Burnout, Professional Fulfillment, Intention to Leave, and Sleep-Related Impairment among Radiology Trainees across the United States (US): A Multisite Epidemiologic Study

OBJECTIVE

To examine the prevalence of burnout among radiology trainees in the United States, and to study the relationships between burnout and professional fulfillment (PF), intent-to-leave (ITL), sleep-related impairment and self-compassion by gender.

METHODS

This cross-sectional study was conducted via an anonymous electronic survey sent to 11 large academic medical centers (Physician Wellness Academic Consortium) between January 2017 and September 2018. The survey included the Professional Fulfillment Index (PFI) and an abbreviated form of the PROMIS Sleep-related impairment (SRI) scale. Two-sample t-tests and chi-square exact tests were used for analysis (p < 0.05).

RESULTS

Two hundred forty-seven radiology residents responded to the survey. Out of these, 36.2% reported burnout, 37.4% endorsed PF, 64.8% reported sleep-related impairment, 7.6% expressed ITL. There were no significant differences between genders. Burnout was associated with reduced PF, increased sleep-impairment (p < 0.001 for both) and increased ITL (p = 0.02). Lower PF, peer support, perceived appreciation for and meaningfulness in work, alignment of organizational and personal values, self-compassion, and higher sleep impairment were associated with burnout (p < 0.001 for all). Burnout was associated with perceptions of less support from department leaders (p = 0.003), control over schedules (p = 0.001) and helpfulness of electronic health record systems (p = 0.01). ITL was associated with reduced PF, perceived work appreciation, and leadership support (p = 0.03, p = 0.04, and p = 0.007, respectively).

DISCUSSION

Burnout is prevalent among radiology residents. Many demonstrate sleep-impairment and reduced professional fulfillment, with a lesser fraction desiring to leave their institution. Key factors to burnout included peer and organizational support, electronic health record systems helpfulness, and personal factors like self-compassion and work appreciation.

[Dramatic changes in the age structure for medical specialists in the field of mental health]

BACKGROUND

Over the past 20 years the importance of treatment of people with mental and neurological disorders has greatly increased. Parallel to this development it has become more difficult to attract young physicians to this field. The aim of this study was to examine the development of the number of physicians specialized in the care of patients suffering from neurological, mental and psychosomatic disorders with special consideration of the age structure.

MATERIAL AND METHODS

The analyses were based on the number of professionally active physicians and specialized physicians published by the German Medical Association for the years 2000-2020. Separate age groups were looked at for psychiatry and psychotherapy (PPT), psychosomatic medicine and psychotherapy (PMPT), Nervenheilkunde (formerly psychiatry and neurology together, NHK) and neurology.

RESULTS

In comparison to the year 2000 the number of specialized physicians working in PPT (4736 vs. 12,053), neurology (2226 vs. 8355) and PMPT (3543 vs. 4130) increased in 2020, while the number of specialists actively working in NHK decreased (5184 vs. 2301). Parallel to this the proportion of women increased. Dramatic changes occurred concerning the age structure. Currently, 77.7% of specialists working in NHK and 59.7% working in PMPT are over 60 years old. In 2020 there were 2988 specialists aged over 60 years in the discipline of PPT compared to only 1070 under 40 years, which is dramatically different from 20 years earlier when only 181 were over 60 years but 1491 were under 40 years old.

CONCLUSION

The overaging of professional specialists and the shortage of junior physicians jeopardize modern and adequate provision of care for mentally ill patients. Possible solutions include a marked increase in medical school capacities as well as strategies to convince young physicians to work in the disciplines of PPT and PMPT.

Predicting physician burnout using clinical activity logs: Model performance and lessons learned

BACKGROUND

Burnout is a significant public health concern affecting more than half of the healthcare workforce; however, passive screening tools to detect burnout are lacking. We investigated the ability of machine learning (ML) techniques to identify burnout using passively collected electronic health record (EHR)-based audit log data.

METHOD

Physician trainees participated in a longitudinal study where they completed monthly burnout surveys and provided access to their EHR-based audit logs. Using the monthly burnout scores as the target outcome, we trained ML models using combinations of features derived from audit log data-aggregate measures of clinical workload, time series-based temporal measures of EHR use, and the baseline burnout score. Five ML models were constructed to predict burnout as a continuous score: penalized linear regression, support vector machine, neural network, random forest, and gradient boosting machine.

