Nursing / 08.03.2021

If you are a registered nurse, or you are thinking about nursing as a career option, then becoming a nurse practitioner is a great way to prove your experience and expertise. It allows you more agency when working with patients, as the advanced level of qualification that nurse practitioners have means that they are allowed to make treatment decisions without the supervision of a physician. Becoming a nurse practitioner also gives you access to higher remuneration, and to specialize in an area of medicine which can be incredibly fulfilling.

What is a nurse practitioner?

nursing, nurse, health care, NP, nurse practitionerNurse Practitioners are registered nurses who have carried out extra training, which means that they have more authority than registered nurses and share a similar responsibility level to doctors. They are able to prescribe medications, order diagnostic tests and provide treatments much as a physician would. Also like a physician, they will have undertaken their training to specialize in a particular area of medicine. Nurse Practitioners begin their careers as registered nurses, which means that they are used to approaching medicine in a patient-centric way. They will often work with an idea of patient comfort at the forefront of their minds, whereas a doctor can operate with an idea of medical treatment at the forefront of theirs. This means that a combination of doctors and Nurse Practitioners within a healthcare facility can lead to a more rounded care experience. In some states, Nurse Practitioners are able to operate without the supervision of a doctor. However, in others, they do need to get a sign off for any treatments that they provide. There is a general movement towards allowing Nurse Practitioners more agency as this is helping to relieve strain on the healthcare system. (more…)
Author Interviews, Education, Nursing / 15.02.2021

nursing-education-dnpIf you’re currently working as a nurse, you are probably well aware of just how rewarding and fulfilling a job role it can be. You get to help patients from all walks of life every single day and make a real difference to not only people’s health but their lives more generally. It’s also a career in which there is a lot of scope for progression. There are so many different spheres within the field of nursing that you can choose to specialize in, whether it’s a particular age group (like pediatrics or gerontology) or a particular health condition (like oncology or emergency care). Some of these paths involve training on the job, whereas others require you to return to college to study and obtain a postgraduate qualification. Among these, one of the highest possible qualifications you can aim for is the DNP, or Doctor of Nursing Practice. DNP online programs and campus courses prepare you for a wide range of advanced nursing roles, including both direct patient care and indirect patient care positions. As such, they are a fantastic choice for nurses who want to reach the top levels in their field. This article will cover everything you need to know about the DNP qualification to help you decide whether it is a degree program that you would like to pursue. This includes more detail about the course itself, the advantages it can bring you, as well as information about eligibility and how to apply. What are DNP online programs? DNP stands for Doctor of Nursing Practice, and it is a doctoral-level qualification in the field of nursing. It’s also a terminal degree, meaning that it is the highest level certification you can achieve in clinical nursing education. The idea of the program is to prepare registered nurses (RNs) for top career positions in areas such as advanced practice nursing, nursing education, healthcare administration, and healthcare policy. DNP online programs and on-campus courses are becoming more popular, partly because the American Association of Colleges of Nursing has called for the qualification to become a requirement in order to work in advanced practice nursing. Although, in many cases, a Master’s qualification in nursing is sufficient, for those who wish to boost their clinical skills and knowledge to the highest level, a DNP is preferable. (more…)
