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PRACTICUM-INTERNSHIP .1. DEVELOPMENT, IMPLEMENTATION AND STUDENT PARTICIPATION

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AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 1976年第1期40卷 16-21页

作者： BENDER, KJ LEMBERGER, MA UNIV FLORIDA COLL PHARMGAINESVILLEFL 32610

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A theory-based curriculum for enhancing surgical skillfulness

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2007年第3期205卷 492-497页

作者： Boehler, Margaret L. Schwind, Cathy J. Rogers, David A. Ketchum, Janet O'Sullivan, Erin Mayforth, Ruth Quin, Jacquelyn Wohltman, Chris Johnson, Colleen Williams, Reed G. Dunnington, Gary So Illinois Univ Sch Med Dept Surg Springfield IL 62794 USA

BACKGROUND: Curricula for surgical technical skills laboratories have traditionally been designed to accommodate the clinical activities of residents, so they typically consist of individual, episodic training sessions. We believe that the skills laboratory offers an opportunity to design a surgical skills curriculum based on the fundamental elements known to be important for motor skill instruction. We hypothesized that training novices with such a curriculum for a 1-month period would yield skills performance levels equivalent to those of second year surgery residents who had trained in a traditional program. STUDY DESIGN: Fourth-year medical students served as study subjects (novice group) during a 4-week senior elective. They were taught each skill during a 1-week period. Subjects received instruction by a content expert followed by a 1-week period of deliberate practice with feedback. The novice performances were videotaped both before and after the intervention, and each videotape was evaluated in a blinded fashion by experts using a validated evaluation instrument. These results were compared with skill performance ratings of first- and second-year surgery residents that had been accumulated over the previous 3 years. RESULTS: Average performance ratings for the novices substantially improved for all four skills after training. There was no marked difference between average performance ratings of postintervention novice scores when compared with the average scores in the resident group. Inter-rater agreement in scoring for the videotaped novice performances exceeded 0.87 (intraclass correlation) for all ratings of pre- and posttraining. CONCLUSIONS: These results demonstrate the effectiveness of a laboratory-based training program that includes fundamentals of motor skills acquisition.

关键词： Adult Clinical Competence Curriculum Education Medical Graduate Educational Measurement 成年人临床工作能力课程教育医学研究生教育考核实习医师和住院医师职务 Clinical Competence Rating Medical graduate Educational Measurement Motor Skills average performance Curriculum Surgery

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A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out system on continuity of care and resident work hours

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2005年第4期200卷 538-545页

作者： Van Eaton, EG Horvath, KD Lober, WB Rossini, AJ Pellegrini, CA Univ Washington Dept Surg Seattle WA 98195 USA Univ Washington Dept Med Educ & Biomed Informat Seattle WA 98195 USA

BACKGROUND: Adoption of limits on resident work hours prompted us to develop a centralized, Web-based computerized rounding and sign-out system (UWCores) that securely stores sign-out information;automatically downloads patient data (vital signs, laboratories);and prints them to rounding, sign-out, and progress note templates. We tested the hypothesis that this tool would positively impact continuity of care and resident workflow by improving team communication involving patient handovers and streamlining inefficiencies, such as hand-copying patient data during work before rounds ("prerounds"). STUDY DESIGN: Fourteen inpatient resident teams (6 general surgery, 8 internal medicine) at two teaching hospitals participated in a 5-month, prospective, randomized, crossover study. Data collected included number of patients missed on resident, rounds, subjective continuity of care quality and workflow efficiency with and without UWCores, and daily self-reported prerounding and rounding times and tasks. RESULTS: UWCores halved the number of patients missed on resident rounds (2-5 versus 5 patients/team/month, p = 0.0001);residents spent 40% more of their prerounds time seeing patients (p = 0.36);residents reported better sign-out quality (69.6% agree or strongly agree);and improved continuity of care (66.1% agree or strongly agree). UWCores halved the portion of prerounding time spent hand-copying basic data (p < 0.0001);it shortened team rounds by 1.5 minutes/patient (p = 0.0006);and residents reported finishing their work sooner using UW Cores (82.1% agree or strongly agree). CONCLUSIONS: This system enhances patient care by decreasing patients missed on resident rounds and improving resident-reported quality of sign-out and continuity of care. It decreases by up to 3 hours per week (range 1.5 to 3) the time used by residents to complete rounds;it diverts prerounding time from recopying data to more productive tasks;and it facilitates meeting the 80-hour work week require

关键词： Continuity of Patient Care Internship and Residency Medical Records Systems Computerized 病人医护连续性实习医师和住院医师职务病案系统计算机化 Residency Randomized Controlled Trial Computerized Rounding off RECORDING SYSTEMS rounding Working time Internship and Residency Continuity of Patient Care

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How do urology residents manage personal finances?

