Journal of graduate medical education最新文献_第5页

A Perspective on Promotion in Place and Competency-Based, Time-Variable Graduate Medical Education. 透视就地晋升和基于能力、时间可变的毕业医学教育。

Journal of graduate medical education Pub Date : 2024-12-01 Epub Date: 2024-12-13 DOI: 10.4300/JGME-D-24-00380.1

Steven H Rose, Timothy R Long

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Implementing a Clinical Decision Support Tool to Reduce Operating Room Anesthetic Fresh Gas Flow: A Resident-Led, Sustainability-Focused Quality Improvement Initiative. 实施临床决策支持工具以减少手术室麻醉新鲜气体流量：一项由住院医师主导、以可持续发展为重点的质量改进计划。

Journal of graduate medical education Pub Date : 2024-12-01 Epub Date: 2024-12-13 DOI: 10.4300/JGME-D-24-00074.1

Julia Collins, Marcus Karim, Bebhinn Akcay, Nandini Palaniappa, Jenson Wong

{"title":"Implementing a Clinical Decision Support Tool to Reduce Operating Room Anesthetic Fresh Gas Flow: A Resident-Led, Sustainability-Focused Quality Improvement Initiative.","authors":"Julia Collins, Marcus Karim, Bebhinn Akcay, Nandini Palaniappa, Jenson Wong","doi":"10.4300/JGME-D-24-00074.1","DOIUrl":"10.4300/JGME-D-24-00074.1","url":null,"abstract":"Background Lowering fresh gas flow (FGF) can help decrease the carbon footprint of the operating room as FGF levels act as an indirect measure of anesthetic gas waste. Objective The aim of this quality improvement project was to reduce clinician FGF during general anesthesia with clinical decision support (CDS) tools within the electronic health record (EHR) at a single institution. Methods A non-interruptive alert to reduce FGF was coded into the anesthesia intraoperative EHR workspace to alert whenever the 10-minute average FGF exceeded 1 L/min. It was targeted at anesthesia residents, attendings, and certified registered nurse anesthetists at a single US large academic level 1 trauma center. The number of general anesthesia cases with a target FGF of ≤2 L/min and the amount of sevoflurane (L/hr) was tracked on an individual and institutional basis. Results Following CDS implementation from July 2023 through July 2024, 2677 of 4573 (58.5%) had a mean FGF ≤2 L/min, demonstrating a 116.7% increase from our institution's baseline of 27.0% (1200 of 4446 cases) from July 2022 to June 2023, corresponding to a sevoflurane usage reduction of 36.7%. Conclusions Implementing a non-interruptive alert in the EHR altered institution-level behaviors to reduce environmentally harmful anesthetic gas emissions.","PeriodicalId":37886,"journal":{"name":"Journal of graduate medical education","volume":"16 6 Suppl","pages":"140-144"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11644587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sustainability in Action: A Financial Incentive for Trainees Embracing Environmentally Friendly Quality Improvement Projects. 可持续发展在行动：对接受环境友好型质量改进项目的受训人员的经济激励。

Journal of graduate medical education Pub Date : 2024-12-01 Epub Date: 2024-12-13 DOI: 10.4300/JGME-D-24-00059.1

Esther H Chen, Elena Fuentes-Afflick

{"title":"Sustainability in Action: A Financial Incentive for Trainees Embracing Environmentally Friendly Quality Improvement Projects.","authors":"Esther H Chen, Elena Fuentes-Afflick","doi":"10.4300/JGME-D-24-00059.1","DOIUrl":"10.4300/JGME-D-24-00059.1","url":null,"abstract":"Background Engaging and motivating busy trainees to work on reducing the climate impact of their clinical practice is challenging. To our knowledge, there are no published studies of graduate medical education (GME)-wide, institutional efforts to engage residents in implementing climate sustainability improvement projects. Objective We piloted a novel, institution-wide, pay-for-performance (P4P) sustainability quality improvement (SusQI) program in 2023-2024 that enabled residents from all GME programs to implement SusQI projects with practice-changing improvement goals for a financial incentive. Methods Project leaders were provided an opportunity to implement a project by identifying a SusQI problem and collaborating with stakeholders toward meeting environmentally friendly monthly improvement goals for an incentive payment. Eligible residents who reached their monthly goal for 6 months of the academic year would receive $400. Results Of the 4 SusQI projects approved for the P4P program, 3 remained active after 6 months. One project stalled because of institutional barriers. Two hundred and ten residents participated. Environmental impacts included an increase in low anesthetic gas flow use in operating room cases (mean [SD] 25% to 53% [0.1]), increase of radiology workroom waste sorting into recycling and composting bins (mean [SD] 20% to 58% [0.1]), and increase in emergency department instruments recycled (mean [SD] 9% to 24% [0.2]). Two hundred and ten residents are set to receive $84,000 at the end of the year for meeting their SusQI goals. Conclusions We were able to integrate sustainability into QI programs by implementing an institution-wide pay-for-performance SusQI program that encouraged residents to develop and implement environmentally friendly practice projects.","PeriodicalId":37886,"journal":{"name":"Journal of graduate medical education","volume":"16 6 Suppl","pages":"135-139"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11644596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Graduate Medical Education Fellowship in Climate Change and Human Health: Experience and Outcomes From the First 5 Years. 气候变化与人类健康医学教育研究生奖学金：前 5 年的经验和成果。

