Encouraging residents' professional development and career planning: the role of a development-oriented performance assessment

Reframing selection as a learning experience: Insights from a residency selection assessment

PURPOSE

Selection for postgraduate medical training is high-stakes and complex. The learning value of assessments for selection has, thus far, been underexplored, limiting their uptake as potentially meaningful learning experiences. The aim of this study was to explore the learning value residency applicants derive from an intelligence, personality, motivation and competency selection assessment and what factors influence the experienced learning value.

METHODS

In Autumn 2020 and Spring 2021, we conducted individual semi-structured interviews with sixteen applicants for pediatric residency training. Selection outcomes were unknown at the time of the interview. Interviews were transcribed verbatim and thematically analyzed.

RESULTS

Participants reported that the assessment was valuable in fostering self-reflection and self-awareness, embracing self-acceptance, pursuing development goals, assessing professional fit, and harnessing motivational drivers in work. The experienced learning value was influenced by applicants' ability to interpret its results, their focus on the high-stakes selection process and concerns regarding the acceptability and credibility of the selection tool.

CONCLUSIONS

While the selection assessment showed learning potential, its learning value was impeded by a preoccupation with the high-stakes nature of the selection procedure. Intentional integration of the selection assessment in the learning curriculum may play a pivotal role in realizing its learning potential.

A systematic scoping review on group non-written reflections in medical education

BACKGROUND

Medical education is tasked with shaping how medical students and physicians think, feel and act as professionals, or their Professional Identity Formation (PIF). This process has traditionally rested upon imparting knowledge; integrating sociocultural, professional and organizational expectations and codes of conduct; inculcating program and practice beliefs, values and principles (belief systems); and imbuing shared identities - quintessential elements that, together, comprise the socialization process. Key to supporting this socialization process is reflective practice. However, regnant approaches to mobilizing reflective cycles are faced with resource, personnel and time constraints, hindering efforts to nurture PIF. Group non-written reflections (GNWR) - broadly defined as facilitator-led discussions of shared reflective experiences within groups of learners - may prove to be an effective compromise. To address diverse approaches and a lack of effective understanding, we propose a systematic scoping review (SSR) to map the current use of GNWR in medical training and its role in shaping PIF.

METHODS

Guided by the Systematic Evidence-Based Approach (SEBA)'s constructivist ontological and relativist epistemological position, this SSR in SEBA searched for articles on GNWR published in PubMed, Embase, Psychinfo, CINAHL, ERIC, ASSIA, SCOPUS, Google Scholar, Open Grey, GreyLit and ProQuest databases. The data found was concurrently analyzed using thematic and direct content analysis. Complementary themes and categories identified were combined, creating the domains that framed the discussion.

RESULTS

Of the 8560 abstracts and 336 full-text articles reviewed, 98 articles were included. The four domains identified were: (1) Indications of use and their value; (2) Structure and how they can be used; (3) Models of reflective practice in GNWR; and (4) Features of communities of practice and the socialisation process.

CONCLUSION

This SSR in SEBA concludes that GNWR does impact PIF when effectively structured and supported. The Krishna-Pisupati Model for PIF platforms a model that explains GNWR's effects of PIF and advances fourteen recommendations to maximize GNWR use.

Dermatology residents as educators: a qualitative study of identity formation

BACKGROUND

One of the many identities a physician comes to form during their career is their identity as an educator. Exploring formation of this identity may enrich our understanding of how physicians make decisions related to their roles as educators, their behaviors, and how this ultimately influences the educational environment. It is the aim of this study to investigate educator identity formation of dermatology residents while early in their careers.

METHODS

Drawing on a social constructionist paradigm, we conducted a qualitative study, utilizing an interpretative approach. We examined longitudinal data over a 12-month period using dermatology residents' written reflections from their professional portfolios and semi-structured interviews. We collected this data as we progressed through and beyond a 4-month professional development program designed to encourage residents' growth as educators. Sixty residents in their second, third, or final year of residency programs located in Riyadh, Saudi Arabia were invited to take part in this study. Twenty residents participated with sixty written reflections and 20 semi-structured interviews. Qualitative data were analyzed using a thematic analysis approach.

RESULTS

Sixty written reflections and 20 semi-structured interviews were analyzed. Data was categorized according to themes corresponding to the original research questions. For the first research question regarding identity formation, themes included definitions of education, the process of education, and identity development. For the second research question, 1 theme entitled professional development program included, the following sub-themes: individual act, interpersonal activity, and an organizational undertaking, with many believing that residency programs should prepare residents for their educator roles. Participants also described newfound leadership ambitions of creating new dermatology fellowship programs as a result of taking part in the Resident-as-Educator program.

CONCLUSIONS

Our study provides insights on the dynamic formation of educator identities amongst dermatology residents. Investment in developing residents as educators through professional development programs may instigate transformational change on the individual physician level and profession's level.

"The Story I Will Never Forget": Critical Incident Narratives in Surgical Residency

OBJECTIVE

We sought to better understand what defines a critical incident experience for the surgical trainee.

SUMMARY BACKGROUND DATA

Critical incidents are formative moments stamped indelibly on one's memory that shape professional identity. The critical incident technique-using participants' narratives to identify patterns and learn from their perceptions-has been explored in some healthcare settings, but there has been no inquiry within surgery.

