The genealogy of graduate medical education in America begins at the bedside. However, today’s graduate medical trainees work in a training environment that is vastly different from medical training a century ago. The goal of the Graduate Medical Education Laboratory (GEL) Study, supported by the American Medical Association’s (AMA) “Reimagining Residency” initiative, is to determine the factors in the training environment that most contribute to resident well-being and developing diagnostic skills. We believe that increasing time at the bedside will improve clinical skill, increase professional fulfillment, and reduce workplace burnout. Our graduate medical education laboratory will test these ideas to understand which interventions can be shared among all training programs. Through the GEL Study, we aim to ensure resident readiness for practice as we understand, then optimize, the learning environment for trainees and staff.
Chaiyachati KH, Shea JA, Asch DA, Lui M, Bellini LM, Dine CJ, et al. Assessment of inpatient time allocation among first-year internal medicine residents using time motion observation. JAMA Intern Med 2019;179:760–7.
Ouyang D, Chen JH, Hom J, Chi J. Internal medicine resident computer usage: an electronic audit of an inpatient service. JAMA Intern Med 2016;176:252–4.
Vulkanovic-Criley JM, Hovanesyan A, Criley SR, Ryan TJ, Plotnik G, Mankowitz K, et al. Confidential testing of cardiac examination competency in cardiology and noncardiology faculty and trainees: a multicenter study. Clin Cardiol 2010;33:738–45.
Myers CG, Pronovost PJ. Making management skills a core component of medical education. Acad Med 2017;92:582–4.
West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. J Am Med Assoc 2011;306:952–60.
Bean RB, Bean WB, editors. Sir William Osler: aphorisms from his bedside teachings and writings. Springfield, IL: Charles C. Thomas, 1961.
Flexner A. Medical education in the United States and Canada: a report to the Carnegie Foundation for the advancement of teaching. New York: The Carnegie Foundation, 1910. https://en.wikipedia.org/wiki/Flexner_Report. Accessed July 13, 2019.
Fye WB. Profiles in cardiology: Albion Walter Hewlett. Clin Cardiol 1993;16:76–8.
Pittman JA. Tinsley Harrison: teacher of medicine. Montgomery, AL: New South Books, 2015.
Thayer LS. Osler, the teacher. Johns Hopkins Hosp Bull 1919;30:198–200.
Hewlett WA. The relation of hospitals to medical schools in the United States. Physicians Surgeons 1909;31:481–91.
Harrison TR. Principles of Internal Medicine. Philadelphia, PA: The Blakiston Company, 1950.
Sloan FA, Valvona V. Why has hospital length of stay declined? An evaluation of alternative theories. Soc Sci Med 1986;22:63–73.
Block L, Habicht R, Wu A, Desai SV, Wang K, Silva KN, et al. In the wake of the 2003 and 2011 duty hours regulations, how do internal medicine interns spend their time? J Gen Intern Med 2013;28:1042–7.
Verghese A. Culture shock – patient as icon, icon as patient. N Engl J Med 2008;359:2748–51.
Rosenthal DI, Verghese A. Meaning and the nature of physician’s work. N Engl J Med 2016;375:1813–5.
Russell SW, Garibaldi BT. The other Sylvian fissure: exploring the divide between traditional and modern bedside rounds. South Med J 2016;109:747–9.
Epstein RM. Assessment in medical education. N Engl J Med 2007;365:387–96.
Elder AT, Verghese A. Bedside matters – putting the patient at the centre of teaching and learning. J R Coll Physicians Edinb 2015;45:186–7.
Singh H, Giardina TD, Meyer AN, Forjuoh SN, Reis MD, Thomas EJ. Types and origins of diagnostic errors in primary care settings. JAMA Intern Med 2013;173:418–25.
Verghese A, Charlton B, Kassirer JP, Ramsey M, Ioannidis JP. Inadequacies of physical examination as a cause of medical errors and adverse events: a collection of vignettes. Am J Med 2015;128:1322–4.
Wagner R, Patow C, Newton R, Casey BR, Koh NJ, Weiss KB. The overview of the CLER program: CLER national report of findings 2016. J Grad Med Educ 2016;8:11–3.