RESULTS

88 trainee physicians participated and completed 416 surveys; greater than10 million audit log actions were collected (Mean [Standard Deviation] = 25,691 [14,331] actions per month, per physician). The workload feature set predicted burnout score with a mean absolute error (MAE) of 0.602 (95% Confidence Interval (CI), 0.412-0.826), and was able to predict burnout status with an average AUROC of 0.595 (95% CI 0.355-0.808) and average accuracy 0.567 (95% CI 0.393-0.742). The temporal feature set had a similar performance, with MAE 0.596 (95% CI 0.391-0.826), and AUROC 0.581 (95% CI 0.343-0.790). The addition of the baseline burnout score to the workload features improved the model performance to a mean AUROC of 0.829 (95% CI 0.607-0.996) and mean accuracy of 0.781 (95% CI 0.587-0.936); however, this performance was not meaningfully different than using the baseline burnout score alone.

CONCLUSIONS

Current findings illustrate the complexities of predicting burnout exclusively based on clinical work activities as captured in the EHR, highlighting its multi-factorial and individualized nature. Future prediction studies of burnout should account for individual factors (e.g., resilience, physiological measurements such as sleep) and associated system-level factors (e.g., leadership).

The Effect of Implicit Bias and Role Misidentification in the Learning Environment

BACKGROUND

Little is known about the impact of implicit bias our trainees experience in the form of role misidentification in the clinical learning environment.

ACTIVITY

We surveyed 540 residents and clinical medical students to determine the frequency and impact of role misidentification.

RESULTS AND DISCUSSION

Most respondents (85%, n = 162) experienced role misidentification, directly resulting in heightened emotions that led to guarded behavior. An additional indirect impact for trainees is transmitted through frequent non-promotional role misidentification and personalizing the incidents. Women and trainees with marginalized identities had significant impacts. These findings present an opportunity to improve our understanding of the trainee experience.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01475-9.

Drawing on experience: exploring the pedagogical possibilities of using rich pictures in health professions education

In both clinical and health professions education research, rich pictures, or participant-generated drawings of complex phenomena, are gaining recognition as a useful method for exploring multifaceted and emotional topics in medicine. For instance, two recent studies used rich pictures to augment semi-structured interviews exploring trainees', health care professionals' (HCPs), and parents' experiences of difficult conversations in the Neonatal Intensive Care Unit (NICU)-an environment in which communication is often challenging, anxiety-provoking, and emotionally distressing. In both studies, participants were invited to draw a picture depicting how they experienced a difficult conversation in this setting. As part of the interview process, participants were asked to both describe how they engaged with rich pictures, and to share their perceptions about the affordances and limitations of this research method. Here, their perspectives are reported and the possibilities of using rich pictures to inform pedagogical innovations in health professions education and research are considered.

Determinants of research productivity during postgraduate medical education: a structured review

BACKGROUND

Although formal participation in research is an integral and often mandatory component of clinical training programs, resulting productivity is highly variable. The objective of this review was to identify determinants of successful research performance among graduate medical education trainees.

METHODS

A structured review of the published literature was performed by searching PubMed, CINAHL, and EMBASE from inception through to 7 April, 2021. Articles examining graduate medical education trainee research productivity evidenced by publications in peer-reviewed journals were included.

RESULTS

Eighty-five articles were included of which most (66; 78%) were reported from the USA or Canada (10; 12%). A wide range of disciplines were represented with the most common being general surgery, internal medicine, orthopedic surgery, and pediatrics. Themes (number of reports) included trainee characteristics (n = 24), project characteristics (n = 8), mentoring/supervision (n = 11), and programmatic aspects (n = 57). Although variable results were observed, research productivity tended to be higher with prior research experience, later years of training, male gender, and pursuit of a postgraduate degree. Few project related aspects of success were identified. Trainee publication was associated with mentors with higher rank, publication productivity, and supportive academic environments. Training programs with organised programs/curricula including protection of time for research were associated with increased productivity as were provision of incentives or rewards but not mandatory requirements.

