National Healthcare Quality and Disparities Report
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Topics
- Adverse Events (2)
- Behavioral Health (2)
- Burnout (6)
- Care Coordination (2)
- Caregiving (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
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- Elderly (1)
- Electronic Health Records (EHRs) (8)
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- Falls (1)
- Guidelines (2)
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- Health Services Research (HSR) (4)
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- Provider Performance (4)
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- Quality Indicators (QIs) (1)
- Quality Measures (1)
- Quality of Care (4)
- Racial and Ethnic Minorities (1)
- Risk (1)
- Simulation (1)
- Social Media (1)
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- Surgery (7)
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- Training (3)
- Transitions of Care (3)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 52 Research Studies DisplayedSutherland BL, Pecanac K, LaBorde TM
Good working relationships: how healthcare system proximity influences trust between healthcare workers.
The authors interviewed healthcare workers who worked with proximal and distributed colleagues to care for patients with diabetic foot ulcers and analyzed transcripts using content analysis. They found that proximal, compared to distributed, dyads had more options available for interactions which, in turn, facilitated communication and working together to build trust. Further, few effective tools existed at the level of interprofessional collaborations, teams, or broader healthcare systems to support trust between distributed healthcare workers.
AHRQ-funded; HS026279.
Citation: Sutherland BL, Pecanac K, LaBorde TM .
Good working relationships: how healthcare system proximity influences trust between healthcare workers.
J Interprof Care 2022 May-Jun;36(3):331-39. doi: 10.1080/13561820.2021.1920897..
Keywords: Health Systems, Provider, Provider: Health Personnel
Grossman LV, Masterson Creber RM, Ryan B
Providers' perspectives on sharing health information through acute care patient portals.
Engaging healthcare providers in acute care patient portal implementation is critical to ensure productive use. However, few studies have assessed provider's perceptions of an acute care portal after implementation. In this study, the investigators surveyed 63 nurses, physicians, and physician assistants following a 3-year randomized trial of an acute care portal. The survey assessed providers' perceptions of the portal and its impact on care delivery.
AHRQ-funded; HS021816.
Citation: Grossman LV, Masterson Creber RM, Ryan B .
Providers' perspectives on sharing health information through acute care patient portals.
AMIA Annu Symp Proc 2018 Dec 5;2018:1273-81..
Keywords: Health Information Technology (HIT), Provider
Edwards ST, Marino M, Balasubramanian BA
Burnout among physicians, advanced practice clinicians and staff in smaller primary care practices.
The purpose of this study was to examine the association between physician-, advanced practice clinician- and staff-reported burnout and specific structural, organizational, and contextual characteristics of smaller primary care practices. Results showed that burnout is prevalent among physicians, advanced practice clinicians, and staff in smaller primary care practices. Members of solo practices less commonly report burnout, while members of health system-owned practices and Federally Qualified Health Centers more commonly report burnout, suggesting that practice level autonomy may be a critical determinant.
AHRQ-funded; HS023940.
Citation: Edwards ST, Marino M, Balasubramanian BA .
Burnout among physicians, advanced practice clinicians and staff in smaller primary care practices.
J Gen Intern Med 2018 Dec;33(12):2138-46. doi: 10.1007/s11606-018-4679-0..
Keywords: Burnout, Primary Care, Provider: Physician, Provider: Clinician, Provider
Goldman MP, Wong AH, Bhatnagar A
Providers' perceptions of caring for pediatric patients in community hospital emergency departments: a mixed-methods analysis.
Approximately 90% of pediatric emergency care is provided in community emergency departments (CEDs) that care for both adults and children. Paradoxically, the majority of pediatric emergency medicine knowledge generation, quality improvement work, and clinical training occurs in children's hospitals. There is a paucity of information of perceptions on pediatric care from CED providers. The objective of this study was to explore interprofessional CED providers' perceptions of caring for pediatric patients.
AHRQ-funded; HS020286.
Citation: Goldman MP, Wong AH, Bhatnagar A .
