Stephanie C. MacKiewicz

Which are the best internal medicine residency programs in the U.S.? Now prospective hospitalists—about a third of whom will complete their residency training in internal medicine—have an answer.

Although a formal ranking system for postgraduate medical training programs doesn't exist, a new survey commissioned by U.S. News & World Report gives some idea about what programs are most popular among physicians.

The survey asked physicians who completed their internal medicine residency in the U.S. to name up to five programs they believe offer the best clinical training.

Four programs: Massachusetts General Hospital in Boston, Johns Hopkins University in Baltimore, Boston’s Brigham and Women’s Hospital, and the University of California San Francisco Medical Center (UCSF) each received almost twice as many nominations as any other program.

Out of more than 9,000 submitted nominations, the top three hospital-based apprenticeship programs each received at least 600 nods: Massachusetts General Hospital (732), Johns Hopkins (696), and Brigham and Women’s (600). UCSF received 579 nominations. Likewise, 20 other internal medicine programs each received between 100 to 300 nominations.

In a separate analysis that looked at the survey responses of general internists as a subgroup—as opposed to subspecialists who completed an internal medicine residency—UCSF received the most nominations (201) of any program.

Harry Hollander, MD, director of UCSF’s internal medicine residency program, says the positive feedback likely “reflects the strong tradition of general internal medicine training here, the prominence of both outstanding ambulatory internists and hospitalists on our faculty, and the accomplishments and reputation of our graduates who have pursued either generalist or subspecialty careers in internal medicine.”

Dr. Hollander noted that the Accreditation Council for Graduate Medical Education plans to introduce a new accreditation system that would, in theory, make the comparison of residency program metrics more transparent.

“However, no matter how much objective data exist, gut feeling and intuition about the place, the people, and the culture will always remain a key part of students choosing the right residency program for them,” he says.

Doximity, an online social network for physicians, conducted the survey through a combination of web notifications and emails sent to 18,695 members. A total of 3,410 physicians responded to the survey, which ran from last December through February 10.

Visit our website for more on internal medicine residency training programs.

Which are the best internal medicine residency programs in the U.S.? Now prospective hospitalists—about a third of whom will complete their residency training in internal medicine—have an answer.

Although a formal ranking system for postgraduate medical training programs doesn't exist, a new survey commissioned by U.S. News & World Report gives some idea about what programs are most popular among physicians.

The survey asked physicians who completed their internal medicine residency in the U.S. to name up to five programs they believe offer the best clinical training.

Four programs: Massachusetts General Hospital in Boston, Johns Hopkins University in Baltimore, Boston’s Brigham and Women’s Hospital, and the University of California San Francisco Medical Center (UCSF) each received almost twice as many nominations as any other program.

Out of more than 9,000 submitted nominations, the top three hospital-based apprenticeship programs each received at least 600 nods: Massachusetts General Hospital (732), Johns Hopkins (696), and Brigham and Women’s (600). UCSF received 579 nominations. Likewise, 20 other internal medicine programs each received between 100 to 300 nominations.

In a separate analysis that looked at the survey responses of general internists as a subgroup—as opposed to subspecialists who completed an internal medicine residency—UCSF received the most nominations (201) of any program.

Harry Hollander, MD, director of UCSF’s internal medicine residency program, says the positive feedback likely “reflects the strong tradition of general internal medicine training here, the prominence of both outstanding ambulatory internists and hospitalists on our faculty, and the accomplishments and reputation of our graduates who have pursued either generalist or subspecialty careers in internal medicine.”

Dr. Hollander noted that the Accreditation Council for Graduate Medical Education plans to introduce a new accreditation system that would, in theory, make the comparison of residency program metrics more transparent.

“However, no matter how much objective data exist, gut feeling and intuition about the place, the people, and the culture will always remain a key part of students choosing the right residency program for them,” he says.

Doximity, an online social network for physicians, conducted the survey through a combination of web notifications and emails sent to 18,695 members. A total of 3,410 physicians responded to the survey, which ran from last December through February 10.

Visit our website for more on internal medicine residency training programs.

Which are the best internal medicine residency programs in the U.S.? Now prospective hospitalists—about a third of whom will complete their residency training in internal medicine—have an answer.

Although a formal ranking system for postgraduate medical training programs doesn't exist, a new survey commissioned by U.S. News & World Report gives some idea about what programs are most popular among physicians.

The survey asked physicians who completed their internal medicine residency in the U.S. to name up to five programs they believe offer the best clinical training.

