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Godschalx-Dekker J, van Mook W. Dutch dismissal practices: characteristics, consequences, and contrasts in residents' case law in community-based practice versus hospital-based specialties. BMC Med Educ 2024; 24:160. [PMID: 38374054 PMCID: PMC10877891 DOI: 10.1186/s12909-024-05106-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 01/28/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND In the Netherlands, 2 to 10% of the residents terminate training prematurely. Infrequently, termination of training is by dismissal. Incidentally, residents may disagree, dispute and challenge these decisions from the programme directors. Resident dismissal is always a difficult decision, most commonly made after, repeated assessments, and triangulation of the resulting assessment data and one or more remediation attempts. Nevertheless, the underlying reasons for dismissal and the policies for remediation and dismissal may differ between training programmes. Such differences may however impact the chance of remediation success, the chance of dismissal and subsequent residents' appeals. METHOD We included a total of 70 residents from two groups (community-based and hospital-based specialties) during 10 years of appeals. Subsequently, we compared these groups on factors potentially associated with the outcome of the conciliation board decision regarding the residents' dismissal. We focused herein on remediation strategies applied, and reasons reported to dismiss residents. RESULTS In both groups, the most alleged reason to dismiss residents was lack of trainability, > 97%. This was related to deficiencies in professionalism in community-based practice and medical expertise in hospital-based specialties respectively. A reason less frequently mentioned was endangerment of patient care, < 26%. However, none of these residents accused of endangerment, actually jeopardized the patients' health, probably due to the vigilance of their supervisors. Remediation strategies varied between the two groups, whereas hospital-based specialties preferred formal remediation plans in contrast to community-based practice. A multitude of remediation strategies per competency (medical expertise, professionalism, communication, management) were applied and described in these law cases. DISCUSSION Residents' appeals in community-based practice were significantly less likely to succeed compared to hospital-based specialties. Hypothesised explanatory factors underlying these differences include community-based practices' more prominent attention to the longitudinal assessment of professionalism, the presence of regular quarterly progress meetings, precise documentation of deficiencies, and discretion over the timing of dismissal in contrast to dismissal in the hospital-based specialties which is only formally possible during scheduled formal summative assessment meetings.
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Affiliation(s)
- Judith Godschalx-Dekker
- Department of Psychiatry and Medical Psychology, GGZ Central, Flevoziekenhuis, Almere, The Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Academy for Postgraduate Training, Maastricht UMC+, and School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.
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Cheong CWS, Quah ELY, Chua KZY, Lim WQ, Toh RQE, Chiang CLL, Ng CWH, Lim EG, Teo YH, Kow CS, Vijayprasanth R, Liang ZJ, Tan YKI, Tan JRM, Chiam M, Lee ASI, Ong YT, Chin AMC, Wijaya L, Fong W, Mason S, Krishna LKR. Post graduate remediation programs in medicine: a scoping review. BMC Med Educ 2022; 22:294. [PMID: 35443679 PMCID: PMC9020048 DOI: 10.1186/s12909-022-03278-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Recognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the importance of the 'deliberate practice of improving performance through practising beyond one's comfort level under guidance'. However, variations in physician, program, contextual and healthcare and educational systems complicate efforts to create a consistent approach to remediation. Balancing the inevitable disparities in approaches and settings with the need for continuity and effective oversight of the remediation process, as well as the context and population specific nature of remediation, this review will scrutinise the remediation of physicians in training to better guide the design, structuring and oversight of new remediation programs. METHODS Krishna's Systematic Evidence Based Approach is adopted to guide this Systematic Scoping Review (SSR in SEBA) to enhance the transparency and reproducibility of this review. A structured search for articles on remediation programs for licenced physicians who have completed their pre-registration postings and who are in training positions published between 1st January 1990 and 31st December 2021 in PubMed, Scopus, ERIC, Google Scholar, PsycINFO, ASSIA, HMIC, DARE and Web of Science databases was carried out. The included articles were concurrently thematically and content analysed using SEBA's Split Approach. Similarities in the identified themes and categories were combined in the Jigsaw Perspective and compared with the tabulated summaries of included articles in the Funnelling Process to create the domains that will guide discussions. RESULTS The research team retrieved 5512 abstracts, reviewed 304 full-text articles and included 101 articles. The domains identified were characteristics, indications, frameworks, domains, enablers and barriers and unique features of remediation in licenced physicians in training programs. CONCLUSION Building upon our findings and guided by Hauer et al. approach to remediation and Taylor and Hamdy's Multi-theories Model, we proffer a theoretically grounded 7-stage evidence-based remediation framework to enhance understanding of remediation in licenced physicians in training programs. We believe this framework can guide program design and reframe remediation's role as an integral part of training programs and a source of support and professional, academic, research, interprofessional and personal development.
