Author Interviews, Education, Outcomes & Safety, Surgical Research, University of Pennsylvania / 25.02.2015

Samuel D. Pimentel Doctoral student Statistics Department Wharton School of the University of PennsylvaniaMedicalResearch.com Interview with: Samuel D. Pimentel Doctoral student Statistics Department Wharton School of the University of Pennsylvania   MedicalResearch: What is the background for this study? What are the main findings? Response: Surgical training has undergone major changes in recent years – including a reduction of six to twelve months of training time – and there is controversy about whether these changes have been good or bad for patient outcomes.   Our work partially addresses the issue by asking whether newly-trained surgeons perform better or worse than experienced surgeons.  We compared surgical patients treated by new surgeons to a similar group of patients treated by experienced surgeons using a new statistical technique called large, sparse optimal matching.  Our analysis found no significant differences in mortality rates between the two groups. (more…)
Author Interviews, Education, Pediatrics / 20.02.2015

Julia Jaekel PhD Department of Developmental Psychology Ruhr-University Bochum in GermanyMedicalResearch.com Interview with: Julia Jaekel PhD Department of Developmental Psychology Ruhr-University Bochum in Germany   Medical Research: What is the background for this study? What are the main findings? Dr. Jaekel: Recent reports suggest that delayed school entry (DSE) may be beneficial for children with developmental delays. However, studies of the effects of DSE are inconclusive. Our study investigated the effects of delayed school entry versus age-appropriate entry (ASE) in a large sample after minimizing selection bias and accounting for confounding effects of preschool knowledge. We found that delayed school entry has no effect on Year 1 teacher ratings of academic performance. In contrast, DSE children’s standardized mean test scores of mathematics, reading, writing and attention at 8 years of age were lower than ASE children’s mean scores. (more…)
AHRQ, Author Interviews, Education, NIH, Race/Ethnic Diversity / 13.02.2015

MedicalResearch.com Interview with: Robert M. Kaplan Office of Behavioral and Social Sciences Research National Institutes of Health Bethesda, MD 20892 Medical Research: What is the background for this study? What are the main findings? Response: Years of formal education is one of the strongest correlates of life expectancy. The purpose of this study was to examine the relationship between educational attainment and life expectancy with adjustments for other social, behavioral, and biological factors. Using data from a large cohort of nearly 30,000 adults, we found that education was a very strong predictor of survival and that biological and behavioral factors only partially explained the relationship. (more…)
Author Interviews, Dermatology, Education / 30.01.2015

Robert S. Kirsner, MD, PhD, FAAD Interim Chairman and Harvey Blank Professor in Dermatology, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine Director, University of Miami Hospital Wound Center Chief of Dermatology, University of Miami HospitalMedicalResearch.com Interview with: Robert S. Kirsner, MD, PhD, FAAD Interim Chairman and Harvey Blank Professor in Dermatology, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine Director, University of Miami Hospital Wound Center Chief of Dermatology, University of Miami Hospital Medical Research: What is the background for this study? What are the main findings? Dr. Kirsner: Psoriasis is common, affecting 7.5 million Americans. The major indication of psoriasis is chronic inflammation of the skin. It is characterized by disfiguring, scaling and erythematous plaques that may be painful or pruritic and may cause significant quality of life issues. Psoriasis may also cause joint pain and more recently has been associated with metabolic syndrome, diabetes, cardiovascular disease, dyslipidemia, hypertension and nonalcoholic fatty liver disease. Thus, patients may be physically and emotionally impacted by psoriasis. The American Academy of Dermatology (Academy) developed a Performance Improvement (PI) CME activity to enhance dermatologists’ care of psoriasis patients by allowing them to evaluate their practice using patient charts, utilize evidence-based strategies to overcome self-identified gaps, and then re-measure their performance using charts for patients seen after practice changes were implemented. It was found that the PI CME activity significantly improved dermatologists’ overall documentation of patient history, patient counseling for lifestyle behaviors and shared decision-making ability. For example, dermatologists who participated in and completed this PI CME activity improved practice performance by either inquiring about or documenting to a greater extent comorbidities (particularly cardiovascular disease), drug costs and interactions, patient preference, other medical problems, and severity of disease, resulting in an overall improvement in documented clinical behaviors. (more…)
Author Interviews, Education, JAMA / 21.01.2015

