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This cross-sectional, retrospective, pre-post repeated measures study aimed to describe Ohio physicians' burnout and mental health experiences as perceived prior to and during the COVID-19 pandemic. A one-time online survey was completed by 1,613 physicians registered with the State Medical Board of Ohio (SMBO). Wilcoxon signed-rank tests were used to assess differences between physicians' self-reports of burnout and mental health prior to and during the pandemic. Mann-Whitney U tests examined response differences between physicians and residents. Data revealed statistically significant differences between physicians' pre-pandemic and pandemic experiences for all measures of burnout and mental health (p < 0.001) with moderate effect sizes for feeling emotionally drained from work (Z = -16.71, r = 0.43); feeling down, depressed, or hopeless (Z = -18.09, r = 0.46); feeling less accom- plished (Z = -11.03, r = 0.29); and caring less about what happens to patients (Z = -12.04, r = 0.31). Small effect sizes were found for thoughts of suicide and concerns about one's substance use. Additionally, resident physicians were more likely than physicians to report many burnout and mental health concerns prior to and during the pandemic, although these effect sizes were small. These findings can inform stakeholders' efforts toward the prevention and reduction of physician burnout and improvement of well-being. [ABSTRACT FROM AUTHOR]

Background: Discovering methods of Residency Teaching Certificate Programs (RTCPs) will allow for collaboration in developing best practices to ensure both high quality of programming and outcomes for participants. Objective: The primary objective of this project is to describe and compare how RTCPs are conducted in the state of Ohio. Secondarily, to identify current practices in assessing RTCPs in both programmatic effectiveness and individual resident teaching outcomes. Methods: The seven coordinators of the seven Ohio RTCPs (n=7) were contacted via email and asked to participate in an IRB-approved interview, either in-person or telephonically. Standardized questions were developed to inquire about six categories of interest: demographics/background, administration/logistics, content, assessment of the resident, program financing, and program continuous quality improvement (CQI). All seven programs participated in interviews. Data was coded by multiple members of the research team for presentation in aggregate form. Results: RTCPs include seminar days at the respective pharmacy colleges; however, the number, length, and content of seminars vary. The majority of programs (n=5) stated using inherited curriculum and materials passed down from previous coordinators. While each RTCP requires participants to submit a teaching portfolio, only three of seven programs assess the summative portfolios. All programs (n=7) award participants a certificate based on completion of requirements without a defined minimum performance standard. Two programs are collecting participant feedback after every session for CQI however no programs are completing an annual programmatic assessment of resident outcomes. The majority of coordinators (n=7) are interested in collaborating and sharing "best practices" between RTCPs in the state. Conclusions: Although published and available resources exist surrounding the development and delivery of RTCPs, in Ohio, their use varies greatly. The most striking outcomes highlighted the lack of resident and program assessment of outcomes in RTCPs. The research has brought forth ideas of ways to improve these programs through resident assessment, program assessment and also leads to reflection and innovation around the best way to deliver these programs. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to determine whether in-person vs virtual interviews in the Oral & Maxillofacial Surgery (OMS) residency application process affects an applicant's perspective on a program and his/her comfort level in ranking a program. This study will also look to assess if the continuation of virtual interviews has any socioeconomic impacts on the application pool., Methods: This cross-sectional study used a descriptive survey sent to all applicants in the 2022 to 2023 OMS residency application cycle to The Ohio State University OMS Residency Program (OSU OMS). The survey involved both scaled and comparative questions aimed to deduce applicant's preferences on the mode of interview process. Questions were designed to both target an applicant's ability to differentiate programs as well uncover any socioeconomic impacts that the reinstatement of in-person interviews caused. All obtained statistics were computed for data analysis., Results: There were 187 applicants to the OSU OMS program in the 2022 to 2023 cycle. Fifty-four applicants completed responses (response rate = 28.9%). A total of 84.4% of respondents preferred in-person interviews., Conclusions: In-person interviews are the preferred modality for OMS interviews. The ability to experience a program and its faculty and residents in-person proved favorable despite the financial and logistical benefits of virtual interviews., (Copyright © 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background/objective: Pediatric residents must demonstrate competence prior to graduation in Accreditation Council for Graduate Medical Education (ACGME) required procedures. Recent literature shows general pediatricians (GPeds) infrequently perform these procedures yet believe them important to learn. The purpose of this study was to determine why GPeds believe learning procedures was important, what barriers prevent them from developing and maintaining procedural skills, and what procedures they believe should be included in training., Methods: Fifty-one GPeds from the American Board of Pediatrics General Examination Committee and the central Ohio region participated in 30-minute semistructured recorded phone interviews that probed their use of procedures across training and current practice. Participants represented urban, suburban, and rural geographic regions and practiced in a variety of settings. We conducted a thematic analysis of transcribed interviews., Results: GPeds believed currently required ACGME procedures were crucial to learn for 5 reasons: 1) adaptation to change in practice type or location, 2) emergency preparedness, 3) counseling patients and families, 4) distance from a tertiary care center and specialists, and 5) professional identity as a pediatrician. Numerous barriers, particularly never learning the procedures, prevented GPeds from performing procedures in practice. Recommended procedures to be taught included high- (eg, circumcision), and low-risk (eg, cerumen removal, nasopharyngeal swabs, umbilical cauterization) skills., Conclusions: GPeds believed procedural training was important, however may never have learned certain procedures. These findings suggest that teaching methods should be adapted or customized procedural education should be implemented to ensure relevancy of skills learned for clinical practice., (Copyright © 2021 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: Patient suicide is a common experience in psychiatry residency, and its effects on trainees can be profound. There are currently no ACGME Common Program Requirements for education about patient suicide, and a need exists for evidence-based curricula to prepare residents for this difficult outcome., Methods: A comprehensive patient suicide curriculum was developed utilizing multiple modes of delivering content, including a training designed to foster built-in support among peers in the healthcare workplace. The content was delivered at intervals over the course of the 2019-2020 academic year for 43 psychiatry residents at The Ohio State University Wexner Medical Center. Pre- and post-curriculum surveys were obtained to assess the resident experience of the new curriculum., Results: Twenty-seven residents completed the pre-curriculum survey and 25 completed the post-curriculum survey. Results demonstrated statistically significant improvements in ratings of preparedness to deal with the loss of a patient by suicide, preparedness to support a co-resident who has experienced the death of a patient by suicide, program-level support for residents, understanding systems-level and quality processes, and knowledge of what steps to take if finding out a patient has completed suicide., Conclusions: A multimodal approach incorporating understanding emotional reactions, provision of support, delineation of procedural issues, and education regarding quality and risk management considerations was effective at improving resident preparedness to cope following a patient suicide.

