Medical Residents University of Washington

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Medical ResidentsUniversity of Washington

• Amy Fields
• March 6, 2003
• LIS 528

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Educational Requirements

• Successful completion of medical school
• Award of Medical Degree

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University of Washington Residency Program

• The Department of Medicine administers three
  fully accredited internal medicine residency
  pathways

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University of Washington Residency Program

• Traditional or categorical pathway
• Seattle Primary Care Internist Pathway
• Seattle/Boise Primary Care Internist Pathway
• In addition
• A preliminary (one year) internship for
  individuals going into other specialties but who
  would like a year of broad exposure to internal
  medicine

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Practice Description

• ACGME general competencies requirements for
  Residency training programs require residents to
  have education experiences that allow them to
  demonstrate competency in the following areas

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Practice Description

• 1) patient care,
• 2) medical knowledge,
• 3) practice-based learning and improvement,
• 4) interpersonal and communication skills,
• 5) professionalism, and
• 6) systems-based practice

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Current Problems/Issues facing Medical Residents

• Resident burnout
• Work hours

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Resident Burnout

• Concerns 30-40 years ago
• Parking spaces
• Midnight snacks
• Off-hours access to library
• Ann Inn Med, 2002

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Resident Burnout

• Concerns present
• Patients are sicker
• Hospital stays shorter
• Attendings are more hassled
• More residents are married
• Many have children
• Great many more are women
• Ann Inn Med, 2002

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Resident Burnout

• Concerns present
• Fewer opportunities to establish relationships
  with patients, peers and faculty
• Amount of debt incurred getting degree major
  source of stress
• Ann Inn Med, 2002

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Self-reported burnout study

• Effects on patient care
• (results of UW cross-sectional study)
• February 2001 a 92-item, self-administered survey
  was sent to all residents in the internal
  Medicine Program
• Burnout was measured using the Maslach Burnout
  Inventory (MBI)
• Ann Inn Med, 2002

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Self-reported burnout study

• MBI evaluates three domains of burnout
• 1) Emotional exhaustion
• 2) depersonalization
• 3) personal accomplishment

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Self-reported burnout study

• Study defined burnout as a high score on the
  depersonalization or emotional exhaustion
  subscales.
• 76 met criteria
• Burned-out residents are 2-3 times more likely to
  report suboptimal patient care practices at least
  monthly or weekly

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Resident work hours

• ACGME (to be implemented by July 2003)
• Total Duty Hours must not exceed 80 hours per
  week, averaged over a four week period
• Workdays that exceed 12 hours are defined as
  on-call

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Past information needs studies

• Information needs during clinical activity
• Online searching skills of residents

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Information needs during clinical activity

• Observational Study
• Anthropologist observed communication among
  subjects re their information needs
• Coding scheme was developed for describing
  information requests
• Ann Inn Med 1991

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Information needs during clinical activity

• Study Results
• Average 5 clinical questions raised for each
  patient
• 52 requested a fact that could be found in
  patient medical record
• 23 were potentially answerable by a textbook,
  journal, or MEDLINE
• 26 required synthesis of patient information and
  medical knowledge.
• Ann Inn Med 1991

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Online Searching

• Study of residents Philadelphia in 1997
• 39 described their MEDLINE searching skills as
  only fair or poor
• 56 felt teaching in this area would be very
  helpful
• Journal of Medical Library Association (JMLA),
  2002

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Online Searching

• Offered a 3-hour workshop
• Residents did a pretest MEDLINE search and then a
  posttest search after the workshop
• More that ½ residents after ambulatory care
  rotation rated the workshop as one of the best
  learning experiences of their rotation
• Journal of Medical Library Association (JMLA),
  2002

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Online Searching

• Continued MEDLINE searching
• Percentage of residents using techniques learned
  in workshop for searching MEDLINE improved
  significantly
• In self-directed MEDLINE searches later in the
  year Residents continued to demonstrate improved
  skills
• After this pilot study, the workshop was
  implemented with all second-year medicine
  residents
• Journal of Medical Library Association (JMLA),
  2002

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Service to meet the needs of Residents

• PrimeAnswers  The specific aims of the project
  will help determine if a simplification or
  reduction in the barriers to access and speed of
  information retrieval can enhance patient care.

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Service to meet the needs of Residents

• PrimeAnswers for Residents
• Help with (decreasing/managing) work hours
• Aid in learning process
• Aid in effective patient care

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Service to meet the needs of Residents

• Clinical Medical Librarians
• Attend reports/conferences
• Literature searches
• Teach (PrimeAnswers, PubMed, MeSH, Medline, etc.)

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Approach to the service

• PrimeAnswers Add teaching component
• 2004 Grant Proposal support learning at the
  point of care through a system of information
  objects organized by clinical educators for
  residents and patients (PrimeConditions)
• Clinical Medical Librarian Add more of them

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Measure of its effectiveness

• PrimeAnswers already proven effective for faculty
• PrimeAnswers averages 5000 hits per month
• Clinical Medical Librarian already proven
  effective for Residents

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Measure of its effectiveness

• Survey Residents
• Similar to 1993 survey of UW Residents re CML

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Clinical Librarian Program study
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Survey

Starting in November 1993, time was allotted at
Resident Report to evaluate the information
supplied by the CML. Residents were asked to
name the principal diagnosis of a patient for
which an information request of the literature
was made. In 6 months' time, 31 questionnaires
were returned with the following results
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Internal Medicine Residents Survey Results
III11/93 - 4/94

 Information supplied was useful or relevant
100 YES  Information supplied
provided new knowledge 100
YES  Information supplied substantiated what I
77 YES already knew or
suspected
23 NO Information supplied did (or will)
contribute 100 YES to better
informed clinical decisions  
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Conclusion

• With the explosion of new medical information and
  limitations on resident work hours and attendings
  teaching time, more efficient ways to teach
  residents must be implemented

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Conclusion

• A system like PrimeAnswers that presents concepts
  in small chunks, making the content searchable,
  and that provides links to existing digital
  textbooks and journal articles is a great tool to
  meet the needs of this group