should provide effective models.

PMID: 21191201 [PubMed - in process]

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Almost Internists: Analysis of Students Who Considered Internal Medicine but Chose Other Fields.

Acad Med. 2010 Dec 16;

Authors: Durning SJ, Elnicki DM, Cruess DF, Reddy S, Kernan WN, Harrell HE, Schwartz MD, Fagan MJ, Battistone M, Hauer KE

PURPOSE: Medical students’ career choices affect health care. To understand how to increase the number of students who choose careers in internal medicine (IM), students who seriously considered IM but chose another field (“Switchers”) and those who rejected IM (“Never Considered”) were compared with those who chose IM (“Choosers”). METHOD: Fourth-year medical students from 11 U.S. institutions were surveyed about demographics, medical school educational experiences, and aspects of the specialty of IM. Univariate analysis and multivariate logistic regression models examined associations between student characteristics and classification as Switchers, Choosers, and Never Considered. RESULTS: A total of 1,177 students completed the survey (82% response rate). There were 274 (23%) Choosers, 398 (34%) Switchers, and 499 (43%) Never Considered. The authors’ models explained over 80% of variance in these three career choice classification groups. For most responses, an increasingly favorable gradient from Never Considered to Choosers was observed. Multivariate analysis revealed six items that were associated with higher probability of choosing IM: types of patients internists see, timing of career decision, interest groups, intellectual challenge, satisfaction among internists, and the core IM clerkship. CONCLUSIONS: Several potentially modifiable educational experiences and aspects of IM distinguished Switchers from the other two groups. The percentage of variance explained by group suggests that these findings identify important underpinnings of career decisions. These items also suggest ways that educational experiences and aspects of the specialty could be redesigned by academicians and policy makers to improve the attractiveness of IM careers.

PMID: 21169784 [PubMed - as supplied by publisher]

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