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Resident ambulatory education

Ali J Hussain
An association has been consistently made about continuity of care with improved quality of care and improved medical outcomes. However, resident ambulatory block scheduling prevents the optimization of continuity of care in ambulatory clinical education. The author performed a PubMed search for studies examining continuity of care and curriculum scheduling in US primary care residency clinics. These studies indicate the success of an X + Y scheduling model in resident ambulatory training. Additional benefits have also been noted, including improved clinical teaching and learning, increased sense of teamwork, increased resident satisfaction, improved recruitment and retention, improved patient satisfaction, and elimination of year-end patient care issues after graduation...
December 1, 2016: Journal of the American Osteopathic Association
Robert J Fortuna, Lynn Garfunkel, Michael D Mendoza, Megan Ditty, Julia West, Karen Nead, Brett W Robbins
BACKGROUND : Continuity of care is a critical element of residents' educational experience in primary care programs. OBJECTIVE : We examined how continuity in resident practices compares to nonteaching practices, identified factors associated with increased continuity, and explored the association between continuity and quality measures. METHODS : We analyzed 117 235 patient visits to 4 resident practices (26 resident teams in internal medicine, pediatrics, family medicine, and medicine-pediatrics) and 270 242 visits to nonteaching community practices between July 2013 and May 2014...
October 2016: Journal of Graduate Medical Education
Mohammad Mahdi Parvizi, Mitra Amini, Mohammad Reza Dehghani, Peyman Jafari, Zahra Parvizi
PURPOSE: Evaluation is the main component in design and implementation of educational activities and rapid growth of educational institution programs. Outpatient medical education and clinical training environment is one of the most important parts of training of medical residents. This study aimed to determine the validity and reliability of the Persian version of Ambulatory Care Learning Educational Environment Measure (ACLEEM) questionnaire, as an instrument for assessment of educational environments in residency medical clinics...
2016: Advances in Medical Education and Practice
Donna P Phillips, Joseph D Zuckerman, Adina Kalet, Kenneth A Egol
The Accreditation Council of Graduate Medical Education requires that residency programs teach and assess trainees in six core competencies. Assessments are imperative to determine trainee competence and to ensure that excellent care is provided to all patients. A structured, direct observation program is feasible for assessing nontechnical core competencies and providing trainees with immediate constructive feedback. Direct observation of residents in the outpatient setting by trained faculty allows assessment of each core competency...
September 2016: Journal of the American Academy of Orthopaedic Surgeons
Rose Gabert, Blake Thomson, Emmanuela Gakidou, Gregory Roth
BACKGROUND: Increasing attention is being paid to the marked disparities in diabetes prevalence and health outcomes in the United States. There is a need to identify the small-area geographic variation in diabetes risk and related outcomes, a task that current health surveillance methods, which often rely on a self-reported diagnosis of diabetes, are not detailed enough to achieve. Broad adoption of electronic health records (EHR) and routine centralized reporting of patient-level data offers a new way to examine diabetes risk and highlight hotspots for intervention...
2016: PloS One
Andrew J Goodwin, Nandita R Nadig, James T McElligott, Kit N Simpson, Dee W Ford
BACKGROUND: Medically underserved areas are composed of vulnerable populations with reduced access to ambulatory care services. Our goal was to determine the association between residence in a medically underserved area and severe sepsis incidence and mortality. METHODS: Using administrative data, we identified adults admitted with severe sepsis to nonfederal hospitals in South Carolina. We determined whether each resident lived in a medically underserved area or nonmedically underserved area from US Census and Department of Health and Human Services data...
October 2016: Chest
Alaka Ray, Danielle Jones, Kerri Palamara, Maryann Overland, Kenneth P Steinberg
The Accreditation Council for Graduate Medical Education (ACGME) requirement that internal medicine residents spend one-third of their training in an ambulatory setting has resulted in programmatic innovation across the country. The traditional weekly half-day clinic model has lost ground to the block or "X + Y" clinic model, which has gained in popularity for many reasons. Several disadvantages of the block model have been reported, however, and residency programs are caught between the threat of old and new challenges...
