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Residents: admissions, training and assessment

Canadian Medical Education Journal

University of Calgary, Health Sciences Centre

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      Educational strategies to promote clinical diagnostic reasoning.

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        How expertise develops in medicine: knowledge encapsulation and illness script formation.

        For over 30 years, research has focused on the question of how knowledge is organised in the doctor's mind. The development of encapsulated knowledge, followed by the formation of illness scripts, may both be considered as important stages in the development of medical expertise. This paper reviews research on the knowledge encapsulation and illness script hypotheses since their initial formulation. Findings in support of these views of expertise development are reported and conflicting data are discussed. A great deal of empirical data have been collected over the years to investigate the view that, through clinical experiences, biomedical knowledge becomes encapsulated and eventually integrated into illness scripts. The findings of most studies, which have used various techniques to probe the ways by which students and doctors mentally represent clinical cases, are in line with this view of expertise development. However, there is still debate concerning the role of biomedical knowledge in clinical case processing. To facilitate the development of expertise in medical school, it is important to teach the basic sciences in a clinical context, and to introduce patient problems early in the curriculum in order to support the processes of encapsulation and illness script formation. In addition, during clerkships ample time should be devoted to enabling reflection on patient problems with peers and expert doctors.
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          A July Spike in Fatal Medication Errors: A Possible Effect of New Medical Residents

          BACKGROUND Each July thousands begin medical residencies and acquire increased responsibility for patient care. Many have suggested that these new medical residents may produce errors and worsen patient outcomes—the so-called “July Effect;” however, we have found no U.S. evidence documenting this effect. OBJECTIVE Determine whether fatal medication errors spike in July. DESIGN We examined all U.S. death certificates, 1979–2006 (n = 62,338,584), focusing on medication errors (n = 244,388). We compared the observed number of deaths in July with the number expected, determined by least-squares regression techniques. We compared the July Effect inside versus outside medical institutions. We also compared the July Effect in counties with versus without teaching hospitals. OUTCOME MEASURE JR = Observed number of July deaths / Expected number of July deaths. RESULTS Inside medical institutions, in counties containing teaching hospitals, fatal medication errors spiked by 10% in July and in no other month [JR = 1.10 (1.06–1.14)]. In contrast, there was no July spike in counties without teaching hospitals. The greater the concentration of teaching hospitals in a region, the greater the July spike (r = .80; P = .005). These findings held only for medication errors, not for other causes of death. CONCLUSIONS We found a significant July spike in fatal medication errors inside medical institutions. After assessing competing explanations, we concluded that the July mortality spike results at least partly from changes associated with the arrival of new medical residents.
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            Author and article information

            Affiliations
            University of Saskatchewan, Saskatoon, Saskatchewan
            Journal
            Can Med Educ J
            Can Med Educ J
            Canadian Medical Education Journal
            University of Calgary, Health Sciences Centre
            1923-1202
            2015
            11 December 2015
            : 6
            : 2
            : e1-e3
            27004071
            4795076
            cmej0601
            © 2015 Premkumar; licensee Synergies Partners

            This is an Open Journal Systems article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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