Journal of graduate medical education Pub Date : 2024-12-01 Epub Date: 2024-12-13 DOI: 10.4300/JGME-D-24-00110.1

Caleb Dresser, Tess Wiskel, Catharina Giudice, Kimberly Humphrey, Latoya Storr, Satchit Balsari

{"title":"A Graduate Medical Education Fellowship in Climate Change and Human Health: Experience and Outcomes From the First 5 Years.","authors":"Caleb Dresser, Tess Wiskel, Catharina Giudice, Kimberly Humphrey, Latoya Storr, Satchit Balsari","doi":"10.4300/JGME-D-24-00110.1","DOIUrl":"10.4300/JGME-D-24-00110.1","url":null,"abstract":"Background Climate change is affecting health and health care, but most physicians lack formal training on climate change. There is a need for graduate medical education (GME) programs that prepare physician leaders to address its health impacts. Objective To describe the development and iterative piloting of a GME fellowship in climate change and health and to assess fellows' academic output and public engagement before and after fellowship matriculation. Methods A GME training program was developed and implemented at an emergency medicine department in a US teaching hospital in collaboration with affiliated academic centers. Participants consisted of emergency physicians from the United States and abroad. Program duration and format were adjusted to meet individual career goals. Outcomes assessed include program completion, postgraduation professional roles, and academic outputs and public engagement before and after fellowship matriculation (2019-2023), compared via paired t tests. Results Five fellows have matriculated; 2 have graduated, while 3 remain in training. Costs and in-kind support include salaries, faculty time, research support, travel to conferences, and tuition for a public health degree. Fellows averaged 0.26 outputs per month before matriculation (95% CI 0.01-0.51) and 2.13 outputs per month following matriculation (95% CI 0.77-3.50); this difference was significant via 2-tailed t test (alpha=.05, P=.01). Subanalyses of academic output and public engagement reveal similar increases. Following matriculation, 186 of 191 (97.4%) of outputs were related to climate change. Conclusions For the 5 fellows that have enrolled in this GME climate change fellowship, academic and public engagement output rates increased following fellowship matriculation.","PeriodicalId":37886,"journal":{"name":"Journal of graduate medical education","volume":"16 6 Suppl","pages":"129-134"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11644595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Resident Physicians Can Promote Environmental Health and Climate-Informed Health Care. 住院医师可以促进环境健康和气候知情医疗保健。

Journal of graduate medical education Pub Date : 2024-12-01 Epub Date: 2024-12-13 DOI: 10.4300/JGME-D-24-00175.1

Jacob Rha, Camille Ezran, Katherine T Liu, Lesley B Gordon

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Music and Medicine in Concert. 音乐会中的音乐和医学。

Journal of graduate medical education Pub Date : 2024-12-01 Epub Date: 2024-12-13 DOI: 10.4300/JGME-D-24-00560.1

Nara Miriam Michaelson

引用次数: 0

Returning to The House of God. 回到神的殿。

Journal of graduate medical education Pub Date : 2024-12-01 Epub Date: 2024-12-13 DOI: 10.4300/JGME-D-24-00475.1

Emmet Hirsch

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Adapting the Planetary Health Report Card for Graduate Medical Training Programs. 为医学研究生培训计划改编 "行星健康报告卡"。

Journal of graduate medical education Pub Date : 2024-12-01 Epub Date: 2024-12-13 DOI: 10.4300/JGME-D-24-00065.1

