Physician MOC Status Linked To Better Diabetes Performance Measure

MedicalResearch.com Interview with:
Bradley Gray, PhD
Senior Health Services Researcher
American Board of Internal Medicine

MedicalResearch.com: What is the background for this study?

Response: This study is part of an ongoing effort to improve and validate ABIM’s MOC process through the use of real data that is ongoing here at ABIM.

MedicalResearch.com: What are the main findings? 

Response: The paper examines the association between MOC status and a set of HEDIS process quality measures for internists twenty years past the time they initially certified. An example of one HEDIS performance measure we looked at was percentage of patients with diabetes that had twice annual HbA1c testing. The key findings of the paper are that physicians who maintained their certification had better scores on 5 of 6 HEDIS performance measures than similar physicians who did not maintain their certification.

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Is More Supervision of Medical Residents Always Better for Patient Care?

MedicalResearch.com Interview with:
Kathleen M. Finn MD, MPhil
Christiana Iyasere MD, MBA
Division of General Internal Medicine
Department of Medicine
Massachusetts General Hospital, Boston

MedicalResearch.com: What is the background for this study?

Response: While the relationship between resident work hours and patient safety has been extensively studied, little research evaluates the role of attending supervision on patient safety. Beginning with the Bell Commission there have been increased calls for enhanced resident supervision due to patient safety concerns. At the same time, with the growth of the hospitalist movement more faculty physicians join daily resident work rounds under the assumption that increased supervision is better for patient safety and resident education. However, we know that supervision is a complex balancing act, so we wanted to study whether these assumptions were true. On the one hand patient safety is important, but on the other adult learning theory argues residents need to be challenged to work beyond their comfort level. Importantly, being pushed beyond your comfort level often requires appropriate space between teacher and learner. To investigate the role of attending supervision on patient safety and resident learning we studied the impact of two levels of physician supervision on an inpatient general medical team.

Twenty-two teaching faculty were randomized to either direct supervision of resident teams for patients previously known to the team vs usual care where they did not join rounds but rather discussed the patients later with the team. Faculty participated in both arms of the study, after completing the first arm they then crossed over to the other arm; each faculty member participated in the study for a total of 4 weeks.

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Female Residents Do Not Perceive Cardiology As Conducive To Work-Family Balance

MedicalResearch.com Interview with:

Pamela S. Douglas, MD, MACC, FASE, FAHA Ursula Geller Professor of Research in Cardiovascular Disease Duke University School of Medicine  Durham, NC 27715   

Dr. Douglas

Pamela S. Douglas, MD, MACC, FASE, FAHA
Ursula Geller Professor of Research in Cardiovascular Disease
Duke University School of Medicine
Durham, NC 27715    

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: For any profession to succeed, it needs to attract top talent. We surveyed internal medicine residents to find out what they valued most in their professional development, how they perceived cardiology as field and how these two areas are associated with  their choosing a career in cardiology or another specialty.

We found that trainees were seeking careers that had stable hours, were family friendly and female friendly, while they perceived cardiology to  have adverse work conditions, interfere with family life and to not be diverse. We were able to predict career choice with 89-97% accuracy from these responses; the predictors are mix of things that attract to cardiology and those that are deterrents.

For men, the attractors outnumber the deterrents, for women its just the opposite.

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Allergic Rhinitis Can Impair Adolescent Sleep and School Performance

MedicalResearch.com Interview with:

Michael S. Blaiss, MD, FACAAI Executive Medical Director American College of Allergy, Asthma & Immunology Arlington Heights, IL 60005

Dr. Blaiss

Michael S. Blaiss, MD, FACAAI
Executive Medical Director
American College of Allergy, Asthma & Immunology
Arlington Heights, IL 60005

MedicalResearch.com: Is this research important? Why or why not?

Response: There has not been a comprehensive review of how allergic rhinitis impacts the adolescent population. Most studies put adolescents in with children and yet we know that how disease affects adolescents may be dramatically different than children. Adolescents is a difficult enough time with a chronic condition

MedicalResearch.com: What is the key take-home message?