Providers' perceptions of caring for pediatric patients in community hospital emergency departments: a mixed-methods analysis.
Acad Emerg Med 2018 Dec;25(12):1385-95. doi: 10.1111/acem.13509..
Keywords: Children/Adolescents, Emergency Department, Hospitals, Provider
Blanco N, Johnson JK, Sorkin JD
Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities.
The purpose of this study was to estimate the risk of transmission of antibiotic-resistant Gram-negative bacteria (RGNB) to gowns and gloves worn by healthcare personnel when providing care to residents of community-based nursing facilities to identify the types of care and resident characteristics associated with transmission. The investigators found that RGNB transmission to either gloves or gowns occurred during 11% of the 584 interactions. Showering the resident, hygiene or toilet assistance, and wound dressing changes were associated with a high risk of transmission.
AHRQ-funded; HS019979.
Citation: Blanco N, Johnson JK, Sorkin JD .
Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities.
Infect Control Hosp Epidemiol 2018 Dec;39(12):1425-30. doi: 10.1017/ice.2018.247.
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Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Nursing Homes, Prevention, Provider, Provider: Health Personnel
Rolnick JA, Ryskina KL
The use of individual provider performance reports by US Hospitals.
In this study, the investigators examined overall trends in how hospitals use the electronic health record to track and provide feedback on provider performance. They used data from 2013 to 2015 from the American Hospital Association (AHA) Annual Survey Information Technology Supplement, which asked hospitals if they have used electronic data to create performance profiles. They linked these data to AHA Annual Survey responses for all general adult and pediatric hospitals and used Multivariable logistic regression to model the odds of use as a function of hospital characteristics.
AHRQ-funded; HS022198.
Citation: Rolnick JA, Ryskina KL .
The use of individual provider performance reports by US Hospitals.
J Hosp Med 2018 Aug;13(8):562-65. doi: 10.12788/jhm.2922..
Keywords: Provider Performance, Quality of Care, Provider, Hospitals, Electronic Health Records (EHRs), Health Information Technology (HIT)
McManus KA, McManus K, Dillingham R
National survey of United States human immunodeficiency virus medical providers' knowledge and attitudes about the Affordable Care Act.
The objective of the study was to explore HIV medical providers' knowledge and attitudes about the Affordable Care Act (ACA). The investigators concluded that: medical providers in Medicaid expansion states were more optimistic about the ACA's likelihood to improve their patients' HIV outcomes; there are gaps in HIV medical providers' understanding of the ACA; and education could enhance systems-based practice.
AHRQ-funded; HS024196.
Citation: McManus KA, McManus K, Dillingham R .
National survey of United States human immunodeficiency virus medical providers' knowledge and attitudes about the Affordable Care Act.
Clin Infect Dis 2018 Oct 15;67(9):1403-10. doi: 10.1093/cid/ciy296..
Keywords: Policy, Human Immunodeficiency Virus (HIV), Medicaid, Provider
Lybarger KJ, Ostendorf M, Riskin E
Asynchronous speech recognition affects physician editing of notes.
Clinician progress notes are an important record for care and communication, but there is a perception that electronic notes take too long to write and may not accurately reflect the patient encounter, threatening quality of care. Automatic speech recognition (ASR) has the potential to improve clinical documentation process; however, ASR inaccuracy and editing time are barriers to wider use. In this study, the investigators hypothesized that automatic text processing technologies could decrease editing time and improve note quality.
AHRQ-funded; HS023631.
Citation: Lybarger KJ, Ostendorf M, Riskin E .
Asynchronous speech recognition affects physician editing of notes.
Appl Clin Inform 2018 Oct;9(4):782-90. doi: 10.1055/s-0038-1673417..
Keywords: Provider: Physician, Provider, Electronic Health Records (EHRs), Health Information Technology (HIT)
Fong A, Ratwani RM
Understanding emergency medicine physicians multitasking behaviors around interruptions.
