Academic medicine : journal of the Association of American Medical Colleges
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Multicenter Study
Medicine residents' self-perceived competence in end-of-life care.
Internal medicine residents frequently provide end-of-life care, yet feel inadequately trained and uncomfortable providing this care, despite efforts to improve end-of-life care curricula. Understanding how residents' experiences and attitudes affect their perceived competence in providing end-of-life care is important for targeting educational interventions. ⋯ Residents with more clinical experience during training had greater self-perceived competence providing end-of-life care. Increasing the quantity and quality of the end-of-life care experiences during residency with appropriate supervision and role modeling may lead to enhanced skill development and improve the quality of end-of-life care. The results suggest that cultivating bedside learning opportunities during residency is an appropriate focus for educational interventions in end-of-life care education.
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Private industry involvement is viewed as tainting research with self-interest, whereas public funding is generally well regarded. Yet, dependence on "soft money" also triggers researcher and university self-interest. No empirical research has compared these factors' effects on academic researchers' behaviors. ⋯ The free play of university and individual self-interests, combined with and contributing to the intense competition for research funding, may be undermining scientific integrity.
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The relationship of the quality of teaching hospitals' clinical performance to resident education in quality and patient safety is unclear. The authors studied residents' knowledge of these areas in major teaching hospitals with higher- and lower-quality performance rankings. They assessed the presence of formal and informal quality curricula to determine whether programmatic differences exist. ⋯ Residents' learning about quality and patient safety is extensive, largely through a positive informal curriculum in the teaching hospital and, less frequently, via a formal curriculum. No relationship was found between the quality performance of the teaching hospital and the residents' curriculum or understanding of quality or safety. Residents seem to learn through an informal curriculum provided by hospital initiatives and resources, and thus these data suggest the importance of major teaching hospitals in quality education.
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The importance of the family's involvement in caring for children with cancer is as tremendous as the need to successfully educate our medical students and residents about the value of effective communication and family-centered care. This article presents a model of change undertaken by one large pediatric cancer center to improve family-centered care. The author describes how the inclusion of families in sit-down medical team rounds influenced family, medical trainee, and attending physician satisfaction. ⋯ Families reported increased feelings of inclusion, respect, and having a better understanding of their child's care. Trainees recognized the value in patient care and family satisfaction, but some doubted the benefit to their own training. Details of this change, including challenges faced, as well as the descriptive survey results of both the families and medical trainees, are discussed.
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To determine (1) whether judges differed in the levels of severity they exercised when rating candidates' performance in an oral certification exam, (2) to what extent candidates' clinical competence ratings were related to their organization/communication ratings, and (3) to what extent clinical competence ratings could predict organization/communication ratings. ⋯ The close association between the two sets of ratings was possibly due to a "halo" effect. Several explanations for this relationship were explored, and the authors considered the implications for their understanding of how judges carry out this complex rating task.