{"id":"https://openalex.org/W1977563672","doi":"https://doi.org/10.1056/nejmsa0908136","title":"Evaluation of a Redesign Initiative in an Internal-Medicine Residency","display_name":"Evaluation of a Redesign Initiative in an Internal-Medicine Residency","publication_year":2010,"publication_date":"2010-04-07","ids":{"openalex":"https://openalex.org/W1977563672","doi":"https://doi.org/10.1056/nejmsa0908136","mag":"1977563672","pmid":"https://pubmed.ncbi.nlm.nih.gov/20375407"},"language":"en","primary_location":{"id":"doi:10.1056/nejmsa0908136","doi":"https://doi.org/10.1056/nejmsa0908136","is_oa":false,"landing_page_url":"https://doi.org/10.1056/nejmsa0908136","pdf_url":null,"source":{"id":"https://openalex.org/S62468778","display_name":"New England Journal of Medicine","issn_l":"0028-4793","issn":["0028-4793","0096-6762","1533-4406","2331-4710"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-class-a","anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320239","host_organization_name":"Massachusetts Medical Society","host_organization_lineage":["https://openalex.org/P4310320239"],"host_organization_lineage_names":["Massachusetts Medical Society"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"New England Journal of Medicine","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5046399206","display_name":"Graham T. McMahon","orcid":"https://orcid.org/0000-0003-4288-6535","observed_orcids":["https://orcid.org/0000-0003-4288-6535"]},"institutions":[{"id":"https://openalex.org/I1283280774","display_name":"Brigham and Women's Hospital","ror":"https://ror.org/04b6nzv94","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I121934306","https://openalex.org/I1283280774","https://openalex.org/I48633490"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Graham T. McMahon","raw_affiliation_strings":["Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. gmcmahon@partners.org","Department of Medicine, Brigham and Women's Hospital, Boston"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. gmcmahon@partners.org","institution_ids":["https://openalex.org/I1283280774"]},{"raw_affiliation_string":"Department of Medicine, Brigham and Women's Hospital, Boston","institution_ids":["https://openalex.org/I1283280774"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5034378265","display_name":"Joel T. Katz","orcid":"https://orcid.org/0000-0002-2491-6510","observed_orcids":["https://orcid.org/0000-0002-2491-6510"]},"institutions":[{"id":"https://openalex.org/I1283280774","display_name":"Brigham and Women's Hospital","ror":"https://ror.org/04b6nzv94","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I121934306","https://openalex.org/I1283280774","https://openalex.org/I48633490"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Joel T. Katz","raw_affiliation_strings":["Department of Medicine, Brigham and Women's Hospital, Boston"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Medicine, Brigham and Women's Hospital, Boston","institution_ids":["https://openalex.org/I1283280774"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5028180387","display_name":"Mary Thorndike","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1283280774","display_name":"Brigham and Women's Hospital","ror":"https://ror.org/04b6nzv94","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I121934306","https://openalex.org/I1283280774","https://openalex.org/I48633490"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Mary E. Thorndike","raw_affiliation_strings":["Department of Medicine, Brigham and Women's Hospital, Boston"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Medicine, Brigham and Women's Hospital, Boston","institution_ids":["https://openalex.org/I1283280774"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5050132863","display_name":"Bruce D. Levy","orcid":"https://orcid.org/0000-0001-9515-5731","observed_orcids":["https://orcid.org/0000-0001-9515-5731"]},"institutions":[{"id":"https://openalex.org/I1283280774","display_name":"Brigham and Women's Hospital","ror":"https://ror.org/04b6nzv94","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I121934306","https://openalex.org/I1283280774","https://openalex.org/I48633490"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Bruce D. Levy","raw_affiliation_strings":["Department of Medicine, Brigham and Women's