Four programs: Massachusetts General Hospital in Boston, Johns Hopkins University in Baltimore, Boston’s Brigham and Women’s Hospital, and the University of California San Francisco Medical Center (UCSF) each received almost twice as many nominations as any other program.

Out of more than 9,000 submitted nominations, the top three hospital-based apprenticeship programs each received at least 600 nods: Massachusetts General Hospital (732), Johns Hopkins (696), and Brigham and Women’s (600). UCSF received 579 nominations. Likewise, 20 other internal medicine programs each received between 100 to 300 nominations.

In a separate analysis that looked at the survey responses of general internists as a subgroup—as opposed to subspecialists who completed an internal medicine residency—UCSF received the most nominations (201) of any program.

Harry Hollander, MD, director of UCSF’s internal medicine residency program, says the positive feedback likely “reflects the strong tradition of general internal medicine training here, the prominence of both outstanding ambulatory internists and hospitalists on our faculty, and the accomplishments and reputation of our graduates who have pursued either generalist or subspecialty careers in internal medicine.”

Dr. Hollander noted that the Accreditation Council for Graduate Medical Education plans to introduce a new accreditation system that would, in theory, make the comparison of residency program metrics more transparent.

“However, no matter how much objective data exist, gut feeling and intuition about the place, the people, and the culture will always remain a key part of students choosing the right residency program for them,” he says.

Doximity, an online social network for physicians, conducted the survey through a combination of web notifications and emails sent to 18,695 members. A total of 3,410 physicians responded to the survey, which ran from last December through February 10.

Visit our website for more on internal medicine residency training programs.

A care model in which physicians and nurses do bedside rounds as a team can reduce average length of stay (LOS) and in-hospital mortality, according to a recent Harvard Business Review blog post written by a group healthcare providers from Emory Healthcare in Atlanta.

In September 2010, members of a quality-improvement program at Emory University Hospital in Atlanta reorganized a 24-bed medical unit where six hospital medicine teams had seen patients into an Accountable Care Unit (ACU). They designed the ACU to have four key features: unit-based physician teams; structured interdisciplinary bedside rounds [PDF]; unit-level performance reports; and unit co-management by nurse and physician directors.

Physicians were assigned to units so more than 90% of their patients could be located on the same floor, which allows scheduling of a permanent daily start time for bedside rounds. This consistent schedule allows the entire health care team to round together. It also makes it easier for family members to know when rounds are happening so they can ask questions and learn about the care plan.

"Rather than having six different hospital medicine teams rounding on eight different units every day, we thought it would make more sense to have those teams round on a single unit each day where all their patients were cohorted together," says hospitalist Jason Stein, MD, SFHM, and lead author of the HBR blog post. Dr. Stein is director for quality in the division of hospital medicine at the Emory University School of Medicine and an innovation advisor to the Center for Medicare and Medicaid Innovation, a unit within the Centers for Medicare and Medicaid Services.

According to the blog post, in the first year that the ACU model was implemented, the average LOS for hospitalized patients decreased from 5 days to 4.5 days and in-hospital mortality declined from 2.3 deaths per 100 encounters to 1.1 deaths per 100 encounters. The ACU model was recognized as the top innovation the 2012 SHM Annual Meeting.

Dr. Stein and fellow blog authors noted two challenges in the ACU model—namely, that creating unit teams required assigning attending physicians to a home unit, and that the structure led physicians and staff to follow a patient- and family-based approach to care-planning activities. Dr. Stein says the group behind the creation of the ACU model is in the process of submitting its data for publication.

Visit our website for more information about improving inpatient care coordination.

A care model in which physicians and nurses do bedside rounds as a team can reduce average length of stay (LOS) and in-hospital mortality, according to a recent Harvard Business Review blog post written by a group healthcare providers from Emory Healthcare in Atlanta.

In September 2010, members of a quality-improvement program at Emory University Hospital in Atlanta reorganized a 24-bed medical unit where six hospital medicine teams had seen patients into an Accountable Care Unit (ACU). They designed the ACU to have four key features: unit-based physician teams; structured interdisciplinary bedside rounds [PDF]; unit-level performance reports; and unit co-management by nurse and physician directors.

Physicians were assigned to units so more than 90% of their patients could be located on the same floor, which allows scheduling of a permanent daily start time for bedside rounds. This consistent schedule allows the entire health care team to round together. It also makes it easier for family members to know when rounds are happening so they can ask questions and learn about the care plan.