December 2016: Journal of General Internal Medicine
Daniel G Tobin, Benjamin R Doolittle, Matthew S Ellman, Christopher B Ruser, Rebecca S Brienza, Inginia Genao
Teaching residents to practice independently is a core objective of graduate medical education (GME). However, billing rules established by the Centers for Medicare and Medicaid Services (CMS) require that teaching physicians physically be present in the examination room for the care they bill, unless the training program qualifies for the Primary Care Exception Rule (PCER). Teaching physicians in programs that use this exception can bill for indirectly supervised ambulatory care once the resident who provides that care has completed six months of training...
June 28, 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Lisa M Trahan, Jude A Spiers, Greta G Cummings
OBJECTIVES: Nursing home (NH) residents are a frail and vulnerable population often faced with iatrogenic effects of hospital stays when transferred to emergency departments for acute changes in health status. Avoidable or unnecessary transfers of care need to be identified and defined to prevent unintended harm. The aim of this scoping review was to identify characteristics of avoidable or unnecessary transitions of NH residents to emergency departments, and examine factors influencing decision-making by NH staff, residents, and their family members to transfer nursing home residents to emergency departments...
June 24, 2016: Journal of the American Medical Directors Association
Erica O Miller, Bryan Stanistreet, Emily Ruckdeschel, Karen Nead, Robert J Fortuna
Obesity is a growing epidemic, yet few patients with obesity receive a clinical diagnosis of obesity or appropriate counseling. We examined the socioeconomic and demographic factors associated with the accurate diagnosis of obesity during ambulatory care visits. We used data from the National Hospital Ambulatory and National Ambulatory Medical Care Surveys (NHAMCS and NAMCS) to determine if a patient with obesity had been clinically diagnosed with obesity during the visit by either of the following: (1) a diagnosis listed in the patient's record; or (2) the provider's answer to the question "despite the diagnoses listed, does this patient have obesity?" We used multivariate models to examine the association between the accurate diagnosis of obesity and socioeconomic and demographic factors...
June 16, 2016: Journal of Community Health
Kathleen Dorcy, Suni Elgar, Diane Heye, Rosemary Ford, Sharol Bohl, Seth Eisenberg, Arlyce Coumar, Pamela Pearson, Julianne Pugh, Karla Mather, Debra Matthews
BACKGROUND: Healthcare reform and the shift of care to the ambulatory setting has created challenges for preparing nurses to practice in these complex clinical settings. Oncology is an area where dramatic transitions to ambulatory care have occurred, and the ambulatory oncology setting holds great potential for teaching evidence-based care to nursing students. OBJECTIVES: The article summarizes the collaboration between a baccalaureate nursing program and a cancer clinic to establish a dedicated education unit (DEU)...
June 1, 2016: Clinical Journal of Oncology Nursing
Paolo Magistri, Giuseppe Nigri, Niccolò Petrucciani, Paolo Aurello, Francesco D'Angelo, Giovanni Ramacciato
AIM: We decided to compare five different teaching models to provide the best training for third-year medical students during their Surgical Rotation. MATERIALS AND METHODS: Group A got a standard rotation. Group B came to the ward once a week at half morning, spent 1 hour with the tutor and the rest of the morning with residents. Group C was divided into smaller groups, each one assigned 2 times to the ambulatory, to the ward and to the pre-admission service. Group D came to the ward once a week at early morning, spent 2 hours with the tutor and the rest of the morning with residents...
2016: Annali Italiani di Chirurgia
Songhai C Barclift, Elizabeth J Brown, Sean C Finnegan, Elena R Cohen, Kathleen Klink
Background The Teaching Health Center Graduate Medical Education (THCGME) program is an Affordable Care Act funding initiative designed to expand primary care residency training in community-based ambulatory settings. Statute suggests, but does not require, training in underserved settings. Residents who train in underserved settings are more likely to go on to practice in similar settings, and graduates more often than not practice near where they have trained. Objective The objective of this study was to describe and quantify federally designated clinical continuity training sites of the THCGME program...
May 2016: Journal of Graduate Medical Education
Michael A Mitchell, Lauren M Broyles, Janice L Pringle, Kevin L Kraemer, Julie W Childers, Raquel A Buranosky, Adam J Gordon
BACKGROUND: Screening and brief intervention counseling for unhealthy alcohol use are among the top ten recommended clinical preventive services for US adults. While federally-funded training programs in alcohol screening, brief intervention, and referral to treatment (SBIRT) have focused on increasing physicians' professional readiness to address drinking with their patients, programs typically focus on knowledge and skill acquisition, with less attention to attitudinal change. The purpose of this study was to assess the impact of a multi-component SBIRT training program on changes in internal medical residents' professional readiness for working with patients with unhealthy alcohol use...
