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  • 1
    In: Academic Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 95, No. 7 ( 2020-07), p. 1014-1019
    Abstract: Recent discussions have brought attention to the utility of contribution analysis for evaluating the effectiveness and outcomes of medical education programs, especially for complex initiatives such as competency-based medical education. Contribution analysis focuses on the extent to which different entities contribute to an outcome. Given that health care is provided by teams, contribution analysis is well suited to evaluating the outcomes of care delivery. Furthermore, contribution analysis plays an important role in analyzing program- and system-level outcomes that inform program evaluation and program-level improvements for the future. Equally important in health care, however, is the role of the individual. In the overall contribution of a team to an outcome, some aspects of this outcome can be attributed to individual team members. For example, a recently discharged patient with an unplanned return to the emergency department to seek care may not have understood the discharge instructions given by the nurse or may not have received any discharge guidance from the resident physician. In this example, if it is the nurse’s responsibility to provide discharge instructions, that activity is attributed to him or her. This and other activities attributed to different individuals (e.g., nurse, resident) combine to contribute to the outcome for the patient. Determining how to tease out such attributions is important for several reasons. First, it is physicians, not teams, that graduate and are granted certification and credentials for medical practice. Second, incentive-based payment models focus on the quality of care provided by an individual. Third, an individual can use data about his or her performance on the team to help drive personal improvement. In this article, the authors explored how attribution and contribution analyses can be used in a complimentary fashion to discern which outcomes can and should be attributed to individuals, which to teams, and which to programs.
    Type of Medium: Online Resource
    ISSN: 1040-2446
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2025367-9
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  • 2
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Academic Medicine Vol. 89, No. 6 ( 2014-06), p. 840-842
    In: Academic Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 89, No. 6 ( 2014-06), p. 840-842
    Type of Medium: Online Resource
    ISSN: 1040-2446
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 2025367-9
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  • 3
    In: Journal of General Internal Medicine, Springer Science and Business Media LLC, Vol. 27, No. 3 ( 2012-3), p. 391-391
    Type of Medium: Online Resource
    ISSN: 0884-8734 , 1525-1497
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2012
    detail.hit.zdb_id: 2006784-7
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  • 4
    In: Family Medicine, Society of Teachers of Family Medicine, Vol. 52, No. 6 ( 2020-6-5), p. 398-407
    Abstract: Background and Objectives: Much can be gained by the three primary care disciplines collaborating on efforts to transform residency training toward interprofessional collaborative practice. We describe findings from a study designed to align primary care disciplines toward implementing interprofessional education. Methods: In this mixed methods study, we included faculty, residents and other interprofessional learners in family medicine, internal medicine, and pediatrics from nine institutions across the United States. We administered a web-based survey in April/May of 2018 and used qualitative analyses of field notes to study resident exposure to team-based care during training, estimates of career choice in programs that are innovating, and supportive and challenging conditions that influence collaboration among the three disciplines. Complete data capture was attained for 96.3% of participants. Results: Among family medicine resident graduates, an estimated 87.1% chose to go into primary care compared to 12.4% of internal medicine, and 36.5% of pediatric resident graduates. Qualitative themes found to positively influence cross-disciplinary collaboration included relationship development, communication of shared goals, alignment with health system/other institutional initiatives, and professional identity as primary care physicians. Challenges included expressed concerns by participants that by working together, the disciplines would experience a loss of identity and would be indistinguishable from one another. Another qualitative finding was that overwhelming stressors plague primary care training programs in the current health care climate—a great concern. These include competing demands, disruptive transitions, and lack of resources. Conclusions: Uniting the primary care disciplines toward educational and clinical transformation toward interprofessional collaborative practice is challenging to accomplish.
    Type of Medium: Online Resource
    ISSN: 0742-3225
    RVK:
    Language: Unknown
    Publisher: Society of Teachers of Family Medicine
    Publication Date: 2020
    detail.hit.zdb_id: 2128318-7
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  • 5
    In: Academic Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 95, No. 1 ( 2020-01), p. 59-68
    Abstract: Current models of quality improvement and patient safety (QIPS) education are not fully integrated with clinical care delivery, representing a major impediment toward achieving widespread QIPS competency among health professions learners and practitioners. The Royal College of Physicians and Surgeons of Canada organized a 2-day consensus conference in Niagara Falls, Ontario, Canada, called Building the Bridge to Quality, in September 2016. Its goal was to convene an international group of educational and health system leaders, educators, frontline clinicians, learners, and patients to engage in a consensus-building process and generate a list of actionable strategies that individuals and organizations can use to better integrate QIPS education with clinical care. Four strategic directions emerged: prioritize the integration of QIPS education and clinical care, build structures and implement processes to integrate QIPS education and clinical care, build capacity for QIPS education at multiple levels, and align educational and patient outcomes to improve quality and patient safety. Individuals and organizations can refer to the specific tactics associated with the 4 strategic directions to create a road map of targeted actions most relevant to their organizational starting point. To achieve widespread change, collaborative efforts and alignment of intrinsic and extrinsic motivators are needed on an international scale to shift the culture of educational and clinical environments and build bridges that connect training programs and clinical environments, align educational and health system priorities, and improve both learning and care, with the ultimate goal of achieving improved outcomes and experiences for patients, their families, and communities.