Interruptions can adversely impact human performance, particularly in fast-paced and high-risk environments such as the emergency department (ED). In this paper, the investigators present a comprehensive framework for understanding interruptions that is composed of three phases, each with multiple levels: interruption start transition, interruption engagement, and interruption end transition. This three-phase framework is not constrained to discrete task transitions, providing a robust method to categorize multitasking behaviors around interruptions. They apply this framework in categorizing 457 interruption episodes.
AHRQ-funded; HS022362.
Citation: Fong A, Ratwani RM .
Understanding emergency medicine physicians multitasking behaviors around interruptions.
Acad Emerg Med 2018 Oct;25(10):1164-68. doi: 10.1111/acem.13496..
Keywords: Emergency Department, Workflow, Patient Safety, Provider: Physician, Provider
Cofer KD, Hollis RH, Goss L
Burnout is associated with emotional intelligence but not traditional job performance measurements in surgical residents.
The purpose of this study was to evaluate whether burnout was associated with emotional intelligence and job performance in surgical residents. The investigators found that burnout was present in surgery residents and was associated with emotional intelligence. There was no association of burnout with United States Medical Licensing Examination scores, American Board of Surgery In-Training Exam percentile, or surgical milestones. The investigators suggested that traditional methods of assessing resident performance may not be capturing burnout and strategies to reduce burnout should consider targeting emotional intelligence.
AHRQ-funded; HS023009.
Citation: Cofer KD, Hollis RH, Goss L .
Burnout is associated with emotional intelligence but not traditional job performance measurements in surgical residents.
J Surg Educ 2018 Sep - Oct;75(5):1171-79. doi: 10.1016/j.jsurg.2018.01.021..
Keywords: Burnout, Education: Continuing Medical Education, Provider, Provider: Physician, Provider Performance
Auger KA, Shah SS, Tubbs-Cooley HL
Effects of a 1-time nurse-led telephone call after pediatric discharge: the H2O II randomized clinical trial.
The purpose of this study was to determine whether a single nurse-led telephone call after pediatric discharge decreased the 30-day reutilization rate for urgent care services and enhanced overall transition success. The investigators concluded that although postdischarge nurse contact did not decrease the reutilization rate of postdischarge urgent health care services, the method showed promise to bolster postdischarge education.
AHRQ-funded; HS024735.
Citation: Auger KA, Shah SS, Tubbs-Cooley HL .
Effects of a 1-time nurse-led telephone call after pediatric discharge: the H2O II randomized clinical trial.
JAMA Pediatr 2018 Sep;172(9):e181482. doi: 10.1001/jamapediatrics.2018.1482..
Keywords: Care Coordination, Children/Adolescents, Health Information Technology (HIT), Health Services Research (HSR), Healthcare Delivery, Healthcare Utilization, Hospital Discharge, Outcomes, Provider, Provider: Nurse, Telehealth, Transitions of Care
Blay E, Engelhardt KE, Hewitt DB
Evaluation of reasons why surgical residents exceeded 2011 duty hour requirements when offered flexibility: a FIRST Trial analysis.
This study’s objective was to examine the reasons why residents exceeded a 24-hour call during their daily shift. Residents in the flexible arm of the Flexibility in Duty Hour Requirement for Surgical Trainees (FIRST) trial were surveyed anonymously. All clinical general surgery residents taking the 2017 American Board of Surgery In-Training Examination were included in the survey. There was a very high response rate (99.2%) which included 1838 of 1852 general surgery residents in the FIRST trial. Of those who responded, 21.7% indicated their programs expected them to stay longer. A large majority (78.1%) indicated they wanted to stay longer with only 7.4% reporting coercion from attending surgeons, and 9.3% reporting coercion from senior residents.
AHRQ-funded; HS000078.
Citation: Blay E, Engelhardt KE, Hewitt DB .
Evaluation of reasons why surgical residents exceeded 2011 duty hour requirements when offered flexibility: a FIRST Trial analysis.
JAMA Surg 2018 Sep;153(9):860-62. doi: 10.1001/jamasurg.2018.1047.