Background: United States student loan debt has surpassed $1.7 trillion and continues to rise. Generally described as a "crisis," the state of student loan debt in the United States is a subject of increasing consideration, research, and analysis by federal government agencies, nonprofit organizations, economists, and students who carry the balance. Excessive student loan debt has been hypothesized to affect students' career choice, diminish quality of life, negatively affect their ability to give back to society at large, and delay progress on achieving other financial goals such as saving for retirement. Current available research evaluating the impact of this debt on student pharmacists and new practitioners is limited., Objective: To assess the impact of student loan debt on financial stability, career choice, professional development, and overall well-being among pharmacists who received first licensure in Ohio within a 5-year period; hereafter referred to as "new practitioners.", Methods: An anonymous survey, consisting of 39 items, was administered using Verint survey software to new practitioners holding an active pharmacist license in Ohio with date of first licensure between May 1, 2012 and March 1, 2017., Results: Total of 4026 pharmacists were invited to participate in the survey, and there were 471 responses, yielding a response rate of 11.7%. Higher student loan debt was associated with perceived limitations regarding amount of available disposable income, career mobility, work satisfaction, charitable contributions, participation in professional organizations, retirement savings, purchasing a home, delay in starting a family, diminished quality of life, and worries about paying off student loans. However, this study did not find a statistically significant relationship between student loan debt and the decision to pursue a residency., Conclusion: On the basis of the results of this study, higher student loan debt has statistically significant effect on new practitioner's perception of their financial stability, ability to pursue professional development opportunities, and overall well-being., (Copyright © 2021 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background: The American Dental Association's (ADA) specialty recognition process has long been the gold standard in dentistry. Specialty advertising regulations have been challenged as inconsistent with commercial speech rights of dentists wishing to advertise as specialists in areas not recognized as ADA specialties. Commission of Dental Accreditation-approved postdoctoral education exists to support this process using standard-based education, continuous quality review and accountability., Purpose: In 2017, a federal court declared Texas dental specialty advertising rules unconstitutional noting the state did not present evidence demonstrating the public was being misled. A state dental association commissioned a professional survey to assess state residents' understanding of the term "specialist" in dental advertising., Methods: Telephone interviews conducted with 812, 18+-year-old Ohio residents focused on advertising related to dental implants and TMJ disorders (not recognized specialties) and orthodontics and oral surgery (recognized specialties)., Results: Respondents indicated they would be inclined to think a dentist who advertised as a specialist had completed an accredited dental residency program and was more qualified to perform specialty care than a general dentist. Respondents also indicated that they would be less likely to choose a dentist who advertised as a specialist who did not have accredited residency training., Conclusions: Tying specialty status to completion of a residency program accredited by an agency recognized by the U.S. Department of Education is important to the public's expectations and has implications for dental education., (© 2020 American Dental Education Association.)

Objective: Developing resident autonomy in the operating room is a complex process and resident established case specific learning goals may increase resident operating room training efficiency. However, little is understood about residents' experience identifying learning goals for a given case. The aim of this study was to explore the essential components contributing to surgery residents' identification of specific learning goals for surgical cases., Design: We conducted focus group interviews with general surgery residents across all post-graduate years (PGY) through convenience sampling. Audio recordings of each interview were transcribed and iteratively analyzed. Emerging themes were identified using a framework method., Setting: The study was conducted within the Department of General Surgery at the Ohio State University Medical Center, a tertiary academic medical center., Participants: Eight junior (PGY 1-2) and 10 senior (PGY 3-5) residents participated, of whom 10 were female and 8 were male., Results: On average, each focus group interview lasted 57.00 (SD ± 12.99) minutes. Three essential components of residents' creation of case-specific learning goals emerged from the focus group interviews: medical knowledge, surgical experience and entrustment. Residents require baseline knowledge and surgical experience with an operation to identify the learning goal they would aim to execute. They also require entrustment of themselves and support of the attending to accomplish the case specific learning goal. Differences in the possession of these three components would likely influence differences in the ability to create learning goals between junior and senior residents., Conclusions: Medical knowledge, surgical experience and entrustment are 3 factors that are imperative to the creation of a resident's case specific learning goal. The complex combination of these three components contributes to the building of the learning goal prior to the start of the operation. Elucidating these aspects provides additional information for targeted interventions in the future., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Pediatric residency programs offer many conferences and activities to meet the educational needs of their residents. We developed and assessed the Pediatric Chief Resident Exchange Program where pediatric chief residents visited another institution for a day with the goal of sharing educational and curricular innovations between residency programs in an experiential manner., Approach/innovation: Pediatric chief residents participated in various activities during the exchange including educational conferences and discussions with residency program leadership at the host institutions. Surveys were administered to all participating chiefs to determine if any changes to educational conferences or curriculum were made or planned to be made at their home program based upon what they observed at the other institution and to have chiefs reflect on what they gained from the experience., Results: Twenty-eight chief residents from 9 programs participated in the exchange program over 3 academic years (2015-2018). All respondents felt the exchange experience was worthwhile. The majority (67%) of programs planned to implement a change at their institution based on participation in the exchange with over half actually making a change by the end of the academic year. Participating chiefs gained a sense of camaraderie, appreciated that other programs experienced similar struggles, and developed further insight into the chief resident role., Discussion: The Pediatric Chief Resident Exchange Program is a novel method of sharing educational practices between institutions that can lead to curricular changes at participating programs. It can also be an opportunity for chief resident professional development., (Copyright © 2019 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the influence of surgical site infection (SSI) on the median disease-free interval (DFI) and median survival time (MST) in dogs after amputation in the curative-intent treatment of appendicular osteosarcoma (OSA)., Study Design: Multi-institutional retrospective cohort study., Animals: Fifteen dogs with OSA and SSI, and 134 dogs with OSA and no SSI., Methods: Medical records were reviewed, and dogs were included if the following criteria were met: histologic confirmation of OSA, no evidence of metastasis, ≥1 chemotherapy treatment, and available follow-up data. We used the definition of SSI from the Centers for Disease Control and Prevention. Kaplan-Meier estimates of median DFI and MST for the SSI and non-SSI groups were compared by log-rank test. Univariate and multivariate Cox proportional hazard regression analysis was evaluated for associations with DFI and survival., Results: The median DFI and MST of all OSA dogs were 236 days (95% CI, 181-283) and 283 days (95% CI 237-355), respectively. The median DFI of dogs with SSI (292 days) did not differ from that of dogs without SSI (224 days, P = .156). The MST of dogs with SSI (292 days) did not differ from that of dogs without SSI (280 days, P = .417). Failure to complete chemotherapy was associated with decreased DFI and survival (P < .001). Adjustments for chemotherapy completion found no effect of SSI on survival., Conclusion: SSI did not influence the survival of dogs with appendicular OSA treated with amputation and curative-intent treatment., Clinical Significance: The extended survival associated with SSI after limb-spare surgery for OSA does not appear to be present after amputation. Interactions between the canine immune system and OSA warrant additional study., (© 2018 The American College of Veterinary Surgeons.)