Dr. Juliane Kämmer Postdoctoral Researcher on behalf of the authors Max Planck Institute for Human Development Center for Adaptive Rationality Berlin GermanyMedicalResearch.com Interview with: Dr. Juliane Kämmer  Postdoctoral Researcher on behalf of the authors Max Planck Institute for Human Development Center for Adaptive Rationality  Berlin Germany Medical Research: What is the background for this study? What are the main findings? Dr. Kämmer: Diagnostic errors contribute substantially to preventable medical error. Of the multiple reasons for diagnostic error (such as technical failures or poorly cooperating patients), cognitive error is among the most frequent. Although a vast amount of literature explores ways to reduce cognitive errors, for example, during data synthesis, the collaborative character of clinical decision making has been largely neglected so far. Thus, the aim of our study was to investigate the effect of working in teams as opposed to working alone on diagnostic accuracy and the diagnostic decision process as such (including the time to diagnosis, number of ordered diagnostic tests and calibration of diagnostic confidence to diagnostic accuracy). In our study, we asked senior medical students to imagine being at the emergency ward and having to diagnose six simulated patients with respiratory distress on a computer – either working individually or in pairs. We indeed found that working in pairs reduced diagnostic error without requiring more diagnostic data gathering. Interestingly, neither differences in knowledge nor in amount and relevance of acquired diagnostic information could explain the superior accuracy of the pairs; neither did the statistically increased likelihood of containing a knowledgeable member. We thus have shown that – similar to other studies outside medicine – collaboration may help correct errors, fill knowledge gaps and counteract reasoning flaws – and thus save lives. Moreover, we found that reflecting on their personal confidence may point members of teams towards an increased probability of a diagnostic error. (more…)
Author Interviews, Education, Technology / 12.01.2015

MedicalResearch.com Interview with: Živa Cotič Research Assistant & PhD Student,Global eHealth Unit Imperial College London and A/Prof Josip Car Director of Health Services and Outcomes Research Programme Lee Kong Chian School of Medicine, Director of Global eHealth Unit School of Public Health, Imperial College London Medical Research: What is the background for this study? What are the main findings? Response: The Department of Health Workforce in collaboration with the Department of Knowledge, Ethics and Research at the World Health Organization commissioned the report to provide countries with evidence to inform and guide the adoption of innovative, technology enabled models into health professional education. The report aims to address complex challenges of 21st century global workforce development through eLearning, which has been recognised as key to building more effective health education and a stronger, better qualified workforce. Global workforce development is one of the most pressing global health issues. The World Health Organization estimates the shortage of the health workforce at approximately 7.2 million health workers, with an expected increase to 12.9 million by 2035. The magnitude of the health workforce challenges the health care systems are facing require both greater investment and more effective and strategic use of available resources. The findings of the report suggest that eLearning could be equivalent to traditional forms of learning in regard to knowledge and skill acquisition in health education. This information is crucial for policy makers and educators who are forming future education. (more…)
Author Interviews, Education, Stroke / 26.12.2014

