Evaluation of a Redesign Initiative in an Internal-Medicine Residency

Abstract

As compared with a traditional inpatient care model, an experimental model characterized by reduced trainee workload and increased participation of attending physicians was associated with higher trainee satisfaction and increased time for educational activities.

In the Wake of the 2003 and 2011 Duty Hours Regulations, How Do Internal Medicine Interns Spend Their Time?

“…23,24 Reorganization of resident teams to decrease patient volume and increase focus on teaching and patient-centered care has been shown to increase educational time and decrease indirect patient care time, and improve patient outcomes. 25,26 Educators might optimize the efficiency of conferences and rounds to ensure residents are deriving maximal benefit from these sessions.…”

Misdiagnosis: analysis based on case record review with proposals aimed to improve diagnostic processes

“…The value of weaving this approach into the teaching process of trainees has been recently explored in the Brigham and Women's Hospital in Boston, USA. 20 Accurate diagnosis requires integrating correct clinical findings with appropriate investigations and framing conclusions accurately. Intuitive thought and action play an important role in this endeavour and will continue to do so.…”

Implementation of 2011 Duty Hours Regulations through a Workload Reduction Strategy and Impact on Residency Training

“…16 Thus, trainees are caring for sicker patients with less continuous time, resulting in further WLC. Goitein and Ludmerer further suggest, Bfocusing on work hours rather than workload, the ACGME…treated the symptom, not the disease.^1 7(pp655) In contrast to WLC, some educators 18 have advocated for Bworkload reduction^(WLR) strategies for PGY-1 internal medicine trainees, essentially reducing the admitting volume and patient census per trainee. Since 2007 one of our general medicine ward team's has had reduction in patient volume per trainee to accommodate a curricular innovation, effectively a WLR strategy.…”