Browsing by Subject "Internship and Residency"
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Item The 80 hour workweek(2005-12-15) Moran, BrettItem Diverse medicine: developing a sustainable medical workforce to meet the needs of our patient population(2020-01-31) Okorodudu, DaleItem Donald W. Seldin, M.D., Research Symposium finalist presentations(2022-04-29) Almonte, Matthew; Duvalyan, Angela; McAdams, Meredith; Onyirioha, Kristeen; Saez-Calveras, Nil; Triana, TaylorThis edition of the UT Southwestern Internal Medicine Grand Rounds features presentations by the six Foster Fellows selected as finalists from the Seventh Annual Donald W. Seldin, M.D. Research Symposium, which was held on April 21, 2022. These Foster Fellows presented work that spanned the breadth and depth of scholarly activity across the department, and at the close of Grand Rounds, one will be selected as the 2022 Seldin Scholar, in honor of Dr. Donald W. Seldin. The Grand Rounds presentation includes additional award presentations recognizing Clinical Vignettes, as well as the Award for Research in Quality and Education at Parkland Hospital and the Social Impact Award.Item An Exanimation of GME Funding: A Critical Look at Non-ACGME Surgical Fellowships(2020-05-01T05:00:00.000Z) Lee, Joo Hyun; Scott, Daniel; Sendelbach, Dorothy; Pearson, Mary JaneBACKGROUND: Since 1997, the Fellowship Council (FC) has evolved into a robust organization that is responsible for the advanced training of nearly half of the U.S. residency graduates entering general surgery practice. While FC fellowships are competitive (55% match rate) and offer outstanding educational experiences, funding is arguably vulnerable as external support has diminished. OBJECTIVE: The aim of this study was to investigate the current funding models of FC fellowships. METHODS: Under an IRB-approved protocol, an electronic survey was administered to 167 FC programs with subsequent phone interview follow-ups to collect data on total cost and sources of funding. De-identified data were also obtained via 2020-2021 Foundation for Surgical Fellowships (FSF) grant applications. Means and ranges are reported. RESULTS: Data were obtained from 59 programs (35% response rate) via the FC survey and 116 programs via FSF applications. The results from the FC and FSF data sets indicated that the average cost to train one fellow per year was USD 107,957 and USD 110,816, respectively. Similar averages were reported for the four components of cost. Programs received an average funding of USD 109,118 and USD 110,816, respectively. Most programs utilized departmental and grants funds. Additionally, 36% (FC data) to 39% (FSF data) of programs indicated that they billed for their fellow, generating USD 74,824 (range USD 15,000-USD 200,000) and USD 33,281 on average (range USD 11,500 - 66,259), respectively. 14% of programs via FC survey reported generating net positive revenue whereas 100% of programs from FSF application declared budget neutral. CONCLUSIONS: Our results indicated similar findings in support of the overall accuracy of these data. Most programs seemed to rely heavily on subsidies from both internal and external sources, although some programs were able to generate a positive revenue stream. The most notable difference was the revenue amount generated from billing. Programs that generated a positive revenue often billed for fellows. Given the value of these fellowships and the inherent vulnerabilities associated with graduate medical education funding, new alternative grant funding models are encouraged. In addition, standardization of annual cost and funding reports would provide greater insights into funding models.Item Lies, damned lies, and evaluations: the quest for "high value" feedback(2022-01-21) Scielzo, Shannon; Kazi, SalahuddinItem [News](1970-06-11) Fenley, Bob; Weeks, JohnItem [News](1988-10-27) West, MikeItem [News](1974-09-13) Harrell, AnnItem [News](1984-07-30) Williams, AnnItem Optimizating and Diffusing a Handover Behavioral Assessment Tool for Simulation(2021-03-18) Chen, Rodney; Reed, W. Gary; Greilich, Philip; Phelps, EleanorINTRODUCTION: With multiple simulated and clinical scenarios included in the ongoing Quality Enhancement Plan (QEP), a standardized approach to assessing and trending handover quality across class years could quantify the improvements established through the QEP. This study assesses the utility of the Liang Handover Assessment Tool for Simulation (L-HATS), a valid and reliable behavioral assessment tool tested during the transition to clerkship (T2C) handover module. Here, we use the L-HATS to assess handovers delivered during residency essentials (RE) and COVID-19 telehealth courses, checking