Are Commonly Used Resident Measurements Associated with Procedural Skills in Internal Medicine Residency Training?

BACKGROUND: Acquisition of competence in performing a variety of procedures is essential during Internal Medicine (IM) residency training. PURPOSES: Determine the rate of procedural complications by IM residents; determine whether there was a correlation between having 1 or more complications and institutional procedural certification status or attending ratings of resident procedural skill competence on the American Board of Internal Medicine (ABIM) monthly evaluation form (ABIM-MEF). Assess if an association exists between procedural complications and in-training examination and ABIM board certification scores. METHODS: We retrospectively reviewed all procedure log sheets, procedural certification status, ABIM-MEF procedural skills ratings, in-training exam and certifying examination (ABIM-CE) scores from the period 1990–1999 for IM residency program graduates from a training program. RESULTS: Among 69 graduates, 2,212 monthly procedure log sheets and 2,475 ABIM-MEFs were reviewed. The overall complication rate was 2.3/1,000 procedures (95% CI: 1.4–3.1/1,000 procedure). With the exception of procedural certification status as judged by institutional faculty, there was no association between our resident measurements and procedural complications. CONCLUSIONS: Our findings support the need for a resident procedural competence certification system based on direct observation. Our data support the ABIM’s action to remove resident procedural competence from the monthly ABIM-MEF ratings

A Study of the Development of Skill in Learning to Operate the Hollerith Card-Punching Machine

In this study the writer served as both subject and experimenter. Previous to this experiment the writer had had 110 experience in punching Hollerith cards. The data used for punching were coded prior to the actual punching- of the cards. The 80-column card was used. There were sixteen 30-minute periods throughout a period of five weeks. With two unavoidable exceptions the practice periods were held each Monday, Wednesday, and Friday at 4:00 P.M

The Allocation of a Prize (R)

Consider agents who undertake costly effort to produce stochastic outputs observable by a principal. The principal can award a prize deterministically to the agent with the highest output, or to all of them with probabilities that are proportional to their outputs. We show that, if there is suf cient dipersion in agents ' skills relative to the noise on output, then the proportional prize will on average elicit more output from the agents than the deterministic prize. Indeed, assuming agents know each others ' skills (the complete information case), this result holds when any Nash selection, under the proportional prize, is compared with any individually rational strategy selection under the deterministic prize. When there is incomplete information, the same result obtains but now we must restrict to Nash selections for both prizes. We also compute the optimal scheme — among a natural class of probabilistic schemes — for awarding the prize, namely that which elicits maximal effort from the agents for the least prize. In general the optimal scheme is a monotonic step function which lies "between" the proportional and the deterministic schemes. When the competition is over small fractional increments (a case that commonly arises in the presence of strong contestants whose base levels of production are high), the optimal scheme awards the prize according to the "log of the odds", where the odds are based on the proportional scheme

Procedural Competency Training during Diagnostic Radiology Residency: Time to Go beyond “See One, Do One, Teach One”!

Objectives: Achieving procedural competency during diagnostic radiology residency can impact the radiologist\u27s future independent practice after graduation, especially in a private practice setting. However, standardized procedure competency training within most radiology residency programs is lacking, and overall procedural skills are still mainly acquired by the traditional “see one, do one, teach one” methodology. We report the development of a simple standardized procedural training protocol that can easily be adopted by residency programs currently lacking any form of structured procedural training. Materials and Methods: An ad hoc resident procedural competency committee was created in our radiology residency program. A procedural certification protocol was developed by the committee which was composed of attending radiologists from the involved divisions and two chief residents. A road map to achieve procedural competency certification status was finalized. The protocol was then implemented through online commercial software. Results: Our procedural certification protocol took effect in September 2014. We reviewed all resident records from September 2014 to December 2016. Eighteen residents of various levels of training participated in our training protocol. About 72% became certified in paracentesis, 11% in thoracentesis, 83% in feeding tube placement, 55% in lumbar puncture/myelogram, and 77% in tunneled catheter removal. Conclusions: Our single-center experience demonstrates that a simple to adopt structured approach to procedural competency training is feasible and effective. Our “certified” radiology residents were deemed capable of performing those procedures under indirect supervision. The following core competencies are addressed in this article: Patient care, Medical knowledge, and Systems-based practice

要介護認定基準の変更と影響の同期検証 －2009 年10 月版と2006 年版一次判定の較差－

本研究では，要介護認定基準2009年10月版と，旧版要介護認定基準2006年版との較差を比較するために，経年的な対象者における要介護状況の変化を除外して，それぞれを同期検証することを研究目的とした。その比較する対象を，同一対象者で同一時期に，それぞれの要介護認定基準ごとに別々の認定調査員の認定調査結果から要介護認定一次判定を実施した。それぞれの認定調査結果から，要介護認定基準の変更と影響について，8施設（400名）と8在宅事業所（208名）の要介護者等608名を研究対象として分析した。同期検証した結果，総体的に2009年10月版は，平均合計要介護時間は3.37分ほど多めに有意差を持って算出された。要介護度の2006年版から2009年10月版での一致率は，半数近くの調査対象者の要介護度が変化して，軽度化する調査対象者も2割半前後いた。要介護5の一致率が64.23%と最も高く，要支援1の一致率は29.73%と最も低くなった。要介護5以上の要介護時間に該当する要介護者は2009年10月版の方が2006年版よりも多く分布し，動ける認知症の要介護度はその全体の41.67%も軽度化していた。要介護認定には，要介護基準等介護時間だけによらない総合的指標である総合介護度の構築が必要である。In this research, the accreditation criteria of certifi cation standards of long-term care needed level have been changed to be stricter at the fiscal year 2009 in Japan. The difference and influence were compared in the primary judgment between the fiscal year 2006 and the fiscal year 2009 October version at the synchronized analysis. As for the synchronized analysis, each different investigator surveyed the same long-term care needed or assisted at the simultaneous time with the certifi cation standard for long-term care needed with 2009 October and 2006 version. The change and the influence of them were detected by each investigation result of the 608 long-term care needed who used the services of 8 institutions or the 8 in-home facilities. As a result, total 3.37 minutes needed more average time for total long-term care was signifi cantly calculated by 2009 October than 2006 version(p<0.01). The long-care needed levels of the same respondents have been changed with over half coincidence rate between 2009 October and 2006 versions. The 2009 October version was possible to slightly improve about 25 percent of the long-term care assisted level from 2006 to 2009 October, version, too. At the long-term care needed level 5, the 64.23% coincidence rate of the long-term care needed level was highest. At the long-term care assisted level 1, the 29.73% coincidence rate of the long-term care assisted level was lowest. There were more time and number distribution over the long-term care needed level 5 calculated by 2009 October than 2006 versions. 41.67% of the self-movable dementia was considerably lightened at the long-term care moderately needed and assisted level. The certification standard for long-term care needed should be constructed by not only the long-term care time but also total factors with the burden or necessity indexes for the judgment of the long-term care needed.報告Report

Girls' 4-H Club

The 4-H club girl of 1927 has much to be thankful for of which her Puritan sister of yesteryear did not even dream. She enjoys all the comforts of a modern home equipped with water system, electric light ·and other conveniences. The rural mail carrier, the telephone and the automobile have overcome the isolation of rural life and now the radio has opened up a new world of possibilities.</p