Faculty Bibliography

BACKGROUND: The competency of professionalism encompasses a range of behaviors in multiple domains. Residency programs are struggling to integrate and effectively assess professionalism. We report results from a survey assessing residents' perceptions of their professional competence and the professionalism of their learning environment. METHODS: A survey was developed to assess specific behaviors reflecting professionalism based on the conceptualizations of key accrediting bodies. Residents rated their ability to perform the behaviors and reported the frequency with which they observed their fellow residents failing to perform the behaviors. Eighty-five senior residents in emergency medicine, internal medicine, pediatrics, psychiatry, and surgery specialties completed the survey (response rate = 77%). Differences among domains (and among items within domains) were assessed. Correlations between perceived professionalism and the professionalism of the learning environment were described. RESULTS: Cronbach alpha for professionalism competence was .93 and for professionalism in the learning environment it was .86. Residents reported feeling most competent in being accountable (mean score = 51.4%; F = 10.3, p<.001) and in demonstrating respect. Some residents reported having trouble being sensitive to patients (n = 5 to 23). Disrespectful behaviors were the most frequently witnessed professionalism lapse in the learning environment (mean = 41.1%; F = 8.1, p<.001). While serious lapses in professionalism were not witnessed with great frequency in the learning environment, instances of over-representing qualifications were reported. Problems in accountability in the learning environment were negatively associated with residents' perceived competence. CONCLUSIONS: Residents reported being able to perform professionally most of the time, especially in terms of accountability and respect. However, disrespect was a feature of the learning environment for many residents and several serious lapses were witnessed by a small number of residents. Accountability in the learning environment may be an important indicator of or influence on residents' professionalism

We implemented a pain assessment and management (PAM) curriculum for second year medical students and evaluated long-term skills retention compared to the prior year's class which did not receive the curriculum. The curriculum included pain pathophysiology, assessment and treatment instruction plus feedback on PAM practice with standardized patients. Both cohorts underwent a required end-of-third-year clinical skills examination. Intervention and control group performance on three pain cases (acute, chronic and terminal) was compared. The PAM curriculum was implemented 1.5years before the intervention cohort participated in the clinical skills exam. More intervention students (134/159, 84.3% response rate) obtained basic (87.2% vs. 76.0%, p=.028) and comprehensive (75.2% vs. 60.9%, p=.051) descriptions of acute pain than control students (n=129/174, 74.1% response rate). Intervention students demonstrated superior skills for terminal pain, including: more often asking about impact on functioning (40.7% vs. 25.8%, p=.027), advising change of medication (97.3% vs. 38.7%, p<.001), and providing additional medication counseling (55.0% vs. 27.0%, p<.001). Virtually all students obtained basic descriptions of chronic (intervention vs. control, 98.1% vs. 96.1%, p=.367) and terminal (92.9% vs. 91.7%, p=.736) pain. Surprisingly, more control than intervention students obtained a comprehensive description of chronic pain (94.6% vs. 77.8%, p<.001) and asked about current pain medication in the terminal case (75.6% vs. 55.0%, p=.004). Exposure to the curriculum resulted in durable increases in students' ability to perform PAM skills in patients with acute and terminal pain

Abstract Objectives: The authors piloted unannounced standardized patients (USPs) in an emergency medicine (EM) residency to test feasibility, acceptability, and performance assessment of professionalism and communication skills. Methods: Fifteen postgraduate year (PGY)-2 EM residents were scheduled to be visited by two USPs while working in the emergency department (ED). Multidisciplinary support was utilized to ensure successful USP introduction. Scores (% well done) were calculated for communication and professionalism skills using a 26-item, behaviorally anchored checklist. Residents' attitudes toward USPs and USP detection were also surveyed. Results: Of 27 USP encounters attempted, 17 (62%) were successfully completed. The detection rate was 44%. Eighty-three percent of residents who encountered a USP felt that the encounter did not hinder daily practice and did not make them uncomfortable (86%) or suspicious of patients (71%). Overall, residents received a mean score of 60% for communication items rated 'well done' (SD +/- 28%, range = 23%-100%) and 53% of professionalism items 'well done' (SD +/- 20%, range = 23%-85%). Residents' communication skills were weakest for patient education and counseling (mean = 43%, SD +/- 31%), compared with information gathering (68%, SD +/- 36% and relationship development (62%, SD +/- 32%). Scores of residents who detected USPs did not differ from those who had not. Conclusions: Implementing USPs in the ED is feasible and acceptable to staff. The unpredictability of the ED, specifically resident schedules, accounted for most incomplete encounters. USPs may represent a new way to assess real-time resident physician performance without the need for faculty resources or the bias introduced by direct observation. ACADEMIC EMERGENCY MEDICINE 2009; 16:1-4 (c) 2009 by the Society for Academic Emergency Medicine

