medical residents university of washington amy fields march 6, 2003 lis 528
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Medical ResidentsUniversity of Washington
Amy FieldsMarch 6, 2003LIS 528
Educational Requirements Successful completion of medical
school Award of Medical Degree
University of Washington Residency Program The Department of Medicine
administers three fully accredited internal medicine residency pathways
University of Washington Residency Program1. Traditional or categorical pathway2. Seattle Primary Care Internist Pathway3. Seattle/Boise Primary Care Internist
PathwayIn addition:
1. A preliminary (one year) internship for individuals going into other specialties but who would like a year of broad exposure to internal medicine
Practice Description ACGME general competencies
requirements for Residency training programs require residents to have education experiences that allow them to demonstrate competency in the following areas:
Practice Description
1) patient care, 2) medical knowledge, 3) practice-based learning and
improvement,4) interpersonal and communication
skills, 5) professionalism, and 6) systems-based practice
Current Problems/Issues facing Medical Residents Resident burnout Work hours
Resident Burnout
Concerns: 30-40 years ago Parking spaces Midnight snacks Off-hours access to library
Ann Inn Med, 2002
Resident BurnoutConcerns: present
Patients are sicker Hospital stays shorter Attendings are more hassled More residents are married Many have children Great many more are women
Ann Inn Med, 2002
Resident Burnout
Concerns: present Fewer opportunities to establish
relationships with patients, peers and faculty
Amount of debt incurred getting degree major source of stress
Ann Inn Med, 2002
Self-reported burnout studyEffects on patient care
(results of UW cross-sectional study)
February 2001 a 92-item, self-administered survey was sent to all residents in the internal Medicine Program
Burnout was measured using the Maslach Burnout Inventory (MBI)
Ann Inn Med, 2002
Self-reported burnout study MBI evaluates three domains of
burnout1) Emotional exhaustion2) depersonalization3) personal accomplishment
Self-reported burnout study Study defined burnout as a high
score on the depersonalization or emotional exhaustion subscales.
76% met criteria Burned-out residents are 2-3 times
more likely to report suboptimal patient care practices at least monthly or weekly
Resident work hours
ACGME (to be implemented by July 2003):
“Total Duty Hours” must not exceed 80 hours per week, averaged over a four week period
Workdays that exceed 12 hours are defined as on-call
Past information needs studies Information needs during clinical
activity Online searching skills of residents
Information needs during clinical activity
Observational Study Anthropologist observed
communication among subjects re: their information needs
Coding scheme was developed for describing information requests
Ann Inn Med 1991
Information needs during clinical activity
Study Results Average: 5 clinical questions raised for each
patient 52% requested a fact that could be found in
patient medical record 23% were potentially answerable by a textbook,
journal, or MEDLINE 26% required synthesis of patient information
and medical knowledge.
Ann Inn Med 1991
Online Searching
Study of residents Philadelphia in 1997: 39% described their MEDLINE searching
skills as only fair or poor 56% felt teaching in this area would be
very helpful
Journal of Medical Library Association (JMLA), 2002
Online SearchingOffered a 3-hour workshop: Residents did a pretest MEDLINE search
and then a posttest search after the workshop
More that ½ residents after ambulatory care rotation rated the workshop as one of the best learning experiences of their rotation
Journal of Medical Library Association (JMLA), 2002
Online SearchingContinued MEDLINE searching: Percentage of residents using techniques
learned in workshop for searching MEDLINE improved significantly
In self-directed MEDLINE searches later in the year Residents continued to demonstrate improved skills
After this pilot study, the workshop was implemented with all second-year medicine residents
Journal of Medical Library Association (JMLA), 2002
Service to meet the needs of Residents PrimeAnswers: The specific aims of
the project will help determine if a simplification or reduction in the simplification or reduction in the barriers to access and speed of barriers to access and speed of information retrieval can information retrieval can enhance patient careenhance patient care..
Service to meet the needs of Residents
PrimeAnswers for Residents Help with (decreasing/managing)
work hours Aid in learning process Aid in effective patient care
Service to meet the needs of Residents
Clinical Medical Librarians Attend reports/conferences Literature searches Teach (PrimeAnswers, PubMed,
MeSH, Medline, etc.)
Approach to the service PrimeAnswers – Add teaching component 2004 Grant Proposal: “support learning at
the point of care through a system of information objects organized by clinical educators for residents and patients (PrimeConditions)”
Clinical Medical Librarian – Add more of them
Measure of its effectiveness PrimeAnswers already proven
effective for faculty PrimeAnswers averages 5000 hits
per month Clinical Medical Librarian already
proven effective for Residents
Measure of its effectiveness Survey Residents
Similar to 1993 survey of UW Residents re CML
Clinical Librarian Program study
Survey
Starting in November 1993, time was allotted at Resident Report to evaluate the information supplied by the CML.
Residents were asked to name the principal diagnosis of a patient for which an information request of the literature was made.
In 6 months' time, 31 questionnaires were returned with the following results:
Internal Medicine Residents Survey Results III11/93 - 4/94
Information supplied was useful or relevant 100% YES
Information supplied provided new knowledge 100% YES
Information supplied substantiated what I 77% YES
already knew or suspected 23% NO
Information supplied did (or will) contribute 100% YES
to better informed clinical decisions
Conclusion With the explosion of new medical
information and limitations on resident work hours and attendings teaching time, more efficient ways to teach residents must be implemented
Conclusion A system like PrimeAnswers that
presents concepts in small chunks, making the content searchable, and that provides links to existing digital textbooks and journal articles is a great tool to meet the needs of this group