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Autonomy and supervision

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https://www.readbyqxmd.com/read/28669788/the-effect-of-gender-on-resident-autonomy-in-the-operating-room
#1
Shari L Meyerson, Joel M Sternbach, Joseph B Zwischenberger, Edward M Bender
OBJECTIVE: Discrimination against women training in medicine and surgery has been subjectively described for decades. This study objectively documents gender differences in the degree of autonomy given to thoracic surgery trainees in the operating room. DESIGN: Thoracic surgery residents and faculty underwent frame of reference training on the use of the 4-point Zwisch scale to measure operative autonomy. Residents and faculty then submitted evaluations of their perception of autonomy granted for individual operations as well as operative difficulty on a real-time basis using the "Zwisch Me!!" mobile application...
June 29, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28651531/supervision-and-autonomy-of-ophthalmology-residents-in-the-outpatient-clinic-in-the-united-states-a-survey-of-acgme-accredited-programs
#2
Eric L Singman, Divya Srikumaran, Laura Green, Jing Tian, Peter McDonnell
BACKGROUND: The development and demonstration of incremental trainee autonomy is required by the ACGME. However, there is scant published research concerning autonomy of ophthalmology residents in the outpatient clinic setting. This study explored the landscape of resident ophthalmology outpatient clinics in the United States. METHODS: A link to an online survey using the QualtricsTM platform was emailed to the program directors of all 115 ACGME-accredited ophthalmology programs in the United States...
June 26, 2017: BMC Medical Education
https://www.readbyqxmd.com/read/28631199/practical-interventions-to-enhance-resident-ownership-of-patient-care
#3
Thomas Soeprono, Jesse Markman, Michael Grodesky, Deborah Cowley
OBJECTIVE: In the modern training environment, some question whether trainees have the opportunity to develop ownership of patient care, which includes concepts such as advocacy, autonomy, commitment, communication, follow-through, knowledge about the patient, responsibility, and teamwork. Despite descriptions of what ownership is, there is little discussion of how to foster ownership during residency. The objective of this study was to solicit psychiatry resident and faculty perspectives on ways to enhance resident ownership in training...
June 19, 2017: Academic Psychiatry
https://www.readbyqxmd.com/read/28607848/progressive-surgical-autonomy-in-a-plastic-surgery-resident-clinic
#4
Kristopher M Day, Jillian K Scott, Lani Gao, Tara M Lee, Jimmy L Waldrop, Larry A Sargent, J Woody Kennedy, Jason P Rehm, Mark A Brzezienski
BACKGROUND: Resident clinics are thought to catalyze educational milestone achievement through opportunities for progressively autonomous surgical care, but studies are lacking for general plastic surgery resident clinics (PSRCs). We demonstrate the achievement of increased surgical autonomy and continuity of care in a PSRC. METHODS: A retrospective review of all patients seen in a PSRC from October 1, 2010, to October 1, 2015, was conducted. Our PSRC is supervised by faculty plastic surgery attendings, though primarily run by chief residents in an accredited independent plastic surgery training program...
May 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28596445/development-of-a-new-care-model-for-hospitalized-children-with-medical-complexity
#5
Christine M White, Joanna E Thomson, Angela M Statile, Katherine A Auger, Ndidi Unaka, Matthew Carroll, Karen Tucker, Derek Fletcher, David E Hall, Jeffrey M Simmons, Patrick W Brady
Children with medical complexity are a rapidly growing inpatient population with frequent, lengthy, and costly hospitalizations. During hospitalization, these patients require care coordination among multiple subspecialties and their outpatient medical homes. At a large freestanding children's hospital, a new inpatient model of care was developed in an effort to consistently provide coordinated, family-centered, and efficient care. In addition to expanding the multidisciplinary team to include a pharmacist, dietician, and social worker, the team redesign included: (1) medication reconciliation rounds, (2) care coordination rounds, and (3) multidisciplinary weekly handoff with outpatient providers...
