Medicare's Prospective Payment System pays teaching hospitals using a regression coefficient in a log-log cost function. Previous literature showed that this coefficient is sensitive to the covariates included in ...
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Medicare's Prospective Payment System pays teaching hospitals using a regression coefficient in a log-log cost function. Previous literature showed that this coefficient is sensitive to the covariates included in the function, but specified teaching intensity as the logarithm of one plus the intern and resident-to-bed ratio. Provided the true relationship is log-log, adding one biases the coefficient substantially but not predicted cost. In a re-specified equation that makes this bias negligible, the coefficient is not nearly as sensitive to the inclusion of other covariates. Because further issues remain to be explored, it is premature to use our results for policy purposes.
Pager-based activity sampling (PAS) is described as a cost-effective and unobtrusive method for sampling residents' activitiesin clinical settings. A sample program evaluation is presented using residents in an ur...
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Pager-based activity sampling (PAS) is described as a cost-effective and unobtrusive method for sampling residents' activitiesin clinical settings. A sample program evaluation is presented using residents in an urban children's hospital resident-trainingprogram. The purposes of the program evaluation were: (a) to establish a behavioral baseline that would help clinical facultyunderstand how residents were using their time, and (b) to determine whether alterations in the way residents were assignedwithin the hospital resulted in desired changes to time spent. The primary rationale for changing resident-assignment policieswere: (a) to decrease the time residents were spending in transit between various locations within the hospital, and (b) toincrease the time spent by residents in educational activities and in direct contact with patients and their families. ThisPAS application demonstrates that the technique can produce statistically supportable conclusions, at minimal cos4 withoutunduly disrupting either the residents or their patients. PAS is compared with other time-sampling methods, its limitationsare discussed, and suggestions for future applications are provided.
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.
Examines a model to improve diversity among trainees in psychiatry in the U.S. Formation of the Harvard Longwood Psychiatry Residency Training Program (HLPRTP) in 1994; Efforts of the HLPRTP to improve minority recrui...
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Examines a model to improve diversity among trainees in psychiatry in the U.S. Formation of the Harvard Longwood Psychiatry Residency Training Program (HLPRTP) in 1994; Efforts of the HLPRTP to improve minority recruitment efforts; Matching of one Afro-American resident who had done the Visiting Clerkship and one Asian who had met with several Diversity Committee members during the application process.
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