Faculty Bibliography

Researchers lack the rich evidence base and benchmark patient outcomes needed to evaluate the effectiveness of medical education practice and guide policy. The authors offer a framework for medical education research that focuses on physician-influenced patient outcomes that are potentially sensitive to medical education. Adapting the concept of ambulatory care sensitive conditions, which provided traction to health services research by defining benchmark patient outcomes to measure health system performance, the authors introduce the concept and propose the adoption of educationally sensitive patient outcomes and suggest two measures: patient activation and clinical microsystem activation. They assert that the ultimate goal of medical education is to ensure that measurement of future physicians' competence and skills is based not only on biomedical knowledge and critical clinical skills but also on the ability to translate these competencies into effective patient- and systems-level outcomes. The authors consider methodological approaches and challenges to measuring such outcomes and argue for large, multiinstitutional, prospective cohort studies and the development of a national Database for Research in Education in Academic Medicine to provide the needed infrastructure. They advocate taking the next steps to establish an educational evidence base to guide the academic medical centers of the 21st century in aligning medical education practice with health care delivery that meets the needs of individuals and populations

BACKGROUND: It is uncertain whether training improves physicians' obesity counseling. OBJECTIVE: To assess the impact of an obesity counseling curriculum for residents. DESIGN: A non-randomized, wait-list/control design. PARTICIPANTS: Twenty-three primary care internal medicine residents; 12 were assigned to the curriculum group, and 11 were assigned to the no-curriculum group. Over a 7-month period (1-8 months post-intervention) 163 of the residents' obese patients were interviewed after their medical visits. INTERVENTION: A 5-hour, multi-modal obesity counseling curriculum based on the 5As (Assess, Advise, Agree, Assist, Arrange) using didactics, role-playing, and standardized patients. MAIN MEASURES: Patient-report of physicians' use of the 5As was assessed using a structured interview survey. Main outcomes were whether obese patients were counseled about diet, exercise, or weight loss (rate of counseling) and the quality of counseling provided (percentage of 5As skills performed during the visit). Univariate statistics (t-tests) were used to compare the rate and quality of counseling in the two resident groups. Logistic and linear regression was used to isolate the impact of the curriculum after controlling for patient, physician, and visit characteristics. KEY RESULTS: A large percentage of patients seen by both groups of residents received counseling about their weight, diet, and/or exercise (over 70%), but the quality of counseling was low in both the curriculum and no curriculum groups (mean 36.6% vs. 31.2% of 19 possible 5As counseling strategies, p = 0.21). This difference was not significant. However, after controlling for patient, physician and visit characteristics, residents in the curriculum group appeared to provide significantly higher quality counseling than those in the control group (std beta = 0.18; R(2) change = 2.9%, P < 0.05). CONCLUSIONS: Residents who received an obesity counseling curriculum were not more likely to counsel obese patients than residents who did not. Training, however, is associated with higher quality of counseling when patient, physician, and visit characteristics are taken into account

BACKGROUND: Teaching and assessing the Accreditation Council for Graduate Medical Education (ACGME) competencies of Professionalism and Communication have proven to be a challenge for surgical residency training programs. This study used innovative pedagogic approaches and tools in teaching these two competencies. The purpose of this study was to determine whether the learners actually are assimilating and using the concepts and values communicated through this curriculum. METHODS: A six-station Objective Structured Clinical Examination (OSCE) was designed using standardized patients to create varying Professionalism and Communication scenarios. The surgical resident learners were evaluated using these OSCEs as a baseline. The faculty then facilitated a specially designed curriculum consisting of six interactive sessions focusing on information gathering, rapport building, patient education, delivering bad news, responding to emotion, and interdisciplinary respect. At the conclusion of this curriculum, the surgical resident learners took the same six-station OSCE to determine if their professionalism and communication skills had improved. RESULTS: The surgical resident learners were rated by the standardized patients according to a strict task checklist of criteria at both the precurricular and postcurricular OSCEs. Improvement in the competencies of Professionalism and Communication did achieve statistical significance (P = .029 and P = .011, respectively). CONCLUSIONS: This study suggests that the Communication and Professionalism ACGME competencies can be taught to surgical resident learners through a carefully crafted curriculum. Furthermore, these newly learned competencies can affect surgical resident interactions with their patients positively

BACKGROUND: Humanistic attitudes are essential in physicians and therefore supporting them is a key component in graduate medical education (GME). The importance of a physician's attitude toward people with disability is especially relevant within the rehabilitation discipline, as prevailing attitudes and misconceptions can be potential barriers to successful diagnosis and treatment. AIM: This study was designed to examine the relationship between participation in a brief disability sensitivity training and knowledge of disability and attitudes of physical medicine and rehabilitation (PM&R) residents toward people with disability. METHODS: A daylong training for residents consisted of lectures and a panel presentation that covered (1) disability facts, (2) personal stories of people with disabilities, and (3) medical evaluation of disability. The presentations were followed by a simulation experience where resident pairs (one assigned to a wheel chair, the other a 'caretaker') performed various tasks. This was followed by a group discussion of their experience. Three instruments were administered prior to the training: (1) a brief demographic questionnaire, (2) 30 multiple choice questions measuring various aspects of knowledge about disability, and (3) the Scale of Attitudes toward Disabled Persons, Form R (SADP). After the training experience, the knowledge instrument and the SADP were re-administered along with a series of items to measure various aspects of students' satisfaction with the training. The three instruments described were re-administered 3 months post-training. RESULTS: There was significant immediate gain in both the disability knowledge and the attitude scores among trainees as compared to a control group of physiatry residents in standard medical training. Knowledge gains of the disability sensitivity training group did not persist, but attitude toward disability gains remained at the 3 months follow up. CONCLUSION: After a brief curriculum in disability knowledge and sensitivity for PM&R physicians in training, there was a short-term improvement in disability knowledge and an improvement in disability attitudes sustained at 3 months

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