dr-gustavo-saposnikMedicalResearch.com Interview with: Gustavo Saposnik, MD, MSc., FAHA, FRCPC Director, Stroke Outcomes Research Center Co-Director, Stroke Program - Research & Innovation Associate Professor & Clinician Scientist Departments of Medicine (Neurology) and Health Policy, Management and Evaluation (HPME) St. Michael’s Hospital University of Toronto Medical Research: What is the background for this study? What are the main findings? Dr. Saposnik: There is some controversy around worse outcomes at the beginning of academic year. Physicians recently graduated from medical schools begin their training and assume responsibilities for patient care in teaching hospitals, usually bearing the first-line duty for managing patients. Consequently, less experienced staff having new roles may influence access to care and contribute to adverse outcomes in patients managed at the beginning of academic year - the so-called “July Effect”. for example, increase of medication errors and in-hospital mortality in July has been reported from teaching hospitals. In our large cohort study, comprising 10,319 stroke patients, 882 (8.5%) were admitted in July. Those patients were 28% less likely to receive thrombolysis (clot-buster treatment) (12% vs. 16%; odds ratio (OR), 0.72; 95% confidence interval (CI), 0.59-0.89) and 22% less likely to receive stroke unit care (62% vs. 68%; 0.78; 0.68-0.90). July admissions were not associated with either of higher death at 30 days (adjusted OR, 95% CI; 0.88, 0.74-1.03) or poor functional outcome (0.92, 0.74-1.14). Results remained consistent in the sensitivity analysis by including both July and August as part of the ‘July effect’. (more…)
Author Interviews, Education / 17.12.2014

Francesco Brigo, MD Department of Neurological and Movement Sciences. Section of Clinical Neurology. University of Verona. Division of Neurology, "Franz Tappeiner" Hospital. Merano (BZ), ItalyMedicalResearch.com Interview with: Francesco Brigo, MD Department of Neurological and Movement Sciences. Section of Clinical Neurology. University of Verona. Division of Neurology, "Franz Tappeiner" Hospital. Merano (BZ), Italy Medical Research: What is the background for this study? What are the main findings? Dr. Brigo: Millions of people surf the Internet every day as a source of health care information looking for materials about symptoms, diagnosis, treatments and their possible adverse effects, or diagnostic procedures. The increasing number of online searches conducted using popular Web search engines, such as Google, generates so-called ‘big data’. This data provides information about online health-related behavior. In this study, I found that the highest peak in Google search volumes related to the terms “Parkinson´s disease” since January 2004 was observed on 15th August 2014, the day after Robin Williams' wife has revealed the late actor, who died of suicide on 11th August, was in the early stages of Parkinson's disease.  I proposed to call the phenomenon of increased online searches for a certain disease driven by news of celebrities having that disease as “Robin Williams´ phenomenon”, in honor of the American actor. (more…)
Author Interviews, Education, JAMA / 13.12.2014

MedicalResearch.com Interview with: John Hayes, MD Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin Medical Research: What is the background for this study? What are the main findings? Response: Prominent in the discussions about ABIM MOC and recertification has been an ongoing debate about the evidence that supports a relationship between recertification, MOC and patient care. Since many healthcare organizations use board certification as a criteria for employment consideration, the new status of “certified” but not meeting MOC throws considerable disarray into credentialing and hiring committees. We can now have ABIM labeling a physician who boarded eleven years ago as “not certified” but a physician who boarded 25 years ago as “certified” with an asterisk. And of course discussions like this bring employers and healthcare organizations back to the question: What is the additive value of MOC and recertification on patient care? The integrated Veterans Health Administration electronic health record generates performance reports for primary care physicians at regular intervals. In our study, we were able to observe for any difference based on certification groups. We reviewed ten industry-standard quality care measures in approximately 68,000 patients across 4 VA medical centers and found that internists holding time-unlimited certificates performed just as well as those holding time-limited certificates. (more…)
Author Interviews, Case Western, Education, JAMA, Surgical Research / 10.12.2014

