The Ambulatory Long-Block: An Accreditation Council for Graduate Medical Education (ACGME) Educational Innovations Project (EIP)

Warm, Eric J.; Schauer, Daniel P.; Diers, Tiffiny; Mathis, Bradley R.; Neirouz, Yvette; Boex, James R.; Rouan, Gregory W.

doi:10.1007/s11606-008-0588-y

Cited by 107 publications

(123 citation statements)

References 23 publications

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“…22,23 Given the noted strain between competing inpatient and outpatient responsibilities, 24 the continuity clinic experience for IM residents can become stressful and there is variable program compliance with ACGME ambulatory training requirements. 25 In an attempt to uncouple inpatient and outpatient training, a few new program models have developed, which include a year long ambulatory block 26 and an alternating 4:1 week inpatient to ambulatory schedule [27][28][29] that might help to support ambulatory education. Emphasizing outpatient training and education during residency while simultaneously providing protected time to practice ambulatory medicine may help retain resident interest in primary care.…”

Section: Discussionmentioning

confidence: 99%

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

et al. 2015

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PURPOSE: Professional and governmental organizations recommend an ideal US physician workforce composed of at least 40 % primary care physicians. They also support primary care residencies to promote careers in primary care. Our study examines the relationship between graduation from a primary care or categorical internal medicine residency program and subsequent career choice. METHODS: We conducted a cross-sectional electronic survey of a cohort of internal medicine residency alumni who graduated between 2001 and 2010 from a large academic center. Our primary predictor was graduation from a primary care versus a categorical internal medicine program and our primary outcome is current career role. We performed chi-square analysis comparing responses of primary care and categorical residents. RESULTS: We contacted 481 out of 513 alumni, of whom 322 responded (67 %). We compared 106 responses from primary care alumni to 169 responses from categorical alumni. Fifty-four percent of primary care alumni agreed that the majority of their current clinical work is in outpatient primary care vs. 20 % of categorical alumni (p<0.001). While 92.5 % of primary-care alumni were interested in a primary care career prior to residency, only 63 % remained interested after residency. Thirty of the 34 primary care alumni (88 %) who lost interest in a primary care career during residency agreed that their ambulatory experience during residency influenced their subsequent career choice. CONCLUSIONS: A higher percentage of primary care alumni practice outpatient primary care as compared to categorical alumni. Some alumni lost interest in primary care during residency. The outpatient clinic experience may impact interest in primary care.

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Section: Discussionmentioning

confidence: 99%

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

et al. 2015

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“…PGY-2 s in our program receive fewer assessments due to a unique residency structure and parallel assessment system. 18,19 Entrustment data are used to create curves for longitudinal assessment. Figure 2b-d shows a comparison of a single NAS milestone, PC-2: develops and achieves comprehensive management plan for each patient, for three PGY-1/2 residents over the first five quarters of residency.…”

Section: Program Evaluationmentioning

confidence: 99%

Entrustment and Mapping of Observable Practice Activities for Resident Assessment

et al. 2014

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Entrustable Professional Activities (EPAs) and the Next Accreditation System reporting milestones reduce general competencies into smaller evaluable parts. However, some EPAs and reporting milestones may be too broad to use as direct assessment tools. We describe our internal medicine residency curriculum and assessment system, which uses entrustment and mapping of observable practice activities (OPAs) for resident assessment. We created discrete OPAs for each resident rotation and learning experience. In combination, these serve as curricular foundation and tools for assessment. OPA performance is measured via a 5-point entrustment scale, and mapped to milestones and EPAs. Entrustment ratings of OPAs provide an opportunity for immediate structured feedback of specific clinical skills, and mapping OPAs to milestones and EPAs can be used for longitudinal assessment, promotion decisions, and reporting. Direct assessment and demonstration of progressive entrustment of trainee skill over time are important goals for all training programs. Systems that use OPAs mapped to milestones and EPAs provide the opportunity for achieving both, but require validation.

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“…Some possible strategies to address this issue include (1) treating intrateam handoffs like interteam handoffs by implementing a formal system, (2) better utilizing senior residents/faculty when interns are covering for each other, (3) using bedside attending rounds to increase the exposure of all team members to the team's patients, (4) block scheduling to avoid absences due to clinics, 12 and (5) …”

Section: Discussionmentioning

confidence: 99%

Intrateam coverage is common, intrateam handoffs are not

Martin

Frank

Fletcher

2014

Journal of Hospital Medicine

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The Ambulatory Long-Block: An Accreditation Council for Graduate Medical Education (ACGME) Educational Innovations Project (EIP)

Cited by 107 publications

References 23 publications

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

Entrustment and Mapping of Observable Practice Activities for Resident Assessment

Intrateam coverage is common, intrateam handoffs are not

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