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Affiliation(s)
- Clarissa Wei Shuen Cheong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Wei Qiang Lim
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Rachelle Qi En Toh
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Christine Li Ling Chiang
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Caleb Wei Hao Ng
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Elijah Gin Lim
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Yao Hao Teo
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Cheryl Shumin Kow
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Raveendran Vijayprasanth
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Zhen Jonathan Liang
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Yih Kiat Isac Tan
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Javier Rui Ming Tan
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Blk MD6, Centre, 14 Medical Dr, #05-01 for Translational Medicine, Singapore, 117599 Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854 Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA UK
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597 Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436 Singapore
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Yan Q, Treffalls RN, Li T, Prasla S, Davies MG. Graduate Medical Education “Trainee in difficulty” current remediation practices and outcomes. Am J Surg 2021. [DOI: 10.1016/j.amjsurg.2021.12.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/23/2022]
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Abstract
SUMMARY The ability of our resident selection process to identify individuals who will ultimately become competent plastic surgeons is crucial to the specialty's future. Current criteria in use are not productive of that outcome. The presence of emotional intelligence and the element of grit have been incorporated in business and the military as factors to be evaluated in potential candidates. Plastic surgery should initiate an investigation of inclusion of a similar assessment of resident applicants.
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Abstract
There are myriad types of problem learners in surgical residency and most have difficulty in more than 1 competency. Programs that use a standard curriculum of study and assessment are most successful in identifying struggling learners early. Many problem learners lack appropriate systems for study; a multidisciplinary educational team that is separate from the team that evaluates the success of remediation is critical. Struggling residents who require formal remediation benefit from performance improvement plans that clearly outline the issues of concern, describe the steps required for remediation, define success of remediation, and outline consequences for failure to remediate appropriately.
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Affiliation(s)
- Lilah F Morris-Wiseman
- University of Arizona, Department of Surgery, Division of Surgical Oncology, 1501 N. Campbell Avenue, PO Box 245058, Tucson, AZ 85724-5058, USA
| | - Valentine N Nfonsam
- University of Arizona, Department of Surgery, Division of Surgical Oncology, 1501 N. Campbell Avenue, PO Box 245058, Tucson, AZ 85724-5058, USA.
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Hagelsteen K, Pedersen H, Bergenfelz A, Mathieu C. Different approaches to selection of surgical trainees in the European Union. BMC Med Educ 2021; 21:363. [PMID: 34193137 PMCID: PMC8243060 DOI: 10.1186/s12909-021-02779-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND There is an increasing global interest in selection processes for candidates to surgical training. The aim of the present study is to compare selection processes to specialist surgeon training in the European Union (EU). A secondary goal is to provide guidance for evidence-based methods by a proposed minimum standard that would align countries within the EU. METHODS Publications and grey literature describing selection strategies were sought. Correspondence with Union Européenne des Médecins Specialists (UEMS) Section of Surgery delegates was undertaken to solicit current information on national selection processes. Content analysis of 13 semi-structured interviews with experienced Swedish surgeons on the selection process. Two field trips to Ireland, a country with a centralized selection process were conducted. Based on collated information typical cases of selection in a centralized and decentralized setting, Ireland and Sweden, are described and compared. RESULTS A multitude of methods for selection to surgical training programs were documented in the 27 investigated countries, ranging from locally run processes with unstructured interviews to national systems for selection of trainees with elaborate structured interviews, and non-technical and technical skills assessments. Associated with the difference between centralized and decentralized selection systems is whether surgical training is primarily governed by an employment or educational logic. Ireland had the most centralized and elaborate system, conducting a double selection process using evidence-based methods along an educational logic. On the opposite end of the scale Sweden has a decentralized, local selection process with a paucity of evidence-based methods, no national guidelines and operates along an employment logic, and Spain that rely solely on examination tests to rank candidates. CONCLUSION The studied European countries all have different processes for selection of surgical trainees and the use of evidence-based methods for selection is variable despite similar educational systems. Selection in decentralized systems is currently often conducted non-transparent and subjectively. A suggested improvement towards an evidence-based framework for selection applicable in centralized and decentralized systems as well as educational and employer logics is suggested.
