Academic medicine : journal of the Association of American Medical Colleges
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To summarize the available evidence about patient handoff characteristics and their impact on subsequent patient care in hospitals. ⋯ Published research is highly diverse and idiosyncratic regarding the handoff characteristics and outcomes assessed and the methodologies used, so comparing studies and drawing general conclusions about the field are difficult endeavors. The quality of research on the topic is rather preliminary, and there is not yet enough research to inform evidence-based handoff strategies. Future research, then, should focus on research methods, which outcomes should be assessed, handoff characteristics beyond information transfer, mechanisms that link handoff characteristics and outcomes, and the conditions that moderate the characteristics' effects.
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Randomized Controlled Trial
Faculty member review and feedback using a sign-out checklist: improving intern written sign-out.
Although residents commonly perform patient care sign-out during training, faculty do not frequently supervise or evaluate sign-out. The authors designed a sign-out checklist, and they investigated whether use of the checklist, paired with faculty member review and feedback, would improve interns' written sign-out. ⋯ A sign-out checklist paired with twice-monthly, face-to-face feedback from a faculty member led to improvements in the content and quality of interns' written sign-out.
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Vital, productive faculty are critical to academic medicine, yet studies indicate high dissatisfaction and attrition. The authors sought to identify key personal and cultural factors associated with intentions to leave one's institution and/or academic medicine. ⋯ Findings suggest that academic medicine does not support relatedness and a moral culture for many faculty. If these issues are not addressed, academic health centers may find themselves with dissatisfied faculty looking to go elsewhere.
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To gauge internal medicine (IM) trainees' perceptions regarding aspects of their inpatient rotations, including supervision, educational opportunities, the perceived effect of duty hours regulations on quality of patient care, the causes of medical errors, and sleep. ⋯ IM trainees agree that limited educational opportunities are the weakest part of the average inpatient rotation. Few have complaints about the adequacy of supervision. These trainees' optimism regarding the positive influence of potential work hours restrictions on patient care and their views of likely causes of medical errors suggest the need for innovative patient care schedules and education curricula.
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Surgical simulation applications have been largely limited to the acquisition and assessment of technical skills. Current teaching and assessment of surgical judgment is nonsystematic and prone to error. Interest in methods to enhance the acquisition and assessment of knowledge-based (judgment) skills for intraoperative decision making has led to the application of cognitive task analysis (CTA) and human error assessment to facilitate this process. ⋯ Web-based simulation applications facilitate curricular learning (rules-guided skills), allow cognitive rehearsal of procedures, and are accessible independent of location and time. Simulation applications that facilitate the assessment and learning of expert intraoperative judgment should include a consensus-derived outline based on CTA of the operative steps and potential points of risk for each surgical procedure; the ability to detect the situational awareness of the performer and the options considered to avoid error at critical steps; an assessment (scoring) of options considered or attempted; immediate evaluation feedback to inform improved performance; and a program of deliberate practice in which progressively more challenging scenarios can be introduced, based on the trainee's demonstrated skills. High-fidelity simulators currently lack these essential components, and future simulation-assisted teaching and assessment of surgical judgment skills are likely to employ low-fidelity simulators coupled to Web-based instruction.