Discharge Education for Residents: A Study of Trainee Preparedness for Hospital Discharge

BACKGROUND: Safe hospital discharges have become a major focus in the national discussion on transitions of care and care coordination. Education on the hospital discharge process is evolving as the needs of trainees are better understood. PURPOSE: This study is a cross-sectional survey of residents in a Midwestern residency program about their confidence in safely discharging patients from the hospital, including how they have or have not learned to do so. METHODS: An anonymous paper questionnaire was distributed to a convenience sample of interns and residents at a weekly meeting of the residency program. RESULTS: Most residents reported a general confidence in their abilities to safely discharge patients from the hospital; however, further probing revealed that their confidence breaks down when required to competently perform specific tasks of the discharge process such as activity restrictions or facilitation of home care. More than 50% of house staff surveyed responded that their education in many specific aspects of the discharge process are lacking. CONCLUSION: Interdisciplinary care education, and the discharge summary in particular, warrant further scrutiny as a care transition tool and means of teaching safe hospital discharge to trainees. We present a questionnaire that may serve useful as an anonymous tool to gauge residents' educational needs

The Validity of Peer Review in a General Medicine Journal

All the opinions in this article are those of the authors and should not be construed to reflect, in any way, those of the Department of Veterans Affairs

Bedside Interactions from the Other Side of the Bedrail

To assess the importance to patients of various aspects of bedside interactions with physician teams. Design : Cross-sectional survey. Setting : VA hospital. Patients : Ninety-seven medical inpatients. Intervention : Survey of 44 questions including short answer, multiple choice, and Likert-type questions. Measurements and Main Results : Data analysis included descriptive statistics. The sample was predominantly male, with a mean age of 62. Overall satisfaction with the hospital experience and with the team of doctors were both high (95% and 96% reported being very or mostly satisfied, respectively). Patients reported learning about several issues during their interactions with the teams; the 3 most highly rated areas were new problems, tests that will be done, and treatments that will be done. Most patients (76%) felt that their teams cared about them very much. Patients were made comfortable when the team showed that they cared, listened, and appeared relaxed (reported by 63%, 57%, and 54%, respectively). Patients were made uncomfortable by the team using language they did not understand (22%) and when several people examined them at once (13%). Many (58%) patients felt personally involved in teaching. The majority of patients liked having medical students and residents involved in their care (69% and 64%, respectively). Conclusions : Patients have much to teach about what is important about interacting with physician teams. Although patients' reactions to team interactions are generally positive, patients are different with respect to what makes them comfortable and uncomfortable. Taking their preferences into account could improve the experience of being in a teaching hospital.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75456/1/j.1525-1497.2005.40192.x.pd

Patterns of Arthritis Medication Use in a Community Sample

Background: Although arthritis is disabling, highly prevalent, and often treated without health professional input, little is known about the treatments selected by affected individuals. Such information is important because of the toxicity associated with some arthritis treatments. Objective: To describe the pattern of drug treatment use in a sample of persons with arthritis. Method: The authors distributed an 11-item survey to veterans attending veterans’ organization post meetings in southeastern Wisconsin during November and December 2009. Of 32 posts, 26 (81%) returned surveys from 446 persons; survey count and attendance figures suggest that the majority of attendees completed surveys at participating posts. Most respondents were older (75% aged 60 years or older) men (90%). Respondents with arthritis reported whether they had used each of seven drug therapies in the past year. Results: Almost all members of participating posts responded to the survey, increasing the likelihood that this was a representative sample. Most respondents (290 of 446, 65%) reported having arthritis, which impaired function in 78.6% of them. Most of those with arthritis (252 of 290, 86.9%) had used at least one drug treatment for arthritis in the last year. Acetaminophen use (41.0%) and use of an over-the-counter nonsteroidal anti-inflammatory drug (42.1%) were common. Nonsteroidal anti-inflammatory drug use did not decrease with older age or increase with greater functional impairment. Conclusions: Self-medication for arthritis is common and often does not follow clinical guidelines. Efforts to improve the quality of osteoarthritis care that focus solely on health care providers are unlikely to ensure optimal osteoarthritis care

Viewpoints from generation X: A survey of candidate and associate viewpoints on resident duty-hour regulations

