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Biomedical subjects

Lisa M Bellini

Publications and source records attributed to Lisa M Bellini.

At least 19 recordsLinked to original sources
PubMed2006

Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns.

PURPOSE: To explore the relationships between sleep deprivation and the evolution of mood disturbances, empathy, and burnout among a cohort of interns. METHOD: In 2002-03, 47 interns in the internal medicine resident program at the University of Pennsylvania School of Medicine completed the following instruments at baseline and at year end: sleep quantities, Epworth Sleepiness Scale, the Beck Depression Inventory-Short Form, the Interpersonal Reactivity Index, and the Maslach Burnout Inventory-Human Services Survey. The prevalences of acute and chronic sleep deprivation, subjective sleepiness, burnout, empathy, and depression at the beginning of the year were compared to prevalences at the end of internship. Associations between sleep deprivation and mood, empathy, or burnout were explored. RESULTS: The prevalence of chronic sleep deprivation, depression, burnout, and empathy increased from baseline to year end. Specifically, the prevalence of "high" scores changed for chronic sleep deprivation (9% to 43%, p = .0001). The prevalence of moderate depression increased from 4.3% to 29.8% (p = .0002). Only 4.3% reported a high level of burnout initially compared with 55.3% at year end (p < .0001). Scores that were originally more favorable than general population norms (p < .001) approached norms at the end of the year for empathic concern (p = .15). There was an association between becoming chronically sleep deprived and becoming depressed (OR = 7, p = .014). CONCLUSIONS: Given the association between chronic sleep deprivation and mood disturbances during internship, outcome assessment is warranted to see if duty-hour reform will translate into more hours slept or fewer hours worked, coincident with improved mood.

Analysis of Variance↗
PubMed2006

Improving resource utilization in a teaching hospital: development of a nonteaching service for chest pain admissions.

PURPOSE: Exclusion of acute coronary syndrome frequently prompts a brief hospital admission for a large proportion of patients presenting to the emergency department with chest pain. At hospitals with residency programs, the volume of such patients creates pressures on these programs because of the limit on the number of patients a resident can accept in a given period. These restrictions have been instituted by the Accreditation Council for Graduate Medical Education (ACGME). The authors hypothesized that a nonteaching service designed to identify and admit low-risk chest pain patients should reduce those pressures. METHOD: A hospitalist-directed nonteaching service (NTS) was created to admit low-risk chest pain patients at the Hospital of the University of Pennsylvania. Patients' admission service was based upon the thrombolysis in myocardial infarction (TIMI) risk score. From September 2003 to June 2004, patients (n = 113) with scores of 0 or 1 (showing low risk) were admitted to the NTS. Simultaneously, a similar group of low-risk chest pain patients (n = 205) were admitted to a traditional internal medicine resident-based service (RBS). RESULTS: The NTS patients had a lower median length of stay (23 hours versus 33 hours; p < .0001) and lower median hospital charges ($8,545 versus $14,150; p < .0001) when compared with the low-risk patients on the RBS. CONCLUSIONS: The development of an NTS for chest pain admissions can assist residency programs in their efforts to meet the ACGME program requirements. The TIMI risk score can be used as a tool to assist in the identification of low-risk chest pain patients.

Accreditation↗
PubMed2006

Are discharge summaries teachable? The effects of a discharge summary curriculum on the quality of discharge summaries in an internal medicine residency program.

BACKGROUND: Interns are often required to dictate discharge summaries without formal training. We investigated the impact of a curriculum aimed at improving the quality (i.e., complete, organized, succinct, internally consistent, and readable) of interns' discharge summaries. METHOD: Fifty-nine medicine interns were randomized to a: (1) control group; (2) discharge summary curriculum; or (3) curriculum plus individualized feedback. Pre- and post-intervention, seven discharge summaries were graded using a 9-item instrument. T-tests, analysis of covariance, and effect sizes assessed group differences. RESULTS: There were multiple, significant within-group improvements for the intervention groups and between group differences post-intervention. The average effect size was large when the curriculum plus feedback group was compared to the control group (.70) and moderate when compared to the curriculum only group (.36). CONCLUSIONS: Interns who received instruction on discharge summary skills improved the quality and of their discharge summaries. Adding feedback to the curriculum provided more benefit.

