Journal of general internal medicine
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Few assessments capture the diagnostic impressions medical students form immediately following patient encounters. However, notes written for objective structured clinical examinations (OSCEs) allow learners to document their clinical reasoning in real time. The University of Illinois at Chicago College of Medicine (UIC-COM) has developed a rubric for scoring patient notes (PNs) in their OSCE for senior students. ⋯ We showed an association between PN scores and clinical rotation performance. Since clinical rotation grades incorporate multiple types of assessments of students' clinical reasoning skills, we believe that this correlation lends validity evidence to using the note-writing task as a measure of clinical reasoning. Future directions include expanding the task to different stages of learners, to real life patient encounters, and to formative rather than summative assessments of note-writing skills.
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Identifying characteristics of primary care practices that perform well on cardiovascular clinical quality measures (CQMs) may point to important practice improvement strategies. ⋯ Multiple strategies-registries, prompts and protocols, patient self-management support, and patient-team partnership activities-were associated with delivering high-quality cardiovascular care over time, measured by CQMs.
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The patient-centered medical home (PCMH) model aims to improve primary health care using a patient-centered approach. Little qualitative research has investigated how the PCMH model affects patient experience with care. ⋯ Most participants had positive experiences with their care. Opportunities exist, however, to improve care for Medicaid and dually eligible beneficiaries, and enhance patient awareness of and involvement in PCMH practice transformation.
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Since 2011, aviation has revolutionized their approach to safety. The aviation industry has adopted a multi-faceted approach to improve safety through decreasing duty hour limits and implementing processes to mitigate fatigue-related errors as well as creating cultural shifts in responsibility for safety. ⋯ Key advancements in aviation fatigue mitigation and implications for residency education are explored in this article. Scientifically based processes to optimize duty hours, quality-improvement strategies to iteratively monitor and reform duty limits, systematic change focusing on a just culture, and financial disincentives and incentives as a catalyst for change are discussed.
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Understanding the impact of the COVID-19 pandemic on healthcare workers (HCW) is crucial. ⋯ In a large healthcare system, HCW had similar odds for testing SARS-CoV-2 positive, but lower odds of hospitalization compared to non-HCW. Patient-facing HCW had higher odds of a positive test. These results are key to understanding HCW risk mitigation during the COVID-19 pandemic.