We describe a method for scheduling shifts in a large academic emergency medicine group. The method starts with a survey of the faculty to assign shift equivalent values to each of the 13 different shifts used during ...
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We describe a method for scheduling shifts in a large academic emergency medicine group. The method starts with a survey of the faculty to assign shift equivalent values to each of the 13 different shifts used during the week. A weekday day shift is assigned a value of 1.0, and the shifts range in value up to 2.1 units. Each faculty member is then assigned a shift allocation for the academic year equally divided among the various shift types. Faculty members can request reallocation of shift types on the basis of the individual shift equivalent values. Once the number of the different shifts are allocated as required by the schedule, a lottery is held whereby individual faculty members choose specific shifts in turn for the upcoming year. The lottery selection is done by the faculty members accessing a common server from their office computers during a specified period. The lottery process continues until all shifts are filled. The creation of shift equivalent values facilitates the initial allocation of shifts and subsequent trades between faculty members.
This study examines the reliability and accuracy of ratings by general surgery residents of surgical faculty. Twenty-three of 33 residents anonymously and voluntarily evaluated 62 surgeons in June, 1988;24 of 28 resid...
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This study examines the reliability and accuracy of ratings by general surgery residents of surgical faculty. Twenty-three of 33 residents anonymously and voluntarily evaluated 62 surgeons in June, 1988;24 of 28 residents evaluated 64 surgeons in June, 1989. Each resident rated each surgeon on a 5-point scale for each of 10 areas of performance: technical ability, basic science knowledge, clinical knowledge, judgment, peer relations, patient relations, reliability, industry, personal appearance, and reaction to pressure. Reliability analyses evaluated internal consistency and interrater correlation. Accuracy analyses evaluated halo error, leniency/severity, central tendency, and range restriction. Ratings had high internal consistency (coefficient alpha = 0.97). Interrater correlations were moderately high (average Pearson correlation = 0.63 among raters). Ratings were generally accurate, with halo error most prevalent and some evidence of leniency. Ratings by chief residents had the least halo. Results were generally replicable across the two academic years. We conclude that anonymous ratings of surgical faculty by groups of residents can provide a reliable and accurate evaluation method, ratings by chief residents are most accurate, and halo error may pose the greatest threat to accuracy, pointing to the need for greater definition of evaluation items and scale points.
Objective: To identify factors associated with the use of episiotomy at spontaneous vaginal delivery. Methods: We studied 1576 consecutive term, singleton, spontaneous vaginal deliveries in nulliparas at Brigham &...
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Objective: To identify factors associated with the use of episiotomy at spontaneous vaginal delivery. Methods: We studied 1576 consecutive term, singleton, spontaneous vaginal deliveries in nulliparas at Brigham & Women's Hospital between December 1, 1994 and July 31, 1995. The association of demographic variables and obstetric factors with the rate of episiotomy use were examined. Adjusted odds ratios (OR) and confidence intervals (CI) were estimated from multiple logistic regression analysis. Results: The overall rate of episiotomy was 40.6% (640 of 1576). Midwives performed episiotomies at a lower rate (21.4%) than faculty (33.3%) and private providers (55.6%) (P = .001). After controlling for confounding factors with logistic regression, private practice provider was the strongest predictor of episiotomy use (OR, 4.1;95% CI, 3.1, 5.4) followed by faculty provider (OR, 1.7;95% CI, 1.1, 2.5), prolonged second stage of labor (OR, 1.8;95% CI, 1.2, 2.7), fetal macrosomia (OR, 1.6;95% CI, 1.1, 2.5), and epidural analgesia (OR 1.4, 95% CI, 1.1, 1.8). Conclusion: The strongest factor associated with episiotomy at delivery was the category of obstetric provider. Obstetric and demographic factors evaluated did not readily explain this association. (C) 2000 by The American College of Obstetricians and Gynecologists.
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