OBJECTIVE:To improve the quality and specificity of written evaluations by faculty attendings of internal medicine residents during inpatient rotations. DESIGN:Prospective randomized controlled trial.SETTING: Four hospitals: tertiary care university hospital, Veterans' Administration hospital, and two community hospitals.PARTICIPANTS: Eighty-eight faculty and 157 residents from categorical and primary-care internal medicine residency training programs rotating on inpatient general medicine teams. INTERVENTION:Focused 20-minute educational session on evaluation and feedback, accompanied by 3 by 5 reminder card and diary, given to faculty at the start of their attending month. MEASUREMENTS AND MAIN RESULTS:Primary outcomes: 1) number of written comments from faculty specific to unique, preselected dimensions of competence; 2) number of written comments from faculty describing a specific resident behavior or providing a recommendation; and 3) resident Likert-scale ratings of the quantity and effect of feedback received from faculty. Faculty in the intervention group provided more written comments specific to defined dimensions of competence, a median of three comments per evaluation form versus two in the control group, but when adjusted for clustering by faculty, the difference was not statistically significant (P = .09). Regarding feedback, residents in the intervention group rated the quantity significantly higher (P = .04) and were significantly more likely to make changes in clinical management of patients than residents in the control group (P = .04). CONCLUSIONS:A brief, focused educational intervention delivered to faculty prior to the start of a ward rotation appears to have a modest effect on faculty behavior for written evaluations and promoted higher quality feedback given to house staff.

Administrative communication is increasingly challenging for residency programs as the number of training sites expands. The Internet provides a cost-effective opportunity to address these needs. Using the World Wide Web, we developed a single, reliable, accurate, and accessible source of administrative information for residents, faculty, and staff in a multisite internal medicine residency at reduced costs. Evaluation of the effectiveness of the website was determined by tracking website use, materials and personnel costs, and resident, staff, and faculty satisfaction. Office supply and personnel costs were reduced by 89% and personnel effort by 85%. All users were highly satisfied with the web communication tool and all reported increased knowledge of program information and a greater sense of``connectedness.'' We conclude that an internet-based communication system that provides a single, reliable, accurate, and accessible source of information for residents, faculty, and staff can be developed with minimum resources and reduced costs. S uccessful administration of residency programs requires timely, efficient, and accurate communication of information among program directors, faculty, residents, and office staff. Changes in work hours and curricula have resulted in increased complexity and size of many residency programs. Changes in affiliations between institutions and training programs have increased the number of training sites. Communicating the resulting complex schedules, program announcements, and administrative directives while maintaining cohesiveness and identity among trainees is difficult. Training programs devote significant material, personnel, and financial resources to meeting this challenge.Evolving computer technology makes the Internet an appealing tool for meeting administrative communication needs. Medical students, residents, faculty, and program administrators are increasingly computer literate. 1,2 Applying to medical school and residency training programs in many specialties is now web-based and paperless. 3±5 Many residency programs enhance the accessibility of their program brochure by placing it on the web, at much less cost than printed brochures. 6,7 A survey of internal medicine residency program directors and administrators attending a workshop on web-based communication in April, 2000 at the Association of Program Directors of Internal Medicine annual meeting revealed that 99% of programs in attendance had their brochure on the web, 33% used the web to communicate with residents and faculty, and all wanted to develop or expand web-based communication resources. 8 We developed an Internet-based residency program website that functions as a single, reliable, accurate source of information. This report describes the process used to develop our website and provides an evaluation of costs and utility.