Use of a voice and video internet technology as an alternative to in-person urgent care clinic visits.

This study aimed to determine the feasibility of patient-initiated online Internet urgent care visits, and to describe patient characteristics, scope of care, provider adherence to protocols, and diagnostic and therapeutic utilization. A total of 456 unique patients were seen via Internet-based technology during the study period, generating 478 consecutive total patient visits. Of the 82 patients referred for an in-person evaluation, 75 patients (91.

Promoting resident wellness: evaluation of a time-off policy to increase residents' utilization of health care services.

Purpose: To evaluate awareness and utilization of a new institutional policy to grant residents time off to access personal and family health care.

Method: In 2012, two years after policy implementation, an electronic survey was sent to all 546 residents and fellows at a tertiary care academic medical center in the United States. Residents were asked questions regarding awareness of the time-off policy, use of the policy, health care status, reasons for policy use, and barriers to use.

"If you build it, they will come": attitudes of medical residents and fellows about seeking services in a resident wellness program.

Background: High rates of burnout and distress in resident physicians suggest a significant number would benefit from counseling.

Intervention: A resident wellness program (RWP) was designed to lower known barriers limiting resident access to services.

Methods: In 2011, medical residents and fellows were surveyed and logistic regression analyses were conducted to identify demographic and training program differences in perceived barriers and willingness to access the RWP.

Plug the leak: align public spending with public need.

We explore the history behind the current structure of graduate medical education funding and the problems with continuing along the current funding path. We then offer suggestions for change that could potentially manage this health care spill. Some of these changes include attracting more students into primary care, aligning federal graduate medical education spending with future workforce needs, and training physicians with skills they will require to practice in systems of the future.

A comparison between physicians and demographically similar peers in accessing personal health care.

Purpose: Residents are a unique subpopulation of physicians, training in a complex work and educational environment that may create barriers to accessing preventive and illness-related health care. This study was designed to investigate residents' utilization of personal health care services and compare with those of demographically similar peers.

Method: All 675 residents in a large, urban, tertiary care U.

Personal time off and residents' career satisfaction, attitudes and emotions.

Objectives: Doctors who are satisfied with their careers have less stress and burnout and are less likely to make medical errors and more likely to provide a higher quality of patient care. In response to reports that residents experienced barriers to taking time off, Oregon Health and Science University designed a survey to evaluate residents' awareness of their programmes' policies for time off, their ability to find time for personal needs, and associations of both with career satisfaction, emotions and training experience.

Methods: All 675 residents in a large, urban, tertiary care academic medical centre located in the USA were invited to participate in a confidential, web-based, cross-sectional survey in 2008; 66% completed the survey.

Education to return nonpracticing physicians to clinical activity: a case study in physician reentry.

Introduction: Physician shortages in the United States are estimated to reach as high as 85 000 by 2020. One strategy for addressing the shortage is to encourage physicians who left clinical practice to return to work, but few programs exist to prepare physicians to reenter practice. The Divisions of Continuing Medical Education and Graduate Medical Education (GME), Oregon Health & Science University, collaborated with clinical departments to establish a physician reentry program.

Institute of medicine committee report on resident duty hours: a view from a trench.

Background: In late 2008, the Institute of Medicine (IOM) published a report recommending more restrictive limits on resident work hours to promote patient safety. Reaction from the graduate medical education community has focused on concerns about a lack of evidence supporting the IOM's recommendations. We highlight 3 concerns with the report: 1) a disproportionate attention to resident fatigue when changes in other areas may have a larger impact on patient safety.

Barriers to innovation in continuing medical education.

Introduction: Criteria for maintenance of certification (MOC) emphasize the importance of competencies such as communication, professionalism, systems-based care, and practice performance in addition to medical knowledge. Success of this new competency paradigm is dependent on physicians' willingness to engage in activities that focus on less traditional competencies. We undertook this analysis to determine whether physicians' preferences for CME are barriers to participation in innovative programs.

Awareness of and participation in maintenance of professional certification: a prospective study.

Introduction: National health care concerns have led to the emergence of maintenance of certification (MOC) as a means to ensure the competence of practicing physicians. Little is known about physician perceptions of the barriers and/or benefits of MOC or proportions of physicians who participate in MOC programs. The purposes of this study were to assess physicians' plans for participating in MOC and to identify influences on decisions to participate.

The impact of the implementation of work hour requirements on residents' career satisfaction, attitudes and emotions.

Background: To assess the impact of work hours' limitations required by the Accreditation Council for Graduate Medical Education (ACGME) on residents' career satisfaction, emotions and attitudes.

Methods: A validated survey instrument was used to assess residents' levels of career satisfaction, emotions and attitudes before and after the ACGME duty hour requirements were implemented. The "pre" implementation survey was distributed in December 2002 and the "post" implementation one in December 2004.

A mid year comparison study of career satisfaction and emotional states between residents and faculty at one academic medical center.

Background: The Accreditation Council for Graduate Medical Education's (ACGME) new requirements raise multiple challenges for academic medical centers. We sought to evaluate career satisfaction, emotional states, positive and negative experiences, work hours and sleep among residents and faculty simultaneously in one academic medical center after implementation of the ACGME duty hour requirements.

Methods: Residents and faculty (1330) in the academic health center were asked to participate in a confidential survey; 72% of the residents and 66% of the faculty completed the survey.

A comparison study of career satisfaction and emotional states between primary care and speciality residents.

Objective: To evaluate career satisfaction, emotional states and positive and negative experiences among residents in primary care and speciality programmes in 1 academic medical centre prior to the implementation of the Accreditation Council for Graduate Medical Education's (ACGME) duty hour requirements.

Design: Cross-sectional survey.

Measurements: All 581 residents in the academic health centre were asked to participate voluntarily in a confidential survey; 327(56%) completed the survey.

Using systems-based practice to integrate education and clinical services.

The authors describe one institution's strategies to implement the Accreditation Council for Graduate Medical Education's (ACGME) Outcomes Project requirements while simultaneously exploring and implementing standards of quality healthcare as endorsed by the Institute of Medicine's (IOM) Crossing the Quality Chasm (2001). Of real interest, application of the authors' institution's paradigm is identical to many of the parameters for system competence as recommended in the IOM's April 2003 report, Health Professions Education: A Bridge to Quality (2003).