Ravi Rajaram MD Division of Research and Optimal Patient Care, American College of Surgeons Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies in the Institute for Public Health and Medicine Feinberg School of Medicine, Northwestern University, Chicago, IllinoisMedicalResearch.com Interview with: Ravi Rajaram MD Division of Research and Optimal Patient Care, American College of Surgeons Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies in the Institute for Public Health and Medicine Feinberg School of Medicine, Northwestern University, Chicago, Illinois Medical Research: What is the background for this study? What are the main findings? Dr. Rajaram: The Accreditation Council for Graduate Medication Education (ACGME) first implemented restrictions to resident duty hours in 2003. In surgical populations, these reforms have not been associated with a change in patient outcomes. However, in 2011, the ACGME further restricted resident duty hours to include: a maximum of 16 hours of continuous duty for first-year residents (interns), direct supervision of interns at all times, a maximum of 4 hours for transitions in care activities for residents in-house for 24 hours, and that these residents be given 14 hours off prior to returning to work. The association between the 2011 ACGME resident duty hour reform with surgical patient outcomes and resident education has not previously been reported. The 2011 resident duty hour reform was not associated with a change in death or serious morbidity in the two years after the reform was implemented. Additionally, the 2011 duty hour reform was not associated with a change in any of the secondary outcomes examined, including any morbidity, failure to rescue, surgical site infection, and sepsis. Furthermore, common measures of surgical resident education, such as in-training examination scores and board certification pass rates, were unchanged after the implementation of the 2011 duty hour reform when compared to scores prior to the reform. (more…)
Author Interviews, Education, JAMA / 10.12.2014

Lisa Diamond, MD, MPH, FACP | Assistant Attending Memorial Sloan-Kettering Cancer Center Immigrant Health and Cancer Disparities Service Department of Psychiatry & Behavioral Sciences | Department of Medicine Evelyn Lauder Breast Center New York, NY 10065MedicalResearch.com Interview with: Lisa Diamond, MD, MPH, FACP | Assistant Attending Memorial Sloan-Kettering Cancer Center Immigrant Health and Cancer Disparities Service Department of Psychiatry & Behavioral Sciences | Department of Medicine Evelyn Lauder Breast Center New York, NY 10065 Medical Research: What is the background for this study? What are the main findings? Dr. Diamond: More than 25 million U.S. residents have limited English proficiency, an 80 percent increase from 1990 to 2010. Limited English proficiency (LEP) may impede participation in the English­ language-dominant health care system. Little is known about the non-English-language skills of physicians in training. In our analysis of the non-English-language skills of applicants to residency programs in the U.S., we found that although applicants are linguistically diverse, most of their languages do not match the languages spoken by the U.S. population with Limited English proficiency. (more…)
Author Interviews, Education, Emergency Care / 09.12.2014

Catherine A. Marco, MD, FACEP Professor Department of Emergency Medicine Wright State University Kettering, OH 45429MedicalResearch.com Interview with: Catherine A. Marco, MD, FACEP Professor Department of Emergency Medicine Wright State University Kettering, OH 45429 Medical Research: What is the background for this study? What are the main findings? Dr. Marco: In 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented standards on duty hours and supervision. A maximum of 80 hours of duty per week were stipulated.  The aim of these standards was to promote resident learning and patient safety.  However, evidence has not clearly demonstrated whether the 2003 requirements improved trainee well-being or patient safety.    On July 1, 2011, the ACGME implemented additional regulations on duty hours and supervision, including a 16 hour maximum shift length for PGY1 residents. The duty hours standards were implemented to ensure patient safety and provide an excellent teaching environment.  Emergency Medicine has additional duty hours requirements for emergency department rotations, including a maximum of 12 continuous scheduled hours, and a maximum 60 scheduled hours per week seeing patients in the emergency department, and no more than 72 duty hours per week. We found that among a large cohort of 4134 Emergency Medicine residents, the majority of residents stated that they are working the appropriate number of hours to practice independently at graduation.  The majority of residents believe that current duty hours regulations improve patient safety.  The majority of residents agreed that duty hour regulations are currently appropriate. (more…)
Author Interviews, CDC, Education / 07.12.2014

MedicalResearch.com Interview with Dr. Rui Li, PhD Division of Diabetes Translation National Center for Chronic Disease Prevention and Health Promotion CDC Medical Research: What is the background for this study? What are the main findings? Dr. Li: Diabetes is a serious disease associated with severe complications and premature death. Diabetes Self-management Education and Training (DSMT) helps patients improve blood sugar control, which could reduce the risk for diabetes complications, hospitalizations, and health care costs. However, data showed that fewer than 7% of persons with private health insurance received DSMT within 1 year after diagnosis with diabetes. Furthermore, across different population subgroups, DSMT participation rates were less than 15%. (more…)
Author Interviews, Education, JAMA / 26.11.2014

