Assessment of knowledge and attitudes towards safety events reporting among residents in a community health system.

Background: Resident physicians are known to be infrequent reporters of patient safety events (PSE). Previous studies assessing barriers to resident PSE reporting have not considered possible cultural barriers faced by international medical graduates (IMG). This study aimed to assess the knowledge and attitudes of residents regarding PSE and possible barriers contributing to poor resident reporting. Methods: A cross sectional survey of all house staff undergoing post-graduate residency training at two independent community hospital based academic medical centers was conducted through an online questionnaire. Sample case vignettes were created to assess the residents' ability to identify safety events and classify them as near miss, adverse events or sentinel events and decide whether they were reportable. Results: The Reporting of PSE increased significantly by year of residency training (p < 0.005), with time taken to file a PSE being the strongest perceived barrier. There was no difference in PSE reporting between IMG's and non- IMG's. We identified major knowledge gaps with only 73.9%, 79.6% and 94.3% of respondents correctly identifying sentinel events, adverse events, and near misses, respectively. 58.1% of respondents did not think near misses were reportable. Conclusions: A lack of knowledge is the most important barrier towards PSE reporting. A different cultural background and lack of previous exposure to patient safety report by IMGs is not a significant barrier towards safety event reporting. In the short-term, it appears that focusing limited institutional resources on education rather than acculturation issues would have the greatest benefit.

Internal medicine fellowship directors' perspectives on the quality and utility of letters conforming to residency program director letter of recommendation guidelines.

Background: In May 2017, the Alliance for Academic Internal Medicine (AAIM) published guidelines intending to standardize and improve internal medicine residency program director (PD) letters of recommendation (LORs) for fellowship applicants. Objectives: This study aimed to examine fellowship PDs impressions of the new guidelines, letter writers' adherence to the guidelines, and the impact of LORs that conformed to guidelines compared to non-standardized letters. Methods: The authors anonymously surveyed fellowship PDs from January to March 2018 to gather input about LORs submitted to their programs during the 2017 fellowship application cycle. Results: A total of 78% of survey respondents were satisfied with letters that followed the AAIM guidelines, whereas 48% of respondents were satisfied with letters that did not. Fellowship PDs felt that letters that followed the AAIM guidelines were more helpful than letters that did not, especially for differentiating between applicants from the same institution and for understanding residents' performance across the six core competency domains. Fellowship PDs provided several suggestions for residency PDs to make the LORs even more helpful. Conclusion: Fellowship PD respondents indicated that LORs that followed the new AAIM guidelines were more helpful than letters that did not.

Award incentives to improve quality care in internal medicine.

INTRODUCTION: Award incentives encourage higher standards of personal performance, which closely reflects the quality of patient care. We report the development, implementation, and success of our internal medicine department awards program. MATERIALS AND METHODS: An anonymous pre award survey collected responses to understand the need for an awards program in our department. Five awards were celebrated. An anonymous post award survey collected responses to evaluate the effectiveness of the program. RESULTS: A total of 69% (175/253) of pre award survey responses were collected. Among those, 100% (175/175) agreed that employee recognition was important. 68% (119/175) felt that performance should be the deciding criteria for employee recognition. There was a winner in each award category. Post award survey showed 78% (102/130) agreed that the award ceremony incentivized them to increase quality of personal performance. CONCLUSION: In summary, we feel that this transparent, objective, and peer-nominated awards program could serve as an incentivized model for healthcare providers to elevate the standards of personal performance, which in turn will benefit the advancement of patient care.