PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-25 (502681)

Clipboard (0)
None

Related Articles

1.  Impact of subspecialty elective exposures on outcomes on the American board of internal medicine certification examination 
BMC Medical Education  2012;12:94.
Background
The American Board of Internal Medicine Certification Examination (ABIM-CE) is one of several methods used to assess medical knowledge, an Accreditation Council for Graduate Medical Education (ACGME) core competency for graduating internal medicine residents. With recent changes in graduate medical education program directors and internal medicine residents are seeking evidence to guide decisions regarding residency elective choices. Prior studies have shown that formalized elective curricula improve subspecialty ABIM-CE scores. The primary aim of this study was to evaluate whether the number of subspecialty elective exposures or the specific subspecialties which residents complete electives in impact ABIM-CE scores.
Methods
ABIM-CE scores, elective exposures and demographic characteristics were collected for MedStar Georgetown University Hospital internal medicine residents who were first-time takers of the ABIM-CE in 2006–2010 (n=152). Elective exposures were defined as a two-week period assigned to the respective subspecialty. ABIM-CE score was analyzed using the difference between the ABIM-CE score and the standardized passing score (delta-SPS). Subspecialty scores were analyzed using percentage of correct responses. Data was analyzed using GraphPad Prism version 5.00 for Windows.
Results
Paired elective exposure and ABIM-CE scores were available in 131 residents. There was no linear correlation between ABIM-CE mean delta-SPS and the total number of electives or the number of unique elective exposures. Residents with ≤14 elective exposures had higher ABIM-CE mean delta-SPS than those with ≥15 elective exposures (143.4 compared to 129.7, p=0.051). Repeated electives in individual subspecialties were not associated with significant difference in mean ABIM-CE delta-SPS.
Conclusions
This study did not demonstrate significant positive associations between individual subspecialty elective exposures and ABIM-CE mean delta-SPS score. Residents with ≤14 elective exposures had higher ABIM-CE mean delta-SPS than those with ≥15 elective exposures suggesting there may be an “ideal” number of elective exposures that supports improved ABIM-CE performance. Repeated elective exposures in an individual specialty did not correlate with overall or subspecialty ABIM-CE performance.
doi:10.1186/1472-6920-12-94
PMCID: PMC3480921  PMID: 23057635
Resident education; Gender; Elective; Subspecialty; Graduate medical education
2.  Are Commonly Used Resident Measurements Associated with Procedural Skills in Internal Medicine Residency Training? 
Background
Acquisition of competence in performing a variety of procedures is essential during Internal Medicine (IM) residency training.
Purposes
Determine the rate of procedural complications by IM residents; determine whether there was a correlation between having 1 or more complications and institutional procedural certification status or attending ratings of resident procedural skill competence on the American Board of Internal Medicine (ABIM) monthly evaluation form (ABIM-MEF). Assess if an association exists between procedural complications and in-training examination and ABIM board certification scores.
Methods
We retrospectively reviewed all procedure log sheets, procedural certification status, ABIM-MEF procedural skills ratings, in-training exam and certifying examination (ABIM-CE) scores from the period 1990–1999 for IM residency program graduates from a training program.
Results
Among 69 graduates, 2,212 monthly procedure log sheets and 2,475 ABIM-MEFs were reviewed. The overall complication rate was 2.3/1,000 procedures (95% CI: 1.4–3.1/1,000 procedure). With the exception of procedural certification status as judged by institutional faculty, there was no association between our resident measurements and procedural complications.
Conclusions
Our findings support the need for a resident procedural competence certification system based on direct observation. Our data support the ABIM’s action to remove resident procedural competence from the monthly ABIM-MEF ratings.
doi:10.1007/s11606-006-0068-1
PMCID: PMC1824756  PMID: 17356968
procedural skills; Internal Medicine residency training program; ABIM evaluation
3.  Are Commonly Used Resident Measurements Associated with Procedural Skills in Internal Medicine Residency Training? 
Background
Acquisition of competence in performing a variety of procedures is essential during Internal Medicine (IM) residency training.
Purposes
Determine the rate of procedural complications by IM residents; determine whether there was a correlation between having 1 or more complications and institutional procedural certification status or attending ratings of resident procedural skill competence on the American Board of Internal Medicine (ABIM) monthly evaluation form (ABIM-MEF). Assess if an association exists between procedural complications and in-training examination and ABIM board certification scores.
Methods
We retrospectively reviewed all procedure log sheets, procedural certification status, ABIM-MEF procedural skills ratings, in-training exam and certifying examination (ABIM-CE) scores from the period 1990–1999 for IM residency program graduates from a training program.