Hospital, Boston"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Medicine, Brigham and Women's Hospital, Boston","institution_ids":["https://openalex.org/I1283280774"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5028396638","display_name":"Joseph Loscalzo","orcid":"https://orcid.org/0000-0002-1153-8047","observed_orcids":["https://orcid.org/0000-0002-1153-8047"]},"institutions":[{"id":"https://openalex.org/I1283280774","display_name":"Brigham and Women's Hospital","ror":"https://ror.org/04b6nzv94","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I121934306","https://openalex.org/I1283280774","https://openalex.org/I48633490"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Joseph Loscalzo","raw_affiliation_strings":["Department of Medicine, Brigham and Women's Hospital, Boston"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Medicine, Brigham and Women's Hospital, Boston","institution_ids":["https://openalex.org/I1283280774"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":[],"corresponding_institution_ids":["https://openalex.org/I1283280774"],"apc_list":null,"apc_paid":null,"fwci":17.042,"has_fulltext":false,"cited_by_count":106,"citation_normalized_percentile":{"value":0.99380037,"is_in_top_1_percent":true,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":89,"max":99},"biblio":{"volume":"362","issue":"14","first_page":"1304","last_page":"1311"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12174","display_name":"Hospital Admissions and Outcomes","score":0.6294000148773193,"subfield":{"id":"https://openalex.org/subfields/2911","display_name":"Leadership and Management"},"field":{"id":"https://openalex.org/fields/29","display_name":"Nursing"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T12174","display_name":"Hospital Admissions and Outcomes","score":0.6294000148773193,"subfield":{"id":"https://openalex.org/subfields/2911","display_name":"Leadership and Management"},"field":{"id":"https://openalex.org/fields/29","display_name":"Nursing"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10254","display_name":"Innovations in Medical Education","score":0.3495999872684479,"subfield":{"id":"https://openalex.org/subfields/3304","display_name":"Education"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T10795","display_name":"Healthcare professionals\u2019 stress and burnout","score":0.002400000113993883,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/internal-medicine-residency","display_name":"internal medicine residency","score":0.8550000190734863},{"id":"https://openalex.org/keywords/attending-physician-supervision","display_name":"attending physician supervision","score":0.6690000295639038},{"id":"https://openalex.org/keywords/team-based-care","display_name":"team-based care","score":0.49900001287460327},{"id":"https://openalex.org/keywords/resident-workload","display_name":"resident workload","score":0.6539999842643738},{"id":"https://openalex.org/keywords/trainee-satisfaction","display_name":"trainee satisfaction","score":0.9589999914169312},{"id":"https://openalex.org/keywords/patient-satisfaction","display_name":"patient satisfaction","score":0.8190000057220459},{"id":"https://openalex.org/keywords/length-of-hospital-stay","display_name":"length of hospital stay","score":0.7570000290870667},{"id":"https://openalex.org/keywords/hospital-readmission","display_name":"hospital readmission","score":0.6579999923706055},{"id":"https://openalex.org/keywords/postgraduate-medical-education","display_name":"graduate medical education","score":0.8859999775886536}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8684937357902527},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.4897329807281494},{"id":"https://openalex.org/C509550671","wikidata":"https://www.wikidata.org/wiki/Q126945","display_name":"Medical education","level":1,"score":0.4692297875881195},{"id":"https://openalex.org/C3019285220","wikidata":"https://www.wikidata.org/wiki/Q256698","display_name":"Residency training","level":3,"score":0.4278659224510193},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.3976505696773529},{"id":"https://openalex.org/C199539241","wikidata":"https://www.wikidata.org/wiki/Q7748","display_name":"Law","level":1,"score":0.0},{"id":"https://openalex.org/C17744445","wikidata":"https://www.wikidata.org/wiki/Q36442","display_name":"Political