Medical Education Commons^™

Enhancing Patient Safety: The Role Of Interdisciplinary Teams In Reducing Blood Culture Contamination, Austin Patrick Eisenberg, Fady M. Awad, Brian Watson, Mohammed Faris

HCA Healthcare Journal of Medicine

Background

Blood cultures are vital to diagnostic workups among many hospitalized patients, providing valuable information about bloodstream infections (BSIs), which cause roughly 250 000 deaths annually between North America and Europe. Despite advances in health care, blood culture contamination remains a substantial problem, with deleterious effects on patient mortality, patient and hospital costs, and microbial resistance. This article reviews the repercussions of blood culture contamination on the health care system and delineates evidence-based strategies to decrease contamination rates.

Methods

To reduce blood culture contamination rates, our health care facility undertook a quality improvement initiative. A task force was created, consisting …

Clinical And Radiological Identification And Management Of Sapho Syndrome, Obyda Al-Housni, Jessica M. Alonso, Matthew Thornburg, Enny Cancio

HCA Healthcare Journal of Medicine

Introduction

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is an autoinflammatory disease whose acronymic name stands for the symptoms commonly seen in the disease. These symptoms typically occur simultaneously, in different combinations, in patients during exacerbations of the disease. SAPHO syndrome is a rare disease, most frequently seen in patients aged 30 to 50. It is estimated to be found in 1 in 10 000 persons in White populations, with an even lower incidence seen in non-White populations.

Case Presentation

A post-menopausal woman with a medical history of SAPHO presented to the emergency department with left foot pain and …

A Survey Of Post-Graduate Satisfaction With Orthopaedic Residency Training At A Single Institution, Jared L. Sain, Craig R. Louer, Robert J. Esther, Christopher W. Olcott

HCA Healthcare Journal of Medicine

Background

The Accreditation Council for Graduate Medical Education (ACGME) has called for self-study within residency programs. Post-graduate surveys allow the graduate to reflect upon their residency experience after years of autonomous practice. Despite their potential utility, a standardized assessment of residency training from the perspective of orthopaedic alumni does not exist. In this study, we aimed to create, analyze, and share with our alumni a post-graduate survey based on ACGME core competencies.

Methods

The survey was developed by full-time orthopaedic faculty and reviewed by a survey methodologist to ensure clarity and an ideal survey format. In May 2020, the survey …

Management Targeted Genetic Evaluation Of An Idiopathic Neuropathy Cohort Through Attrv Amyloidosis Screening, Kristy A. Fisher, Santiago Diaz, Jeffrey Gelblum, Charles Brock, Niraja Suresh, Meghan Towne

HCA Healthcare Journal of Medicine

Background

While the reported prevalence of polyneuropathies is 1%-3%, the incidence of hereditary transthyretin amyloidosis in the United States is estimated to be 1 in 100 000 individuals. Polyneuropathies are known to be difficult to treat and lead to significant morbidity. The aim of pain management is symptomatic treatment, with varying approaches to progression prevention being based on the causative pathophysiology.

We assessed the prevalence of hereditary amyloid transthyretin variant (ATTRv) amyloidosis, a progressive autosomal dominant multisystem disease caused by the abnormal formation and extracellular deposition of transthyretin protein fibrils in various tissues, in an idiopathic polyneuropathy population by using …

The Heart Of Residency, Julia Fashner, Samantha Gionocchio

HCA Healthcare Journal of Medicine

As part of wellness activities in 2023, our family medicine residents produced individual paintings. Samantha coalesced these 4 x 4 canvases to create this heart. The following quote is also poignant for those of us in family medicine:

Wherever the art of Medicine is loved there is also a love of Humanity. -Hippocrates

Well-Being And Leadership Within The Emergency Department, Jacob T. Berg, Thomas Matese, Dennis Anthony Cardriche, David Hotwagner

HCA Healthcare Journal of Medicine

This article looks at well-being and the role of leadership from the perspective of emergency medicine. The importance of leadership within the emergency department (ED), emergency medicine writing at large, and the prevention of burnout and compassion fatigue cannot be overstated. This article looks at the need for more research and measured interventions within the ED. It also highlights some measures that could be taken to help improve well-being from a leadership perspective to improve patient safety and outcomes within the ED.