Author Interviews, Brigham & Women's - Harvard, Critical Care - Intensive Care - ICUs, NEJM, Pediatrics / 24.06.2020 Interview with: Christopher P. Landrigan, MD, MPH Chief, Division of General Pediatrics, Boston Children’s Hospital Director, Sleep and Patient Safety Program, Brigham and Women's Hospital William Berenberg Professor of Pediatrics, Harvard Medical School Boston Children's Hospital Boston, MA 02115 What is the background for this study? Response: An enormous body of literature demonstrates that sleep deprivation adversely affects the safety and performance of resident physicians, as well as individuals across other occupations.  Resident physicians are at greatly increased risk of suffering motor vehicle crashes and needlestick injuries, and are at substantially increased risk of making medical errors, when working on traditional schedules that include 24-hour shifts. We previously conducted a randomized controlled trial in two intensive care units that found resident physicians made 36% fewer medical errors when a scheduling intervention was introduced that eliminated 24-hour shifts but held resident workload constant. The current study, ROSTERS, was a 6-center study that again introduced a scheduling intervention to eliminate 24-hour shifts in intensive care units.  Due to varying resources and unit organization across sites, each hospital developed its own staffing plan to accommodate the intervention​. (more…)
Author Interviews, Education, Genetic Research, PNAS / 20.01.2020 Interview with: Per Engzell PhD Postdoctoral Prize Research Fellow Nuffield College, University of Oxford
Felix C. Tropf, PhD Assistant Professor in Social Science Genetics, CREST-ENSAE, Paris What is the background for this study? Response: We know that parents and offspring often resemble each other in their socio-economic outcomes: higher-educated parents tend to have children who reach a similar level of education while children of disadvantaged families struggle in school. To the extent that this compromises equality of opportunity – that is, some children end up better educated only because of their social background – social policies aim to compensate for it and promote social mobility. At the same time, not all similarity between parents and offspring can be seen as equally troubling. A society that blocked entry to university for any child born to academics would achieve high mobility, but few of us would see it as a model of equal opportunity. So some channels of transmission then, it seems, are more fair than others. Although we may disagree where to draw the line, things like parents’ ability to pay for good neighborhoods, schools, or access to college appear clearly more troubling than the inheritance of traits that make for educational success. In this study, we ask whether societies that have achieved a high degree of intergenerational mobility have done so by limiting the reach of "nature" (inherited traits), "nurture" (other family advantages), or both. We do so by combining the rich literatures of social mobility research and behavior genetics, comparing variation across several cohorts of men and women in 10 countries.  (more…)
Author Interviews, Education, Gender Differences, JAMA / 13.11.2019 Interview with: Shannon Ruzycki, MD, MPH, FRCPC, (she/hers) General Internist & Clinical Lecturer Department of Medicine Department of Community Health Sciences Cumming School of Medicine University of Calgary What is the background for this study? Response: After hearing about the National Academies of Science, Engineering, and Medicine 2018 report to congress on sexual harassment of women in academia, our Department Head asked myself and Dr. Aleem Bharwani to study experiences of gender inequity or equity in our Department. We conducted an in-depth, 18-month mixed methods study of women and men in our Department, including semi-structured interviews and survey. (more…)
Author Interviews, Education, NEJM, Surgical Research / 31.10.2019 Interview with: Ryan J. Ellis, MD MS General Surgery Resident Surgical Outcomes and Quality Improvement Center (SOQIC) Northwestern Medicine What is the background for this study? Response: Burnout has emerged as a significant problem affecting the entire healthcare workforce and it has been likely to myriad downstream problems such as increases in medical errors, alcoholism, and depression. Despite the attention on clinician burnout, there are significant gaps in our understanding of how the workplace environment may lead to burnout. Moreover, there are particular concerns about the workplace environment in training, specifically with regards to abuse, discrimination, and harassment. We had the opportunity to survey all U.S. general surgery residents to comprehensively define the frequency of workplace mistreatment and its relationship with burnout and suicidal thoughts among surgical residents. (more…)
ASCO, Author Interviews, Education, Gender Differences, Surgical Research / 04.06.2019 – Responses Marina Stasenko, MD Memorial Sloan Kettering Cancer Center What is the background for this study? What are the main findings? Response: Sexual harassment is a form of discrimination that includes gender harassment, unwanted sexual attention, and sexual coercion. A recent report in Fortune magazine noted that over half of US women have experienced sexual harassment at some point in their lives. Until recently, much of the conversation about sexual harassment in the workplace has been relegated to private discussions behind closed doors. However, the MeToo movement has shined a spotlight on the pervasive nature of sexual harassment in various