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Chen JX, Chao TN, Bowe SN, Zhao NW. Conceptualizing Fit in Surgical Residency Selection: The Experience in Otolaryngology-Head and Neck Surgery. JOURNAL OF SURGICAL EDUCATION 2024; 81:1057-1065. [PMID: 38796361 DOI: 10.1016/j.jsurg.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/15/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE Fit is a crucial factor in surgical residency selection, but how this abstract concept is applied in practice is poorly understood. Person-environment (PE) fit theory suggests that there are multiple fit domains that can clarify usage: person-job, person-organization, and person-workgroup fit. We used PE fit theory to explore how otolaryngology residency selection committee (RSC) members operationalize the concept of fit. DESIGN One-hour focus groups were conducted in November 2022. Interview questions explored participants' definitions and uses of fit in the resident selection process. Transcripts were analyzed using directed qualitative content analysis to generate themes and evaluate how these align with PE fit domains. SETTING Society of University Otolaryngologists Annual Meeting breakout session in November 2022. PARTICIPANTS 21 RSC members from 20 different otolaryngology-head and neck surgery departments participated in three seven-person focus groups. RESULTS Participants described aspects of fit that aligned with PE fit domains. Person-job included how applicants fit as both surgeons and residents. Person-organization included how applicants fit with the program's characteristics, program's mission, and the local community. Person-workgroup emphasized how applicants fit with current residents. Various challenges in the selection process limited the extent to which PE fit was operationalized, including 1) ambiguous uses of fit, 2) unique features of the match process, 3) lack of outcomes data for selection decisions, and 4) interactions with diversity, equity, and inclusion goals. CONCLUSIONS Fit manifests in various ways during the surgical residency selection process that parallel domains of PE fit theory. Recommendations are made to assist programs in using fit in resident selection, including clearly articulating definitions of fit to increase transparency in conversations. Further work on selection challenges is needed to maximize the utility of fit in practice.
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Affiliation(s)
- Jenny X Chen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tiffany N Chao
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA-Ft. Sam Houston, Texas
| | - Nina W Zhao
- Department of Otolaryngology - Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio.
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Kwon D, Taherian M, Milton DR, Iaeger P, Chin K, Aung PP. The Secret Life of Junior Pathologists: Challenges and Future Directions. Arch Pathol Lab Med 2024; 148:836-845. [PMID: 37852170 DOI: 10.5858/arpa.2023-0195-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 10/20/2023]
Abstract
CONTEXT.— Transition from pathology trainee to independent pathologist is stressful. No study has examined junior pathologists' challenges and concerns during this transition. OBJECTIVE.— To identify challenges and concerns of junior pathologists. DESIGN.— Junior pathologists were defined as those who had been practicing independently for up to 5 years after completion of residency/fellowship. An institutional review board-approved electronic survey was created and distributed to recent pathology graduates of MD Anderson Cancer Center (Houston, Texas) and MedStar Georgetown University Hospital (Washington, District of Columbia). The survey was open from October 13, 2022, to January 31, 2023. The survey included 16 multiple-choice and free-text questions. RESULTS.— Responses were received from 39 junior pathologists. Participants working in academic settings indicated independence, work-life balance, and professional identity formation as challenges; those in nonacademic settings indicated pathology reporting, efficiency, and administration as challenges. Areas where participants wished they received more guidance differed by practice setting: participants in academic settings more often chose effective time management and importance of turnaround time (35% [7 of 20] versus 0% [0 of 14], P = .03) and tumor board conference presentation skills (25% [5 of 20] versus 0% [0 of 14], P = .06), while those in nonacademic settings more often chose Current Procedural Terminology (CPT) coding, billing, and cost-effective patient care (79% [11 of 14] versus (35% [7 of 20]; P = .02). More female than male participants indicated that they wished they had received more guidance in leadership and soft skills (79% [11 of 14] versus 28% [5 of 18]; P = .01). CONCLUSIONS.— This study identified challenges experienced by junior pathologists. Collective efforts from training programs, experienced pathologists, and professional organizations can explore ways to improve the transition experience.