A Resident Led Newsletter Is A Powerful Communication Tool, Jonathan Brown, Zuhair Ali, An Dao, Mike Wong, Rajeev Raghavan

HCA Healthcare Journal of Medicine

Background

Communication with stakeholders for a graduate medical education (GME) program depends on shared visual and written content. Residency training programs are embracing social media as a communication channel. However, curated information that may only be viewed by subscribers or followers is difficult to archive and may appear overwhelming to novice users. An electronic, printable newsletter may be a unique communication tool for training programs to share information among residents, faculty, and hospital administration.

Methods

We published a monthly electronic newsletter sent to all residents, teaching faculty, and additional stakeholders in our internal medicine residency program. We conducted an electronic …

The Feasibility And Impact Of An Asynchronous Interprofessional Well-Being Course On Burnout In Health Care Professionals, Mari Ricker, Audrey J. Brooks, Mei-Kuang Chen, Joy Weydert, Amy Locke, E Kyle Meehan, Paula Cook, Patricia Lebensohn, Victoria Maizes

HCA Healthcare Journal of Medicine

Background

Well-being initiatives are essential components in fostering an engaged workforce and creating an effective health care ecosystem. Health care professional (HCP) burnout is widespread and has worsened since the COVID-19 pandemic. In 2014, with Health Resources and Services Administration funding support, the Andrew Weil Center for Integrative Medicine created an online course for HCP well-being. It was subsequently studied in medical residents and revised in 2020. In this study, we explore the impact of the course across larger systems, as well as the long-term impact on HCPs.

Methods

The Health Care Professional Well-Being course is 4.5 hours of interactive …

Resident Feedback On Incorporating Reflection Rounds Into A Family Medicine Residency Wellness Curriculum: A Brief Report, Stacy Ogbeide, Jasmin Aldridge Hamlett, Inez Isabel Cruz

HCA Healthcare Journal of Medicine

Background

We sought to understand well-being from the perspectives of residents in a family medicine residency program and to assess the residents’ opinions on implementing “Reflection Rounds” (RR) to promote wellness and combat burnout through self-reflection. These aims were achieved through descriptive qualitative analysis of a focus group of family medicine residents.

Methods

Participation was voluntary and open to all 45 residents in the program. The final participant sample consisted of 14 residents who shared similar characteristics, including level of training and being exposed to similar training stressors. Both a priori and open coding were used for this analysis.

Results …

A Multi-Wave Study Of Factors Associated With Resident Engagement, Depression, Burnout, And Stay Intent, Anne M. Brafford, Brendon Ellis, Greg Guldner, Gabrielle Riazi, Xitao Liu, Jessica C. Wells, Jason T. Siegel

HCA Healthcare Journal of Medicine

Background

Many studies have documented the epidemic of mental ill-being among resident physicians, but fewer have focused on mental well-being or on guiding intervention design to make progress toward positive change in residency programs to support resident thriving. Informed by the job demands-resources model (JD-R) and positive psychology, the current study examines 4 potential predictors of residents’ ill-being (burnout, depression) and well-being (engagement, stay intent) that are malleable and thus capable of change through intervention: psychological capital (PsyCap), supervising physicians’ autonomy-supportive leadership style (ASL), social support, and meaningful work.

Methods

Three waves of data were collected between November 2017 and …

Perceived Disruption Of Covid-19 On Medical Education In Incoming Psychiatric Residents, Steven Sprenger, Ashley Mahajan, Jeffrey Anderson, Napatkamon Ayutyanont, Jessica C. Wells, Gregory Guldner

HCA Healthcare Journal of Medicine

Background

In 2020, the global COVID-19 pandemic caused educational disruptions to many medical students nationally. Societal and hospital guidelines, including social distancing protocols, resulted in the cancellation or postponement of many elective procedures. A shortage in personal protective equipment also contributed to restrictions in clinical experiences for trainees. The purpose of this study was to determine resident-perceived preparedness in core clinical competencies and evaluate the disruptions to core clerkships.

Methods

A survey was developed to assess self-perceptions of clinical competencies and disruptions to core clerkship experiences. It was distributed to 63 incoming psychiatric residents who were matched to training programs …

The Effects Of The Covid-19 Pandemic On Resident Education And Burnout, Timbre Backen, Oliwier Dziadkowiec, Jeffery S. Durbin, Gregory Guldner, Glenda Quan

HCA Healthcare Journal of Medicine

Background

The COVID-19 pandemic has impacted the residency experience for physicians across all specialties. There have been studies examining resident perspectives on changes in curriculum and clinical experiences due to the pandemic; however, little research has been conducted on how residents in different specialties interpreted their educational experience and rates of burnout during the pandemic.