Despite increasing numbers of patients with neurodisability, residents lack training to develop physical examination skills. Following a blended educational intervention combining online and bedside teaching, residents demonstrated desired patient-care behaviors on standardized clinical exam assessment., (Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Using innovative technology to teach about social determinants of health might address current training barriers related to standardization, sustainability, and scalability. A virtual tour of an impoverished neighborhood that used 360° videos was noninferior to the previous in-person experience., (Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Background: The American Center for Reproductive Medicine's summer internship course in reproductive medicine and research at Cleveland Clinic is a rigorous, results-oriented annual program that began in 2008 to train both local and international students in the fundamentals of scientific research and writing. The foremost goal of the program is to encourage premedical and medical students to aspire toward a career as a physician-scientist. The internship provides participants with an opportunity to engage in original bench research and scientific writing while developing theoretical knowledge and soft skills. This study describes selected survey responses from interns who participated in the 2014 internship program. The objective of these surveys was to elicit the interns' perspective on the internship program, its strengths and weaknesses, and to obtain insight into potential areas for improvement., Methods: Questionnaires were structured around the five fundamental aspects of the program: 1) theoretical knowledge, 2) bench research, 3) scientific writing, 4) mentorship, and 5) soft skills. In addition, an exit survey gathered information on factors that attracted the interns to the program, communication with mentors, and overall impression of the research program., Results: The opportunity to experience hands-on bench research and scientific writing, personalized mentorship, and the reputation of the institution were appreciated and ranked highly among the interns. Nearly 90% of the interns responded that the program was beneficial and well worth the time and effort invested by both interns and faculty., Conclusion: The outcomes portrayed in this study will be useful in the implementation of new programs or refinement of existing medical research training programs.

Objective: To assess the effect of a structured postgraduate year 1 educational curriculum, including online surgical training, on American Board of Surgery In-Training Examination (ABSITE) scores., Design: This was a retrospective cohort study., Setting: The study was performed in an academic surgical residency program in a tertiary care hospital, Cleveland Clinic Foundation, Cleveland, Ohio., Participants: The participants were 140 surgical postgraduate year 1 residents from 2000 to 2009. Interns from 2000 to 2004 were grouped together and completed a self-directed learning curriculum. Interns from 2005 to 2009 participated in a structured educational curriculum that included lectures and the use of an online program. Lectures were based on the American College of Surgeons curriculum. The online program consisted of 8 to 12 hours of assigned tutorials and quizzes that corresponded to the lectures and 3 multiple-choice (MC) examinations., Results: Use of a structured educational curriculum led to improved ABSITE scores (66 ± 9%) compared with that of those who had no curriculum (55 ± 10%, p < 0.001). Several variables positively correlated with the ABSITE score: United States Medical Licensing Examination step 1 score (p < 0.001), monthly quiz scores (p = 0.003), average MC examination scores (p = 0.005), lecture attendance (p = 0.02), and time spent online (p = 0.04). Multivariable analysis demonstrated that the step 1 United States Medical Licensing Examination score, time spent online, and MC examination score are predictive of total the ABSITE score. When ABSITE subscores (basic science and clinical science) were compared, the online curriculum had a greater effect on basic science subscores, whereas lectures had a greater effect on clinical science subscores., Conclusions: Providing surgery residents a structured curriculum with lectures and an online component positively impacts ABSITE scores., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: Failures in nontechnical skills (NTS) rather than technical expertise are frequently at the root of medical errors in the operating room (OR). NTS are the cognitive (decision making and situation awareness) and interpersonal (communication and teamwork) skills that are recognized but are not formally addressed in surgical training. The purpose of the study was to examine the effect of simulation-based training (SBT) on NTS performance of surgical residents during simulated laparoscopic cholecystectomy (LC)., Setting: The study was performed in a simulated OR at the Center for Medical Education and Innovation at Riverside Methodist Hospital, Columbus, OH. The simulated OR was arranged with standard equipment for LC, a high-fidelity patient simulator, and a real OR team., Design: General surgical residents completed 2 identical SBT sessions. For each session, residents were briefed on the LC case, completed the case in the simulated OR, and debriefed their videotaped simulation performance with a content expert. The video recordings were reviewed and the residents' NTS were scored using a perioperative time-out checklist and an intraoperative checklist for LC by 4 raters who were blinded to both the residents' postgraduate year level and the order of the videotaped simulation sessions., Results: Residents showed a significant improvement in completeness of the perioperative time-out checklist from session 1 (mean score = 1.27 ± 1.00) to session 2 (mean score = 5.00 ± 1.28), p < 0.001. Residents' scores on the intraoperative checklist also improved from session 1 to session 2, p < 0.05. Overall, residents felt that the simulation was a valuable teaching and training tool and recommend that it be incorporated into residency training., Conclusion: SBT appears to be an effective technique for improving NTS of surgical residents during the perioperative and intraoperative phases of surgery. As surgical proficiency is 75% nontechnical and 25% technical, it could be reasonably argued that improved NTS of surgeons could improve surgical outcomes., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Obesity and being overweight are both significant risk factors for multiple chronic conditions. Primary care physicians are in a position to provide health behavior counseling to the majority of US adults, yet most report insufficient training to deliver effective counseling for obesity., Objective: To assess the degree to which residents training in adult primary care programs are prepared to provide obesity, nutrition, and physical activity (ONPA) counseling., Methods: Senior residents (postgraduate year [PGY]-3 and PGY-4) from 25 Ohio family medicine, internal medicine, and obstetrics and gynecology programs were surveyed regarding their knowledge about obesity risks and effective counseling, as well as their attitudes, self-efficacy, and perceived professional norms toward ONPA counseling. We examined summary scores, and used regression analyses to assess associations with resident demographics and training program characteristics., Results: A total of 219 residents participated (62% response rate). Mean ONPA counseling knowledge score was 50.8 (± 15.6) on a 0 to 100 scale. Specialty was associated with counseling self-efficacy (P < .001) and perceived norms (P = .002). Residents who reported having engaged in an elective rotation emphasizing ONPA counseling had significantly higher self-efficacy and more positive attitudes and professional norms scores., Conclusions: Our findings suggest that primary care residents' knowledge of ONPA assessment and management strategies has room for improvement. Attitudes, self-efficacy, and perceived norms also are low and vary by training program characteristics. A deeper understanding of curricula associated with improved performance in these domains could inform interventions to enhance residents' ONPA counseling skills and prevent chronic disease.

