Team Effect on Variation in Laboratory Utilization on Subspecialty Services

Background: The objective was to determine whether variation in laboratory utilization exists and whether physicians were responsible for a portion of this variation. Method: Variation in laboratory test ordering was collected on subspecialty services: the Medical Intensive Care Unit (MICU) and the Oncology Service. Ordinary least-squares regression was used to determine the effect of interns, residents, and attendings on the variation observed. Results: Variation in laboratory utilization attributable to physicians exists. Housestaff explain a proportion of this variation on each subspecialty service. Conclusions: Housestaff explain a large proportion of laboratory utilization attributable to physicians. This may represent an opportunity for education on systems-based practice and practice-based learning.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65005/1/09.Dine.Bellini.I.Acad.Med.pd

Sevrage tabagique (intérêt des traitements non nicotiniques et rôle du pharmacien)

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

A Novel Ambulatory Curriculum for Pulmonary and Critical Care Fellowship Training.

Background: Dedicated ambulatory training during pulmonary and critical care medicine (PCCM) fellowships is often limited. A novel 2-year longitudinal outpatient pulmonary fellowship curriculum was previously developed, piloted, and studied. The exportability and potential impact of this ambulatory curriculum on PCCM fellowship training nationally is not known. Objective: We aim to understand the current state of ambulatory training in PCCM fellowships and the impact of a standardized outpatient curriculum on fellows' ambulatory knowledge and competency. Methods: Nineteen programs participated in the study from 2017 to 2019. Six programs received the first year of content, seven programs received the entire 2-year curriculum, and seven programs served as a control. Fellows, faculty, and program directors (PDs) completed a series of surveys assessing satisfaction with ambulatory education and the curriculum. Fellows completed a series of medical knowledge inventories, and programs submitted in-training exam scores. Results: A total of 221 fellows (39%) and 17 PDs (89%) completed the precurriculum surveys, and 38 (12%) fellows and 10 (53%) PDs completed postcurriculum surveys. Before curriculum implementation, only 34.4% of fellows rated the quality of their ambulatory education as good or outstanding compared with 57.9% at the end of the study. Eighty-five percent of faculty and 89% of PDs rated the curriculum as good or excellent. Faculty believed that the teaching scripts were easy to use (78.4%), were factually accurate (86.3%), and provided high-yield information (82.1%). The majority of PDs indicated that the curriculum positively impacted patient care (78%) and fulfilled an unmet educational need (100%), and most planned to continue the curriculum after the study (78%). Feedback surrounded the need for updated content based on recently published guidelines and studies. Conclusion: The curriculum is a standardized and feasible way to address a previously unmet need in PCCM fellowship education. PDs rated the curriculum highly and most plan to continue it in the future. Our limited data set suggests that the curriculum was well received by fellows and faculty and positively impacted perceptions of ambulatory education and preparedness for independent practice. Future study with a larger sample of fellows is needed to better understand the generalizability of these findings

A Novel Ambulatory Curriculum for Pulmonary and Critical Care Fellowship Training.

Background: Dedicated ambulatory training during pulmonary and critical care medicine (PCCM) fellowships is often limited. A novel 2-year longitudinal outpatient pulmonary fellowship curriculum was previously developed, piloted, and studied. The exportability and potential impact of this ambulatory curriculum on PCCM fellowship training nationally is not known. Objective: We aim to understand the current state of ambulatory training in PCCM fellowships and the impact of a standardized outpatient curriculum on fellows' ambulatory knowledge and competency. Methods: Nineteen programs participated in the study from 2017 to 2019. Six programs received the first year of content, seven programs received the entire 2-year curriculum, and seven programs served as a control. Fellows, faculty, and program directors (PDs) completed a series of surveys assessing satisfaction with ambulatory education and the curriculum. Fellows completed a series of medical knowledge inventories, and programs submitted in-training exam scores. Results: A total of 221 fellows (39%) and 17 PDs (89%) completed the precurriculum surveys, and 38 (12%) fellows and 10 (53%) PDs completed postcurriculum surveys. Before curriculum implementation, only 34.4% of fellows rated the quality of their ambulatory education as good or outstanding compared with 57.9% at the end of the study. Eighty-five percent of faculty and 89% of PDs rated the curriculum as good or excellent. Faculty believed that the teaching scripts were easy to use (78.4%), were factually accurate (86.3%), and provided high-yield information (82.1%). The majority of PDs indicated that the curriculum positively impacted patient care (78%) and fulfilled an unmet educational need (100%), and most planned to continue the curriculum after the study (78%). Feedback surrounded the need for updated content based on recently published guidelines and studies. Conclusion: The curriculum is a standardized and feasible way to address a previously unmet need in PCCM fellowship education. PDs rated the curriculum highly and most plan to continue it in the future. Our limited data set suggests that the curriculum was well received by fellows and faculty and positively impacted perceptions of ambulatory education and preparedness for independent practice. Future study with a larger sample of fellows is needed to better understand the generalizability of these findings