A qualitative study of improving preceptor feedback delivery on professionalism to postgraduate year 1 residents through education, observation, and reflection.

BACKGROUND: To better standardize the teaching of professionalism, the American Board of Internal Medicine and the Accreditation Council for Graduate Medical Education established competency-based training milestones for internal medicine residency programs. Accordingly, professionalism milestones served as the basis for a faculty development program centered on providing feedback to postgraduate year 1 residents (interns) on their own professionalism behaviors during preceptor-resident sessions in the internal medicine continuity clinic. METHODS: To determine the level of faculty (n=8) understanding and comfort in providing feedback, surveys listing 12-month professionalism milestones were distributed to core internal medicine teaching faculty. Current interns (n=10) also rated their understanding of the same milestones. The faculty development program included interpersonal communication education, role-plays of difficult situations, and pocket resources, as well as direct feedback on videotaped sessions with residents. At the end of the intervention period, participating faculty completed a postdevelopment survey, and the current 6-month interns completed a follow-up assessment. RESULTS: Average ratings between the pre- and postintervention teaching faculty surveys fell approximately 0.25%-0.50% on all measures of understanding, but increased slightly on measures of comfort. Conversely, average ratings between the pre- and postintervention 6-month intern surveys generally increased 0.25%-0.50% for measures of comfort and understanding. CONCLUSIONS: The faculty perceived the intervention as helpful in teaching them to focus on behaviors that change the context of overall feedback delivery. However, the study results showed that the system in place was not conducive to implementing such a program without modification and the introduction of resources.

The Ventriloscope: 'am I hearing things?'.

BACKGROUND: Knowledge of the benefits of incorporating medical simulation into healthcare curricula is rapidly increasing. Though impeded by the high cost of complicated technology, medical simulation devices offer the ability to provide safe and controlled training environments, exposure to rare clinical scenarios, as well as unlimited training opportunities. METHODS: This report describes a novel, inexpensive method of broadcasting normal and abnormal auscultatory findings to a relatively normal appearing stethoscope for use in training of healthcare professionals. RESULTS: Using wireless transmitter broadcasting to a stethoscope fitted with a receiver apparatus, the student is able to perform a typical medical exam with auscultation of an unlimited variety of clinical sounds from anatomically appropriate sources while being observed from another room. CONCLUSIONS: Implications of this low-cost device include limitless training possibilities worldwide and across disciplines. The simplicity and portability of this device increases potential for use in rapid training of recognition of clinical signs associated with chemical/biological warfare agents, mass casualty incidents and field military applications. This is the first device to simulate clinically relevant sounds in a realistic manner on standardized patients and mannequins. The benefits of such simulation in medical education ultimately serve to increase trainee confidence and consequently, improve patient care and safety.