Sarah Schear, Karly Hampshire, Taylor Diedrich, Isabel Waters, Aisha Barber

{"title":"Adapting the Planetary Health Report Card for Graduate Medical Training Programs.","authors":"Sarah Schear, Karly Hampshire, Taylor Diedrich, Isabel Waters, Aisha Barber","doi":"10.4300/JGME-D-24-00065.1","DOIUrl":"10.4300/JGME-D-24-00065.1","url":null,"abstract":"Background Leading medical organizations recognize climate change as an urgent threat to public health and social justice. Medical students created the Planetary Health Report Card (PHRC) to evaluate and spur climate action in medical schools. Graduate medical trainees lack a similar tool to evaluate and improve their training programs and institutions. Objective To adapt the PHRC to graduate medical education (GME) contexts and report preliminary validity evidence. Methods In 2023, based on literature review, we adapted the 2022 undergraduate medical PHRC metrics on curriculum and sustainability. We modified keywords in all PHRC domains to apply to GME. We recruited participants with expertise in planetary health, sustainability, and health equity affiliated with GME. Using a modified Delphi Panel method, we surveyed participants on adapted metric validity. We determined percent agreement among participants. Results We recruited 45 eligible participants, of whom 20 (44%) completed a first-round survey. Participants included a senior medical student, residents, fellows, faculty, and program directors from the United States, Canada, and the United Kingdom. Participants had a high level of agreement on metrics in the domains of curriculum, support for trainee-led initiatives, and sustainability. Some metrics in research and community engagement domains fell below the agreement threshold. Conclusions In the first round of a modified Delphi Panel survey, trainees and faculty agreed that metrics adapted from the PHRC are relevant to evaluating GME programs on planetary health, sustainability, and environmental justice.","PeriodicalId":37886,"journal":{"name":"Journal of graduate medical education","volume":"16 6 Suppl","pages":"104-110"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11644582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Planetary Health and Sustainable Health Care Education Through Quality Improvement: A Residency Curriculum Integration. 通过质量改进实现行星健康和可持续医疗保健教育：住院实习课程整合。

Journal of graduate medical education Pub Date : 2024-12-01 Epub Date: 2024-12-13 DOI: 10.4300/JGME-D-24-00064.1

Catherine Chen, Radhika Kadakia

引用次数: 0

Teaching Climate and Health in Preventive Medicine Residency Programs: A Survey of Program Directors. 预防医学住院医师培训项目中的气候与健康教学：项目主任调查。

Journal of graduate medical education Pub Date : 2024-12-01 Epub Date: 2024-12-13 DOI: 10.4300/JGME-D-24-00348.1

Marian R Passannante, Shaun Shahani, Michael Gochfeld, Wendy M Purcell, Sajjad A Savul, Pauline Thomas

{"title":"Teaching Climate and Health in Preventive Medicine Residency Programs: A Survey of Program Directors.","authors":"Marian R Passannante, Shaun Shahani, Michael Gochfeld, Wendy M Purcell, Sajjad A Savul, Pauline Thomas","doi":"10.4300/JGME-D-24-00348.1","DOIUrl":"10.4300/JGME-D-24-00348.1","url":null,"abstract":"Background Climate change and related pollution and environmental damage are an urgent focus for public health physicians. Curricular content is increasing in medical schools, but to date, only pediatrics has published guidance for residency education. Objective To survey program directors of Accreditation Council for Graduate Medical Education preventive medicine specialties (public health and preventive medicine [PHPM], occupational and environmental medicine [OEM], and aerospace medicine [AM]) for current teaching on climate and health issues. Methods Links to an online 9-question confidential survey were sent to all program directors through Listservs January through March 2024. Questions were developed with guidance from a climate health expert. Responses were analyzed via summary statistics for continuous data, as well as Fisher's Exact, Kruskal-Wallis, and Wilcoxon pairwise comparison tests for nominal data. Results Thirty-five of 71 programs responded (49.3%), including 21 of 42 PHPM, 12 of 23 OEM, and 2 of 6 AM programs. Two (5.9%) reported having a formal curriculum for climate and health issues, and 2 (5.9%) reported not covering any included topics. Programs differed by topic emphasis with OEM and AM more likely to address fire, smoke, wind, and flooding effects. Lectures and local or state health department rotations were the most frequent teaching strategies. Of complete responders, 23 of 34 (67.6%) expressed interest in joining a workgroup to develop shared curricula. Conclusions This survey of preventive medicine residency programs found that most include climate and health topics, but only 2 have a formal curriculum, and 2 reported no topics included in the survey.","PeriodicalId":37886,"journal":{"name":"Journal of graduate medical education","volume":"16 6 Suppl","pages":"120-124"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11644597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0