An Intensive Continuity Clinic Immersion Experience for Interns: A Springboard to Confidence and Satisfaction With Continuity Clinic.

BACKGROUND: Providing a robust continuity clinic experience is difficult due to uneven distribution of resident time. Immersion experiences early in training may improve residents' learning experiences. OBJECTIVE: We designed and implemented a continuity immersion experience to improve internal medicine interns' satisfaction and confidence with their outpatient skills, and we evaluated the timing of the experience and its benefits for learners. METHODS: Two cohorts of interns at 1 academic institution participated in a 3-week immersion block (during the first or second quarter of the intern year). Interns were surveyed twice about satisfaction and confidence. Analysis included independent and paired sample t tests to compare interns' responses pre- and postimmersion, and to evaluate effects over time. RESULTS: A total of 124 interns completed the immersion, with a survey response rate of 61%. Interns' self-rated confidence on a 5-point Likert scale improved significantly compared with preimmersion in the areas of medical knowledge and confidence with their electronic health record and communication skills (P ≤ .010 for all assessments). Interns reported high satisfaction with continuity clinic following immersion (cohort 1: 4.5 ± 0.54; cohort 2: 4.3 ± 0.68; on a 5-point scale with 5 = very satisfied). Improvements in knowledge, skills, and satisfaction in cohort 1 were sustained over 3 months. CONCLUSIONS: A 3-week immersion experience in the first 6 months of residency improved interns' confidence in ambulatory content areas and satisfaction with clinic.

Defining the ideal qualities of mentorship: a qualitative analysis of the characteristics of outstanding mentors.

OBJECTIVE: The study's objective was to identify the important qualities of outstanding mentors as described by their mentees' letters of nomination for a prestigious lifetime achievement award in mentorship. METHODS: The Lifetime Achievement in Mentorship Award at the University of California, San Francisco, recognizes a faculty member who has demonstrated sustained mentoring excellence in the academic health sciences. Recommendation letters in support of the top 10 nominees in 2008 (n=53 letters) were analyzed using grounded theory and constant comparative technique until thematic saturation was achieved. RESULTS: In 2008, 29 faculty members (of>1000 eligible senior faculty) were nominated. Nominees were 53 to 78 years old, and 30% were women. The nominees represented 4 schools (Medicine, Nursing, Pharmacy and Dentistry) and 22 departments/divisions. Five themes emerged from the analysis. Outstanding mentors: 1) exhibit admirable personal qualitites, including enthusiasm, compassion, and selflessness; 2) act as a career guide, offering a vision but purposefully tailoring support to each mentee; 3) make strong time commitments with regular, frequent, and high-quality meetings; 4) support personal/professional balance; and 5) leave a legacy of how to be a good mentor through role modeling and instituting policies that set global expectations and standards for mentorship. CONCLUSION: This is the first study to describe the qualities of admired mentors by analyzing nomination letters for a prestigious mentoring award. Our results give new insight into how mentors foster the careers of junior faculty in the academic health sciences. The results can guide academic leaders on how to train and evaluate mentors.

Teaching medical students about communicating with patients with major mental illness.

Persons with major mental illness often have chronic diseases and poor physical health. Therefore, all practicing physicians should learn about communicating effectively with these patients. Few efforts to teach medical students communication skills have specifically targeted patients with major mental illness. Indeed, most of the limited literature on this topic is decades old, predating significant scientific advances in cognitive neuroscience and psychiatric therapeutics and changes in social policies regarding major mental illness. To gather preliminary insight into training needs, we interviewed 13 final-year students from 2 Boston medical schools. Students' observations coalesced around 4 themes: fears and anxieties about interacting with persons with major mental illness; residents "protecting" students from patients with major mental illness; lack of clinical maturity; and barriers to learning during psychiatry rotations. Educational researchers must explore ways to better prepare young physicians to communicate effectively with patients with major mental illness.

Decision making and counseling around mammography screening for women aged 80 or older.

BACKGROUND: Despite uncertain benefit, many women over age 80 (oldest-old) receive screening mammography. OBJECTIVE: To explore decision-making and physician counseling of oldest-old women around mammography screening. DESIGN: Qualitative research using in-depth semi-structured interviews. PARTICIPANTS: Twenty-three women aged 80 or older who received care at a large academic primary care practice (13 had undergone mammography screening in the past 2 years) and 16 physicians at the same center. APPROACH: We asked patients and physicians to describe factors influencing mammography screening decisions of oldest-old women. We asked physicians to describe their counseling about screening to the oldest-old. RESULTS: Patients and/or physicians identified the importance of physician influence, patient preferences, system factors, and social influences on screening decisions. Although physicians felt that patient's health affected screening decisions, few patients felt that health mattered. Three types of elderly patients were identified: (1) women enthusiastic about screening mammography; (2) women opposed to screening mammography; and (3) women without a preference who followed their physician's recommendation. However, physician counseling about mammography screening to elderly women varies; some individualize discussions; others encourage screening; few discourage screening. Physicians report that discussions about stopping screening can be uncomfortable and time consuming. Physicians suggest that more data could facilitate these discussions. CONCLUSIONS: Some oldest-old women have strong opinions about screening mammography while others are influenced by physicians. Discussions about stopping screening are challenging for physicians. More data about the benefits and risks of mammography screening for women aged 80 or older could inform patients and improve provider counseling to lead to more rational use of mammography.

Mentoring matters. Mentoring and career preparation in internal medicine residency training.

PURPOSE: Mentoring during the early stages of a career has been associated with high career satisfaction and may guide development of professional expertise. Little is known about mentoring experiences during residency training. Our purpose was to describe mentoring relationships among internal medicine residents, and to examine the relationship between mentoring and perceived career preparation. SUBJECTS AND METHODS: We designed and administered a mailed survey to all interns and residents enrolled in the five independent Internal Medicine Residency Training Programs affiliated with Harvard Medical School. We examined the development of mentoring relationships during residency training, and measured satisfaction with mentoring and with perceived career preparation. RESULTS: Of the 329 respondents (65% response rate), 93% reported that it is important to have a mentor during residency, but only half identified a current or past mentor. Interns [adjusted odds ratio (AOR) 0.3 (95% confidence interval (CI) 0.2, 0.5)] and underrepresented minority residents [0.3 (0.1, 0.7)] were significantly less likely to establish a mentoring relationship than their peers. Mentored residents were nearly twice as likely to describe excellent career preparation [1.8 (1.1, 3.1)]. CONCLUSION: Our findings demonstrate the importance of mentoring to medical residents, and identify a relationship between mentoring and perceived career preparation. We also identify a relative lack of mentoring among interns and underrepresented minority residents.