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Biomedical subjects

Joseph C Kolars

Publications and source records attributed to Joseph C Kolars.

18 recordsLinked to original sources
PubMed2006

Changes in career decisions of internal medicine residents during training.

BACKGROUND: Little is known about the timing and stability of internal medicine resident career decisions during the course of residency training. OBJECTIVE: To assess changes in reported career plans among internal medicine trainees during their training. DESIGN: Observational cohort using data collected as part of the annual Internal Medicine In-Training Examination (IM-ITE) survey. SETTING: 411 internal medicine residency programs in North America participating in the annual IM-ITE. PARTICIPANTS: 2638 internal medicine residents who took the IM-ITE and responded to career plan questions on the test survey in all 3 years of training (2002-2004). MEASUREMENTS: Self-reported career plans for individual residents during their postgraduate year 1 (PGY-1), postgraduate year 2 (PGY-2), and postgraduate year 3 (PGY-3) of training. RESULTS: 2281 of 2638 residents (86.5%) identified a specific career plan in internal medicine during PGY-3. Of these 2281 residents, 1417 (62.1%) changed career plans at least once during the study period. Career plans reported by PGY-1 and PGY-2 residents matched subsequent PGY-3 plans for 55.1% and 68.4%, respectively. Six hundred eighty-six (26.0%) PGY-1, 278 (10.5%) PGY-2, and 205 (7.8%) PGY-3 residents remained undecided about their career plans at the time of the IM-ITE. Only 25.0% of graduating residents reported plans for a general internal medicine career. LIMITATIONS: The study cohort represents a convenience sample and is restricted to the subset of residents sitting for the IM-ITE and responding to career plan questions in all 3 years of postgraduate training. Career plans were assessed by self-report, and it is possible that residents who responded in all years of training differed from those who did not. CONCLUSIONS: In a subset of internal medicine residents in the class of 2004, career decisions changed late into residency training and enthusiasm for careers in general internal medicine remained low.

Career Choice↗
PubMed2006

Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study.

CONTEXT: Medical errors are associated with feelings of distress in physicians, but little is known about the magnitude and direction of these associations. OBJECTIVE: To assess the frequency of self-perceived medical errors among resident physicians and to determine the association of self-perceived medical errors with resident quality of life, burnout, depression, and empathy using validated metrics. DESIGN, SETTING, AND PARTICIPANTS: Prospective longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic Rochester. Data were provided by 184 (84%) of 219 eligible residents. Participants began training in the 2003-2004, 2004-2005, and 2005-2006 academic years and completed surveys quarterly through May 2006. Surveys included self-assessment of medical errors and linear analog scale assessment of quality of life every 3 months, and the Maslach Burnout Inventory (depersonalization, emotional exhaustion, and personal accomplishment), Interpersonal Reactivity Index, and a validated depression screening tool every 6 months. MAIN OUTCOME MEASURES: Frequency of self-perceived medical errors was recorded. Associations of an error with quality of life, burnout, empathy, and symptoms of depression were determined using generalized estimating equations for repeated measures. RESULTS: Thirty-four percent of participants reported making at least 1 major medical error during the study period. Making a medical error in the previous 3 months was reported by a mean of 14.7% of participants at each quarter. Self-perceived medical errors were associated with a subsequent decrease in quality of life (P = .02) and worsened measures in all domains of burnout (P = .002 for each). Self-perceived errors were associated with an odds ratio of screening positive for depression at the subsequent time point of 3.29 (95% confidence interval, 1.90-5.64). In addition, increased burnout in all domains and reduced empathy were associated with increased odds of self-perceived error in the following 3 months (P=.001, P<.001, and P=.02 for depersonalization, emotional exhaustion, and lower personal accomplishment, respectively; P=.02 and P=.01 for emotive and cognitive empathy, respectively). CONCLUSIONS: Self-perceived medical errors are common among internal medicine residents and are associated with substantial subsequent personal distress. Personal distress and decreased empathy are also associated with increased odds of future self-perceived errors, suggesting that perceived errors and distress may be related in a reciprocal cycle.

Adult↗
PubMed2006

Changing morning report: evaluation of a transition to an interactive mixed-learner format in an internal medicine residency program.