Dr. Arthur Reynolds PhD, Professor Humphrey School of Public Affairs University of Illinois at ChicagoMedicalResearch.com Interview with: Dr. Arthur Reynolds PhD, Professor Institute of Child Development Humphrey School of Public Affairs University of Minnesota Medical Research: What is the background for this study? What are the main findings? Dr. Reynolds: Given the high national priority on enhancing early childhood development, evidence about the relationship between full-day preschool participation and school readiness is meager. The study found that among about 1000 children attending 11 schools in low-income neighborhood. participation in full-day preschool at ages 3 or 4 for 7 hours per day was associated with significantly higher school readiness skills at the end of preschool in language and literacy, socio-emotional development, math, and physical health than part-day participation for 3 hours per day.  This translate to about a half of a year of growth in learning. Full-day preschool was also associated with significantly higher attendance and lower rates of chronic absences. No differences were found in parent involvement in school. (more…)
Author Interviews, Education, General Medicine / 22.09.2014

Chester G. Chambers PhD Armstrong Institute for Patient Safety and Quality Johns Hopkins Carey Business School, Baltimore, MarylandMedicalResearch.com Interview with: Chester G. Chambers PhD Armstrong Institute for Patient Safety and Quality Johns Hopkins Carey Business School, Baltimore, Maryland Medical Research: What are the main findings of the study? Dr. Chambers: The main findings of this study are that several metrics of system performance can be improved by using simple methods proven to be effective in many production settings. Specifically, the idea of using “Pre-processing” as an aspect of medical education improves patient flow times, waiting times, system throughput, and system capacity. When fixed costs are spread across more patients, we are effectively reducing the cost per patient as well. In this context “Pre-processing” simply refers to the practice of having medical trainees present and review cases with the attending prior to patient clinic visits as opposed to doing it in the midst of the patient visit. This simple idea is common in many areas including surgery but tends to get omitted in other settings involving ambulatory care. Our simple experiment verified that this practice has real value in a wide array of settings. (more…)
Education, HIV, Yale / 24.07.2014

Lynn E. Fiellin, M.D. Associate Professor of Medicine Director, play2PREVENT Lab Yale University School of Medicine New Haven, CT 06510MedicalResearch.com Interview with Lynn E. Fiellin, M.D. Associate Professor of Medicine Director, play2PREVENT Lab Yale University School of Medicine New Haven, CT 06510 Medical Research: What are the main findings of the study? Dr. Fiellin: The current findings are part of a larger study evaluating an interactive evidence-based video game, PlayForward: Elm City Stories, developed on the iPad and targeting risk reduction and HIV prevention in 333 young teens (ages 11-14). The larger study is examining a range of outcomes including knowledge, intentions, self-efficacy and actual behaviors and we are collecting at baseline, 6 weeks, 3, 6, 12, and 24 months. We are examining these outcomes in our experimental group compared with a control group playing a set of off-the-shelf games on the iPad. The current findings of the 196 teens who have completed the 6 weeks of gameplay and for whom we have baseline and 3 month data, reveal that, while the two groups had no differences in their baseline HIV risk knowledge, the PlayForward group had statistically significant gains in knowledge at 6 weeks (p<0.0001), sustained at 3 months (p<0.01). In addition, examining the association between exposure to the game and performance on the standardized assessments revealed that the number of game levels completed (a measure of exposure to the intervention) was positively correlated with knowledge gains measured at 3 months (r=0.42; p<0.001). (more…)
Author Interviews, Education, JAMA, Surgical Research, UC Davis / 23.07.2014