for tool reliability in settings other than T2C. In cases where we find the tool to be less reliable, we optimize the L-HATS by improving the observer training course. The study aim is to confirm tool reliability of ICC>0.75, consistent with levels of reliability found during testing in the T2C module. METHODS: We select volunteer observers from a group of medical students who had completed the T2C course, with each observer assigned a set of videos to score for each activity. The primary outcome measure for this study is the two-way random effects ICC, which represents tool inter-rater reliability in each novel activity. An ICC>0.75 is considered good reliability, an ICC 0.5-0.75 is considered moderate reliability, and an ICC<0.5 is considered poor reliability. As the volunteer observer training improves across activities, we assess for observers' intra-rater reliability. Intra-rater reliability is assessed along the same scale used for inter-rater reliability. RESULTS: RE inter-rater reliability was 0.561 [0.167, 0.953], with each of six observers scoring four videos. COVID-19 telehealth inter-rater reliability was 0.644 [0.244, 0.964], with five observers each scoring four videos. The intra-rater reliability calculated for the telehealth course ranged from 0.105 [-0.361, 0.863] to 0.667 [0.020, 0.971]. CONCLUSION: This study demonstrates moderate levels of reliability in both the RE and telehealth courses. However, neither novel activity could match the reliability scores calculated during original L-HATS testing, suggesting that the tool is less reliable in settings outside of the T2C course. Future studies might increase the number of graded videos per handover activity, to narrow the confidence intervals found in the present study. Moreover, we find that a universally flexible assessment tool is difficult to design, suggesting that each new learning activity may require a uniquely tailored behavioral assessment tool.Item Resident Complicaitons of Intravitreal Injections at a Large County Hospital(2018-01-23) Balachandar, Neeraja; Bolisetty, Keerthana; Robertson, ZacharyINTRODUCTION: Intravitreal injections (IVIs) have now surpassed cataract surgery as the most frequently performed procedure in ophthalmology. Their incidence has increased from less than 3,000 in 1999 to more than 2.3 million in 2012. The most common pharmacologic agents administered intravitreally inhibit angiogenesis by blocking vascular endothelial growth factor. Diabetic macular edema, exudative age-related macular degeneration, and venous-occlusion associated macular edema are the most common indications. As such, IVI usage will only increase in the future as the population ages, new medications become available, and indications broaden. With IVIs being performed at increasing rates at the Parkland county hospitalメs resident ophthalmology clinic, identification of an accurate risk profile must be delineated, including possible complications during cataract surgery. METHODS: A retrospective chart review of patients who received one or more IVIs by an ophthalmology resident at Parkland between 01/2010 and 07/2016 was conducted. Charts were reviewed for a variety of IVI-related complications as well as the incidence of posterior capsule rupture (PCR) during cataract surgery, after one or more IVIs. RESULTS: 1893 eyes (from 1300 subjects) that had undergone at least one IVI were included. Of a total of 8642 IVIs that were reviewed, 76 complications (0.88%) were noted. Their nature ranged from relatively non-vision threatening (corneal abrasion, ptosis, and posterior vitreous detachment) to severely vision threatening (endophthalmitis, intraocular pressure (IOP) elevation, retinal detachment (RD), and other patient movement-related complications). The majority of complications did not occur at a significantly higher or lower rate than those reported in the literature. However, a significantly lower rate of RD (p=0.039) and a significantly higher rate of acute and chronic IOP elevation (p=0.001) was found. Further, of 354 cataract surgeries included and reviewed on eyes with prior IVIs, PCR occurred 12 eyes. Of these 13 eyes, 7 eyes were excluded for a prior history of pars plana vitrectomy, a known independent risk factor for PCR. This resulted in a PCR rate of 1.41% compared to average rates in literature of 1.9-2.1% (p=0.677). DISCUSSION: Resident administered IVIs at Parkland pose an overall low risk of complication, minimally different from IVIs administered at other institutions. The PCR rate in eyes with a history of IVIs at Parkland, excluding previously vitrectomized eyes, is not significantly different than the standard rate in literature. This data will prove useful in