Introduction Postrotation evaluations are frequently used by residency program directors for early detection of residents with academic difficulties; however, the accuracy of these evaluations in assessing resident performance has been questioned. Methods This retrospective case-control study examines the ability of postrotation evaluation characteristics to predict the need for remediation. We compared the evaluations of 17 residents who were placed on academic warning or probation, from 2000 to 2007, with those for a group of peers matched on sex, postgraduate year (PGY), and entering class. Results The presence of an outlier evaluation, the number of words written in the comments section, and the percentage of evaluations with negative or ambiguous comments were all associated with the need for remediation (P = .01, P = .001, P = .002, P = < .001, respectively). In contrast, United States Medical Licensing Examination step 1 and step 2 scores, total number of evaluations received, and percentage of positive comments on the evaluations were not associated with the need for remediation (P = .06, P = .87, P = .55, respectively). Discussion Despite ambiguous evaluation comments, the length and percentage of ambiguous or negative comments did indicate future need for remediation. Conclusions Our study demonstrates that postrotation evaluation characteristics can be used to identify residents as risk. However, larger prospective studies, encompassing multiple institutions, are needed to validate various evaluation methods in measuring resident performance and to accurately predict the need for remediation.
Anxiety disorders are among the most common psychiatric disorders in the general population and among patients in primary care settings. However, the majority of anxiety disorders go unrecognized and untreated in primary care practices. The most common anxiety disorders in primary care settings are panic disorder, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder. These disorders are readily treated with medications and/or evidence-based therapies once accurately identified and diagnosed. This chapter will describe targeted, high-yield screening practices for anxiety disorders, as well as collaborative, integrated treatment pathways for primary care settings and integrated health care environments.
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