Wang JK, Ouyang D, Hom J, Chi J, Chen JH. Characterizing electronic health record usage patterns of inpatient medicine resident using event event log data. PLoS One 2019;14:e0205379.
D-Souza T, Rosen M, Bertram AK, Apfel A, Desai SV, Garibaldi BT. Use of a real-time location system to understand resident location in an academic medical center. J Grad Med Educ 2019;11:324–7.
Chrisinger BW, King AC. Stress experiences in neighborhood and social environments (SENSE): a pilot study to integrate the quantified self with citizen science to improve the built environment and health. Int J Health Geogr 2018;17:17.
Trockel M, Bohman B, Lesure E, Hamidi MS, Welle D, Roberts L, et al. A brief instrument to assess both burnout and professional fulfillment in physicians: reliability and validity, including correlation with self-reported medical errors, in a sample of resident and practicing physicians. Acad Psychiatry 2018;42:11–24.
Rosen M, Dietz A, Lee N, Wang IJ, Markowitz J, Wyskiel RM, et al. Sensor-based measurement of critical care nursing workload: unobtrusive measures of nursing activity complement traditional tasks and patient level indicators of workload to predict perceived exertion. PLoS One 2018;13:e0204819.
Chaiyachati KH, Roy J, Asch DA, Dine CJ, Desai S, Bellini LM, et al. Improving longitudinal survey participation among internal medicine residents: incorporating behavioral techniques and avoiding Friday or Saturday invitations. J Gen Intern Med 2019;34:823–4.
Chatterjee S, Desai S, Manesh R, Sun J, Nundy S, Wright SM. Assessment of a simulated case-based measurement of physician diagnostic performance. JAMA Netw Open 2019;2:e187006.
Elder A, McManus C, McAlpine L, Dacre J. What skills are tested in the new PACES examination? Ann Acad Med Singapore 2011;40:119–25.
Holmboe ES. Faculty and the observation of trainees’ clinical skills: problems and opportunities. Acad Med 2004;79:16–22.
Haber RJ, Avins AL. Do rating on the American board of internal medicine resident evaluation form detect differences in clinical competence? J Gen Intern Med 1994;9:140–5.
Lichstein PR, Atkinson HH. Patient-centered bedside rounds and the clinical examination. Med Clin N Am 2018;102:509–19.
Peccoralo LA, Tackett S, Ward L, Federman A, Helenius I, Christmas C, et al. Resident satisfaction with continuity clinic and career choice in general internal medicine. J Gen Intern Med 2013;28:1020–7.
O’Rourke P, Tseng E, Chacko K, Shalaby M, Cioletti A, Wright S. A national survey of internal medicine primary care residency program directors. J Gen Intern Med 2019;34:1207–12.
Schwartz R, Haverfield MC, Brown-Johnson CG, Maitra A, Tierney AA, Bharadwaj S, et al. Transdisciplinary strategies for physician wellness: qualitative insights from diverse fields. J Gen Intern Med 2019;34:1251–7.
Zulman DM, Haverfield MC, Shaw J, Brown-Johnson CG, Schwartz R, Tierney AA, et al. Practices to foster physician presence and connection with patients in the clinical encounter. J Am Med Assoc 2020;323:70–81.
Corresponding author: Stephen W. Russell, MD, Associate Professor of Internal Medicine and Pediatrics, The University of Alabama at Birmingham, c/o UAB Medicine Leeds, 1141 Payton Way, Leeds, AL 35094, USA, Phone: +205-441-0108, Fax: +205-699-0662
Diagnosis aims at answering the question how diagnosis determines the quality of medical care. It focuses on how diagnosis can be advanced, how it is taught, and how and why it can fail, leading to diagnostic errors. The journal welcomes both fundamental and applied works, improvement initiatives, opinions, and debates to encourage new thinking on improving this critical aspect of healthcare quality.
22 Jan 2014
Nicolas Argy, Paul L. Epner, Giuseppe Lippi, Geeta Singhal, Kathryn McDonald, Hardeep Singh and David Newman-Toker