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UROLOGY 2001年第5期57卷 866-871页

作者： Teichman, JMH Bernheim, BD Espinosa, EA Cecconi, PP Meyer, J Pearle, MS Preminger, GM Leveillee, RJ Univ Texas Hlth Sci Ctr Div Urol San Antonio TX 78229 USA Univ Texas SW Med Ctr Div Urol Dallas TX USA Duke Univ Med Ctr Div Urol Durham NC USA Univ Miami Med Ctr Div Urol Miami FL 33152 USA Stanford Univ Dept Econ Palo Alto CA 94304 USA

Objectives. To examine personal financial management among residents to answer three research questions: do residents make reasonable financial choices;why do some residents not save;and what steps can be taken to improve residents' personal financial decisions. Methods. Portions of the Federal Reserve Board's Survey of Consumer Finances were modified and piloted to elicit demographic, expense, saving, and income data. The final questionnaire was completed by 151 urology residents at 20 programs. Results. Comparing residents with the general population in the same age and income categories, the median debt/household income ratio was 2.58 versus 0.64. Residents had greater educational debt, greater noneducational debt, and lower savings. Resident participation in retirement accounts was 100% at institutions with employer-matching 401k or 403b plans, 63% at institutions with nonmatching 401k or 403b plans, and 48% at institutions without retirement plans for residents (P = 0.002). Fifty-nine percent of residents budgeted expenses, 27% had cash balances below $1000, 51% had paid interest charges on credit cards within the previous year, and 12% maintained unpaid credit card balances greater than $10,000. The median resident income was $58,400. Conclusions. A significant minority of residents appear not to make reasonable financial choices. Some residents save little because of a failure to budget, indebtedness, high projected income growth, or insufficient attention to personal financial management. Residents save more when they are eligible for tax-deferred retirement plans, particularly when their institution matches their contributions. Many residents would benefit from instruction concerning prudent financial management. UROLOGY 57: 866-871, 2001. (C) 2001, Elsevier Science Inc.

关键词： Income Internship and Residency Physicians Urology 收入实习医师和住院医师职务医师泌尿科学 Residency financial planning Income Financial Management Urology Personal Financing Retirement Credit cards Otolaryngologists indebtedness Internship and Residency

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Developing criteria for proficiency-based training of surgical technical skills using simulation:: Changes in performances as a function of training year

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2008年第2期206卷 205-211页

作者： Brydges, Ryan Kurahashi, Allison Bruemmer, Vera Satterthwaite, Lisa Classen, Roger Dubrowski, Adam Univ Toronto Wilson Ctr Toronto ON M5G 2C5 Canada Univ Toronto Dept Surg Toronto ON M5G 2C5 Canada Univ Toronto Fac Nursing Toronto ON M5G 2C5 Canada German Sport Univ Cologne Inst Motor Control & Movement Tech Cologne Germany S Pointee Hosp Warrensville Heights OH USA

BACKGROUND: Proficiency-based residency training programs can be more efficient than the current duration-based formats. For their successful implementation, appropriate proficiency criteria must be developed. The objective of this study was to investigate the relationship between technical skill performances assessed using computer- and expert-based methods and training year. An assumption was that asymptotes in performance as a function of training year can be used to set the proficiency level for a technical skill, so the value at which the asymptote occurs can be labeled as the proficiency criteria. STUDY DESIGN: Thirty-eight general surgery residents performed one-handed knot tying on bench-top simulators at two levels of difficulty: superficial and deep. Motion-efficiency measures and expert-based measures were used to evaluate performance. Total number of operations (ie, surgical volume) that each trainee participated in during residency was also acquired. RESULTS: On the superficial model, asymptotes were observed at year I for motion-cfficiency and year 3 for expert-based measures. On the deep model, asymptotes were observed at year 2 for motion-efficiency and year 4 for expert-based measures. CONCLUSIONS: The data demonstrate the challenges associated with defining technical skills proficiency criteria. Different asymptotes were observed for the two assessment methods and neither covaried substantially with surgical volume. These data suggest that this asymptote approach in defining proficiency criteria can be suitable for development of proficiency-based residency training programs. The sensitivity of this approach to the type of assessment method and to the functional difficulty of the simulators used for assessment must be considered.