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Affiliation(s)
- DongHyang Kwon
- the Department of Pathology, MedStar Georgetown University Hospital, Washington, District of Columbia (Kwon)
| | - Mehran Taherian
- From the Departments of Pathology, The University of Texas MD Anderson Cancer Center, Houston(Taherian, Aung)
| | - Denái R Milton
- From the Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston(Milton)
| | - Paula Iaeger
- Academic Analytics and Technology, The University of Texas MD Anderson Cancer Center, Houston(Iaeger)
| | | | - Phyu P Aung
- From the Departments of Pathology, The University of Texas MD Anderson Cancer Center, Houston(Taherian, Aung)
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Watsjold BK, Griffith M, Ilgen JS. Stuck in the middle: the liminal experiences of entering practice. Emerg Med J 2023; 40:622-623. [PMID: 37438097 DOI: 10.1136/emermed-2023-213327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Bjorn K Watsjold
- Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Max Griffith
- Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jonathan S Ilgen
- Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Naughton S, Clarke M. Post-CSCST fellowships: beyond subspecialization. Ir J Med Sci 2023; 192:2023-2027. [PMID: 36279039 DOI: 10.1007/s11845-022-03197-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
The transition from higher training to consultanthood is a crucial point in the medical training pathway. Despite comprehensive higher training programs, studies of new consultants have reported a disparity in their sense of preparation for non-clinical and clinical duties. Post- "Certificate of Satisfactory Completion of Specialist Training" (CSCST) fellowships have traditionally been undertaken as a means to access subspecialty clinical training which is otherwise unavailable in higher training programs. However, fellowships have a role beyond this subspecialization model, particularly in meeting the non-clinical training needs of new CSCST graduates.The design and goals of fellowship posts should be considered in this context, to align them with the reported needs of new consultants. Special consideration should be given to defining roles of independence for the fellow and to the nature of the mentorship relationship, distinguishing these posts from higher specialist training. Well-designed post-CSCST fellowships have an important role in facilitating the successful transition to consultanthood.
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Affiliation(s)
- Sean Naughton
- DETECT, Early Intervention in Psychosis Service, Avila House, Block 5, Blackrock Business Park, Carysfort Avenue, Blackrock, Co. Dublin, Ireland.
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Mary Clarke
- DETECT, Early Intervention in Psychosis Service, Avila House, Block 5, Blackrock Business Park, Carysfort Avenue, Blackrock, Co. Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
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Vaa Stelling BE, Andersen CA, Suarez DA, Nordhues HC, Hafferty FW, Beckman TJ, Sawatsky AP. Fitting In While Standing Out: Professional Identity Formation, Imposter Syndrome, and Burnout in Early-Career Faculty Physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:514-520. [PMID: 36512808 DOI: 10.1097/acm.0000000000005049] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Professional identity formation (PIF) is a dynamic process by which an individual internalizes the core values and beliefs of a specific profession. Within medical education, PIF begins in medical school and continues throughout training and practice. Transitions affect PIF, with a critical transition occurring between medical training and unsupervised practice. This study aims to characterize PIF during the transition from resident to early-career faculty physician and explores the relationship between PIF and burnout during this transition. METHOD The authors conducted a qualitative study using constructivist grounded theory. They conducted semistructured interviews with early-career faculty physicians (defined as practicing for ≤ 5 years) from the Department of Medicine, Mayo Clinic. Deidentified interview transcripts were processed through open and axial coding. The authors organized themes and identified relationships between themes that were refined through discussion and constant comparison with newly collected data. During data analysis, the authors identified self-determination theory, with the concepts of autonomy, competence, and relatedness, as a framework to support the organization and analysis of the data. RESULTS Eleven early-career faculty physicians participated in the interviews. Their PIF was characterized by the dual desires to fit in and stand out. Striving for these desires was characterized by imposter syndrome, driving physicians to question their decision making and overall competence. Participants associated imposter syndrome and academic pressures with burnout. Autonomy support by the institution to pursue opportunities important for career development helped mitigate burnout and support PIF. CONCLUSIONS Early-career faculty physicians face identity challenges when transitioning from training to unsupervised practice, including striving to fit in and stand out. They link this tension to imposter syndrome, which they associated with burnout. Institutional awareness and support, including addressing structural and cultural contributors to imposter syndrome, are paramount as new faculty explore their identities and navigate new challenges.