Curriculum↗
PubMed2006

Internal medicine and general surgery residents' attitudes about the ACGME duty hours regulations: a multicenter study.

PURPOSE: To assess internal medicine and general surgery residents' attitudes about the effects of the Accreditation Council for Graduate Medical Education duty hours regulations on medical errors, quality of patient care, and residency experiences. METHOD: In 2005, the authors surveyed 200 residents who trained both before and after duty hours reform at six residency programs (three internal medicine, three general surgery) at five academic medical centers in the United States. Residents' attitudes about the effects of the duty hours regulations on the quality of patient care, residency education, and quality of life were measured using a survey instrument containing 19 Likert scale questions on a scale of 1 to 5. Survey responses were compared using the Student's t-test. RESULTS: The response rate was 80% (159 residents). Residents reported that whereas fatigue-related errors decreased slightly, errors related to reduced continuity of care significantly increased. Additionally, duty hours regulations somewhat decreased opportunities for formal education, bedside learning, and procedures, but there was no consensus that graduates would be less well trained after duty hours reform. Residents, particularly surgical trainees, reported improvements in quality of life and reduced burnout. CONCLUSIONS: Residents in medicine and surgery had similar opinions about the effects of duty hours reform, including improved quality of life. However, resident opinions suggest that reduced fatigue-related errors have been offset by errors related to decreased continuity of care and that the quality of the educational experience may have declined. Quantifying the degree to which regulating duty hours affected errors related to discontinuity of care should be a focus of future research.

Attitude↗
PubMed2006

The impact of resident duty hours reform on the internal medicine core clerkship: results from the clerkship directors in internal medicine survey.

PURPOSE: In July 2003, resident duty hours regulations were implemented. The impact of these regulations on medical student education has received minimal attention. The objective of this study was to evaluate the perceptions of internal medicine clerkship directors about the impact of resident physician duty hours reform on medical student teaching, assessment, and clerkship structure. METHOD: A survey was sent to 114 institutional members of Clerkship Directors in Internal Medicine in May 2004. The survey included 17 attitude items rated on a 5-point Likert scale, five items related to clerkship structure, and four open-ended questions. Descriptive statistics were performed on the responses. RESULTS: Ninety-six surveys were returned (84%). The majority of respondents did not believe duty hours reform had a positive impact on clerkship students' educational experiences, whereas 48.3% agreed or strongly agreed that residents had more difficulty evaluating students' clinical skills. There was not a significant change in inpatient clerkship structure after duty hours implementation. Time for teaching students, concerns about a shift-work mentality, and student continuity with their teams were major challenges. Impact on ambulatory internal medicine rotations was minimal. CONCLUSIONS: Internal medicine clerkship directors are concerned about the impact of resident duty hours reform on student education. Additional studies of this educational impact are needed.

Attitude↗
PubMed2006

Improvement of resident perceptions of nurse practitioners after the introduction of a collaborative care model: a benefit of work hour reform?

BACKGROUND: Nurse practitioners (NPs) are assuming larger roles in many residency programs as a result of work hour reform, which is creating the potential for collaboration with interns and residents. PURPOSE: To assess housestaff perceptions of NPs. METHODS: We used a 17-item survey before and after the implementation of a collaborative care model in a university-based medicine residency. RESULTS: The majority of residents held favorable attitudes about NPs before the introduction of the collaborative care model. After 1 year, more interns and residents appreciated NPs' clinical judgment (effect size [ES] = .26, p =.02), thought they should be able to order laboratory tests (ES = .23, p = .05) and perform basic procedures (ES = .67, p < .0001), and viewed them as colleagues (ES = .25, p = .04). Only a minority felt NPs contributed to their education. CONCLUSIONS: The promotion of collaborative care can be an unintended consequence of work hour reform. Educators are encouraged to think about how changes in the curriculum structure can provide opportunities for positive collaborative care experiences.

