Clinical Skills: In this innovation report from the Really Good Stuff series, investigators studied the use of video selfies for students learning to interview patients. In the video-selfie group, students used iPods to record themselves, then reviewed and edited the footage to create 5 minute “highlight” clips to present to a small group of peers and faculty preceptor after giving an oral case presentation. Control group students interviewed patients and gave oral presentations without use of video. Students reported that reviewing and editing their videos allowed self-reflection and that presenting videos to peers facilitated discussions and identified “key incidents” and learning moments missed during oral presentations alone. The use of video selfies may be appealing to both millennial students who are tech savvy and, for the most part, quite comfortable with selfies, as well as to course directors at schools struggling with direct observation of students by faculty. This approach also takes advantage of a feature on mobile devices that many students already carry in their pockets, obviating the need for schools to rely on high cost audio-visual systems. But keep in mind that this study was done in a research setting with patient consent. Whether this approach will be well accepted by patients and students in other settings, and whether the mounting video footage to be viewed will be perceived as increased workload by the faculty remain to be seen. — Sarang Kim, MD
T Sellito, A Ryan and T Judd. “Video selfies” for feedback and reflection. Med Educ 2016;50:564-591.
Link To Article
Trust: How do residents decide to trust their interns? Researchers at multiple internal medicine residencies explored this issue, deriving a model using qualitative methods, interviews and focus groups, and validating the resultant model with a quantitative survey. The factors which carried the most weight were intern-related, e.g. reliability and competence, followed closely by system-related factors such as patient characteristics and system supports. — Laura Willett, MD
Sheu L, O’Sullivan PS, Aagaard EM, Tad-Y D, Harrell HE, Kogan JR, Nixon J, Hollander H, Hauer KE. How Residents Develop Trust in Interns: A Multi-Institutional Mixed-Methods Study. Acad Med. 2016 Mar
Link To Article
Time Management: Results of another time and motion study of internal medicine residents will not be surprising to observers of the 21st-century hospital. Residents spent 50% of their time on the computer, 60% of their time multi-tasking (e.g. on the computer and the phone simultaneously), and less than 10% of their time with their patients. This was less than the amount of time moving from one location to another or waiting. The electronic health record has many benefits but also many unintended consequences. — Laura Willett, MD
Mamykina L, Vawdrey DK, Hripcsak G. How Do Residents Spend Their Shift Time? A Time and Motion Study With a Particular Focus on the Use of Computers. Acad Med. 2016 Mar
Link To Article
Internship Skills: More than 20,000 internal medicine residents completed a survey at the end of their in-training examinations, asking which skills from a previously-identified list were most important for those entering internship. All identified skills were felt to be important, but the top three were “identifying when to seek additional help and expertise”, “prioritizing clinical tasks and managing time efficiently”, and “communicating with other providers around care transitions”. The subinternship and ward rotations were felt to be the courses that provided the best practice for these skills. These skills are similar to those rated as important by internal medicine program directors. — Laura Willett, MD
Pereira AG, Harrell HE, Weissman A, Smith CD, Dupras D, Kane GC. Important Skills for Internship and the Fourth-Year Medical School Courses to Acquire Them: A National Survey of Internal Medicine Residents. Acad Med. 2016 Mar
Link To Article
Quality Improvement: The US certifying body for residencies now requires involvement in QI (Quality Improvement) for all residents, so interest in successful programs should be high. In this report of 27 redesigned monthly morbidity and mortality (M&M) conferences, authors at University of Colorado describe how they choose cases/adverse events to highlight key QI domains, encourage routine inter-professional participation, and link lessons learned to ongoing improvement activities. Investment of time appears to be substantial. “Case selection and careful curation of teaching points for facilitated discussion were both time and labor intensive because of the intentionality of the model.” The program relied on faculty with QI training, a specifically designated chief resident for quality and safety, Graduate Medical Education office support, support from the hospital’s risk management and clinical effectiveness departments, and a vice chair for quality. About 2 action items per case were generated, leading to the need for follow-up. — Laura Willett, MD
Tad-Y DB, Pierce RG, Pell JM, Stephan L, Kneeland PP, Wald HL. Acad Med. 2016 Mar Leveraging a Redesigned Morbidity and Mortality Conference That Incorporates the Clinical and Educational Missions of Improving Quality and Patient Safety. Acad Med. 2016 Mar
Link To Article
Assessment: This article discusses excellent ways to ensure the defensibility of assessment methods and outcomes. Such guidance is increasingly important given the increasing emphasis on competency-based education and assessment. These 12 tips include aligning assessments to curricula, utilizing standard setting methods when developing assessments, and analyzing the data gained as a result of those assessments. The article provides a roadmap for anyone involved in medical student education, particularly those who are contemplating the development of new assessment methods. Educators who follow these 12 tips will be well on their way to planning to valid, reliable, and therefore defensible assessment tools. — Pamela Ludmer, MD
Coombes L, Roberts M, Zahra D, and Burr S. Twelve tips for assessment psychometrics. Med Teach (2016) 38:3, 250-254.
Link To Article
Resident Duty Hours: In a large national cluster randomized controlled trial (N= 4330 general surgery residents in 117 residency programs), Bilimoria et al report whether strict adherence to the standard ACGME resident duty hour rules versus flexible duty hours, while maintaining same total weekly work hours, impacts patient outcomes. Much of the criticism about ACGME duty hour regulations has to do with lack of robust data to support stringent duty hour regulations, so the results of this rigorously designed study were much anticipated. In analysis of data from 138,000 patients during the 1 year study period, the rates of death or serious complications were no different in the 2 study groups (9.1% in flexible group vs 9.0% in standard group, p =0.92). Self reports of having to leave during an operation or hand off active patient issues were lower in the flexible policy group, but there were no significant differences in resident perception of personal or patient safety or satisfaction with educational quality. Do the results of this trial give ammunition to the critics of ACGME duty hours to go back to the good old days? Not so fast. Lack of a significant difference in patient outcomes or resident satisfaction actually should lend support to both the proponents and opponents of the standard duty hours. But before one makes a definitive conclusion, it’s worth pointing out that the changes in duty hours occurred in the setting of increasing attending supervision. In order to conclude there is no difference in patient outcomes or quality of education, a study with longer duration of follow up tracking patient outcomes after these residents have graduated might provide more robust evidence. — Sarang Kim, MD
Senior Resident Perspective: As an intern, I often felt that the 16-hour limit interfered with my ability to spend sufficient time with my patients. I was expected to be efficient, but the patients were complex and much of my time was sequestered behind a computer. I found night float challenging since it required evaluating new complaints on patients I had never met or laid hands on during the day. As a senior resident, I’ve found 24 hour calls tiring, but I appreciate the opportunity to see patients through critical situations and immediately learn from my decision making. The time off after a 24-hour call has been important to my well-being and the required day off every seven has enabled me to recharge and enjoy life with family and friends. Ultimately, I’m not so sure that my postmillennial generation of learners would ever want to go back to the sort of hours their attendings once endured, but it appears that some flexibility might not be so bad. — Madeline Sterling, MD, MPH
Bilimore et al. National Cluster Randomized Controlled Trial of Duty-Hour Flexibility in Surgical Training. NEJM 2016;374:713-27.
Link To Article