Methods

We extended surveys to 281 residents across 15 separate residency programs between November 17, 2020, and December 20, 2020. The questions pertained to burnout and the effects of the pandemic on their careers. Differences between general and specialty medicine resident responses were analyzed using …

Learning From Health Care Counselors’ Perspectives On Health Care Worker Distress: A Qualitative Analysis, Nancy Downs, Judy Davidson, Angela Haddad, Sidney Zisook

HCA Healthcare Journal of Medicine

Background

Health care provider stress and emotional distress were well documented long before the COVID-19 pandemic, and there is growing data suggesting these have increased in response to the pandemic. The goal of this study was to take advantage of the unique experiences of licensed mental health (MH) clinicians working with health care trainees and clinicians before and during the pandemic to identify how this crisis affected both ongoing as well as new sources of stress. The Healer Education, Assessment and Referral Program (HEAR) provides MH screening, support, and MH referrals to ~19 000 health care students, trainees, staff, and …

A Qualitative Follow-Up To A Survey Of Program Directors On Wellness Programming At A Large Healthcare Organization: Interviews Of High- And Low-Exemplar Programs, Sabrina Menezes, Kelsey M. Carpenter, Alexander W. Marshburn, Stephanie Ramirez, Gregory Guldner, Jessica C. Wells, Jason T. Siegel

HCA Healthcare Journal of Medicine

Background

The current research used a qualitative approach to understand which factors facilitate and hinder wellness programming in residency programs.

Methods

Program directors identified from a previous quantitative study as having residency programs with notably more or less resident wellness programming than others (ie, high- and low-exemplars, respectively) were contacted. In total, semi-structured interviews were conducted over Zoom with 7 low-exemplars and 9 high-exemplars.

Results

The results of this qualitative examination suggest common themes across the 2 exemplar groups, such as wanting more resources for resident wellness with fewer barriers to implementation, viewing wellness as purpose-driven, and seeing wellness as …

A Nation-Wide Survey Of Program Directors At A Large Health Care Organization: Prevalence And Perceptions Of Resident Wellness Activities, Alexander W. Marshburn, Gabrielle Riazi, Sabrina Menezes, Stephanie Ramirez, Gregory Guldner, Jessica C. Wells, Jason T. Siegel

HCA Healthcare Journal of Medicine

Background

This study evaluated wellness programs in a large hospital network to determine residency program directors’ (PDs) perspectives on their wellness programs' state, including wellness prioritization, frequency of wellness activities, and wellness’ influence on decision-making across organizational levels.

Methods

In 2021, 211 PDs were sent surveys on program policies, program implementation frequency, perceptions of the administration’s ability to prioritize wellness, funding sources, and perceptions of resident wellness’ impact on decision-making.

Results

Among 211 contacted programs, 148 surveys were completed (70.1%). The majority reported having wellness programs, committees, and funding. Fewer than 25% reported having a chief wellness officer. PDs perceived …

Burnout In Graduate Medical Education: Uncovering Resident Burnout Profiles Using Cluster Analysis, Nicholas A. Yaghmour, Nastassia M. Savage, Paul H. Rockey, Sally A. Santen, Kristen E. Decarlo, Grace Hickam, Joanne G. Schwartzberg, Dewitt C. Baldwin Jr., Robert A. Perera

HCA Healthcare Journal of Medicine

Background

Burnout is common among residents and negatively impacts patient care and professional development. Residents vary in terms of their experience of burnout. Our objective was to employ cluster analysis, a statistical method of separating participants into discrete groups based on response patterns, to uncover resident burnout profiles using the exhaustion and engagement sub-scales of the Oldenburg Burnout Inventory (OLBI) in a cross-sectional, multispecialty survey of United States medical residents.

Methods

The 2017 ACGME resident survey provided residents with an optional, anonymous addendum containing 3 engagement and 3 exhaustion items from the OBLI, a 2-item depression screen (PHQ-2), general queries …

Exercise Is A Vital Sign, Megan Dannemiller, Anthony Shadiack, Marvin Sineath Jr, Andrew Baird, Marc Poirier, Kevin Thomas, Michael G. Flynn

HCA Healthcare Journal of Medicine

In this review, we argue that exercise (physical activity) be monitored as a vital sign since no other basic sign or symptom provides as much information about a patient's health status. The influence of regular exercise on patient health is indisputable, with strong evidence to show the power of exercise to mitigate chronic disease and improve overall health. Several simple tools, such as Physical Activity as a Vital Sign and Exercise as a Vital Sign are available to assess patient physical activity. When properly applied, there is evidence to support the efficacy of these tools, but there are barriers that …

