- Email: [email protected]
17 Developing a Taxonomy of “Problem Residents”
CORD Abstracts not receive screening. Screening rotating students may improve the overall quality of applicants and thereby the residency program.
16
Real-Time, Shift-Card-Based Resident Feedback System Improves the Quality of Resident Feedback
Shenvi C, Shofer F, Biese K/University of North Carolina Hospitals, Jacksonville, NC; Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
Background: Feedback from attending physicians is a critical component of graduate medical education. Study Objectives: We sought to measure resident satisfaction with attending feedback received before and after switching from a computer-based feedback system to a real-time shift-card (RTSC) system and to solicit resident input regarding which questions should be included in the RTSCs. Methods: Residents were anonymously surveyed regarding the feedback they received using the computer-based feedback system. An RTSC system was then introduced, in which residents asked attending physicians to complete a shift card and give verbal feedback at the end of the shift. A second survey to assess resident satisfaction with the new system was then performed. PGY1 residents were not asked to compare the 2 systems as they had not used the computer-based system; however, all residents (PGY1 to PGY3) were asked which questions should be included on the shift cards. Results: Eleven PGY2/3 residents completed the initial survey, and 9 also completed the follow-up survey. After switching to the RTSC system, 56% of residents stated they received direct useful feedback more than half the time as compared to only 27% while using the computer-based system, and 78% reported that the feedback had more than minimally impacted the way they practiced medicine, compared with only 36% using the computer-based system. Seven of the 9 respondents thought the RTSC system was an overall improvement. Many residents suggested that the shift card prompt for one specific change the resident should make to improve performance. Conclusion: The majority of EM residents surveyed preferred an RTSC feedback system to a computer-based system. Both the quantity of useful feedback received and the degree to which the feedback impacted their practice of medicine were higher. Requiring evaluation of the residents at the end of shifts may lead to improved feedback.
17
Developing a Taxonomy of “Problem Residents”
Taira T, Santen SA, Roberts NK/SUNY at Stony Brook, Stony Brook, NY; University of Michigan Medical School, Ann Arbor, MI; Southern Illinois University School of Medicine, Springfield, IL
Background: The term “problem resident” is commonly used in graduate medical education. The studies to date have defined the problem resident as “a trainee who demonstrated a significant enough problem that requires intervention by someone of authority.” This definition is broad to the point of being nonspecific and does not reflect the diversity of problem residents encountered in emergency medicine training programs. Study Objectives: We aim to clarify the diversity of emergency medicine program directors’ (PDs) definitions of problem resident through the creation of a taxonomy. Methods: We performed semistructured interviews with a convenience sample of 11 emergency medicine PDs. PDs were asked to describe specific residents whom they defined as a problem resident. We performed a qualitative analysis of the transcripts using grounded theory supported by Atlas.ti. The extracted codes were used to develop themes and domains. Results: We found that there is no single solitary definition of a problem resident. The types of problems lay within the realms of clinical performance, academic performance, professionalism, and interpersonal difficulties. Within each realm, the problems exist on a continuum from those amenable to individual attention to egregious problems requiring dismissal. Further, there was considerable variation of the individual PDs’ threshold for defining a resident as a problem resident. Although PDs consistently classified residents with nonfixable problems as problem residents, there was a distinct split between those who did and did not consider residents who required remediation as being problem residents. This diversity of definition is in direct contrast to the solitary definition that has been used previously in the literature.
Volume , . : November
Conclusions: We found that there is a great deal of diversity in both PDs’ definitions of problem resident and in their threshold for categorizing a resident as a problem resident.
18
Relative Value of Previous Careers in EM
Van Dermark JT, Cyril E/University of Texas Southwestern Medical Center, Dallas, TX
Background: In selecting a student for an EM residency, “soft” categories such as previous EM-related careers and leadership positions exist, which students use to strengthen their application for a given EM residency. Being a scribe is a unique experience in EM and has not been examined compared to the value of traditional preresidency activities. Study Objectives: The value of previous activities of students pursuing a residency in EM will be ranked by EM faculty and compared to the opinions of EM residents who have performed these same careers. Methods: An observational, e-mail survey to EM residency faculty and residents in all ACGME EM programs. Program Directors (PD) and associate/assistant programs directors (APD) volunteered for the study and then forwarded to their respective residents. The primary observation of this study was to compare faculty attitudes of the value of 6 different activities or careers in selecting students for an EM residency versus the residents’ assessment of the same. Secondary observations were the 2 groups’ opinions as to whether these activities helped a resident clinically or academically, or to obtain their job of choice. Results: One hundred twenty-seven EM faculty and 865 EM residents completed survey in a 6-week period. Faculty felt that a scribe background was the least valuable activity when compared to other careers. Residents felt that a scribe was next to last in value. Faculty felt being a scribe was of the least value in academic performance of a resident and not of any increased value in any other aspect. Residents felt that being a scribe was just as valuable as other previous careers in academic, clinical, and jobseeking performance. Conclusions: A previous career as an EM scribe was not of higher value than other traditional careers for EM faculty who are selecting students for an EM residency. EM residents also did not believe being a scribe was of higher value in helping them to match.
