Strategies for Residency Programs that Improve Medicine Departments and Teaching Hospitals (original) (raw)
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Building Capacity Within a Residency Program
The chief resident plays a critical role in the educational, administrative, service, and research mission of the residency program. As the future leaders in academic medicine, we felt it was prudent to nurture the leadership skills and capacities of residents in ways that would serve and support the health of the program both during their time with us, but also as they move forward into their professional lives. A review of past practices had revealed weaknesses. For example, in the selection processes, there was a lack of clear role defini-tions, eligibility criteria, a transparent selection process, training or support for the role, or even clearly delineated responsibilities. Despite the ambiguity, past chief residents have all succeeded in their roles and have provided excellent role models for our newer chiefs; however, the training committee decided that this was an area that could be strengthened. A goal was established to conduct a needs assessment and then to research and document a plan to address the shortcomings. Our research revealed that our lack of attention to this area was actually quite common; few programs had clear processes, criteria, or policies in place. There also appeared to be conflicts between the ways in which the chief resident's role was conceptualized, compared to how it was carried out in practice.
Achieving hospital medicine's promise through internal medicine residency redesign
Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 2008
The promise of the hospital medicine movement is that the hospitalist model of care will provide better outcomes than the system it replaced. This means improving the quality and processes of care, reducing inefficiencies and lowering costs. Despite some documented improvements in these areas hospitalists have yet to achieve their pinnacle. These shortfalls likely result from training providers in residencies that have yet to evolve to address the specific needs of hospitalists. While most internal medicine residency training programs stress inpatient care they underemphasize key components of a successful hospitalist career. This paper overviews the state of the hospitalist movement, the current educational training deficiencies and the methods to deliver hospitalist-focused training.
Internal Medicine Residency Redesign: Proposal of the Internal Medicine Working Group
The American Journal of Medicine, 2011
Concerned with the quality of internal medicine training, many leaders in the field assembled to assess the state of the residency, evaluate the decline in interest in the specialty, and create a framework for invigorating the discipline. Although many external factors are responsible, we also found ourselves culpable: allowing senior role models to opt out of important training activities, ignoring a progressive atrophy of bedside skills, and focusing on lock-step curricula, lectures, and compiled diagnostic and therapeutic strategies. The group affirmed its commitment to a vision of internal medicine rooted in science and learned with mentors at the bedside. Key factors for new emphasis include patient-centered small group teaching, greater incorporation of clinical epidemiology and health services research, and better schedule control for trainees. Because previous proposals were weakened by lack of evidence, we propose to organize the Cooperative Educational Studies Group, a pool of training programs that will collect a common data set describing their programs, design interventions to be tested rigorously in multimethodological approaches, and at the same time produce knowledge about high-quality practice.
Journal of community hospital internal medicine perspectives, 2014
The role of the internal medicine chief resident includes various administrative, academic, social, and educational responsibilities, fulfillment of which prepares residents for further leadership tasks. However, the chief resident position has historically only been held by a few residents. As fourth-year chief residents are becoming less common, we considered a new model for rotating third-year residents as the chief resident. Online surveys were given to all 29 internal medicine residents in a single university-based program after implementation of a leadership curriculum and specific job description for the third-year chief resident. Chief residents evaluated themselves on various aspects of leadership. Participation was voluntary. Descriptive statistics were generated using SPSS version 21. Thirteen junior (first- or second-year) resident responses reported that the chief residents elicited input from others (mean rating 6.8), were committed to the team (6.8), resolved conflict...
2005
T he structure, process, and outcomes of internal medicine residency training have concerned the profession for over 20 years. Over the last decade the initiative to move to outcomes-based education redefined the competencies physicians should obtain during training. The core principle of outcomes-based education is the objective demonstration that a graduating trainee, whether from medical school or a residency, possesses the knowledge, skills, and attitudes necessary to progress to the next stage of his or her professional career. The Accreditation Council for Graduate Medical Education (ACGME) and the Institute of Medicine (IOM) have defined core competencies for physicians shown in Table 1. While both the ACGME and IOM provide a framework for the desired outcomes, medical educators bear the burden of designing the structures and processes to achieve them. Educators face several key challenges in redesigning residency programs. First, residency programs must prepare trainees for ...
Academic medicine : journal of the Association of American Medical Colleges, 2015
The scope and scale of developments in health care redesign have not been sufficiently adopted in primary care residency programs. The interdisciplinary Primary Care Faculty Development Initiative was created to teach faculty how to accelerate revisions in primary care residency training. The program focused on skill development in teamwork, change management, leadership, population management, clinical microsystems, and competency assessment. The 2013 pilot program involved 36 family medicine, internal medicine, and pediatric faculty members from 12 residencies in four locations. The percentage of participants rating intention to implement what was learned as "very likely…
Hospital Medicine Resident Training Tracks: Developing the Hospital Medicine Pipeline
Journal of hospital medicine, 2017
Hospital medicine (HM) is rapidly evolving into new clinical and nonclinical roles. Traditional internal medicine (IM) residency training likely does not optimally prepare residents for success in HM. Hospital medicine residency training tracks may offer a preferred method for specialized HM education. Internet searches and professional networks were used to identify HM training tracks. Information was gathered from program websites and discussions with track directors. The 11 HM tracks at academic medical centers across the United States focus mostly on senior residents. Track structure and curricular content are determined largely by the structure and curricula of the IM residency programs in which they exist. Almost all tracks feature experiential quality improvement projects. Content on healthcare economics and value is common, and numerous track leaders report this content is expanding from HM tracks into entire residency programs. Tracks also provide opportunities for scholars...
Academic Medicine, 2007
* This list enumerates a number of factors that have recently stimulated discussions concerning educational redesign in internal medicine. Several factors are repeated from earlier episodes of redesign activity while others are new to this period. The recommendations of the Alliance for Academic Internal Medicine Education Redesign Task Force take into consideration these and other factors. * This list provides the major recommendations of the AAIM Education Redesign Task Force. These recommendations were approved by all of the alliance organizations in April and May 2007. The authors encourage readers to consider the total effect of the recommendations rather than the effect of individual recommendations.
Academic Medicine, 2014
With approximately four physicians per 100,000 inhabitants, Mozambique faces one of the most severe health care provider shortages in Sub-Saharan Africa. The lack of sufficient wel-trained medical school faculty is Mozambique's major barrier to producing new physicians annually. A partnership between the Universidade Eduardo Mondlane and the University of California, San Diego, has addressed this challenge with support from the Medical Education Partnership Initiative. Following an initial needs assessment involving questionnaires and focus groups of residents, and working with key members from the Ministry of Health, the Medical Council, and Maputo Central Hospital, a set of interventions was designed. The hospital's Internal Medicine Residency Program was chosen as the focus for the plan. Interventions included curriculum design, new teaching methodologies, investment in an informatics infrastructure for access to digital references, building capacity to support clinical research, and providing financial incentives to retain junior faculty. The number of candidates entering the Internal Medicine (IM) residency program has increased, and detailed monitoring and evaluation is measuring the impact of these changes on the quality of training. These changes are expected to improve the long-term quality of postgraduate training in general through dissemination to other departments. They also have the potential to facilitate equitable distribution of specialists nationwide by expanding postgraduate training to other hospitals and universities. With approximately four physicians per 100,000 inhabitants, Mozambique has a critical shortage of medical doctors. 1 As in other African countries, only a small proportion of the medical doctors are trained as specialists. 2,3,4 This physician shortage goes back at least four decades, when most doctors left Mozambique shortly after the country's independence (in 1975