June 8, 2017: Hospital Pediatrics
https://www.readbyqxmd.com/read/28549405/twelve-tips-for-the-implementation-of-epas-for-assessment-and-entrustment-decisions
#6
Harm Peters, Ylva Holzhausen, Christy Boscardin, Olle Ten Cate, H Carrie Chen
The concept of entrustable professional activities (EPAs) reframes the approach to assessment in competency-based medical education. Key to this concept is the linking of assessment to decision making about entrusting learners with clinical responsibilities. Based on recent literature and the authors' experiences with implementing EPAs, this article provides practical recommendations for how to implement EPAs for assessment and entrustment decisions in the workplace. Tips for supervising clinicians include talking to learners about trust, using EPA descriptions to guide learning and teaching, providing learners with greater ad hoc responsibilities, using EPAs to identify/create opportunities for assessment and feedback, including case-based discussions and acknowledging gut feelings about learner readiness for more autonomy...
May 26, 2017: Medical Teacher
https://www.readbyqxmd.com/read/28436048/dealing-with-the-tension-how-residents-seek-autonomy-and-participation-in-the-workplace
#7
Francisco M Olmos-Vega, Diana H J M Dolmans, Nicolas Vargas-Castro, Renée E Stalmeijer
CONTEXT: The workplace can be a strenuous setting for residents: although it offers a wealth of learning opportunities, residents find themselves juggling their responsibilities. Even though supervisors regulate what is afforded to residents, the former find it difficult to strike the proper balance between residents' independence and support, which could create tensions. But what tensions do residents experience during clinical supervision and how do they cope with them to maximise their learning opportunities? Understanding how residents act on different affordances in the workplace is of paramount importance, as it influences their learning...
April 24, 2017: Medical Education
https://www.readbyqxmd.com/read/28386952/student-perspectives-of-a-student-led-groups-program-model-of-professional-practice-education-in-a-brain-injury-rehabilitation-unit
#8
Freyr Patterson, Jennifer Fleming, Kathryn Marshall, Nadine Ninness
BACKGROUND/AIM: Professional practice education is a core and essential component of occupational therapy training. With increasing numbers of education programmes and more students requiring professional practice placements, development of innovative models of professional practice education has emerged, but these require investigation. The aim of this study was to investigate student experiences and perceptions of the Student-Led Groups Program model of professional practice education in an inpatient brain injury rehabilitation unit...
April 7, 2017: Australian Occupational Therapy Journal
https://www.readbyqxmd.com/read/28363675/effect-of-ongoing-assessment-of-resident-operative-autonomy-on-the-operating-room-environment
#9
Jonathan P Fryer, Ezra N Teitelbaum, Brian C George, Mary C Schuller, Shari L Meyerson, Christina M Theodorou, Joseph Kang, Amy Yang, Lihui Zhao, Debra A DaRosa
OBJECTIVE: We have previously demonstrated the feasibility and validity of a smartphone-based system called Procedural Autonomy and Supervision System (PASS), which uses the Zwisch autonomy scale to facilitate assessment of the operative performances of surgical residents and promote progressive autonomy. To determine whether the use of PASS in a general surgery residency program is associated with any negative consequences, we tested the null hypothesis that PASS implementation at our institution would not negatively affect resident or faculty satisfaction in the operating room (OR) nor increase mean OR times for cases performed together by residents and faculty...
March 28, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28257886/effects-of-payment-for-performance-on-accountability-mechanisms-evidence-from-pwani-tanzania
#10
Iddy Mayumana, Jo Borghi, Laura Anselmi, Masuma Mamdani, Siri Lange
Payment for Performance (P4P) aims to improve provider motivation to perform better, but little is known about the effects of P4P on accountability mechanisms. We examined the effect of P4P in Tanzania on internal and external accountability mechanisms. We carried out 93 individual in-depth interviews, 9 group interviews and 19 Focus Group Discussions in five intervention districts in three rounds of data collection between 2011 and 2013. We carried out surveys in 150 health facilities across Pwani region and four control districts, and interviewed 200 health workers, before the scheme was introduced and 13 months later...