关键词： Clinical Competence Competency-Based Education Computer Simulation Cross-Sectional Studies 临床工作能力基于能力的教育计算机模拟横断面研究教育考核实习医师和住院医师职务 evaluation method Residency Competency-Based Education asymptotes Surgery simulator Cross-Sectional Studies Functional training technical skill Clinical Competence

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Resident participation in flexible sigmoidoscopy does not affect patient satisfaction

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第6期95卷 1563-1566页

作者： Jackson, JL Osgard, E Fincher, RK Uniformed Serv Univ Hlth Sci Dept Med Bethesda MD 20814 USA Walter Reed Army Med Ctr Dept Gastroenterol Washington DC 20307 USA

OBJECTIVE: We sought to assess the effect of resident involvement in flexible sigmoidoscopy on patient satisfaction and comfort. METHODS: Adults undergoing flexible sigmoidoscopy completed a previsit questionnaire on indication for procedure, GI-related history, and functional status. Immediately after the procedure, satisfaction and procedure comfort were assessed. Additional information collected included procedure duration, depth of sigmoidoscope penetration, and visualization of diverticuli or polyps. RESULTS: Among 408 endoscopies, patient characteristics and procedure indications were similar between sigmoidoscopies done by residents (n = 111)or staff. There were no differences in patient satisfaction, procedure comfort, or willingness to undergo the procedure again in the future. Sigmoidoscopies involving residents averaged 5.6 min longer, even after adjusting for preparation quality, depth of insertion, specific endoscopist, and the presence of polyps or diverticuli. CONCLUSIONS: Patient satisfaction and comfort with flexible sigmoidoscopy was not reduced by resident involvement, though the procedure duration was slightly longer. (Am J Gastroenterol 2000;95:1563-1566. (C) 2000 by Am. Cell. of Gastroenterology).

关键词：实习医师和住院医师职务病人满意度柔韧性乙状结肠镜乙状结肠镜检查时间因素女(雌)性人类男(雄)性中年人

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Does US Medical Licensing Examination Step 1 score really matter in surgical residency match outcomes (and should it)?

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2008年第3期206卷 533-539页

作者： Andriole, Dorothy A. Yan, Yan Jeffe, Donna B. Washington Univ Sch Med Dept Surg St Louis MO 63110 USA Washington Univ Sch Med Dept Med St Louis MO 63110 USA

BACKGROUND: The relationship between US Medical Licensing Examination Step 1 scores and core surgical-specialty match outcomes has not been well defined. STUDY DESIGN: With IRB approval, we measured associations between aggregate Step 1 scores and other specialty-specific, match-process variables for 3 surgical-specialty matches. Chi-square tests measured differences between proportions of US students and independent applicants (ie, all non-US allopathic student applicants) who matched. Independent samples t-tests compared differences in Step 1 scores between matched- and unmatched-applicant groups. Pearson correlations measured the magnitude and direction of associations between matched-applicants' Step 1 scores and other variables of interest and between Step 1 scores for all match participants and percentage of positions filled by US students (two-tailed p values). RESULTS: Step 1 scores were lower for unmatched than matched-applicant groups for each specialty examined (each p < 0.0001). Matched-applicant groups' Step I scores positively correlated with each unmatched-applicant groups' Step 1 scores (r=.82, p < 0.0001), Step 1 gap between matched- and unmatched-applicant groups' scores (r=.40, p=0.035), percentage of positions filled by US students (r=.62, p < 0.0001), and mean number of applications filed/applicant (r=.50, p < 0.0001). Step 1 scores for all match participants correlated with percentage of positions filled by US students (r=.61, p=0.0006). CONCLUSIONS: Step 1 scores were closely related to match process outcomes and match participation itself, with increasing Step 1 scores among both matched- and unmatched-applicant groups as specialty selectivity increased.