19
Reformatting Resident Education: Using Adult Learning Theory, Knowledge Translation, and Web 2.0 to Accelerate Resident Learning
Cooney RR, Casey K, LeWitt M, Johnston G/LECOM/Conemaugh Valley Memorial Center Hospital, Johnstown, PA
Background: Many programs rely on the traditional didactic lecture format as the mainstay of resident education. For many reasons, lectures have been demonstrated to be problematic for adult learners. Study Objective: We sought to use the EM model as a guide to create a curriculum that utilized the principles of adult learning to promote resident learning. Methods: We created 92 modular reading assignments based on the model. To stimulate curiosity, promote critical learning, and challenge dogma, traditional texts and lectures were replaced with reading assignments derived from the medical literature. Each assignment contains between 4 and 10 articles (50100 pages) and includes original research, guidelines, and review articles. To further distill the learning process, 2 hours of lecture were replaced with facultyfacilitated small-group discussion. This allows for the residents to serve as active participants in their learning. The faculty moderator is then able to use questioning skills to promote further learning and clarification of confusing topics. Faculty focus on 3 key themes: assimilation of factual material, acquisition of concepts relating to the material, and application of the concepts to solve clinical problems (Figure 1). The curriculum is hosted on a wiki. Web 2.0 technologies allow the content of the curriculum to be updated quickly. This rapid dissemination of new research promotes knowledge translation. It also allows a resident to learn new material if a module is repeated. Faculty “experts” continuously update the modules to include the new information. Conclusion: The curriculum has been in place for 5 years. Feedback has been positive. Resident feedback has allowed for real-time changes in the curriculum. This allows them to assume some control over their learning process. Real-time assessment of outcomes is ongoing; however, in-service scores have been promising (Figure 2) and the first graduating class achieved a 100% pass rate.
Annals of Emergency Medicine S169
16
Real-Time, Shift-Card-Based Resident Feedback System Improves the Quality of Resident Feedback
Shenvi C, Shofer F, Biese K/University of North Carolina Hospitals, Jacksonville, NC; Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
Background: Feedback from attending physicians is a critical component of graduate medical education. Study Objectives: We sought to measure resident satisfaction with attending feedback received before and after switching from a computer-based feedback system to a real-time shift-card (RTSC) system and to solicit resident input regarding which questions should be included in the RTSCs. Methods: Residents were anonymously surveyed regarding the feedback they received using the computer-based feedback system. An RTSC system was then introduced, in which residents asked attending physicians to complete a shift card and give verbal feedback at the end of the shift. A second survey to assess resident satisfaction with the new system was then performed. PGY1 residents were not asked to compare the 2 systems as they had not used the computer-based system; however, all residents (PGY1 to PGY3) were asked which questions should be included on the shift cards. Results: Eleven PGY2/3 residents completed the initial survey, and 9 also completed the follow-up survey. After switching to the RTSC system, 56% of residents stated they received direct useful feedback more than half the time as compared to only 27% while using the computer-based system, and 78% reported that the feedback had more than minimally impacted the way they practiced medicine, compared with only 36% using the computer-based system. Seven of the 9 respondents thought the RTSC system was an overall improvement. Many residents suggested that the shift card prompt for one specific change the resident should make to improve performance. Conclusion: The majority of EM residents surveyed preferred an RTSC feedback system to a computer-based system. Both the quantity of useful feedback received and the degree to which the feedback impacted their practice of medicine were higher. Requiring evaluation of the residents at the end of shifts may lead to improved feedback.
