Impact of subspecialty elective exposures on outcomes on the American board of internal medicine certification examination

Shanmugam, Victoria K.; Tsagaris, Katina C; Schilling, Amber; McNish, Sean; Desale, Sameer; Adams, Michael R.

doi:10.1186/1472-6920-12-94

Cited by 7 publications

(8 citation statements)

References 18 publications

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“…Rheumatology curricula including formal didactics, case-based learning and an information package have been shown to increase resident satisfaction and self-confidence [10]. However, additional studies show that a rheumatology specific curriculum may not result in an improved performance in OSCE or on board scores [11, 12]. Specific rheumatology skill workshops have been shown to improve mean comfort level with knee and shoulder arthrocentesis [12, [13].…”

Section: Discussionmentioning

confidence: 99%

Rheumatologic skills development: what are the needs of internal medicine residents?

et al. 2015

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Given the burden of rheumatic disease in our society and the anticipated future shortage of rheumatologists, all internal medicine (IM) residencies need to train internists who are capable of caring for patients with rheumatic diseases. The objective of this study was to perform a targeted needs assessment of the self-confidence of IM residents in the evaluation and care of patients with rheumatologic diseases. A 16-item, web-based self-assessed confidence survey tool was administered to participating post graduate year (PGY) 1 (N=83) and PGY3 (N=37) residents. The categories of questions included self-confidence in performing a rheumatologic history and exam, performing common rheumatologic procedures, ordering and interpreting rheumatologic laboratory tests, and caring for patients with common rheumatologic diseases. Resident demographics, prior rheumatology exposure, and career plans were also queried. PGY3 residents had higher self-assessed confidence than PGY1 residents in all categories. Self-assessed confidence in joint procedures was consistently low in both groups and when compared to other categories. Prior exposure to a rheumatology course or elective was not consistently associated with higher self-assessed confidence ratings across all categories. PGY3 residents showed less interest in rheumatology as a career than PGY1 residents, although the interest in the topic of rheumatology was not statistically different. Our needs assessment shows a low level of self-assessed confidence in rheumatology knowledge and skills among IM residents. Despite improvement with PGY year of training, self-assessed confidence remains low. To improve resident’s skills and self-confidence in rheumatology, more curricular innovations are needed. Such innovations should be assessed for overall effectiveness.

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Section: Discussionmentioning

confidence: 99%

Rheumatologic skills development: what are the needs of internal medicine residents?

et al. 2015

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“…This means that a student might spend the whole internal medicine clerkship without ever treating a patient with hypertension, pneumonia or any other common conditions of general internal medicine he will have to deal with even during postgraduate training in surgery. However, a study on the impact of subspecialty elective exposures on outcomes on the American board of internal medicine certification examination did not demonstrate significant positive associations between individual subspecialty elective exposures and ABIM-CE mean standardized passing score [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…It has been demonstrated though that great differences in clerkship experiences exist between family medicine, paediatrics and internal medicine [ 15 ]. In postgraduate medical education, subspecialty elective exposures were without impact on outcomes on the American board of internal medicine certification examination [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Overspecialized and undertrained? Patient diversity encountered by medical students during their internal medicine clerkship at a university hospital

2015

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BackgroundDuring the four-month internal medicine clerkship in their final year, undergraduate medical students are closely involved in patient care. Little is known about what constitutes their typical learning experiences with respect to patient diversity within the different subspecialties of internal medicine and during on call hours.Methods25 final year medical students (16 female, 9 male) on their internal medicine clerkship participated in this observational single-center study. To detail the patient diversity encountered by medical students at a university hospital during their 16-week internal medicine clerkship, all participants self-reported their patient contacts in the different subspecialties and during on call hours on patient encounter cards. Patients’ chief complaint, suspected main diagnosis, planned diagnostic investigations, and therapy in seven different internal medicine subspecialties and the on call medicine service were documented.Results496 PECs were analysed in total. The greatest diversity of chief complaints (CC) and suspected main diagnoses (SMD) was observed in patients encountered on call, with the combined frequencies of the three most common CCs or SMDs accounting for only 23% and 25%, respectively. Combined, the three most commonly encountered CC/SMD accounted for high percentages (82%/63%), i.e. less diversity, in oncology and low percentages (37%/32%), i.e. high diversity, in nephrology. The percentage of all diagnostic investigations and therapies that were classified as “basic” differed between the subspecialties from 82%/94% (on call) to 37%/50% (pulmonology/oncology). The only subspecialty with no significant difference compared with on call was nephrology for diagnostic investigations. With respect to therapy, nephrology and infectious diseases showed no significant differences compared with on call.ConclusionsInternal medicine clerkships at a university hospital provide students with a very limited patient diversity in most internal medicine subspecialties. Shadowing the on call resident or shorter rotations could provide a more extended patient diversity.

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“…Rheumatology is not part of the core inpatient training based on ACGME requirements, therefore the amount of time each resident spends training in rheumatology varies but may be less than other subspecialties. Shanmugam et al revealed that residents had less exposure to rheumatology than cardiology, hematology, infectious disease, and pulmonology during IM residency from 2006-2010 at one institution [3]. Leverenz et al found that resident con dence is low amongst resident learners across most disease categories in rheumatology, yet perceived pro ciency by rheumatology educators is typically even lower [4,5].…”

Section: Introductionmentioning

confidence: 99%

Assessing resident needs and faculty perceptions to improve training in rheumatology

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Leverenz

et al. 2022

Preprint

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Background Internal medicine (IM) residents lack confidence in rheumatology. Due to the wide variety of topics in rheumatology, identifying the most important subjects to learn during training is vital to create future interventions to increase confidence and knowledge. The preferred teaching modality for both attendings/fellows and residents is not known. Methods An electronic survey was distributed to all IM residents, rheumatology fellows, and rheumatology faculty at the University of Chicago during the 2020–2021 academic year. Residents reported self-confidence levels on 10 rheumatology topics, while rheumatology attendings/fellows were asked to rank these from most to least important to learn during IM residency. All groups were asked preferred teaching modality. Results Median confidence level [interquartile range] among residents for caring for patients with rheumatological conditions was 6 [3.6–7.5] for inpatient and 5 [3.7–6.5] for outpatient settings (10 being very confident). Attendings and fellows identified the most important topics to learn during the rheumatology rotation as ordering and interpreting autoimmune serologies and musculoskeletal exam. Both attendings/fellows and residents preferred bedside teaching in the inpatient setting and case-based learning in the outpatient setting. Conclusions While some disease-specific topics such as autoimmune serologies were identified as important rheumatology topics for IM residents to learn, more practical topics like musculoskeletal exam skills were also deemed important. This highlights the need for comprehensive interventions that focus on more than standardized exam topics alone to improve rheumatology confidence in IM residents. There are different preferences of teaching styles in various clinical settings.

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Impact of subspecialty elective exposures on outcomes on the American board of internal medicine certification examination

Cited by 7 publications

References 18 publications

Rheumatologic skills development: what are the needs of internal medicine residents?

Rheumatologic skills development: what are the needs of internal medicine residents?

Overspecialized and undertrained? Patient diversity encountered by medical students during their internal medicine clerkship at a university hospital

Assessing resident needs and faculty perceptions to improve training in rheumatology

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