Biomedical subjects

Brent W Beasley

Publications and source records attributed to Brent W Beasley.

13 recordsLinked to original sources

PubMed2006

Personal growth during internship: a qualitative analysis of interns' responses to key questions.

BACKGROUND: During clinical training, house officers frequently encounter intense experiences that may affect their personal growth. The purpose of this study was to explore processes related to personal growth during internship. DESIGN: Prospective qualitative study conducted over the course of internship. PARTICIPANTS: Thirty-two postgraduate year (PGY)-1 residents from 9 U.S. internal medicine training programs. APPROACH: Every 8 weeks, interns responded by e-mail to an open-ended question related to personal growth. Content analysis methods were used to analyze the interns' writings to identify triggers, facilitators, and barriers related to personal growth. RESULTS: Triggers for personal growth included caring for critically ill or dying patients, receiving feedback, witnessing unprofessional behavior, experiencing personal problems, and dealing with the increased responsibility of internship. Facilitators of personal growth included supportive relationships, reflection, and commitment to core values. Fatigue, lack of personal time, and overwhelming work were barriers to personal growth. The balance between facilitators and barriers may dictate the extent to which personal growth occurs. CONCLUSIONS: Efforts to support personal growth during residency training include fostering supportive relationships, encouraging reflection, and recognizing interns' core values especially in association with powerful triggers.

Attitude of Health Personnel↗

PubMed2006

Perceived, actual, and desired knowledge regarding Medicare billing and reimbursement. A national needs assessment survey of internal medicine residents.

BACKGROUND: Economics and reimbursement have become a daily part of practicing physicians' lives. Yet, few internal medicine (IM) programs have offered formal curricula during residency about practice management or economics. OBJECTIVE: To determine perceived, desired, and actual knowledge of Medicare billing and reimbursement among residents compared with community-based General Internists. DESIGN AND PARTICIPANTS: Cross-sectional needs assessment survey of community and university-based second-year IM residents from 4 geographic regions of the United States. RESULTS: One hundred and thirty-three second-year IM residents completed the questionnaire. Residents rated their level of knowledge about Medicare as a 2.0 (SD=0.9) on a Likert scale (1="very low," 5="very high"). Residents agreed that Medicare reimbursement should be taught in residency with a score of 4.0 (SD=1.1; 1="strongly disagree," 5="strongly agree" SD=1.1). On the knowledge assessment portion of the questionnaire, residents scored significantly lower than a group of general IM physicians who completed the same questions (percent correct=41.8% vs 59.0%, P<.001). Residents' scores correlated with their self-assessed level of knowledge (P=.007). CONCLUSIONS: Our study demonstrates that second year IM residents feel they have a low level of knowledge regarding outpatient Medicare billing, and have a lower test score than practicing Internists to back up their feelings. The residents also strongly agree that they do not receive enough education about Medicare reimbursement, and believe it should be a requirement in residency training.

Cross-Sectional Studies↗

PubMed2005

A time to be promoted. The Prospective Study of Promotion in Academia (Prospective Study of Promotion in Academia).

OBJECTIVE: The study's objectives were to determine (1) the rate at which department of medicine faculty in the United States are promoted, (2) if clinician-educators (CEs) are promoted to Associate Professor at the same rate as clinician-investigators (CIs), and (3) the variables that predict promotion. METHODS: The Prospective Study of Promotion in Academia was a part-retrospective, part-prospective (from 2000 to 2003) cohort study. Six-hundred and four Internal Medicine junior faculty across the United States who had been registered as new appointees with the Association of American Medical Colleges in 1995 were invited to participate. Twenty-one percent of these had already left their institution when the study began. One hundred and eighty-three Internal Medicine faculty from 87 institutions in 35 states enrolled. The main outcome measure was the time from appointment as Assistant Professor to promotion to Associate Professor. RESULTS: Follow-up was complete for all 183 faculty. Among the faculty that achieved promotion, the estimated median time to promotion was 6.0 years (95% Conf. Int.=5.8 to 6.2). The unadjusted sixth-year promotion rate for CEs was 16%, while for CIs it was 26% (P=.002). Independent negative predictors of promotion included low amount of research time (Hazard Ratio [HR] =0.3, 95% Conf. Int.=0.2 to 0.5), having a manuscript review service (HR=0.4, 95% Conf. Int.=0.2 to 0.7), never meeting with Chairman/Chief about promotion (HR=0.4, 95% Conf. Int.=0.2 to 0.7), low job satisfaction (HR=0.5, 95% Conf. Int.=0.3 to 0.9), and working in the Northeast (HR=0.6, 95% Conf. Int.=0.4 to 1.1). Positive predictors included making between 130 dollars and 149,000 dollars per year (HR=1.9, 95% Conf. Int.=1.1 to 3.4), working more than 60 h/wk (HR=1.9, 95% Conf. Int.=1.1 to 3.0), having a career mentor available (HR=1.8, 95% Conf. Int.=1.1 to 2.9), and having access to a grant office (HR=1.6, 95% Conf. Int.=1.0 to 2.6). CONCLUSION: CEs and CIs appear to be promoted at different rates. The characteristics that are independently associated with earlier promotion may be helpful for institutions and individual faculty that are committed to achieving promotion efficiently.