Response: The symptoms associated with nasal and eye allergies can be different in adolescents compared with adults and children and lead to poor quality of life and impair learning in school. Adolescents with AR/ARC may experience difficulties falling asleep, night waking, and snoring, and generally have poorer sleep. Therefore health care providers need to aggressively control the adolescent’s allergic rhinitis.  Continue reading

SKINDER App Teaches Intuitive Visual Diagnosis of Melanoma

MedicalResearch.com Interview with:

SKINDER APP

Image from SKINDER APP

Michael SKolodneyMD, PhD
Section of Dermatology, Department of Medicine
West Virginia University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Melanoma is easily curable if recognized early.   Dermatologists are good at spotting melanomas because they develop an innate sense of how melanomas appear after examining thousands of malignant and benign lesions.  In contrast, most medical students are relatively disadvantaged by their limited dermatology exposure. We felt that too little experience, rather than lack of knowledge of the rules, is the primary barrier to development of pattern-recognition and intuition as a reliable tool for melanoma diagnosis in non-experts.  To remedy this problem, we developed a novel web-based application to mimic the training of a dermatologist by teaching medical students intuitive melanoma diagnosis in a highly condensed period of time.

Our application, which we call Skinder, teaches intuitive visual diagnosis of melanoma by quickly presenting the learner with thousands of benign and malignant skin lesions.  The user makes rapid binary decisions, by swiping right for benign or left for malignant, and receives instant feedback on accuracy. With this application, the learner can amass a mental repository of diagnostic experience in a short amount of time. To determine if intuitive visual diagnosis training is superior to a traditional rule-based approach, we compared our web-based application to a rules based approach, the publicly available INFORMED Skin Education Series.

Medical students were tested on the ability top differentiate melanomas from benign pigmented lesions before and after training with either Skinder of the Informed Skin Education Series. The pre-test mean for the Skinder group was 75% correct, compared to 74.7% correct for the INFORMED group. The post-test mean for the skinder application group was 86.3% correct, compared to 77.5% correct for the INFORMED group which was highly signifcant.

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When Do Organized Activities for Kids Become Too Much?

MedicalResearch.com Interview with:

Dr Sharon Wheeler PhD

Dr Sharon Wheeler PhD Lecturer in Sport, Physical Activity and Health Department of Sport and Physical Activity Faculty of Arts and Sciences Edge Hill University Lancashire

Dr. Wheeler

Lecturer in Sport, Physical Activity and Health
Department of Sport and Physical Activity
Faculty of Arts and Sciences
Edge Hill University
Lancashire

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is well-known that family background and parents’ investment in their children has a big impact on a number of outcomes, including how well people do at school, the jobs they get, and how they spend their leisure time. It is also known that it is middle-class parents who tend to work particularly hard to make sure their children get on in life.

This research starts to question whether parents’ investment in their children’s organised activities is having the desired impact. Parents initiate and facilitate their children’s participation in organised activities as it shows that they are a ‘good’ parent and they hope such activities will benefit their children in both short-term (keeping fit and healthy, developing friendship groups) and long-term ways (getting jobs, having lots of opportunities in the future).

The reality, which has been highlighted in this research, is that while children might experience some of these benefits, a busy organised activity schedule can put considerable strain on parents’ resources and families’ relationships, as well as potentially harm children’s development and well-being.

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Variety of Interventions Can Improve Childhood Self-Regulation Skills

MedicalResearch.com Interview with:
“Children Playing at Swyalana Lagoon” by Doug Hay is licensed under CC BY 2.0Dr Anuja Pandey

Population, Policy and Practice Programme,
UCL Great Ormond Street Institute of Child Health
London UK 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Evidence from longitudinal studies suggests that self-regulation skills can be a powerful predictor of positive health, educational, financial and social outcomes. Hence, self-regulation has received interest as an intervention target and a number of interventions have been evaluated in children and adolescents.

