Publications by authors named "Alfred Reid"
Background And Objectives: Direct observation is a critical part of assessing learners' achievement of the Accreditation Council for Graduate Medical Education (ACGME) Milestones and subcompetencies. Little research exists identifying the content of peer feedback among residents; this study explored the content of residents' peer assessments as they relate to ACGME Milestone subcompetencies in a family medicine residency program.
Methods: Using content from a mobile app-based observation tool (M3App), we examined resident peer observations recorded between June 2014 and November 2017, tabulating frequency of observation for each ACGME subcompetency and calculating the proportion of observations categorized under each subcompetency, as well as for each postgraduate year (PGY) class.
Background: Computer-based learning (CBL) is considered by many to be an effective means of education. However, features of computer-based modules purported to contribute to learning have not been studied with medical student education.
Objective: This study was designed to evaluate the effect of auditory supplements in a computer-based instructional module on learning and knowledge retention.
Background And Objectives: The Accreditation Council for Graduate Medical Education Common Residency Program Requirements stipulate that each faculty member's performance be evaluated annually. Feedback is essential to this process, yet the culture of medicine poses challenges to developing effective feedback systems. The current study explores existing and ideal characteristics of faculty teaching evaluation systems from the perspectives of key stakeholders: faculty, residents, and residency program directors (PDs).
View Article and Find Full Text PDFObjective: Healthcare organizations are expanding community-based serious illness care programs to deliver care for homebound patients. Programs typically focus on home-based primary care or home-based palliative care, yet this population may require both services. We developed and evaluated a primary and palliative care program serving seriously ill older adults, called the Reaching Out to Enhance the Health of Adults in Their Communities and Homes (REACH) program.
View Article and Find Full Text PDFBackground: Evidence from several specialties suggests that practice patterns developed in residency influence the quality and cost of care long after completion of training. Improving the quality, cost, and patient experience of care (the "Triple Aim") is foundational to future health systems change.
Objective: We measured variation in Triple Aim measures among family medicine residency programs in a regional quality improvement collaborative (I Population Health Collaborative).
Background: Lean is emerging as a quality improvement (QI) strategy in health care, but there has been minimal adoption in primary care teaching practices. This study describes a strategy for implementing Lean in an academic family medicine center and provides a formative assessment of this approach.
Methods: A case study of the University of North Carolina Family Medicine Center that used the Consolidated Framework for Implementation Research to guide a formative evaluation.
Purpose: Results of a study evaluating quality-of-care, financial, and patient satisfaction outcomes of pharmacist-conducted telehealth visits for diabetes management and warfarin monitoring are reported.
Methods: A retrospective pre-post study was conducted to determine the impact of an electronic visit (e-visit) program targeting 2 groups of outpatients: adults with uncontrolled diabetes and warfarin-treated adults performing patient self-testing (PST) for monitoring of International Normalized Ratio (INR) values.
Results: A total of 36 patients participated in the e-visit program during the 2-year study period.
Background And Objectives: The I3 POP Collaborative sought to improve health of patients attending North Carolina, South Carolina, and Virginia primary care teaching practices using the triple aim framework of better quality, appropriate utilization, and enhanced patient experience. We examined change in triple aim measures over 3 years, and identified correlates of improvement.
Methods: Twenty-nine teaching practices representing 23 residency programs participated.
Background: Physician burnout is a problem that often is attributed to the use of the electronic health record (EHR).
Objective: To estimate the prevalence of burnout and work-life balance satisfaction in primary care residents and teaching physicians, and to examine the relationship between these outcomes, EHR use, and other practice and individual factors.
Methods: Residents and faculty in 19 primary care programs were anonymously surveyed about burnout, work-life balance satisfaction, and EHR use.
Background And Objectives: Specialty physician visits account for a significant portion of ambulatory visits nationally, contribute significantly to cost of care, and are increasing over the past decade. Marked variability in referral rates exists among primary care practices without obvious causality. We present data describing the referral process and specialty referral curriculum within the I3 collaborative.
