GME researchers who find and wish to use or modify relevant survey scales can usually contact authors and request such use. Instead, we adapted several items and used Bridges' work to better define our constructs of 3 separate but related ideas: current satisfaction, perceptions of the impact of the integration on the training experience, and beliefs about the readiness of the training programs to make the transition. ![]() Ultimately, we did not use any of these items verbatim. 3 We reviewed several of Bridges' survey instruments to identify common themes and items that might be applicable to our survey. Some of the most widely published, well-studied examples of organizational change were developed by William Bridges. However, we found a number of examples of organizational change and restructuring in the business literature. ![]() Our review revealed that very little has been published on integration of GME programs. It also helps one identify existing survey scales that could be employed or adapted. ![]() This step provides information about how the construct of interest has been defined in previous research. Question 2: How Have Others Addressed This Construct in the Past?Ī thorough review of the literature should be the next step in the GME survey design process. The residents of each program were identified as the target population for our survey. Further, we felt a survey was the appropriate tool because it would allow us to collect real-time feedback from participants rather than waiting for more objective outcomes, such as in-service exam scores and board scores, which, although valuable, would occur much later. 2 We believed that understanding these factors from the residents' perspective would enable leadership to identify threats to successful integration as well as potential opportunities for process improvement. In the context of the residency merger, we wanted to understand how the integration effort would have an impact on key GME quality elements and program requirements as specified by the Accreditation Council for Graduate Medical Education (ACGME). On the other hand, if a researcher is more interested in assessing a directly observable behavior, such as residents' skill level for a particular clinical procedure, an observational tool may be a better choice. If, for example, the research question relates to the beliefs, opinions, or attitudes of the intended audience, a survey makes sense. Question 1: Is a Survey an Appropriate Tool to Help Answer My Research Question?īefore creating a survey, it is important to consider the research question(s) of interest and the variables (or constructs) the researcher intends to measure. Given these programmatic differences, we were interested in understanding how individuals in both programs thought the integration would affect the quality of the IM residency. Residents at the National Naval Medical Center worked under a night-float system that eliminated the risk of duty hour violations but increased the number of handoffs. Yet, this call system risked violating work hour restrictions. For example, residents at Walter Reed were accustomed to an overnight, 24-hour call structure that was thought to bring a strong experiential learning element to the program. During the merger these IM programs were asked to integrate seamlessly into a unified program.ĭespite many similarities, the 2 IM programs had important differences that might inhibit successful integration. ![]() Prior to this integration, each hospital maintained independently accredited GME programs, including separate IM residency programs. In 2010, the Department of Defense mandated the integration of the Walter Reed Army Medical Center in Washington, DC, with the National Naval Medical Center in Bethesda, Maryland.
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