"Rather than having six different hospital medicine teams rounding on eight different units every day, we thought it would make more sense to have those teams round on a single unit each day where all their patients were cohorted together," says hospitalist Jason Stein, MD, SFHM, and lead author of the HBR blog post. Dr. Stein is director for quality in the division of hospital medicine at the Emory University School of Medicine and an innovation advisor to the Center for Medicare and Medicaid Innovation, a unit within the Centers for Medicare and Medicaid Services.

According to the blog post, in the first year that the ACU model was implemented, the average LOS for hospitalized patients decreased from 5 days to 4.5 days and in-hospital mortality declined from 2.3 deaths per 100 encounters to 1.1 deaths per 100 encounters. The ACU model was recognized as the top innovation the 2012 SHM Annual Meeting.

Dr. Stein and fellow blog authors noted two challenges in the ACU model—namely, that creating unit teams required assigning attending physicians to a home unit, and that the structure led physicians and staff to follow a patient- and family-based approach to care-planning activities. Dr. Stein says the group behind the creation of the ACU model is in the process of submitting its data for publication.

Visit our website for more information about improving inpatient care coordination.

A care model in which physicians and nurses do bedside rounds as a team can reduce average length of stay (LOS) and in-hospital mortality, according to a recent Harvard Business Review blog post written by a group healthcare providers from Emory Healthcare in Atlanta.

In September 2010, members of a quality-improvement program at Emory University Hospital in Atlanta reorganized a 24-bed medical unit where six hospital medicine teams had seen patients into an Accountable Care Unit (ACU). They designed the ACU to have four key features: unit-based physician teams; structured interdisciplinary bedside rounds [PDF]; unit-level performance reports; and unit co-management by nurse and physician directors.

Physicians were assigned to units so more than 90% of their patients could be located on the same floor, which allows scheduling of a permanent daily start time for bedside rounds. This consistent schedule allows the entire health care team to round together. It also makes it easier for family members to know when rounds are happening so they can ask questions and learn about the care plan.

"Rather than having six different hospital medicine teams rounding on eight different units every day, we thought it would make more sense to have those teams round on a single unit each day where all their patients were cohorted together," says hospitalist Jason Stein, MD, SFHM, and lead author of the HBR blog post. Dr. Stein is director for quality in the division of hospital medicine at the Emory University School of Medicine and an innovation advisor to the Center for Medicare and Medicaid Innovation, a unit within the Centers for Medicare and Medicaid Services.

According to the blog post, in the first year that the ACU model was implemented, the average LOS for hospitalized patients decreased from 5 days to 4.5 days and in-hospital mortality declined from 2.3 deaths per 100 encounters to 1.1 deaths per 100 encounters. The ACU model was recognized as the top innovation the 2012 SHM Annual Meeting.

Dr. Stein and fellow blog authors noted two challenges in the ACU model—namely, that creating unit teams required assigning attending physicians to a home unit, and that the structure led physicians and staff to follow a patient- and family-based approach to care-planning activities. Dr. Stein says the group behind the creation of the ACU model is in the process of submitting its data for publication.

Visit our website for more information about improving inpatient care coordination.

How's this for a quality-improvement success story? In 2011, three Minnesota-based institutions—the Institute for Clinical Systems Improvement (ICSI), the Minnesota Hospital Association, and Stratis Health—launched the Reducing Avoidable Readmissions Effectively (RARE) campaign to reduce avoidable hospital readmissions across the state. So far, the campaign's 82 participating hospitals and 100 community partners have prevented 6,211 readmissions between Jan. 1, 2011 and June 30, 2013.

The efforts were recognized last month when RARE was named a recipient of the 2013 John M. Eisenberg Patient Safety and Quality Award for Innovation in Patient Safety and Quality.

Launched in 2002 by National Quality Forum and Joint Commission, the award honors John M. Eisenberg, MD, MBA, a former administrator of the Agency for Healthcare Research and Quality and an advocate for patient safety and healthcare quality. SHM won the John M. Eisenberg Innovation in Patient Safety and Quality award in 2011 for its mentored-implementation program.

According to ICSI project manager Kathy Cummins, RN, MA, hospitals involved in RARE aren't given specific instructions on how to reduce readmissions, but are encouraged to focus their efforts on these areas:

Comprehensive discharge planning;

Medication management;

Patient and family engagement;

Transition-care support; and

Transition communications.

While the campaign provides guidance and technical support, each hospital comes up with its own strategies for achieving these goals. Ms. Cummins, for example, describes how one hospital that was tasked with reducing readmissions without adding staff had paramedics use their downtime to visit recently discharged patients. The paramedics now check in to see if patients are exhibiting warning signs of illness and make sure they’re taking their prescribed medications.