BACKGROUND: Morning report is an important conference for medical education, but direct comparisons of approaches to morning report have only rarely been reported. DESCRIPTION: During the 2003 to 2004 academic year, we conducted both our traditional single-learner-level morning report and a new highly interactive multiple-learner-level format. Attendees were rotating students, residents, and faculty on the inpatient general medicine services. EVALUATION: We conducted anonymous surveys of participants to record their evaluations of the morning report formats. We received evaluations from 293 (60%) of 490 students, residents, and faculty. Students, 1st-year residents, and faculty preferred the mixed-learner model significantly more than did senior residents. Overall, more than 80% of participants rated the interactive multilevel format as good or very good when asked about content, discussion quality, level, and usefulness. CONCLUSIONS: An interactive morning report involving learners across multiple levels was well-received and has several educational benefits, with a greater emphasis on collaborative case discussion and active learning. Education leaders should remain open to experimenting with even the most well-established institutional traditions as they continuously reevaluate the effectiveness of teaching conferences.

Communication↗
PubMed2005

The impact of a hands-on ERCP workshop on clinical practice.

BACKGROUND: Hands-on endoscopy workshops are increasingly common venues for procedure training. However, the effect of this type of training on the practices of participants is unknown. The goal of this study was to examine the changes in individual clinical practices subsequent to participation in an ERCP hands-on course. METHODS: Forty-eight practicing pancreatobiliary endoscopists participating in a 2-day hands-on advanced ERCP course were asked to complete a 24-item survey evaluating their endoscopic practices both before and 3 months after workshop participation. The surveys evaluated monthly volume and self-confidence in performing the following procedures: diagnostic ERCP, standard sphincterotomy, needle-knife pre-cut sphincterotomy, biliary stone extraction, mechanical lithotripsy, plastic stent placement, metal stent placement, and biliary brushing for cytologic specimens. RESULTS: Thirty-one of the 48 participants (65%) who completed both pre- and postcourse surveys form the study cohort. After the workshop, there was a significant increase in use of needle-knife pre-cut sphincterotomy in clinical practices. In addition, the post-workshop survey indicated a significant increase in confidence for procedures such standard sphincterotomy, needle-knife pre-cut sphincterotomy, stone extraction, mechanical lithotripsy, placement of metal stents, and cytology brushing. Confidence in basic diagnostic ERCP and plastic stent placement did not increase because of high initial confidence levels. CONCLUSIONS: Participation in a hands-on course appears to increase the confidence of endoscopists in the performance of more complex interventions. However, this was only associated with increased clinical application for one technique.

Adult↗
PubMed2005

Teaching evidence-based medicine to internal medicine residents: the efficacy of conferences versus small-group discussion.

BACKGROUND: Evidence-based medicine (EBM) is a required component of the Accreditation Council for Graduate Medical Education's Practice-Based Learning core competency. PURPOSE: To compare the efficacy of conferences and small-group discussions in enhancing EBM competency. METHODS: EBM conferences and small-group discussions were integrated into an internal medicine curriculum. EBM competency was assessed by written examination following participation in both groups and compared with residents who had not participated in either format. RESULTS: Small-group discussion participants (n = 10) scored higher on an EBM exam (17.8 +/- 4.5 correct out of 25) when compared with 10 conference participants (12.2 +/- 4.6, p = .010) and 26 residents who did not participate in either format (12.0 +/- 4.5, p = .002). Small-group discussion participants also reported increased confidence and high satisfaction. CONCLUSIONS: Although more resource intensive, small-group discussions resulted in increased EBM knowledge, increased confidence with critical appraisal skills, and high satisfaction compared with a conference-based format.

Clinical Competence↗
PubMed2005

Introduction of a 14-hour work shift model for housestaff in the medical ICU.

STUDY OBJECTIVE: To describe the outcomes of switching housestaff from a traditional model of "long-call" every 4 days to a 14-h work-shift model in a medical ICU (MICU) over a 5-week pilot period. DESIGN: Retrospective comparison of a 5-week pilot period for a 14-h work-shift model vs a 4-month period for the traditional model. SETTING: The MICU of a tertiary medical center. PARTICIPANTS: A total of 626 patients admitted to the MICU and 34 internal medicine residents taking care of them. INTERVENTIONS: None. MEASUREMENTS: Severity-adjusted patient outcomes, housestaff performance on end-of-rotation examinations, and scheduled duty hours during the 5-week 14-h work-shift pilot period compared to a 16-week traditional nonpilot work period. RESULTS: There were no statistically significant differences in patients' adjusted mortality rates, hospital lengths of stay, or housestaff performance on end-of-rotation knowledge assessment examinations between the pilot and nonpilot periods. During the pilot period, each resident was scheduled to work for an average of 61.3 h weekly, and each fellow for 65.3 h weekly. In comparison, each resident and fellow was scheduled to work for an average of 73.3 h weekly during the nonpilot period. CONCLUSIONS: The 14-h work shift is a feasible option for housestaff rotation in the MICU. Although the power of our study to detect significant differences in mortality, length of stay, and educational outcomes was low, there was no evidence of compromised patient care or housestaff education associated with the 14-h shift model over the course of this 5-week pilot study.

Adult↗
PubMed2004

Computer simulation training enhances patient comfort during endoscopy.

BACKGROUND & AIMS: Computer-based endoscopy simulator (CBES) training's impact on patient-based outcomes has never been examined. This study examines whether the endoscopy skills of trainees are improved and patient discomfort is reduced as a result of CBES training. METHODS: From July 2001-June 2002, 38 residents received either 1 week of patient-based training (PBT) alone in flexible sigmoidoscopy (FS) or 3 hours of simulator-based training (SBT) before a week of training in FS. Patients completed questionnaires grading the discomfort experienced during endoscopy (1, no pain; 10, worst pain of life). In addition, residents' performance was graded by the supervising staff and themselves with 8 performance parameters by using a 1-10 Likert scale (1, strongly agree; 5, neutral; 10, strongly disagree). RESULTS: Nineteen SBT and 19 PBT residents performed 150 and 175 FS, respectively. During this same period, staff completed 585 FS. The median patient discomfort score for SBT residents was significantly less than for PBT residents, 3 (25%-75% interquartile range [IQR], 2-5) vs. 4 (IQR, 2-6) (P < 0.01). Discomfort scores for both resident groups were significantly greater than those recorded by staff endoscopists, 2 (IQR, 1-4) (P < 0.01). No difference was seen in the residents' procedural skill scores. Resident self-evaluation scores were significantly greater than those received from the supervising staff. CONCLUSIONS: Increased patient comfort resulted from simulation training, demonstrating that CBES training has a direct benefit to the patient. Although no measurable impact on residents' performance skills was observed, we do demonstrate that residents perceive themselves as having acquired greater endoscopic skills in contrast to staff evaluations.

Clinical Competence↗
PubMed2004

Computer simulator training enhances the competency of gastroenterology fellows at colonoscopy: results of a pilot study.

OBJECTIVES: Computer-based colonoscopy simulation (CBCS) is being utilized in endoscopy training without supporting evidence that it improves patient-based colonoscopy performance. The goal of this pilot study was to determine if CBCS training improves gastroenterology (GI) fellows' patient-based colonoscopy skills. METHODS: Competency at colonoscopy among 4 novice GI fellows who completed a 6-h CBCS curriculum was compared with 4 novice fellows who were not CBCS-trained. Measurements of competency were rendered by supervising faculty by recording "insertion time,""depth of unassisted insertion,""independent procedure completion,""ability to identify endoscopic landmarks,""inserts in a safe manner,""adequately visualizes mucosa on withdrawal," and "responds appropriately to patient discomfort" with each colonoscopy. RESULTS: Simulator-trained fellows outperformed traditionally trained fellows during their initial 15 colonoscopies in all performance aspects except "insertion time" (pp < 0.05). Simulator-trained fellows inserted the endoscope significantly further and reached the cecum independently nearly twice as often during this early training period. Three parameters ("depth of insertion,""independent completion," and "ability to identify landmarks") demonstrated a continued advantage out to 30 colonoscopies. Beyond 30 procedures, there was no difference in the performance of the two groups. CONCLUSION: In this pilot study, a 6-h CBCS curriculum provides an early training advantage by enhancing competency at the early stages of patient-based colonoscopy. These advantages are negligible after approximately 30 patient-based procedures. CBCS-enhanced training may allow faculty to be more efficient with their colonoscopy practice.

Clinical Competence↗
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↗
PubMed2003

Validation of a computer-based colonoscopy simulator.

