Despite a substantial allotment of time to night rotations, there appear to be lost teaching and learning opportunities in the current night float system. Modification of the existing format may improve its educational value.

BACKGROUND: Discharges against medical advice (AMA) occur in 1% to 2% of hospital stays and are associated with increased morbidity, readmission rates, and 30-day mortality. Risk factors associated with AMA have been investigated, but interventions at the time of discharge have not been carefully examined.

It is a paradox. Although physicians do not control patient behavior, physician effectiveness is increasingly determined by patient behavior. There is a trend toward physician ratings being based on specific metrics related to the management of chronic illness. Such markers include glycosylated hemoglobin levels, blood pressure, body mass index, and smoking rates, along with other factors known to affect risk of morbidity and mortality. However, the physician contribution to changing the actual outcomes is limited.Population analyses of health outcomes suggest that medical care accounts for only 10% of the variance in outcomes, whereas approximately 50% can be attributed to behavioral and social factors.1 With respect to the chronic conditions that receive the largest proportion of health care attention, such as cardiovascular disease and diabetes, physicians identify risk factors,

incorporated the program director, program coordinator, and residents into each roadshow experience.We began by using geographic filters to focus on applicants with ties to our 3-state region for the roadshow. After review of application credentials, we selected an average of 90 candidates for interviews. We then identified 4 regional cities that are home to academic medical centers (Augusta, Greenville/Spartanburg, Chapel Hill, and Charleston). Candidates were selected for individual days based on geographic proximity (FIGURE). Recruitment Roadshow days were divided into morning and afternoon sessions to minimize candidate time away from campus. All informational material, including information on current residents, program policies, local attractions, and contact information, were given to candidates in electronic format on a customized USB flash drive.The program director, program coordinator, and at least one resident representative with prior educational connections to the city-specific academic medical center traveled to each roadshow location. Information sessions and interviews were held at hotels in close proximity to each academic medical center. Two additional on-campus interview days with associated ''open houses'' at our institution were offered for applicants who were unable to attend the regional interviews, or for those regional participants who wanted to visit our institution in person. Outcomes to DateIn the 3 years since the Residency Recruitment Roadshow inception, 157 candidates have been interviewed through this program. An additional 94 applicants were scheduled for interviews on open house days at our institution. A total of 210 of 252 candidates (92%) attended medical school in either Georgia, South Carolina, or North Carolina. Nearly 85% of candidates (132 of 157) traveled less than 30 minutes to attend the interview. Feedback from applicants was universally positive regarding this regional interview concept.We present the Residency Recruitment Roadshow as a potential strategy for other residency programs to emulate for successful regionally targeted, candidatecentered recruitment. Our approach reduces time and financial burdens on applicants while still providing in-person interactions with key program leadership and current residents as they embark on their graduate medical education journey.Substance misuse is not consistently addressed within the scope of routine medical practice. More than 90% of primary care physicians fail to diagnose substance misuse when presented with early symptoms of alcohol or drug misuse in an adult patient. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an integrated, evidence-based approach aimed at delivering early intervention in medical settings for drug and alcohol misuse. An integral component of SBIRT is motivational interviewing (MI), a brief, evidence-based, interventional practice that has been demonstrated to be highly effective in triggering change in high-risk lifestyle behaviors. MI is a patient-focused conversation betwe...

Introduction: Interacting with patients in a manner that furthers self-responsibility for health is an important skill for primary care clinicians. Motivational interviewing (MI) is such an approach to patient engagement, but it remains to be more widely implemented. In a program training health professionals and health professions students in MI, we examined posttraining attitudes and intentions regarding the utilization of MI. Of particular interest was how posttraining intentions were associated with self-reported action 1 month later. Methods: We obtained immediate posttraining and 30-day follow-up data from 209 participants regarding intent to utilize the MI approach (self-reported implementation at the follow-up interval), impact on confidence with patient interaction, and perceived importance of the training. We analyzied frequencies and percentages for all categorical/ordinal variables to describe the participants and the survey question responses. Results: While 91.5% of participants intended to incorporate MI into their approach with patients (to a moderate or great extent) at posttraining, only 48.7% reported that they had actually implemented the MI approach (to a moderate or great extent) 30 days later. However, another 32.1% indicated that they had occasionally utilized MI. Attitudes toward the importance of MI training and the impact of training on confidence remained strong over the 30 days. Conclusion: Achieving more widespread implementation of the MI approach in the primary care setting is likely to be less dependent on convincing clinicians about its importance for patient engagement, but rather on the translation of intent to actual practice and implementation.