fields, like media and business world. Although there are more female physicians in practice today than ever before, with women accounting for over 50% of young physicians, sexual harassment and gender disparities continue to plague the field of medicine. Despite the large female representation, gynecologic oncology is not immune from gender disparities. The Society of Gynecologic Oncology is a professional organization of over 2000 physicians, scientists, allied health professionals, nurses, and patient advocates dedicated to the care of patients with gynecologic cancer. As of 2015, 46% of members of the SGO were women, and that number is steadily growing. SGO leadership is also increasingly female – with 2 of the last 3 presidents being women. Despite the large female representation, gynecologic oncology is not immune from gender disparities. The 2015 SGO practice survey noted that while 22% of male Gynecologic Oncologists held the rank of professor, only 11% of their female counterparts held the title. They also noted that the mean annual salary for male physicians was nearly 150,000$ greater than salary for female physicians. Given the fact that there is little objective data on sexual harassment in gynecologic oncology, the objective of our study was to evaluate perceptions of sexual harassment and gender disparities among physician members of the Society of Gynecologic Oncology. (more…)
Author Interviews, Education, JAMA, University of Pennsylvania / 16.04.2019 Interview with: Krisda Chaiyachati, MD, MPH, MSHP Assistant Professor Medicine, Perelman School of Medicine Clinical Innovation Manager Penn's Center for Health Care Innovation Perelman School of Medicine Medical Director, Penn Medicine's FirstCall Virtual Care What is the background for this study? What are the main findings?  Response: The United States spends more than $12 billion annually on training young doctors who have rates of burnout and depression at an alarmingly high rate. Yet, we have limited evidence as to what they are doing while training in the hospital. We sought to glimpse into how their day is spent. In the largest study to date, we observed 80 first-year internal medicine physicians (“interns”) for nearly 2200 hours across 194 work shifts at 6 different sites. Our research sought to understand what medical residents did by categorizing training activities into themes such as time spent in education or patient care.  (more…)
Author Interviews, Brigham & Women's - Harvard, Gender Differences, JAMA, Surgical Research / 16.04.2019 Interview with: Nelya Melnitchouk, MD,MSc Director, Program in Peritoneal Surface Malignancy, HIPEC Dr. Melnitchouk is an associate surgeon at Brigham and Women’s Hospital (BWH) and Brigham and Women’s Faulkner Hospital (BWFH) and instructor of surgery at Harvard Medical School. What is the background for this study? What are the main findings? Response: Current literature on women in surgery show that female physicians, particularly those in procedural specialties, face many challenges in balancing responsibilities between work and home. We hypothesized that these challenges may affect career satisfaction more negatively for physician mothers in procedural specialties than those in nonprocedural specialties. In our study, we found that physician mothers in procedural specialties who had more domestic responsibilities were more likely to report a desire to change careers than those in nonprocedural specialties.  (more…)
Author Interviews, Education, Health Care Systems / 14.03.2019 Interview with: Nicholas A. Rattray, Ph.D. Research Scientist/Investigator VA HSR&D Center for Health Information and Communication Implementation Core, Precision Monitoring to Transform Care (PRISM) QUERI Richard L. Roudebush Veterans Affairs Medical Center Indiana University Center for Health Services & Outcomes Research Regenstrief Institute, Inc. Indianapolis, Indiana on behalf of study co-authors re: Rattray NA, Flanagan ME, Militello LG, Barach P, Franks Z, Ebright P, Rehman SU, Gordon HS, Frankel RM What is the background for this study? What are the main findings?  Response: End-of-shift handoffs pose a substantial patient safety risk. The transition of care from one doctor to another has been associated with delays in diagnosis and treatment, duplication of tests or treatment and patient discomfort, inappropriate care, medication errors and longer hospital stays with more laboratory testing. Handoff education varies widely in medical schools and residency training programs. Although there have been efforts to improve transfers of care, they have not shown meaningful improvement. Led for the last decade by Richard Frankel, Ph.D., a senior health scientist at Regenstrief Institute and Indiana University and professor at Indiana University School of Medicine, our team has studied how health practitioners communicate during end-of-shift handoffs. In this current study, funded by VA