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Affiliation(s)
- Brianna E Vaa Stelling
- B.E. Vaa Stelling is assistant professor of medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carl A Andersen
- C.A. Andersen is assistant professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Diego A Suarez
- D.A. Suarez is instructor of medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hannah C Nordhues
- H.C. Nordhues is assistant professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-5610-0663
| | - Frederic W Hafferty
- F.W. Hafferty is professor of medical education, Division of General Internal Medicine, Program in Professionalism and Values, and College of Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-5604-7268
| | - Thomas J Beckman
- T.J. Beckman is professor of medicine and medical education, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Adam P Sawatsky
- A.P. Sawatsky is associate professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-4050-7984
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Putnam EM, Baetzel AE, Leis A. Paediatric anaesthesiology education: simulation-based 'attending boot camp' for fellows shows feasibility and value in the early years of attendings' careers. BJA OPEN 2022; 4:100115. [PMID: 37588785 PMCID: PMC10430843 DOI: 10.1016/j.bjao.2022.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/14/2022] [Indexed: 08/18/2023]
Abstract
Background Established simulation-based 'boot camps' utilise adult learning theory to engage and teach technical and non-technical skills to medical graduates transitioning into residency or fellowship. However, the transition from trainee to the attending role has not been well studied. The primary aim of this study was to design and execute a simulation-based educational day, exposing senior trainees in paediatric anaesthesia to commonly encountered challenges and teaching critical technical skills relevant to their new role. Secondary aims included assessment of its value and relevance in early years of graduated fellows' new careers as attendings. Methods An 'attending boot camp' day comprised the following: two crisis simulations, an otolaryngologist-taught cadaver cricothyroidotomy laboratory, and a difficult conversations workshop. There was a debriefing after each section. Data were collected using end-of-day and early-career e-mail surveys for five consecutive fellow cohorts from 2016 to 2020. Results Forty fellows participated; overall feedback was positive. The end-of-day surveys revealed planned changes in practice for 89% (25/28) of fellows, and 54% (15/28) highlighted communication skills as 'most beneficial'. Early-career follow-up surveys found 96% (23/24) identified increased confidence in skill acquisition because of the day; 79% (19/24) experienced scenarios in real life similar to those simulated. The qualitative analysis revealed four high-value themes: delegation, leadership, clinical skills, and difficult communication. Conclusions The transition from senior trainee to attending physician remains under-researched. A tailored simulation-based 'attending boot camp' was feasible and valued and may be useful in bridging this transition. Participants identified leadership practice, life-saving technical skills, and difficult communication practice as valuable and relevant in their early careers.