CONCLUSION

This review identifies several trainee characteristics, project and mentor aspects, and programmatic aspects associated with increased productivity that may serve as a useful resource for trainees and graduate medical education training programs.

Leveraging e-Learning technology to enhance pre-service training for healthcare trainees in Ghana: evidence from a pilot project and pointers to policy reforms

BACKGROUND

E-Learning solutions are increasingly being advocated to augment existing traditional teaching and learning efforts in health training institutions. Unfortunately, these emerging technologies rarely focus on health sciences education within the context of public universities, hence the need for this study. This project evaluated experiences of healthcare trainees with a pilot e-Learning project (SMART e-Learning project) initiated in one of Ghana's public universities in 2017. The study used a mixed methods cross-sectional approach among 363 healthcare trainees. Data collection was between 17th October, 2019 to 3rd December, 2019. Data was analysed descriptively and test for variable differences done using Pearson Chi-square and Fisher's Exact for categorical variables. Wilcoxon Mann-Whitney test was used to test for differences in the Likert scale items. Additionally, rotated varimax factor analysis was performed for the health trainees' rated satisfaction factors.

RESULTS

Out of 446 respondents who consented to participate in the study, 363 responses were complete and valid, representing a response rate of 81 %. Most frequently used e-learning facilities by healthcare trainees were: writing interim assessments (IAs) (82 %) while the least used function was live chating with faculty (5 %). Challenges associated with the e-learning pilot project were: limited workspace in the pilot computer laboratory (33 %), slow internet/intranet speed (29 %) and limited capacity of teaching and ICT staff to support users (28 %).

CONCLUSIONS

There is the need to engage relevant stakeholders at the University, ministries of health and education through policy dialogues to develop statutory e-Learning guidelines for health educational institutions of higher learning to complement existing traditional teaching and learning approaches.

Factors that impact burnout and psychological wellbeing in Australian postgraduate medical trainees: a systematic review protocol

BACKGROUND

The stressful nature of medical training and other work-related factors put postgraduate medical trainees at high risk of burnout and poor psychological wellbeing. This has negative implications for patient care and the effectiveness of the healthcare system. The structure of the healthcare system and postgraduate medical education in Australia is different to that of other countries. Whilst a significant body of research exists on burnout and wellbeing in trainees in the USA, evidence specific to Australian trainees is lacking. The aim of this review is to synthesise the current knowledge on the factors that impact burnout and psychological wellbeing in Australian postgraduate medical trainees.

METHODS/DESIGN

A systematic review will be conducted across eight digital databases: Academic Search Complete, MEDLINE, Embase, Web of Science, PsychInfo, Scopus, CINAHL Plus and Informit Health Collection. Peer reviewed empirical studies and relevant grey literature published after 2000 that address an aspect of burnout or psychological wellbeing in Australian postgraduate medical trainees will be included. Two reviewers will independently review each article against the inclusion and exclusion criteria, with disagreements resolved via discussion and consensus. Data will be extracted using a standard form and quality will be assessed using the assessment tools available from the Joanna Briggs Institute. A thematic narrative synthesis of the studies will be presented, along with an assessment of current gaps in the literature and areas for future research.

DISCUSSION

This review will be the first to integrate the evidence on burnout and psychological wellbeing specific to Australian postgraduate medical trainees. The findings will contribute to a better understanding of the factors that impact burnout and psychological wellbeing in this population and will lay the foundation for future research into appropriate strategic interventions.

SYSTEMATIC REVIEW REGISTRATION

This protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020203195 ).

Postgraduate Surgical Training in the UK: the Trainees' Perspective

Over the last 20 years, surgical training in the United Kingdom (UK) has changed dramatically. There have been considerable efforts towards creating a programme that delivers the highest standard of training while maintaining patient safety. However, the journey to improve the quality of training has faced several hurdles and challenges. Recruitment processes, junior doctor contracts, flexible working hours and equality and diversity have all been under the spotlight in recent times. These issues, alongside the extended surgical team and the increasingly recognised importance of trainee wellbeing, mean that postgraduate surgical training is extremely topical. Alongside this, as technology has evolved, this has been incorporated into all aspects of training, from recruitment to simulated training opportunities and postgraduate examinations. The coronavirus (COVID-19) pandemic has brought technology and simulation to the forefront in an attempt to compensate for reduced operative exposure and experience, and has transformed the way that we learn and work. In this article, we reflect on the UK surgical trainee experience and discuss areas of success as well as highlighting potential areas for improvement going forward.