Results
Among 69 graduates, 2,212 monthly procedure log sheets and 2,475 ABIM-MEFs were reviewed. The overall complication rate was 2.3/1,000 procedures (95% CI: 1.4–3.1/1,000 procedure). With the exception of procedural certification status as judged by institutional faculty, there was no association between our resident measurements and procedural complications.
Conclusions
Our findings support the need for a resident procedural competence certification system based on direct observation. Our data support the ABIM’s action to remove resident procedural competence from the monthly ABIM-MEF ratings.
doi:10.1007/s11606-006-0068-1
PMCID: PMC1824756  PMID: 17356968
procedural skills; Internal Medicine residency training program; ABIM evaluation
4.  Teaching Internal Medicine Residents Quality Improvement Techniques using the ABIM’s Practice Improvement Modules 
Summary
Introduction/aim
Standard curricula to teach Internal Medicine residents about quality assessment and improvement, important components of the Accreditation Council for Graduate Medical Education core competencies practiced-based learning and improvement (PBLI) and systems-based practice (SBP), have not been easily accessible.
Program description
Using the American Board of Internal Medicine’s (ABIM) Clinical Preventative Services Practice Improvement Module (CPS PIM), we have incorporated a longitudinal quality assessment and improvement curriculum (QAIC) into the 2 required 1-month ambulatory rotations during the postgraduate year 2. During the first block, residents complete the PIM chart reviews, patient, and system surveys. The second block includes resident reflection using PIM data and the group performing a small test of change using the Plan–Do–Study–Act (PDSA) cycle in the resident continuity clinic.
Program Evaluation
To date, 3 resident quality improvement (QI) projects have been undertaken as a result of QAIC, each making significant improvements in the residents’ continuity clinic. Resident confidence levels in QI skills (e.g., writing an aim statement [71% to 96%, P < .01] and using a PDSA cycle [9% to 89%, P < .001]) improved significantly.
Discussion
The ABIM CPS PIM can be used by Internal Medicine residency programs to introduce QI concepts into their residents’ outpatient practice through encouraging practice-based learning and improvement and systems-based practice.
doi:10.1007/s11606-008-0549-5
PMCID: PMC2517947  PMID: 18449612
Internal Medicine residents; quality improvement; practiced-based learning and improvement; systems-based practice; practice improvement module
5.  Charting the Road to Competence: Developmental Milestones for Internal Medicine Residency Training 
Background
The Accreditation Council for Graduate Medical Education (ACGME) Outcome Project requires that residency program directors objectively document that their residents achieve competence in 6 general dimensions of practice.
Intervention
In November 2007, the American Board of Internal Medicine (ABIM) and the ACGME initiated the development of milestones for internal medicine residency training. ABIM and ACGME convened a 33-member milestones task force made up of program directors, experts in evaluation and quality, and representatives of internal medicine stakeholder organizations. This article reports on the development process and the resulting list of proposed milestones for each ACGME competency.
Outcomes
The task force adopted the Dreyfus model of skill acquisition as a framework the internal medicine milestones, and calibrated the milestones with the expectation that residents achieve, at a minimum, the “competency” level in the 5-step progression by the completion of residency. The task force also developed general recommendations for strategies to evaluate the milestones.
Discussion
The milestones resulting from this effort will promote competency-based resident education in internal medicine, and will allow program directors to track the progress of residents and inform decisions regarding promotion and readiness for independent practice. In addition, the milestones may guide curriculum development, suggest specific assessment strategies, provide benchmarks for resident self-directed assessment-seeking, and assist remediation by facilitating identification of specific deficits. Finally, by making explicit the profession's expectations for graduates and providing a degree of national standardization in evaluation, the milestones may improve public accountability for residency training.
doi:10.4300/01.01.0003
PMCID: PMC2931179  PMID: 21975701
6.  A nomogram to predict the probability of passing the American Board of Internal Medicine examination 
Medical Education Online  2012;17:10.3402/meo.v17i0.18810.
Background
Although the American Board of Internal Medicine (ABIM) certification is valued as a reflection of physicians’ experience, education, and expertise, limited methods exist to predict performance in the examination.
Purpose
The objective of this study was to develop and validate a predictive tool based on variables common to all residency programs, regarding the probability of an internal medicine graduate passing the ABIM certification examination.
Methods
The development cohort was obtained from the files of the Cleveland Clinic internal medicine residents who began training between 2004 and 2008. A multivariable logistic regression model was built to predict the ABIM passing rate. The model was represented as a nomogram, which was internally validated with bootstrap resamples. The external validation was done retrospectively on a cohort of residents who graduated from two other independent internal medicine residency programs between 2007 and 2011.
