RESUMO
BACKGROUND: Interns experience challenges in their transition from medical school to residency. Orientation is traditionally delivered by faculty and administrators and often does not address practical skills needed by interns during the transition. OBJECTIVES: The objective is to address traditional orientation gaps and improve incoming interns' transition experience. Methods: We identified opportunities with our intern orientation using a quality improvement methodology. Plan Do Study Act (PDSA) cycle 1 consisted of a pilot boot camp. PDSA cycle 2 was conducted over two weeks, June 9-23, 2021, at the Detroit Medical Center, Detroit, MI. Participation was voluntary. Residents were assigned incoming interns on a 1:1 basis. Five virtual sessions were conducted addressing: daily workflow, documentation, presentation skills, and utilization of the Electronic Health Record (EHR). All participants received pre- and post-program surveys. Results: Twenty-two rising second- and third-year residents (26%) and 22 incoming interns (58%) participated. There was a significant improvement in the understanding of daily workflow (mean improvement 0.957, p=0.003), and most tasks associated with EHR including comfort with the sign-out process (mean improvement 1.21; p=0.002), accessing specific team lists (mean improvement 1.75, p=0.001), writing orders (mean improvement 1.41; p=0.002), composing documentation (mean improvement 1.23; p=0.001). Writing notes improved significantly (mean improved by 0.52; p=0.04). Nearly all (93.2%) stated the program achieved its overall goals and believed (92.9%) the program should be continued for incoming intern classes. CONCLUSION: A targeted orientation bootcamp led by near-peers positively impacted the intern experience improving understanding of day-to-day responsibilities and comfort utilizing the electronic health record.
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BACKGROUND: Game-based learning is an engaging and effective educational strategy in medical education. The Internal Medicine resident board review at our institution was considered dull and poorly attended by trainees. We hypothesized that a gamified, longitudinal, team-based approach to board review would rejuvenate board review and improve learner perception of quality and attendance. METHODS: We sought to improve the resident perception of and participation in board review through an innovative longitudinal, team-based, game-based intervention, the "Cohort Cup". The "Cohort Cup" was developed and implemented over a 22-week intervention period from November 2017 to May 2018. Teams (cohorts) competed in real-time against one another. Evaluation methods include a pre/post attitudes survey on a 5-point Likert scale (1 - strongly disagree, 5 - strongly agree) and attendance data. Findings: Of 105 residents eligible to participate, 82 completed the pre-intervention survey, and 74 completed the post-intervention survey. We observed statistically significant increases in self-perceptions of engagement, the perceived value of the sessions, and preferences for game-based learning. Self-perceptions of learner engagement improved from 2.74 to 3.8. The value of the educational experience increased from 2.68 to 3.95. Preferences for game-based learning improved from 3.77 to 4.32. Board review attendance doubled. Residents commented the intervention improved class bonding. Board passage rate increased from 86% to 97%. CONCLUSIONS: Our game-based intervention successfully rejuvenated our board review. We observed more joy in the learning environment and improvements in resident engagement, and in their attitudes regarding board review. Game-based learning can be a valuable educational tool and can be a positive facet of educational communities.
RESUMO
Comparative outcomes of transcatheter aortic valve implantation (TAVI) in patients with and without hypothyroidism were not previously reported. This study aimed to appraise the clinical outcomes and impact of hypothyroidism on patients who underwent TAVI. Patients with hypothyroidism who underwent TAVI from 2011 to 2014 were identified in the National Inpatient Sample database using the International Classification of Diseases, ninth Revision, Clinical Modification. The primary outcome was the effect of hypothyroidism on inpatient mortality. Secondary outcomes were the impact of hypothyroidism on post-TAVI complications. We also evaluated the length of hospital stay and the cost of hospitalization. Propensity score-matched analysis was performed to address potential confounding. The hypothyroid patients who underwent TAVI had no significant increase in the risk of in-hospital mortality (odds ratio 0.78; 95% confidence interval 0.51 to 1.21, p = 0.282), or most postprocedural complications. However, hypothyroid patients were more likely to develop hemorrhage requiring transfusion (odds ratio 1.36, 95% confidence interval 1.05 to 1.76, pâ¯=â¯0.043). In conclusion, TAVI is a feasible and relatively safe alternative with reasonable in-hospital outcomes in patients with hypothyroidism and severe symptomatic aortic stenosis. However, hypothyroid patients are more likely to require a blood transfusion after TAVI. Additional randomized trials are needed to evaluate TAVR outcomes in hypothyroid patients.
