BMC medical education
-
BMC medical education · Nov 2018
A mixed-methods exploration of cognitive dispositions to respond and clinical reasoning errors with multiple choice questions.
Cognitive dispositions to respond (i.e., cognitive biases and heuristics) are well-established clinical reasoning phenomena. While thought by many to be error-prone, some scholars contest that these cognitive dispositions to respond are pragmatic solutions for reasoning through clinical complexity that are associated with errors largely due to hindsight bias and flawed experimental design. The purpose of this study was to prospectively identify cognitive dispositions to respond occurring during clinical reasoning to determine whether they are actually associated with increased odds of an incorrect answer (i.e., error). ⋯ This study supports the theoretical understanding of cognitive dispositions to respond as phenomena associated with errors in a new prospective manner. With further research, these findings may inform teaching, learning, and assessment of clinical reasoning toward a reduction in patient harm due to clinical reasoning errors.
-
BMC medical education · Nov 2018
Attitudes toward cost-conscious care among U.S. physicians and medical students: analysis of national cross-sectional survey data by age and stage of training.
The success of initiatives intended to increase the value of health care depends, in part, on the degree to which cost-conscious care is endorsed by current and future physicians. This study aimed to first analyze attitudes of U.S. physicians by age and then compare the attitudes of physicians and medical students. ⋯ Physician attitudes toward cost-conscious care are similar across age groups. However, physician attitudes differ significantly from medical students, even among the youngest physicians most proximate to students in age. Medical student responses suggest they are more accepting of cost-conscious care than physicians and attribute more responsibility for reducing costs to organizations and systems rather than individuals. This may be due to the combined effects of generational differences, new medical school curricula, students' relative inexperience providing cost-conscious care within complex healthcare systems, and the rapidly evolving U.S. healthcare system.
-
BMC medical education · Nov 2018
How does training in anesthesia residency shape residents' approaches to patient care handoffs? A single-center qualitative interview study.
Handoffs are a complex procedure whose success relies on mutual discussion rather than simple information transfer. Particularly among trainees, handoffs present major opportunities for medical error. Previous research has explored best practices and pitfalls in general handoff education but has not discussed barriers specific to anesthesiology residents. This study characterizes the experiences of residents in anesthesiology as they learn handoff technique in order to inform strategies for teaching this important component of perioperative care. ⋯ In a single center study of anesthesiology resident handoff education, residents exhibited confusion related to a perceived disconnect between the stated importance of effective handoffs and a lack of consensus on proper handoff technique. Standardization of curriculum and framing expectations has the potential to enhance resident handoff training in academic anesthesia departments.
-
BMC medical education · Nov 2018
Female trainees believe that having children will negatively impact their careers: results of a quantitative survey of trainees at an academic medical center.
Medical training occurs during peak childbearing years. However, the intense workload, long work hours, and limited financial compensation are potential barriers to having children during this time. Here, we aimed to identify gender-based differences in beliefs and experiences of having children during graduate medical education. We hypothesized that both genders face significant challenges, but women are more likely to experience stressors related to work-family conflicts. ⋯ Women face greater work-related conflicts in their beliefs and experiences of having a family during graduate medical education. Trainees should be aware of these potential challenges when making life and career decisions. We recommend that institutions employ solutions to accommodate the needs and wellbeing of trainees with families while optimizing training and workload equity for all trainees.
-
BMC medical education · Nov 2018
Content counts, but context makes the difference in developing expertise: a qualitative study of how residents learn end of shift handoffs.
Handoff education is both formal and informal and varies widely across medical school and residency training programs. Despite many efforts to improve clinical handoffs, little evidence has shown meaningful improvement. The objective of this study was to identify residents' perspectives and develop a deeper understanding on the necessary training to conduct safe and effective patient handoffs. ⋯ Residents identified the immersive performance and the experience of covering night shifts as the most important aspects of learning to execute effective handoffs. Formal education alone can miss the critical role of real-time sense-making throughout the process of handing off from one trainee to another. Interventions targeting senior resident mentoring and night shift could positively influence the cognitive and performance capacity for safe, effective handoffs.