February 20, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28248447/feasibility-of-training-nurses-in-motivational-interviewing-to-improve-patient-experience-in-mental-health-inpatient-rehabilitation-a-pilot-study
#11
John Crowley, Nicola Smedley, Marie-France Mutti, Angela Cashen, Trevor Thompson, John Foster, Mel Bunyan
INTRODUCTION: There is limited research addressing the experiences of patients in inpatient rehabilitation (rehabilitation), who often spend long periods in hospital, and the nursing approaches utilised. AIM: Based on evidence that Motivational Interviewing (MI) may improve nursing practice, this was a pilot study evaluating the feasibility of training rehabilitation nurses in MI and measuring patient experience. METHOD: Nurses underwent training and supervision focusing on MI spirit...
March 1, 2017: Journal of Psychiatric and Mental Health Nursing
https://www.readbyqxmd.com/read/28245877/incentives-to-change-effects-of-performance-based-financing-on-health-workers-in-zambia
#12
Gordon C Shen, Ha Thi Hong Nguyen, Ashis Das, Nkenda Sachingongu, Collins Chansa, Jumana Qamruddin, Jed Friedman
BACKGROUND: Performance-based financing (PBF) has been implemented in a number of countries with the aim of transforming health systems and improving maternal and child health. This paper examines the effect of PBF on health workers' job satisfaction, motivation, and attrition in Zambia. It uses a randomized intervention/control design to evaluate before-after changes for three groups: intervention (PBF) group, control 1 (C1; enhanced financing) group, and control 2 (C2; pure control) group...
February 28, 2017: Human Resources for Health
https://www.readbyqxmd.com/read/28225194/observing-bedside-rounds-for-faculty-development
#13
Somnath Mookherjee, Daniel Cabrera, Christy M McKinney, Elizabeth Kaplan, Lynne Robins
BACKGROUND: Bedside rounds are an ideal opportunity for clinical teaching. We previously offered faculty development on balancing learner autonomy, patient care and teaching. We noticed that participants often asked whether attending physicians and learners shared the same perceptions of the key elements (patient-centredness, efficiency and educational value) of bedside rounds. Understanding these perceptions and identifying areas of discordance would inform faculty development for optimal bedside rounds...
February 22, 2017: Clinical Teacher
https://www.readbyqxmd.com/read/28131050/ergometer-cycling-with-strict-versus-minimal-contact-supervision-among-the-oldest-adults-a-cluster-randomised-controlled-trial
#14
RANDOMIZED CONTROLLED TRIAL
Evelien Van Roie, Sofie Martien, Emalie Hurkmans, Johan Pelssers, Jan Seghers, Filip Boen, Christophe Delecluse
OBJECTIVE: To evaluate the feasibility and short- and long-term effects of two 10-wk structured ergometer-cycling programs among elderly in assisted-living residences. DESIGN, SETTING, AND PARTICIPANTS: Eight assisted-living residences (N=95; age=81.2±5.9years) were randomly assigned to one of three conditions: 1) ergometer-cycling with strict coach-supervision (STRICT, N=3; n=35); 2) ergometer-cycling with autonomy-supportive minimal contact coach-supervision (AUT; N=3; n=36); or 3) control condition (CON; N=2, n=24)...
May 2017: Archives of Gerontology and Geriatrics
https://www.readbyqxmd.com/read/28122155/support-workers-in-community-mental-health-teams-for-older-people-roles-boundaries-supervision-and-training
#15
Mark Wilberforce, Michele Abendstern, Sue Tucker, Saima Ahmed, Rowan Jasper, David Challis
AIMS: The aim of this study was to explore the support worker functions in community mental health teams for older adults in relation to roles, boundaries, supervision and training. BACKGROUND: Support workers in community mental health teams provide important help to older people with complex mental and physical health needs in their own homes. Their numbers have grown substantially in recent years, but without professional registration there is concern that boundaries with qualified practitioners are insufficiently clear and that they do not receive the support they require...