Adult↗

PubMed2004

Motivating factors for academic physicians within departments of medicine.

OBJECTIVE: To understand what motivates academic physicians at a time when physician dissatisfaction is prevalent. SUBJECTS AND METHODS: Of a cohort of 480 physician faculty members (identified from the Association of American Medical Colleges faculty roster) hired at the assistant professor level, 183 were monitored prospectively for a characterization of their success in achieving promotion. In mid-2001, follow-up data were collected about the factors that physicians described as motivating in their work. We conducted this study to understand the differences in motivators between clinician-educators and cliniclan-investigators and between male and female physicians, as well as to validate a previously used instrument developed to assess motivation and occupational values. RESULTS: Of 183 physicians monitored, 144 (79%) responded to an interim follow-up questionnaire. Factor analysis revealed that physicians' occupational motivators could be grouped statistically into 3 factors: self-expression, helping others, and extrinsic rewards. Compared with clinician-educators, clinician-investigators were more motivated in their current work by having the ability to express themselves (composite factor score, 4.30 vs 3.84; P<.001). Clinician-investigators also rated 4 of the 6 items within the factor of self-expression as being significantly stronger motivators for them than did the clinician-educators. Compared with male physicians, female physicians Indicated they were more motivated by helping others (composite factor score, 4.18 vs 3.89; P=.03). CONCLUSIONS: Factors that motivate physicians appear to be different for clinician-investigators and clinician-educators as well as for male and female physicians. Understanding the inspiration for physicians may help medical leadership to better motivate and relate to their physician workforce.

Faculty, Medical↗

PubMed2003

Promotion criteria for clinician-educators.

OBJECTIVE: Department of medicine chairs have a critical role in the promotion of clinician-educators. Our primary objective was to determine how chairs viewed: 1) the importance of specific areas of clinician-educator performance in promotion decisions; and 2) the importance and quality of information on available measures of performance. A secondary objective was to compare the views of department chairs with those of promotion and tenure committee chairs. METHODS: In October 1997, a questionnaire was mailed to all department chairs in the United States and Canada asking them to rate the importance of 11 areas of clinician-educators' performance in evaluating them for promotion. We also asked them to rate 36 measures of performance. We compared their responses to a similar 1996 survey administered to promotion committee chairs. RESULTS: One hundred fourteen of 139 department chairs (82%) responded to the survey. When considering a clinician-educator for promotion, department chairs view teaching skills and clinical skills as the most important areas of performance, as did the promotion committee chairs. Of the measures used to evaluate teaching performance, teaching awards were considered most important and rated as a high-quality measure. When evaluating a clinician-educator's clinical skills, peer and trainee evaluation were considered as the most important measures of performance, but these were rated low in quality. Patient satisfaction and objective outcome measures also were viewed as important measures that needed improvement. Promotion committee chairs placed more emphasis on productivity in publications and external grant support when compared to department chairs. CONCLUSION: It is reassuring that both department chairs and promotion committee chairs value teaching skills and clinical skills as the most important areas of a clinician-educator's performance when evaluating for promotion. However, differences in opinion regarding the importance of several performance measures and the need for improved quality measures may represent barriers to the timely promotion of clinician-educators.

