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Furman S McDonald

Publications and source records attributed to Furman S McDonald.

7 recordsLinked to original sources
PubMed2005

A curricular initiative for internal medicine residents to enhance proficiency in internal jugular central venous line placement.

OBJECTIVE: To determine the feasibility, efficacy, and outcomes of teaching Internal Jugular (IJ) central venous line placement (CVLP) to internal medicine residents in a hands-on training experience with adult patients. SUBJECTS AND METHODS: Data were obtained from 47 residents during their 3-year residency program through questionnaires and a proprietary system that tracks resident procedures. Twenty-five postgraduate year (PGY) 2 residents at the Mayo Clinic in Rochester, Minn, were assigned to IJ-CVLP training in the cardiac catheterization laboratory from January 2001 to June 2001. Their experience, analyzed immediately after training and at completion of residency, was compared with that of 22 PGY-2 residents in the same class who were not assigned to IJ-CVLP training. RESULTS: The median Likert scores of the residents' self-reported perception of independence in IJ-CVLP increased from 3.0 (mean +/- SD score, 2.8+/-1.4) before the intervention to 5.0 (4.4+/-0.9) after the intervention (P<.001, signed rank test). At graduation, trained residents had performed more IJ-CVLPs than the control residents (mean +/- SD, 17.8+/-8.4 vs 9.8+/-6.3, respectively; P<.001). Residents who received IJ-CVLP training, compared with those who did not, showed a significant increase in the mean percentage of IJ-CVLPs performed independently between PGY-1 (2.2%) and PGY-3 (31.2%) (P=.008). CONCLUSIONS: Training internal medicine residents to perform IJ-CVLP is feasible in the cardiac catheterization laboratory with supervision from an attending cardiologist. Trained residents performed significantly more IJ-CVLPs independently during their third year compared with their first year of training. We believe this initiative may be implemented successfully in graduate medical education curriculums.

Adult↗
PubMed2003

Knowledge base evaluation of medicine residents on the gastroenterology service: Implications for competency assessments by faculty.

BACKGROUND AND AIMS: Clinician educators are asked to provide both formative and summative evaluations on the medical knowledge of residents. This study evaluated the accuracy of these evaluations and the perception of residents regarding the ability of faculty to assess medical knowledge. METHODS: Gastroenterology knowledge ratings provided by 15 faculty gastroenterologists on 49 internal medicine residents during a required gastroenterology rotation were correlated with performance on the gastroenterology subsection of the In-Training Examination for Internal Medicine. Residents also were surveyed regarding their perception of the ability of faculty to judge their knowledge of medical gastroenterology. RESULTS: The mean correlation (Kendall's tau b) of faculty ratings with performance on the ITE was 0.30 (P < 0.01). The range of correlation values for individual faculty (-0.39 to 0.80) indicated that some faculty were able to assess the medical knowledge of residents better than others. Residents, as well as the faculty themselves, perceived that faculty were able to rate their medical knowledge relatively well. CONCLUSIONS: The ability of faculty gastroenterologists to judge the knowledge of gastroenterology in their resident trainees was quite limited. Residents, as well as faculty, inaccurately perceive the ability of gastroenterologists to render professional judgments on their knowledge base as good. An end-of-rotation written examination would appear to be required to provide an accurate assessment of the medical knowledge of residents.

Adult↗
PubMed2002

A real-time computer model to assess resident work-hours scenarios.

OBJECTIVE: To accurately model residents' work hours and assess options to forthrightly meet Residency Review Committee-Internal Medicine (RRC-IM) requirements. DESCRIPTION: The requirements limiting residents' work hours are clearly defined by the Accreditation Council for Graduate Medical Education (ACGME) and the RRC-IM: "When averaged over any four-week rotation or assignment, residents must not spend more than 80 hours per week in patient care duties."(1) The call for the profession to realistically address work-hours violations is of paramount importance.(2) Unfortunately, work hours are hard to calculate. We developed an electronic model of residents' work-hours scenarios using Microsoft Excel 97. This model allows the input of multiple parameters (i.e., call frequency, call position, days off, short-call, weeks per rotation, outpatient weeks, clinic day of the week, additional time due to clinic) and start and stop times for post-call, non-call, short-call, and weekend days. For each resident on a rotation, the model graphically demonstrates call schedules, plots clinic days, and portrays all possible and preferred days off. We tested the model for accuracy in several scenarios. For example, the model predicted average work hours of 85.1 hours per week for fourth-night-call rotations. This was compared with logs of actual work hours of 84.6 hours per week. Model accuracy for this scenario was 99.4% (95% CI 96.2%-100%). The model prospectively predicted work hours of 89.9 hours/week in the cardiac intensive care unit (CCU). Subsequent surveys found mean CCU work hours of 88, 1 hours per week. Model accuracy for this scenario was 98% (95% CI 93.2-100%). Thus validated, we then used the model to test proposed scenarios for complying with RRC-IM limits. The flexibility of the model allowed demonstration of the full range of work-hours scenarios in every rotation of our 36-month program. Demonstrations of status-quo work-hours scenarios were presented to faculty as well as real-time demonstrations of the feasibility, or unfeasibility, of their proposed solutions. The model clearly demonstrated that non-call (i.e., short-call) admissions without concomitant decreases in overnight call frequency resulted in substantial increases in total work hours. Attempts to "get the resident out" an hour or two earlier each day had negligible effects on total hours and were unrealistic paper solutions. For fourth-night-call rotations, the addition of a "golden weekend" (i.e., a fifth day off per month) was found to significantly reduce work hours. The electronic model allowed the development of creative schedules for previously third-night-call rotations that limit resident work hours without decreasing continuity of care by scheduling overnight call every sixth night alternating with sixth-night-short-call rotations. DISCUSSION: Our electronic model is sufficiently robust to accurately estimate work hours on multiple and varied rotations. This model clearly demonstrates that it is very difficult to meet the RRC-IM work-hours limitations under standard fourth-night-call schedules with only four days off per month. We are successfully using our model to test proposed alternative scenarios, to overcome faculty misconceptions about resident work-hours "solutions," and to make changes to our call schedules that both are realistic for residents to accomplish and truly diminish total resident work hours toward the requirements of the RRC-IM.

Computer Simulation↗