July 2017: Journal of Advanced Nursing
https://www.readbyqxmd.com/read/27932029/implementing-a-resident-acute-care-surgery-service-improving-resident-education-and-patient-care
#16
Olga Kantor, Andrew B Schneider, Marko Rojnica, Andrew J Benjamin, Nancy Schindler, Mitchell C Posner, Jeffrey B Matthews, Kevin K Roggin
BACKGROUND: To simulate the duties and responsibilities of an attending surgeon and allow senior residents more intraoperative and perioperative autonomy, our program created a new resident acute care surgery consult service. METHODS: We structured resident acute care surgery as a new admitting and inpatient consult service managed by chief and senior residents with attending supervision. When appropriate, the chief resident served as a teaching assistant in the operation...
March 2017: Surgery
https://www.readbyqxmd.com/read/27886972/the-resident-run-minor-surgery-clinic-a-pilot-study-to-safely-increase-operative-autonomy
#17
REVIEW
Brandon M Wojcik, Zhi Ven Fong, Madhukar S Patel, David C Chang, Emil Petrusa, John T Mullen, Roy Phitayakorn
OBJECTIVE: General surgery training has evolved to align with changes in work hour restrictions, supervision regulations, and reimbursement practices. This has culminated in a lack of operative autonomy, leaving residents feeling inadequately prepared to perform surgery independently when beginning fellowship or practice. A resident-run minor surgery clinic increases junior resident autonomy, but its effects on patient outcomes have not been formally established. This pilot study evaluated the safety of implementing a resident-run minor surgery clinic within a university-based general surgery training program...
November 2016: Journal of Surgical Education
https://www.readbyqxmd.com/read/27789309/a-prospective-cohort-study-of-the-feasibility-and-acceptability-of-depot-medroxyprogesterone-acetate-administered-subcutaneously-through-self-injection
#18
Jane Cover, Allen Namagembe, Justine Tumusiime, Jeanette Lim, Jennifer Kidwell Drake, Anthony K Mbonye
OBJECTIVES: Evidence on contraceptive self-injection from the United States and similar settings is promising, and the practice may increase access. There are no published studies on the feasibility of contraceptive self-injection in sub-Saharan Africa to date. The purpose of this study was to assess feasibility of subcutaneous depot medroxyprogesterone acetate self-injection in Uganda, with specific objectives to (a) measure the proportion of participants who self-injected competently, (b) measure the proportion who self-injected on time 3 months after training (defined conservatively as within 7 days of their reinjection date) and (c) assess acceptability...
March 2017: Contraception
https://www.readbyqxmd.com/read/27733569/selective-posterior-callosotomy-for-drop-attacks-a-new-approach-sparing-prefrontal-connectivity
#19
Eliseu Paglioli, William Alves Martins, Ney Azambuja, Mirna Portuguez, Thomas More Frigeri, Larissa Pinos, Ricardo Saute, Cora Salles, João Rubião Hoefel, Ricardo Bernardi Soder, Jaderson Costa da Costa, Marta Hemb, Tom Theys, André Palmini
OBJECTIVE: To evaluate a novel approach to control epileptic drop attacks through a selective posterior callosotomy, sparing all prefrontal interconnectivity. METHODS: Thirty-six patients with refractory drop attacks had selective posterior callosotomy and prospective follow-up for >4 years. Falls, episodes of aggressive behavior, and IQ were quantified. Autonomy in activities of daily living, axial tonus, and speech generated a functional score ranging from 0 to 13...
November 8, 2016: Neurology
https://www.readbyqxmd.com/read/27638966/mental-and-behavioral-health-environments-critical-considerations-for-facility-design
#20
Mardelle McCuskey Shepley, Angela Watson, Francis Pitts, Anne Garrity, Elizabeth Spelman, Janhawi Kelkar, Andrea Fronsman
OBJECTIVES: The purpose of the study was to identify features in the physical environment that are believed to positively impact staff and patients in psychiatric environments and use these features as the foundation for future research regarding the design of mental and behavioral health facilities. METHODS: Pursuant to a broad literature review that produced an interview script, researchers conducted 19 interviews of psychiatric staff, facility administrators and architects...
September 2016: General Hospital Psychiatry
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