Background: In–hospital venous thromboembolism (VTE) remains a major cause of morbidity and mortality in US hospitals and is known to be preventable. Despite an extremely high level of compliance with VTE prophylaxis guidelines at our institution, VTE events continue to occur. The multidisciplinary Anticoagulation Task Force was assembled to review each VTE event with the [...]

Background: In 1999, the Accreditation Council for Graduate Medical Education identified six general competencies in which residents must be trained. Among these are two relatively abstract and complex competencies: Practice–Based Learning & Improvement (PBLI) and Systems–Based Practice (SBP). Many program directors find that PBLI and SBP are difficult concepts to grasp, perhaps limiting their ability [...]

Background: Electronic Medical Record (EMR) systems are becoming more prevalent in clinical settings. However, students generally receive little formal instruction regarding effective use of the EMR during their undergraduate medical training. Since the implementation of an EMR system at our institution, faculty have observed clerkship students spending an increasingly disproportionate amount of time on patient [...]

Background: Experience in invasive bedside procedures is increasingly difficult to acquire for both resident and attending physicians. Inconsistent training, work hours restrictions, decreasing emphasis on procedural training, and lack of confidence can lead to a vicious cycle of decreasing experience in procedures. We established a medical inpatient procedure service (MIPS) consisting of an attending and [...]

Background: Approximately $700B of annual healthcare spending is wasted, with physicians directly influencing 87% of this expenditure. Medical training has emphasized quality improvement but few programs are addressing the ACGME requirement that physicians–in–training now “incorporate considerations of cost awareness” into practice. Purpose: To develop an inpatient curriculum to promote cost awareness, highlight current clinical guidelines, [...]

Background: The American Board of Internal Medicine (ABIM) states that Internists who perform procedures must obtain the appropriate training to safely and competently perform that procedure. ABIM also recommends initial training in these procedures be simulation–based, but there is wide variability in existing curriculum from didactics to the classic “see one, do one, teach one.” [...]

Background: Integrating healthcare quality into the Internal Medicine resident training curriculum has been a focus of our institution’s Educational Innovations Program of the ACGME. Five years ago, at Baystate Medical Center we began a PGY2 two week block rotation called ‘Tracer’, which assigns a resident as the Quality Officer on a ward team. The early [...]

Background: Documentation of Advance Care Planning (ACP) is often driven by outpatient providers. However, in–patient hospitalization presents a unique opportunity to elicit and document end–of–life wishes, and additionally strengthen communication between inpatient and outpatient providers. A chart audit of patients hospitalized on the medical service at our hospital revealed that house–staff did not document ACP [...]

Background: Formal training in quality improvement (QI) has become increasingly important. Both theAccreditation Council for Graduate Medical Education (ACGME) and the American Board of Internal Medicine(ABIM) have created competencies in the areas of practice–based learning improvement (PBLI), systems–based practice (SBP) and communication that must be met. Most QI curricula for internal medicine residents are implemented [...]

Background: As Hospitalist demand continues to grow, a growing number of programs are utilizing Physician’s Assistants (PAs) and Nurse Practitioners (NPs) to assist with delivery of care on the inpatient medical wards. Since the field of Hospital Medicine is relatively new, often these Non Physician Providers (NPPs) come with varied skill sets and training backgrounds [...]