Background: Interest in global health has been increasing for years among American residents and medical students. Many residency programs have developed global health tracks or electives in response to this need., Objectives: Our goal was to create a global surgery elective based on a synergistic partnership between our institution and a hospital in the developing world., Design: We created a business plan and 1-year schedule for researching potential sites and completing a pilot rotation at our selected hospital., Setting: We administered a survey to general surgery residents at the University of Cincinnati and visited medical facilities in Sierra Leone, Cameroon, and Malawi., Participants: The survey was given to all general surgery residents. A resident and a faculty member executed the fact-finding trip as well as the pilot rotation., Results: Our general surgery residents view an international elective as integral to residency training and would participate in such an elective. After investigating 6 hospitals in sub-Saharan Africa, we conducted a pilot rotation at our selected hospital and gained the necessary information to organize a curriculum. We will begin sending senior residents for 8-week rotations in the coming academic year., Conclusions: By systematically approaching the process of creating a global surgery elective, we were able to gain considerable insight into choosing a location and organizing the elective., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objectives: The goal of residency programs is to provide trainees with exposure to all aspects of their chosen field so that they exit the program ready to be independent practitioners. However, it is common in some plastic surgery residency training programs to exclude residents from participation in consultations with patients who are seeking cosmetic surgery. The purpose of this study was to determine whether cosmetic surgery patients had a different view about resident involvement than reconstructive surgery patients and to evaluate what factors might be linked to patient attitudes on this topic., Participants: All new patients older than 18 years presenting to either academic or nonacademic locations were asked to complete the voluntary survey at their initial consultation., Setting: The study was conducted at both the Ohio State University (academic) and Advanced Aesthetic and Laser Surgery (private practice) in Columbus, Ohio., Design: The survey asked patients to identify their surgical concern as either cosmetic or reconstructive and to indicate the location on their body where they were having surgery. Additionally, a series of statements regarding resident involvement was presented with a 5-point Likert-type rating system to assess each patient's attitudes about a range of factors, such as resident sex and seniority., Results: In total, 119 patients participated in the study by completing the survey. Of this population, 59.7% (n = 71) were classified as reconstructive surgery patients and 40.3% (n = 48) were classified as cosmetic surgery patients. Based on responses, it was determined that reconstructive surgery patients were more approving of resident involvement in their care than cosmetic surgery patients were. When other factors were analyzed, the patients seeking breast surgery were found to be more apprehensive about resident participation than non-breast surgery patients were., Conclusion: Although there were some differences in the way resident participation was perceived by cosmetic and reconstructive surgery patient populations, neither group strongly believed that resident participation decreased the quality of patient care. Based on these findings, plastic surgery training programs should begin to allow residents to become more involved in the care of cosmetic surgery patients., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: Screening and management of the social determinants of health (SDH) are critical for child health promotion. We sought to evaluate the impact of a facilitated video curriculum on resident SDH screening competence, parental perceptions of resident practice, resident-initiated referrals to a medical-legal partnership (MLP), and formula distribution to food-insecure families., Methods: This was a pre-post study with concurrent control performed at a large pediatric residency program. Second- and third-year residents were assigned to control and intervention groups on the basis of their continuity clinic day. The curriculum included videotaped vignettes of screening for SDH and a "day in the life" series of families describing the impact of intervention on their lives. Residents completed self-assessments on screening competence and resource knowledge. After a well-child encounter, families (3 per resident) assessed their level of trust and respect for the resident and the number of SDHs screened for. MLP referral rates and formula distribution were compared., Results: The intervention group's self-assessed competence in screening for housing, benefits, and educational concerns was significantly higher compared to controls (each P ≤ .05). Parents' rating of trust and respect was high and did not differ between groups. Screening for each SDH was higher in the intervention group with domestic violence (odds ratio 2.16, 95% confidence interval 1.01-4.63) and depression (odds ratio 2.63, 95% confidence interval 1.15-5.99), reaching statistical significance. MLP referral rates increased (P = .06), and formula distribution (P = .02) reached statistical significance in the intervention group., Conclusions: This SDH video curriculum improved resident self-assessed screening competence, parental perception of screening, and both MLP referrals and formula distribution., (Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine whether a standardized patient encounter and self-guided tutorial would improve first-year residents' self-efficacy for disclosing medical errors., Method: In 2011, 55 first-year residents participated in a simulation in which they disclosed an error to a standardized patient playing the part of a family member. Residents completed the simulation twice, four weeks apart, and completed presession knowledge and self-efficacy (based on the Accreditation Council for Graduate Medical Education [ACGME] core competencies) assessments and repeated the self-efficacy assessment after the sessions. Residents reviewed the videos of their encounters either alone (self-debrief) or with a faculty observer (faculty debrief). Between sessions, they completed a self-paced learning tutorial. Two external faculty also rated the residents' performances using videos of the encounters., Results: Residents' self-efficacy significantly increased from a Session 1 pretest mean (standard deviation) score of 119.6 (26.6) to a Session 2 posttest score of 150.3 (24.9) for all ACGME competencies (P < .001, Cohen's d = 1.19). The external reviewers' ratings provided additional, objective support for residents' improvement on questions assessing ACGME competencies (P = .001). Comparisons of the self-efficacy of residents in the self-debrief versus faculty debrief groups yielded no significant differences on any ACGME competencies., Conclusions: Timely, explicit, and empathetic disclosure of medical errors to patients and family is essential to maintaining trust and is an important part of patient-centered medical care. This intervention easily could be replicated in other settings and is applicable to many members of the health care team, not just to residents.

Background and Objective: Acute compartment syndrome (ACS) is a rare but serious complication of extremity injury that can cause permanent damage or death. ACS development is variable and unpredictable, and delay in recognition or treatment of ACS can lead to significant morbidity. Our objective was to create a reliable system for recognition of patients at risk and monitoring for ACS that could withstand frequent provider turnover., Methods: Using the Model for Improvement, we identified key drivers and failure modes for 2 processes: resident and nurse practitioner proper order entry and bedside nurse proper documentation of monitoring. Interventions were tested in frequent plan-do-study-act cycles. Effective interventions were used in combination to test for sustainability., Results: Proper order entry increased from 23% at baseline to 90%. Proper documentation for patients with correct orders increased from 15% to 70%. Individual interventions, including pocket card distribution, electronic medical record order set, and direct discussion by team leaders, were associated with improvement among residents but were not sustained with team turnover. Incorporating all 4 individual interventions into the on-boarding process for residents produced consistent success. Nursing documentation improved with education and maintenance of proper order entry., Conclusions: We built a reliable, sustainable system to recognize and monitor patients at risk for ACS. Interventions designed to minimally disrupt existing workflows were individually associated with improvement. We achieved sustainability through staff turnover when we incorporated the interventions into routine orientation for new staff. Hospitals can use existing orders and protocols to sustain surveillance for ACS and other acute conditions.