Autonomy Versus Independence: Implications For Resident And Faculty Engagement, Performance, And Well-Being, Adam P. Neufeld, C. Scott Rigby

HCA Healthcare Journal of Medicine

Research shows that when educational leaders support their learners’ autonomy, it positively impacts both parties. This is particularly important in graduate medical education (GME), given that there is a strong emphasis on resident performance, evaluation, and development. Unfortunately, GME faculty often misunderstand autonomy as the resident’s desire for independence or “freedom,” when in fact it refers to the core psychological need to feel volitional and agentic. The distinction is important because volition is not synonymous with independence, and providing freedom can be at odds with strategies that provide true autonomy support. This, in turn, can contribute to the stress, maladjustment, …

What Motivates You?, Mohamad S. Saad

HCA Healthcare Journal of Medicine

For over 100 years, we have tried to understand how human motivation works. Although various theories have been developed and different experiments have been conducted to explain motivational drive, we have realized that extrinsic motivation factors, such as rewards and punishment, and financial incentives are not the answers. More important and central to motivation is nourishing our innate human need to be autonomous, competent, and to relate to our organizational culture. All of us need to understand the story of motivation because, as dire as our need for high-quality motivation is, high-quality motivation remains an asymptote.

Addressing Burnout And Enhancing Well-Being Among Academic Physicians: A Call For Future Research And Organizational Support, Kelly D. Holder, Sharon Y. Lee, Fatima Zehra Raza, Laura R. Stroud

HCA Healthcare Journal of Medicine

Burnout among academic physicians, who navigate multiple roles beyond the clinical environment, is a pressing issue. However, the factors driving burnout among academic physicians are not fully understood. Prior research has revealed differences in burnout dimensions between clinical and basic science faculty, but the impact of balancing research, education, and clinical demands on academic physicians is still unclear. This knowledge gap negatively affects the clinical, translational science, research, and medical education workforces and has particular implications for minoritized and marginalized groups working in academic medical centers. Creating a culture of well-being has been vital in addressing burnout. Further research is …

Empowering Voices: Cultivating A Supportive Network From The Women In Medicine And Health Care Symposium, Rutuja D. Bhalerao, Kyle Mefferd, Jocelyn A. Limas

HCA Healthcare Journal of Medicine

There are many studies, some discussed in this article, that recognize the numerous issues faced by women in medicine and the health care field. In response to the prevalence of these challenges, Riverside Community Hospital’s General Medical Education department organized the second Women in Medicine & Healthcare Symposium on November 17, 2023. The symposium featured a panel of women leaders addressing challenges, such as work-life balance, maternity leave, fertility concerns, and family planning. Personal stories and studies on gender bias and infertility shed light on the shared experiences of women physicians. The positive response prompted Riverside Community Hospital to view …

Creating And Supporting Well-Being In Graduate Medical Education, Gregory Guldner

HCA Healthcare Journal of Medicine

Graduate medical education strives to create the next generation of skillful and compassionate physicians for our nation. Yet, research shows a high degree of depression, anxiety, workplace burnout, lack of engagement, and general dissatisfaction with the work and learning environment for many of these dedicated individuals. We present this special issue related to creating and supporting well-being in the graduate medical education community.

Dercum’S Disease: The Clinical Presentation, Diagnosis, Radiological Findings, And Treatment Of A Rare, Debilitating Inflammatory Disorder, Obyda Al-Housni, Constantinos Boufeas, Valori Slane

HCA Healthcare Journal of Medicine

Introduction

Dercum’s disease, also known as adiposis dolorosa, is a rare syndrome characterized by the growth of multiple, and painful, subcutaneous adipose tissues that commonly present in the abdomen and extremities. The scientific community hypothesizes that Dercum’s disease is a combination of neurologic and endocrine disorders. Patients commonly describe it as chronic adipose pain, which manifests as sporadic painful flares throughout their history with the disease.

Case Presentation

We share the case of a 32-year-old woman who presented to the emergency department for an acute episode of left lower extremity pain and swelling associated with a previously diagnosed history of …

Structured Textbook Review And Individualized Learning Plans Successfully Remediate Underperforming Residents And Improve General Surgery Program Performance On The Absite, Aaron Pinnola, Christoph Kaufmann

HCA Healthcare Journal of Medicine

Background

We endeavored to create an evidence-based curriculum to improve general surgery resident fund of knowledge. Global and resident-specific interventions were employed to this end. These interventions were monitored via multiple choice question results on a weekly basis and American Board of Surgery In-Training Examination (ABSITE) performance.