Background The American Medical Student Association, the Committee of Interns and Residents, and Public Citizen petitioned the Occupational Safety and Health Administration for national resident duty-hour limitations. Subsequently, federal legislation was introduced to limit resident duty hours. To preempt the federal government, the Accreditation of Graduate Medical Education implemented resident duty-hour guidelines. Study design To evaluate the viewpoints and attitudes of surgical resident and staff physicians as they pertain to the national resident duty-hour guidelines, we asked attendees of the American College of Surgeons\u27 Candidate Associate Society Forum during the American College of Surgeons Clinical Congress meeting in 2001 to complete a self-administered questionnaire. Analyses were performed to determine the frequency of response for each survey item. Results Eighty-six of the 102 (84%) surgeons who attended the American College of Surgeons Forum completed the survey. Most disagreed with the federal government involvement in regulating duty hours. Although most agreed that residents should not be on call more than every third night, viewpoints varied on the other duty-hour guidelines. Most (63.4%) reported that residents should work 81 to 100 hours per week, but 11% reported that residents should work \u3e 101 hours per week and 25.6% reported that ≤ 80 hours per week was optimal. Conclusions As future guidelines are considered, further studies must be done to determine the viewpoints and attitudes of surgical resident and staff physicians with regard to resident duty-hour reform. These front line individuals may have unique insights into the benefits and barriers of duty-hour regulations. © 2004 by the American College of Surgeons

Spanish medical interpreters\u27 management of challenges in end of life discussions

OBJECTIVE: Professional medical interpreters facilitate patient understanding of illness, prognosis, and treatment options. Facilitating end of life discussions can be challenging. Our objective was to better understand the challenges professional medical interpreters face and how they affect the accuracy of provider-patient communication during discussions of end of life. METHODS: We conducted semi-structured interviews with professional Spanish medical interpreters. We asked about their experiences interpreting end of life discussions, including questions about values, professional and emotional challenges interpreting these conversations, and how those challenges might impact accuracy. We used a grounded theory, constant comparative method to analyze the data. Participants completed a short demographic questionnaire. RESULTS: Seventeen Spanish language interpreters participated. Participants described intensive attention to communication accuracy during end of life discussions, even when discussions caused emotional or professional distress. Professional strains such as rapid discussion tempo contributed to unintentional alterations in discussion content. Perceived non-empathic behaviors of providers contributed to rare, intentional alterations in discussion flow and content. CONCLUSION: We found that despite challenges, Spanish language interpreters focus intensively on accurate interpretation in discussions of end of life. PRACTICE IMPLICATIONS: Provider training on how to best work with interpreters in these important conversations could support accurate and empathetic interpretation

Barriers to Accessing Nighttime Supervisors: a National Survey of Internal Medicine Residents

© 2021, Society of General Internal Medicine. Background: Single-center studies have reported residents experience barriers to accessing supervising physicians overnight, but no national dataset has described barriers perceived by residents or the association between supervision models and perceived barriers. Objective: To explore residents’ perception of barriers to accessing overnight supervision. Design: Questions about overnight supervision and barriers to accessing it were included on the American College of Physicians Internal Medicine In-Training Examination® (IM-ITE®) Resident Survey in Fall 2017. Participants: All US-based internal medicine residents who completed the 2017 IM-ITE®. Responses from 20,744 residents (84%) were analyzed. Main Measures: For our main outcome, we calculated percentages of responses for eight barriers and tested for association with the presence or absence of nocturnists. For our secondary outcome, we categorized free-text responses enumerating barriers from all residents into the five Systems Engineering Initiative for Patient Safety (SEIPS) categories to elucidate future areas for study or intervention. Key Results: Internal medicine residents working in hospitals without nocturnists more commonly reported having at least one barrier to accessing a supervising physician “always” or “most of the time” (5075/9842, 51.6%) compared to residents in hospitals with nocturnists (3074/10,902, 28.2%, p \u3c 0.001). Among residents in hospitals without nocturnists, the most frequently reported barrier to accessing attending supervision was attendings not being present in the hospital (30.4% “always” or “most of the time”); residents in hospitals with nocturnists most frequently reported desire to make their own decisions as a barrier to contacting attendings (15.7% “always” or “most of the time”). Free-text responses from residents with and without nocturnists most commonly revealed organization (47%) barriers to accessing supervision; 28% cited person barriers, and 23% cited tools/technology barriers. Conclusions: Presence of nocturnists is associated with fewer reported barriers to contacting supervising physicians overnight. Organizational culture, work schedules, desire for independence, interpersonal interactions, and technology may present important barriers