Making large-scale surgical trials possible: collaboration and the role of surgical trainees

BACKGROUND

Recruitment to surgical randomised controlled trials (RCTs) can be challenging. The Sunflower study is a large-scale multi-centre RCT that seeks to establish the clinical and cost effectiveness of pre-operative imaging versus expectant management in patients with symptomatic gallstones undergoing laparoscopic cholecystectomy at low or moderate risk of common bile duct stones. Trials such as Sunflower, with a large recruitment target, rely on teamworking. Recruitment can be optimised by embedding a QuinteT Recruitment Intervention (QRI). Additionally, engaging surgical trainees can contribute to successful recruitment, and the NIHR Associate Principal Investigator (API) scheme provides a framework to acknowledge their contributions.

METHODS

This was a mixed-methods study that formed a component part of an embedded QRI for the Sunflower RCT. The aim of this study was to understand factors that supported and hindered the participation of surgical trainees in a large-scale RCT and their participation in the API scheme. It comprised semi-structured telephone interviews with consultant surgeons and surgical trainees involved in screening and recruitment of patients, and descriptive analysis of screening and recruitment data. Interviews were analysed thematically to explore the perspectives of-and roles undertaken by-surgical trainees.

RESULTS

Interviews were undertaken with 34 clinicians (17 consultant surgeons, 17 surgical trainees) from 22 UK hospital trusts. Surgical trainees contributed to patient screening, approaches and randomisation, with a major contribution to the randomisation of patients from acute admissions. They were often encouraged to participate in the study by their centre principal investigator, and career development was a typical motivating factor for their participation in the study. The study was registered with the API scheme, and a majority of the trainees interviewed (n = 14) were participating in the scheme.

CONCLUSION

Surgical trainees can contribute substantial activity to a large-scale multi-centre RCT. Benefits of trainee engagement were identified for trainees themselves, for local sites and for the study as a whole. The API scheme provided a formal framework to acknowledge engagement. Ensuring that training and support for trainees are provided by the trial team is key to optimise success for all stakeholders.

Simulation in shoulder arthroplasty education using three-dimensional planning software: the role of guidelines and predicted range of motion

AIM

To demonstrate how reverse shoulder arthroplasty (RSA) planning software could be used to improve how the trainees position glenoid and humeral implants and obtain optimal simulated range of motion (ROM).

METHODS

We selected four groups of five various level participants: medical student (MS), junior resident (JR), senior resident (SR), and shoulder expert (SE). Thereafter, the 20 participants planned five cases of arthritic shoulders for a RSA on a validated planning software following three phases: (1) no guidelines and no ROM feedback, (2) guidelines but no ROM feedback, and (3) guidelines and ROM feedback. We evaluated the final simulated impingement-free ROM, the choice of the implant (baseplate size, graft, glenosphere), and the glenoid implant positioning.

RESULTS

MS planning were significantly improved by the ROM feedback only. JR took the best advantage of both guidelines and ROM in final results. SR planning were less performant than SE into phase 1 regarding flexion, external rotation, and adduction (respectively - 10°, p = 0.03; - 11°, p = 0.003; and - 3°, p = 0,03), but reached similar results into phase 3 (respectively - 2°, p = 0.329; - 4°, p = 0.44; - 2°, p = 0.319). For MS, JR, and SR, we observed a systematic improvement in the agreement over the study course. The glenoid diameter remained highly variable even for SE. Comparing glenoid implant position to SE, the distance error decreased with advancing phases.

CONCLUSION

Planning software can be used as a simulation training tool to improve implant positioning in shoulder arthroplasty procedures.

Headache History-Taking in an Emergency Department: Impact Evaluation of a Training Session

INTRODUCTION

Headache represents about 25% of the total neurological consultations at the emergency department (ED). Up to 80% of these consultations are represented by primary headaches, in which an accurate and directed history-taking may help reach the specific diagnosis avoiding unnecessary complementary tests and reducing diagnostic latencies.

