Papers by Preetha Basaviah
Journal of Hospital Medicine, Sep 1, 2009
The panelists and their respective organizations do not necessarily support these final recommend... more The panelists and their respective organizations do not necessarily support these final recommendations or their ascribed levels of evidence. The authors also acknowledge Tina Budnitz and the Healthcare Quality and Safety Committee of the Society of Hospital Medicine. Last, they are indebted to the staff support provided by Shannon Roach from the Society of Hospital Medicine. Disclosure: Nothing to report. BACKGROUND: Handoffs are ubiquitous to Hospital Medicine and are considered a vulnerable time for patient safety. PURPOSE: To develop recommendations for hospitalist handoffs during shift change and service change. DATA SOURCES: PubMed (through January 2007), Agency for Healthcare Research and Quality (AHRQ) Patient Safety Network, white papers, and hand search of article bibliographies. STUDY SELECTION: Controlled studies evaluating interventions to improve in-hospital handoffs (n ¼ 10). DATA EXTRACTION: Studies were abstracted for design, setting, target, outcomes (including patient-level, staff-level, or system-level outcomes), and relevance to hospitalists. DATA SYNTHESIS: Although there were no studies of hospitalist handoffs, the existing literature from related disciplines and expert opinion support the use of a verbal handoff supplemented with written documentation in a structured format or technology solution. Technology solutions were associated with a reduction in preventable adverse events, improved satisfaction with handoff quality, and improved provider identification. Nursing studies demonstrate that supplementing verbal exchange with a written medium leads to improved retention of information. White papers characterized effective verbal exchange, as focusing on ill patients and actions required, with time for questions and minimal interruptions. In addition, content should be updated daily to ensure communication of the latest clinical information. Using this literature, recommendations for hospitalist handoffs are presented with corresponding levels of evidence. Recommendations were reviewed by hospitalists at the Society of Hospital Medicine (SHM) Annual Meeting and by an interdisciplinary team of expert consultants and were endorsed by the SHM governing board. CONCLUSIONS: The systematic review and resulting recommendations provide hospitalists a starting point from which to improve in-hospital handoffs.
PubMed, Mar 1, 2016
Background and objectives: Despite a growing demand for skilled clinician-educators, residents to... more Background and objectives: Despite a growing demand for skilled clinician-educators, residents today rarely receive formal training in clinical teaching, curriculum development, administration, leadership, or educational scholarship. The authors describe the development, implementation, and preliminary evaluation of the O'Connor Stanford Leaders in Education Residency (OSLER) track, a novel clinician-educator track within the family medicine residency program affiliated with Stanford University School of Medicine. Methods: In 2010, the OSLER track was introduced at O'Connor Hospital, a community hospital that houses an 8-8-8 family medicine residency program. Residents who are in good standing can apply to the track at the midpoint of their first postgraduate year. Residents are immersed in a flexible, experience-based, 2.5-year-long curriculum with hands-on teaching activities at its core. To foster skills in educational scholarship, track residents are required to design and complete a scholarly project. Results: A comprehensive evaluation plan is currently in progress. Preliminary data indicates high levels of satisfaction with the track's overall value, impact on core teaching skills, and effect on career trajectory. Residents gained more confidence in core teaching skills as they progressed through the track. Scholarly work output by residents has increased significantly since the track was implemented. The residency program has seen an increased interest from applicants since the track was started, with data suggesting that applicant quality has increased from the pre-track to post-track years. Conclusions: More research is needed to assess the effectiveness and reproducibility of this clinician-educator track. If proven, this model may be replicated at other academic medical centers.
Academic Medicine, Feb 23, 2021
Teaching and Learning in Medicine, Oct 1, 2012
The majority of US medical schools now have pre-clerkship clinical skills (PCCS) courses. Course ... more The majority of US medical schools now have pre-clerkship clinical skills (PCCS) courses. Course directors for these often logistically complicated courses may be in different medical specialties and, historically, have had few formal opportunities for communication and collaboration with their counterparts at other institutions. As such, we hypothesized that leaders of PCCS courses would benefit from a national network. In this paper, we outline the methodology used to form a national collaborative from grass roots interest. Over three years, a self-identified eleven-person task force with national representation has created an organization for PCCS course directors from US medical schools called Directors Of Clinical Skills courses (DOCS) that meets annually. Through iterative presentations at regional and national medical education meetings, we have produced an inventory of educational issues for those developing, administering, and evaluating PCCS courses. Further development of this nascent organization is ongoing. Our process is generalizable.