Results
Of the 194 Cleveland Clinic graduates used for the nomogram development, 175 (90.2%) successfully passed the ABIM certification examination. The final nomogram included four predictors: In-Training Examination (ITE) scores in postgraduate year (PGY) 1, 2, and 3, and the number of months of overnight calls in the last 6 months of residency. The nomogram achieved a concordance index (CI) of 0.98 after correcting for over-fitting bias and allowed for the determination of an estimated probability of passing the ABIM exam. Of the 126 graduates from two other residency programs used for external validation, 116 (92.1%) passed the ABIM examination. The nomogram CI in the external validation cohort was 0.94, suggesting outstanding discrimination.
Conclusions
A simple user-friendly predictive tool, based on readily available data, was developed to predict the probability of passing the ABIM exam for internal medicine residents. This may guide program directors’ decision-making related to program curriculum and advice given to individual residents regarding board preparation.
doi:10.3402/meo.v17i0.18810
PMCID: PMC3475012  PMID: 23078794
board examination; in-training examination; internal medicine; residents; program directors
7.  Associations between quality indicators of internal medicine residency training programs 
BMC Medical Education  2011;11:30.
Background
Several residency program characteristics have been suggested as measures of program quality, but associations between these measures are unknown. We set out to determine associations between these potential measures of program quality.
Methods
Survey of internal medicine residency programs that shared an online ambulatory curriculum on hospital type, faculty size, number of trainees, proportion of international medical graduate (IMG) trainees, Internal Medicine In-Training Examination (IM-ITE) scores, three-year American Board of Internal Medicine Certifying Examination (ABIM-CE) first-try pass rates, Residency Review Committee-Internal Medicine (RRC-IM) certification length, program director clinical duties, and use of pharmaceutical funding to support education. Associations assessed using Chi-square, Spearman rank correlation, univariate and multivariable linear regression.
Results
Fifty one of 67 programs responded (response rate 76.1%), including 29 (56.9%) community teaching and 17 (33.3%) university hospitals, with a mean of 68 trainees and 101 faculty. Forty four percent of trainees were IMGs. The average post-graduate year (PGY)-2 IM-ITE raw score was 63.1, which was 66.8 for PGY3s. Average 3-year ABIM-CE pass rate was 95.8%; average RRC-IM certification was 4.3 years. ABIM-CE results, IM-ITE results, and length of RRC-IM certification were strongly associated with each other (p < 0.05). PGY3 IM-ITE scores were higher in programs with more IMGs and in programs that accepted pharmaceutical support (p < 0.05). RRC-IM certification was shorter in programs with higher numbers of IMGs. In multivariable analysis, a higher proportion of IMGs was associated with 1.17 years shorter RRC accreditation.
Conclusions
Associations between quality indicators are complex, but suggest that the presence of IMGs is associated with better performance on standardized tests but decreased duration of RRC-IM certification.
doi:10.1186/1472-6920-11-30
PMCID: PMC3126786  PMID: 21651768
program quality; Residency Review Committee; American Board of Internal Medicine Certifying Examination
8.  Predicting Pass Rates on the American Board of Internal Medicine Certifying Examination 
Our objective was to determine the ability of the internal medicine In-Training Examination (ITE) to predict pass or fail outcomes on the American Board of Internal Medicine (ABIM) certifying examination and to develop an externally validated predictive model and a simple equation that can be used by residency directors to provide probability feedback for their residency programs. We collected a study sample of 155 internal medicine residents from the three Virginia internal medicine programs and a validation sample of 64 internal medicine residents from a residency program outside Virginia. Scores from both samples were collected across three class cohorts. The Kolmogorov-Smirnov z test indicated no statistically significant difference between the distribution of scores for the two samples (z = 1.284, p = .074). Results of the logistic model yielded a statistically significant prediction of ABIM pass or fail performance from ITE scores (Wald = 35.49, SE = 0.036, df = 1, p < .005) and overall correct classifications for the study sample and validation sample at 79% and 75%, respectively. The ITE is a useful tool in assessing the likelihood of a resident's passing or failing the ABIM certifying examination but is less predictive for residents who received ITE scores between 49 and 66.
doi:10.1046/j.1525-1497.1998.00122.x
PMCID: PMC1496976  PMID: 9669571
certifying examination; in-training examination; education; predictions; residents
9.  Procedural Experience and Comfort Level in Internal Medicine Trainees 
BACKGROUND
The American Board of Internal Medicine (ABIM) has recommended a specific number of procedures be done as a minimum standard for ensuring competence in various medical procedures. These minimum standards were determined by consensus of an expert panel and may not reflect actual procedural comfort or competence.
OBJECTIVE
To estimate the minimum number of selected procedures at which a majority of internal medicine trainees become comfortable performing that procedure.
DESIGN
Cross-sectional, self-administered survey.
SETTING
A military-based, a community-based, and 2 university-based programs.
PARTICIPANTS
Two hundred thirty-two internal medicine residents.
