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Biomedical subjects

D C Yao

Publications and source records attributed to D C Yao.

6 recordsLinked to original sources
PubMed2001

The challenge of problem residents.

Internal medicine residency training is demanding and residents can experience a wide variety of professional and personal difficulties. Residency programs everywhere have had and will continue to have problem residents. Training programs should be equipped to effectively identify and manage residents who experience problems. Previous articles that have been published on the topic of problem residents primarily addressed concerns such as impairment due to depression and substance abuse. The content of this article is derived from a comprehensive review of the literature as well as other data sources such as interviews with program directors and workshops at national professional meetings. This article focuses primarily on four issues related to problem residents: their identification, underlying causes, management, and prevention. The study attempts to be evidence-based, wherever possible, highlighting what is known. Recommendations based on the synthesis of the data are also made. Future ongoing studies of problem residents will improve our understanding of the matters involved, and may ultimately lead to improved outcomes for these trainees.

Clinical Competence↗
PubMed2000

National survey of internal medicine residency program directors regarding problem residents.

CONTEXT: Internal medicine residency training is demanding and residents can experience a wide variety of professional and personal difficulties. A problem resident is defined by the American Board of Internal Medicine as "a trainee who demonstrates a significant enough problem that requires intervention by someone of authority." Data are sparse regarding identification and management of such residents. OBJECTIVE: To gain more understanding of the prevalence, identification, management, and prevention of problem residents within US internal medicine residency programs. DESIGN, SETTING, AND PARTICIPANTS: Mailed survey of all 404 internal medicine residency program directors in the United States in October 1999, of whom 298 (74%) responded. MAIN OUTCOME MEASURES: Prevalence of problem residents; type of problems encountered; factors associated with identification and management of problem residents. RESULTS: The mean point prevalence of problem residents during academic year 1998-1999 was 6.9% (SD, 5.7%; range, 0%-39%), and 94% of programs had problem residents. The most frequently reported difficulties of problem residents were insufficient medical knowledge (48%), poor clinical judgment (44%), and inefficient use of time (44%). Stressors and depression were the most frequently identified underlying problems (42% and 24%, respectively). The most frequent processes by which problem residents were discovered included direct observation (82%) and critical incidents (59%). Chief residents and attending physicians most frequently identified problem residents (84% and 76%, respectively); problem residents rarely identified themselves (2%). Many program directors believed that residents who are from an underrepresented minority, are international medical graduates, or are older than 35 years are at increased risk of being identified as a problem resident (P<.05). Program directors believed that frequent feedback sessions (65%) and an assigned mentor for structured supervision (53%) were the most helpful interventions. CONCLUSION: Nearly all internal medicine residency programs in this sample had problem residents, whose presenting characteristics and underlying issues were diverse and complex. JAMA. 2000;284:1099-1104

Administrative Personnel↗
PubMed1995

Bronchogenic carcinoma in 13 patients infected with the human immunodeficiency virus (HIV): clinical and radiographic findings.

Bronchogenic carcinoma is a cause of parenchymal or hilar masses with or without mediastinal adenopathy in HIV-seropositive smokers. Lung cancer can occur earlier than the more commonly recognized opportunistic infections and in patients not known to be HIV seropositive. Tumor cell types do not differ markedly from those expected in HIV-seronegative young lung cancer patients, but are often poorly differentiated; patients with high-grade malignancies fare poorly independent of their degree of immunocompromise at diagnosis. Computed tomography (CT) scans not only add important information with regard to disease distribution and preferred means of diagnosis, but also result in the detection of new sites of disease with respect to the plain radiography in many patients. Because lung cancer often occurs before the diagnosis of AIDS, the association may not be suspected in some cases; poorly differentiated, rapidly growing tumors in young smokers may raise the suspicion of underlying HIV infection.

Adult↗
PubMed1995

Musculoskeletal tuberculosis.

The diagnosis of musculoskeletal tuberculous infection remains a challenge to clinicians and requires a high index of suspicion. The combination of indolent onset of symptoms, positive tuberculin skin test, and compatible radiographic findings strongly suggest the diagnosis. TB, however, must be confirmed by positive culture or histologic proof from the aspiration of synovial fluid or biopsy of the bone or synovium. Prompt diagnosis and treatment of skeletal TB are important to prevent serious bone and joint destruction and severe neurologic sequelae in the case of spinal involvement.

Adult↗