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Affiliation(s)
- Elizabeth M. Putnam
- Department of Anesthesiology, University of Michigan Health Systems, Ann Arbor, MI, USA
- Department of Learning Health Sciences, and University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Anne E. Baetzel
- Department of Anesthesiology, University of Michigan Health Systems, Ann Arbor, MI, USA
| | - Aleda Leis
- Department of Epidemiology, University of Michigan Health Systems, Ann Arbor, MI, USA
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McQueen SA, Hammond Mobilio M, Moulton CA. Pulling our lens backwards to move forward: an integrated approach to physician distress. MEDICAL HUMANITIES 2022; 48:404-410. [PMID: 34417324 DOI: 10.1136/medhum-2020-012100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 06/13/2023]
Abstract
The medical community has recently acknowledged physician stress as a leading issue for individual wellness and healthcare system functioning. Unprecedented levels of stress contribute to physician burnout, leaves of absence and early retirement. Although recommendations have been made, we continue to struggle with addressing stress. One challenge is a lack of a shared definition for what we mean by 'stress', which is a complex and idiosyncratic phenomenon that may be examined from a myriad of angles. As such, research on stress has traditionally taken a reductionist approach, parsing out one aspect to investigate, such as stress physiology. In the medical domain, we have traditionally underappreciated other dimensions of stress, including emotion and the role of the environmental and sociocultural context in which providers are embedded. Taking a complementary, holistic approach to stress and focusing on the composite, subjective individual experience may provide a deeper understanding of the phenomenon and help to illuminate paths towards wellness. In this review article, we first examine contributions from unidimensional approaches to stress, and then outline a complementary, integrated approach. We describe how complex phenomena have been tackled in other domains and discuss how holistic theory and the humanities may help in studying and addressing physician stress, with the ultimate goal of improving physician well-being and consequently patient care.
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Affiliation(s)
| | - Melanie Hammond Mobilio
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Rees CE, Ottrey E, Kemp C, Brock TP, Leech M, Lyons K, Monrouxe LV, Morphet J, Palermo C. Understanding Health Care Graduates' Conceptualizations of Transitions: A Longitudinal Qualitative Research Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1049-1056. [PMID: 34879008 DOI: 10.1097/acm.0000000000004554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Although transitions have been defined in various ways in the higher education literature (e.g., inculcation, development, becoming), little research exists exploring health care learners' conceptualizations of transitions across their transition from final year to new graduate. How they understand transitions is important because such conceptualizations will shape how they navigate their transitions and vice versa. METHOD The authors conducted a 3-month longitudinal qualitative research study with 35 health care learners from 4 disciplines (medicine, dietetics, nursing, and pharmacy) across their final year to new graduate transition to explore how they conceptualized transitions. Data collection occurred between July 2019 and April 2020 at Monash University in Victoria, Australia. The authors employed framework analysis to interrogate the interview and longitudinal audio diary data cross-sectionally and longitudinally. RESULTS The authors found 10 different conceptualizations of transitions broadly categorized as time bound and linear (one-off events, systems, linear, adaptation, linked to identities), ongoing and complex (ongoing processes, multifaceted, complex), or related to transition shock (labor, linked to emotions). The adaptation conceptualization increased in dominance over time, the linear conceptualization was more apparent in the interviews (time points 1 and 3), and the multifaceted and emotion-linked conceptualizations were more dominant in the longitudinal audio diaries (time point 2). CONCLUSIONS This novel study illustrates conceptualizations of transitions as broadly consistent with existing higher education literature but extends this research considerably by identifying differences in conceptualizations across time. The authors encourage health care learners, educators, and policy makers to develop expanded and more sophisticated understandings of transitions to ensure that health care learners can better navigate often challenging graduate transitions. Further research should explore stakeholders' transition conceptualizations over lengthier durations beyond the new graduate transition.