MEASUREMENTS
Survey questions included number of specific procedures performed, comfort level with performing specific procedures, and whether respondents desired further training in specific procedures. The comfort threshold for a given procedure was defined as the number of procedures at which two thirds or more of the respondents reported being comfortable or very comfortable performing that procedure.
RESULTS
For three of seven procedures selected, residents were comfortable performing the procedure at or below the number recommended by the ABIM as a minimum requirement. However, residents needed more procedures than recommended by the ABIM to feel comfortable with central venous line placement, knee joint aspiration, lumbar puncture, and thoracentesis. Using multivariate logistic regression analysis, variables independently associated with greater comfort performing selected procedures included increased number performed, more years of training, male gender, career goals, and for skin biopsy, training in the community-based program. Except for skin biopsy, comfort level was independent of training site. A significant number of advanced-year house officers in some programs had little experience in performing selected common ambulatory procedures.
CONCLUSION
Minimum standards for certifying internal medicine residents may need to be reexamined in light of house officer comfort level performing selected procedures.
doi:10.1046/j.1525-1497.2000.91104.x
PMCID: PMC1495602  PMID: 11089715
ABIM; procedure comfort level; residents
10.  Comprehensive Ambulatory Medicine Training for Categorical Internal Medicine Residents 
It is challenging to create an educational and satisfying experience in the outpatient setting. We developed a 3-year ambulatory curriculum that addresses the special needs of our categorical medicine residents with distinct learning objectives for each year of training and clinical experiences and didactic sessions to meet these goals. All PGY1 residents spend 1 month on a general medicine ambulatory care rotation. PGY2 residents spend 3 months on an ambulatory block focusing on 8 core medicine subspecialties. Third-year residents spend 2 months on an advanced ambulatory rotation. The curriculum was started in July 2000 and has been highly regarded by the house staff, with statistically significant improvements in the PGY2 and PGY3 evaluation scores. By enhancing outpatient clinical teaching and didactics with an emphasis on the specific needs of our residents, we have been able to reframe the thinking and attitudes of a group of inpatient-oriented residents.
doi:10.1046/j.1525-1497.2003.20712.x
PMCID: PMC1494851  PMID: 12709096
medical education; residency training; ambulatory medicine
11.  Training family medicine residents to care for children 
Canadian Family Physician  2011;57(2):e46-e50.
Abstract
Problem addressed
There is a lack of consensus around the optimal way to train family medicine residents to care for children.
Objective of program
Evaluation of an ambulatory versus an inpatient pediatrics rotation for family medicine residents.
Program description
A 4-week pediatrics rotation for second-year family medicine residents was introduced involving half-day ambulatory pediatric clinics. A nonequivalent control group evaluation study design was followed. Patient logbook entries, as well as residents’ satisfaction, knowledge, and self-reported confidence outcomes were compared between family medicine residents completing the new ambulatory rotation and those completing a traditional inpatient-ambulatory pediatrics rotation.
Conclusion
An ambulatory rotation in pediatrics is a feasible option for facilitating family medicine resident learning in child health care. Residents report exposure to more patient cases that reflect a family practice office setting and the same level of knowledge and confidence as residents completing an inpatient-ambulatory rotation. Intraprofessional collaboration, flexibility in scheduling, and the support of pediatric preceptors are key factors in the organization and implementation of an ambulatory rotation.
PMCID: PMC3038832  PMID: 21321160
12.  Principles to Consider in Defining New Directions in Internal Medicine Training and Certification 
SGIM endoreses seven principles related to current thinking about internal medicine training: 1) internal medicine requires a full three years of residency training before subspecialization; 2) internal medicine residency programs must dramatically increase support for training in the ambulatory setting and offer equivalent opportunities for training in both inpatient and outpatient medicine; 3) in settings where adequate support and time are devoted to ambulatory training, the third year of residency could offer an opportunity to develop further expertise or mastery in a specific type or setting of care; 4) further certification in specific specialties within internal medicine requires the completion of an approved fellowship program; 5) areas of mastery in internal medicine can be demonstrated through modified board certification and recertification examinations; 6) certification processes throughout internal medicine should focus increasingly on demonstration of clinical competence through adherence to validated standards of care within and across practice settings; and 7) regardless of the setting in which General Internists practice, we should unite to promote the critical role that this specialty serves in patient care.
doi:10.1111/j.1525-1497.2006.00393.x
PMCID: PMC1828096  PMID: 16637826
education; medical; graduate; certification; internal medicine; hospitalists; ambulatory care
13.  BRIEF REPORT: Brief Instrument to Assess Geriatrics Knowledge of Surgical and Medical Subspecialty House Officers 
PROBLEM
Initiatives are underway to increase geriatrics training in nonprimary care disciplines. However, no validated instrument exists to measure geriatrics knowledge of house officers in surgical specialties and medical subspecialties.
