Effects on Physician Practice After Exposure to a Patient-Centered Care Curriculum During Residency.

BACKGROUND: A novel patient-centered curricular experience was implemented in an internal medicine residency program in 2007. There is little published evidence that what is taught in residency affects practice after graduation. OBJECTIVE: We sought to evaluate whether graduates perceived any long-term effects of participation in this patient-centered curriculum. METHODS: From July to September 2015, a web-based survey with quantitative and qualitative components was sent to graduates of the program to assess self-reported effects of this curriculum on current practice. Graduates spent 2 to 8 weeks on the intervention team during their training. Responses to open-ended questions were independently coded by 2 investigators, using the editing analysis method. Emergent themes and representative quotes are reported. RESULTS: Of 150 residents who completed at least 1 year of training from 2007 to 2014, 94 of 110 (85%) with available email addresses responded to this survey. Of respondents, 21 (22%) were still in fellowship training, and 71 (76%) were in full-time practice. The majority responded "a great deal" when asked if the experience was valuable to their training as a physician (72 of 94, 77%) or influenced their practice (59 of 94, 63%). Free-text comments indicate that residents felt the experience enhanced their understanding of social determinants of health, communication skills, relationship building, and ability to tailor treatments to individual patients. CONCLUSIONS: Internal medicine residency graduates reported that exposure to a curriculum focused on knowing patients as individuals had important enduring effects on their practice.

Power Injection Through Ultrasound-Guided Intravenous Lines: Safety and Efficacy Under an Institutional Protocol.

BACKGROUND: After an index case of contrast-associated compartment syndrome, an urban hospital instituted a protocol limiting high-speed injection to intravenous (IV) lines started proximal to the forearm and testing those lines before contrast injection. OBJECTIVE: In this article, we estimate the safety and efficacy of high-speed injection using this protocol in patients with IV lines inserted under ultrasound guidance. METHODS: In an ambispective study, we enrolled prospective cohorts of ED patients requiring high-speed radiographic contrast media injection (≥3.5 mL/sec) into two groups: those with IV lines placed under ultrasound guidance and those with IV lines placed using traditional inspection and palpation. We also performed a retrospective review involving those groups. In addition, we reviewed hospital records for all patients with compartment syndrome between January 2010 and December 2011. We calculated 95% confidence intervals using normal approximation or exact calculation. RESULTS: Between November 2013 and August 2014, the ED referred 32 patients to the Department of Radiology for computed tomography angiography involving high-speed contrast injection through ultrasound-guided IV lines. Of these, 25 of 32 (78%) had successful injection (7 failed in the Department of Radiology) vs. 26 of 27 (96%) with catheters inserted using traditional methods (risk difference 0.18 [95% confidence interval -0.01 to 0.38]). Based on retrospective records, we estimated 79 additional cases. We found no cases of compartment syndrome during either period, for an incidence estimate of 0 per 100 cases (95% confidence interval 0-3). CONCLUSION: A hospital policy for high-speed contrast injection through ultrasound-guided IV lines has a safe record. However, 22% of patients with ultrasound-guided IV lines were refused for CT.