SHM board member Howard Epstein, MD, FHM, ICSI's chief health systems officer, says the RARE campaign targets issues hospitalists have long struggled with.

"Hospitalists don't want to see their patients readmitted to the hospital," Dr. Epstein says. "It doesn't look good on their part, and it's not the best thing for their patients. The [RARE] campaign galvanized the system to support what hospitalists have been demanding for many years."

Stephanie C. Mackiewicz is a freelance author in California.

Visit our website for more information about the RARE campaign.

How's this for a quality-improvement success story? In 2011, three Minnesota-based institutions—the Institute for Clinical Systems Improvement (ICSI), the Minnesota Hospital Association, and Stratis Health—launched the Reducing Avoidable Readmissions Effectively (RARE) campaign to reduce avoidable hospital readmissions across the state. So far, the campaign's 82 participating hospitals and 100 community partners have prevented 6,211 readmissions between Jan. 1, 2011 and June 30, 2013.

The efforts were recognized last month when RARE was named a recipient of the 2013 John M. Eisenberg Patient Safety and Quality Award for Innovation in Patient Safety and Quality.

Launched in 2002 by National Quality Forum and Joint Commission, the award honors John M. Eisenberg, MD, MBA, a former administrator of the Agency for Healthcare Research and Quality and an advocate for patient safety and healthcare quality. SHM won the John M. Eisenberg Innovation in Patient Safety and Quality award in 2011 for its mentored-implementation program.

According to ICSI project manager Kathy Cummins, RN, MA, hospitals involved in RARE aren't given specific instructions on how to reduce readmissions, but are encouraged to focus their efforts on these areas:

Comprehensive discharge planning;

Medication management;

Patient and family engagement;

Transition-care support; and

Transition communications.

While the campaign provides guidance and technical support, each hospital comes up with its own strategies for achieving these goals. Ms. Cummins, for example, describes how one hospital that was tasked with reducing readmissions without adding staff had paramedics use their downtime to visit recently discharged patients. The paramedics now check in to see if patients are exhibiting warning signs of illness and make sure they’re taking their prescribed medications.

SHM board member Howard Epstein, MD, FHM, ICSI's chief health systems officer, says the RARE campaign targets issues hospitalists have long struggled with.

"Hospitalists don't want to see their patients readmitted to the hospital," Dr. Epstein says. "It doesn't look good on their part, and it's not the best thing for their patients. The [RARE] campaign galvanized the system to support what hospitalists have been demanding for many years."

Stephanie C. Mackiewicz is a freelance author in California.

Visit our website for more information about the RARE campaign.

How's this for a quality-improvement success story? In 2011, three Minnesota-based institutions—the Institute for Clinical Systems Improvement (ICSI), the Minnesota Hospital Association, and Stratis Health—launched the Reducing Avoidable Readmissions Effectively (RARE) campaign to reduce avoidable hospital readmissions across the state. So far, the campaign's 82 participating hospitals and 100 community partners have prevented 6,211 readmissions between Jan. 1, 2011 and June 30, 2013.

The efforts were recognized last month when RARE was named a recipient of the 2013 John M. Eisenberg Patient Safety and Quality Award for Innovation in Patient Safety and Quality.

Launched in 2002 by National Quality Forum and Joint Commission, the award honors John M. Eisenberg, MD, MBA, a former administrator of the Agency for Healthcare Research and Quality and an advocate for patient safety and healthcare quality. SHM won the John M. Eisenberg Innovation in Patient Safety and Quality award in 2011 for its mentored-implementation program.

According to ICSI project manager Kathy Cummins, RN, MA, hospitals involved in RARE aren't given specific instructions on how to reduce readmissions, but are encouraged to focus their efforts on these areas:

Comprehensive discharge planning;

Medication management;

Patient and family engagement;

Transition-care support; and

Transition communications.

While the campaign provides guidance and technical support, each hospital comes up with its own strategies for achieving these goals. Ms. Cummins, for example, describes how one hospital that was tasked with reducing readmissions without adding staff had paramedics use their downtime to visit recently discharged patients. The paramedics now check in to see if patients are exhibiting warning signs of illness and make sure they’re taking their prescribed medications.

SHM board member Howard Epstein, MD, FHM, ICSI's chief health systems officer, says the RARE campaign targets issues hospitalists have long struggled with.

"Hospitalists don't want to see their patients readmitted to the hospital," Dr. Epstein says. "It doesn't look good on their part, and it's not the best thing for their patients. The [RARE] campaign galvanized the system to support what hospitalists have been demanding for many years."

