Culture change and lessons learned from ten years in the VA centers of excellence in primary care education.

Background: Team-based care is critical to achieving health care value while maximizing patient outcomes. Few descriptions exist of graduate-level team training interventions and practice models. Experience from the multisite, decade-long Veterans Affairs (VA) Centers of Excellence in Primary Care Education provides lessons for developing internal medicine training experiences in interprofessional clinical learning environments.

Expanding Primary Care Experiences With Novel Rotations for Residents at a VA Medical Center.

Background: The number of graduating primary care physicians will not meet the demands of the growing and aging US population. In 2011, the Veterans Affairs (VA) Office of Academic Affiliations established 5 Centers of Excellence in Primary Care Education (CoEPCE) to transform primary care training.

Objective: We created an innovative training model with immersive primary care experiences to foster careers in primary care for residents.

Interprofessional Academic Patient Aligned Care Team Panel Management Model.

The panel management model brings together trainees, faculty, and clinic staff to proactively provide team-based care to high-risk patients with unmet chronic care needs.

Implementation of a novel population panel management curriculum among interprofessional health care trainees.

Background: Gaps in chronic disease management have led to calls for novel methods of interprofessional, team-based care. Population panel management (PPM), the process of continuous quality improvement across groups of patients, is rarely included in health professions training for physicians, nurses, or pharmacists. The feasibility and acceptance of such training across different healthcare professions is unknown.

Changes in Resident Well-Being at One Institution Across a Decade of Progressive Work Hours Limitations.

Purpose: To measure changes in markers of resident well-being over time as progressive work hours limitations (WHLs) were enforced, and to investigate resident perceptions of the 2011 WHLs.

Method: A survey study of internal medicine residents was conducted at the University of Washington's multihospital residency program in 2012. The survey included validated well-being questions: the Maslach Burnout Inventory, the two-question PRIME-MD depression screen, and career satisfaction questions.

Pharmacologic Therapies in Anticoagulation.

Anticoagulants are beneficial for prevention and treatment of venous thromboembolism and stroke prevention in atrial fibrillation. The development of target-specific oral anticoagulants is changing the landscape of anticoagulation therapy and created growing interest on this subject. Understanding the pharmacology of different anticoagulants is the first step to adequately treat patients with best available therapy while avoiding serious bleeding complications.

Reflections of the Veterans Administration Puget Sound Health Care System Regional Nurse Practitioner Residency Forum.

Problem: There is a proliferation of advanced practice residency programs. However, there is no uniform model of developing and evaluating program success.

Methods: An information forum was convened by Veterans Health Administration Puget Sound Health Care System's Center for Primary Care Education on September 17, 2013, in Seattle, Washington, to explore critical aspects of residency models.

Recommendations for nurse practitioner residency programs.

The purpose of this study was to identify and prioritize critical aspects needed in the design and execution of new nurse practitioner (NP) residency programs. Subjects answered a series of questions on formulating residency programs and on key outcomes and cost measures related to their sustainability. These results serve as potential guideposts for future work in NP residency standardization and sustainability development.

Low back pain.

Low back pain is a common, frequently recurring condition that often has a nonspecific cause. Most nonspecific acute low back pain will improve within several weeks with or without treatment. The diagnostic workup should focus on evaluation for evidence of systemic or pathologic causes.

The effect of rural training experiences during residency on the selection of primary care careers: a retrospective cohort study from a single large internal medicine residency program.

Background: Little is known about the factors during internal medicine residency that influence career choice.

Purpose: To determine if rural training experiences were associated with primary care career choice.

Methods: We conducted a retrospective cohort study at a single, large, internal medicine residency program.

Resident perceptions of the educational value of night float rotations.

Background: Night float rotations are being increasingly used in the era of resident physician work-hour regulations, but their impact on resident education is not clear.

Purpose: Our objective was to clarify resident perceptions of the educational aspects of night float rotations.

Methods: An anonymous survey of internal medicine residents at a university-based residency program was completed.

Development of a Tool to Assess the Team Leadership Skills of Medical Residents.

Purpose: To develop a tool to assess the team leadership skills of internal medicine residents.

Method: A 27-item pilot instrument developed by two authors was distributed to interns on ward and intensive care unit teams at the end of rotations from a single institution's internal medicine residency program. These items were factor analyzed and reduced to a seven-item resident leadership scale (RLS).

The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program.

Background: The Accreditation Council for Graduate Medical Education work-hour limitations (WHLs) were implemented in July 2003. Effects on resident well-being, patient care, and education are not well understood. We investigated these effects of WHLs.

A literature review of "resident-as-teacher" curricula: do teaching courses make a difference?

Objectives: To examine the evaluation methods of resident teaching courses and to estimate the effectiveness of these teaching courses.

Design: We searched the literature from 1975 to May 2003 using the PubMed MESH terms internship and residency and teaching; 1,436 articles were identified and 77 contained information regarding teaching courses. Fourteen articles contained information regarding outcomes of resident teaching courses and were selected for intensive review.

Preparing graduates for the first year of residency: are medical schools meeting the need?

Purpose: Changes in graduate medical education associated with full implementation of the Balanced Budget Act of 1997 have required medical schools to review and revise their curricula. As limited funding increases pressures to streamline training, residencies will potentially expect an entry level of skill and competence that is greater than that which schools are currently providing. To determine whether medical school curricular requirements correlate with residency needs, this multidisciplinary pilot study investigated expectations and prerequisites for postgraduate specialty training.

Burnout and self-reported patient care in an internal medicine residency program.

Background: Burnout is a syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment. Little is known about burnout in residents or its relationship to patient care.

Objective: To determine the prevalence of burnout in medical residents and explore its relationship to self-reported patient care practices.