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Keywords: Surgery, Provider: Physician, Education: Continuing Medical Education, Provider
Kanters AE, Shubeck SP, Sandhu G
Justifying our decisions about surgical technique: evidence from coaching conversations.
The objective of this qualitative study was to determine the extent to which practicing surgeons participating in a coaching program justify their technical decisions based on their experience or based on evidence. The investigators found that practicing surgeons often justify their surgical decisions with anecdotal evidence and "lessons learned," rather than deferring to surgical literature. The authors suggest that this either represents a lack of evidence or poor uptake of existing data.
AHRQ-funded; HS023597; HS000053.
Citation: Kanters AE, Shubeck SP, Sandhu G .
Justifying our decisions about surgical technique: evidence from coaching conversations.
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Keywords: Decision Making, Education: Continuing Medical Education, Provider, Practice Patterns, Surgery
Poghosyan L, Norful AA, Liu J
Nurse practitioner practice environments in primary care and quality of care for chronic diseases.
In this study, the authors investigated the relationship between nurse practitioner (NP) practice environments and quality of care for chronic diseases. The investigators found that NP practice environment affected the quality of care for 2 chronic conditions. They assert that efforts should be implemented to improve NP practice environment to potentially improve care quality.
AHRQ-funded; HS020999.
Citation: Poghosyan L, Norful AA, Liu J .
Nurse practitioner practice environments in primary care and quality of care for chronic diseases.
Med Care 2018 Sep;56(9):791-97. doi: 10.1097/mlr.0000000000000961..
Keywords: Chronic Conditions, Quality of Care, Primary Care, Provider
Simpkin AL, Khan A, West DC
Stress from uncertainty and resilience among depressed and burned out residents: a cross-sectional study.
This study examined how stress from uncertainty is related to resilience among medical residents and whether those attributes are related to depression and burnout. The investigators surveyed 86 residents in pediatric residency programs from 4 urban freestanding children’s hospitals in North America in 2015. They used the Physicians’ Reaction to Uncertainty Scale to measure stress from uncertainty, the 14-item Resilience Scale to measure uncertainty, the Harvard National Depression Scale for depression, and the Maslach Burnout Inventory for burnout. There was a response rate of 58.1%. Five residents met depression criteria, and 15 residents met the burnout criteria. Depressed and burned out residents both had higher mean levels of stress compared to residents who neither depressed nor burned out.
AHRQ-funded; HS022986.
Citation: Simpkin AL, Khan A, West DC .
Stress from uncertainty and resilience among depressed and burned out residents: a cross-sectional study.
Acad Pediatr 2018 Aug;18(6):698-704. doi: 10.1016/j.acap.2018.03.002..
Keywords: Burnout, Stress, Depression, Provider: Physician, Behavioral Health, Provider, Education: Continuing Medical Education, Hospitals
Shah PD, Calo WA, Marciniak MW
Support for pharmacist-provided HPV vaccination: national surveys of U.S. physicians and parents.
Cancer Epidemiol Biomarkers Prev 2018 Aug;27(8):970-78. doi: 10.1158/1055-9965.Epi-18-0380.
State laws about pharmacists providing human papillomavirus (HPV) vaccines vary considerably, limiting many pharmacists' ability to provide this important cancer prevention service. In this study, the investigators characterized physician and parent support for pharmacist-provided HPV vaccination for adolescents who are past due for vaccination. The authors concluded that to increase support for HPV vaccination services, pharmacists should raise awareness about their immunization training and standardize vaccination protocols that ensure coordination with primary care.
State laws about pharmacists providing human papillomavirus (HPV) vaccines vary considerably, limiting many pharmacists' ability to provide this important cancer prevention service. In this study, the investigators characterized physician and parent support for pharmacist-provided HPV vaccination for adolescents who are past due for vaccination. The authors concluded that to increase support for HPV vaccination services, pharmacists should raise awareness about their immunization training and standardize vaccination protocols that ensure coordination with primary care.