关键词： Career Choice Case-Control Studies Humans Internship and Residency Licensure Medical 职业选择病例对照研究实习医师和住院医师职务许可证医学试验预期值 Licensure Students licensing Steps Occupational Choice Medical Case-Control Studies United States Internship and Residency Association (Psychology)

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Construct validity of anterior segment anti-tremor and forceps surgical simulator training modules: Attending versus resident surgeon performance

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JOURNAL OF CATARACT AND REFRACTIVE SURGERY 2008年第6期34卷 980-985页

作者： Mahr, Michael A. Hodge, David O. Mayo Clin Dept Ophthalmol Rochester MN 55905 USA

PURPOSE: To compare the performance of the anterior segment forceps and anti-tremor training modules of the EYESi surgical simulator (VRmagic) by residents and experienced attending surgeons using the simulator for the first time. SETTING: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA. METHODS: Twelve residents (4 per year) in the Mayo Clinic ophthalmology residency program and 3 experienced anterior segment surgeons participated. Each participant completed a total of 20 task trials on the EYESi forceps and anti-tremor level 4 training modules. Thus, the 15 participants completed a total of 300 task trials. RESULTS: For the forceps module, experienced surgeons achieved significantly better total scores (P = .03), with lower total task time (P = .007) and instrument-in-eye time (P = .006) measurements. For the anti-tremor module, experienced surgeons achieved significantly better total scores (P = .02), with lower task time (P = .04) and instrument-in-eye time (P = .02) measurements. In addition, experienced surgeons performing the anti-tremor task had 76% more precise surgical outcomes as measured by the out-of-tolerance percentage (P = .03). All forceps and antitremor-measured parameters indicated significantly lower performance (P < .05) for the first 1 or 2 trials, with the exception of anti-tremor module incision stress, out-of-tolerance percentage, and average tremor values. Experienced surgeons had more consistent (lower variance) total scores on the forceps (P = .05) and anti-tremor (P = .03) training modules. CONCLUSION: The EYESi surgical simulator anterior segment forceps and anti-tremor modules showed significant (P <.05) construct validity.

关键词： Adult Anterior Eye Segment Clinical Competence Computer Simulation Education Medical Graduate 成年人眼前半段临床工作能力计算机模拟教育医学研究生实习医师和住院医师职务 Surgeons Residency Forceps Construct Validity Anterior Eye Segment Medical Clinical Competence Adults graduate

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Curriculum recommendations for resident training in geriatrics interdisciplinary team care

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JOURNAL OF THE AMERICAN GERIATRICS SOCIETY 1999年第9期47卷 1149-1150页

作者： Fulmer, T IndianaUniversitySchoolofMedicine Indianapolis46202USA.

Sets out guidelines that have been developed to facilitate the development of geriatrics interdisciplinary team care experiences within residency training programs, the Task Force on Resident Training in Geriatrics Interdisciplinary Team Care of the American Geriatrics Society (AGS) Education Committee. The recommendations are intended to assist program directors in developing curriculum in geriatrics interdisciplinary team care and provide a framework for evaluating their current training in geriatrics interdisciplinary team care. (Original abstract - amended)

关键词：课程老年医学/教育实习医师和住院医师职务病人医疗小组人类

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A report of the ABO resident clinical outcome study (the pilot study)

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AMERICAN JOURNAL OF ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS 2006年第5期130卷 656-661页

作者： Dykhouse, Vance J. Moffitt, Allen H. Grubb, John E. Greco, Peter M. English, Jeryl D. Briss, Barry S. Jamieson, Scott A. Kastrop, Marvin C. Owens, S. Ed, Jr. Amer Board Orthodont St Louis MO 63141 USA

Introduction: A 4-year collaborative project between the American Board of Orthodontics (ABO) and 15 American orthodontic graduate programs concluded at the ABO Clinical Examination in February 2006. Methods: Fifty recent graduates (the pilot study group) presented cases that were treated in their graduate programs as partial fulfillment of the requirements for ABO certification. The examinees were tested by calibrated ABO examiners and required to satisfy traditional ABO standards. They presented appropriate case reports that contained the ABO's 3 measurement instruments. Thirty-nine practicing orthodontists (the control group) presented cases according to the traditional ABO Clinical Examination process. Results: Ninety percent of the pilot study group and 85% of the control group successfully accomplished ABO certification. There was a difference of 2.38 points between the 2 groups for the mean total scores of the cases that passed. The pilot study group presented cases that met the historic averages for case complexity (discrepancy index). Conclusions: Residents in orthodontic programs are able to treat cases to ABO standards of quality.

关键词： Certification Education Dental Graduate Internship and Residency Orthodontics 证明教育牙科研究生实习医师和住院医师职务正畸学专业委员全 Orthodontics Dentistry ABO gene Pilot Studies graduate certification Internship and Residency

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