Cooperative Behavior↗
PubMed2006

William Pepper Jr, MD (1843-1898): portrait of a nineteenth-century medical educator.

Dr William Pepper Jr was a prominent Philadelphia physician whose contributions to medicine in the late 19th century are not widely known. As a young physician he rose in stature rapidly due to his abilities as a diagnostician, teacher, writer and researcher. His primary interest, however, was to improve the education of physicians. He orchestrated the creation of America's first university-controlled teaching hospital, the Hospital of the University of Pennsylvania, enabling substantial improvements in clinical training. Pepper later became Provost of the University of Pennsylvania and ambitiously transformed the curriculum of the medical school, providing greater basic science and clinical training. He also worked to establish several institutes and museums in Philadelphia in order to promote academic pursuits, particularly in medicine. William Pepper Jr was one of the 19th century's foremost medical educators and his accomplishments helped reshape the way medicine was taught throughout the United States.

Epidemiology↗
PubMed2005

Mood change and empathy decline persist during three years of internal medicine training.

PURPOSE: To examine longitudinal changes in mood and empathy over the course of the internal medicine residency. METHOD: The authors conducted a cohort study of 61 residents who completed the Profile of Mood States (POMS) and the Interpersonal Reactivity Index (IRI) at six time points during their internal medicine residency at a university-based program. (POMS was administered five times, and IRI was administered six times.) The main outcomes measured were trends in mood disturbances and multiple domains of empathy over the three-year residency, and comparisons to norms. RESULTS: Response rates varied from Time 1 to Time 6 (98%, 72%, 79%, 79%, 94%, and 95%, respectively). Interns had better scores on four POMS subscales: Depression-Dejection (p = .0031), Anger-Hostility (p < .0001), Fatigue-Inertia (p < .0001), and Vigor-Activity (p < .0001) compared with later administrations, especially midinternship. By the end of residency all POMS scores were returning towards baseline (effects sizes in the .20 s), but only depression was no longer significantly different. IRI scores showed the decline in Empathic Concern remained over residency whereas Personal Distress peaked midinternship year but approached baseline at the end of residency. Compared with the general population, the graduating residents were less tense, depressed, and confused. Personal Distress was significantly lower than the norm group. CONCLUSIONS: Internal medicine residency presents challenges resulting in common mood disturbances. Although graduating residents appear to be better off than the population norms, some domains of their mood disturbances and empathy never fully recover from their internship year.

Affect↗
PubMed2005

A randomized-controlled study of encounter cards to improve oral case presentation skills of medical students.

OBJECTIVE: To determine the feasibility of oral case presentation (OCP) encounter cards as a tool for formative evaluation, to estimate the reliability and validity of the ratings when used in a medicine clerkship, and to examine whether the use of OCP encounter cards improves students' OCP skills. DESIGN: Randomized controlled study. SETTING: Medicine core clerkship at a U.S. medical school. PARTICIPANTS/INTERVENTION: Students enrolled in the medicine core clerkship (n=164) from January to December of 2003 were randomly assigned to receive weekly feedback using OCP encounter cards rating nine presentation compentencies or receive usual feedback. Mean OCP ratings were correlated with multiple summative assessments. Performance on an end-of-clerkship OCP was compared between intervention and control groups. MAIN RESULTS: Eighty percent of cards were completed. The mean OCP rating averaged over 9 competencies was 7.7 (SD=0.8) on a 9-point scale. Standard error of ratings was 0.3. OCP ratings were correlated with inpatient evaluations (r=.58), inpatient ratings of presentation skills (r=.43), and final grades (r=.40). Final OCP performance was similar for the intervention and control groups (7.0 vs 7.2, P=.09). CONCLUSION: OCP encounter cards are a novel and feasible tool to assess clerkship students' oral case presentation skills. OCP card ratings are reproducible, and validity is suggested by their correlation with multiple markers of performance. However, encounter cards did not improve performance on summative oral presentations.

