RESUMEN
Importance: At least 10 million people in the United States have an intellectual and/or developmental disability (IDD). People with IDD experience considerably higher rates of poor overall health, chronic conditions including diabetes, mental health challenges, maternal mortality, and preventable deaths. This Special Communication proposes national goals based on a community-led consensus model that advances priority health outcomes for people with IDD and their caregivers/partners and identifies critical policy opportunities and challenges in achieving these goals. A community-led consensus agenda offers a foundation for focusing research, improving data collection and quality measurement, enhancing coverage and payment for services, and investing in a prepared clinical workforce and infrastructure in ways that align with lived experiences and perspectives of community members. Observations: People with IDD prioritize holistic health outcomes and tailored supports and services, driven by personalized health goals, which shift over their life course. Caregivers/partners need support for their own well-being, and easy access to resources to optimize how they support loved ones with IDD. Development of an adequately prepared clinical workforce to serve people with IDD requires national and regional policy changes that incentivize and structure training and continuing education. Ensuring effective and high-value coverage, payment, and clinical decisions requires investments in new data repositories and data-sharing infrastructure, shared learning across public and private payers, and development of new technologies and tools to empower people with IDD to actively participate in their own health care. Conclusions and Relevance: Consensus health priorities identified in this project and centered on IDD community members' perspectives are generalizable to many other patient populations. Public and private payers and regulators setting standards for health information technology have an opportunity to promote clinical data collection that focuses on individuals' needs, quality measurement that emphasizes person-centered goals rather than primarily clinical guidelines, and direct involvement of community members in the design of payment policies. Clinical education leaders, accrediting bodies, and investors/entrepreneurs have an opportunity to innovate a better prepared health care workforce and shared data infrastructure to support value-based care programs.
Asunto(s)
Discapacidades del Desarrollo , Política de Salud , Discapacidad Intelectual , Humanos , Discapacidad Intelectual/terapia , Discapacidades del Desarrollo/terapia , Estados UnidosRESUMEN
This study uses survey data to describe the types of sexual harassment experienced by internal medicine residents, their knowledge of reporting mechanisms, their reporting intentions and actions, and satisfaction with reporting outcomes.
Asunto(s)
Internado y Residencia , Médicos Mujeres , Acoso Sexual , Humanos , Autoinforme , Encuestas y CuestionariosAsunto(s)
Atención Ambulatoria , Educación de Pregrado en Medicina , Medicina Interna/educación , Atención Ambulatoria/métodos , Atención Ambulatoria/organización & administración , Prácticas Clínicas/métodos , Educación de Pregrado en Medicina/métodos , Educación de Pregrado en Medicina/estadística & datos numéricos , Humanos , Facultades de Medicina/clasificación , Facultades de Medicina/estadística & datos numéricos , Encuestas y Cuestionarios , Enseñanza , Estados UnidosRESUMEN
Individualized structured feedback is an integral part of a resident's learning in communication skills. However, it is not clear what feedback residents receive for their communication skills development in real patient care. We will identify the most common feedback topics given to residents regarding communication skills during Internal Medicine residency training. We analyzed Resident Audio-recording Project feedback data from 2008 to 2013 by using a content analysis approach. Using open coding and an iterative categorization process, we identified 15 emerging themes for both positive and negative feedback. The most recurrent feedback topics were Patient education, Thoroughness, Organization, Questioning strategy, and Management. The residents were guided to improve their communication skills regarding Patient education, Thoroughness, Management, and Holistic exploration of patient's problem. Thoroughness and Communication intelligibility were newly identified themes that were rarely discussed in existing frameworks. Assessment rubrics serve as a lens through which we assess the adequacy of the residents' communication skills. Rather than sticking to a specific rubric, we chose to let the rubric evolve through our experience.
Asunto(s)
Competencia Clínica , Comunicación , Retroalimentación , Medicina Interna/educación , Internado y Residencia , Adulto , Femenino , Humanos , Masculino , Educación del Paciente como Asunto/métodos , Relaciones Médico-Paciente , Grabación en Cinta/métodosRESUMEN
The transition of care from hospital to home is susceptible to clinical errors and adverse drug events. Despite this risk and the benefits of an interprofessional approach to patient care, medicine and pharmacy do not often collaborate during transitions of care. The purpose of this study was to evaluate the impact of an interprofessional education experience consisting of medical and pharmacy students performing transitions of care. A total of 88 students (13 pharmacy students and 75 medical students) participated and were surveyed before and after the experience, to evaluate their confidence in performing aspects of the transition of care process as well as their attitudes towards interprofessional care. Pharmacy students had higher baseline levels of confidence compared with the medical students, and both student groups revealed a significantly greater level of confidence in their abilities after the experience. The impact of the experience on students' attitudes towards interprofessional care varied, with medical students showing very little change from baseline and pharmacy students showing improved attitudes in several areas. The results of this study have positive implications for an interprofessional approach to transitions of care while highlighting potential future areas of study.
Asunto(s)
Actitud del Personal de Salud , Personal de Salud/educación , Relaciones Interprofesionales , Estudiantes de Medicina/psicología , Estudiantes de Farmacia/psicología , Cuidado de Transición/organización & administración , Continuidad de la Atención al Paciente , Conducta Cooperativa , Humanos , Alta del PacienteRESUMEN
In this position paper, the Alliance for Academic Internal Medicine and the American College of Physicians examine the state of graduate medical education (GME) financing in the United States and recent proposals to reform GME funding. They make a series of recommendations to reform the current funding system to better align GME with the needs of the nation's health care workforce. These recommendations include using Medicare GME funds to meet policy goals and to ensure an adequate supply of physicians, a proper specialty mix, and appropriate training sites; spreading the costs of financing GME across the health care system; evaluating the true cost of training a resident and establishing a single per-resident amount; increasing transparency and innovation; and ensuring that primary care residents receive training in well-functioning ambulatory settings that are financially supported for their training roles.
Asunto(s)
Educación de Postgrado en Medicina/economía , Política Pública , Apoyo a la Formación Profesional , Financiación Gubernamental , Humanos , Medicina Interna , Internado y Residencia/economía , Medicare/economía , Médicos/provisión & distribución , Médicos de Atención Primaria/provisión & distribución , Sociedades Médicas , Estados Unidos , Recursos HumanosRESUMEN
BACKGROUND: Systems-based practice is one of the six general competencies proposed by the Accreditation Council for Graduate Medical Education in their Outcome Project. However, little has been published on its assessment--possibly because the systems-based practice competency has been viewed as difficult to define and measure. PURPOSE: The purpose of this study was to determine whether a full performance-based examination of systems-based practice cases simulated and scored by standardized participants in the health care system could feasibly be constructed and implemented that would provide reliable and valid measurements. METHODS: In the 1st year of the project (2008), four systems-based practice cases were developed and pilot tested with 13 residents. Videotapes of residents were studied to develop an instrument for subsequent assessment of performance by standardized participants. In the 2nd year (2009), the examination was expanded to a full 12 cases, which were completed by 11 second-year residents, and psychometric analyses were performed on the scores. RESULTS: The generalizability coefficient for the full 12-case examination based on scoring by standardized participants was .71, which is nearly equal to that based on scoring by faculty physician observers, which was .78. The correlation between total scores obtained with standardized participants and physician observers was .78. CONCLUSIONS: A performance-based examination can provide a feasible and reliable assessment of systems-based practice. However, attempts to evaluate convergent validity and discriminant validity-by correlating systems-based practice performance assessments with mean global ratings of residents on the 6 competencies by faculty throughout training-were unsuccessful, due to a lack of independence between the rated dimensions.