Our study summarised the evidence from 50 rigorously evaluated self-regulation interventions in children and adolescents including 23098 participants. We found that while most interventions were successful in improving self-regulation (66%), some of them did not produce a noticeable change (34%).Curriculum based approach was most commonly used to deliver interventions, and this involved training teachers, who implemented these interventions.  Continue reading

Grouping Students By Abilities Fosters Dependence and Caps Opportunities for Learning

MedicalResearch.com Interview with:
“Classroom” by frankjuarez is licensed under CC BY 2.0Dr Anna Mazenod

Institute of Education
University of London
UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In this paper we report baseline findings from a large study of grouping practices in state-funded secondary schools in England. The study seeks to improve our understanding of how students are grouped for their English and mathematics classes, and the potential impact of different grouping practices on student outcomes and experiences of schooling. This paper draws on a survey of 597 teachers and 34 teacher interviews in schools where students are grouped by their attainment for the subject. It focuses on teacher perspectives on teaching and learning in the lower attainment groups.

We found that students in the lower attainment groups were typically constructed as learners who benefit from specific approaches to learning justified through discourses of nurturing and protection. Most teachers felt that students in the lower attainment groups were not able to access learning independently from their teachers in comparison with their peers in the higher attainment groups. Some teachers for example described students in the lower attainment groups as ‘more dependent on people’ and students in the higher attainment groups as ‘independent learners.’

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Physicians Passage of MOC Exam Linked to Fewer State Disciplinary Actions

MedicalResearch.com Interview with:

Dr. Furman S. McDonald MD MPH Lead author of the research and  Senior Vice President for Academic and Medical Affairs American Board of Internal Medicine (ABIM)

Dr. McDonald

Dr. Furman S. McDonald MD MPH
Lead author of the research and
Senior Vice President for Academic and Medical Affairs
American Board of Internal Medicine (ABIM)

MedicalResearch.com: What is the background for this study? Would you briefly explain how the MOC examination works?

Response: To earn Board Certification from the American Board of Internal Medicine (ABIM), doctors take an exam after completing a medical education training program accredited by the Accreditation Council for Graduate Medical Education to demonstrate they have the knowledge to practice in a specialty. Previously, ABIM conducted research that showed that physicians who passed a certification exam were five times less likely to be disciplined by a state licensing board than those who do not become certified.

After becoming board certified, physicians can participate in ABIM’s Maintenance of Certification (MOC) program, which involves periodic assessments and learning activities to support doctors in staying current with medical knowledge through their careers. ABIM has been in conversations across the medical community and many people have expressed interest in whether performance on the MOC exams doctors take is also associated with important outcomes relevant to patients.

For this study, my ABIM colleagues and I studied whether there was any association between Internal Medicine MOC exam performance and disciplinary actions by state licensing boards. We studied MOC exam results and any reported disciplinary actions for nearly 48,000 general internists who initially certified between 1990 and 2003.  Continue reading

Dark Skin Tones May Be Underrepresented in Medical Textbooks

MedicalResearch.com Interview with:

Patricia Louie, MA PhD Student, Department of Sociology University of Toronto Toronto, ON, Canada

Patricia Louie

Patricia Louie, MA
PhD Student, Department of Sociology
University of Toronto
Toronto, ON, Canada 

MedicalResearch.com: What is the background for this study?

 

Response: While most physicians believe that they treat patients equally, research shows that racial inequality pervades the U.S. health care system (Feagin and Bennefield 2014; Williams 2012). Because these inequities persist even after demographic and other socio-economic differences are taken into consideration scholars have started to look at the representation of race in the medical curriculum. The idea is that medical curriculum creates both implicit and explicit connections between race and disease. We build on this body of work by investigating the representation of race (White, Black and Person of Color) and skin tone (light, medium and dark) in the images of four preclinical anatomy textbooks – Atlas of Human AnatomyBates’ Guide to Physical Examination & History Taking, Clinically Oriented Anatomy, and Gray’s Anatomy for Students.  Skin tone is important.

The majority of medical imagery consists of decontextualized images of body parts where skin tone, which may be related to disease presentation, is the only phenotypical marker. If doctors associate light skin tones with White patients, this may also influence how doctors think about who is a “typical” patient, particularly for the type of disease that is shown in that image.

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