BACKGROUND: Physicians frequently report negative attitudes about obesity which is thought to affect patient care. However, little is known about how attitudes toward treating obese patients are formed. We conducted a cross-sectional survey of physicians in order to better characterize their attitudes and explore the relationships among attitudes, perceived competency in obesity care, including report of weight loss in patients, and other key physician, training, and practice characteristics. METHODS: We surveyed all 399 physicians from internal medicine, pediatrics, and psychiatry specialties at one institution regarding obesity care attitudes, competency, including physician report of percent of their patients who lose weight. We performed a factor analysis on the attitude items and used hierarchical regression analysis to explore the degree to which competency, reported weight loss, physician, training and practice characteristics explained the variance in each attitude factor. RESULTS: The overall response rate was 63%. More than 40% of physicians had a negative reaction towards obese patients, 56% felt qualified to treat obesity, and 46% felt successful in this realm. The factor analysis revealed 4 factors-Physician Discomfort/Bias, Physician Success/Self Efficacy, Positive Outcome Expectancy, and Negative Outcome Expectancy. Competency and reported percent of patients who lose weight were most strongly associated with the Physician Success/Self Efficacy attitude factor. Greater skill in patient assessment was associated with less Physician Discomfort/Bias. Training characteristics were associated with outcome expectancies with newer physicians reporting more positive treatment expectancies. Pediatric faculty was more positive and psychiatry faculty less negative in their treatment expectancies than internal medicine faculty. CONCLUSION: Physician attitudes towards obesity are associated with competency, specialty, and years since postgraduate training. Further study is necessary to determine the direction of influence and to explore the impact of these attitudes on patient care

BACKGROUND AIMS: Objective structured clinical encounters (OSCEs) are used widely to educate and assess the competence of medical students and residents; they generally are absent from fellowship training. The Accreditation Council for Graduate Education has cited OSCEs as a best practice for assessing the 6 core competencies. This article reports on the use of an OSCE to assess the competence of second-year gastroenterology fellows in the difficult-to-assess core competencies: interpersonal and communication skills and professionalism. METHODS: We developed a 4-station, faculty-observed OSCE with 4 standardized patients. Information gathering, relationship development, patient education, and counseling skills were assessed. Professionalism skills assessed included obtaining informed consent, delivering bad news, managing difficult situations, and showing interdisciplinary respect. In each station, faculty and standardized patients completed an 18- to 24-item checklist evaluating fellows' performance and provided feedback to the fellows. Nine fellows and 5 faculty from 4 gastroenterology training programs in NYC participated. RESULTS: Fellows and faculty generally highly rated the realism of the OSCE and favorably rated the OSCE for its difficulty and their overall experience. Across all cases, fellows were rated as receiving "well dones" for 56.4% of the communication items (SD, 18.3%) and for 79.1% of the professionalism items (SD, 16.4%). CONCLUSIONS: Integrating OSCEs into gastroenterology fellowship training may help enhance communication skills and prepare fellows for dealing with difficult clinical situations and provides mechanisms for constructive feedback. OSCEs developed collaboratively can assist in program self-evaluation and reduce costs by sharing resources, in addition to fulfilling Accreditation Council for Graduate Education mandates.