Applying a mixed-method approach to improve on-the-job learning and job satisfaction in a cohort of interns at a university hospital

Introduction: Job satisfaction is vital for the optimal functioning of medical practitioners. Herein, we report our experience of restructuring the internship program by identifying the gaps, developing, implementing strategies to overcome gaps and sharing the results of the pre-implementation and post-implementation audit, as an example for establishing a system for improving intern\u27s work-based learning and satisfaction in a university hospital setting.Methods: Using Kern\u27s six-step instructional model, a prospective mixed-method study was conducted at Aga Khan University Hospital. In phase 1 (2013) gaps were identified by evaluating various aspects of the internship program. Strategies were developed and implemented to overcome the identified gaps. In phase 2 (2014-2016) the impact of these developmental strategies was assessed.Results: A total of 65 interns, 30 residents, and 22 faculty members participated in phase I, while 71 interns participated in phase II. The reformation of orientation sessions, including practical exposure and content of sessions, opportunities to enhance hands-on experience and supervision in inpatient areas, operating rooms, supervision by fellows, supervision for hands-on procedures, career counseling, and mentorship, led to significant improvement in satisfaction. It was identified that the lack of hands-on opportunities can be overcome by surgical skills-based workshops. These reforms led to an overall rise in intern satisfaction (50% vs 75.4%, p=0.02).Conclusion: Periodic restructuring of an existing program helps to improve the work-based learning experience and overall satisfaction among interns. This not only maximizes learning but also eases interns into their postgraduate life and workload subsequently enabling them to become more competent and well-rounded health practitioners

Overcoming the barriers of teaching physical examination at the bedside: More than just curriculum design

Background: Physicians in training must achieve a high degree of proficiency in performing physical examinations and must strive to become experts in the field. Concerns are emerging about physicians' abilities to perform these basic skills, essential for clinical decision making. Learning at the bedside has the potential to support skill acquisition through deliberate practice. Previous skills improvement programs, targeted at teaching physical examinations, have been successful at increasing the frequency of performing and teaching physical examinations. It remains unclear what barriers might persist after such program implementation. This study explores residents' and physicians' perceptions of physical examinations teaching at the bedside following the implementation of a new structured bedside curriculum: What are the potentially persisting barriers and proposed solutions for improvement? Methods: The study used a constructivist approach using a qualitative inductive thematic analysis that was oriented to construct an understanding of the barriers and facilitators of physical examination teaching in the context of a new bedside curriculum. Participants took part in individual interviews and subsequently focus groups. Transcripts were coded and themes were identified. Results: Data analyses yielded three main themes: (1) the culture of teaching physical examination at the bedside is shaped and threatened by the lack of hospital support, physicians' motivation and expertise, residents' attitudes and dependence on technology, (2) the hospital environment makes bedside teaching difficult because of its chaotic nature, time constraints and conflicting responsibilities, and finally (3) structured physical examination curricula create missed opportunities in being restrictive and pose difficulties in identifying patients with findings. Conclusions: Despite the implementation of a structured bedside curriculum for physical examination teaching, our study suggests that cultural, environmental and curriculum-related barriers remain important issues to be addressed. Institutions wishing to develop and implement similar bedside curricula should prioritize recruitment of expert clinical teachers, recognizing their time and efforts. Teaching should be delivered in a protected environment, away from clinical duties, and with patients with real findings. Physicians must value teaching and learning of physical examination skills, with multiple hands-on opportunities for direct role modeling, coaching, observation and deliberate practice. Ideally, clinical teachers should master the art of combining both patient care and educational activities

Practical Strategies for Pharmacist Integration with Primary Care: A Workbook.

This workbook is a practical set of tips and resources to assist pharmacists in providing clinical pharmacy services to primary care providers and their patients. The content was written based on experiences in Vermont in 2014, however the topics should generalize to pharmacists in other areas

Clinical decision support system, a potential solution for diagnostic accuracy improvement in oral squamous cell carcinoma: A systematic review