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Affiliation(s)
- Kristine Hagelsteen
- Practicum Clinical Skills Centre, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Hanne Pedersen
- Practicum Clinical Skills Centre, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Anders Bergenfelz
- Practicum Clinical Skills Centre, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Chris Mathieu
- Department of Sociology, Faculty of Social Sciences, Lund University, Lund, Sweden
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Gardner AK, Cavanaugh KJ, Willis RE, Dent D, Reinhart H, Williams M, Truitt MS, Scott BG, Dunkin BJ. Great Expectations? Future Competency Requirements Among Candidates Entering Surgery Training. J Surg Educ 2020; 77:267-272. [PMID: 31606376 DOI: 10.1016/j.jsurg.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/29/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION We describe a multimethod, multi-institutional approach documenting future competencies required for entry into surgery training. METHODS Five residency programs involved in a statewide collaborative each provided 12 to 15 subject matter experts (SMEs) to participate. These SMEs participated in a 1-hour semistructured interview with organizational psychologists to discuss program culture and expectations, and rated the importance of 20 core competencies derived from the literature for candidates entering general surgery training within the next 3 to 5 years (1 = importance decreases significantly; 3 = importance stays the same; 5 = importance increases significantly). RESULTS Seventy-three SMEs across 5 programs were interviewed (77% faculty; 23% resident). All competencies were rated to be more important in the next 3 to 5 years, with team orientation (3.87 ± 0.81), communication (3.82 ± 0.79), team leadership (3.81 ± 0.82), feedback receptivity (3.79 ± 0.76), and professionalism (3.76 ± 0.89) rated most highly. CONCLUSIONS These findings suggest that the competencies desired and required among future surgery residents are likely to change in the near future.
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Affiliation(s)
- Aimee K Gardner
- Baylor College of Medicine, Houston, Texas; SurgWise Consulting, Houston, Texas.
| | - Katelyn J Cavanaugh
- SurgWise Consulting, Houston, Texas; MD Anderson Cancer Center, Houston, Texas
| | - Ross E Willis
- SurgWise Consulting, Houston, Texas; University of Texas Health Sciences Center, San Antonio, Texas
| | - Daniel Dent
- University of Texas Health Sciences Center, San Antonio, Texas
| | | | - Mark Williams
- Texas Tech University Health Sciences Center, Lubbock, Texas
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Gardner AK, Dunkin BJ. Evaluation of Validity Evidence for Personality, Emotional Intelligence, and Situational Judgment Tests to Identify Successful Residents. JAMA Surg 2019; 153:409-416. [PMID: 29282462 DOI: 10.1001/jamasurg.2017.5013] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The ability to identify candidates who will thrive and successfully complete their residency is especially critical for general surgery programs. Objective To assess the extent to which 3 screening tools used extensively in industrial selection settings-emotional intelligence (EQ), personality profiles, and situational judgment tests (SJTs)-could identify successful surgery residents. Design, Setting, and Participants In this analysis, personality profiles, EQ assessments, and SJTs were administered from July through August 2015 to 51 postgraduate year 1 through 5 general surgery residents in a large general surgery residency program. Associations between these variables and residency performance were investigated through correlation and hierarchical regression analyses. Interventions Completion of EQ, personality profiles, and SJT assessments. Main Outcomes and Measures Performance in residency as measured by a comprehensive performance metric. A score of zero represented a resident whose performance was consistent with that of their respective cohort's performance; below zero, worse performance; and greater than zero, better performance. Results Of the 61 eligible residents, 51 (84%) chose to participate and 22 (43%) were women. US Medical Licensing Examination Step 1 (USMLE1), but not USMLE2, emerged as a significant factor (t2,49 = 1.98; β = 0.30; P = .03) associated with overall performance. Neither EQ facets nor overall EQ offered significant incremental validity over USMLE1 scores. Inclusion of the personality factors did not significantly alter the test statistic and did not explain any additional portion of the variance. By contrast, inclusion of SJT scores accounted for 15% more of the variance than USMLE1 scores alone, resulting in a total of 25% of the variance explained by both USMLE1 and SJT scores (F2,57 = 7.47; P = .002). Both USMLE1 (t = 2.21; P = .03) and SJT scores (t = 2.97; P = .005) were significantly associated with overall resident performance. Conclusions and Relevance This study found little support for the use of EQ assessment and only weak support for some distinct personality factors (ie, agreeableness, extraversion, and independence) in surgery resident selection. Performance on the SJT was associated with overall resident performance more than traditional cognitive measures (ie, USMLE scores). These data support further exploration of these 2 screening assessments on a larger scale across specialties and institutions.