medRxiv (Cold Spring Harbor Laboratory), Mar 29, 2023
All rights reserved. No reuse allowed without permission. (which was not certified by peer review... more All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
Academic Medicine, Sep 1, 2020
of the Stanford Curriculum. Shown is a diagram of the Stanford curriculum for a 4-year program. A... more of the Stanford Curriculum. Shown is a diagram of the Stanford curriculum for a 4-year program. Additional scholarly work (in research years or in master's or Ph.D. programs) is strongly encouraged and undertaken by the majority of Stanford medical students. Research can take place in the form of dedicated research year(s) or by extending ("splitting") the second year of medical school to allow longitudinal scholarship, or by both methods. Supplemental Digital Appendix 2 Program Objectives and Assessment Methods Program Objectives Assessment Methods Discovery Communicate clearly and accurately new knowledge obtained from scientific inquiry Exam-Institutionally Developed, Written/Computerbased Critically analyze existing literature in a field of inquiry and formulate new investigative questions Exam-Institutionally Developed, Clinical Performance Describe and apply the requirements for ethical conduct of scientific inquiry Research or Project Assessment Describe and employ appropriate research methods to answer a specific investigative question Exam-Institutionally Developed, Written/Computerbased Formulate a high-quality research question and hypothesis Research or Project Assessment Interpersonal and Communication Skills Communicate effectively with colleagues within one's profession or specialty, other health professionals, and health related agencies Clinical Performance Rating/Checklist Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds Clinical Performance Rating/Checklist Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions Clinical Performance Rating/Checklist Demonstrate sensitivity, honesty, and compassion in difficult conversations, including those about death, end of life, adverse events, bad news, disclosure of errors, and other sensitive topics Clinical Performance Rating/Checklist
JAMA, Feb 28, 2007
S THE SPECIALTY OF HOSPItal medicine expands, the transfer of responsibility for p a t i e n t c ... more S THE SPECIALTY OF HOSPItal medicine expands, the transfer of responsibility for p a t i e n t c a r e b e t w e e n hospital-based physicians (hospitalists) and primary care physicians becomes increasingly common, creating an urgent need to improve communication and information transfer between inpatient and outp a t i e n t p h y s i c i a n s a t h o s p i t a l discharge. 1-3 Timely transfer of accurate, relevant data about diagnostic findings, treatment, complications, consultations, tests pending at discharge, and arrangements for postdischarge follow-up may improve the continuity of this handoff. 4,5 By contrast, delayed communication or inaccuracies in information transfer among health care professionals, particularly during the early postdischarge period, may have substantial implications for continuity of care, patient safety, patient and clinician satisfaction, and resource use. 6-10 The discharge summary is the most common method for documenting a patient's diagnostic findings, hospital management, and arrangements for postdischarge follow-up. The Joint Context Delayed or inaccurate communication between hospital-based and primary care physicians at hospital discharge may negatively affect continuity of care and contribute to adverse events. Objectives To characterize the prevalence of deficits in communication and information transfer at hospital discharge and to identify interventions to improve this process. Data Sources MEDLINE (through November 2006), Cochrane Database of Systematic Reviews, and hand search of article bibliographies. Study Selection Observational studies investigating communication and information transfer at hospital discharge (n=55) and controlled studies evaluating the efficacy of interventions to improve information transfer (n=18). Data Extraction Data from observational studies were extracted on the availability, timeliness, content, and format of discharge communications, as well as primary care physician satisfaction. Results of interventions were summarized by their effect on timeliness, accuracy, completeness, and overall quality of the information transfer. Data Synthesis Direct communication between hospital physicians and primary care physicians occurred infrequently (3%-20%). The availability of a discharge summary at the first postdischarge visit was low (12%-34%) and remained poor at 4 weeks (51%-77%), affecting the quality of care in approximately 25% of follow-up visits and contributing to primary care physician dissatisfaction. Discharge summaries often lacked important information such as diagnostic test results (missing from 33%-63%), treatment or hospital course (7%-22%), discharge medications (2%-40%), test results pending at discharge (65%), patient or family counseling (90%-92%), and follow-up plans (2%-43%). Several interventions, including computer-generated discharge summaries and using patients as couriers, shortened the delivery time of discharge communications. Use of standardized formats to highlight the most pertinent information improved the perceived quality of documents. Conclusions Deficits in communication and information transfer at hospital discharge are common and may adversely affect patient care. Interventions such as computer-generated summaries and standardized formats may facilitate more timely transfer of pertinent patient information to primary care physicians and make discharge summaries more consistently available during follow-up care.
