Health IT implementations often introduce radical changes to clinical work processes and workflow. Prior research investigating this effect has shown conflicting results. Recent time and motion ...studies have consistently found that this impact is negligible; whereas qualitative studies have repeatedly revealed negative end-user perceptions suggesting decreased efficiency and disrupted workflow. We speculate that this discrepancy may be due in part to the design of the time and motion studies, which is focused on measuring clinicians' 'time expenditures' among different clinical activities rather than inspecting clinical 'workflow' from the true 'flow of the work' perspective. In this paper, we present a set of new analytical methods consisting of workflow fragmentation assessments, pattern recognition, and data visualization, which are accordingly designed to uncover hidden regularities embedded in the flow of the work. Through an empirical study, we demonstrate the potential value of these new methods in enriching workflow analysis in clinical settings.
Context
Competency‐based education (CBE) has been widely cited as an educational framework for medical students and residents, and provides a framework for designing educational programmes that ...reflect four critical features: a focus on outcomes, an emphasis on abilities, a reduction of emphasis on time‐based training, and promotion of learner centredness. Each of these features has implications and potential challenges for implementing CBE.
Methods
As an experiment in CBE programme design and implementation, the University of Michigan Master of Health Professions Education (UM‐MHPE) degree programme was examined for lessons to be learned when putting CBE into practice. The UM‐MHPE identifies 12 educational competencies and 20 educational entrustable professional activities (EPAs) that serve as the vehicle for both learning and assessment. The programme also defines distinct roles of faculty members as assessors, mentors and subject‐matter experts focused on highly individualised learning plans adapted to each learner.
Conclusions
Early experience with implementing the UM‐MHPE indicates that EPAs and competencies can provide a viable alternative to traditional courses and a vehicle for rigorous assessment. A high level of individualisation is feasible but carries with it significant costs and makes intentional community building essential. Most significantly, abandoning a time‐based framework is a difficult innovation to implement in a university structure that is predicated on time‐based education.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Pediatric residency programs must adapt their curriculum to meet evolving patient needs yet face limited resources to implement changes resulting in gaps. We performed a categorical pediatric ...residency program curriculum needs assessment to inform curriculum development efforts.
We analyzed data from the 2017 American Academy of Pediatrics Annual Survey of Graduating Residents and pediatric program and associate program director polls conducted at a 2019 pediatric residency program director national meeting. We used conventional content analysis to code and categorize.
Participants included 528 (53%) graduating residents representing 88% of programs, 89 program directors, and 177 associate program directors representing at minimum 45% of programs. Participants demonstrated concordance on the top 4 needs—additional clinical experiences, career development, business of medicine, and health systems. Program leaders also identified wellness and resiliency; disparities; diversity, equity, and inclusion; and communication.
This is the first categorical pediatric program general curriculum needs assessment conducted of pediatric leadership and graduating residents in over a decade. While program leadership and resident data were collected 2 years apart, we found concordance on the top 4 categories and consistency with prior national needs assessments with the exception of career development. New curriculum development efforts are underway.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, VSZLJ, ZAGLJ, ZRSKP
Background: The Pediatrics Milestones Assessment Pilot employed a new multisource feedback (MSF) instrument to assess nine Pediatrics Milestones among interns and subinterns in the inpatient context.
...Objective: To report validity evidence for the MSF tool for informing milestone classification decisions.
Methods: We obtained MSF instruments by different raters per learner per rotation. We present evidence for validity based on the unified validity framework.
Results: One hundred and ninety two interns and 41 subinterns at 18 Pediatrics residency programs received a total of 1084 MSF forms from faculty (40%), senior residents (34%), nurses (22%), and other staff (4%). Variance in ratings was associated primarily with rater (32%) and learner (22%). The milestone factor structure fit data better than simpler structures. In domains except professionalism, ratings by nurses were significantly lower than those by faculty and ratings by other staff were significantly higher. Ratings were higher when the rater observed the learner for longer periods and had a positive global opinion of the learner. Ratings of interns and subinterns did not differ, except for ratings by senior residents. MSF-based scales correlated with summative milestone scores.
Conclusion: We obtain moderately reliable MSF ratings of interns and subinterns in the inpatient context to inform some milestone assignments.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Children with limb pain have significantly diminished quality of life. Although this could result directly from the pain, we investigated the extent to which associated insomnia may contribute.
A ...consecutive series of pediatric rheumatology clinic patients (age 3-18 yrs) who presented for initial evaluation of limb pain were offered participation. Parents and children, as appropriate, completed the Pediatric Sleep Questionnaire and Pediatric Quality of Life Inventory (PedsQL 4.0). Validated measures of pain duration and current pain level were provided by the children. Subjects were judged to have substantial insomnia if they had at least 2 of the following symptoms: difficulty falling asleep at night, waking more than twice on average, trouble falling back to sleep, or waking in the morning feeling unrefreshed. Linear regression was used to model the total PedsQL 4.0 score on insomnia, pain duration, and pain level.
Seventy-four subjects were recruited (47 girls, mean age 10 +/-3.9); 25 (33%) had juvenile idiopathic arthritis and 40 (54%) had insomnia. A low PedsQL 4.0 score was predicted by insomnia (p < 0.001), but not by pain duration or level (each p > 0.10). Neither pain level nor duration differed significantly between subjects with or without insomnia (each p > 0.10).
Significant insomnia may affect half of the children who present to a pediatric rheumatology clinic for limb pain. Quality of life in this setting may depend more on insomnia than on current level or duration of pain.
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