Academic Medical Centers↗

PubMed2003

Rehabilitation for patients with chronic obstructive pulmonary disease: meta-analysis of randomized controlled trials.

OBJECTIVE: To develop a meta-analysis to determine the effectiveness of rehabilitation in patients with chronic obstructive pulmonary disease (COPD). DATA SOURCES: medline, cinhal, and Cochrane Library searches for trials of rehabilitation for COPD patients. Abstracts presented at national meetings and the reference lists of pertinent articles were reviewed. STUDY SELECTION: Studies were included if: trials were randomized; patients were symptomatic with forced expiratory volume in one second (FEV1) <70% or FEV1 divided by forced vital capacity (FEV1/FVC) <70% predicted; rehabilitation group received at least 4 weeks of rehabilitation; control group received no rehabilitation; and outcome measures included exercise capacity or shortness of breath. We identified 69 trials, of which 20 trials were included in the final analysis. DATA EXTRACTION: Effect of rehabilitation was calculated as the standardized effect size (ES) using random effects estimation techniques. RESULTS: The rehabilitation groups of 20 trials (979 patients) did significantly better than control groups on walking test (ES = 0.71; 95% confidence interval [95% CI], 0.43 to 0.99). The rehabilitation groups of 12 trials (723 patients) that used the Chronic Respiratory Disease Questionnaire had less shortness of breath than did the control groups (ES = 0.62; 95% CI, 0.35 to 0.89). Trials that used respiratory muscle training only showed no significant difference between rehabilitation and control groups, whereas trials that used at least lower-extremity training showed that rehabilitation groups did significantly better than control groups on walking test and shortness of breath. Trials that included severe COPD patients showed that rehabilitation groups did significantly better than control groups only when the rehabilitation programs were 6 months or longer. Trials that included mild/moderate COPD patients showed that rehabilitation groups did significantly better than control groups with both short- and long-term rehabilitation programs. CONCLUSION: COPD patients who receive rehabilitation have a better exercise capacity and they experience less shortness of breath than patients who do not receive rehabilitation. COPD patients may benefit from rehabilitation programs that include at least lower-extremity training. Patients with mild/moderate COPD benefit from short- and long-term rehabilitation, whereas patients with severe COPD may benefit from rehabilitation programs of at least 6 months.

Dyspnea↗

PubMed2003

Looking forward to promotion: characteristics of participants in the Prospective Study of Promotion in Academia.

OBJECTIVES: To determine what clinician-educators consider important for promotion, and what support they find helpful and useful for success. DESIGN: Cross-sectional study. SETTING: Eighty academic medical centers in the United States. PARTICIPANTS: One hundred eighty-three participants of the Prospective Study of Promotion in Academia comprising assistant professors in departments of medicine from 80 different medical schools in 35 states. MEASUREMENTS: Differences between clinician-educators' and clinician-investigators' work activities, promotion preparedness, and faculty support needs. RESULTS: One hundred seven (58%) of the faculty were clinician-educators (CEs), and 63 (34%) were clinician-investigators (CIs); the remaining 13 fit neither category. Participants had been in their faculty position for 4.7 years. Ninety-eight percent of CIs reported a publication expectation for promotion, and 75% of CEs also reported such an expectation. More CIs had career mentors available than CEs (68% vs 32%, P <.001). Seventy-nine percent of CIs indicated >10% protected scholarly work time, compared to only 35% of CEs (P <.001). Fifty-three percent of CIs as compared to 32% of CEs (P <.01) meet more often than yearly with their chief/chair for performance review, and more CIs have seen written promotion guidelines (72% vs 51%, P <.01). Clinician educators believed out of 11 job performance areas, research, written scholarship, and reputation were the 3 most important factors that would determine the success of their application for promotion. Both CEs and CIs sense that CIs are more likely get promoted (82% vs 79%). CONCLUSIONS: Clinician educators are less familiar with promotion guidelines, meet less often with superiors for performance review, and have less protected time than CI colleagues. There is dissonance between CEs' beliefs and previously published data from promotion committee chairs in the importance given to specific aspects of job performance.

Academic Medical Centers↗

PubMed2003

Incidence of venous thromboembolic events among nursing home residents.