Rationale and Objectives: Providing evidence-based appropriate imaging potentially increases diagnostic yield and prevents unnecessary imaging. The American College of Radiology's (ACR) evidence-based Appropriateness Criteria(®) (ACR-AC) were developed to provide imaging guidelines given various clinical scenarios. The goal of this study was to evaluate the knowledge level of the appropriate thoracic imaging study to be performed, given a clinical scenario., Methods: An online survey comprising 20 multiple-choice questions was developed on the basis of excerpts from the ACR-AC for thoracic imaging. The survey was piloted and invitations were sent out to resident trainees in radiology (n = 32), medicine (n = 119), and surgery (n = 40) and to pulmonary and critical medicine fellows (n = 16)., Results: Sixty-nine trainees (33%) completed the survey. The trainees among those who completed the survey included 14 (20%) in radiology, 32 (46%) in medicine, eight (12%) in surgery, and 15 (22%) in pulmonary and critical medicine. Of the 69 trainees, most were male (n = 47 [68%]), aged 25 to 35 years (n = 65 [94%]), and in postgraduate years 1 to 3 (n = 44 [64%]). The overall median and percentage number of correct responses were 13 (interquartile range [IQR], 11-15) and 65% (n = 44), respectively. As would be expected, radiology residents performed better, with a median number of correct responses of 15 (IQR, 11-16) compared to 10 (IQR, 9-12) for medicine trainees, nine (IQR, 9-12) for surgery trainees, and 13 (IQR, 12-15) for pulmonary and critical medicine trainees. There was an increase in the median number of correct responses with years of training, ranging from 10 for postgraduate year 1 to 12 for postgraduate year 6., Conclusions: This study shows an opportunity to increase the awareness of the ACR-AC. Increasing the awareness of the ACR-AC among trainees will likely increase their use in practice and ultimately improve patient care., (Copyright © 2012 AUR. Published by Elsevier Inc. All rights reserved.)

Objective: High-risk infant follow-up programs have the potential to act as multipurpose clinics by providing continuity of clinical care, education of health care trainees and facilitating outcome data research. Currently there are no nationally representative data on high-risk infant follow-up practices in the United States. The objective of this study is to collect information about the composition of high-risk infant follow-up programs associated with academic centers in the United States, with respect to their structure, function, funding resources and developmental assessment practices, and to identify the barriers to establishment of such programs., Study Design: Staff neonatologists, follow-up program directors and division directors of 170 Neonatal Intensive Care Units (NICU) associated with pediatric residency programs were invited to participate in an anonymous online survey from October 2009 to January 2010., Result: The overall response rate was 84%. Ninety three percent of the respondents have a follow-up program associated with their NICU. Birth weight, gestational age and critical illness in the NICU were the major criteria for follow-up care. Management of nutrition and neurodevelopmental assessments was the most common service provided. Over 70% have health care trainees in the clinic. About 75% of the respondents have the neurodevelopmental outcome data available. Most of the respondents reported multiple funding sources. Lack of personnel and funding were the most common causes for not having a follow-up program., Conclusion: High-risk infant follow-up programs associated with academic centers in the United States are functioning as multidisciplinary programs providing clinical care, trainee education and facilitating outcomes research.

Background and Objectives: Infants who live in households experiencing food insecurity are at risk for negative health and developmental outcomes. Despite large numbers of households within our population experiencing food insecurity, identification of household food insecurity during standard clinical care is rare. The objective of this study was to use quality-improvement methods to increase identification of household food insecurity by the second-year pediatric residents working in the Pediatric Primary Care Center from 1.9% to 15.0% within 6 months. A secondary aim was to increase the proportion of second-year pediatric residents identifying food insecurity., Methods: A team was formed to identify key drivers thought to be critical to the process of identifying food insecurity during well-child care. This project addressed 5 key drivers and tested interventions based on these drivers over a 6-month period at a hospital-based primary care site that serves ∼15 000 children from underserved neighborhoods. Tests included implementing an evidence-based electronic screen for food insecurity, educational interventions to improve understanding of food insecurity, empowerment exercises targeting clinicians and families, and gaining buy-in and support from ancillary personnel., Results: Implementation of these changes led to an increase in the identification rate of household food insecurity from 1.9% to 11.2% over the 6 months (P < .01). The proportion of residents identifying food insecurity increased from 37.5% to 91.9% (P < .01)., Conclusions: Application of quality-improvement methods in a primary care clinic increased ability to effectively screen and positively identify households with food insecurity in this population.

Objective: The objective of this study was to evaluate patient satisfaction in an outpatient community-based surgical clinic to seek opportunities for improvement., Methods: A paper survey was distributed to patients at the Faculty Medical Center Clinic over a 12-week period. The survey allowed patients to rate their experience on a 5-point scale from "very dissatisfied" to "very satisfied." The survey addressed referral to the clinic, appointment scheduling, visit experience, wait times, laboratory testing, and satisfaction with surgery. Separate from the surveys, data were collected regarding wait time in clinic prior to being placed in an examining room, time spent waiting for the physician, time spent with the physician, overall time spent in clinic, and appointment time to surgery., Results: During the 12-week time period, 87 surveys were returned from patients in the surgery clinic for a 69% response rate. Most patients were referred to the surgery clinic from the emergency department or their primary care physicians at 44% and 43%, respectively. Just over half of the patients responded that they were "very satisfied" with their overall experience. Of those surveyed, 40% of patients were "very satisfied" with their wait time for the first visit to the clinic, 52% with time in waiting room, 43% with time in examining room, and 47% with time spent with physician. Only 16.4% of patients were "very dissatisfied" or "mostly dissatisfied" with time waiting for appointment, 17.9% with time available for appointment, 14.3% with time in waiting room, 18.2% in time waiting in examination room for the physician, and 20.9% of time wait to schedule surgery. Data were also collected on 203 surgical clinic patients during this time. Of the 203 patients, 55% were new patients, 31% were postoperative patients, and 14% were in the clinic for another type of visit., Conclusions: Overall patient satisfaction was good for the clinic, yet there were areas to improve. Efficiency of scheduling patients, improving wait time for waiting room, examining room, and time prior to scheduling surgery are areas that need improvement. Modification of the current practice at the surgery clinic could result in improvement of patient satisfaction in future evaluation., (Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background/aims: To determine the effect of duty-hour restrictions on the operative experience of obstetrics and gynecology residents., Methods: Operative numbers were obtained from graduates of Mayo Clinic (Rochester, Minn., USA) and Good Samaritan Hospital (Cincinnati, Ohio, USA). Mean operative numbers between graduates in 2007 and 2003 were compared. The following procedures were evaluated: spontaneous vaginal delivery, forceps-assisted vaginal delivery, vacuum-assisted vaginal delivery, cesarean delivery, surgery on antenatal patients, amniocentesis, total abdominal hysterectomy, total vaginal hysterectomy, laparotomy, incontinence or pelvic floor surgery, operative laparoscopy, hysteroscopy, cervical conization, and surgical sterilization. The number of procedures performed (total and as the primary surgeon) were evaluated. We analyzed each institution's residents separately., Results: At Mayo Clinic, the 2007 graduates performed significantly fewer conizations than the 2003 graduates (p = 0.006). At Good Samaritan Hospital, the 2007 graduates performed significantly more vacuum-assisted vaginal deliveries (p = 0.002), cesarean deliveries (p = 0.002), and sterilizations (p < 0.001) than the 2003 graduates. The above findings were unchanged when evaluating procedures for which the resident was the primary surgeon., Conclusion: Duty-hour restrictions have not adversely affected the operative experience of obstetrics and gynecology residents. No significant differences in the number of the spontaneous vaginal deliveries, abdominal hysterectomies, or vaginal hysterectomies performed were observed., (Copyright © 2011 S. Karger AG, Basel.)