  Erin Brown, MD General Surgery PGY6 UC Davis Medical CenterMedicalResearch.com Interview with: Erin Brown, MD General Surgery PGY6 UC Davis Medical Center Medical Research: What are the main findings of the study? Dr. Brown: This study sought to determine with childrearing during training put residents at increased risk of quiting.  We looked at both male and female surgical residents who chose to have children during residency and found that residents having children during training were not more likely to quit than those who did not have children.  We also found that there childrearing had no negative impact on surgical training based on total surgical case numbers, board pass rates, and annual exam scores.  Main findings of the study were that neither female gender nor childrearing during training were associated with residents quitting. (more…)
Author Interviews, Education, JAMA / 22.07.2014

MedicalResearch.com Interview with: Brian M. Wong, MD, FRCPC Staff Physician, Division of General Internal Medicine Assistant Professor, Department of Medicine Director, Continuing Education & Quality Improvement Associate Director, Centre for Quality Improvement & Patient Safety (C-QuIPS) Sunnybrook Health Sciences Centre Lisa Richardson, MD., MA, FRCPC Department of Medicine, University of Toronto, Division of General Internal Medicine, University Health Network, HoPingKong Centre for Excellence in Education and Practice, University Health Network, Toronto, Ontario, Canada Medical Research: What are the main findings of the study? Answer: Our study sought to characterize how many clinically important issues that occur during the overnight on-call period were handed over and discussed by the on-call resident with the daytime medical team. For example, if a patient developed chest pain in the middle of the night and the on-call resident evaluated the patient, did the resident then 'handover' this issue to the team the next morning so that they could follow up and make sure that the patient receives timely care? In our study, we found that approximately 40% of these issues did not get handed over. This finding was consistent across 2 major Canadian academic teaching hospitals. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Education / 21.05.2014

Dr. Price Kerfoot MD, EdM Rabkin Fellow in Medical Education Associate Professor of Surgery, Harvard Medical SchoolMedicalResearch.com Interview with: Dr. Price Kerfoot MD, EdM Rabkin Fellow in Medical Education Associate Professor of Surgery, Harvard Medical School   MedicalResearch: What are the main findings of the study? Dr. Kerfoot: (1) An online spaced education game improved clinicians' knowledge of hypertension intensification and generated a modest but significant improvement in time to blood pressure target among their patients with hypertension. (2) As a method to increase clinicians' long-term knowledge, the spaced education game was significantly more effective than providing the identical content via a traditional method (online posting with e-mail reminders). (more…)
Author Interviews, Education, Exercise - Fitness, Infections / 11.01.2014

MedicalResearch.com Interview with: Anna-Christina Lauer, MD Department of Audiology and Phoniatrics Charité-University Medicine Berlin Berlin, Germany MedicalResearch.com: What are the main findings of the study? Dr. Gross: We could show that the injury rates depend on the undergraduate medical training the students attended. This demonstrates that medical undergraduatue education, especially a hands-on training, is critical in the prevention of needlestick- and sharps injuries. Also the use of safety devices has proven to reduce injury rates significantly. Given the large size of our study we could not only comfirm that needlestick and sharps injuries are still a common problem, looking at an injury rate of about 20% per year, we also learned a lot about the accident circumstances: Most accidents occur at bedside during venepuncture and intravenous cannulation. The second most common setting is the operating room, where suturing and instrument transfers can lead to injuries. Since we analyzed official reports and the anonymous surveys at the same time we could affirm an underreporting rate of more than 50%. (more…)
Author Interviews, Education, Nutrition, Sugar / 02.01.2014

