Changes in Stress and Workplace Shortages Reported by U.S. Critical Care Physicians Treating Coronavirus Disease 2019 Patients.

Objectives: Eleven months into the coronavirus disease 2019 pandemic, the country faces accelerating rates of infections, hospitalizations, and deaths. Little is known about the experiences of critical care physicians caring for the sickest coronavirus disease 2019 patients. Our goal is to understand how high stress levels and shortages faced by these physicians during Spring 2020 have evolved.

The Role of Gender in the Experience and Impact of Recertification Exam Preparation: A Qualitative Study of Primary Care Physicians.

Little is known about how physicians experience preparing for board recertification examinations. As women make up a growing proportion of the primary care physician workforce, we aimed to explore how primary care physicians experience the personal and professional impacts of recertification examination preparation activities, and whether these impacts differ by gender. We conducted exploratory qualitative semistructured interviews with 80 primary care physicians, who had recently taken either the American Board of Family Medicine or American Board of Internal Medicine recertification examination and who practice outpatient care.

"That Was Pretty Powerful": a Qualitative Study of What Physicians Learn When Preparing for Their Maintenance-of-Certification Exams.

Background: A key component of Maintenance of Certification (MOC) for family and internal medicine physicians is the requirement to pass a periodic examination of medical knowledge. Little is known about the effects of preparing for MOC exams on knowledge and practice.

Objective: To understand how MOC exam preparation can affect knowledge and practice.

How Physicians Prepare for Maintenance of Certification Exams: A Qualitative Study.

Purpose: Little is known about how board-certified physicians prepare for their periodic maintenance of certification (MOC) examinations. This qualitative study explores how physicians experience MOC exam preparation: how they prepare for the exams and decide what to study and how exam preparation compares with what they normally do to keep their medical knowledge current.

Method: Between September 2016 and March 2017, the authors interviewed 80 primary care physicians who had recently taken either the American Board of Family Medicine or American Board of Internal Medicine MOC exam.

The intersection of professionalism and interprofessional care: development and initial testing of the interprofessional professionalism assessment (IPA).

Valid assessment of interprofessional education and collaborative practice (IPECP) is challenging. The number of instruments that measure various aspects of IPECP, or in various sites is growing, however. The Interprofessional Professionalism Assessment (IPA) measures observable behaviors of health care professionals-in-training that demonstrate professionalism and collaboration when working with other health care providers in the context of people-centered care.

Tiny Moments Matter: Promoting Professionalism in Everyday Practice.

Introduction: Professionalism rests upon a number of individual, environmental, and societal level factors, leading to specific professional behavior in specific situations. Focusing on professional lapses to identify and remediate unprofessional physicians is incomplete. We explored professionalism in practicing internal medicine physicians in the context of everyday practice, to highlight how typical experiences contribute to positive, yet often unnoticed, professional behavior.

Physicians' Voices: What Skills and Supports Are Needed for Effective Practice in an Integrated Delivery System? A Case Study of Kaiser Permanente.

Payers are demanding that US health care become more accountable and integrated, posing new demands for physicians and the organizations that partner with them. We conducted focus groups with 30 physicians in a large integrated delivery system who had previous experience practicing in less integrated settings and asked about skills they need to succeed in this environment. Physicians identified 3 primary skills: orienting to teams and systems, engaging patients as individuals and as a panel, and integrating cost awareness into practice.

Ensuring Resident Competence: A Narrative Review of the Literature on Group Decision Making to Inform the Work of Clinical Competency Committees.

Background The expectation for graduate medical education programs to ensure that trainees are progressing toward competence for unsupervised practice prompted requirements for a committee to make decisions regarding residents' progress, termed a clinical competency committee (CCC). The literature on the composition of these committees and how they share information and render decisions can inform the work of CCCs by highlighting vulnerabilities and best practices. Objective We conducted a narrative review of the literature on group decision making that can help characterize the work of CCCs, including how they are populated and how they use information.

How hospitalists work to pull healthcare teams together.

Purpose: The purpose of this paper is to document everyday practices by which hospitalist physicians negotiate barriers to effective teamwork.

Design/methodology/approach: Ethnographic observation with a sample of hospitalists chosen to represent a range of hospital and practice types.

Findings: Hospitals rely on effective, interprofessional teamwork but typically do not support it.

Assessment and evaluation in interprofessional education: exploring the field.

Background: The practice of interprofessional education (IPE) is expanding rapidly in the United States and globally. The publication of competencies from the Interprofessional Education Collaborative (IPEC) was a significant step forward to recognize the importance of health professions collaboration and to guide institutions for educational program development. However, there remains substantial difficulty in implementation, as well as considerable variability in assessment of learners' interprofessional collaborative knowledge and skills and evaluation of IPE programs.

Reviewing residents' competence: a qualitative study of the role of clinical competency committees in performance assessment.

Purpose: Clinical competency committees (CCCs) are now required in graduate medical education. This study examined how residency programs understand and operationalize this mandate for resident performance review.

Method: In 2013, the investigators conducted semistructured interviews with 34 residency program directors at five public institutions in California, asking about each institution's CCCs and resident performance review processes.

Assessing interprofessional teamwork: pilot test of a new assessment module for practicing physicians.

Introduction: Teamwork is a basic component of all health care, and substantial research links the quality of teamwork to safety and quality of care. The TEAM (Teamwork Effectiveness Assessment Module) is a new Web-based teamwork assessment module for practicing hospital physicians. The module combines self-assessment, multisource feedback from members of other professions and specialties with whom the physician exercises teamwork, and a structured review of those data with a peer to develop an improvement plan.

A new tool to give hospitalists feedback to improve interprofessional teamwork and advance patient care.

Teamwork is a vital skill for health care professionals, but the fragmented systems within which they work frequently do not recognize or support good teamwork. The American Board of Internal Medicine has developed and is testing the Teamwork Effectiveness Assessment Module (TEAM), a tool for physicians to evaluate how they perform as part of an interprofessional patient care team. The assessment provides hospitalist physicians with feedback data drawn from their own work of caring for patients, in a way that is intended to support immediate, concrete change efforts to improve the quality of patient care.

The roles of practice systems and individual effort in quality performance.

Introduction: Individual effort and practice systems contribute to quality performance, but the nature of their contributions remains unclear.

Methods: This study assessed the roles of individual attributes and behaviours versus practice attributes in quality performance by assessing general internists' perceptions of factors that drive their engagement in quality improvement (QI). The authors interviewed 20 physicians in two distinct categories from diverse practice settings who had the greatest discordance between their ranked scores on standardised measures of individual quality performance and practice 'systems' performance.

Feedback data sources that inform physician self-assessment.

Background: Self-assessment is a process of interpreting data about one's performance and comparing it to explicit or implicit standards.

Aim: To examine the external data sources physicians used to monitor themselves.

Methods: Focus groups were conducted with physicians who participated in three practice improvement activities: a multisource feedback program; a program providing patient and chart audit data; and practice-based learning groups.

How teams work--or don't--in primary care: a field study on internal medicine practices.

We conducted a field study in three primary care practices representing different practice types: a solo practice; a certified patient-centered medical home; and a multiphysician, multispecialty practice connected to a local university. All three practices shared a common culture in the way that practice members related to each other. In each instance, the practice team operated in separate social "silos," isolating physicians from each other and from the rest of the practice staff.