Health Services and Research Development, we conducted interviews with 35 internal medicine and surgery residents at three VA medical centers about a recent handoff and analyzed the responses. Our team also video-recorded and analyzed more than 150 handoffs. Published in the Journal of General Internal Medicine, this study explains how the person receiving the handoff can affect the interaction. Medical residents said they changed their delivery based on the doctor or resident who was taking over (i.e., training level, preference for fewer details, day or night shift). We found that handoff communication involves a complex combination of socio-technical information where residents balance relational factors against content and risk. It is not a mechanistic process of merely transferring clinical data but rather is based on learned habits of communication that are context-sensitive and variable, what we refer to as “recipient design”. In another paper led by Laura Militello, we focus on how residents cognitively prepare for handoffs. In the paper published in The Joint Commission Journal of Quality and Patient Safety®, researchers detailed the tasks involved in cognitively preparing for handoffs. A third paper, published in BMC Medical Education, reports on the limited training that physicians receive during their residency. Residents said they were only partially prepared for enacting handoffs as interns, and clinical experience and enacting handoffs actually taught them the most.   (more…)
Author Interviews, Education, Health Care Systems, Outcomes & Safety, University of Pennsylvania / 07.03.2019 Interview with: Jeffrey H. Silber, MD, PhD Director, Center for Outcomes Research Nancy Abramson Wolfson Endowed Chair Health Services Research Children's Hospital of Philadelphia Professor of Pediatrics, Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania Professor of Health Care Management Wharton School, University of Pennsylvania What is the background for this study? Response: This was a year-long randomized trial that involved 63 internal medicine residency programs from around the US.  In 2015-2016, about half of the programs were randomized to follow the existing rules about resident duty hours that included restrictions on the lengths of shifts and the rest time required between shifts (the standard arm of the trial) and the other half of the programs didn’t have those shift length or rest period rules (the flexible arm of the trial).  We measured what happened to the patients cared for in those programs (the safety study), and other studies examined how much sleep the residents received, and how alert they were at the end of shifts (the sleep study), and previously we published on the educational outcomes of the interns. To measure the impact on patient outcomes when allowing program directors the ability to use a flexible shift length for their interns, we compared patient outcomes after the flexible regimen went into place to outcomes the year before in the same program. We did the same comparison for the standard arm. Then we compared the difference between these comparisons. Comparing before and after the implementation of the trial within the same program allowed us to be more confident that a particularly strong or weak program, or a program with especially sick or healthy patients, would not throw off the results of the study. The trial was designed to determine, with 95% confidence, if the flexible arm did not do more than 1% worse than the standard arm. If this were true for the flexible arm, we could say the flexible regimen was “non-inferior” to the standard regimen. (more…)
Author Interviews, Dermatology, Education / 13.01.2019 Interview with: Yssra-SolimanYssra S. Soliman, BA Division of Dermatology, Department of Internal Medicine Albert Einstein College of Medicine Bronx, New York What is the background for this study? What are the main findings?  Response: As the population of the United States becomes increasingly diverse, certain fields within medicine have not followed this trend. Dermatology is the least diverse field after orthopedics. We wanted to understand what barriers prevent medical students from applying to dermatology and whether these barriers differed based on students' racial, ethnic or socioeconomic backgrounds. The main findings of this study are that certain groups are more likely to cite specific barriers than non-minority students. These barriers are significant deterrents to applying to dermatology and include the lack of diversity in dermatology, negative perceptions of minority students by residency programs, socioeconomic barriers such as lack of loan forgiveness and poor accessibility to mentors.  (more…)
