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Presenters Kevin Sweeney, MD, CCFP, Jessica [...], Context : Although the CanMEDS include a leader role, specific leadership competency training is lacking in family medicine residency in Quebec and Canada. Objective : To increase the awareness about the leadership competency in family medicine residents. Study design and Analysis : It is a multi-method study using a questionnaire and qualitative semi-structured interviews. Setting : GMF-U Charles-LeMoyne, a family medicine training clinic with 35 residents and 25 attending family medicine physicians and teachers. Population Studied : The residents, the primary care health professionals and the clinician teachers of the clinic. Intervention : Using the Kern framework for curriculum development, a workshop of two hours intended for residents and clinician teachers was elaborated. It was presented in March 2022 to residents at the GMF-U Charles-LeMoyne. The workshop used methods of participative co-learning and aimed at the appropriation of theoretical concepts relative to clinical leadership through the analysis of examples and situations lived by participants. It was structured around a field note designed for observation of positive leadership actions. Outcome measures : Right after the workshop, participants evaluated their reaction, learning and anticipated change in behaviour with a questionnaire including open questions and 26 Likert scale questions. A semi-structured group interview two months after the workshop also took place with the residents (PGY1) to evaluate the appreciation and use of the field note. Results : 9 residents (PGY1), 12 clinician teachers and 1 nurse practitioner attended the workshop. 9 people answered the questionnaire and they all evaluated positively the workshop regarding its content, relevance, structure, animation and participation. All respondents claimed they would use the acquired knowledge in their practice. The residents who participated the semi- directed group interview said the field note was still not used much and suggested we offer the workshop to the psychosocial team so that they can help provide field notes when they participate in direct observation. Conclusions : This workshop and field note answer a normative need in the family medicine curriculum through the facilitation of "conscious" leadership in the residents' professional activities. This formation also contributes as an activity for faculty development. This educative activity will be given to other family medicine units who showed interest.

Practice management is a taboo subject in medical education. During medical school and residency education, trainees are provided with the knowledge required to care for patients. However, at the completion [...], Background: Practice management is an overlooked and undertaught subject in medical education. Many physicians feel that their exposure to billing education during residency training was inadequate. The purpose of this study was to compare resident and staff physicians in terms of their billing knowledge and exposure to billing education during residency training. Methods: Senior residents and staff physicians completed a scenario-based clinical billing assessment. Posttest surveys were completed to determine exposure to practice management and billing education during training. Results: A total of 16 resident physicians and 17 staff physicians completed the billing assessment. Overall, the billing accuracy of respondents was poor. Staff physicians had a greater percentage of correct billing codes (55.3% v. 37.5%, p < 0.001) and underbilled codes (6.2% v. 3.4%, p = 0.009), with fewer missed billing codes (38.5% v. 59.1%, p < 0.001), compared with resident physicians. The percentage value of correct billings was significantly higher for staff physicians (71.5% v. 56.8%, p = 0.01). In the posttest survey, 100.0% of residents and 79.0% of staff physicians desired more billing education during training. Conclusion: In general, staff physicians billed more accurately than resident physicians, but even experienced staff physicians missed a substantial amount of potential revenue because of billing errors and omissions. The majority of the residents and staff physicians who participated in our study felt that current billing education is both insufficient and ineffective. Incorporating practice management and billing education into residency training is critical to ensure that the next generation of medical trainees possess the financial competence to required to manage a successful medical practice. Contexte : La gestion medicale est un sujet souvent oublie et trop peu enseigne durant les etudes de medecine. Beaucoup de medecins ont l&apos;impression que la formation sur la facturation offerte durant leur residence etait insuffisante. L&apos;objectif de cette etude etait de comparer les connaissances sur la facturation et l&apos;exposition, durant la residence, a la formation sur ce sujet des residents et des medecins membres du personnel. Methodes : Les residents seniors et les medecins membres du personnel ont effectue une evaluation de facturation clinique a partir de mises en situation. Ils ont repondu a un sondage apres le test pour determiner leur exposition a la formation sur la gestion medicale et la facturation durant leurs etudes. Resultats : Au total, 16 medecins residents et 17 medecins membres du personnel ont fait l&apos;evaluation de facturation. Dans l&apos;ensemble, l&apos;exactitude de leur facturation etait faible. Les medecins membres du personnel avaient un pourcentage plus eleve de codes de facturation corrects (55,3 % contre 37,5 %,p < 0,001) et de codes de facturation insuffisants (6,2 % contre 3,4 %, p = 0,009), et avaient moins de codes manquants (38,5 % contre 59,1 %,p < 0,001), comparativement aux medecins residents. Le pourcentage de facturations correctes etait significativement plus eleve chez les medecins membres du personnel (71,5 % contre 56,8 %, p = 0,01). Dans le sondage post-test, 100,0 % des residents et 79,0 % des medecins membres du personnel desiraient avoir davantage de formation sur la facturation durant les etudes. Conclusion : En general, les medecins membres du personnel ont produit des factures plus exactes que les medecins residents, mais meme des medecins membres du personnel experimented ont perdu des revenus potentiels considerables en raison d&apos;erreurs de facturation et d&apos;omissions. La majorite des residents et des medecins membres du personnel qui ont participe a l&apos;etude avaient l&apos;impression que la formation actuelle sur la facturation etait a la fois insuffisante et inefficace. Il est essentiel d&apos;integrer la formation sur la gestion medicale et la facturation dans la residence pour garantir que la prochaine generation de futurs medecins possede les competences financieres necessaires pour gerer un cabinet prospere.