Sohyun Park, PhD, Division of Nutrition, Physical Activity, and Obesity National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Atlanta, GA 30341MedicalResearch.com Interview with: Sohyun Park, PhD, Division of Nutrition, Physical Activity, and Obesity National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention Atlanta, GA 30341 MedicalResearch.com:  What are the main findings of the study? Dr. Park: Nearly 1 out of 3 U.S. adults (30.5%) consumed sugar-sweetened beverages at least 1 time per day; 20% consumed sugar-sweetened beverages at least 2 times per day. About 8 out of 10 adults agreed that drinking sugar-sweetened beverages can contribute to weight gain. However, 8 of 10 adults also did not know the actual calorie content of a 24-oz fountain soda. After controlling for sociodemographic factors, adults who were neutral (neither agreed nor disagreed) that drinking sugar-sweetened beverages can contribute to weight gain were more than 1-and-a-half times more likely to consume sugar-sweetened beverages at least 2 times per day. Conversely, knowledge about the calorie content of a 24-oz fountain soda was not associated with sugar-sweetened beverage intake. (more…)
Author Interviews, Diabetes, Education, Lancet, Nutrition / 23.12.2013

Prof. Raj S Bhopal Bruce and John Usher Professor of Public Health Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH89AGMedicalResearch.com Interview with: Prof. Raj S Bhopal Bruce and John Usher Professor of Public Health Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh EH89AG MedicalResearch.com: What are the main findings of the study? Prof. Bhopal: In a randomised controlled trial, a tailored, family orientated intervention whereby dietitians worked in the family home to provide diet and exercise advice in people at high risk of developing diabetes, had a modest but potentially important effect in reducing weight at the end of the three-year intervention, by 1.6 kg more than in the control group. (more…)
Author Interviews, Cost of Health Care, Education, JAMA, University of Pennsylvania / 19.12.2013

Mitesh Patel, MD, MBA RWJF Clinical Scholar, University of Pennsylvania Mitesh Patel, MD, MBA is a Robert Wood Johnson Clinical Scholar the University of Pennsylvania and primary care physician at the Philadelphia VA Medical CenterMedicalResearch.com Interview with: Mitesh Patel, MD, MBA RWJF Clinical Scholar, University of Pennsylvania Mitesh Patel, MD, MBA is a Robert Wood Johnson Clinical Scholar the University of Pennsylvania and primary care physician at the Philadelphia VA Medical Center MedicalResearch.com: What are the main findings of the study? Dr. Patel: We evaluated survey responses from nearly 300 internal medicine residency programs directors to assess whether residency programs were teaching residents the fundamental concepts of practicing high-value, cost-conscious care.  We found that 85% of program directors feel that graduate medical education has a responsibility to help curtail the rising costs of health care.  Despite this, about 6 out of every 7 internal medicine residency programs have not yet adopted a formal curriculum teaching new physicians these important concepts. (more…)
Author Interviews, Depression, Education, End of Life Care, JAMA, Stanford / 06.12.2013

J. Randall Curtis, MD, MPH Professor of Medicine Director, UW Palliative Care Center of Excellence Section Head, Pulmonary and Critical Care Medicine, Harborview Medical CenterA. Bruce Montgomery, M.D. – American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine University of Washington, Seattle, WA 98104MedicalResearch.com Interview with: J. Randall Curtis, MD, MPH Professor of Medicine Director, UW Palliative Care Center of Excellence Section Head, Pulmonary and Critical Care Medicine, Harborview Medical CenterA. Bruce Montgomery, M.D. – American Lung Association Endowed Chair in Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA 98104 MedicalResearch.com: What are the main findings of the study? Dr. Curtis: We examined the effect of a communication-skills intervention for internal medicine and nurse practitioner trainees on patient- and family-reported outcomes.  The study was funded by the National Institutes of Nursing Research of the National Institutes of Heatlh.  We conducted a randomized trial with 391 internal medicine and 81 nurse practitioner trainees at two universities.  Participants were randomized to either an 8-session simulation-based, communication-skills intervention or to usual education.  We collected outcome data from a large number of patients with life-limiting illness and their families, including 1866 patient ratings and 936 family ratings.  The primary outcome was patient-reported quality of communication and, overall, this outcome did not change with the intervention.  However, when we restricted our analyses to only patients who reported their own health status as poor, the intervention was associated with increased communication ratings. Much to our surprise, the intervention was associated with a small but significant increase in depression scores among post-intervention patients.  Overall, this study demonstrates that among internal medicine and nurse practitioner trainees, simulation-based communication training compared with usual education improved communication skills acquisition, but did not improve quality of communication about end-of-life care for all patients.  However, the intervention was associated with improved patient ratings of communication for the sickest patients. Furthermore, the intervention was associated with a small increase in patients’ depressive symptoms, and this appeared most marked among patients of the first-year residents. (more…)
Author Interviews, Education, JAMA, University of Pennsylvania / 06.12.2013