View Article and Find Full Text PDFBackground And Objectives: Competency-based evaluation of the Accreditation Council for Graduate Medical Education (ACGME) Milestones requires the development of new evaluation tools that can better capture learners' behavior. This study describes the implementation and initial assessment of an innovative point-of-care mobile application, the M3App,© linked to the Family Medicine Milestones.
Methods: Seven family medicine residency programs in North Carolina implemented the M3App.
Background: Implementation of the educational milestones benefits from mobile technology that facilitates ready assessments in the clinical environment. We developed a point-of-care resident evaluation tool, the Mobile Medical Milestones Application (M3App), and piloted it in 8 North Carolina family medicine residency programs.
Objective: We sought to examine variations we found in the use of the tool across programs and explored the experiences of program directors, faculty, and residents to better understand the perceived benefits and challenges of implementing the new tool.
Background And Objectives: The I3 POP Collaborative's goal is to improve care of populations served by primary care residencies in North Carolina, South Carolina, and Virginia by dramatically improving patients' experience, quality of care, and cost-effectiveness. We examine residency baseline triple aim measures, compare with national benchmarks, and identify practice characteristics associated with data reporting.
Methods: We used a cross-sectional design, with 27 primary care residency programs caring for over 300,000 patients.
Background: It is well established that group visits offer an appropriate alternative to individual care with respect to efficiency, clinical effectiveness, and patient and provider satisfaction and are feasible in the training setting. The purpose of this paper is to describe resident educational outcomes from participation in prenatal and well-child group visits over the last 6 years.
Methods: We surveyed the 48 physicians who graduated from the University of North Carolina Family Medicine Residency from 2006 through 2011 regarding their current scope of practice, the number of group visits they experienced, and the educational value of group visits.
Introduction: Over the last decade, the use of medical marijuana has expanded dramatically; it is now permitted in 16 states and the District of Columbia. Our study of family physicians in Colorado is the first to gather information about physician attitudes toward this evolving practice.
Methods: We distributed an anonymous web-based electronic survey to the 1727 members of the Colorado Academy of Family Physicians' listserv.
Background: Computer-based learning (CBL) is an effective form of medical education. Educators have developed recommendations for instructional design but there is only minimal research that evaluates these recommendations.
Aim: To evaluate the effect of case-based questions contained in computer modules on learning efficacy.
Background: Improving the quality of care in residencies is critical for the profession and for our discipline, but how to do this on a large scale is unclear. The purpose of the I³ collaborative was to assess the feasibility of a regional quality improvement collaborative limited to residencies and to improve significantly dramatically the quality of care for diabetes and congestive heart failure.
Methods: Ten residencies in North and South Carolina with more than 345,000 patient visits/year, 252 residents and 92 faculty participated in an Institute for Healthcare Improvement breakthrough series type collaborative, enriched with additional support for academic settings, over 3 years.
Background: The Patient-centered Medical Home (PCMH) model provides a roadmap for practices engaged in practice transformation to improve quality, accessibility, and satisfaction. Primary care residencies can use these principles to transform their practices, but it is unclear how best to facilitate this transformation. This paper describes the design, implementation, and initial outcomes of an academic PCMH collaborative.
View Article and Find Full Text PDFBackground And Objectives: Typical well-child visits are often unsatisfactory both to providers and patients. Group visits have been shown effective in some settings but have not been recently assessed for well-child care. Here we describe a model for infant well-child visits, WellBabies, along with participating mothers' perspectives and comparisons of quality outcomes.
View Article and Find Full Text PDFBackground And Objectives: The long-term effect of teaching critical appraisal (CA) and evidence-based medicine (EBM) skills is unknown. This study explores long-term behaviors and learner satisfaction after a 3-year longitudinal CA/EBM curriculum.
Methods: Telephone interviews were conducted with 1996-1998 graduates of an academic family medicine residency program with an established CA/EBM curriculum.
Objective: To identify clinical outcomes that headache sufferers consider meaningful.
Background: Several standardized instruments have been developed to assess the severity of headaches and the impact of headaches on an individual's quality of life. To our knowledge, however, little research has been conducted to determine which of these many clinical endpoints are considered by headache sufferers themselves to be most important.