A study attempts to understand the different unique factors that help distinguish highly professional resident physicians from their peers. Results conclude that residents' knowledge, clinical skills and conscientious behaviors all helped to make a highly professional resident physician.

COMMUNICATION AND PROFESSIONALISM are fundamental to the patient-physician relationship. Effective communication improves patient satisfaction and health outcomes, (1,2) whereas poor communication and unprofessional behavior are linked to patient complaints and [...], OBJECTIVE. Evaluation procedures that rely solely on attending physician ratings may not identify residents who display poor communication skills or unprofessional behavior. Inclusion of non-physician evaluators should capture a more complete account of resident competency. No published reports have examined the relationship between resident evaluations obtained from different sources in pediatric settings. The objective of this study was to determine whether parent and nurse ratings of specific resident behaviors significantly differ from those of attending physicians. METHODS. Thirty-six pediatric residents were evaluated by parents, nurses, and attending physicians during their first year of training. For analysis, the percentage of responses in the highest response category was calculated for each resident on each item. Differences between attending physician ratings and those of parents and nurses were compared using the signed rank test. RESULTS. Parent and attending physician ratings were similar on most items, but attending physicians indicated that they frequently were unable to observe the behaviors of interest. Nurses rated residents lower than did attending physicians on items that related to respecting staff (69 % vs 97 %), accepting suggestions (56 % vs 82%), teamwork (63% vs 88%), being sensitive and empathetic (62% vs 85%), respecting confidentiality (73% vs 97%), demonstrating integrity (75% vs 92%), and demonstrating accountability (67% vs 83%). Nurse responses were higher than attending physicians on anticipating postdischarge needs (46% vs 25%) and effectively planning care (52% vs 33%). CONCLUSIONS. Expanding resident evaluation procedures to include parents and nurses does enhance information that is gathered on resident communication skills and professionalism and may help to target specific behaviors for improvement. Additional research is needed to determine whether receiving feedback on parent and nurse evaluations will have a positive impact on resident competency. Key Words medical education resident education/ training, multisource feedback patient--doctor communication, professionalism Abbreviations ABIM--American Board of Internal Medicine PSQ--Patient Satisfaction Questionnaire

A study is being developed that will compare the performance of medical residents who work more than 30 continuous hours every third day with those who work no more than 12 continuous hours on any given day. Researchers discussed the study and related topics at a national conference on sleep, fatigue, and medical training in October, 2001.