Objectives: To assure that orthopaedic residents have the knowledge needed to critically appraise the medical/surgical literature and the skills needed to design and conduct musculoskeletal and orthopaedic research., Setting: Residency program of the Department of Orthopaedic Surgery, Sports Medicine and Rehabilitation at Wright State University Boonshoft School of Medicine, Dayton, Ohio., Participants: Established in 2005, members of the residency program's Research Team (RT) include orthopaedic faculty and residents, university faculty and graduate students, community scientists, and department staff., Methods: The membership and responsibilities of the Research Team are described. The goals of the three-month research rotation during the second year of residency and the activities of the assigned resident are reported. The work of the two research residents during the second year of their six-year program is explained. Helpful educational resources are noted, the role of the faculty research mentor defined, funding sources listed, and the financial support for RT members and research staff presented., Results: The scholarly activity of orthopaedic surgery residents increased substantially from the five-year period before the implementation of the Research Team (September 2000 through August 2005) to the four-year period after initiation of the RT (September 2005 through November 2009). For peer-reviewed scholarship activity, publications on which residents were authors increased from 1 to 10 per year, national presentations at professional meetings increased from 6 to 11 per year, and local and regional presentations increased from 2 to 4 per year., Conclusions: The Research Team is an effective strategy for assuring that orthopaedic residents have the knowledge and skills to evaluate clinical care evidence and to conduct musculoskeletal and orthopaedic research., (Copyright (c) 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Changing locations disrupts the populations served by primary health care clinics, and such changes may differentially affect access to care for vulnerable populations., Methods: Online geographic information systems mapping tools were used to define how the relocation of a family medicine center impacted access to care for black and Hispanic patients with chronic disease., Results: Maps created from practice management data revealed a distinct shift in black and Hispanic patients with chronic disease being served in the new location., Conclusions: Geographic information systems tools are valuable aids in defining changing service areas of primary health care clinics.

Objective: This article describes a residency training program that incorporates a rural didactic curriculum and rural clinical training., Methods: Residents participate in didactic seminars and a rural clinical rotation., Results: In this jointly funded (academic-state-agency) model, faculty members from a community-based medical school train psychiatric residents at a rural clinic. This model differs from a primary care model because it is a direct care model and not a consultation model., Conclusion: Locations near medical schools that are within driving distance of a rural or rural/manufacturing community could use this model. It would require modification (including telemedicine) where greater distances are involved or where faculty clinical work must be done at the medical school site to support a university-based hospital or clinic.

Objectives: This study aimed to identify factors that chief residents believe impact the teaching of junior residents under normal working conditions and the areas in which they believe education on the role of resident as teacher would be beneficial., Methods: Obstetrics and gynaecology (O&G) chief residents were asked to rate the importance of teaching various skills, how often conflict situations arose, and to identify training that would be helpful through a national web-based survey. An e-mail was sent to coordinators of the Residency Review Committee (RRC) O&G residency programmes with a request that they forward the link to their chief residents three times from January through March 2006., Results: Responses were received from 204 postgraduate Year 4 (PGY4) residents (18% of all PGY4 residents) from 133 programmes (54% of all residency programmes) and 33 states. Teaching junior residents how to prioritise patient care and obtain critical information in an emergent situation was considered very to extremely important by 97%. Conflict situations with junior residents were reported to occur between one and five times by 41-58%; an additional 26-28% reported that these situations occurred six or more times. Residents felt it would be helpful to extremely helpful to have training in resolving conflicts that involved patient care (48-59%), as well as in resolving conflict among junior residents, communicating effectively with them and becoming an effective leader (65-78%)., Conclusions: The skills that chief residents considered most important to teach junior residents involved direct patient care. Chief residents would like training in how to resolve conflict with, and among, junior residents, and in how to become an effective leader.

A descriptive, comparative study was conducted to examine the attitudes of nurses, physicians and residents towards collaboration and to assess their self-perception of servant leadership characteristics. The Jefferson Scale of Attitudes toward Physician-Nurse Collaboration and the Barbuto-Wheeler Servant Leadership Questionnaire were utilized for data collection. Registered nurses (RNs) (n = 2,660), physicians (n = 447) and residents (n = 171) in a Southeastern United States health system were surveyed via the intranet; there were 497 responses for analysis. The response rate should be considered and generalizations made with caution regarding the study results. RN scores were higher for both total scores and subscales as compared to physician/resident groups for collaboration and servant leadership. There was a weak positive correlation between collaboration and servant leadership in the RN group and no significant correlation between the variables in the physician/resident group. Findings from this study have implications for nursing and physician education and practice and may serve as a framework for future studies. Representative samples are needed to gain further insight and to guide future research.

Background: For many new dental school graduates, working as an associate may be an attractive option. To provide practical information for new job-seeking dentists, the authors conducted a survey to assess dentists' preferences with regard to hiring an associate., Methods: The authors mailed surveys to a random sample of 3,875 general dentists in four states that asked questions about the characteristics they preferred when hiring an associate. Five hundred seventy-four dentists (14.8 percent) responded to the survey., Results: The results of this survey showed a wide variation in the characteristics dentists prefer when hiring an associate, but interpersonal skills appear to be at least as important as technical skills for new dentists' success., Conclusions: Opportunities for associate positions appear to be available to new dentists who have a range of skills, experience and training. Practical Implications. These results provide new dentists with information regarding the variety of career opportunities available for associates.