Stephanie C. Mackiewicz is a freelance author in California.

Visit our website for more information about the RARE campaign.

A standardized handoff program can reduce medical errors and can be replicated at hospitals across the country, says the lead researcher of a new study published in JAMA.

Researchers reviewed the medical literature for successful handoff-intervention programs that they could teach to residents and senior interns working within two units at Boston Children’s Hospital. They ultimately settled on a bundle that included standardized communication and handoff training, a verbal mnemonic to help staff members remember what information to pass off to the next team, and a handoff structure that involved junior and senior physicians meeting in a quiet room to discuss the handoff. In addition, on one unit, residents used a computerized tool linked to the electronic medical record that made it easier for them to pass along important information about the patient.

The analysis included 642 handoffs that occurred before the intervention and 613 that happened afterwards. Researchers found that medical errors decreased from 33.8 per 100 admissions (95% CI, 27.3–40.3) prior to the intervention to 18.3 per 100 admissions (95% CI, 14.7–21.9; P?P=0.04).

Amy Starmer, MD, MPH, associate scientific researcher at Boston Children’s Hospital and lecturer in pediatrics at Harvard Medical School in Boston, says that when implementing an intervention program, it’s important to involve staff from all levels of the hospital.

“We thought carefully about who should be able to make transformational change happen,” says Dr. Starmer. “That included resident program directors, educators, attending physicians who help observe the residents, and senior administrative people in the hospital who knew this was going on and were supportive. Even the technology team was able to devote programming support and resources to allow the development of a computerized tool.”

Visit our website for more information on hospital handoff programs.

A standardized handoff program can reduce medical errors and can be replicated at hospitals across the country, says the lead researcher of a new study published in JAMA.

Researchers reviewed the medical literature for successful handoff-intervention programs that they could teach to residents and senior interns working within two units at Boston Children’s Hospital. They ultimately settled on a bundle that included standardized communication and handoff training, a verbal mnemonic to help staff members remember what information to pass off to the next team, and a handoff structure that involved junior and senior physicians meeting in a quiet room to discuss the handoff. In addition, on one unit, residents used a computerized tool linked to the electronic medical record that made it easier for them to pass along important information about the patient.

The analysis included 642 handoffs that occurred before the intervention and 613 that happened afterwards. Researchers found that medical errors decreased from 33.8 per 100 admissions (95% CI, 27.3–40.3) prior to the intervention to 18.3 per 100 admissions (95% CI, 14.7–21.9; P?P=0.04).

Amy Starmer, MD, MPH, associate scientific researcher at Boston Children’s Hospital and lecturer in pediatrics at Harvard Medical School in Boston, says that when implementing an intervention program, it’s important to involve staff from all levels of the hospital.

“We thought carefully about who should be able to make transformational change happen,” says Dr. Starmer. “That included resident program directors, educators, attending physicians who help observe the residents, and senior administrative people in the hospital who knew this was going on and were supportive. Even the technology team was able to devote programming support and resources to allow the development of a computerized tool.”

Visit our website for more information on hospital handoff programs.

A standardized handoff program can reduce medical errors and can be replicated at hospitals across the country, says the lead researcher of a new study published in JAMA.

Researchers reviewed the medical literature for successful handoff-intervention programs that they could teach to residents and senior interns working within two units at Boston Children’s Hospital. They ultimately settled on a bundle that included standardized communication and handoff training, a verbal mnemonic to help staff members remember what information to pass off to the next team, and a handoff structure that involved junior and senior physicians meeting in a quiet room to discuss the handoff. In addition, on one unit, residents used a computerized tool linked to the electronic medical record that made it easier for them to pass along important information about the patient.

The analysis included 642 handoffs that occurred before the intervention and 613 that happened afterwards. Researchers found that medical errors decreased from 33.8 per 100 admissions (95% CI, 27.3–40.3) prior to the intervention to 18.3 per 100 admissions (95% CI, 14.7–21.9; P?P=0.04).

Amy Starmer, MD, MPH, associate scientific researcher at Boston Children’s Hospital and lecturer in pediatrics at Harvard Medical School in Boston, says that when implementing an intervention program, it’s important to involve staff from all levels of the hospital.

“We thought carefully about who should be able to make transformational change happen,” says Dr. Starmer. “That included resident program directors, educators, attending physicians who help observe the residents, and senior administrative people in the hospital who knew this was going on and were supportive. Even the technology team was able to devote programming support and resources to allow the development of a computerized tool.”

Visit our website for more information on hospital handoff programs.