James Guevara, MD, MPH Associate Professor of Pediatrics & Epidemiology Senior Diversity Search Advisor, Perelman School of Medicine University of Pennsylvania,Director of Interdisciplinary Initiatives PolicyLab: Center to Bridge Research, Practice, & Policy The Children's Hospital of Philadelphia,Philadelphia, PA 19104MedicalResearch.com Interview with: James Guevara, MD, MPH Associate Professor of Pediatrics & Epidemiology Senior Diversity Search Advisor, Perelman School of Medicine University of Pennsylvania,Director of Interdisciplinary Initiatives PolicyLab: Center to Bridge Research, Practice, & Policy The Children's Hospital of Philadelphia,Philadelphia, PA  19104 MedicalResearch.com: What did the study attempt to address? Dr. Guevara: Medical schools have sought to build more diverse faculty in their institutions through faculty development programs targeted to underrepresented minority faculty members. This study was conduct by THE CHILDREN'S HOSPITAL OF PHILADELPHIA'S POLICYLAB  and The University of Pennsylvania and sought to determine if there was an association between minority faculty development programs and the representation, recruitment, and promotion of underrepresented minority faculty. (more…)
Author Interviews, Education / 29.10.2013

Lauren Block, MD Assistant Professor, North Shore–LIJ Hofstra School of Medicine 2001 Marcus Ave., Suite S160 Lake Success, NY 11042MedicalResearch.com Interview with: Lauren Block, MD Assistant Professor, North Shore–LIJ Hofstra School of Medicine 2001 Marcus Ave., Suite S160 Lake Success, NY 11042   MedicalResearch.com: What are the main findings of the study? Dr. Block: Our goal was to look at how often doctors in training were performing basic niceties with their patients, such as introducing themselves and sitting down. We found that while the doctors usually asked open-ended questions and touched patients, resident physicians were unlikely to introduce themselves, explain their role, or sit down when talking to patients. (more…)
Author Interviews, Education / 17.10.2013

Eva Aagaard, MD Associate Professor of Medicine, Assistant Dean for Lifelong Learning, Director of the Academy of Medical Educators, Director of the Center for Advancing Professional Excellence, and Director of Faculty Development in General Internal Medicine at the University of ColoradoMedicalResearch.com Interview with: Eva Aagaard, MD Associate Professor of Medicine, Assistant Dean for Lifelong Learning, Director of the Academy of Medical Educators, Director of the Center for Advancing Professional Excellence, and Director of Faculty Development in General Internal Medicine at the University of Colorado MedicalResearch.com: What are the main findings of the study? Dr. Aagaard: We obtained feedback on, and assessed the construct validity and perceived feasibility and utility of, draft Internal Medicine Milestones for Patient Care and Systems-Based Practice used a mixed methods  study involving competency committee members in Internal Medicine residency programs. An initial survey assessed participant and program demographics; focus groups obtained feedback on the draft milestones and explored their perceived utility in resident assessment, and an exit survey elicited input on the value of the draft milestones in resident assessment. Thirty-four participants from 17 programs completed surveys and participated in 1 of 6 focus groups. Overall, the milestones were perceived as useful in formative and summative assessment of residents. Participants raised concerns about the length and complexity of some draft milestones and suggested specific changes. The focus groups also identified a need for faculty development. In the exit survey, most participants agreed that the Patient Care and Systems-Based Practice Milestones would help competency committees assess trainee progress toward independent practice. (more…)