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Affiliation(s)
- Charlotte E Rees
- C.E. Rees is head of school, School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia, and adjunct professor, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0003-4828-1422
| | - Ella Ottrey
- E. Ottrey is postdoctoral fellow, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0002-2979-548X
| | - Caitlin Kemp
- C. Kemp is research assistant, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0002-4056-2230
| | - Tina P Brock
- T.P. Brock is professor of pharmacy education and practice, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; ORCID: https://orcid.org/0000-0001-7455-4063
| | - Michelle Leech
- M. Leech is deputy dean and head of medical course, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Kayley Lyons
- K. Lyons is Ware fellow for pharmacy education and leadership, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; ORCID: https://orcid.org/0000-0003-2224-1107
| | - Lynn V Monrouxe
- L.V. Monrouxe is professor for work integrated learning and academic lead of health professions education research, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, New South Wales, Australia; ORCID: https://orcid.org/0000-0002-4895-1812
| | - Julia Morphet
- J. Morphet is associate professor, Monash Nursing and Midwifery, and affiliate, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0001-7056-6526
| | - Claire Palermo
- C. Palermo is director, Monash Centre for Scholarship in Health Education, and head of education and education research, Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0002-9423-5067
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Cormi C, Parpex G, Julio C, Ecarnot F, Laplanche D, Vannieuwenhuyse G, Duclos A, Sanchez S. Understanding the surgeon's behaviour during robot-assisted surgery: protocol for the qualitative Behav'Robot study. BMJ Open 2022; 12:e056002. [PMID: 35393313 PMCID: PMC8991054 DOI: 10.1136/bmjopen-2021-056002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Robot-assisted surgery is spreading worldwide, accounting for more than 1.2 million procedures in 2019. Data are sparse in the literature regarding the surgeon's mechanisms that mediate risk-taking during a procedure, especially robot-assisted. This study aims to describe and understand the behaviour of the surgeons during robot-assisted surgery and the change in their behaviour with increasing experience in using the robot. METHODS AND ANALYSIS This is a qualitative study using semistructured interviews with surgeons who perform robot-assisted surgery. An interview guide comprising open questions will be used to ensure that the points to be discussed are systematically addressed during each interview (ie, (1) difference in behaviour and preparation of the surgeon between a standard procedure and a robot-assisted procedure; (2) the influence of proprioceptive modifications, gain in stability and cognitive biases, inherent in the use of a surgical robot and (3) the intrinsic effect of the learning curve on the behaviour of the surgeons. After transcription, interviews will be analysed with the help of NVivo software, using thematic analysis. ETHICS AND DISSEMINATION Since this project examines professional practices in the field of social and human sciences, ethics committee was not required in accordance with current French legislation (Decree no 2017-884, 9 May 2017). Consent from the surgeons is implied by the fact that the interviews are voluntary. Surgeons will nonetheless be informed that they are free to interrupt the interview at any time.Results will be presented in peer-reviewed national and international congresses and submitted to peer-reviewed journals for publication. The communication and publication of the results will be placed under the responsibility of the principal investigator and publications will be prepared in compliance with the ICMJE uniform requirements for manuscripts. TRIAL REGISTRATION NUMBER NCT04869995.
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Affiliation(s)
- Clément Cormi
- Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, Troyes, France
- LIST3N/Tech-CICO, Université de Technologie de Troyes, Troyes, France
| | - Guillaume Parpex
- Department of Gynecology Obstetrics II and Reproductive Medicine, Hôpital Cochin, Paris, France
| | - Camille Julio
- Department of Digestive Surgery, Hôpital Saint-Louis, Paris, France
| | - Fiona Ecarnot
- EA3920, Burgundy Franche-Comté University, Besancon, France
| | - David Laplanche
- Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, Troyes, France
| | - Geoffrey Vannieuwenhuyse
- Département de chirurgie gynécologique, mammaire et carcinologique, Centre Hospitalier de Troyes, Troyes, France
| | - Antoine Duclos
- Health Data Department, Hospices Civils de Lyon, Lyon, France
- Research on Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, Lyon, France
| | - Stéphane Sanchez
- Pôle Territorial Santé Publique et Performance des Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, Troyes, France
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Dunbar-Yaffe R, Wu PE, Kay T, Mylopoulos M, McDonald-Blumer H, Gold WL, Stroud L. Understanding the Influence of the Junior Attending Role on Transition to Practice: A Qualitative Study. J Grad Med Educ 2022; 14:89-98. [PMID: 35222826 PMCID: PMC8848868 DOI: 10.4300/jgme-d-21-00728.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/27/2021] [Accepted: 12/07/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The Junior Attending (JA) role is an educational model, commonly implemented in the final years of training, wherein a very senior resident assumes the responsibilities of an attending physician under supervision. However, there is heterogeneity in the model's structure, and data are lacking on how it facilitates transition to independent practice. OBJECTIVE The authors sought to determine the value of the JA role and factors that enabled a successful experience. METHODS The authors performed a collective case study informed by a constructivist grounded theory analytical approach. Twenty semi-structured interviews from 2017 to 2020 were conducted across 2 cases: (1) Most Responsible Physician JA role (general internal medicine), and (2) Consultant JA role (infectious diseases and rheumatology). Participants included recent graduates who experienced the JA role, supervising attendings, and resident and faculty physicians who had not experienced or supervised the role. RESULTS Experiencing the JA role builds resident confidence and may support the transition to independent practice, mainly in non-medical expert domains, as well as comfort in dealing with clinical uncertainty. The relationship between the supervising attending and the JA is an essential success factor, with more productive experiences reported when there is an establishment of clear goals and role definition that preserves the autonomy of the JA and legitimizes the JA's status as a team leader. CONCLUSIONS The JA model offers promise in supporting the transition to independent practice when key success factors are present.
