The effectiveness of interruptive prescribing alerts in ambulatory CPOE to change prescriber behaviour & improve safety.

Background: Prescribing alerts of an electronic health record are meant to be protective, but often are disruptive to providers. Our goal was to assess the effectiveness of interruptive medication-prescriber alerts in changing prescriber behaviour and improving patient outcomes in ambulatory care settings via computerised provider order entry (CPOE) systems.

Methods: A standardised search strategy was developed and applied to the following key bibliographical databases: PubMed, Embase, CINAHL and The Cochrane Library.

A Conversation About the Role of Humiliation in Teaching: The Ugly, the Bad, and the Good.

In this Invited Commentary, the authors identify the ugly, the bad, and the good in teaching in medical education, based on their experiences as medical students and then educators. They reflect on the mistreatment they endured during medical school and its impact on their education and their careers as educators. They also highlight those exemplars from their training who role modeled the type of physician and educator they want to be.

The process of development of a prioritization tool for a clinical decision support build within a computerized provider order entry system: Experiences from St Luke's Health System.

To establish a process for the development of a prioritization tool for a clinical decision support build within a computerized provider order entry system and concurrently to prioritize alerts for Saint Luke's Health System. The process of prioritizing clinical decision support alerts included (a) consensus sessions to establish a prioritization process and identify clinical decision support alerts through a modified Delphi process and (b) a clinical decision support survey to validate the results. All members of our health system's physician quality organization, Saint Luke's Care as well as clinicians, administrators, and pharmacy staff throughout Saint Luke's Health System, were invited to participate in this confidential survey.

Teaming up to take down costs.

By linking specialty-specific clinical teams with supply chain experts, Saint Luke's Health System established cost-containment strategies that align with clinical pathways and create new leverage with vendors. Since the initiative launched in January 2013, Saint Luke's has reduced medical supply costs by more than $6 million. In several instances, physicians have led the way in formulating cost-cutting ideas that exceeded the expectations of supply chain administrators.

Characteristics of CPOE systems and obstacles to implementation that physicians believe will affect adoption.

Background: Computerized Physician Order Entry (CPOE) has the potential to decrease medical errors and improve quality. Our health system plans to implement CPOE in response to the ARRA HITECH Act.

Objectives: To determine (A) physicians' projections of the most important characteristics of a CPOE system that will affect their willingness to adopt CPOE, and (B) the obstacles they foresee in adopting CPOE.

Major concerns about internal medicine: insights from program directors.

Objective: To better understand and characterize the challenges facing internal medicine from the perspective of internal medicine residency program directors.

Methods: In 2007, internal medicine program directors were surveyed by the Association of Program Directors in Internal Medicine (APDIM). An open-ended question asked: "What are your major concerns regarding internal medicine?" Responses to this question were independently coded by two investigators and compared for agreement.

Ambulatory office organization for internal medicine resident medical education.

Purpose: Residents will most effectively learn about ambulatory, systems-based practice by working in highly functional ambulatory practices; however, systems experiences in ambulatory training are thought to be highly variable. The authors sought to determine the prevalence of functional-practice characteristics at clinics where residents learn.

Method: In 2007, the authors conducted a national survey of medical directors of resident continuity clinics using a comprehensive, Web-based instrument that included both a residency clinic assessment and a practice system assessment (PSA).

Prevalence and functionality of electronic health records in internal medicine continuity clinics.

Purpose: Health information technology (HIT), particularly electronic health records (EHRs), will become universal in ambulatory practices, but the current roles and functions that HIT and EHRs play in the ambulatory clinic settings of internal medicine (IM) residents are unknown.

Method: The authors conducted a Web-based survey from July 2007 to January 2008 to ascertain HIT prevalence and functionality. Respondents were directors of one or more ambulatory clinics where IM residents completed any required outpatient training, as identified by directors of accredited U.

Pharmaceutical industry support and residency education: a survey of internal medicine program directors.

Background: Interactions with the pharmaceutical industry are known to affect the attitudes and behaviors of medical residents; however, to our knowledge, a nationally representative description of current practices has not been reported.

Methods: The Association of Program Directors in Internal Medicine surveyed 381 US internal medicine residency program directors in 2006-2007 regarding pharmaceutical industry support to their training programs. The primary outcome measure was program director report of pharmaceutical financial support to their residency.

Humor in intern retreats: scrubbing away the blues.

Humor in everyday practice has been shown to reduce work stress and increase efficiency. We aimed to study the effect of humor on interns for which we employed humor in one of the intern retreats and later asked the interns to rate the value of each retreat. Pre- and post- retreat mood states were also surveyed.

Hospitalist involvement in internal medicine residencies.

Context: The ways hospitalists interact with and contribute to internal medicine residencies in the United States have been described locally, but have not been documented on a national level.

Objectives: To describe the penetration of hospitalists into medicine residency faculty nationally, and document their contributions to teaching activities.

Design, Setting, And Participants: Survey of all 386 internal medicine residency directors in the United States in 2005 (272 respondents) and 2007 (236 respondents).

Demographic and work-life study of chief residents: a survey of the program directors in internal medicine residency programs in the United States.

Context: Chief residents play a crucial role in internal medicine residency programs in administration, academics, team building, and coordination between residents and faculty. The work-life and demographic characteristics of chief residents has not been documented.

Objective: To delineate the demographics and day-to-day activities of chief residents.

What predicts residency accreditation cycle length? Results of a national survey.

Purpose: To determine whether residency program baseline characteristics, program director characteristics, and the date of the most recent Accrediation Council for Graduate Medical Education (ACGME) site visit would affect program accreditation cycle length.

Method: A survey asked about cycle length as well as program and program director characteristics. The survey was sent to all 391 accredited internal medicine residency programs registered with the Association of Program Directors in Internal Medicine in March 2005.

What do you do when your loved one is ill? The line between physician and family member.

Conventional wisdom and professional ethics generally dictate that physicians should avoid doctoring family members because of potential conflicts of interest. Nevertheless, cross-sectional surveys find that the practice is commonplace. Physicians have unique opportunities to influence their family member's care because they possess knowledge and status within the health care system; however, when physicians participate in the care of family members, they must not lose objectivity and confuse their personal and professional roles.

The state of evaluation in internal medicine residency.

Background: There are no nationwide data on the methods residency programs are using to assess trainee competence. The Accreditation Council for Graduate Medical Education (ACGME) has recommended tools that programs can use to evaluate their trainees. It is unknown if programs are adhering to these recommendations.

Personal growth and its correlates during residency training.

Objectives: To explore the characteristics of and factors associated with personal growth during residency training.

Methods: In 2003, 359 house officers on 7 internal medicine residency training programmes in the USA were surveyed about their training experiences and issues related to their personal growth. Factor analysis and internal reliability testing were used to develop a 'personal growth scale'.

Personal growth during internship: a qualitative analysis of interns' responses to key questions.

Background: During clinical training, house officers frequently encounter intense experiences that may affect their personal growth. The purpose of this study was to explore processes related to personal growth during internship.

Design: Prospective qualitative study conducted over the course of internship.