Author Interviews, Breast Cancer, Surgical Research / 17.09.2018 Interview with: Dr. Emily Albright, MD Surgical Oncology Missouri University Health Care What is the background for this study? What are the main findings? Response: Traditional medicine had a paternalistic approach but more recent changes have transitioned into shared decision making and a patient centered approach. However, current research has not addressed the mode of communicating bad news to patients. This study was designed to look at trends in modes of communication of a breast cancer diagnosis. This study identified a trend for patients to receive a diagnosis of breast cancer over the telephone in more recent years. Also noted was that of those receiving the diagnosis in person 40% were alone. (more…)
Author Interviews, Dermatology, Education, Gender Differences, JAMA / 03.09.2018 Interview with: Lia E. Gracey, MD, PhD Department of Dermatology Baylor Scott & White Health Austin, Texas What is the background for this study? What are the main findings?  Response: The co-authors and I were interested in this issue as new parent leave (or the lack thereof) is increasingly being examined in many professions.  As a mother who had children during dermatology residency, I felt the pressure to take a short new parent leave to avoid having to make up time at the end of my training. I came back to work only 3 ½ weeks after having my first baby. Anecdotally, other new parent residents (both men and women) reported similar concerns and we noticed a lack of data about new parent leave policies in dermatology residency training programs. We distributed surveys to dermatology residency program directors and residents and were struck by a basic lack of awareness by residents for whether their institution even offered new parent leave.  Less than 50% of surveyed residents were aware of a written new parent leave policy for their residency program, yet over 80% of program directors stated they had a policy in place. We also found discrepancies between resident and program director perceptions of sufficiency of new parent leave and the availability of pumping facilities for breastfeeding mothers.  (more…)
Author Interviews, Brigham & Women's - Harvard, Education, Gender Differences, JAMA, Surgical Research / 09.08.2018 Interview with: Erika L. Rangel, MD,MS Instructor, Harvard Medical School Trauma, Burn and Surgical Critical Care Department of Surgery, Center for Surgery and Public Health Brigham and Women’s Hospital Harvard T. H. Chan School of Public Health Boston, Massachusetts What is the background for this study? What are the main findings?  Response: Although women make up half of medical student graduates in 2018, they only comprise a third of applicants to general surgery. Studies suggest that lifestyle concerns and perceptions of conflict between career and family obligations dissuade students from the field. After entering surgical residencies, women residents have higher rates of attrition (25% vs 15%) and cite uncontrollable lifestyle as a predominant factor in leaving the field. Surgeons face reproductive challenges including stigma against pregnancy during training, higher rates of infertility, need for assisted reproduction, and increased rates of pregnancy complications. However, until recently, studies capturing the viewpoints of women who begin families during training have been limited. Single-institution experiences have described mixed experiences surrounding maternity leave duration, call responsibilities, attitudes of coworkers and faculty, and the presence of postpartum support. Earlier this year, our group presented findings of the first national study of perspectives of surgical residents who had undergone pregnancy during training. A 2017 survey was distributed to women surgical residents and surgeons through the Association of Program Directors in Surgery, the Association of Women Surgeons and through social media via twitter and Facebook. Responses were solicited from those who had at least one pregnancy during their surgical training. 39% of respondents had seriously considered leaving surgical residency, and 30% reported they would discourage a female medical student from a surgical career, specifically because of the difficulties of balancing pregnancy and motherhood with training (JAMA Surg 2018; July 1; 153(7):644-652). These findings suggested the challenges surrounding pregnancy and childrearing during training may have a significant impact on the decision to pursue or maintain a career in surgery. The current study provides an in-depth analysis of cultural and structural factors within residency programs that influence professional dissatisfaction. We found that women who faced stigma related to their pregnancies, who had no formal maternity leave at their programs, and who altered subspecialty training plans due to perceived challenges balancing motherhood with the originally chosen subspecialty were most likely to be unhappy with their career or residency. (more…)