BACKGROUND AND AIM: Oral squamous cell carcinoma (OSCC) is a rapidly progressive disease and despite the progress in the treatment of cancer, remains a life-threatening illness with a poor prognosis. Diagnostic techniques of the oral cavity are not painful, non-invasive, simple and inexpensive methods. Clinical decision support systems (CDSSs) are the most important diagnostic technologies used to help health professionals to analyze patients’ data and make decisions. This paper, by studying CDSS applications in the process of providing care for the cancer patients, has looked into the CDSS potentials in OSCC diagnosis. METHODS: We retrieved relevant articles indexed in MEDLINE/PubMed database using high-quality keywords. First, the title and then the abstract of the related articles were reviewed in the step of screening. Only research articles which had designed clinical decision support system in different stages of providing care for the cancer patient were retained in this study according to the input criteria. RESULTS: Various studies have been conducted about the important roles of CDSS in health processes related to different types of cancer. According to the aim of studies, we categorized them into several groups including treatment, diagnosis, risk assessment, screening, and survival estimation. CONCLUSION: Successful experiences in the field of CDSS applications in different types of cancer have indicated that machine learning methods have a high potential to manage the data and diagnostic improvement in OSCC intelligently and accurately. KEYWORDS: Squamous Cell Carcinoma; Clinical Decision Support System; Neoplasm; Dental Informatic

Digest of the Philadelphia College of Osteopathic Medicine (Summer 2014)

The Summer 2014 issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles: Message from the President PCOM Updates Development News Institutional Advancement: Gifting the Optimum in Simulation Technology for Skills Training and Competency Assessment Institutional Memory: Remembering Herbert Lotman, LLD (Hon.) Institutional Heritage: Founders’ Day 2014 Institutional Feature: A Time of Transition With Gratitude . . . Reflection about Dr. Schure: Collegial Harmony Reflection about Dr. Schure: Doctoring the Doctor Reflection about Dr. Schure: Legacy in the South Reflection about Dr. Schure: Seeds Planted Are Bearing Fruit PCOM Welcomes Jay S. Feldstein, DO ’81, as Eighth President and Chief Executive Officer Class Notes In Memoriam My Turn Essayhttps://digitalcommons.pcom.edu/digest/1216/thumbnail.jp

Management of chest pain: exploring the views and experiences of chiropractors and medical practitioners in a focus group interview

BACKGROUND: We report on a multidisciplinary focus group project related to the appropriate care of chiropractic patients who present with chest pain. The prevalence and clinical management, both diagnosis and treatment, of musculoskeletal chest pain in ambulatory medical settings, was explored as the second dimension of the focus group project reported here. METHODS: This project collected observational data from a multidisciplinary focus group composed of both chiropractic and medical professionals. The goals of the focus group were to explore the attitudes and experiences of medical and chiropractic clinicians regarding their patients with chest pain who receive care from both medical and chiropractic providers, to identify important clinical or research questions that may inform the development of 'best practices' for coordinating or managing care of chest pain patients between medical and chiropractic providers, to identify important clinical or research questions regarding the diagnosis and treatment of chest pain of musculoskeletal origin, to explore various methods that might be used to answer those questions, and to discuss the feasibility of conducting or coordinating a multidisciplinary research effort along this line of inquiry. The convenience-sample of five focus group participants included two chiropractors, two medical cardiologists, and one dual-degreed chiropractor/medical physician. The focus group was audiotaped and transcripts were prepared of the focus group interaction. Content analysis of the focus group transcripts were performed to identify key themes and concepts, using categories of narratives. RESULTS: Six key themes emerged from the analysis of the focus group interaction, including issues surrounding (1) Diagnosis; (2) Treatment and prognosis; (3) Chest pain as a chronic, multifactorial, or comorbid condition; (4) Inter-professional coordination of care; (5) Best practices and standardization of care; and (6) Training and education. CONCLUSION: This study carries implications for chiropractic clinical training relative to enhancing diagnostic competencies in chest pain, as well as the need to ascertain and improve those skills, competencies, and standards for referrals and sharing of clinical information that may improve cross-disciplinary coordination of care for chest pain patients

Utilizing Patient-Reported Outcome Measures in the Management of Inflammatory Bowel Disease

Inflammatory bowel disease, a chronic relapsing-remitting disorder, affects three million adults in the United States. One of the main therapeutic goals in patients with inflammatory bowel disease is mucosal healing, measured by endoscopy, an invasive procedure that does not always reflect patient symptomatology. To address these limitations, clinicians have developed patient-reported outcome measures, questionnaires evaluating bowel symptoms and quality of life. However, the clinical utility of these patient-reported outcome measures and their correlation to objective markers of inflammation is unclear. We will determine the efficacy of using a patient-reported outcome measure to inform treatment for inflammatory bowel disease. In a randomized clinical trial, we will compare disease metrics of patients receiving treatment guided by a patient-reported outcome measure compared to those of patients receiving standard treatment. This study will confirm the utility of patient-reported outcome measures, revolutionizing inflammatory bowel disease treatment and transitioning the field towards patient-centered care