Objectives Though peer support groups are often utilized during residency training, the dynamics, content, and impact of social support offered through peer support are poorly understood. We explored trainee perceptions of the benefits, drawbacks, and optimal membership and facilitation of peer support groups. Methods After engaging in a peer support program at an emergency medicine residency program, 15 residents and 4 group facilitators participated in four focus groups in 2018. Interview questions explored the dynamics of group interactions, types of support offered, and psychological impacts of participation. The authors conducted a reflexive thematic analysis of data, performing iterative coding and organization of interview transcripts. Results Discussions with experienced senior residents and alumni normalized residents’ workplace struggles and provided them with insights into the trajectory of their residency experiences. Vulnerable group dialogue was enhanced by the use of “insider” participants; however, residents acknowledged the potential contributions of mental health professionals. Though groups occasionally utilized maladaptive coping strategies and lacked actual solutions, they also enhanced residents’ sense of belonging, willingness to share personal struggles, and ability to “reset” in the clinical environment. Conclusions Participants offered insights into the benefits and drawbacks of peer support as well as optimal peer group composition and facilitation. Support groups may be more effective if they engage a complementary model of alumni and pre‐briefed psychologist facilitators, avoid fatalism, and aim to foster intimate connections among residents. These findings can inform the development of future initiatives aiming to create a safe space for trainees to discuss workplace stressors.
It is imperative for physician assistant (PA) students to be exposed to hospital medicine as 40% of practicing PAs identify the hospital as their principal clinical practice setting. 1 Many of these rotations were canceled due to the COVID-19 pandemic, negatively impacting the 70% of PA programs not affiliated with an academic medical center. 2 To address this need and provide a comparable experience for PA students, medical educators at the University of Chicago created a Virtual PA Rotation (VPAR). The purpose of this project was to develop a high-yield clinical rotation for private PA programs negatively impacted by COVID-19 by implementing and evaluating a 4-week-long VPAR comprising (1) direct patient care, (2) medical educator-facilitated breakout sessions, and (3) asynchronous learning.Approach: Five students worked with 3 preceptors for the VPAR and were assigned 3-6 patients daily. Direct patient experiences included virtual interviews using FaceTime, preceptor staffing via Zoom, and completion of daily progress notes. This was augmented with medical educator-facilitated breakout sessions and didactic sessions. Evaluation of the VPAR included: (1) comparison of virtual vs traditional in-person rotation patient logs, (2) postcurriculum survey of students and medical educators' satisfaction and self-efficacy, and (3) student pass rate on the end of rotation (EOR) examination.
I nvestigators at multiple institutions conducted a multicenter prospective intervention study to assess the impact of the implementation of a standardized handoff program for residents on the rate of medical errors and preventable adverse events. Eligible participants included residents at 9 pediatric residency training programs. The intervention included the I-PASS Handoff Bundle, which used the I-PASS mnemonic (Illness severity, Patient summary, Action list, Situation awareness and contingency plan, and Synthesis by receiver) for written and oral handoffs, a 2-hour educational workshop, a 1-hour role-playing session for practicing skills, a computer module for individual practice, direct-observation tools for faculty to provide feedback, and a faculty development program. This intervention was implemented in a non-ICU pediatric inpatient unit at each of the 9 participating sites over 6 months accompanied by a 6-month pre-and postintervention data collection period.The primary outcomes were medical errors (preventable failures in processes of care) and preventable adverse events (unintended consequences of medical care that lead to patient harm). These outcomes were assessed pre-and postintervention using daily surveillance of formal incident reports, solicited reports from nurses, and daily medical-error survey reports from resident participants. Two physician investigators blinded to the phase of the study in which an incident occurred classified the incident as a medical error, preventable or nonpreventable adverse event, or neither. Secondary outcomes that were also assessed pre-and postintervention included resident time spent conducting handoffs and providing direct patient care, as measured by time-motion observations, as well as the quality of written and oral handoffs, determined by reviewing copies of all written handoff documents and audiotapes of evening oral handoffs for the presence of key handoff I-PASS elements. Additional pre-and postintervention data collected included characteristics of patients at each participating site, such as length of stay and medical complexity.A total of 875 residents participated and 10,740 patient admissions were analyzed, including 5,516 admissions preintervention and 5,224 postintervention. Patient characteristics did not differ significantly between pre-and postintervention periods. Overall, there was a 23% relative reduction in medical error rate from preintervention to postintervention (24.5 vs 18.8 per 100 admissions; P < .001). There was a 30% relative reduction in preventable adverse events from preintervention to postintervention (4.7 vs 3.3 per 100 admissions; P < .001). There was no significant decrease in nonpreventable adverse events. Resident time conducting handoffs and providing direct patient care was not significantly different pre-and postintervention, but there was significant improvement in inclusion of I-PASS elements in handoffs between pre-and postintervention.The investigators conclude that implementation of a standardized handoff program re...
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