analyzing the unique risks of IVIs and subsequent cataract surgeries in individual patients. The etiology of the increased rates of IOP elevations at Parkland requires further investigation.Item Southwestern Medical School graduates named to internships across the nation(1969-05-28) Chappell, Frank W., Jr.; Weeks, JohnItem Standardization of Internal Jugular Central Venous Catheter Insertion Between Multiple Specialties with Simulation(2018-03-29) Weia, Benjamin Chun-Bang; Reed, W. Gary; Sulistio, Melanie; Phelps, EleanorBACKGROUND: Insertion of central venous catheters is a medical procedure with the risk of adverse outcomes. Between the different specialties at the University of Texas Southwestern Medical Center (UT Southwestern), there is a wide variation in the training and performance of the procedure. At other medical institutions, standardization of central venous catheter insertion decreased the frequency of adverse outcomes including failure, infection, pneumothorax, and arterial puncture. SPECIFIC AIM: Increase compliance with a standardized method for central venous catheter insertion among resident physicians in six departments at UT Southwestern to 95% as measured by a checklist by July 2019. METHODS: Consensus was achieved on a standardized method between six departments by a modified Delphi method. A training curriculum was created for the standardized method by following the Define-Measure-Analyze-Design-Validate (DMADV) framework. In designing the curriculum, strategies were utilized from implementation science, mastery-based learning, and simulation education. During the design phase, the curriculum was improved through two Plan-Do-Study-Act cycles with two pilot training sessions. RESULTS: Created a checklist for measuring compliance to the standardized method and a written exam for measuring knowledge required for the method. Designed multiple manuals and a video for learners and educators to standardize the training. CONCLUSION: A standardized method for inserting central venous catheters has been developed with consensus between multiple departments in a large academic institution. To introduce compliance with the method, a simulation-based training curriculum has been implemented. These achievements allow for the following phase of training resident physicians at UT Southwestern and measuring for an increase in compliance to the standardized method for central venous catheter insertion.Item UT Southwestern Standardization of IJ CVC Insertion Across Multiple Specialties(2018-03-29) Kuo, Eric Jia-Young; Reed, W. Gary; Sulistio, Melanie; Phelps, EleanorBACKGROUND: Standardization of procedures decreases patient complications and improves patient care. University of Texas Southwestern(UTSW) Medical Center is a large academic institution that fosters/trains physicians from all over the country and world. The diversity of physician background in specialties and clinical interests leads to a large variation for the teaching and insertion of internal jugular(IJ) central venous catheters (CVC). In order to improve clinical training of residents and decrease patient harm, the standardization of IJ CVC insertion was undertaken at UTSW. OBJECTIVE: Standardize IJ CVC Insertion Across All Specialties at UTSW METHODS: Stakeholders were identified at the project's inception for proper sponsorship and support. Consensus across multiple specialties was achieved using a modified Delphi method. Process Map was generated using previously identified standards of practice1,2,3 for CVC insertion and modified for implementation according to resources specific to UTSW hospital system. UTSW Checklist was created based on expert consensus and the UTSW process map that included elements from work done by other academic institutions4-12. Education resources were created tailored to the UTSW process map in order to create a simulation training for future physicians and residents at UTSW. Training Video and exams were created to measure learner's competency/retention of UTSW IJ CVC insertion. RESULTS: Consensus for one method of IJ CVC insertion across multiple specialties was achieved. Checklist, educator manual, learner manual, and video were created specific to UTSW CVC insertion method. Simulation training of UTSW Physicians was begun on March 19, 2018. CONCLUSION: Creation of the UTSW IJ CVC insertion method and a simulation curriculum to teach residents/physicians was successful. Future work could be collected on hospital complications rates associated with CVC insertion and comparing the complications of 2018-2019 year to prior 2017-2018 year. Residents can be followed at 6 months intervals out of simulation training to determine retention and mastery of skill.