Chronic care facility stay has been shown to be an independent risk factor for venous thromboembolism. Review of the literature, however, reveals a paucity of data addressing the issue of venous thromboembolism in nursing home residents. The purpose of this study was to determine the incidence of venous thromboembolic events among nursing home residents. A retrospective cohort study was derived from data compiled in the State of Kansas Minimum Data Set (MDS) for nursing home residents from July 1, 1997 to July 1, 1998. A total of 18,661 residents (median age, 85 years, 74% female, 95% white) satisfied the study criteria. The outcome measures of the primary endpoint-development of a venous thromboembolic event (VTE)-were obtained from the MDS quarterly health assessments and the Medicare ICD-9 codes. We determined the incidence of VTE among nursing home residents as 1.30 events per 100 person-years of observation.

Aged↗

PubMed2002

Evidence-based medicine knowledge, attitudes, and skills of community faculty.

CONTEXT: As medical schools turn to community physicians for ambulatory care teaching, assessing the preparation of these faculty in principles of evidence-based medicine (EBM) becomes important. OBJECTIVE: To determine the knowledge and attitudes of community faculty concerning EBM and their use of EBM in patient care and teaching. DESIGN: Cross-sectional survey conducted from January to March of 2000. SETTING: A clinical campus of a state medical school; a midwestern city of a half-million people with demographics close to national means. MAIN OUTCOME MEASURES: Comparisons of community faculty with full-time faculty in perceived importance and understanding of EBM (5-point scale), knowledge of EBM, and use of EBM in patient care and teaching. MAIN RESULTS: Responses were obtained from 63% (177) of eligible community faculty and 71% (22) of full-time faculty. Community faculty considered EBM skills to be less important for daily practice than did full-time faculty (3.1 vs 4.0; P < .01). Primary care community faculty were less confident of their EBM knowledge than were subspecialty community or full-time faculty (2.9 vs 3.3 vs 3.6; P < .01). Objective measures of EBM knowledge showed primary care and subspecialty community faculty about equal and significantly below full-time faculty (P < .01). Thirty-three percent of community faculty versus 5% of full-time faculty do not incorporate EBM principles into their teaching (P < .01). CONCLUSIONS: Community faculty are not as equipped or motivated to incorporate EBM into their clinical teaching as are full-time faculty. Faculty development programs for community faculty should feature how to use and teach basic EBM concepts.

Adult↗

PubMed2002

Benchmarks of support in internal medicine residency training programs.

PURPOSE: To identify benchmarks of financial and staff support in internal medicine residency training programs and their correlation with indicators of quality. METHOD: A survey instrument to determine characteristics of support of residency training programs was mailed to each member program of the Association of Program Directors of Internal Medicine. Results were correlated with the three-year running average of the pass rates on the American Board of Internal Medicine certifying examination using bivariate and multivariate analyses. RESULTS: Of 394 surveys, 287 (73%) were completed: 74% of respondents were program directors and 20% were both chair and program director. The mean duration as program director was 7.5 years (median = 5), but it was significantly lower for women than for men (4.9 versus 8.1; p =.001). Respondents spent 62% of their time in educational and administrative duties, 30% in clinical activities, 5% in research, and 2% in other activities. Most chief residents were PGY4s, with 72% receiving compensation additional to base salary. On average, there was one associate program director for every 33 residents, one chief resident for every 27 residents, and one staff person for every 21 residents. Most programs provided trainees with incremental educational stipends, meals while oncall, travel and meeting expenses, and parking. Support from pharmaceutical companies was used for meals, books, and meeting expenses. Almost all programs provided meals for applicants, with 15% providing travel allowances and 37% providing lodging. The programs' board pass rates significantly correlated with the numbers of faculty fulltime equivalents (FTEs), the numbers of resident FTEs per office staff FTEs, and the numbers of categorical and preliminary applications received and ranked by the programs in 1998 and 1999. Regression analyses demonstrated three independent predictors of the programs' board pass rates: number of faculty (a positive predictor), percentage of clinical work performed by the program director (a negative predictor), and financial support from pharmaceutical companies (also a negative predictor). CONCLUSIONS: These results identify benchmarks of financial and staff support provided to internal medicine residency programs. Some of these benchmarks are correlated with board pass rate, an accepted indicator of quality in residency training. Program directors and chairs can use this information to identify areas that may benefit from enhanced financial and administrative support.