METHODS

We carried out a training session on headache management at the ED, focusing on history-taking and primary headaches' diagnoses and management. We retrospectively compared the number of variables included in the medical reports and the percentage of patients who were diagnosed and/or treated for a primary headache between two months before and two months after the training session.

RESULTS

A total of 369 medical histories were analyzed for this study (196 before and 173 after the training session). The number of essential variables regarding pain characteristics included in the medical reports showed a post-intervention increment from 4.34 ± 1.224 to 4.67 ± 1.079 (P = .007) and the number of total items registered also increased from 6.87 ± 1.982 to 7.53 ± 1.686 (P = 0.001). The percentage of patients that were given a specific diagnosis for primary headache showed an increment of 11.8% (P = .002) in the post-intervention group.

CONCLUSION

Educational interventions can improve history-taking in headache patients in the ED. This fact grants them as potential efficient measures to optimize patient management at Emergency Room.

The development of a diversity, equity, and inclusion committee in a neurology department and residency program

BACKGROUND

Diversity, Equity, and Inclusion (DEI) initiatives have been described in different academic and graduate medical education settings, but not specifically in neurology.

OBJECTIVE

To describe the development of a DEI committee within a neurology department and training program.

METHODS

The need to prioritize DEI as a critical focus within our neurology department led to the appointment of an initial task force who identified strategic priorities and stakeholders to establish a committee. DEI committee members included faculty, trainees, and staff, and this phase of the initiative took place from May 2019 through January 2021.

RESULTS

The DEI committee was established and has met monthly for over one year. Initial meetings formulated goals of the initiative. Specific objectives were developed in the domains of recruitment, education, engagement, training, conflict resolution, and recognition. Early outcomes included augmented resident recruitment efforts of UiM students, curriculum changes including frequent representation of DEI topics in Grand Rounds, and measures to reduce unconscious bias.

CONCLUSIONS

The creation of a DEI Committee within a specialty department such as neurology is feasible and can result in immediate and long-term actions related to recruitment and education in particular. Our blueprint that heavily involves graduate medical education stakeholders may be generalizable to other specialty departments in academic medicine.

Developing confidence in oral and maxillofacial dental core trainees: a national review of the trainee experience

This study considers the confidence of dental core trainees (DCTs) as they mature and progress through their first six months in an oral and maxillofacial surgery (OMFS) training post. Trainees have different incentives for embarking on a year in OMFS: to develop additional skills before settling into general dental practice; as a step towards specialty training; and to help decide about their career direction. Traditionally, an OMFS year has been associated with creating well-rounded and confident clinicians. We surveyed 123 DCTs at three stages over a six-month period to monitor their confidence in 10 clinical domains: assessing dentofacial infection, mandibular fractures, midface fractures, intraoral/extraoral swellings, airway risks, intraoral/extraoral lesions (benign/malignant), CT/MRI scans, and performing intraoral/extraoral suturing. The study demonstrates an increase in trainee confidence across all domains over the first six months of an OMFS post, with a particularly significant increase in the assessment of dentofacial infection, mandibular/midface fracture, and both intraoral and extraoral lesions and swellings.

Future developments in training

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has demonstrated the value of highly skilled and extensively trained specialists in clinical microbiology (CM) and infectious diseases (ID). Training curricula in CM and ID must constantly evolve to prepare trainees for future pandemics and to allow trainees to reach their full clinical and academic potential.

OBJECTIVES

In this narrative review, we aim to outline necessary future adaptations in CM and ID training curricula and identify current structural barriers in training with the aim of discussing possibilities to address these shortcomings.

SOURCES

We reviewed literature from PubMed and included selected books and online publications as appropriate. There was no time constraint on the included publications.

CONTENT

Drawing from the lessons learnt during the pandemic, we summarize novel digital technologies relevant to CM and ID trainees and highlight interdisciplinary teamwork and networking skills as important competencies. We centre CM and ID training within the One Health framework and discuss gender inequalities and structural racism as barriers in both CM and ID training and patient care.

IMPLICATIONS

CM and ID trainees should receive training and support developing skills in novel digital technologies, leadership, interdisciplinary teamwork and networking. Equally important is the need for equity of opportunity, with firm commitments to end gender inequality and structural racism in CM and ID. Policy-makers and CM and ID societies should ensure that trainees are better equipped to achieve their professional goals and are better prepared for the challenges awaiting in their fields.

