Journal of general internal medicine
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The struggling medical resident is faced with many adaptive challenges that may require change in mindset. However, formal remediation within graduate medical education (GME) often employs overly structured technical solutions to address trainee deficiencies. These strategies may ultimately fail to result in sustained improvement. ⋯ These strategies may be particularly useful within the traditionally difficult-to-remediate competencies of systems-based practice, practice-based learning and improvement, and professionalism. The authors provide a descriptive overview of each of Cranton's perspectives, introducing concrete examples drawn from the medical literature. This article will contrast current remediation strategies with those using TL theory in order to assist graduate medical educators in applying these principles to the remediation of their own struggling residents.
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This perspective describes federal efforts in the United States (U. S.) to integrate care for an especially complex, vulnerable, and costly patient population: adults eligible for both Medicare and Medicaid insurance. The goal of the paper is to demystify for clinical policy leaders and practicing clinicians the origins and evolution of the Dual-Eligible Special Needs Plans (D-SNPs) recently permanently authorized by the U. S. Congress and to explore the potential for these policy changes to help such health plans improve care for the sickest and most vulnerable Americans.
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Interns are vulnerable to emotional distress and burnout. Little is known about the extent to which interns' well-being can be influenced by peer support provided by their senior residents. ⋯ We propose a model illustrating key points at which near-peers can make an impact in reducing interns' distress and suggest strategies they can use. Given the substantial role peer learning plays in intern development, senior residents can impact their interns by normalizing emotions, allowing vulnerability, and highlighting the importance of self-care. A formalized peer support skill-building curriculum for senior residents may empower them to provide more effective support as part of their supervisory efforts.
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The novel coronavirus disease 2019 (COVID-19) infected over 5 million United States (US) residents resulting in more than 180,000 deaths by August 2020. To mitigate transmission, most states ordered shelter-in-place orders in March and reopening strategies varied. ⋯ Additional mitigation measures such as mask use counteract the potential growth in COVID-19 cases and deaths due to reopening businesses. This study contributes to the growing evidence that mask usage is essential for mitigating community transmission of COVID-19. States should delay further reopening until mask mandates are fully implemented, and enforcement by local businesses will be critical for preventing potential future closures.
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Goals of care (GOC) is a communication and decision-making process that occurs between a clinician and a patient (or surrogate decision-maker) during an episode of care to facilitate a plan of care that is consistent with the patient's preferences and values. Little is known about patients' experiences of these discussions. ⋯ Effective communication, and patients' values and expectations set the stage for goals of care discussions; however, the environment plays a significant role. Communication skills training and education designed to equip clinicians to negotiate GOC interactions effectively are essential. These interventions must also be accompanied by systemic changes including building a culture supportive of GOC, clear policies and guidelines, and champions who facilitate uptake of GOC discussions.