Benchmarking↗

PubMed2002

Determining the predictors of internal medicine residency accreditation: what they do (not what they say).

PURPOSE: The Accreditation Council for Graduate Medical Education and the Residency Review Committee for Internal Medicine (RRC-IM) evaluate internal medicine residency programs using a list of 301 program requirements. The authors investigated which requirements, program demographics, and site-visitor characteristics were the strongest predictors of accreditation. METHOD: The authors surveyed the program directors of all 405 accredited internal medicine residency programs in February 1998, obtaining data on the duration of the accreditation process, site visitors, and number and quality of citations. They also requested a copy of the notification letter containing citations and length of time until the next accreditation site visit (cycle length). RESULTS: A total of 217 responses (54%) was received. The mean cycle length was 3.0 years, and the accreditation process averaged 14.5 months. Smaller programs had a shorter average cycle length. Site visitors were reported to be prepared and professional overall. However, site visitors with the lowest evaluations by program directors were associated with shorter cycle lengths. Four program characteristics and program citations accounted for 60% of the variation in cycle length: total number of citations in the notification letter, percentage of graduates passing the American Board of Internal Medicine Certifying Examination, inadequate demonstration of resident scholarship, and inadequate ambulatory care experience. CONCLUSION: The authors devised an independent mechanism for determining the duration of the RRC-IM review process, influence of program demographics on the process, influence of site visitors on the accreditation action, and program requirements having the greatest effect on cycle length.

Accreditation↗

PubMed2002

Utility of palmtop computers in a residency program: a pilot study.

BACKGROUND: With advancing technology and flourishing medical information on the Internet, we studied the use of palmtop (handheld) computers by internal medicine residents. METHODS: At a university-community hospital consortium, nine internal medicine residents and their program director participated in an 8-month cohort pilot study using palmtop computers with desktop synchronization and Internet access capabilities. RESULTS: After 2 months of use, the residents had found a variety of uses for palmtop computers, such as the calendar, downloading residency-provided medical information, taking lecture notes, using a spreadsheet for common formulas, Internet/MEDLINE searching with modem access, infrared file transfer, downloading call schedules, and patient tracking. At 8 months, the residents were comfortable using palmtops on a daily basis. Technical difficulties included cumbersome modem cords, incompatible platforms and difficult Internet access at times, finding analog telephone lines in the hospital, and synchronization with home computers. CONCLUSION: Palmtop computers are useful in the residency setting, and residents are capable of devising ways to use palmtops to suit their individual needs.

Humans↗

PubMedDate not supplied

Comparing practice differences of residency graduates: implications for curricular change.

OBJECTIVE: To document and assess differences in the practice experiences and practice patterns of graduates from two similar sized but regionally separated community-based internal medicine residency programs. RESULTS: Sixty percent responded to the survey. Responses from graduates practicing general internal medicine were used in the analyses (Wichita n = 20; Baystate n = 23). Only graduates from Wichita were in solo practice (15%). Baystate graduates had a significantly higher percentage of HMO patients (32% vs. 17%, p < .05). A higher percentage of Kansas respondents worked in a community with a population of less than 50,000 (55% vs. 26%, p = .052). Of 28 components of a residency curriculum, 7 were considered significantly more important to daily practice by Kansas respondents than by Baystate respondents: Critical Care, Dermatology, Gastroenterology, Nephrology, Neurology, Occupational Medicine, and Rheumatology. Kansas respondents performed on average significantly more procedures than Massachusetts respondents in the last year in 6 of 16 procedures: bone marrow biopsy, exercise stress tests, flexible sigmoidoscopy, liquid nitrogen, skin biopsy, and thoracentesis. The procedures of skin biopsy, stress testing, and the curricula of dermatology, nephrology, neurology and rheumatology remained significantly different when controlled for the size of the community population (<50,000). Wichita graduates scored higher on the practice intensity measure than Baystate graduates. CONCLUSIONS: We have documented differences in the importance of particular curricula, procedures, and practice intensity likely related to the community population in which residency graduates practice. Understanding the needs of graduates and incorporating this information into existing rotations or new initiatives is integral to the ongoing development of residency curricula.

Catchment Area, Health↗