Background. There is widespread agreement among pediatric educators that continuity (following a panel of patients on a first contact basis for all their health care) is an important part of the education of pediatricians. Objective. To measure continuity in a pediatric residency practice and to compare this continuity with 2 nearby private general pediatric group practices. We also examined measures of continuity suggested in the literature. Design. Visit data were obtained from the practice billing system for a resident continuity practice and 2 nearby private practices for the 3-year period from July 1, 1992, to June 30, 1995. Visit data used were restricted to patients seen in the office of the practices during regular office hours. Continuity was measured using 5 different indices: 1) the usual provider of care index, visits by the usual clinician/total visits, 2) continuity for patient, the average proportion of visits that an individual patient was seen by his or her own physician, 3) continuity for physician (PHY), the average proportion of visits that an individual physician saw his or her own patients, 4) Continuity of Care Index (COC), and 5) the Modified, Modified Continuity Index. During the period examined, pediatric residents were present in the continuity practice for 1 half-day each week. The resident continuity practice (RCP) had 57 residents and saw 3386 patients for 18 955 visits. Private practice 1 (PP1) had 4 pediatricians who saw 4968 patients for 33 537 visits. Private practice 2 (PP2) had 5 pediatricians who saw 11 953 patients for 75 778 visits. Results. For all visit types, continuity in the RCP was not as high as in the private practices, PHY-RCP versus PP1, PP2; 53% versus 70%, 77%. However, continuity in RCP was greater than 50% for all measures except the COC index, which precipitously decreases as the number of clinicians seen increases. Examining continuity for health maintenance visits (PHY-RCP, PP2 vs PP1; 96%, 96% vs 82%) RCP was equal to the best of the private practices. The percentage of patients not seen for a health maintenance visit during the study period was lowest in the resident practice (RCP/PP1/PP2, 15/22/30). Conclusion. Although continuity for all visits in this RCP was less than in private practice, it was surprisingly high, considering the limited time residents spend in clinic. In a particularly important area for continuity, health maintenance visits, continuity was identical to one and superior to the other private practice. Pediatrics 2001; 108:1263-1268; continuity of patient care, pediatric, internship and residency, health services, evaluation studies., ABBREVIATIONS. RRC, residency review committees; PP1, private practice 1; PP2, private practice 2; RCP, resident continuity practice; UPC, usual provider of care; PHY, continuity for physician; PAT, continuity for patient; [...]

Evaluation of residents is an important but time-consuming task. Its purpose is to improve and to facilitate development of knowledge and skins in the learner.[1] Achievement of this goal requires [...]

Pediatrics 1996,97: 179-184, evaluation of clinical competence, criterion-referenced evaluation. ABBREVIATIONS. OSCE, Objective Structured Clinical Examination; MPL, minimum pass level; ITE, in-training examination; RPR, resident performance rating. Evaluating clinical competence is [...]

The health supervision examination enables pediatric residents to learn about and gain experience in such content areas as anticipatory guidance, development assessment, screening procedures, nutrition counseling and physician-patient relationships. It also is an ideal place for faculty to judge the resident's performance in areas such as clinical judgment, communication of medical information, professional behavior and interpersonal skills. A videocamcorder was used in a longitudinal cohort study to compare residents' before-and-after performance during a 6-month ambulatory rotation that involved conducting health supervision examinations on real patients. The video-assisted interactive review of examinations in a continuity practice measurably improved residents' performance on the postintervention test compared with the preintervention test., Study objectives. To demonstrate reliability of a method for evaluating pediatric resident performance of health supervision examinations of infants using real patients and to evaluate pediatric resident performance of health supervision examinations of infants before and after an educational intervention consisting of a 6-month ambulatory rotation combined with video-assisted review of resident performance of the examination. Design. Longitudinal cohort study in which all second-year residents were enrolled. Residents&apos; preintervention (baseline) videotapes were compared with postintervention videotapes. Each resident served as his or her own control. Setting. University hospital pediatric resident continuity clinic. Subjects. Sixteen second-year pediatric residents who were participating in a required 6-month ambulatory rotation. Method and main results. Reliability study: Using a 51-item instrument derived from the American Academy of Pediatrics Guidelines for Health Supervision, trained raters blind to the sequence and dates of the videotaped health supervision examinations independently rated 44 resident encounters (a minimum of two raters per tape) and achieved good interrater reliability ([Kappa] = 0.80). Intervention study: After a 6-month ambulatory rotation which included resident-faculty reviews of preintervention videotapes, residents showed a 14% mean improvement in performance scores for the examination (P < .05). Conclusions. The results indicate that videotaped health supervision examinations using real patients can be reliably evaluated by observational techniques in a continuity practice. A 6-month ambulatory block rotation coupled with video-assisted interactive review of examinations is associated with measurable improvement in resident performance on the postintervention test. Pediatrics 1993;92:116-120; medical education, resident training, infant health supervision, videotape, evaluation, continuity clinic.