    Type of Medium: Online Resource
    ISSN: 1040-2446
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2025367-9
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  • 6
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Academic Medicine Vol. 96, No. 7S ( 2021-07), p. S56-S63
    In: Academic Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 96, No. 7S ( 2021-07), p. S56-S63
    Abstract: Educators use entrustment, a common framework in competency-based medical education, in multiple ways, including frontline assessment instruments, learner feedback tools, and group decision making within promotions or competence committees. Within these multiple contexts, entrustment decisions can vary in purpose (i.e., intended use), stakes (i.e., perceived risk or consequences), and process (i.e., how entrustment is rendered). Each of these characteristics can be conceptualized as having 2 distinct poles: (1) purpose has formative and summative , (2) stakes has low and high , and (3) process has ad hoc and structured . For each characteristic, entrustment decisions often do not fall squarely at one pole or the other, but rather lie somewhere along a spectrum. While distinct, these continua can, and sometimes should, influence one another, and can be manipulated to optimally integrate entrustment within a program of assessment. In this article, the authors describe each of these continua and depict how key alignments between them can help optimize value when using entrustment in programmatic assessment within competency-based medical education. As they think through these continua, the authors will begin and end with a case study to demonstrate the practical application as it might occur in the clinical learning environment.
    Type of Medium: Online Resource
    ISSN: 1040-2446
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2025367-9
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  • 7
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2011
    In:  Journal of General Internal Medicine Vol. 26, No. 11 ( 2011-11), p. 1253-1257
    In: Journal of General Internal Medicine, Springer Science and Business Media LLC, Vol. 26, No. 11 ( 2011-11), p. 1253-1257
    Type of Medium: Online Resource
    ISSN: 0884-8734 , 1525-1497
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2011
    detail.hit.zdb_id: 2006784-7
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  • 8
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Academic Medicine Vol. 94, No. 2 ( 2019-02), p. 195-201
    In: Academic Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 94, No. 2 ( 2019-02), p. 195-201
    Abstract: W. Edwards Deming, in his System of Profound Knowledge, asserts that leaders who wish to transform a system should understand four essential elements: appreciation for a system, theory of knowledge, knowledge about variation, and psychology. The Accreditation Council for Graduate Medical Education (ACGME) introduced the milestones program as a part of the Next Accreditation System to create developmental language for the six core competencies and facilitate programmatic assessment within graduate medical education systems. Viewed through Deming’s lens, the ACGME can be seen as the steward of a large system, with everyone who provides assessment data as workers in that system. The authors use Deming’s framework to illustrate the working components of the assessment system of the University of Cincinnati College of Medicine’s internal medicine residency program and draw parallels to the macrocosm of graduate medical education. Successes and failures in transforming resident assessment can be understood and predicted by identifying the system and its aims, turning information into knowledge, developing an understanding of variation, and appreciating the psychology of motivation of participants. The authors offer insights from their experience for educational leaders who wish to apply Deming’s elements to their own assessment systems, with questions to explore, pitfalls to avoid, and practical approaches in doing this type of work.
    Type of Medium: Online Resource
    ISSN: 1040-2446
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2025367-9
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  • 9
    In: Academic Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 94, No. 9 ( 2019-09), p. 1376-1383
    Abstract: To inform graduate medical education (GME) outcomes at the individual resident level, this study sought a method for attributing care for individual patients to individual interns based on “footprints” in the electronic health record (EHR). Method Primary interns caring for patients on an internal medicine inpatient service were recorded daily by five attending physicians of record at University of Cincinnati Medical Center in August 2017 and January 2018. These records were considered gold standard identification of primary interns. The following EHR variables were explored to determine representation of primary intern involvement in care: postgraduate year, progress note author, discharge summary author, physician order placement, and logging clicks in the patient record. These variables were turned into quantitative attributes (e.g., progress note author: yes/no), and informative attributes were selected and modeled using a decision tree algorithm. Results A total of 1,511 access records were generated; 116 were marked as having a primary intern assigned. All variables except discharge summary author displayed at least some level of importance in the models. The best model achieved 78.95% sensitivity, 97.61% specificity, and an area under the receiver-operator curve of approximately 91%. Conclusions This study successfully predicted primary interns caring for patients on inpatient teams using EHR data with excellent model performance. This provides a foundation for attributing patients to primary interns for the purposes of determining patient diagnoses and complexity the interns see as well as supporting continuous quality improvement efforts in GME.
    Type of Medium: Online Resource
    ISSN: 1040-2446
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2025367-9
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  • 10
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Academic Medicine Vol. 94, No. 8 ( 2019-08), p. 1064-1065
    In: Academic Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 94, No. 8 ( 2019-08), p. 1064-1065
    Type of Medium: Online Resource
    ISSN: 1040-2446
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2025367-9
    Location Call Number Limitation Availability
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