Clinical Clerkship↗
PubMed2004

Sleep behaviors and attitudes among internal medicine housestaff in a U.S. university-based residency program.

PURPOSE: Physicians-in-training are susceptible to fatigue given their prolonged duty hours. Sleep deprivation has been shown to alter perceptions of sleepiness and performance. This study examined the state of sleepiness and attitudes about sleep and performance of work- and non-work-related tasks among incoming and current housestaff; and how rotation, call cycle, and call status are related to acute and chronic sleep deprivation and perceptions of sleepiness. METHOD: A survey instrument was administered in June 2001 to 53 incoming interns and 79 current housestaff at the University Pennsylvania School of Medicine, a university-based internal medicine residency program. RESULTS: All 132 participants (100%) completed the instrument. Acute sleep deprivation was experienced by 34% of the current housestaff and 64% of current housestaff were chronically sleep deprived. Current housestaff admitted to the possibility of dozing while performing various work-related tasks such as writing notes in charts (69%), reviewing medication lists (61%), interpreting labs (51%), and writing orders (46%). At least half of all respondents felt their patients received good care despite residents' sleepiness and as many believed sleep deprivation was a necessary part of training. Nearly half (48%) of current housestaff rotating on a ward service reported acute sleep deprivation, as did 81% of those who were postcall. Over two-thirds of the housestaff on wards and in the ICU reported chronic sleep deprivation. Subjective sleepiness did not vary much across rotations, call cycle, and call status. CONCLUSION: Chronic and acute sleep deprivation contribute to residents' fatigue. Education could be targeted at attitudes. Further investigation of factors contributing to chronic sleep deprivation in this population is warranted.

Academic Medical Centers↗
PubMed2004

The impact of resident duty hour reform in a medicine core clerkship.

PROBLEM STATEMENT: Residency programs have changed to comply with resident duty hour regulations. This study's purpose was to determine if there are differences in medicine clerkship students' activities, associations, and perceptions of educational value before and after duty hour reform. METHOD: Medicine clerkship students, both before (n = 36) and after (n = 33) duty hour reform, wore random reminder pagers for one week and completed time allocation surveys with each signal. Event proportions were calculated and analysis of variance assessed group differences. RESULTS: A total of 804 and 912 surveys were completed before and after reform, respectively. No differences existed in proportion of time for direct patient care (.13 versus.14, p =.35), indirect patient care (.35 versus.32, p =.21), and education (.38 versus.37, p =.69) activities, students' associations, educational value, and time in the hospital before and after reform. CONCLUSIONS: Residency program changes had minimal impact on medicine clerkship students.

Clinical Clerkship↗
PubMed2004

Program directors' views of the importance and prevalence of mentoring in internal medicine residencies.

Program directors establish priorities for residency programs. Their views of mentoring likely influence the tone about and availability of mentoring programs. This survey to all internal medicine program directors assessed attitudes toward mentoring, existence of formal mentoring programs, and features of the mentoring programs. The response was 60%. The majority (>60%) favored mentoring. Forty-nine percent of the residencies had structured mentoring programs. Programs differed in frequency of meetings, use of evaluations, and presence of curriculum. Overall, although program directors' attitudes are favorable and at least half have formal mentoring programs, the programs are largely unstructured, loosely monitored, and underevaluated.

Attitude of Health Personnel↗
PubMed2003

Feasibility, reliability, and validity of the mini-clinical evaluation exercise (mCEX) in a medicine core clerkship.