science","level":0,"score":0.0},{"id":"https://openalex.org/C2988064887","wikidata":"https://www.wikidata.org/wiki/Q828748","display_name":"Continuing education","level":2,"score":0.0}],"mesh":[{"descriptor_ui":"D000368","descriptor_name":"Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D001900","descriptor_name":"Boston","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D003625","descriptor_name":"Data Collection","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006784","descriptor_name":"Hospitals, Teaching","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007297","descriptor_name":"Inpatients","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007388","descriptor_name":"Internal Medicine","qualifier_ui":"Q000193","qualifier_name":"education","is_major_topic":true},{"descriptor_ui":"D007396","descriptor_name":"Internship and Residency","qualifier_ui":"Q000379","qualifier_name":"methods","is_major_topic":true},{"descriptor_ui":"D007396","descriptor_name":"Internship and Residency","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":false},{"descriptor_ui":"D007588","descriptor_name":"Job Satisfaction","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D007902","descriptor_name":"Length of Stay","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008505","descriptor_name":"Medical Staff, Hospital","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D010346","descriptor_name":"Patient Care Management","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":true},{"descriptor_ui":"D010348","descriptor_name":"Patient Care Team","qualifier_ui":"Q000458","qualifier_name":"organization & administration","is_major_topic":true},{"descriptor_ui":"D011787","descriptor_name":"Quality of Health Care","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D016526","descriptor_name":"Workload","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D017060","descriptor_name":"Patient Satisfaction","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D017598","descriptor_name":"Efficiency, Organizational","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D056164","descriptor_name":"Teaching Rounds","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":2,"locations":[{"id":"doi:10.1056/nejmsa0908136","doi":"https://doi.org/10.1056/nejmsa0908136","is_oa":false,"landing_page_url":"https://doi.org/10.1056/nejmsa0908136","pdf_url":null,"source":{"id":"https://openalex.org/S62468778","display_name":"New England Journal of Medicine","issn_l":"0028-4793","issn":["0028-4793","0096-6762","1533-4406","2331-4710"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-class-a","anvur-scientific","cwts-core","dongbi-a","doyens","jufo-3","ki-jl-3","medline","norway-2","poland-200","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320239","host_organization_name":"Massachusetts Medical Society","host_organization_lineage":["https://openalex.org/P4310320239"],"host_organization_lineage_names":["Massachusetts Medical Society"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"New England Journal of Medicine","raw_type":"journal-article"},{"id":"pmid:20375407","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/20375407","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The New England journal of medicine","raw_type":"Comparative Study"}],"best_oa_location":null,"sustainable_development_goals":[{"display_name":"Good health and well-being","score":0.9391000270843506,"id":"https://metadata.un.org/sdg/3"},{"display_name":"Quality education","score":0.6164000034332275,"id":"https://metadata.un.org/sdg/4"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":30,"referenced_works":["https://openalex.org/W1533746441","https://openalex.org/W1969034871","https://openalex.org/W1969432998","https://openalex.org/W1984821528","https://openalex.org/W1985319918","https://openalex.org/W2007598609","https://openalex.org/W2021729931","https://openalex.org/W2034111937","https://openalex.org/W2039683137","https://openalex.org/W2043230006","https://openalex.org/W2053650513","https://openalex.org/W2054298923","https://openalex.org/W2062158580","https://openalex.org/W2064251880","https://openalex.org/W2073344513","https://openalex.org/W2074193481","https://openalex.org/W2076631930","https://openalex.org/W2091114540","https://openalex.org/W2105954873","https://openalex.org/W2111497168","https://openalex.org/W2124295678","https://openalex.org/W2124733926","https://openalex.org/W2126255037","https://openalex.org/W2138468723","https://openalex.org/W2157499347","https://openalex.org/W2166268694","https://openalex.org/W2166406376","https://openalex.org/W2412655099","https://openalex.org/W2442449343","https://openalex.org/W2984765906"],"related_works":["https://openalex.org/W2164957697","https://openalex.org/W1998935562","https://openalex.org/W2153148614","https://openalex.org/W1449503096","https://openalex.org/W2006296972","https://openalex.org/W2093425221","https://openalex.org/W2040952001","https://openalex.org/W2148082722","https://openalex.org/W1978266979","https://openalex.org/W2170016550"],"abstract_inverted_index":{"BACKGROUND:":[0],"Several":[1],"organizations":[2],"have":[3,19],"advocated":[4],"for":[5,65,214,294],"comprehensive":[6],"redesign":[7,17],"of":[8,22,53,95,128,205,216,224,248,256,282],"graduate":[9],"medical":[10],"training,":[11],"but":[12],"the":[13,70,73,115,119,126,145,151,154,173,180,191,194,228,243],"effect":[14],"that":[15],"residency":[16],"will":[18],"on":[20,125,172,179,227,242],"measures":[21],"patient":[23,31,206],"satisfaction,":[24,29],"resident":[25,44,97],"and":[26,30,59,75,98,118,148,161,184,236,279,291],"intern":[27,158],"(trainee)":[28],"care":[32,218,269],"is":[33],"unknown.":[34],"METHODS:":[35],"We":[36],"designed":[37],"an":[38,271],"experimental":[39,81,116,146,174,195,229,272],"inpatient-medicine":[40],"service":[41],"with":[42,49,85,92,190,200,265,287],"reduced":[43,276],"workload":[45,278],"comprising":[46,89],"two":[47,54,57,90,99],"teams,":[48,91,121,193],"each":[50,93],"team":[51],"consisting":[52,94],"attending":[55,104,283],"physicians,":[56,63],"residents,":[58],"three":[60],"interns.":[61],"Attending":[62],"selected":[64],"their":[66],"teaching":[67,237],"prowess,":[68],"supervised":[69],"teams":[71,117,147,175,182,196,230,245],"throughout":[72],"workday":[74],"during":[76],"bedside":[77],"team-teaching":[78],"rounds.":[79],"This":[80],"model":[82,88,273],"was":[83,159,167,219,285],"compared":[84,189,264],"a":[86,137,201,266],"control":[87,120,152,181,192,244],"one":[96],"interns,":[100],"plus":[101],"multiple":[102],"supervising":[103],"physicians":[105,284],"who":[106],"volunteered":[107],"to":[108,114,123,133,144,150,212],"participate.":[109],"Patients":[110],"were":[111,142,197],"alternately":[112],"assigned":[113,143],"subject":[122],"limits":[124],"number":[127],"patients":[129,141],"interns":[130,241],"are":[131],"allowed":[132],"admit.":[134],"RESULTS:":[135],"Over":[136],"12-month":[138],"period,":[139],"1892":[140],"2096":[149],"teams;":[153],"average":[155,203],"census":[156],"per":[157],"3.5":[160],"6.6":[162],"patients,":[163],"respectively.":[164],"Overall":[165],"satisfaction":[166,290],"significantly":[168],"higher":[169,202,288],"among":[170,177],"trainees":[171],"than":[176,239],"those":[178],"(78%":[183],"55%,":[185],"respectively;":[186],"P=0.002).":[187],"As":[188,263],"not":[198],"associated":[199,286],"length":[204],"stay":[207],"or":[208],"readmission":[209],"rate;":[210],"adherence":[211],"standards":[213],"quality":[215],"inpatient":[217,268],"similar":[220],"in":[221,234],"both":[222],"groups":[223],"teams.":[225],"Interns":[226],"spent":[231],"more":[232],"time":[233,250,258,293],"learning":[235],"activities":[238],"did":[240],"(learning:":[246],"20%":[247],"total":[249,257],"vs.":[251,259],"10%,":[252],"P=0.01;":[253],"teaching:":[254],"8%":[255],"2%,":[260],"P=0.006).":[261],"CONCLUSIONS:":[262],"traditional":[267],"model,":[270],"characterized":[274],"by":[275],"trainee":[277,289],"increased":[280,292],"participation":[281],"educational":[295],"activities.":[296]},"counts_by_year":[{"year":2026,"cited_by_count":4},{"year":2025,"cited_by_count":3},{"year":2024,"cited_by_count":1},{"year":2023,"cited_by_count":3},{"year":2022,"cited_by_count":4},{"year":2021,"cited_by_count":3},{"year":2020,"cited_by_count":5},{"year":2019,"cited_by_count":5},{"year":2018,"cited_by_count":7},{"year":2017,"cited_by_count":10},{"year":2016,"cited_by_count":4},{"year":2015,"cited_by_count":8},{"year":2014,"cited_by_count":7},{"year":2013,"cited_by_count":11},{"year":2012,"cited_by_count":8}],"updated_date":"2026-11-06T12:05:46.655746","created_date":"2016-06-24T00:00:00"}