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Medical Residents University of Washington

Medical Residents University of Washington. Amy Fields March 6, 2003 LIS 528. Educational Requirements. Successful completion of medical school Award of Medical Degree. University of Washington Residency Program.

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Medical Residents University of Washington

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  1. Medical ResidentsUniversity of Washington Amy Fields March 6, 2003 LIS 528

  2. Educational Requirements • Successful completion of medical school • Award of Medical Degree

  3. University of Washington Residency Program • The Department of Medicine administers three fully accredited internal medicine residency pathways

  4. University of Washington Residency Program • Traditional or categorical pathway • Seattle Primary Care Internist Pathway • Seattle/Boise Primary Care Internist Pathway In addition: • A preliminary (one year) internship for individuals going into other specialties but who would like a year of broad exposure to internal medicine

  5. Practice Description • ACGME general competencies requirements for Residency training programs require residents to have education experiences that allow them to demonstrate competency in the following areas:

  6. Practice Description 1) patient care, 2) medical knowledge, 3) practice-based learning and improvement, 4) interpersonal and communication skills, 5) professionalism, and 6) systems-based practice

  7. Current Problems/Issues facing Medical Residents • Resident burnout • Work hours

  8. Resident Burnout Concerns: 30-40 years ago • Parking spaces • Midnight snacks • Off-hours access to library Ann Inn Med, 2002

  9. Resident Burnout Concerns: present • Patients are sicker • Hospital stays shorter • Attendings are more hassled • More residents are married • Many have children • Great many more are women Ann Inn Med, 2002

  10. Resident Burnout Concerns: present • Fewer opportunities to establish relationships with patients, peers and faculty • Amount of debt incurred getting degree major source of stress Ann Inn Med, 2002

  11. Self-reported burnout study Effects on patient care (results of UW cross-sectional study) • February 2001 a 92-item, self-administered survey was sent to all residents in the internal Medicine Program • Burnout was measured using the Maslach Burnout Inventory (MBI) Ann Inn Med, 2002

  12. Self-reported burnout study • MBI evaluates three domains of burnout 1) Emotional exhaustion 2) depersonalization 3) personal accomplishment

  13. Self-reported burnout study • Study defined burnout as a high score on the depersonalization or emotional exhaustion subscales. • 76% met criteria • Burned-out residents are 2-3 times more likely to report suboptimal patient care practices at least monthly or weekly

  14. Resident work hours ACGME (to be implemented by July 2003): • “Total Duty Hours” must not exceed 80 hours per week, averaged over a four week period • Workdays that exceed 12 hours are defined as on-call

  15. Past information needs studies • Information needs during clinical activity • Online searching skills of residents

  16. Information needs during clinical activity Observational Study • Anthropologist observed communication among subjects re: their information needs • Coding scheme was developed for describing information requests Ann Inn Med 1991

  17. Information needs during clinical activity Study Results • Average: 5 clinical questions raised for each patient • 52% requested a fact that could be found in patient medical record • 23% were potentially answerable by a textbook, journal, or MEDLINE • 26% required synthesis of patient information and medical knowledge. Ann Inn Med 1991

  18. Online Searching Study of residents Philadelphia in 1997: • 39% described their MEDLINE searching skills as only fair or poor • 56% felt teaching in this area would be very helpful Journal of Medical Library Association (JMLA), 2002

  19. Online Searching Offered a 3-hour workshop: • Residents did a pretest MEDLINE search and then a posttest search after the workshop • More that ½ residents after ambulatory care rotation rated the workshop as one of the best learning experiences of their rotation Journal of Medical Library Association (JMLA), 2002

  20. Online Searching Continued MEDLINE searching: • Percentage of residents using techniques learned in workshop for searching MEDLINE improved significantly • In self-directed MEDLINE searches later in the year Residents continued to demonstrate improved skills • After this pilot study, the workshop was implemented with all second-year medicine residents Journal of Medical Library Association (JMLA), 2002

  21. Service to meet the needs of Residents • PrimeAnswers:  The specific aims of the project will help determine if a simplification or reduction in the barriers to access and speed of information retrieval can enhance patient care.

  22. Service to meet the needs of Residents PrimeAnswers for Residents • Help with (decreasing/managing) work hours • Aid in learning process • Aid in effective patient care

  23. Service to meet the needs of Residents Clinical Medical Librarians • Attend reports/conferences • Literature searches • Teach (PrimeAnswers, PubMed, MeSH, Medline, etc.)

  24. Approach to the service • PrimeAnswers – Add teaching component • 2004 Grant Proposal: “support learning at the point of care through a system of information objects organized by clinical educators for residents and patients (PrimeConditions)” • Clinical Medical Librarian – Add more of them

  25. Measure of its effectiveness • PrimeAnswers already proven effective for faculty • PrimeAnswers averages 5000 hits per month • Clinical Medical Librarian already proven effective for Residents

  26. Measure of its effectiveness • Survey Residents • Similar to 1993 survey of UW Residents re CML

  27. Clinical Librarian Program study

  28. Survey Starting in November 1993, time was allotted at Resident Report to evaluate the information supplied by the CML. Residents were asked to name the principal diagnosis of a patient for which an information request of the literature was made. In 6 months' time, 31 questionnaires were returned with the following results:

  29. Internal Medicine Residents Survey Results III11/93 - 4/94 Information supplied was useful or relevant 100% YES  Information supplied provided new knowledge 100% YES  Information supplied substantiated what I 77% YES already knew or suspected 23% NO Information supplied did (or will) contribute 100% YES to better informed clinical decisions

  30. Conclusion • With the explosion of new medical information and limitations on resident work hours and attendings teaching time, more efficient ways to teach residents must be implemented

  31. Conclusion • A system like PrimeAnswers that presents concepts in small chunks, making the content searchable, and that provides links to existing digital textbooks and journal articles is a great tool to meet the needs of this group

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