An alternative practice model: residents transform continuity clinic and become systems thinkers.

Background: A changing health care environment has created a need for physicians trained in health system improvement. Residency programs have struggled to teach and assess practice-based learning and improvement and systems-based practice competencies, particularly within ambulatory settings.

Intervention: We describe a resident-created and resident-led quality and practice-improvement council in an internal medicine continuity clinic.

Nurses' perceptions of simulation-based interprofessional training program for rapid response and code blue events.

Following completion of an interprofessional simulation program for rapid response and code blue events, we explored hospital unit nurses' perspectives of the training, through a mixed-methods analysis. The results of this study advocate for the use of simulation training in preparing nurses and promoting communication among team members, effective teamwork, and early recognition of clinically deteriorating patients. This study provides support for the implementation and continued use of simulation interprofessional programs in hospital settings.

Systems-based practice in graduate medical education: systems thinking as the missing foundational construct.

Background: Since 2001, residencies have struggled with teaching and assessing systems-based practice (SBP). One major obstacle may be that the competency alone is not sufficient to support assessment. We believe the foundational construct underlying SBP is systems thinking, absent from the current Accreditation Council for Graduate Medical Education competency language.

What can medical education learn from the neurobiology of learning?

The last several decades have seen a large increase in knowledge of the underlying biological mechanisms that serve learning and memory. The insights gleaned from neurobiological and cognitive neuroscientific experimentation in humans and in animal models have identified many of the processes at the molecular, cellular, and systems levels that occur during learning and the formation, storage, and recall of memories. Moreover, with the advent of noninvasive technologies to monitor patterns of neural activity during various forms of human cognition, the efficacy of different strategies for effective teaching can be compared.

Enhancing competency in professionalism: targeting resident advance directive education.

Background: Education about advance directives typically is incorporated into medical school curricula and is not commonly offered in residency. Residents' experiences with advance directives are generally random, nonstandardized, and difficult to assess. In 2008, an advance directive curriculum was developed by the Scott & White/Texas A&M University System Health Science Center College of Medicine (S&W/Texas A&M) internal medicine residency program and the hospital's legal department.

Students learn systems-based care and facilitate system change as stakeholders in a free clinic experience.

Systems-based practice (SBP) is rarely taught or evaluated during medical school, yet is one of the required competencies once students enter residency. We believe Texas A&M College of Medicine students learn about systems issues informally, as they care for patients at a free clinic in Temple, TX. The mandatory free clinic rotation is part of the Internal Medicine clerkship and does not include formal instruction in SBP.

The patient panel conference experience: what patients can teach our residents about competency issues.

Purpose: In 2007, the Scott & White/Texas A&M HSC College of Medicine began requiring all internal medicine residents to attend quarterly patient panel conferences, during which former Scott & White patients speak frankly about their inpatient and outpatient experiences. The main purpose of this mixed-methods pilot study was to determine whether residents' competency education could be enhanced via the conferences.

Method: Of the 54 internal medicine residents in the residency program, 31, 39, and 41 participated in three patient panel conferences, respectively, between December 2007 and August 2008.

Using simulation to orient code blue teams to a new hospital facility.

Objectives: Prompt and successful cardiopulmonary resuscitation during a sudden cardiac arrest can be hindered by multiple variables, ie, ineffective communication, stress, lack of training, and an unfamiliar environment, such as a new hospital facility. The main objective of the study was to use high-fidelity simulations to orient Code Blue Teams (CBTs) to critical events in a new hospital facility. A secondary objective was to elucidate factors that may have contributed to responses by debriefing teams.

Procedural and interpretive skills of medical students: experiences and attitudes of fourth-year students.

Background: Recent data do not exist regarding fourth-year medical students' performance of and attitudes toward procedural and interpretive skills, and how these differ from third-year students'.

Method: Cross-sectional survey conducted in February 2006 of 122 fourth-year students from seven U.S.

The effect of two different faculty development interventions on third-year clerkship performance evaluations.

Background And Objectives: Clinical performance evaluations of medical students often fail to identify significant deficiencies. Many physicians are unwilling to give a poor or failing performance evaluation. Consequently, many clinical rotation grades are inflated and do not reflect actual student performance.

Complying with ACGME resident duty hours restrictions: restructuring the 80-hour workweek to enhance education and patient safety at Texas A&M/Scott & White Memorial Hospital.

Compliance with the Accreditation Council for Graduate Medical Education resident duty hours rules has created unique educational and patient-care challenges for the general medicine inpatient teaching (GMIT) teams at Texas A&M/Scott & White Memorial Hospital, including multiple patient hand-offs, multiple resident absences during teaching time, and loss of continuity of care for individual patients, all of which may have compromised patient safety. The Texas A&M/Scott & White Memorial Hospital internal medicine residency program initially complied with the duty hours rules by having residents take call every fourth night, followed by a six-hour post-call day. This system proved to be inefficient because it significantly disrupted patient care and resident education.

Procedural and interpretive skills of medical students: experiences and attitudes of third-year students.

Background: Recent data do not exist on medical students' performance of and attitudes toward procedural and interpretive skills deemed important by medical educators.

Method: A total of 171 medical students at seven medical schools were surveyed regarding frequency of performance, self-confidence, and perceived importance of 21 procedural and interpretive skills.

Results: Of the 122 responding students (71% response rate), a majority had never performed lumbar puncture, thoracentesis, paracentesis, or blood culture, and students reported lowest self-confidence in these skills.

Do attending physicians, nurses, residents, and medical students agree on what constitutes medical student abuse?

Background: Whether attending physicians, residents, nurses, and medical students agree on what constitutes medical student abuse, its severity, or influencing factors is unknown.

Method: We surveyed 237 internal medicine attending physicians, residents, medical students, and nurses at 13 medical schools after viewing five vignettes depicting potentially abusive behaviors.

Results: The majority of each group felt the belittlement, ethnic insensitivity, and sexual harassment scenarios represented abuse but that excluding a student from participating in a procedure did not.

Medical students' perspectives on and responses to abuse during the internal medicine clerkship.

Background: The abuse of medical students on clinical rotations is a recognized problem, but the effects on students and their responses warrant further study.

Purpose: To determine the severity of student abuse and the effects of abuse on students during the internal medicine clerkship.

Methods: Internal medicine clerks at 11 medical schools (N = 1,072) completed an exit survey.