Journal of General Internal Medicine, Apr 13, 2017
BACKGROUND: Demand for faculty with teaching expertise is increasing as medical education is beco... more BACKGROUND: Demand for faculty with teaching expertise is increasing as medical education is becoming well established as a career pathway. Junior faculty may be expected to take on teaching responsibilities with minimal training in teaching skills. AIM: To address the faculty development needs of junior clinician-educators with teaching responsibilities and those changing their career focus to include teaching. SETTING: Sessions at two Society of General Internal Medicine (SGIM) annual meetings combined with local coaching and online learning during the intervening year. PARTICIPANTS: Eighty-nine faculty scholars in four consecutive annual cohorts from 2013 to 2016. PROGRAM DESCRIPTION: Scholars participate in a fullday core teaching course as well as selective workshops at the annual meetings. Between meetings they receive direct observation and feedback on their teaching from a local coach and participate in an online discussion group. PROGRAM EVALUATION: Sessions were evaluated using a post-session survey. Overall content rating was 4.48 (out of 5). Eighty-nine percent of participants completed all requirements. Of these, 100% agreed that they had gained valuable knowledge and skills. DISCUSSION: The TEACH certificate program provides inexperienced faculty teachers an opportunity to develop core skills. Satisfaction is high. Future research should focus on the impact that this and similar programs have on teaching skills.
Academic Medicine, May 1, 2016
Academic Psychiatry, Apr 27, 2018
Objective A majority of physicians feel poorly trained in the treatment of chronic pain and addic... more Objective A majority of physicians feel poorly trained in the treatment of chronic pain and addiction. As such, it is critical that medical students receive appropriate education in both pain management and addiction. The purpose of this study was to assess the pre-clinical curriculum in pain medicine and addiction from the perspective of students after they had completed their preclinical training and to assess what they perceived as the strengths and weaknesses of their training. Methods The authors conducted focused interviews among clinical medical students who had completed at least 6 months of clerkships. The interviews targeted the students' retrospective opinions about the pre-clinical curriculum and their preparedness for clinical encounters with either pain or addiction-related issues during their rotations. Coders thematically analyzed the deidentified interview transcripts, with consensus reached through discussion and code modification. Results Themes that emerged through the focused interviews included: fragmented curricular structure (and insufficient time) for pain and addiction medicine, not enough specific treatment strategies for pain or addiction, especially for complex clinical scenarios, and lack of a trained workforce to provide guidance in the management of pain and addiction. Conclusion This study demonstrated the feasibility of gathering student perspectives to inform changes to improve the preclinical curriculum in pain and addiction medicine. Students identified multiple areas for improvement at the pre-clerkship level, which have informed updates to the curriculum. More research is needed to determine if curricular changes based on student feedback lead to improved learning outcomes.
Medical Education, May 1, 2003
ImportanceStudies show that ChatGPT, a general purpose large language model chatbot, could pass t... more ImportanceStudies show that ChatGPT, a general purpose large language model chatbot, could pass the multiple-choice US Medical Licensing Exams, but the model’s performance on open-ended clinical reasoning is unknown.ObjectiveTo determine if ChatGPT is capable of consistently meeting the passing threshold on free-response, case-based clinical reasoning assessments.DesignFourteen multi-part cases were selected from clinical reasoning exams administered to pre-clerkship medical students between 2019 and 2022. For each case, the questions were run through ChatGPT twice and responses were recorded. Two clinician educators independently graded each run according to a standardized grading rubric. To further assess the degree of variation in ChatGPT’s performance, we repeated the analysis on a single high-complexity case 20 times.SettingA single US medical schoolParticipantsChatGPTMain Outcomes and MeasuresPassing rate of ChatGPT’s scored responses and the range in model performance across ...
Academic Psychiatry, 2018
Objective A majority of physicians feel poorly trained in the treatment of chronic pain and addic... more Objective A majority of physicians feel poorly trained in the treatment of chronic pain and addiction. As such, it is critical that medical students receive appropriate education in both pain management and addiction. The purpose of this study was to assess the pre-clinical curriculum in pain medicine and addiction from the perspective of students after they had completed their preclinical training and to assess what they perceived as the strengths and weaknesses of their training. Methods The authors conducted focused interviews among clinical medical students who had completed at least 6 months of clerkships. The interviews targeted the students' retrospective opinions about the pre-clinical curriculum and their preparedness for clinical encounters with either pain or addiction-related issues during their rotations. Coders thematically analyzed the deidentified interview transcripts, with consensus reached through discussion and code modification. Results Themes that emerged through the focused interviews included: fragmented curricular structure (and insufficient time) for pain and addiction medicine, not enough specific treatment strategies for pain or addiction, especially for complex clinical scenarios, and lack of a trained workforce to provide guidance in the management of pain and addiction. Conclusion This study demonstrated the feasibility of gathering student perspectives to inform changes to improve the preclinical curriculum in pain and addiction medicine. Students identified multiple areas for improvement at the pre-clerkship level, which have informed updates to the curriculum. More research is needed to determine if curricular changes based on student feedback lead to improved learning outcomes.
The virtual mentor : VM, 2013
Medical Science Educator, 2011
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Papers by Preetha Basaviah