Frequency and Severity of Moral Distress in Nephrology Fellows: A National Survey

INTRODUCTION

Moral distress is a negative affective response to a situation in which one is compelled to act in a way that conflicts with one's values. Little is known about the workplace scenarios that elicit moral distress in nephrology fellows.

METHODS

We sent a moral distress survey to 148 nephrology fellowship directors with a request to forward it to their fellows. Using a 5-point (0-4) scale, fellows rated both the frequency (never to very frequently) and severity (not at all disturbing to very disturbing) of commonly encountered workplace scenarios. Ratings of ≥3 were used to define "frequent" and "moderate-to-severe" moral distress.

RESULTS

The survey was forwarded by 64 fellowship directors to 386 fellows, 142 of whom (37%) responded. Their mean age was 33 ± 3.6 years and 43% were female. The scenarios that most commonly elicited moderate to severe moral distress were initiating dialysis in situations that the fellow considered futile (77%), continuing dialysis in a hopelessly ill patient (81%) and carrying a high patient census (75%), and observing other providers giving overly optimistic descriptions of the benefits of dialysis (64%). Approximately 27% had considered quitting fellowship during training, including 9% at the time of survey completion.

CONCLUSION

A substantial majority of nephrology trainees experienced moral distress of moderate to severe intensity, mainly related to the futile treatment of hopelessly ill patients. Efforts to reduce moral distress in trainees are required.

The effect of COVID-19 on trainee operative experience at a multihospital academic neurosurgical practice: A first look at case numbers

Background

COVID-19 has had a significant impact on the economy, health care, and society as a whole. To prevent the spread of infection, local governments across the United States issued mandatory lockdowns and stay-at-home orders. In the surgical world, elective cases ceased to help "flatten the curve" and prevent the infection from spreading to hospital staff and patients. We explored the effect of the cancellation of these procedures on trainee operative experience at our high-volume, multihospital neurosurgical practice.

Methods

Our department cancelled all elective cases starting March 16, 2020, and resumed elective surgical and endovascular procedures on May 11, 2020. We retrospectively reviewed case volumes for 54 days prelockdown and 54 days postlockdown to evaluate the extent of the decrease in surgical volume at our institution. Procedure data were collected and then divided into cranial, spine, functional, peripheral nerve, pediatrics, and endovascular categories.

Results

Mean total cases per day in the prelockdown group were 12.26 ± 7.7, whereas in the postlockdown group, this dropped to 7.78 ± 5.5 (P = 0.01). In the spine category, mean cases per day in the prelockdown group were 3.13 ± 2.63; in the postlockdown group, this dropped to 0.96 ± 1.36 (P < 0.001). In the functional category, mean cases per day in the prelockdown group were 1.31 ± 1.51, whereas in the postlockdown group, this dropped to 0.11 ± 0.42 (P < 0.001). For cranial (P = 0.245), peripheral nerve (P = 0.16), pediatrics (P = 0.34), and endovascular (P = 0.48) cases, the volumes dropped but were not statistically significant decreases.

Conclusion

The impact of this outbreak on operative training does appear to be significant based solely on statistics. Although the drop in case volumes during this time can be accounted for by the pandemic, it is important to understand that this is a multifactorial effect. Further studies are needed for these results to be generalizable and to fully understand the effect this pandemic has had on trainee operative experience.

"You Really Never Forget It!" Psychiatry Trainee Supervision Needs and Supervisor Experiences Following the Suicide of a Patient

OBJECTIVE

Suicide is the second leading cause of death in children, adolescents, and young adults ages 10-34 and the rates continue to rise in the USA. An estimated 30-60% of Psychiatry Residents experience patient suicide during their training. This study aimed to understand trainee and supervisor experiences after the suicide of a patient in order to better inform the supervision and response to such an event.

METHOD

Twenty-seven participants were identified by criterion sampling and recruited from General Psychiatry residency, Consultation Liaison fellowship, and Child and Adolescent Psychiatry fellowship training programs in the New England region of the USA. Semi-structured interviews of trainees and supervisors were conducted and analyzed using inductive thematic analysis.