AHRQ-funded; HS000032.
Citation: Shah PD, Calo WA, Marciniak MW .
Support for pharmacist-provided HPV vaccination: national surveys of U.S. physicians and parents.
Cancer Epidemiol Biomarkers Prev 2018 Aug;27(8):970-78. doi: 10.1158/1055-9965.Epi-18-0380..
Keywords: Caregiving, Children/Adolescents, Infectious Diseases, Provider, Provider: Pharmacist, Provider: Physician, Vaccination
Jones LK, Jennings BM, Higgins MK
Ethological observations of social behavior in the operating room.
This study used ethological observation techniques, recording live all social behavior to document the full range of behavior of operating room teams. The study focused on examining the hierarchical, mixed-gender aspects of clinical teams.
AHRQ-funded; HS023403.
Citation: Jones LK, Jennings BM, Higgins MK .
Ethological observations of social behavior in the operating room.
Proc Natl Acad Sci U S A 2018 Jul 17;115(29):7575-80. doi: 10.1073/pnas.1716883115..
Keywords: Patient Safety, Surgery, Provider: Physician, Provider
Denton CA, Soni HC, Kannampallil TG
Emergency physicians' perceived influence of EHR use on clinical workflow and performance metrics.
In this article, the authors investigated the perceived effects of electronic health record (EHR) use on clinical workflow and meaningful use (MU) performance metrics. The investigators concluded that physicians' perception of EHRs was likely to influence their practices. They suggested that with negative perceptions of EHR usability problems, positive aspects of EHR use, including the influence on MU performance metrics, may be overridden.
AHRQ-funded; HS022670.
Citation: Denton CA, Soni HC, Kannampallil TG .
Emergency physicians' perceived influence of EHR use on clinical workflow and performance metrics.
Appl Clin Inform 2018 Jul;9(3):725-33. doi: 10.1055/s-0038-1668553..
Keywords: Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Workflow, Provider: Physician, Provider
Sittig DF, Salimi M, Aiyagari R
Adherence to recommended electronic health record safety practices across eight health care organizations.
The Safety Assurance Factors for EHR Resilience (SAFER) guides were released in 2014 to help health systems conduct proactive risk assessment of electronic health record (EHR)- safety related policies, processes, procedures, and configurations. This study examined the extent to which SAFER recommendations are followed. The study concluded that despite availability of recommendations on how to improve use of EHRs, most recommendations were not fully implemented. New national policy initiatives are needed to stimulate implementation of these best practices.
AHRQ-funded; HS024459; HS022087; HS023602.
Citation: Sittig DF, Salimi M, Aiyagari R .
Adherence to recommended electronic health record safety practices across eight health care organizations.
J Am Med Inform Assoc 2018 Jul;25(7):913-18. doi: 10.1093/jamia/ocy033..
Keywords: Electronic Health Records (EHRs), Guidelines, Health Information Technology (HIT), Patient Safety, Provider
Costa DK, Moss M
The cost of caring: emotion, burnout, and psychological distress in critical care clinicians.
This paper comments on emotion, burnout, and psychological distress in critical care clinicians. It stresses that the current management approaches for burnout and other forms of psychological distress are insufficient and discusses possibilities for improvement.
AHRQ-funded; HS024552.
Citation: Costa DK, Moss M .
The cost of caring: emotion, burnout, and psychological distress in critical care clinicians.
Ann Am Thorac Soc 2018 Jul;15(7):787-90. doi: 10.1513/AnnalsATS.201804-269PS..
Keywords: Burnout, Critical Care, Provider, Workforce
Bayramzadeh S, Joseph A, San D
The impact of operating room layout on circulating nurse's work patterns and flow disruptions: a behavioral mapping study.
The purpose of this study was to assess how the adjacencies of functionally different areas within operating rooms (ORs) can influence the circulating nurse's (CN) workflow patterns and disruptions. The investigators video recorded and thematically coded a convenience sample of 25 surgeries for CN's activities, locations, and flow disruptions. The investigators suggest that optimum adjacencies should be considered while designing ORs such that they are more efficient and safer.