The role of neonatal nurse practitioners, or nurses specialized in the care of newborns, has become more important because of the improved survival of infants with very low birthweight, the shortage of doctors involved in the intensive care of newborns, and the growing significance of advanced training of nurses. Neonatal nurse practitioners are trained in complete management of neonatal and delivery problems. These include resuscitation and evaluation of the newborn, and testing and treatment of the newborn with the supervision of a neonatologist, or physician specialized in neonatal care. The neonatal nurse practitioner can perform various medical skills, including diagnosis, ordering of drugs and medical tests, intubation (insertion of a tube into the airway to help breathing), lumbar puncture (insertion of a needle into the lower spine to obtain samples of spinal fluid or to deliver medications), and other tasks. Neonatal nurse practitioners are also involved in training physicians and nurses, and in research. The knowledge and problem-solving, communication and clinical skills of neonatal nurse practitioners and pediatric residents were compared. The results showed that the neonatal nurse practitioners and pediatric residents had similar scores on tests of knowledge, problem-solving, communication, and clinical skills. These findings suggest that neonatal nurse practitioners are as qualified as second-year pediatric residents in providing care in the neonatal intensive care unit and may serve as alternative caregivers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physicians are licensed on the basis of their performance on written examinations; the validity and fairness of written examinations are based on years of experience as well as research by psychometric experts. However, the evaluation of actual performance in the treatment of patients is far more problematical. Traditionally, the only evaluation of physician performance has been on the basis of reviews by other physicians. Most commonly, this review takes place only in the early years of a physician's career. Now, new emphasis is being placed on the assessment of medical competence; this new emphasis requires the development of new methods of assessment. New test protocols are being developed which can test medical competence in an organized fashion. Several such tests involve the establishment of a series of test stations; at each station the physician performs a set task under the observation of a rater. These tasks include such items as taking a medical history, performing a specific physical examination, or reviewing laboratory results. In most cases, the patients for these tasks are simulated, and the role of patient many in some cases be played by the rater himself. Other tests are being developed which make use of modern computer technology. These tests are taken by interacting with a computer terminal which requires a videodisc. The details of the test case are contained in video sequences on the disc and provide authenticity which cannot be matched by the traditional written examination. These videodisc tasks also have the advantage of uniformity among all taking the examination. While the assessment of competence in the day-to-day practice of medicine is difficult, some progress is being made. A few certification boards, such as the American Board of Obstetrics and Gynecology, require a list of procedures performed in the six months prior to a recertification request. Physicians whose practice seems to be below standards may then be invited in for an oral examination which focusses on the apparent weaknesses. The assessment of clinical practice is important to assure the public that the level of medical competence is the highest practical. However, the tests need to be sufficiently accurate and objective that they are seen by physicians as an excellent means of maintaining quality, and not as an intrusion of 'Big Brother.' (Consumer Summary produced by Reliance Medical Information, Inc.)

Pediatric education in community settings is an idea whose time has come. The board of the Johnson & Johnson Pediatric Institute recognized this reality, and they deserve great credit for [...]

I remember getting the phone call. It was a Tuesday night in June, just like any ordinary Tuesday night. It was around 11:30 pm and I was in deep sleep, [...]

Objective. To compare the ability of pediatric residents to differentiate an asymmetric from a symmetric red reflex in patients with anisometropia and microstrabismus using the Bruckner reflex and the Medical Technology Innovations (MTI) photoscreener. Methods. A prospective, masked, case-control study was performed. Twelve pediatric residents evaluated 10 study patients and 6 control subjects in a masked manner in 2 separate sessions, using the Bruckner reflex or the MTI photoscreener, evaluating for asymmetric (abnormal) or symmetric (normal) red reflexes between the 2 eyes. Each study patient had asymmetric red reflexes and the amblyogenic risk factor of anisometropia or microstrabismus. Each control subject had symmetric red reflexes. Results. The pediatric residents had a mean correct score of 82% (69%-100%) using the MTI photoscreener versus a mean correct score of 65% (44%-81%) using the Bruckner reflex (McNemar test: [Alpha] [is less than] 0.01). The sensitivity of the MTI photoscreener evaluation was 89% in comparison to 61% for the Bruckner reflex. The specificities for the MTI photoscreener versus the Bruckner reflex were similar at 69% and 71%, respectively. Conclusions. Pediatric residents were better at detecting asymmetric red reflexes in patients with anisometropia and microstrabismus when evaluating MTI photoscreener photographs than when evaluating the red reflexes by the Bruckner reflex. The MTI photoscreener may be a more sensitive method than the Bruckner reflex to screen for the common amblyogenic risk factors of anisometropia and microstrabismus by easier detection of red reflex asymmetry. Pediatrics 2001;107(4). URL: http://www.pediatrics.org/cgi/content/full/107/4/e74; amblyopia, red reflex, photoscreener, Bruckner, anisometropia, microstrabismus.

Practically all internal medicine resident training programs have residents who have difficulty fulfilling their role, according to a survey of 298 internal medicine program directors. The most common difficulties were insufficient medical knowledge, poor clinical judgment, inefficient use of time, stress, and depression.