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Affiliation(s)
- Richard Dunbar-Yaffe
- Richard Dunbar-Yaffe, MDCM, MSc*, is a General Internist, Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, Ontario, Canada, and an Assistant Professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter E. Wu
- Peter E. Wu, MD, MSc*, is a General Internist and Clinical Pharmacologist/Toxicologist, Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, Ontario, Canada, and an Assistant Professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tatjana Kay
- Tatjana Kay, MSc, is a Research Assistant, University of Toronto, Toronto, Ontario, Canada
| | - Maria Mylopoulos
- Maria Mylopoulos, PhD, is a Scientist & Associate Director of Training Programs, Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Heather McDonald-Blumer
- Heather McDonald-Blumer, MD, MSc, is a Rheumatologist, Division of Rheumatology, Sinai Health System, Toronto, Ontario, Canada, Associate Professor of Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wayne L. Gold
- Wayne L. Gold, MD, is a General Internist, Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, Ontario, Canada, and Infectious Disease Specialist, Division of Infectious Diseases, Sinai Health System and University Health Network, Toronto, Ontario, Canada, and a Professor of Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lynfa Stroud
- Lynfa Stroud, MD, MEd, is an Associate Professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada, Researcher, Wilson Centre, University of Toronto, Toronto, Ontario, Canada, and General Internist, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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11
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Gkiousias V. Scalpel Please! A Scoping Review Dissecting the Factors and Influences on Professional Identity Development of Trainees Within Surgical Programs. Cureus 2021; 13:e20105. [PMID: 35003955 PMCID: PMC8723698 DOI: 10.7759/cureus.20105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/05/2022] Open
Abstract
Professional identity development is a multifaceted process that has recently sparked interest in medical education. Literature in professional identity development has focused predominantly on medical students and postgraduate medical training and much less on surgery, despite the unique challenges faced by surgical trainees while trying to emulate the identity of a self-actualized surgeon. A scoping review was performed to explore the factors and influences on professional identity development of surgeons in training. MEDLINE, PubMed, and OpenGrey databases were initially screened for relevant existing literature of professional identity development in surgical trainees, including quantitative, qualitative, and gray literature, followed by a hand search of references that appeared to be of pertinence. Seven hundred and five records were initially identified. Following the removal of duplicates and application of study selection criteria, 11 studies were included in the review. Professional identity development in surgical trainees was found to be influenced by a variety of intricately interrelating factors. Gaps in the literature were identified, highlighting possible areas of future research to better elucidate the overall process of identity development in budding surgeons and help guide interventions and programs to facilitate the transition of trainees to qualified and independently practicing surgeons.