METHODS
A 23-item multiple-choice test emphasizing inpatient care and common geriatric syndromes was developed through expert panels and pilot testing, and administered to 305 residents and fellows at 4 institutions in surgical disciplines (25% of respondents), emergency medicine (29%), medicine subspecialties (19%), internal medicine (12%), and other disciplines (15%).
RESULTS
Three items decreased internal reliability. The remaining 20 items covered 17 topic areas. Residents averaged 62% correct on the test. Internal consistency was appropriate (Cronbach's α coefficient = 0.60). Validity was supported by the use of expert panels to develop content, and by overall differences in scores by level of training (P<.0001) and graded improvement in test performance, with 58%, 63%, 62%, and 69% correct responses among HO1, HO2, HO3, and HO4s, respectively.
CONCLUSIONS
This reliable, valid measure of clinical geriatrics knowledge can be used by a wide variety of surgical and medical graduate medical education programs to guide curriculum reform or evaluate program performance to meet certification requirements. The instrument is now available on the web.
doi:10.1111/j.1525-1497.2006.00433.x
PMCID: PMC1484789  PMID: 16704394
measurement; internship and residency; education; surgery; specialists
14.  Teaching Internal Medicine Residents to Sustain Their Improvement Through the Quality Assessment and Improvement Curriculum 
ABSTRACT
INTRODUCTION
Although sustainability is a key component in the evaluation of continuous quality improvement (CQI) projects, medicine resident CQI projects are often evaluated by immediate improvements in targeted areas without addressing sustainability.
AIM/SETTING
To assess the sustainability of resident CQI projects in an ambulatory university-based clinic.
PROGRAM DESCRIPTION
During their ambulatory rotation, all second year internal medicine residents use the American Board of Internal Medicine’s Clinical Preventive Services (CPS) Practice Improvement Modules (PIM) to complete chart reviews, patient surveys, and a system survey. The residents then develop a group CQI project and collect early post data. Third year residents return to evaluate their original CQI project during an ambulatory rotation two to six months later and complete four plan-do-study-act (PDSA) cycles on each CQI project.
PROGRAM EVALUATION
From July 2006 to June 2009, 64 (100%) medicine residents completed the CQI curriculum. Residents completed six group projects and examined their success using early (2 to 6 weeks) and late (2 to 6 months) post-intervention data. Three of the projects demonstrated sustainable improvement in the resident continuity clinic.
DISCUSSION
When residents are taught principles of sustainability and spread and asked to complete multiple PDSA cycles, they are able to identify common themes that may contribute to success of QI projects over time.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-010-1547-y) contains supplementary material, which is available to authorized users.
doi:10.1007/s11606-010-1547-y
PMCID: PMC3019318  PMID: 21053089
resident education; quality improvement; sustainability; practice-based learning and improvement; system-based practice
15.  A tool for self-assessment of communication skills and professionalism in residents 
Background
Effective communication skills and professionalism are critical for physicians in order to provide optimum care and achieve better health outcomes. The aims of this study were to evaluate residents' self-assessment of their communication skills and professionalism in dealing with patients, and to evaluate the psychometric properties of a self-assessment questionnaire.
Methods
A modified version of the American Board of Internal Medicine's (ABIM) Patient Assessment survey was completed by 130 residents in 23 surgical and non-surgical training programs affiliated with a single medical school. Descriptive, regression and factor analyses were performed. Internal consistency, inter-item gamma scores, and discriminative validity of the questionnaire were determined.
Results
Factor analysis suggested two groups of items: one group relating to developing interpersonal relationships with patients and one group relating to conveying medical information to patients. Cronbach's alpha (0.86) indicated internal consistency. Males rated themselves higher than females in items related to explaining things to patients. When compared to graduates of U.S. medical schools, graduates of medical schools outside the U.S. rated themselves higher in items related to listening to the patient, yet lower in using understandable language. Surgical residents rated themselves higher than non-surgical residents in explaining options to patients.
Conclusion
This appears to be an internally consistent and reliable tool for residents' self-assessment of communication skills and professionalism. Some demographic differences in self-perceived communication skills were noted.
doi:10.1186/1472-6920-9-1
PMCID: PMC2631014  PMID: 19133146
16.  Patients’ assessment of professionalism and communication skills of medical graduates 
BMC Medical Education  2014;14:28.
Background
Professionalism and communication skills constitute important components of the integral formation of physicians which has repercussion on the quality of health care and medical education. The objective of this study was to assess medical graduates’ professionalism and communication skills from the patients’ perspective and to examine its association with patients’ socio-demographic variables.