This study explores whether a clinical teaching effectiveness (CTE) instrument provides valid scores for summative faculty assessment. The sample included all CTE instruments (n = 10,087) that learners (N = 1,194) completed to assess clinical teachers (N = 872) during 1 academic year. The authors investigated response processes (e.g., missing data, straight-line responses, level of learner), internal structure (e.g., confirmatory and exploratory factor analysis), teaching ratings by learner group (medical student or resident), and relation to other variables (e.g., correlation with global rating). Response processes identified a high prevalence of straight-line responses (same rating across all items) and differential patterns of missing data by learner group. Medical students rated their teachers higher than residents, and CTE scores had different factor structures depending on learner group. High correlation coefficients of CTE items with a single rating of overall teaching performance suggest that learners consider global performance when assessing clinical teaching performance.

Objective: The authors evaluated the confidence and willingness of resident graduates to treat individuals with intellectual disability (ID), following a residency rotation in developmental disability., Methods: Thirty-two graduates of a single residency program were surveyed regarding their post-residency experience with patients with intellectual disability. All graduates had completed a 3 month, half-time residency rotation in intellectual disability. The anonymous 12-question survey sought feedback about satisfaction with the rotation, confidence in serving persons with ID, and actual post-residency work with ID patients., Results: Twenty-three of 32 (72%) of graduates returned surveys. On a 6-point scale (1=strongly disagree; 6=strongly agree), residents most strongly endorsed that the rotation had built their capacity in ID (5.78), confidence (5.48), and satisfaction (5.37). Lowest ratings were given to professional contact in ID initiated by the graduate (2.74), identifying expertise to the community (3.22), and post-residency practice with patients with ID (3.30). Differences between respondents who identified post-residency contact with persons with ID (N=8), and respondents who did not (N=15), did not reach statistical significance., Conclusions: Psychiatric graduates appear to value specialized education and experience in working with ID patients during residency, and feel more confident as a result. In spite of this, the majority of resident graduates did not identify ID training or expertise to their practice community, or choose to work with ID patients following residency.

Introduction: A series of experiments involving 3 orthodontic departments has shown that distance learning can be acceptable to residents and effective in teaching concepts that are fundamental to orthodontic practice., Methods: Residents in each department participated in distance seminars, clinical conferences, and clinical seminars via high-speed Internet connections. The acceptability of this form of instruction was judged from evaluation forms completed by the residents. Its effectiveness was judged from pretests and posttests on the seminar topics., Results: The improvement from pretest to posttest scores after observing a sequence of distance seminars was similar to that with direct instruction. Orthodontic residents rated the educational experiences positively. Live participation in seminars via video conferencing was preferred to live observation or later observation of a recording, but observation provided similar improvement in test scores., Conclusions: The acceptability of the distance seminars appeared to be influenced by the instructor's personality and teaching style in facilitating interaction, the seminar subject, the residents' comfort level in dealing with this technology, and the sequence for interaction vs observation. Further development of recorded seminars with live follow-up discussions has the potential to supplement instruction in graduate orthodontic programs and help with the impending shortage of experienced full-time orthodontic faculty.

Background and Objectives: While medical students' interest in family medicine declines, and residency programs face recruiting challenges, interest in international health is increasing. We studied the influence of offering an international health track (IHT) on residency recruitment., Methods: We surveyed all graduates between the years 1994--2003 of a family medicine residency program offering an optional IHT (n=90). Descriptive and bivariate analyses characterized and compared the geographic scope and residency selection criteria of IHT participants and nonparticipants., Results: The response rate was 77%. Compared to nonparticipants in the IHT, residents who participated in the IHT reported coming a significantly greater median distance from their medical school training site (250--499 miles versus 0--99) and from their "home" (500--999 miles versus 100--249) for residency training. Participants reported that the factor most positively influencing their choice of this residency training site over others was the IHT (mean=+2.5, standard deviation [SD]=0.90), outscoring, on average, location, faculty quality, resident quality, and spousal preference. Nonparticipants' choices were influenced most by the traditionally reported selection factors location (mean=+2.37, SD=1.14) and faculty quality (mean=+2.29, SD=0.97)., Conclusions: One program's experience suggests that the presence of international health training opportunities may influence the residency selection choices of family medicine residents. As family medicine moves to reinvent residency education and to recapture student interest, attractive training models that integrate clinical, community, and public health should be evaluated further.

Background: Patient satisfaction is an important component of quality of care. To date, no studies have looked at differences in faculty and resident patient satisfaction in a pediatric practice., Purpose: The purpose was to compare physician measures of patient satisfaction among residents in training and faculty attendings., Methods: We conducted satisfaction surveys containing 4 questions related to physician performance at a children's health clinic. We compared satisfaction scores across training levels of physicians., Results: We analyzed 676 surveys. The 2nd-year and 3rd/4th-year residents had similar high scores on all questions compared to faculty preceptors. The 1st-year residents scored significantly lower than faculty preceptors, 3rd/4th-year residents, and 2nd-year residents on 1 question and the combined average of the 3 physician-specific questions., Conclusions: The 1st-year residents scored lower on patient satisfaction than physicians at higher levels of training. The 2nd-year and 3rd/4th-year residents achieved high satisfaction scores in a primary care clinic, comparable to scores of experienced practitioners.

Pediatric residents on block community rotations completed journals and exit interviews regarding their perceptions of the rotation. Three common themes present in residents' responses were identified via qualitative analysis: enlightenment and attitude change, impact of direct participation, and rotation challenges. Advantages and disadvantages to block rotations in community pediatrics, and their relationship to learning child advocacy skills, are discussed. Finally, the use of journals as a tool to document systems-based practice competency is explored.

Background and Objectives: Two million elderly Americans are abused or neglected each year. Elderly patients visit their physicians approximately five times each year. Yet physicians initiate only about 2% of the reported cases of abuse and neglect. This study's purpose was to assess the experience, knowledge, and attitudes of primary care physicians toward elder mistreatment., Methods: A self-report questionnaire was mailed to a random sample of 500 primary care physicians. The population included 250 family physicians and 250 general internists in Ohio, divided equally between large urban, suburban, and rural practice settings., Results: The overall response rate was 78%, with 216 family physicians and 176 internists responding. Nearly 72% of those responding reported no exposure or only minimal exposure to the physical, emotional, or sexual abuse of the elderly. More than half of the respondents in both groups reported that they had never identified a case of elder mistreatment. Both family physicians and general internists estimated its prevalence as roughly less than 25% of the prevalence documented in the medical literature, and both were reluctant to accept the problem as universal. More than 60% of clinicians in both groups indicated they had never asked their elderly patients about abuse. Family physicians tended to have a better knowledge of those elements encompassing elder mistreatment and were more aware of management options., Conclusions: Physicians need more education about elder mistreatment.