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12
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Transition from trainee to educator in the operating room: A needs assessment and framework to support junior faculty. Am J Surg 2021; 223:1112-1119. [PMID: 34799075 DOI: 10.1016/j.amjsurg.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transitioning from trainee to attending surgeon requires learners to become educators. The purpose of this study is to evaluate educational strategies utilized by surgeons, define gaps in preparation for operative teaching, and identify opportunities to support this transition. METHODS A web-based, Association of Surgical Education approved survey was distributed to attending surgeons. RESULTS There were 153 respondents. Narrating actions was the most frequently reported educational model, utilized by 74% of junior faculty [JF] (0-5yrs) and 63% of senior faculty [SF] (>6yrs). Other models used included educational time-outs (29% JF, 27% SF), BID teaching model (36% JF, 51% SF), and Zwisch model (13% JF, 25% SF). Compared with 91% JF, 65% SF reported struggling with instruction (p < 0.001). Five themes emerged as presenting difficulty during the resident to attending transition: lack of relationships, ongoing learning, systems-based, cognitive load, impression management. CONCLUSIONS Our results represent a needs assessment in the transition from learner to educator in the OR.
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Chew QH, Steinert Y, Sim K. Factors associated with professional identity formation within psychiatry residency training: A longitudinal study. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:279-285. [PMID: 34235641 PMCID: PMC8505594 DOI: 10.1007/s40037-021-00673-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Conceptual frameworks for professional identity (PI) formation highlight the importance of developmental stages and socialization as the learner progresses from legitimate peripheral to full participation. Based on extant literature and clinical impressions, the authors aimed to explore factors associated with PI formation in psychiatry residents over time, and hypothesized that time in training, seniority status, and duration of exposure to psychiatry prior to residency would be associated with PI formation. METHODS Eighty out of 96 psychiatry residents (response rate, 83.3%) from the National Psychiatry Residency Program in Singapore participated and rated their PI development using the Professional Self Identity Questionnaire (PSIQ) across four timepoints from January 2016-December 2019. The residents were classified as junior (first 3 years) or senior residents (years 4-5). Linear mixed model analyses were conducted, with time in training, seniority status (junior versus senior residents), duration of psychiatry postings prior to residency, and their interaction as associated factors with PI over time. RESULTS Time in training, seniority, and duration of psychiatry postings before residency (all p < 0.01) were significantly associated with higher PSIQ scores at baseline. Over time, although all residents had increases in PSIQ scores, this rate of change did not differ significantly between junior and senior residents. DISCUSSION Exposure to psychiatry postings before residency, time in learning, and seniority are factors which influence PI development in residents. This has implications for psychiatry residency selection and training, adequate clinical exposure during training rotations, and continual support for new and senior residents to foster PI formation over time.
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Affiliation(s)
- Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Yvonne Steinert
- Institute of Health Sciences Education, Faculty of Family Medicine & Health Science, McGill University, Montreal, Quebec, Canada
| | - Kang Sim
- National Psychiatry Residency Program and West Region, Institute of Mental Health, Singapore, Singapore.
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Firdouse M, Chrystoja C, de Montbrun S, Escallon J, Cil T. Transition to Independent Surgical Practice and Burnout Among Early Career General Surgeons. Surg Innov 2021; 29:249-257. [PMID: 34461776 PMCID: PMC9016671 DOI: 10.1177/15533506211039682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The transition from surgical residency to independent practice is a challenging period that has not been well studied. Methods: An email invitation to complete a 55-item survey and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was sent to early career general surgeons across Canada. The chi-square test or Fisher's exact test was used to compare demographic and survey characteristics with burnout. Multivariable logistic regression was performed. Results: Of the 586 surgeons contacted, 88 responded (15%); 51/88 surgeons (58.0%) were classified as burnt out according to the MBI-HSS. Most surgeons (68.2%) were not confident in their abilities to handle the business aspect of practice. The majority (60.2%) believed that a transition to independent practice program would be beneficial to recent surgical graduates. Conclusions: Our data showed high prevalence of burnout among recently graduated general surgeons across Canada. Further, respondents were not confident in their managerial and administrative skills required to run a successful independent practice.