Methods
This is a hospital based cross-sectional study. It involved 315 patients and 105 medical graduates selected by convenient sampling method. A modified and validated version of the American Board of Internal Medicine’s (ABIM) Patient Assessment survey questionnaire was used for data collection through a face to face interview. Data processing and analysis were performed using the Statistical Package for Social Science (SPSS) 16.0. Mean, frequency distribution, and percentage of the variables were calculated. A non-parametric Kruskal Wallis test was applied to verify whether the patients’ assessment was influenced by variables such as age, gender, education, at a level of significance, p ≤ 0.05.
Results
Female patients constituted 46% of the sample, whereas males constituted 54%. The mean age was 36 ± 16. Patients’ scoring of the graduate’s skills ranged from 3.29 to 3.83 with a mean of 3.64 on a five-point Likert scale. Items assessing the “patient involvement in decision-making” were assigned the minimum mean values, while items dealing with “establishing adequate communication with patient” assigned the maximum mean values. Patients, who were older than 45 years, gave higher scores than younger ones (p < 0.001). Patients with higher education reported much lower scores than those with lower education (p = 0.003). Patients’ gender did not show any statistically significant influence on the rating level.
Conclusion
Generally patients rated the medical graduates’ professionalism and communication skills at a good level. Patients’ age and educational level were significantly associated with the rating level.
doi:10.1186/1472-6920-14-28
PMCID: PMC3923249  PMID: 24517316
17.  Description of a Developmental Criterion-Referenced Assessment for Promoting Competence in Internal Medicine Residents 
Rationale
End-of- rotation global evaluations can be subjective, produce inflated grades, lack interrater reliability, and offer information that lacks value. This article outlines the generation of a unique developmental criterion-referenced assessment that applies adult learning theory and the learner, manager, teacher model, and represents an innovative application to the American Board of Internal Medicine (ABIM) 9-point scale.
Intervention
We describe the process used by Southern Illinois University School of Medicine to develop rotation-specific, criterion-based evaluation anchors that evolved into an effective faculty development exercise.
Results
The intervention gave faculty a clearer understanding of the 6 Accreditation Council for Graduate Medical Education competencies, each rotation's educational goals, and how rotation design affects meaningful work-based assessment. We also describe easily attainable successes in evaluation design and pitfalls that other institutions may be able to avoid. Shifting the evaluation emphasis on the residents' development of competence has made the expectations of rotation faculty more transparent, has facilitated conversations between program director and residents, and has improved the specificity of the tool for feedback. Our findings showed the new approach reduced grade inflation compared with the ABIM end-of-rotation global evaluation form.
Discussion
We offer the new developmental criterion-referenced assessment as a unique application of the competences to the ABIM 9-point scale as a transferable model for improving the validity and reliability of resident evaluations across graduate medical education programs.
doi:10.4300/01.01.0012
PMCID: PMC2931180  PMID: 21975710
18.  The 4∶1 Schedule: A Novel Template for Internal Medicine Residencies 
Background
It is widely acknowledged that there is need for redesign of internal medicine training. Duty hour restrictions, an increasing focus on patient safety, the possibility of inadequate training in ambulatory care, and a growing shortage of primary care physicians are some factors that fuel this redesign movement.
Intervention
We implemented a 4∶1 scheduling template that alternates traditional 4-week rotations with week-long ambulatory blocks. Annually, this provides 10 blocks of traditional rotations without continuity clinic sessions and 10 weeks of ambulatory experience without inpatient responsibilities. To ensure continuous resident presence in all areas, residents are divided into 5 groups, each staggered by 1 week.
Evaluation
We surveyed residents and faculty before and after the intervention, with questions focused on attitudes toward ambulatory medicine and training. We also conducted focus groups with independent groups of residents and faculty, designed to assess the benefits and drawbacks of the new scheduling template and to identify areas for future improvement.
Results
Overall, the scheduling template minimized the conflicts between inpatient and outpatient training, promoted a stronger emphasis on ambulatory education, allowed for focused practice during traditional rotations, and enhanced perceptions of team development. By creating an immersion experience in ambulatory training, the template allowed up to 180 continuity clinic sessions during 3 years of training and provided improved educational continuity and continuity of patient care.
Conclusion
Separating inpatient and ambulatory education allows for enhanced modeling of the evolving practice of internists and removes some of the conflict inherent in the present system.
doi:10.4300/JGME-D-10-00044.1
PMCID: PMC3010937  PMID: 22132275
19.  Outpatient Morning Report 
To clarify the use of outpatient morning report in internal medicine residency programs, we conducted a national survey of internal medicine residency directors and a local survey of a cohort of residents at a large teaching hospital. The program directors reported a 24% prevalence of outpatient morning report. The cohort of residents reported that the conference contributed much to their education by meeting specific learning needs and covering topics not covered elsewhere in their residency training.
doi:10.1046/j.1525-1497.2000.91109.x
PMCID: PMC1495611  PMID: 11119176
internship and residency; teaching; internal medicine; morning report
20.  An Assessment of Patient-Based and Practice Infrastructure–Based Measures of the Patient-Centered Medical Home: Do We Need to Ask the Patient? 
