Medical Residents University of Washington Amy Fields March 6, 2003 LIS 528

Educational Requirements Successful completion of medical school Award of Medical Degree

University of Washington Residency Program The Department of Medicine administers three fully accredited internal medicine residency pathways

University of Washington Residency Program 1. Traditional or categorical pathway 2. Seattle Primary Care Internist Pathway 3. Seattle/Boise Primary Care Internist Pathway In addition: 1. A preliminary (one year) internship for individuals going into other specialties but who would like a year of broad exposure to internal medicine

Practice Description ACGME general competencies requirements for Residency training programs require residents to have education experiences that allow them to demonstrate competency in the following areas:

Practice Description 1) patient care, 2) medical knowledge, 3) practice-based learning and improvement, 4) interpersonal and communication skills, 5) professionalism, and 6) systems-based practice

Current Problems/Issues facing Medical Residents Resident burnout Work hours

Resident Burnout Concerns: years ago Parking spaces Midnight snacks Off-hours access to library Ann Inn Med, 2002

Resident Burnout Concerns: present Patients are sicker Hospital stays shorter Attendings are more hassled More residents are married Many have children Great many more are women Ann Inn Med, 2002

Resident Burnout Concerns: present Fewer opportunities to establish relationships with patients, peers and faculty Amount of debt incurred getting degree major source of stress Ann Inn Med, 2002

Self-reported burnout study Effects on patient care (results of UW cross-sectional study) February 2001 a 92-item, self- administered survey was sent to all residents in the internal Medicine Program Burnout was measured using the Maslach Burnout Inventory (MBI) Ann Inn Med, 2002

Self-reported burnout study MBI evaluates three domains of burnout 1) Emotional exhaustion 2) depersonalization 3) personal accomplishment

Self-reported burnout study Study defined burnout as a high score on the depersonalization or emotional exhaustion subscales. 76% met criteria Burned-out residents are 2-3 times more likely to report suboptimal patient care practices at least monthly or weekly

Resident work hours ACGME (to be implemented by July 2003): “Total Duty Hours” must not exceed 80 hours per week, averaged over a four week period Workdays that exceed 12 hours are defined as on-call

Past information needs studies Information needs during clinical activity Online searching skills of residents

Information needs during clinical activity Observational Study Anthropologist observed communication among subjects re: their information needs Coding scheme was developed for describing information requests Ann Inn Med 1991

Information needs during clinical activity Study Results Average: 5 clinical questions raised for each patient 52% requested a fact that could be found in patient medical record 23% were potentially answerable by a textbook, journal, or MEDLINE 26% required synthesis of patient information and medical knowledge. Ann Inn Med 1991

Online Searching Study of residents Philadelphia in 1997: 39% described their MEDLINE searching skills as only fair or poor 56% felt teaching in this area would be very helpful Journal of Medical Library Association (JMLA), 2002

Online Searching Offered a 3-hour workshop: Residents did a pretest MEDLINE search and then a posttest search after the workshop More that ½ residents after ambulatory care rotation rated the workshop as one of the best learning experiences of their rotation Journal of Medical Library Association (JMLA), 2002

Online Searching Continued MEDLINE searching: Percentage of residents using techniques learned in workshop for searching MEDLINE improved significantly In self-directed MEDLINE searches later in the year Residents continued to demonstrate improved skills After this pilot study, the workshop was implemented with all second-year medicine residents Journal of Medical Library Association (JMLA), 2002

Service to meet the needs of Residents simplification or reduction in the barriers to access and speed of information retrieval can enhance patient care. PrimeAnswers: The specific aims of the project will help determine if a simplification or reduction in the barriers to access and speed of information retrieval can enhance patient care.

Service to meet the needs of Residents PrimeAnswers for Residents Help with (decreasing/managing) work hours Aid in learning process Aid in effective patient care

Service to meet the needs of Residents Clinical Medical Librarians Attend reports/conferences Literature searches Teach (PrimeAnswers, PubMed, MeSH, Medline, etc.)

Approach to the service PrimeAnswers – Add teaching component 2004 Grant Proposal: “support learning at the point of care through a system of information objects organized by clinical educators for residents and patients (PrimeConditions)” Clinical Medical Librarian – Add more of them

Measure of its effectiveness PrimeAnswers already proven effective for faculty PrimeAnswers averages 5000 hits per month Clinical Medical Librarian already proven effective for Residents

Measure of its effectiveness Survey Residents Similar to 1993 survey of UW Residents re CML

Clinical Librarian Program study

Survey Starting in November 1993, time was allotted at Resident Report to evaluate the information supplied by the CML. Residents were asked to name the principal diagnosis of a patient for which an information request of the literature was made. In 6 months' time, 31 questionnaires were returned with the following results:

Internal Medicine Residents Survey Results III 11/93 - 4/94 Information supplied was useful or relevant 100% YES Information supplied provided new knowledge 100% YES Information supplied substantiated what I 77% YES already knew or suspected 23% NO Information supplied did (or will) contribute 100% YES to better informed clinical decisions

Conclusion With the explosion of new medical information and limitations on resident work hours and attendings teaching time, more efficient ways to teach residents must be implemented

Conclusion A system like PrimeAnswers that presents concepts in small chunks, making the content searchable, and that provides links to existing digital textbooks and journal articles is a great tool to meet the needs of this group