PURPOSE: To determine the feasibility, reliability and validity of the mCEX when used to evaluate medical students' clinical skills in a medicine core clerkship. METHOD: In 2002, students were required to complete nine mCEX during their medicine clerkship. Mean mCEX scores were correlated with exam scores and course grades. RESULTS: 89% of targeted mCEX were completed. The reproducibility coefficient for eight mCEX was.77. Mean mCEX scores were significantly correlated with exam scores (r =.22; p =.004), inpatient (r =.43; p <.0001), outpatient (r =.35; p <.0001), and final course grades (r =.19; p =.014). CONCLUSIONS: These data support the feasibility, reproducibility, and validity of the mCEX in evaluating medicine clerkship students' clinical skills.

Clinical Clerkship↗
PubMed2003

Residents as members of intern selection committees: can they partially replace faculty?

BACKGROUND: Faculty involvement in the residency selection process is important, but increasing pressures on available faculty resources have made their ability to participate more difficult. Residents may be acceptable substitutions for some faculty in the selection process. PURPOSE: To test 2 new interview models and explore whether residents could partially replace faculty by examining what role the interview itself plays in the overall assessment of an applicant, comparing faculty and resident ratings of the interview, and asking whether partially substituting residents for faculty had an impact on the match outcome. METHODS: Applicants to an internal medicine residency program were assigned to 1 of 3 interview models: faculty-faculty, resident-faculty, resident-faculty-faculty. The 12 interview days were randomly assigned to a model and all applicants on each day had the same model. Interviewers used an applicant assessment form to assign ratings to 6 components of the portfolio and a final score. RESULTS: For both residents and faculty, the final score was highly correlated with the formal interview component. Within-model analyses showed residents consistently gave more favorable scores than faculty interviewers. There was no impact of interview model on initial or final rank position. Similarly, there was no difference between models in their match "success" rates. CONCLUSIONS: Residents can be successfully substituted for some faculty in the residency selection process. The use of residents does not impact the match results. Developing a small, committed group of interviewers should benefit both programs and applicants.

Analysis of Variance↗
PubMed2002

Variation of mood and empathy during internship.

CONTEXT: Internship is a time of great transition, during which mood disturbances are common. However, variations in mood and empathy levels throughout the internship year have not been investigated. OBJECTIVE: To examine mood patterns and changes in empathy among internal medicine residents over the course of the internship year. DESIGN: Cohort study of interns involving completion of survey instruments at 4 points: time 1 (June 2000; Profile of Mood States [POMS] and Interpersonal Reactivity Index [IRI]), times 2 and 3 (November 2000 and February 2001; POMS), and time 4 (June 2001; POMS and IRI). SETTING: Internal medicine residency program at a university-based medical center. PARTICIPANTS: Sixty-one interns. MAIN OUTCOME MEASURES: Baseline scores of mood states and empathy; trends in mood states and empathy over the internship year. RESULTS: Response rates for time 1 were 98%; for time 2, 72%; for time 3, 79%; and for time 4, 79%. Results of the POMS revealed that physicians starting their internship exhibit less tension, depression, anger, fatigue, and confusion and have more vigor than general adult and college student populations (P<.001 for all). Results of the IRI showed better baseline scores for perspective taking (P<.001) and empathic concern (P =.007) and lower scores for personal distress (P<.001) among interns compared with norms. Five months into internship, however, POMS scores revealed significant increases in the depression-dejection (P<.001), anger-hostility (P<.001), and fatigue-inertia (P<.001) scales, as well as an increase in IRI personal distress level (P<.001). These increases corresponded with decreases in the POMS vigor-activity scores (P<.001) and IRI empathic concern measures (P =.005). Changes persisted throughout the internship period. CONCLUSIONS: We found that, in this sample, enthusiasm at the beginning of internship soon gave way to depression, anger, and fatigue. Future research should be aimed at determining whether these changes persist beyond internship.

Adult↗