May 10, 2016: Substance Abuse
Leslie A Wimsatt, James M Cooke, Wendy S Biggs, Joel J Heidelbaugh
UNLABELLED: Phenomenon: Existing research provides little specific evidence regarding the association between public and private medical school curricular settings and the proportion of medical students matching into family medicine careers. Institutional differences have been inadequately investigated, as students who match into family medicine are often consolidated into the umbrella of primary care along with those matching in internal medicine and pediatrics. However, understanding medical school contexts in relation to career choice is critical toward designing targeted strategies to address the projected shortage of family physicians...
July 2016: Teaching and Learning in Medicine
Renee Butkus, Susan Lane, Alwin F Steinmann, Kelly J Caverzagie, Thomas G Tape, Susan T Hingle, Darilyn V Moyer
In this position paper, the Alliance for Academic Internal Medicine and the American College of Physicians examine the state of graduate medical education (GME) financing in the United States and recent proposals to reform GME funding. They make a series of recommendations to reform the current funding system to better align GME with the needs of the nation's health care workforce. These recommendations include using Medicare GME funds to meet policy goals and to ensure an adequate supply of physicians, a proper specialty mix, and appropriate training sites; spreading the costs of financing GME across the health care system; evaluating the true cost of training a resident and establishing a single per-resident amount; increasing transparency and innovation; and ensuring that primary care residents receive training in well-functioning ambulatory settings that are financially supported for their training roles...
July 19, 2016: Annals of Internal Medicine
Leigh Simmons, Lauren Leavitt, Alaka Ray, Blair Fosburgh, Karen Sepucha
PROBLEM: Physicians must be competent in several different kinds of communication skills in order to implement shared decision making; however, these skills are not part of routine medical student education, nor are they formally taught during residency training. INTERVENTION: We developed a 1- and 2-hour workshop curriculum for internal medicine residents to promote shared decision making in treatment decisions for four common chronic conditions: diabetes, depression, hypertension, and hyperlipidemia...
2016: Teaching and Learning in Medicine
Hariharan Regunath, Kelly Cochran, Kasey Cornell, James Shortridge, Daniel Kim, Syed Akbar, Barbara Boshard, Rebecca Chitima-Matsiga, Jyotsna Reddy, Steven Keithahn, James P Koller
BACKGROUND: Prescribing opioids for chronic non-cancer pain (CNCP) is a challenge due to associated risks from abuse, addiction and adverse effects. We surveyed resident physicians on their knowledge, attitude and practices in opioid prescription practices in the ambulatory setting and conducted an educational module to address their knowledge gaps. METHODS: A phase 1 survey assessed knowledge, attitudes and practices of residents in the out-patient management of CNCP with opioids...
January 2016: Missouri Medicine
M Patrice Eiff, Larry A Green, Eric Holmboe, Furman S McDonald, Kathleen Klink, David Gary Smith, Carol Carraccio, Rose Harding, Eve Dexter, Miguel Marino, Sam Jones, Kelly Caverzagie, Mumtaz Mustapha, Patricia A Carney
PURPOSE: To report findings from a national effort initiated by three primary care certifying boards to catalyze change in primary care training. METHOD: In this mixed-method pilot study (2012-2014), 36 faculty in 12 primary care residencies (family medicine, internal medicine, pediatrics) from four institutions participated in a professional development program designed to prepare faculty to accelerate change in primary care residency training by uniting them in a common mission to create effective ambulatory clinical learning environments...
September 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Tamar F Barlam, Rene Soria-Saucedo, Howard J Cabral, Lewis E Kazis
Background.  Up to 40% of antibiotics are prescribed unnecessarily for acute respiratory tract infections (ARTIs). We sought to define factors associated with antibiotic overprescribing of ARTIs to inform efforts to improve practice. Methods.  We conducted a retrospective analysis of ARTI visits between 2006 and 2010 from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Those surveys provide a representative sample of US visits to community-based physicians and to hospital-based emergency departments (EDs) and outpatient practices...
January 2016: Open Forum Infectious Diseases
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