Medical ResidentsUniversity of Washington

Amy FieldsMarch 6, 2003LIS 528

Educational Requirements Successful completion of medical

school Award of Medical Degree

University of Washington Residency Program The Department of Medicine

administers three fully accredited internal medicine residency pathways

University of Washington Residency Program1. Traditional or categorical pathway2. Seattle Primary Care Internist Pathway3. Seattle/Boise Primary Care Internist

PathwayIn addition:

1. A preliminary (one year) internship for individuals going into other specialties but who would like a year of broad exposure to internal medicine

Practice Description ACGME general competencies

requirements for Residency training programs require residents to have education experiences that allow them to demonstrate competency in the following areas:

Practice Description

1) patient care, 2) medical knowledge, 3) practice-based learning and

improvement,4) interpersonal and communication

skills, 5) professionalism, and 6) systems-based practice

Current Problems/Issues facing Medical Residents Resident burnout Work hours

Resident Burnout

Concerns: 30-40 years ago Parking spaces Midnight snacks Off-hours access to library

Ann Inn Med, 2002

Resident BurnoutConcerns: present

Patients are sicker Hospital stays shorter Attendings are more hassled More residents are married Many have children Great many more are women

Ann Inn Med, 2002

Resident Burnout

Concerns: present Fewer opportunities to establish

relationships with patients, peers and faculty

Amount of debt incurred getting degree major source of stress

Ann Inn Med, 2002

Self-reported burnout studyEffects on patient care

(results of UW cross-sectional study)

February 2001 a 92-item, self-administered survey was sent to all residents in the internal Medicine Program

Burnout was measured using the Maslach Burnout Inventory (MBI)

Ann Inn Med, 2002

Self-reported burnout study MBI evaluates three domains of

burnout1) Emotional exhaustion2) depersonalization3) personal accomplishment

Self-reported burnout study Study defined burnout as a high

score on the depersonalization or emotional exhaustion subscales.

76% met criteria Burned-out residents are 2-3 times

more likely to report suboptimal patient care practices at least monthly or weekly

Resident work hours

ACGME (to be implemented by July 2003):

“Total Duty Hours” must not exceed 80 hours per week, averaged over a four week period

Workdays that exceed 12 hours are defined as on-call

Past information needs studies Information needs during clinical

activity Online searching skills of residents

Information needs during clinical activity

Observational Study Anthropologist observed

communication among subjects re: their information needs

Coding scheme was developed for describing information requests

Ann Inn Med 1991

Information needs during clinical activity

Study Results Average: 5 clinical questions raised for each

patient 52% requested a fact that could be found in

patient medical record 23% were potentially answerable by a textbook,

journal, or MEDLINE 26% required synthesis of patient information

and medical knowledge.

Ann Inn Med 1991

Online Searching

Study of residents Philadelphia in 1997: 39% described their MEDLINE searching

skills as only fair or poor 56% felt teaching in this area would be

very helpful

Journal of Medical Library Association (JMLA), 2002

Online SearchingOffered a 3-hour workshop: Residents did a pretest MEDLINE search

and then a posttest search after the workshop

More that ½ residents after ambulatory care rotation rated the workshop as one of the best learning experiences of their rotation

Journal of Medical Library Association (JMLA), 2002

Online SearchingContinued MEDLINE searching: Percentage of residents using techniques

learned in workshop for searching MEDLINE improved significantly

In self-directed MEDLINE searches later in the year Residents continued to demonstrate improved skills

After this pilot study, the workshop was implemented with all second-year medicine residents

Journal of Medical Library Association (JMLA), 2002

Service to meet the needs of Residents PrimeAnswers:  The specific aims of

the project will help determine if a simplification or reduction in the simplification or reduction in the barriers to access and speed of barriers to access and speed of information retrieval can information retrieval can enhance patient careenhance patient care..

Service to meet the needs of Residents

PrimeAnswers for Residents Help with (decreasing/managing)

work hours Aid in learning process Aid in effective patient care

Service to meet the needs of Residents

Clinical Medical Librarians Attend reports/conferences Literature searches Teach (PrimeAnswers, PubMed,

MeSH, Medline, etc.)

Approach to the service PrimeAnswers – Add teaching component 2004 Grant Proposal: “support learning at

the point of care through a system of information objects organized by clinical educators for residents and patients (PrimeConditions)”

Clinical Medical Librarian – Add more of them

Measure of its effectiveness PrimeAnswers already proven

effective for faculty PrimeAnswers averages 5000 hits

per month Clinical Medical Librarian already

proven effective for Residents

Measure of its effectiveness Survey Residents

Similar to 1993 survey of UW Residents re CML

Clinical Librarian Program study

Survey

Starting in November 1993, time was allotted at Resident Report to evaluate the information supplied by the CML.

Residents were asked to name the principal diagnosis of a patient for which an information request of the literature was made.

In 6 months' time, 31 questionnaires were returned with the following results:

Internal Medicine Residents Survey Results III11/93 - 4/94

 Information supplied was useful or relevant 100% YES 

Information supplied provided new knowledge 100% YES 

Information supplied substantiated what I 77% YES

already knew or suspected 23% NO

Information supplied did (or will) contribute 100% YES

to better informed clinical decisions

 

Conclusion With the explosion of new medical

information and limitations on resident work hours and attendings teaching time, more efficient ways to teach residents must be implemented

Conclusion A system like PrimeAnswers that

presents concepts in small chunks, making the content searchable, and that provides links to existing digital textbooks and journal articles is a great tool to meet the needs of this group