Do we practice what we preach? A qualitative assessment of resident–preceptor interactions for adherence to evidence‐based practice

Background  Evidence‐based medicine (EBM) is important in training doctors for high‐quality care. Yet little is known about whether ambulatory precepting incorporates the concepts and principles of EBM. Methods  The authors observed and audiotaped 95 internal medicine residency precepting interactions and rated interactions using a qualitative analytic template consisting of three criteria: (1) presence of clinical questions; (2) presence of an evidence‐based process; and (3) resident ability to articulate a clinical question. Results  Sixty‐seven of 95 audio tapes (71%) were of acceptable quality to allow template analysis. Thirty (45%) contained explicit clinical questions; 11 (16%) included an evidence‐based process. Resident ability to articulate a clinical question when prompted was rated as at least ‘fair’ in 59 of 67 interactions (88%). Conclusions  EBM was not optimally implemented in these clinics. Future research could explore more systematically what factors facilitate or impair the use of EBM in the real‐time ambulatory training context.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99027/1/j.1365-2753.2008.00966.x.pd

Success, Regret, and the Struggle for Balance

The genesis of this article was a conversation between the authors: M.I., a senior faculty member, and J.C., his primary care doctor and a midcareer faculty member. It addresses the challenges facing physicians today as they struggle to strike the proper balance between career and personal life; it also addresses the potential toll to oneself and loved ones when career success is placed above all other concerns

Minority race and male sex as risk factors for non-beneficial gastrostomy tube placements after stroke.

Percutaneous endoscopic gastrostomy (PEG) tubes are widely used for enteral feeding after stroke; however, PEG tubes placed in patients in whom death is imminent are considered non-beneficial.We sought to determine whether placement of non-beneficial PEG tubes differs by race and sex.In this retrospective cohort study, inpatient admissions for stroke patients who underwent palliative/withdrawal of care, were discharged to hospice, or died during the hospitalization, were identified from the Nationwide Inpatient Sample between 2007 and 2011. Logistic regression was used to evaluate the association between race and sex with PEG placement.Of 36,109 stroke admissions who underwent palliative/withdrawal of care, were discharge to hospice, or experienced in-hospital death, a PEG was placed in 2,258 (6.3%). Among PEG recipients 41.1% were of a race other than white, while only 22.0% of patients without PEG were of a minority race (p<0.001). The proportion of men was higher among those with compared to without a PEG tube (50.0% vs. 39.2%, p<0.001). Minority race was associated with PEG placement compared to whites (OR 1.75, 95% CI 1.57-1.96), and men had 1.27 times higher odds of PEG compared to women (95% CI 1.16-1.40). Racial differences were most pronounced among women: ethnic/racial minority women had over 2-fold higher odds of a PEG compared to their white counterparts (OR 2.09, 95% CI 1.81-2.41), while male ethnic/racial minority patients had 1.44 increased odds of a PEG when compared to white men (95% CI 1.24-1.67, p-value for interaction <0.001).Minority race and male sex are risk factors for non-beneficial PEG tube placements after stroke

Odds of non-beneficial PEG tubes among the different race/sex groups stratified by stroke type.

<p>Odds of non-beneficial PEG tubes among the different race/sex groups stratified by stroke type.</p

Race and sex as determinants of non-beneficial PEG tubes after stroke.

<p>Race and sex as determinants of non-beneficial PEG tubes after stroke.</p

Graphic representation of odds ratios of PEG among ethnic/racial minority women, white men, and ethnic/racial minority men, compared to white women as reference.

<p>Data are presented for all stroke (top panel), and stratified by stroke subtype (medium and lower panel), respectively. * indicates a p-value <0.001 for comparison of PEG in ethnic/racial minority vs. white for each sex. P-values for interaction following square brackets compare the odds of PEG in ethnic/racial minorities vs. white between men and women. OR: odds ratio; CI: confidence interval; ICH: intracerebral hemorrhage.</p