Methods

This study was performed in a prospective manner over a 2-year period. A structured textbook review with testing was implemented for all residents. A focused textbook question-writing assignment and a Surgical Council on Resident Education (SCORE)-based individualized learning plan (ILP) were implemented for residents scoring below the 35th percentile on the ABSITE. …

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Acne Vulgaris - Comedonal Acne, Christopher M. Wong, Christina Guo, Christian J. Scheufele, Daniel A. Nguyen, Jean Elizze M. Charles, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Acne vulgaris is a common inflammatory skin condition of the pilosebaceous unit in adolescents and young adults and is primarily characterized by the presence of open and closed comedones. In patients of various skin pigmentations, skin-colored comedones may be difficult to appreciate and lead to incorrect or delayed diagnosis of acne. To aid in the identification of acne vulgaris in patients of various skin pigmentations, we present comedonal acne in different skin types and commonly encountered differential diagnoses. With its significant volume and burden of disease, acne vulgaris should be correctly identified in various skin pigmentations by primary care clinicians …

Variation In Transcript Reports Among Residency Applicants: An Anesthesia Program’S Perspective, Alex M. Hendon, Imani Thornton

HCA Healthcare Journal of Medicine

Background

With recent changes made to move USMLE Step 1 and COMLEX Level 1 scores to Pass/Fail, it becomes necessary to find other metrics to evaluate residency candidates. One conserved metric included in all residency applications is medical school transcripts. This study aims to highlight the highly varied transcript reporting in a new era of holistic applicant review.

Methods

Medical school transcripts were extracted from the Electronic Residency Application Service applications to our anesthesiology residency program for the 2021-2022 application cycle. All personally identifiable information was removed. Results were categorized and tallied by 2 independent reviewers. Overall, we assessed transcript …

Impact Of Psychiatry Clerkship Rotation In Attitudes Towards Mental Illness And Psychiatry As A Career Among Medical Students, Jae Kim, Brian Blum, Shivani Kaushal, Sara Khan, Patrick Hardigan, Clara Alvarez Villaba

HCA Healthcare Journal of Medicine

Background

Stigma associated with mental illness (MI) permeates many professions, including healthcare. Recognizing and correcting bias is critical in delivering impartial and beneficial healthcare for all patients. Early educational interventions providing exposure to individuals with MI have shown to be effective at reducing MI stigma. The primary aim of our study was to assess the impact of a psychiatry clerkship on attitudes to MI. A secondary aim was to determine if the psychiatry clerkship influenced medical students’ perceptions of psychiatry as a career.

Methods

A cohort of third-year medical students in Florida was invited to complete an online survey before …

Ambivalence At 10 000 Feet, Marc Perlman

HCA Healthcare Journal of Medicine

The transition from medical neophyte to seasoned physician is a gradual process spanning the course of many years. However, there are various milestones throughout the experience that capture increases in decision-making capacity and responsibility, such as the switch from pre-clinical to clinical medical education. Medical students in their clinical years are endowed with an abundance of knowledge from their pre-clinical years and are just beginning to synthesize and apply that information to patient care. “Ambivalence at 10 000 Feet” captures a reflection of a third-year medical student on the theoretical decision to provide emergency medical care in the absence of …

A Guide To Writing Quality Case Reports, Robert Chait, Graig Donini, Michael G. Flynn

HCA Healthcare Journal of Medicine

Case reports play an essential role in the dissemination of knowledge in medicine. A published case is typically an unusual or unexpected presentation in which the outcomes, clinical course, and prognosis are linked to a literature review in order to place the case into the appropriate context. Case reports are a good option for new writers to generate scholarly output. This article can serve as a template for writing a case report, which includes instructions for creating the abstract and crafting the body of the case report—introduction, case presentation, and discussion. Instructions for writing an effective cover letter to the …

An Introduction To Reviewing Research Articles For Academic Journals, William B. Dehart, Edward Griffin, Shala Sundaram, Brian E. Wood, Michael G. Flynn

HCA Healthcare Journal of Medicine

Among the pillars of science is the galvanizing process of peer review. Editors of medical and scientific publications recruit specialty leaders to evaluate the quality of manuscripts. These peer reviewers help to ensure that data are collected, analyzed, and interpreted as accurately as possible, thereby moving the field forward and ultimately improving patient care. As physician-scientists, we are given the opportunity and responsibility to participate in the peer review process. There are many benefits to engaging in the peer review process including exposure to cutting-edge research, growing your connection with the academic community, and fulfilling the scholarly activity requirements of …