RESULTS

The death of a patient by suicide was described as a notable event with a significant impact on the professional lives of the participants. The event was typically characterized as having an immediate emotional impact, led to changes in self-efficacy, and a sense of responsibility for the patient's death. Responses to suicide were influenced by modifiable factors such as (1) unpreparedness of individuals, program, and institution and (2) mediating/complicating factors, including the credibility of the supervisor, societal expectations, and specific patient characteristics.

CONCLUSIONS

The death of a patient is a personal and emotional experience for the psychiatrist, for which they do not consistently feel well prepared. The institutional response may be misaligned, more analytical in character and prioritize assessment of risk. There is significant room to improve supervision and preparedness for the death of a patient by suicide.

Differences in echocardiography interpretation techniques among trainees and expert readers

Background

Trainees learn transthoracic echocardiogram (TTE) interpretation through independently completing and reviewing selected portions of the study with experts. The diagnostic accuracy of novice TTE interpretation is known to be low and schema for reading TTEs systematically are lacking. The purpose of our study is to identify techniques experts use while reading TTEs which could be used to more effectively teach novice readers.

Methods

We performed a prospective qualitative case study to observe how experts and trainees interpret TTEs in an academic institution using a concurrent think aloud (CTA) method. Three TTEs of intermediate complexity were given to 3 advanced imaging fellows, 3 first year fellows and 3 expert TTE readers Participants filled out a report while reading and described aloud their thought processes. Sessions were video and audiotaped for analysis.

Results

Experts and advanced fellows used specific techniques that novices did not including: previewing studies, reviewing multiple images simultaneously, having flexibility in image review order and disease coding, and saving hardest elements to code for the end. Direct observation of TTE reading informed trainee inefficiencies and was a well-received educational tool.

Conclusions

In this single centered study we identified several unique approaches experts use to interpret TTEs which may be teachable to novices. Although limited in generalizability the findings of this study suggests that a more systematic approach to TTE interpretation, using techniques found in experts, might be of significant value for trainees. Further study is needed to evaluate teaching practices at other institutions and to assess whether implementation of these techniques by novices improves can improve their diagnostic accuracy and efficiency of reading at an earlier stage in their training.

Variable Learning Curve of Basic Rigid Bronchoscopy in Trainees

BACKGROUND

Despite increased use of rigid bronchoscopy (RB) for therapeutic indications and recommendations from professional societies to use performance-based competency, an assessment tool has not been utilized to measure the competency of trainees to perform RB in clinical settings.

OBJECTIVES

The aim of the study was to evaluate a previously developed assessment tool - Rigid Bronchoscopy Tool for Assessment of Skills and Competence (RIGID-TASC) - for determining the RB learning curve of interventional pulmonary (IP) trainees in the clinical setting and explore the variability of learning curve of trainees.

METHODS

IP fellows at 4 institutions were enrolled. After preclinical simulation training, all RBs performed in patients were scored by faculty using RIGID-TASC until competency threshold was achieved. Competency threshold was defined as unassisted RB intubation and navigation through the central airways on 3 consecutive patients at the first attempt with a minimum score of 89. A regression-based model was devised to construct and compare the learning curves.

RESULTS

Twelve IP fellows performed 178 RBs. Trainees reached the competency threshold between 5 and 24 RBs, with a median of 15 RBs (95% CI, 6-21). There were differences among trainees in learning curve parameters including starting point, slope, and inflection point, as demonstrated by the curve-fitting model. Subtasks that required the highest number of procedures (median = 10) to gain competency included ability to intubate at the first attempt and intubation time of <60 s.

CONCLUSIONS

Trainees acquire RB skills at a variable pace, and RIGID-TASC can be used to assess learning curve of IP trainees in clinical settings.

