Teaching Resident Self-Assessment Through Triangulation of Faculty and Patient Feedback

Problem: To accurately determine one\u27s ability in any clinical competency, an individual must be able to self-assess performance and identify personal limitations. Existing research demonstrates that physicians of all levels are unreliable self-assessors. This poses a concern in medical practice, which requires continuous updates to clinical competencies and awareness of personal limitations. Few published studies examine graduate medical education curricula designed to develop self-assessment skills. Intervention: Conceptual models, such as self-determination theory, suggest that self-assessment is most effectively learned through reflective processes. The Family Medicine Residency Program at Lehigh Valley Health Network developed a learner-centered competency assessment process that integrates advising and performance review. The multisource, observable behavior-based process encourages conversation between resident and advisor. Utilizing feedback from clinical preceptors and patient surveys, advisors guide residents in determining individual learning needs in core competency areas, including relationship-centered care. Development of medical learners\u27 capacity to form relationships is one means to improving the patient experience. Context: This retrospective case study evaluates the accuracy of senior residents\u27 self-assessment in relationship-centered care compared with that of junior residents. The study population includes the 34 residents enrolled from AY 2009–2012. Data sets represent specific 6-month periods and have 3 component scores—Self, Faculty, and Patient—which were triangulated to determine concordance rates by postgraduate year level. Outcome: The concordance rate among first-years was 26.7%, whereas third-years saw 60.0% concordance. A discordance analysis found the Patient score most often deviated from the other 2 scores, whereas the Faculty score was never the sole dissenter. When all 3 scores differed, the Self score frequently fell between the other 2 scores. Lessons Learned: The principles of self-determination theory provide a valuable framework for understanding the development of residents\u27 intrinsic motivation to become lifelong learners. The trend in improved concordance rates among senior residents suggests that prompting learners to triangulate feedback from multiple sources can lead to a shift in perspective about competency. Further study is needed to determine whether our results are generalizable to other competencies and educational setting

Management Strategies of Cesarean Section Ectopic Pregnancy: A Case Report

Introduction: Cesarean scar ectopic pregnancy is a rare form of pregnancy with potential life-threatening complications such as severe hemorrhage, uterine rupture, and emergency hysterectomy Currently, there is no consensus regarding a standardized treatment algorithm for this specific variant of ectopic pregnancies. Case Description: This case describes a 28-year-old female with history of two prior cesarean sections who was diagnosed with cesarean section scar ectopic pregnancy. Initial management with intramuscular methotrexate was unsuccessful in the setting of inadequate decrease in β-hCG level. The patient ultimately underwent surgical management with dilation and suction evacuation under ultrasound guidance for removal of the ectopic pregnancy. Following surgery, the patient continued to have an appropriate downward trend of β-hCG, indicating a successful result of the procedure. Discussion: The objective of this case report is to review this case of cesarean scar ectopic pregnancy, identify various treatment modalities for this condition, and analyze their success rates and possible reasons for failure based on literature review. We conclude that the wide use of methotrexate for cesarean section ectopic pregnancies should be reconsidered and minimally invasive techniques such as the double-balloon catheter procedure be further researched

Patient-Reported Barriers and Limitations to Attending Diabetes Group Visits.

PURPOSE: Through this exploratory study, we sought to understand why group visit participation is low among adult patients with type 2 diabetes. METHODS: Eligible study participants included adult patients with type 2 diabetes. After a pilot survey was sent to a random sample of 48 patients, the remaining 187 eligible patients were invited to complete a revised version of the survey. RESULTS: Most frequently cited reasons for not attending group visits included diabetes under control, work and/or other responsibilities, and time barriers. There was variability in the desired time for the visits, though the majority of patients preferred evening visits. While some patients reported copays as a challenge, the likelihood of attending did not decrease for this subgroup. Most patients surveyed (54%) indicated interest in diabetes group visits. CONCLUSION: Implementing strategies to address the patient-identified system barriers (eg, time, transportation, and copays) may increase participation in diabetes group visits

Comparative methane estimation from cattle based on total CO₂ production using different techniques

The objective of this study was to compare the precision of CH4 estimates using calculated CO2 (HP) by the CO2 method (CO2T) and measured CO2 in the respiration chamber (CO2R). The CO2R and CO2T study was conducted as a 3 × 3 Latin square design where 3 Dexter heifers were allocated to metabolic cages for 3 periods. Each period consisted of 2 weeks of adaptation followed by 1 week of measurement with the CO2R and CO2T. The average body weight of the heifer was 226 ± 11 kg (means ± SD). They were fed a total mixed ration, twice daily, with 1 of 3 supplements: wheat (W), molasses (M), or molasses mixed with sodium bicarbonate (Mbic). The dry mater intake (DMI; kg/day) was significantly greater (P < 0.001) in the metabolic cage compared with that in the respiration chamber. The daily CH4 (L/day) emission was strongly correlated (r = 0.78) between CO2T and CO2R. The daily CH4 (L/kg DMI) emission by the CO2T was in the same magnitude as by the CO2R. The measured CO2 (L/day) production in the respiration chamber was not different (P = 0.39) from the calculated CO2 production using the CO2T. This result concludes a reasonable accuracy and precision of CH4 estimation by the CO2T compared with the CO2R