Dermato-epidemiology curriculum has been identified by the American Academy of Dermatology (AAD) as an important foundation for dermatology residency training. However, no one has yet reported implementation of dermato-epidemiology curriculum. To evaluate and relate our experience carrying out a dermato-epidemiology resident education initiative, based on recommendations by the AAD Epidemiology Committee. Monthly lectures based on topics suggested by the AAD Epidemiology Curriculum. Pre- and post-test multiple choice and free-form question measures were employed to examine performance, assess resident enthusiasm, and solicit feedback from the initiative. Quantitative achievement on multiple-choice items improved slightly, but insignificantly, from 53 percent to 58 percent. Resident level of enthusiasm and perceived efficacy for the intervention varied from 3.3 to 4.0 on a 5-point Likert scale where "1" indicates strongly disagree and "5" indicates strongly agree with measures of effectiveness. Dermato-epidemiology curriculum is desirable and achievable even in dermatology programs without full-time epidemiologists. A successful epidemiology curriculum should be clinically and board-examination relevant, incorporating aspects of problem-based, interactive learning.

Objectives: This study was performed to examine the preferences of patients regarding physician attire, and if their perception of physician competence was influenced by the physicians' clothing style., Methods: Patients attending the obstetrics and gynecology clinic in which residents provided the majority of direct patient care were invited to participate in this study by completing a questionnaire. Patients were first asked to respond to 3 questions about their preference regarding physician attire. They were then asked to examine a series of photographs illustrating a variety of physician clothing styles worn by a model. Patients were asked to respond to 2 questions: 1). If your doctor is dressed in this outfit, would that make you more or less comfortable talking to your physician?, and 2). If your doctor is dressed in this outfit, would it make you feel more or less confident in his/her abilities?, Results: The majority of the respondents expressed no preference for their physician wearing a white coat (60%/110/183), or they did not respond that a physician's dress influenced their comfort level (63%/111/179) or the confidence (62%/114/181) they had in their physician. However, for both male and female physician models, the comfort level of patients and their perceptions of physician competence were the highest in response to images of physicians dressed in scrubs with a white coat, and least for casual dress., Conclusion: Resident physician attire makes a difference to patients. Our patients prefer the white coat with surgical scrubs. Casual clothing is less well liked by our patients.

Background: We know little about the activities that occur during asthma-related visits with primary care physicians. A better understanding of how time is spent during visits for asthma may facilitate the design of programs to enhance asthma disease management., Objective: To describe the content of asthma visits made to family physicians., Methods: Research nurses directly observed consecutive outpatient visits during two separate days in the offices of 138 community family physicians. Time was classified into 20 different behavioral categories using the Davis Observation Code, and compared for visits for asthma, visits for other chronic conditions, and visits for non-asthma-related acute illnesses during 3035 visits by patients of all ages., Results: Visits for asthma shared several characteristics with visits for other chronic conditions but were longer than visits for other chronic illnesses or for acute illness. Asthma visits were distinguished from both acute care and other chronic care visits by a greater percentage of time spent discussing patient compliance, evaluating patient knowledge, and providing smoking assessment and cessation advice., Conclusions: Visits for asthma are structured differently than acute care visits and specifically address issues important to asthma self-management. Future quality improvement initiatives should recognize, affirm, and enhance many current behaviors by family physicians, while working to expand specific areas of care that still fall short of asthma care guidelines.

This article discusses an approach to the teaching of residents and medical students by hospitalist physicians on a general pediatric unit. It focuses on three basic principles of teaching and describes how these can be operationalized in a practical way. If this approach is followed, hospitalist physicians can be more effective teachers.

Background and Objectives: Our residency program experienced applicants who actively misrepresented qualifications, background, or abilities. The experiences of other family practice residencies were unknown. This study 1) determined what information family practice residency directors required from applicants, 2) assessed whether this information was confirmed or verified, and 3) describes the deceptive application information discovered by program directors., Methods: A questionnaire was sent to directors of all accredited family practice residencies. Information was collected about required information, data confirmation, and the deception and misrepresentation perceived., Results: Thirty-two percent of the directors responded. Eight of 13 items on the Electronic Residency Application System were designated as required by more than half of responding directors. Only two of the items (licensure and certain facts in the personal statement) were confirmed by a majority of directors who required them. Deception was recognized by nearly half of respondents within the past 5 years. Most cases involved specialty choice or the personal statement of candidates and were recognized during the interview or by direct confirmation of data., Conclusions: Most directors appear to accept application information at face value. Recognition of deception about application information was reported. Misrepresentation by applicants may be a more common event than previously realized and may require more thorough verification of application credentials.

Objective: To explore residents' opinions regarding various aspects of continuity clinic in a hospital clinic vs private office, with emphasis on primary care relationships., Design: Cross-sectional study. Residents (N = 47) who had spent time in both a clinic and an office setting were given a 49-question survey. Five-point Likert scales were used to quantify the residents' sense of quality of various aspects of training. A set of 10 statements was included to assess the degree to which residents took primary care responsibility for a cohort of patients. Residents also chose the combination of setting(s) (office, clinic, or both) that they considered optimal for their training., Setting: Large metropolitan area. The hospital clinic, based in a freestanding children's hospital, served a primarily indigent population. The private offices (n = 20) served the surrounding suburbs and primarily middle- and upper-income families., Hypothesis: Residents would perceive their clinic-based experience as significantly better than their office-based experience with respect to establishing primary care relationships with their patients., Results: Residents' ratings for the primary care responsibility index were significantly higher for the clinic than for the office (mean + SD, 4.1 + 0.8 vs 2.2 + 0. 9; P<.001). Residents found many aspects of the 2 settings comparable, including overall educational value and the preceptor as a positive role model. The office was rated higher for business and managed care aspects, care of school-age children, and experience with adolescents. The clinic was rated higher for care of infants and complex psychosocial and complex medical issues. Two thirds of residents chose the combined half day in office and half day in clinic as their preferred training model., Conclusion: The opportunity for residents to take advantage of the unique strengths of both clinic- and office-based training may significantly improve their overall residency experience. Arch Pediatr Adolesc Med. 2000;154:1209-1213.