Assessing Interdisciplinary Trainees' Objective and Self-Reported Knowledge of Autism Spectrum Disorder and Confidence in Providing Services

The importance of accurate identification and high-quality intervention for individuals with autism spectrum disorder (ASD) is indisputable. Clinicians from multiple professions need adequate knowledge of ASD to make appropriate referrals to specialists, conduct thorough evaluations, and provide effective interventions. ASD knowledge development for many professionals may start at the pre-service training level. An interdisciplinary sample consisting of trainees from Leadership Education in Neurodevelopmental and Related Disabilities (LEND) programs and University Centers for Excellence in Developmental Disabilities (UCEDDs) across the country (N = 155) was evaluated on their objectively measured ASD knowledge using the ASKSP-R. Self-reported knowledge of ASD and self-reported confidence in providing services to individuals who have ASD was evaluated using a 0-100 scale. Results from an ANOVA demonstrated a significant difference in objectively measured knowledge across disciplines, F(7, 146) = 4.68, p < .001. Specifically, trainees in psychology had significantly higher levels of objectively measured ASD knowledge than trainees in physical/occupational therapy, social work, and non-clinical disciplines. Pre-service and professional development experiences predicted trainees' objectively measured ASD knowledge, self-reported ASD knowledge, and self-reported confidence. Implications and recommendations regarding interdisciplinary training to improve outcomes for individuals with ASD are discussed.

Patient Perceptions of Trust in Trainees During Delivery of Surgical Care: A Thematic Analysis

OBJECTIVE

Trust is an essential element of an effective physician-patient relationship. There is limited literature examining trust between trainees and patients in the surgical setting. The goal of this study was to investigate how otolaryngology patients perceive trust in trainees during delivery of surgical care.

DESIGN

We extracted trainee-specific data from a larger, qualitative interview study examining trust in the surgeon-patient relationship. We then used realist thematic analysis to explore preoperative otolaryngology patients' perceptions of trust in trainees during delivery of surgical care.

SETTING

Department of Otolaryngology-Head and Neck Surgery at Michigan Medicine in Ann Arbor, MI, a tertiary academic medical center.

PARTICIPANTS

Using convenience sampling, adults 18 years or older scheduled to undergo elective otolaryngologic surgery between February and June 2019 were invited, and 12 agreed to participate in the study.

RESULTS

All participants (n = 12) self-identified as White/Caucasian with a mean age of 60 years (range, 28-82). Participants were 50% (n = 6) female and 50% (n = 6) male. Thematic analysis of participants' perspectives about trust in trainees during delivery of surgical care revealed 3 themes. Trust in trainees is conditional based on (i) level of trainee involvement; (ii) trust in the attending surgeon; and, (iii) trust in the institution.

CONCLUSION

Trust in trainees during delivery of surgical care is conditional on types of tasks trainees perform, bounded by trust in their attending surgeon, and positively influenced by institutional trust. Trainees and surgical educators must look to innovative methods to engender trust more efficiently in the clinic and immediate pre-operative setting. Such approaches can have a positive impact on patient outcomes, facilitate stronger trainee-attending interpersonal relationships, and empower surgeons to practice the professional values integral to surgical care.

Surgical training tools for dermatology trainees: porcine vs. synthetic skin for excision and repair

Since dermatologists routinely perform surgery in an outpatient setting, ensuring that dermatology trainees are provided with opportunities to develop sufficient proficiency in excisional surgery and suture technique is paramount. The objectives of this study are to assess trainee preference for silicone-based synthetic skin compared with porcine skin as a surgical training medium and to assess the ability of trainees to successfully demonstrate basic surgical skills using the simulated skin model. Participants were a convenience sample of dermatology residents from the greater Chicago area, who were asked to perform an elliptical excision and bilayered repair on a silicone-based synthetic skin model. Residents were then surveyed regarding their satisfaction with the model. Four blinded dermatologist raters evaluated digital photographs obtained during the performance of the procedures and graded the execution of each maneuver using a surgical task checklist. Nineteen residents were enrolled. Residents were more likely to prefer pig skin to simulated skin for overall use (p = 0.040) and tissue repair (p = 0.018), but the nominal preference for tissue handling was nonsignificant (p = 0.086). There was no significant difference between satisfaction with pig skin versus synthetic skin with regard to excision experience (p = 0.82). The majority of residents (10/19) performed all surgical checklist tasks correctly. Of those residents who did not perform all steps correctly, many had difficulty obtaining adequate dermal eversion and wound approximation. Synthetic skin may be conveniently and safely utilized for hands-on surgical practice. Further refinement may be necessary to make synthetic skin comparable in feel and use to animal skin.