Faculty Bibliography

Background: The failure of recent generations of physicians to be proficient in physical diagnosis is well known in the medical community, and recently even the mainstream(Image presented) media have taken to reporting on the problem. However, the medical literature does not offer guidance to programs interested in improving the education of physical diagnosis. Purpose: To describe the peer-led curriculum implemented at our institution to teach cardiac physical diagnosis to hospitalists and house staff. Description: Our institution has created a peer-led curriculum to enhance the teaching of the cardiac physical examination that focuses on faculty development. The curriculum consists of a series of lectures and regular bedside rounds led by experienced hospitalists and cardiologists. Lecture topics include heart sounds, murmurs, and examination of the precordium and neck veins. Lectures on physical diagnosis are evidence based and supplemented with heart sounds played through a loudspeaker so learners can hear and see cardiac findings. Bedside teaching is enhanced with an electronic stethoscope wired for simultaneous auscultation with a group of learners and an iPod application that displays real-time phonocardiography (Fig. 1). These same tools allow for bedside teaching to be transferred easily to a variety of conference-based settings such as morning report or physical diagnosis-themed lectures. Conclusions: Implementation of a cardiac physical diagnosis curriculum aimed at hospitalists is an effective way to improve the education of faculty, house staff, and medical students, offers an opportunity for scholarship, and may improve patient care

Torture has been defined most precisely in legal contexts. Practitioners who work with torture survivors and researchers who study torture have frequently cited legal definitions, particularly those in the United States' Torture Victims Relief Act, the United Nations Convention against Torture, or the World Medical Association's Declaration of Tokyo. Few practitioners have operationalized these definitions and applied them in their practice. We describe how a New York City torture treatment clinic used a coding checklist that operationalizes the definitions, and present results. We found that in practice these definitions were nested; that using guidelines for applying the definitions in practice altered the number of cases meeting criteria for these definitions; and that the severity of psychological symptoms did not differ between those who were tortured and those who were not under any definition. We propose theoretical and practical implications of these findings.

Background: Hospital discharge is a critical transition in care, yet recent data show much room for improvement: 1 in 5 patients experiences an adverse event or readmission within 30 days of discharge. Presently, metrics for the quality of discharge care are limited, and little is known about factors affecting the quality of hospital discharge from the perspective of physicians. Residents' perceptions are particularly important given their unique viewpoint of the discharge process as trainees and their role as primary care givers at teaching hospitals, which collectively provide 20% of all hospital care in the United States. Methods: We employed qualitative methods to describe the dischargeprocess from the resident's perspective and generate hypotheses about quality-limiting factors and key strategies for improvement through in-depth in-person interviews. We developed a purposeful sample of participants with attention to postgraduate year and experience in different hospital settings. Our study design included 2 internal medicine training programs-Yale and New York University (NYU)-to ensure a wide breadth of experiences. To date, we have completed 17 interviews with Yale residents and have begun enrollment at NYU. Interviews were professionally transcribed and independently coded by 2 investigators, and discrepancies were resolved by consensus. Thematic analysis was performed by a diverse research team using the constant comparative method. Results: We have analyzed interviews with 17 Yale residents to date: 10 (59%) were seniors (PGY-2 or PGY-3), 7 were interns (41%), and 10 were female (59%). Based on these interviews, we have identified 5 unifying themes representing factors perceived to limit the quality of discharge care: (1) competing priorities of timely versus thorough discharge, (2) lack of communication between discharge team members, (3) uncertainty about provider roles and patient readiness for discharge, (4) lack of standardization in discharge procedures, and (5) poor patient communication and postdischarge feedback. Representative excerpts from interview transcripts will be presented to illustrate conceptual variations of these quality-limiting factors as well as to support the overall consistency and robustness of each theme above. Conclusions: Quality-limiting factors identified by residents may generate hypotheses to develop novel quantitative measures of quality that are grounded in the experiences of physicians providing discharge care. Residents' insights on this topic may also help shape training and practice to improve the quality of discharge care at teaching hospitals

Historians of medicine generally credit the hospital standardization movement of the early 20th century with establishing the record as a sign of hospital and staff quality. The medical record's role had already been the subject of intense interest at the New York Hospital several decades before, however. In the 1880s malpractice and insurance concerns caused the administration to attempt to supervise record creation, quality, and access, over the objections of physicians. Contemporary concerns about the uses of the medical record were in play well before 1910.