Author Interviews, Education, JAMA / 02.08.2018 Interview with: “Doctors with patient, 1999” by Seattle Municipal Archives is licensed under CC BY 2.0Dr. Laura M. Mazer, MD Goodman Surgical Education Center Department of Surgery Stanford University School of Medicine Stanford, California What is the background for this study? What are the main findings?  Response: There are numerous articles that clearly document the high prevalence of mistreatment of medical trainees. We have all seen and experienced the results of an “I’ll do unto you like they did unto me” attitude towards medical education. Our motivation for this study was to go beyond just documenting the problem, and start looking at what people are doing to help fix it. Unfortunately, we found that there are comparatively few reports of programs dedicated to preventing or decreasing mistreatment of medical trainees. In those studies we did review, the study quality was generally poor. Most of the programs had no guiding conceptual framework, minimal literature review, and outcomes were almost exclusively learner-reported. (more…)
Author Interviews, Education, JAMA / 04.06.2018 Interview with: Kathleen M. Finn MD, MPhil Christiana Iyasere MD, MBA Division of General Internal Medicine Department of Medicine Massachusetts General Hospital, Boston 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. (more…)
Author Interviews, Education, Outcomes & Safety / 16.03.2018 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) 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.  (more…)
Author Interviews, Education, Race/Ethnic Diversity, Social Issues / 07.03.2018 Interview with: Patricia Louie, MA PhD Student, Department of Sociology University of Toronto Toronto, ON, Canada 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. (more…)
Author Interviews, Education, JAMA, UCLA / 22.08.2017 Interview with: Christian de Virgilio, MD LA BioMed lead researcher and corresponding author for the study He also is the former director of the general surgery residency program Harbor-UCLA Medical Center and the recipient of several teaching awards. What is the background for this study? What are the main findings? Response: Recent forecasts have predicted the United States will have a deficit of as many as 29,000 surgeons by 2030 because of the expected growth in the nation’s population and the aging of the Baby Boomers. This expected shortfall in surgeons has made the successful training of the next generation of surgeons even more important than it was before. Yet recent studies have shown that as many as one in five general surgery residents leave their training programs before completion to pursue other specialties. Our team of researchers studied 21 training programs for general surgeons and published our findings in the Journal of the American Medical Association Surgery (JAMA Surgery) on August 16, 2017. What we found was the attrition rate among residents training in general surgery was lower than previously determined – just 8.8% instead of 20% – in the 21 programs we surveyed. Our study also found that program directors’ attitudes and support for struggling residents and resident education were significantly different when the authors compared high- and low-attrition programs. General surgeons specialize in the most common surgical procedures, including abdominal, trauma, gastrointestinal, breast, cancer, endocrine and skin and soft tissue surgeries. General surgery residency training follows medical school and generally requires five to seven years. The programs are offered through universities, university affiliated hospitals and independent programs. In this study, the research team surveyed 12 university-based programs, three program affiliated with a university and six independent programs. In those programs, 85 of the 966 general surgery residents failed to complete their training during the five-year period the research team studied, July 1, 2010 to June 30, 2015. Of those who failed to complete their general surgery training, 15 left during the first year of training; 34 during the second year, and 36 during the third year or later. Notably, we found a nearly seven-fold difference between the training program with the lowest attrition rate, 2.2%, and the one with the highest rate, 14.3%, over the five-year period surveyed. In the programs with lower attrition rates, we found about one in five residents received some support or remediation to help ensure they would complete their In the programs with higher attrition rates, the research team reported that only about one in 15 residents received such remediation. (more…)
