Journal of general internal medicine
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Randomized Controlled Trial
Evaluating the SPIKES Model for Improving Peer-to-Peer Feedback Among Internal Medicine Residents: a Randomized Controlled Trial.
Feedback improves trainee clinical performance, but the optimal way to provide it remains unclear. Peer feedback offers unique advantages but comes with significant challenges including a lack of rigorously studied methods. The SPIKES framework is a communication tool adapted from the oncology and palliative care literature for teaching trainees how to lead difficult conversations. ⋯ With modest implementation requirements and notable limitations, a brief educational intervention focused on SPIKES increased PGY1 perception of the extent, specificity, and satisfaction with feedback from PGY2s.
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There is increasing recognition of the importance of supporting patients in their health-related goals. Patient-provider discussions and health-related mobile applications (apps) can support patients to pursue health goals; however, their impact on patient goal setting and achievement is not well understood. ⋯ Efforts to further promote patient-led goal setting should leverage the influence of patient-provider conversations. Use of patient-facing technologies, specifically mobile health apps, may facilitate goal-oriented care, but further work is needed to examine the potential benefits of apps to support patient goals, particularly if providers discuss and endorse use of those apps with patients.
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Given efforts to reduce opioid use, and because marijuana potentially offers a lower-risk alternative for treating chronic pain, there is interest in understanding the public health impact of marijuana legalization on opioid-related outcomes. ⋯ Our analysis does not support the supposition that access to marijuana lowers use of chronic opioids for pain.
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Due to concerns of inadequate primary care access, national agencies like the Health Resources and Services Administration (HRSA) support primary care (PC) residencies. Recent research demonstrates that up to 35% of PC alumni lost interest in PC during residency. These alumni who lost interest noted that their continuity clinic experience influenced their career choice. The purpose of this study was to identify the specific aspects of PC residency experience that influenced career choice. ⋯ Strong interpersonal relationships with patients and clinic mentors were associated with a PC career. These factors may compensate for the reported frustrations of clinic. Enhancing patient and mentor relationships may increase the retention of PC residents in ambulatory careers and may help address the current and projected shortage of primary care physicians.