METHODS

Surgical residents at 5 residency programs (1 community, 1 university-affiliated, 3 university) were surveyed using an online questionnaire from November to December 2020. Convenience sampling was used to identify the study population. Participants were invited to write about formative, impactful experiences in training. Interpretive description was the qualitative methodology used to locate information, analyze, and record patterns in the data. Individual responses were categorized and assessed for overlying themes.

RESULTS

Overall, 28 narratives were collected from surgery residents in 3 specialties (general surgery, plastic surgery, and urology), with postgraduate year representation of post-graduate years 1 to 6. Respondents were 40% female. Nineteen of the narratives reported a negative experience. Four themes were identified from responses: 1) growth through personal self-reflection, 2) difficult interpersonal interactions, 3) positive team dynamics as a psychological safety net, and 4) supportive program cultures that promote learning.

CONCLUSIONS

Critical incident narratives among surgical residents indicate that unforgettable and formative experiences-both positive and negative- occur in 4 domains: within the individual, within a relationship, among a team, and within a program. Further exploring these domains in surgical training will inform optimal educational programming to support trainee development and wellbeing.

A Virtual Book Club for Professional Development in Emergency Medicine

INTRODUCTION

Professional development is an important component of graduate medical education, but it is unclear how to best deliver this instruction. Book clubs have been used outside of medicine as a professional development tool. We sought to create and evaluate a virtual professional development book club for emergency medicine interns.

METHODS

We designed and implemented a virtual professional development book club during intern orientation. Afterward, participants completed an evaluative survey consisting of Likert and free-response items. Descriptive statistics were reported. We analyzed free-response data using a thematic approach.

RESULTS

Of 15 interns who participated in the book club, 12 (80%) completed the evaluative survey. Most (10/12; 83.3%) agreed or strongly agreed that the book club showed them the importance of professional development as a component of residency training and helped them reflect on their own professional (11/12; 91.7%) and personal development (11/12; 91.7%). Participants felt the book club contributed to bonding with their peers (9/12; 75%) and engagement with the residency program (9/12; 75%). Our qualitative analysis revealed five major themes regarding how the book club contributed to professional and personal development: alignment with developmental stage; deliberate practice; self-reflection; strategies to address challenges; and communication skills.

CONCLUSION

A virtual book club was feasible to implement. Participants identified multiple ways the book club positively contributed to their professional development. These results may inform the development of other book clubs in graduate medical education.

How Applicants to General Surgery Residency Define Resilience

OBJECTIVE

Resilience is a vital quality for the successful completion of any residency training program. Resilience is a commonly used but poorly understood term and is defined in multiple ways by people during different times of their lives. The transition from medical student to general surgical resident (GSR) is one of the most formative times in a young surgeon's professional career. The purpose of this study is to determine how a cohort of aspiring surgical residents define resilience.

DESIGN

This is a qualitative study where interviews were conducted prospective GSRs over 2 application seasons. During the institution's standard interview process, applicants were asked to provide a definition of resilience. Responses were documented. Qualitative content analysis was conducted by the research team. Initial codes were developed and defined. Research team members independently coded the responses, and then an iterative group consensus process was used to develop the final themes.

SETTING

This study was conducted at Geisinger Medical Center, an academic tertiary care hospital in Danville, PA with 5 categorical GSR positions per year.

PARTICIPANTS

All applicants who underwent an in-person interview were included in this study.

RESULTS

A total of 261 comments about resilience were available from 117 interviews. These responses were categorized into 5 themes: support, learning from failure, adaptability, self-reflection, and perseverance.

CONCLUSION

Resilience as defined by applicants to a general surgery residency program is a multifaceted term. The thematic categories suggest that resilience can be viewed through the framework of the 5 components of emotional intelligence: self-aware, self-regulation, motivation, empathy, and social skills.

Doctoral students' perceived working environment, obstacles and opportunities at a Swedish medical faculty: a qualitative study

BACKGROUND

Investment in research is high on the agenda of many countries in recognition of the fact that research is important for the development of society. Doctoral students have a vital role and represent a substantial part of this investment. It is therefore imperative to reduce the risk of students dropping out from doctoral studies. The aim of this qualitative study was to gain deeper insight into the working conditions of, and obstacles and opportunities for, doctoral students at an institute of medicine in Sweden.

METHODS

Semi-structured interviews were conducted in 2013 with 17 doctoral students-of varying genders, professions and fields of research-from the Institute of Medicine, Sahlgrenska Academy, at the University of Gothenburg, Sweden. The recorded interviews were transcribed and analysed using systematic text condensation.

RESULTS

Four categories emerged from the data. They were: Safety, Frustrating Structures, Others - not me, and the future. They included positive as well as negative perceptions. Among the positive perceptions were recognition of the importance of the supervisor, as well as secure conditions, and personal development. Frustrating structures in the academic culture, stress and differences in career building constituted the negative points.

CONCLUSIONS

Our findings suggest that there is a need for structures within the university that support doctoral students who feel they are not receiving the assistance they need, who believe they have unreasonable working conditions, or who may need to change supervisors in order to complete their graduate research studies. Our study also highlights the fact that supervisors have a major influence on the work environment of doctoral students, and that the general and academic perception of the research area likewise has an effect on the successful completion of the research project and dissertation. Providing leadership training for supervisors could be an important measure that may help improve conditions for the doctoral students they supervise.