A systematic review of the effects of residency training on patient outcomes

<p>Abstract</p> <p>Background</p> <p>Residents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes.</p> <p>Methods</p> <p>The literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes.</p> <p>Results</p> <p>Ninety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design.Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained.</p> <p>Conclusions</p> <p>The majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care.</p

Explaining how faculty members act upon residents' feedback to improve their teaching performance

Responsiveness to feedback is a complex phenomenon that requires and receives attention. However, knowledge on the responsiveness of faculty members to residents' feedback on their teaching performance is lacking. Excellent teaching performance is essential to ensure patient safety and residents' learning in residency training. This study aims to increase our understanding of how faculty staff react to and act upon residents' feedback on their teaching performance. This multi-specialty, multi-institution interview study was conducted to gain insight into: (i) how teaching faculty proceed after they have received residents' feedback on their teaching performance, and (ii) the factors that influence their progression. Between August and December 2011, 24 faculty members who had received formative feedback on their teaching performance through valid and reliable feedback systems participated in this study. They reflected upon their (re)action(s) during individual semi-structured interviews. The interview protocol and analysis were guided by a comprehensive transtheoretical framework describing and explaining stages and processes of behavioural change. Faculty staff involved in residency training used residents' feedback to different extents to adapt or improve their teaching performance. Important tipping points in the processes of change necessary for faculty staff to put feedback into practice were: experiencing negative emotions in themselves or recognising those in residents as a result of failure to act upon feedback; realising that something should be done with or without support from others, and making a strong commitment to change. In addition, having the confidence to act upon feedback and recognising the benefits of change were found to stimulate faculty members to change their teaching behaviour. The responsiveness of faculty members to residents' feedback on their teaching performance varies. The adapted transtheoretical framework explains how and why faculty members do or do not proceed to action after receiving residents' feedback. Given this, organising residents' feedback for faculty staff in a systematic way is a first step and is necessary to effect potential improvements in teaching performanc

Residents' narrative feedback on teaching performance of clinical teachers: analysis of the content and phrasing of suggestions for improvement

High-quality teaching performance is important to ensure patient safety and encourage residents' learning. This study aims to explore the content and phrasing of suggestions for improvement that residents provide to support excellent teaching performance of their supervisors. From February 2010 to November 2011, 577 residents were invited to evaluate 501 teachers from both surgical and medical residency training programmes from 20 hospitals. Feedback was collected through a validated formative feedback system named System for Evaluation of Teaching Qualities. Two researchers independently coded the suggestions for improvement with literature-based coding schemes on (1) content and (2) linguistic characteristics. Besides these qualitative outcomes, descriptive statistics were calculated using SPSS. In total, 422 residents (73%) evaluated 488 teachers (97%), yielding 4184 evaluations. Of all teachers, 385 (79%) received suggestions for improvement focusing on teaching skills (TS), 390 (80%) on teaching attitude (TA) and 151 (31%) on personal characteristics. For 13%-47% of the suggestions for improvement, residents added (1) the location or situation where the observed TS or TA had taken place, (2) concrete examples of what teachers could do to improve or (3) (expected) effects of what the change in TS or TA would mean for residents. Residents provide mainly relevant suggestions for improvement that mirror important aspects of teaching performance. However, these comments often lack specific phrasing limiting their value for performance improvement. Therefore, residents are recommended to increase the specificity of the suggestions for improvement. The paper provides directions to phrase narrative feedbac

The impact of clinicians' personality and their interpersonal behaviors on the quality of patient care: a systematic review

To review systematically the impact of clinicians' personality and observed interpersonal behaviors on the quality of their patient care. We searched MEDLINE, EMBASE and PsycINFO from inception through January 2014, using both free text words and subject headings, without language restriction. Additional hand-searching was performed. The PRISMA framework guided (the reporting of) study selection and data extraction. Eligible articles were selected by title, abstract and full text review subsequently. Data on study setting, participants, personality traits or interpersonal behaviors, outcome measures and limitations were extracted in a systematic way. Our systematic search yielded 10 476 unique hits. Ultimately, 85 studies met all inclusion criteria, 4 on clinicians' personality and 81 on their interpersonal behaviors. The studies on interpersonal behaviors reported instrumental (n = 45) and affective (n = 59) verbal behaviors or nonverbal behaviors (n = 20). Outcome measures in the studies were quality of processes of care (n = 68) and patient health outcomes (n = 35). The above categories were non-exclusive. The majority of the studies found little or no effect of clinicians' personality traits and their interpersonal behaviors on the quality of patient care. The few studies that found an effect were mostly observational studies that did not address possible uncontrolled confounding. There is no strong empirical evidence that specific interpersonal behaviors will lead to enhanced quality of care. These findings could imply that clinicians can adapt their interactions toward patients' needs and preferences instead of displaying certain specific behaviors per s

Clinical teaching performance improvement of faculty in residency training: A prospective cohort study

The purpose of this study is to investigate how aspects of a teaching performance evaluation system may affect faculty's teaching performance improvement as perceived by residents over time. Prospective multicenter cohort study conducted in The Netherlands between 1 September 2008 and 1 February 2013. Nine hundred and one residents and 1068 faculty of 65 teaching programs in 16 hospitals were invited to annually (self-) evaluate teaching performance using the validated, specialty-specific System for Evaluation of Teaching Qualities (SETQ). We used multivariable adjusted generalized estimating equations to analyze the effects of (i) residents' numerical feedback, (ii) narrative feedback, and (iii) faculty's participation in self-evaluation on residents' perception of faculty's teaching performance improvement. The average response rate over three years was 69% for faculty and 81% for residents. Higher numerical feedback scores were associated with residents rating faculty as having improved their teaching performance one year following the first measurement (regression coefficient, b: 0.077; 95% CI: 0.002-0.151; p = 0.045), but not after the second wave of receiving feedback and evaluating improvement. Receiving more suggestions for improvement was associated with improved teaching performance in subsequent years. Evaluation systems on clinical teaching performance appear helpful in enhancing teaching performance in residency training programs. High performing teachers also appear to improve in the perception of the resident

Homogeneity analysis withk sets of variables: An alternating least squares method with optimal scaling features

homogeneity analysis, correspondence analysis, optimal scaling, transformation, alternating least squares, canonical correlation analysis, principal component analysis,