BACKGROUND: The computer-based colonoscopy simulator is intended to provide a realistic colonoscopic experience and feedback to operators regarding procedure skills. Advocates hope that computer-based colonoscopy simulators will enhance the mastery of colonoscopy by trainees. Before this hypothesis can be tested, the claims made for a simulator must be validated. The aims of this study were to answer the following: Does a computer-based colonoscopy simulator provide a "realistic" experience? Do computer-based colonoscopy simulators' performance parameters differentiate varying levels of experience? METHODS: Ten staff gastroenterologists, 6 gastroenterology fellows, and 6 residents each performed 2 computer-based colonoscopy simulator colonoscopies and performance parameters were recorded. Staff colonoscopists then completed a 6-item survey grading the "realism" of the simulation and procedure difficulty. Survey responses and performance scores were compared with the Wilcoxon rank-sum test. RESULTS: Faculty found the computer-based colonoscopy simulator experience to be realistic despite the "cases" being markedly easier than actual colonoscopy. The computer-based colonoscopy simulator distinguishes subjects according to endoscopic experience with 3 of its measured parameters (total procedure time, insertion time, time in "red-out"). No significant difference in the ability to distinguish among user types was found for the other 10 computer-based colonoscopy simulator measurements for which data were analyzable. CONCLUSION: The computer-based colonoscopy simulator provides a favorable degree of virtual realism with regard to visual simulation and colonoscope mechanics, although the "cases" were regarded as considerably easier than actual colonoscopy. The computer-based colonoscopy simulator has only limited capability for distinguishing varying levels of competence at actual colonoscopy. These findings suggest that a study to determine the role of computer-based colonoscopy simulators in the curriculum of trainees is warranted.

Clinical Competence↗
PubMed2002

Evaluation of diarrhea in the returned traveler.

Diarrhea in the returned traveler is common, but it is generally self-limited. Although the concern is often directed at the presence of an ongoing infection, postinfectious and noninfectious etiologies must be considered [table: see text] also. Answers to the clinical questions posed in this article will guide the clinician toward an appropriate diagnostic and management strategy.

Antidiarrheals↗
PubMed2002

Colonoscopy curriculum development and performance-based assessment criteria on a computer-based endoscopy simulator.

OBJECTIVE: Computer-based colonoscopy simulators (CBCS) have been developed and are being introduced into the training environment. The ability of these simulators to replicate the dimensions of patient-based diagnostic colonoscopy is good. However, the benefit of simulators to either learners or their patients has not yet been established. We describe a process by which a CBCS curriculum and CBCS-based performance criteria were established for first-year gastroenterology fellows at the Mayo Clinic in Rochester, Minnesota. DESCRIPTION: We used a commercially available CBCS (AccuTouch Endoscopy Simulator, Immersion Medical, Gaithersburg, MD), which consists of a specialized colonoscope that is inserted into a computer-based module with a screen showing the colonic lumen of a virtual patient. A tutorial and six cases of varying complexity are available on the CBCS. Performance variables that are measured by the simulator include the time to complete the procedure, the distance that the scope was advanced, the degree to which the mucosa was adequately visualized, the possible complications such as colonic perforation, and the level of pain experienced by the simulated patient. To begin, we established ideal performance standards by measuring the above variables for ten "expert" faculty colonscopists who completed two cases on the CBCS. Next, we measured CBCS performance standards for five partially trained colonoscopists. Finally, two non-physician gastrointestinal assistants, without prior endoscopic training, were asked to practice on the simulator to determine the time and procedure frequency required to improve their CBCS proficiency. By calculating average performance standards within each of these three groups, we were able to estimate the number of CBCS cases and minimal performance standards for new trainees. Based on the learning curves for novice colonoscopists as well as the performances of partially trained and expert colonoscopists, we speculated that if CBCS training were to be beneficial, the benefit would most likely occur at the early stages of training. The curriculum we developed consists of viewing a one-hour, multimedia tutorial, which describes the procedure and various colonoscopy techniques. This is followed by nine hours of hands-on CBCS experience, during which time the trainee will complete approximately 25 CBCS colonoscopies. Before advancing to live-patient colonoscopies, the trainee must meet certain performance standards on specific CBCS cases. These standards include the ability to view the entire colon in less than 15 minutes with minimal pain and no complications. DISCUSSION: If effective, this new colonoscopy training curriculum should result in improved competency at patient-based colonoscopy, particularly in the early stages of training. To address this question, first-year gastroenterology fellows at Mayo Clinic have been randomized into two groups: (1) a group that experiences a tutorial with hands-on CBCS curriculum and (2) a group that experiences a tutorial only. Their performances at patient-based colonoscopy as well as surveys of patient satisfaction will be measured and analyzed to determine what, if any, benefit is provided by CBCS.

Clinical Competence↗