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Affiliation(s)
| | | | | | - Jaime Escallon
- 60329Department of Surgery, Toronto, ON, Canada.,10051Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Tulin Cil
- 60329Department of Surgery, Toronto, ON, Canada.,10051Princess Margaret Cancer Centre, Toronto, ON, Canada
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Tang A, Cohan CM, Beattie G, Mooney CM, Chiang A, Keeley JA. Factors that Predict the Need for Subtotal Cholecystectomy. Am Surg 2020; 87:1245-1251. [PMID: 33339461 DOI: 10.1177/0003134820979783] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Subtotal cholecystectomy is a "damage control" or "bailout procedure" that is used in difficult gallbladder cases when severe inflammation distorts the local anatomy resulting in increased risk in damage to surrounding structures. Subtotal cholecystectomy rates increased nationally over the past decade. We aimed to determine provider experience and patient factors associated with the performance of subtotal cholecystectomies. METHODS All cholecystectomies from 2016 to 2019 were reviewed. Patient demographics, laboratory values, imaging, preoperative diagnosis, surgical technique (fenestrating vs. reconstituting), and years of attending and resident experience were collected. Multivariable regression analysis was performed to evaluate for factors that increase the likelihood of subtotal cholecystectomy. RESULTS Of 916 cholecystectomies, 86 were subtotal. The likelihood of subtotal cholecystectomy did not increase based on attending experience of ≤5 vs. > 5 years (odds ratio (OR) .66, P = .09). Older age (adjusted odds ratio (aOR) 1.23, P = .03), male sex (aOR 2.59, P < .01), white blood cells (WBC) above 10.3 (aOR 2.02, P = .02), and preoperative diagnosis of acute on chronic cholecystitis (aOR 5.47, P < .01) were associated with increased likelihood of subtotal cholecystectomy. DISCUSSION Older age, male sex, WBC above 10.3, and preoperative diagnosis of acute on chronic cholecystitis were associated with the increased likelihood of subtotal cholecystectomies. The performance of subtotal cholecystectomy was not impacted by attending years of experience. In cases of severe gallbladder pathology, this technique is being used as an operative strategy among all surgeon levels.
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Affiliation(s)
- Annie Tang
- Department of Surgery, 8785University of California San Francisco, East Bay-Oakland, CA, USA
| | - Caitlin M Cohan
- Department of Surgery, 8785University of California San Francisco, East Bay-Oakland, CA, USA
| | - Genna Beattie
- Department of Surgery, 8785University of California San Francisco, East Bay-Oakland, CA, USA
| | - Colin M Mooney
- Department of Surgery, 8785University of California San Francisco, East Bay-Oakland, CA, USA
| | - Anna Chiang
- 1438University of California Berkeley, Berkeley, CA, USA
| | - Jessica A Keeley
- Department of Surgery, 8785University of California San Francisco, East Bay-Oakland, CA, USA
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Morris MC, Baker JE, Edwards MJ. Surgeons, Scholars, and Leaders Symposium: A 5-Year Experience. Am Surg 2020. [DOI: 10.1177/000313481908501224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Department of Surgery at the University of Cincinnati developed the Surgeons, Scholars, and Leaders Symposium to address the underappreciated aspects of surgical education that are critical in the development of the academic surgeon. Surgical education has undergone many gaps since the beginning of a traditional surgical residency, first pioneered by Dr. Halsted in 1904; still, many gaps in surgical education remain. Topics such as research, financial planning, leadership, career development, and many others are not adequately addressed in formalized training. The Surgeons, Scholars, and Leaders Symposium was first held in January 2015 in Jackson Hole, WY, and has subsequently become an annual event. Recurrent themes addressed at the Symposium include global health, resident autonomy, research program development, leadership, mentorship, career development, and managing transitions. The annual Surgeons, Scholars, and Leaders Symposium has been instrumental in addressing these underappreciated aspects of surgeon development and will continue to be an important venue for the next generation of surgical leaders.
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Affiliation(s)
- Mackenzie C. Morris
- Department of Surgery, Section of General Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Jennifer E. Baker
- Department of Surgery, Section of General Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Michael J. Edwards
- Department of Surgery, Section of General Surgery, University of Cincinnati, Cincinnati, Ohio
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