AHRQ-funded; HS024380.
Citation: Bayramzadeh S, Joseph A, San D .
The impact of operating room layout on circulating nurse's work patterns and flow disruptions: a behavioral mapping study.
HERD 2018 Jul;11(3):124-38. doi: 10.1177/1937586717751124..
Keywords: Surgery, Workflow, Hospitals, Nursing, Provider: Nurse, Provider, Patient Safety
Hanna RM, Fischer G, Conroy MB
Online lifestyle modification intervention: survey of primary care providers' attitudes and views.
The aim of this study was to evaluate the response of primary care providers (PCPs) to a referral model for implementing a year-long online intervention for weight loss to obese adult patients. The investigators suggest that understanding providers' views and barriers regarding the integration of online tools will facilitate widespread implementation of an online lifestyle modification intervention.
AHRQ-funded; HS018155.
Citation: Hanna RM, Fischer G, Conroy MB .
Online lifestyle modification intervention: survey of primary care providers' attitudes and views.
J Med Internet Res 2018 Jun 8;20(6):e167. doi: 10.2196/jmir.8616..
Keywords: Health Information Technology (HIT), Lifestyle Changes, Obesity, Primary Care, Provider
Huber MT, Ham SA, Qayyum M
Association between job factors, burnout, and preference for a new job: a nationally representative physician survey.
Investigators used an experimental vignette to test associations between physician demographics, salary, and working with exemplary colleagues on the likelihood of preferring a new job among burned out and non-burned out physicians in various specialties. They found that, among burned out physicians, the opportunity for better salary and colleagues made them more likely to prefer a new job compared to non-burned out physicians, with change in salary associated with the greatest difference. They recommended focusing on improving physician-colleague relationships to improve job retention.
AHRQ-funded; HS000078.
Citation: Huber MT, Ham SA, Qayyum M .
Association between job factors, burnout, and preference for a new job: a nationally representative physician survey.
J Gen Intern Med 2018 Jun;33(6):789-91. doi: 10.1007/s11606-018-4412-z..
Keywords: Burnout, Workforce, Provider: Physician, Provider
Yeo HL, Abelson JS, Symer MM
Association of time to attrition in surgical residency with individual resident and programmatic factors.
Attrition in general surgery residency remains high, and attrition that occurs in the later years is the most worrisome. Although several studies have retrospectively investigated the timing of attrition, no study to date has prospectively evaluated a national cohort of residents to understand which residents are at risk for attrition and at what point during residency. The purpose of this study was to prospectively evaluate individual resident and programmatic factors associated with the timing of attrition during general surgery residency.
AHRQ-funded; HS000066.
Citation: Yeo HL, Abelson JS, Symer MM .
Association of time to attrition in surgical residency with individual resident and programmatic factors.
JAMA Surg 2018 Jun;153(6):511-17. doi: 10.1001/jamasurg.2017.6202.
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Keywords: Education: Continuing Medical Education, Provider, Provider: Physician, Surgery
Barsuk JH, Cohen ER, Williams MV
Simulation-based mastery learning for thoracentesis skills improves patient outcomes: a randomized trial.
Physicians-in-training often perform bedside thoracenteses in academic medical centers, and complications are more common among less experienced clinicians. Simulation-based mastery learning (SBML) is one potential solution to this problem. This study evaluated the effects of a randomized trial of thoracentesis SBML on patient complications: iatrogenic pneumothorax, hemothorax, and reexpansion pulmonary edema.
AHRQ-funded; HS021202.
Citation: Barsuk JH, Cohen ER, Williams MV .
Simulation-based mastery learning for thoracentesis skills improves patient outcomes: a randomized trial.
Acad Med 2018 May;93(5):729-35. doi: 10.1097/acm.0000000000001965..
Keywords: Education: Continuing Medical Education, Patient Safety, Provider, Provider: Physician, Simulation, Training