Author Interviews, Education, Weight Research / 02.08.2017 Interview with: Gregory Gayer, PhD Associate Professor Chair of Basic Science Department TUCOM California What is the background for this study? What are the main findings? Response: The prevalence of obesity in the United States continues to be a growing and remains a major health concern.  Closely associated with obesity is an extensive list of chronic diseases, including hypertension, dyslipidemia, and type 2 diabetes.  Unfortunately, physician bias against obese people may create a self-defeating environment that can produce less effective communication in a manner that could reduce the patient’s willingness to participate in their own health. Our overall goal is to prepare future physicians to appropriately engage the obese patient in order to optimize health care delivery. This study was initiated in response to the ever increasing demand on the medical profession to properly care for the obese patient. We demonstrated that medical students have the same inherent bias as other health care providers and this bias can be sustainably reduced by education. We hope that this reduction in bias shown in medical school will enable students to be better prepared to address the concerns of their obese patients and ultimately translate into better clinical outcomes for them. (more…)
Author Interviews, Surgical Research / 14.06.2017 Interview with: Jacob Quick, M.D. Assistant professor of acute care surgery University of Missouri School of Medicine Dr. Quick also serves as a trauma surgeon at MU Health Care. What is the background for this study? What are the main findings? Response: During five to seven years of surgical training, surgical faculty determine the level of clinical competency, confidence and decision-making skills of each resident physician through personal observations. This skill evaluation is based on a subjective assessment, which essentially is a gut feeling. We monitored electrodermal activity, or EDA, using dermal sensors on the wrists of residents while they performed laparoscopic cholecystectomies. Our initial findings indicated that at crucial points during the procedures, residents’ EDA increased as much as 20 times more than experienced faculty performing the same surgery. However, over the course of the study, and as their proficiency developed, surgical residents’ EDA levels began to lower in accordance with their experience. (more…)
Author Interviews, Education, Psychological Science, Technology, University of Pennsylvania / 21.05.2017 Interview with: Jason Han, MD Resident, Cardiothoracic Surgery Hospital at the University of Pennsylvania What is the background for this study? What are the main findings? Response: The inspiration for this study comes from my personal experience as a medical student on clinical rotations. Despite having been a victim of a medical error while growing up myself, I found it extraordinarily difficult to admit to even some of my smallest errors to my patients and team. Perplexed by the psychological barriers that impeded error disclosure, I began to discuss this subject with my advisory Dean and mentor, Dr. Neha Vapiwala. We wanted to analyze the topic more robustly through an academic lens and researched cognitive biases that must be overcome in order to facilitate effective disclosure of error, and began to think about potential ways to implement these strategies into the medical school curriculum with the help of the director of the Standardized Patient program at the Perelman School of Medicine, Denise LaMarra. We ultimately contend that any educational strategy that aims to truly address and improve error disclosure must target the cognitive roots of this paradigm. And at this point in time, simulation-based learning seems to be the most direct way to do so, but also remain hopeful that emerging technologies such as virtual and augmented reality may offer ways for students as well as staff to rehearse difficult patient encounters and improve. (more…)
Author Interviews, Education, JAMA, Outcomes & Safety, Surgical Research / 24.04.2017 Interview with: Haggi Mazeh, MD, FACS Endocrine and General Surgery Department of Surgery Hadassah-Hebrew University Medical Center, Mount Scopus Jerusalem, Israel 91240 What is the background for this study? What are the main findings? Response: The level of operating room autonomy given to surgical residents varies greatly between different institutions and different countries. On one hand, providing residents the opportunity to operate alone augments their confidence and their sense of responsibility, possibly accelerating their learning process. On the other hand, it may be argued that the presence of a senior general surgeon in every operation is a safer approach. Before 2012, a large proportion of appendectomies at our institution were performed by surgical residents alone. After 2012, our institutional policy changed to require the presence of a senior general surgeon in every appendectomy case. This unique situation provided us the opportunity to compare the outcomes of appendectomies performed by residents alone to those performed in the presence of a senior general surgeon. Our study demonstrated no difference in the complication rates between the two groups of patients. However, surgeries performed in the presence of senior general surgeons were significantly shorter than those performed by residents. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, Education, Outcomes & Safety / 06.02.2017 Interview with: Yusuke Tsugawa, MD, MPH, PhD Research Associate at Department of Health Policy and Management Harvard T.H. Chan School of Public Health What is the background for this study? What are the main findings? Response: Prior evidence has been mixed as to whether or not patient outcomes differ between U.S. and foreign medical graduates. However, previous studies used small sample sizes or data from a small number of states. Therefore, it was largely unknown how international medical graduates perform compared with US medical graduates. To answer this question, we analyzed a nationally representative sample of Medicare beneficiaries admitted to hospitals with a medical condition in 2011-2014. Our sample included approximately 1.2 million hospitalizations treated by 40,000 physicians. After adjusting for severity of illness of patients and hospitals (we compared physicians within the same hospital), we found that patient treated by international medical graduates had lower mortality than patients cared for by US medical graduates (adjusted 30-day mortality rate 11.2% vs 11.6%, p<0.001). We observed no difference in readmissions, whereas costs of care was slightly higher for international medical graduates. (more…)
Annals Internal Medicine, Author Interviews, Education, Electronic Records / 30.01.2017 Interview with: Dresse Nathalie Wenger Cheffe de clinique FMH médecine interne Département de Médecine Interne CHUV - Lausanne What is the background for this study? Response: The structure of a residents’ working day dramatically changed during the last decades (limitation of working hours per week, wide implementation of electronic medical records (EMR), and growing volume of clinical data and administrative tasks), especially in internal medicine with increasing complexity of patients. Electronic Medical Records (EMR) have some positive effects but negative effects have been also described ie more time writing notes, more administrative works, and less time for communication between physicians and patients. Few time motion studies have been published about the resident's working day in Internal Medicine: the impact of the computer, and what really do the residents do during their work, especially the time spent with the patient versus the computer, as now the EMRs are widely implemented. Previous studies have been mostly performed in the US, so we decided to conduct one observational and objective study in Europe. (more…)
Author Interviews, Education, JAMA, Surgical Research / 15.12.2016 Interview with: Mohammed Al-Omran, MD, MSc, FRCSC Head, Division of Vascular Surgery St. Michael’s Hospital Professor, Department of Surgery University of Toronto What is the background for this study? What are the main findings? Response: General surgery residency is among the most demanding clinical training programs in medicine. Several studies have suggested surgical residents have a relatively high attrition rate; however, no study has systematically reviewed the overall prevalence and causes of attrition among general surgery residents. We included over 20 studies representing 19,821 general surgery residents in our review. Most studies were from the US. We found the pooled estimate of attrition prevalence among general surgery residents was 18%. Female residents were more likely to leave than male (25% versus 15%), and residents were most likely to leave after their first training year (48%). Departing residents most commonly switched to another medical specialty (such as anaesthesia, plastic surgery, radiology or family medicine) or relocated to another general surgery program. The most common causes of attrition were uncontrollable lifestyle (range of 18% to 88%) and transferring to another specialty (range of 18% to 39%). (more…)
Author Interviews, Education, JAMA, Outcomes & Safety, UCSF / 12.12.2016 Interview with: Charlie M. Wray, DO, MS Assistant Clinical Professor of Medicine University of California, San Francisco Department of Medicine San Francisco VA Medical Center What is the background for this study? Response: Since the establishment of residency duty hour regulations in 2010, which subsequently lead to increased discontinuity of inpatient care and more resident shift work, educators and researchers have attempted to establish which shift handoff technique(s) or strategies work best. National organizations, such as the ACGME, AHRQ, and the Joint Commission have made specific recommendations that are considered "best practice". In our study, using an annual national survey given to Internal Medicine Program Directors, we examined the degree of implementation of these recommended handoff strategies and the proportion of Program Director satisfaction with each of the respective strategies. (more…)