17
Developing a Taxonomy of “Problem Residents”
Taira T, Santen SA, Roberts NK/SUNY at Stony Brook, Stony Brook, NY; University of Michigan Medical School, Ann Arbor, MI; Southern Illinois University School of Medicine, Springfield, IL
Background: The term “problem resident” is commonly used in graduate medical education. The studies to date have defined the problem resident as “a trainee who demonstrated a significant enough problem that requires intervention by someone of authority.” This definition is broad to the point of being nonspecific and does not reflect the diversity of problem residents encountered in emergency medicine training programs. Study Objectives: We aim to clarify the diversity of emergency medicine program directors’ (PDs) definitions of problem resident through the creation of a taxonomy. Methods: We performed semistructured interviews with a convenience sample of 11 emergency medicine PDs. PDs were asked to describe specific residents whom they defined as a problem resident. We performed a qualitative analysis of the transcripts using grounded theory supported by Atlas.ti. The extracted codes were used to develop themes and domains. Results: We found that there is no single solitary definition of a problem resident. The types of problems lay within the realms of clinical performance, academic performance, professionalism, and interpersonal difficulties. Within each realm, the problems exist on a continuum from those amenable to individual attention to egregious problems requiring dismissal. Further, there was considerable variation of the individual PDs’ threshold for defining a resident as a problem resident. Although PDs consistently classified residents with nonfixable problems as problem residents, there was a distinct split between those who did and did not consider residents who required remediation as being problem residents. This diversity of definition is in direct contrast to the solitary definition that has been used previously in the literature.
Volume , . : November
Conclusions: We found that there is a great deal of diversity in both PDs’ definitions of problem resident and in their threshold for categorizing a resident as a problem resident.
18
Relative Value of Previous Careers in EM
Van Dermark JT, Cyril E/University of Texas Southwestern Medical Center, Dallas, TX
Background: In selecting a student for an EM residency, “soft” categories such as previous EM-related careers and leadership positions exist, which students use to strengthen their application for a given EM residency. Being a scribe is a unique experience in EM and has not been examined compared to the value of traditional preresidency activities. Study Objectives: The value of previous activities of students pursuing a residency in EM will be ranked by EM faculty and compared to the opinions of EM residents who have performed these same careers. Methods: An observational, e-mail survey to EM residency faculty and residents in all ACGME EM programs. Program Directors (PD) and associate/assistant programs directors (APD) volunteered for the study and then forwarded to their respective residents. The primary observation of this study was to compare faculty attitudes of the value of 6 different activities or careers in selecting students for an EM residency versus the residents’ assessment of the same. Secondary observations were the 2 groups’ opinions as to whether these activities helped a resident clinically or academically, or to obtain their job of choice. Results: One hundred twenty-seven EM faculty and 865 EM residents completed survey in a 6-week period. Faculty felt that a scribe background was the least valuable activity when compared to other careers. Residents felt that a scribe was next to last in value. Faculty felt being a scribe was of the least value in academic performance of a resident and not of any increased value in any other aspect. Residents felt that being a scribe was just as valuable as other previous careers in academic, clinical, and jobseeking performance. Conclusions: A previous career as an EM scribe was not of higher value than other traditional careers for EM faculty who are selecting students for an EM residency. EM residents also did not believe being a scribe was of higher value in helping them to match.
19
Reformatting Resident Education: Using Adult Learning Theory, Knowledge Translation, and Web 2.0 to Accelerate Resident Learning
Cooney RR, Casey K, LeWitt M, Johnston G/LECOM/Conemaugh Valley Memorial Center Hospital, Johnstown, PA
Background: Many programs rely on the traditional didactic lecture format as the mainstay of resident education. For many reasons, lectures have been demonstrated to be problematic for adult learners. Study Objective: We sought to use the EM model as a guide to create a curriculum that utilized the principles of adult learning to promote resident learning. Methods: We created 92 modular reading assignments based on the model. To stimulate curiosity, promote critical learning, and challenge dogma, traditional texts and lectures were replaced with reading assignments derived from the medical literature. Each assignment contains between 4 and 10 articles (50100 pages) and includes original research, guidelines, and review articles. To further distill the learning process, 2 hours of lecture were replaced with facultyfacilitated small-group discussion. This allows for the residents to serve as active participants in their learning. The faculty moderator is then able to use questioning skills to promote further learning and clarification of confusing topics. Faculty focus on 3 key themes: assimilation of factual material, acquisition of concepts relating to the material, and application of the concepts to solve clinical problems (Figure 1). The curriculum is hosted on a wiki. Web 2.0 technologies allow the content of the curriculum to be updated quickly. This rapid dissemination of new research promotes knowledge translation. It also allows a resident to learn new material if a module is repeated. Faculty “experts” continuously update the modules to include the new information. Conclusion: The curriculum has been in place for 5 years. Feedback has been positive. Resident feedback has allowed for real-time changes in the curriculum. This allows them to assume some control over their learning process. Real-time assessment of outcomes is ongoing; however, in-service scores have been promising (Figure 2) and the first graduating class achieved a 100% pass rate.
Annals of Emergency Medicine S169