Redesigning Residency Education in Internal Medicine: A Position Paper from the Association of Program Directors in Internal Medicine

Fitzgibbons, John P.; Bordley, Donald R.; Berkowitz, Lee R.; Miller, Beth; Henderson, Mark C.

doi:10.7326/0003-4819-144-12-200606200-00010

Cited by 151 publications

(95 citation statements)

References 46 publications

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“…The challenge of educating residents to practice in today's healthcare environment has led to calls for a major redesign of residency education-particularly in the outpatient setting. [1][2][3][4][5] In synergy with these efforts, new program requirements from the Accreditation Council for Graduate Medical Education (ACGME) demand flexibility and creativity from internal medicine training programs. Specifically, they mandate that programs "develop models and schedules that minimize conflicting inpatient and outpatient responsibilities," 6 to address the longstanding and stressful situation where residents must balance a continuity clinic session and an inpatient service at the same time.…”

Section: S Everal Important Themes Have Emerged In Recent Yearsmentioning

confidence: 99%

Ambulatory Education Redesign: Time to Get Inspired

Papp

Wayne²

2013

J GEN INTERN MED

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Section: S Everal Important Themes Have Emerged In Recent Yearsmentioning

confidence: 99%

Ambulatory Education Redesign: Time to Get Inspired

Papp

Wayne²

2013

J GEN INTERN MED

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“…Como consecuencia, en EEUU, el interés entre los egresados de medicina ha declinado notoriamente, especialmente en el ejercicio ambulatorio de la MI general 15 . En Chile, se mantiene el interés por la MI entre los egresados, sin embargo, al fi nalizar sus 3 años de MI muchos optan por una subespecialidad.…”

Section: Interés En La Especialidadunclassified

Definición actual de la medicina interna y el internista

et al. 2011

Rev. méd. Chile

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A consensus defi nition of internal medicine and the internist L as especialidades médicas surgen basadas en diferentes criterios: sistemas, edades, género, enfermedades o tecnologías 1,2 . La Medicina Interna (MI), especialidad básica de la Medicina se refería a la disciplina que enfrentaba problemas de los órganos internos que el cirujano no podía abordar. Actualmente, cirujanos e internistas abordan patologías "externas" e "internas" y, aunque el nombre persiste, estaría obsoleto. El primer texto de medicina interna fue publicado por el médico alemán J. von Mering, en 1901 ("Lehrbuch der Inneren Medizin") 3 . Internal Medicine is a basic clinical specialty in Medicine, but due to it's vast fi eld of action it is quite diffi cult to defi ne. This consensus article analyzes different defi nitions and proposes a current defi nitionComo toda especialidad, cambia permanentemente; Sir W. Osler, uno de los padres de la medicina interna 4 , consideraba las necropsias parte de la MI. Una encuesta del American College of Physicians (ACP) a 990 internistas generales (IG) mostró que entre 1986 y 2004 disminuyó el número y variedad de procedimientos realizados por IG; procedimientos como paracentesis, tóra-cocentesis y punciones lumbares que realizaban la mayoría de los IG, el 2004 sólo las realizaban la cuarta parte de ellos 5,6 .Su amplitud también genera confusión en la sociedad.

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“…Several professional organizations including the Alliance for Academic Internal Medicine advocate a move to training based on patient-centered care [9]. Recognizing that working in a PCMH does not necessarily equate with understanding PCMH goals and priorities, PCMH curricula for residents have been developed [10–12].…”

Section: Introductionmentioning

confidence: 99%

Do medical residents perform patient-centered medical home tasks? A mixed-methods study

Block

LaVine

Verbsky

et al. 2017

Medical Education Online

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Background: Increasingly, residents are being trained in Patient-centered Medical Home (PCMH) settings. A set of PCMH entrustable professional activities (EPAs) for residents has been defined but not evaluated in practice. Objective: To understand whether residents trained at PCMH sites reported higher likelihood of engaging in PCMH tasks than those training in non-PCMH sites. Design: Survey and nominal group data from post-graduate trainees at three residency programs. Results: A total of 179 residents responded (80% response). Over half (52%) cared for patients at PCMH sites. Residents at PCMH sites were more likely to report engaging in tasks in the NCQA domains of enhancing access and continuity (p < 0.01 for 4/11 tasks), planning and managing care (p < 0.01 for 3/4 tasks), providing self-care and community support (p < 0.01 for 3/5 tasks), and identifying and managing patient populations (p < 0.01 for 1/6 tasks), but were not more likely to report tracking and coordinating care or measuring and improving performance. Residents at PCMH sites were more likely to report working with medical assistants (p < 0.01), but not other healthcare professionals. Qualitative data showed staff teamwork and continuity of care as facilitators of patient-centered care, and technological problems and office inefficiencies as barriers to care. Conclusions: Residents trained at PCMH sites were more likely to engage in tasks in several NCQA domains, but not care coordination and quality assessment. Similar facilitators and barriers to trainee provision of patient-centered care were cited regardless of PCMH status. Curricula on PCMH principles and workflows that foster continuity and communication may help to inform residents on PCMH tenets and incorporate residents into team-based care. Abbreviations: EPA: Entrustable professional activity; GIM: General Internal Medicine; NCQA: National Center for Quality Assurance; PCMH: Patient-centered medical home

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Redesigning Residency Education in Internal Medicine: A Position Paper from the Association of Program Directors in Internal Medicine

Cited by 151 publications

References 46 publications

Ambulatory Education Redesign: Time to Get Inspired

Ambulatory Education Redesign: Time to Get Inspired

Definición actual de la medicina interna y el internista

Do medical residents perform patient-centered medical home tasks? A mixed-methods study

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