Health Services Research  2011;47(1 Pt 1):4-21.
Objective
To examine the importance of patient-based measures and practice infrastructure measures of the patient-centered medical home (PCMH).
Data Sources
A total of 3,671 patient surveys of 202 physicians completing the American Board of Internal Medicine (ABIM) 2006 Comprehensive Care Practice Improvement Module and 14,457 patient chart reviews from 592 physicians completing ABIM's 2007 Diabetes and Hypertension Practice Improvement Module.
Methodology
We estimated the association of patient-centered care and practice infrastructure measures with patient rating of physician quality. We then estimated the association of practice infrastructure and patient rating of care quality with blood pressure (BP) control.
Results
Patient-centered care measures dominated practice infrastructure as predictors of patient rating of physician quality. Having all patient-centered care measures in place versus none was associated with an absolute 75.2 percent increase in the likelihood of receiving a top rating. Both patient rating of care quality and practice infrastructure predicted BP control. Receiving a rating of excellent on care quality from all patients was associated with an absolute 4.2 percent improvement in BP control. For reaching the maximum practice-infrastructure score, this figure was 4.5 percent.
Conclusion
Assessment of physician practices for PCMH qualification should consider both patient based patient-centered care measures and practice infrastructure measures.
doi:10.1111/j.1475-6773.2011.01302.x
PMCID: PMC3447253  PMID: 22092245
Patient-centered care; practice infrastructure; medical home; blood pressure control
21.  The use of standardized patients for mock oral board exams in neurology: a pilot study 
Background
Mock oral board exams, fashioned after the live patient hour of the American Board of Psychiatry and Neurology exam, are commonly part of resident assessment during residency training. Exams using real patients selected from clinics or hospitals are not standardized and do not allow comparisons of resident performance across the residency program. We sought to create a standardized patient mock oral board exam that would allow comparison of residents' clinical performance.
Methods
Three cases were created and then used for this mock oral boards exercise utilizing trained standardized patients. Residents from the University of Cincinnati and Indiana University participated in the exam. Residents were scored by attending physician examiners who directly observed the encounter with the standardized patient. The standardized patient also assessed each resident. A post-test survey was administered to ascertain participant's satisfaction with the examination process.
Results
Resident scores were grouped within one standard deviation of the mean, with the exception of one resident who was also subjectively felt to "fail" the exam. In exams with two faculty "evaluators", scores were highly correlated. The survey showed satisfaction with the examination process in general.
Conclusion
Standardized patients can be used for mock oral boards in the live patient format. Our initial experience with this examination process was positive. Further testing is needed to determine if this examination format is more reliable and valid than traditional methods of assessing resident competency.
doi:10.1186/1472-6920-6-22
PMCID: PMC1464094  PMID: 16638135
22.  Did I Answer Your Question? 
Accurately recognizing the learning goals of trainees should enhance teachers' effectiveness. We sought to determine how commonly such recognition occurs and whether it improves residents' satisfaction with the teaching interaction. In a cross-sectional survey of 97 internal medicine residents and 42 ambulatory clinic preceptors in five ambulatory care clinics in Washington and Oregon, we systematically sampled 236 dyadic teaching interactions. Each dyad participant independently indicated the residents' perceived learning needs from a standardized list. Overall, the preceptors' recognition of the residents' learning needs, as measured by percentage of agreement between preceptors and residents on the learning topics, was modest (κ 0.21, p = .02). The percentage of agreement for all topics was 43%, ranging from 8% to 66%. Greater time pressures were associated with lower agreement (38% vs 56% for the highest and lowest strata of resident-reported time pressure; 15% vs 43% for highest and lowest strata of preceptor-reported time pressure). Agreement increased as the number of sessions the pair had worked together increased (62% for pairs with >20 vs 17% for pairs with 0 previous sessions). Satisfaction with teaching encounters was high (4.5 on a 5-point scale) and unrelated to the degree of agreement (p = .92). These findings suggest that faculty development programs should emphasize precepting skills in recognizing residents' perceived learning needs and that resident clinics should be redesigned to maximize preceptor-resident continuity and minimize time pressure.
doi:10.1046/j.1525-1497.2000.11318.x
PMCID: PMC1495324  PMID: 10632833
ambulatory care; residents; medical education; adult learning theory
23.  Changing Habits of Practice 
Journal of General Internal Medicine  2005;20(12):1181-1187.
Purpose
The majority of health care, both for acute and chronic conditions, is delivered in the ambulatory setting. Despite repeated proposals for change, the majority of internal medicine residency training still occurs in the inpatient setting. Substantial changes in ambulatory education are needed to correct the current imbalance. To assist educators and policy makers in this process, this paper reviews the literature on ambulatory education and makes recommendations for change.
Methods
The authors searched the Medline, Psychlit, and ERIC databases from 2000 to 2004 for studies that focused specifically on curriculum, teaching, and evaluation of internal medicine residents in the ambulatory setting to update previous reviews. Studies had to contain primary data and were reviewed for methodological rigor and relevance.
Results
Fifty-five studies met criteria for review. Thirty-five of the studies focused on specific curricular areas and 11 on ambulatory teaching methods. Five involved evaluating performance and 4 focused on structural issues. No study evaluated the overall effectiveness of ambulatory training or investigated the effects of current resident continuity clinic microsystems on education.
Conclusion
This updated review continues to identify key deficiencies in ambulatory training curriculum and faculty skills. The authors make several recommendations: (1) Make training in the ambulatory setting a priority. (2) Address systems problems in practice environments. (3) Create learning experiences appropriate to the resident's level of development. (4) Teach and evaluate in the examination room. (5) Expand subspecialty-based training to the ambulatory setting. (6) Make faculty development a priority. (7) Create and fund multiinstitutional educational research consortia.
doi:10.1111/j.1525-1497.2005.0248.x
PMCID: PMC1490278  PMID: 16423112
ambulatory; graduate medical education; curriculum; faculty development; internal medicine
24.  Maintenance of certification in Internal Medicine: participation rates and patient outcomes 
The clinical practice of internal medicine continues to evolve with the addition of new information and new technology. Most internists in practice will have erosion of their knowledge after they complete training unless life-long learning occurs. The American Board of Internal Medicine (ABIM) began to issue time-limited certification in 1990 and asserts that the Maintenance of Certification (MOC) program promotes the professional development of internists. However, the available medical literature does not provide strong support for the assumption that internists with certification or recertification have better patient outcomes. This relationship between recertification and patient outcomes needs more study. In addition, the participation in the Maintenance of Certification program by internists with lifetime certifications has been low, and recertification by leaders in internal medicine has also been relatively low. Some physicians in practice have concerns about the relevance of the program and the cost. Our review suggests that the ABIM needs to review its current Maintenance of Certification program and make changes to enhance its clinical relevance and educational value. We suggest that professional development should be based on focused reviews of the current literature, which is immediately relevant to clinical practice, and that recertification could be based on completion of modules and more frequent, less onerous testing.
doi:10.3402/jchimp.v2i4.19753
PMCID: PMC3715151  PMID: 23882382
certification; recertification; internal medicine; patient outcomes; mortality
25.  Alternative Approaches to Ambulatory Training: Internal Medicine Residents’ and Program Directors’ Perspectives 
ABSTRACT
BACKGROUND
Internal medicine ambulatory training redesign, including recommendations to increase ambulatory training, is a focus of national discussion. Residents’ and program directors’ perceptions about ambulatory training models are unknown.
OBJECTIVE
To describe internal medicine residents’ and program directors’ perceptions regarding ambulatory training duration, alternative ambulatory training models, and factors important for ambulatory education.
DESIGN
National cohort study.
PARTICIPANTS
Internal medicine residents (N = 14,941) and program directors (N = 222) who completed the 2007 Internal Medicine In-Training Examination (IM-ITE) Residents Questionnaire or Program Directors Survey, representing 389 US residency programs.
RESULTS
A total of 58.4% of program directors and 43.7% of residents preferred one-third or more training time in outpatient settings. Resident preferences for one-third or more outpatient training increased with higher levels of training (48.3% PGY3), female sex (52.7%), primary care program enrollment (64.8%), and anticipated outpatient-focused career, such as geriatrics. Most program directors (77.3%) and residents (58.4%) preferred training models containing weekly clinic. Although residents and program directors reported problems with competing inpatient-outpatient responsibilities (74.9% and 88.1%, respectively) and felt that absence of conflict with inpatient responsibilities is important for good outpatient training (69.4% and 74.2%, respectively), only 41.6% of residents and 22.7% of program directors supported models eliminating ambulatory sessions during inpatient rotations.
CONCLUSIONS
Residents’ and program directors’ preferences for outpatient training differ from recommendations for increased ambulatory training. Discordance was observed between reported problems with conflicting inpatient-outpatient responsibilities and preferences for models maintaining longitudinal clinic during inpatient rotations. Further study regarding benefits and barriers of ambulatory redesign is needed.
doi:10.1007/s11606-009-1015-8
PMCID: PMC2710468  PMID: 19475458
medical education-graduate; ambulatory care; curriculum/program evaluation; medical student and residency education

Results 1-25 (502681)