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Affiliation(s)
- Aimee K Gardner
- Department of Surgery, School of Allied Health Sciences, Baylor College of Medicine, Houston, Texas
| | - Brian J Dunkin
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
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Hagelsteen K, Johansson BM, Bergenfelz A, Mathieu C. Identification of Warning Signs During Selection of Surgical Trainees. J Surg Educ 2019; 76:684-693. [PMID: 30594481 DOI: 10.1016/j.jsurg.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/16/2018] [Accepted: 12/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The aim was to document empirical observations about antecedents to and practices of unsuitable behaviours amongst surgical trainees and develop an interview guide that could be used for the selection process. DESIGN A mixed methods design was adopted combining a survey distributed to senior surgeons and heads of departments, followed by semi-structured interviews with experienced surgeons. SETTING All surgical departments and hospitals in The South Swedish Health Care Region. PARTICIPANTS The survey was completed by 54 of 83 eligible surgeons above 50years of age, and 4 of 7 heads of surgical departments. Semi-structured interviews with 13 surgeons representing local, regional, and university hospitals from the same cohort. RESULTS Forty-six (85%) surgeons and four of seven heads of departments responded that they had come across surgical trainees deemed unsuitable to train and work as a surgeon. All heads of department and 31 of 54 of the surgeons believed tendencies towards unsuitability are evident early during training. From the survey, 107 statements described reasons for finding a trainee unsuitable. Qualitative analysis of the interviews and free-text answers of the survey led to identification of 11 problem domains with associated "warning signs". An interview guide to help detect unsuitability tendencies in candidates during selection procedures was constructed. CONCLUSIONS Experienced surgeons have quite consistent views on what makes a person unsuitable as a surgeon. Their views have been systematized into 11 problem domains, and a set of 'warning signs' for unsuitable behaviours and traits has been developed. Early detection of these signs and traits is important for the individual, the work environment, and patient safety. A recommendation for a minimum framework for selection including the constructed interview guide is presented.
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Affiliation(s)
- Kristine Hagelsteen
- Department of Clinical Sciences and Surgery, Lund University, Skåne University Hospital, Lund, Sweden; Practicum Clinical Skills Centers, Skåne University Hospital, Lund, Sweden.
| | | | - Anders Bergenfelz
- Department of Clinical Sciences and Surgery, Lund University, Skåne University Hospital, Lund, Sweden; Practicum Clinical Skills Centers, Skåne University Hospital, Lund, Sweden.
| | - Chris Mathieu
- Department of Sociology, Lund University, Lund, Sweden.
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Symer MM, Abelson JS, Gade L, Mao J, Sosa JA, Yeo HL. Association between American Board of Surgery in-training examination score and attrition from general surgery residency. Surgery 2018; 164:206-211. [DOI: 10.1016/j.surg.2018.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/13/2018] [Accepted: 03/27/2018] [Indexed: 11/26/2022]
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Gardner AK, Grantcharov T, Dunkin BJ. The Science of Selection: Using Best Practices From Industry to Improve Success in Surgery Training. J Surg Educ 2018; 75:278-285. [PMID: 28751186 DOI: 10.1016/j.jsurg.2017.07.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/22/2017] [Accepted: 07/08/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND The selection of high-quality applicants is critical to the future of surgery. However, it is unclear if current practices meet industry criteria of a successful selection system, as measured by administrative efficiency and performance and attrition of those selected. METHODS We performed a modified systematic review process to gain an understanding of current selection processes, remediation practices, and attrition rates in surgery residency training programs in the United States. We also conducted semistructured interviews with local residency program directors and coordinators to obtain a specific snapshot of the amount of time and resources dedicated to these activities in various sized programs. The associated financial costs of these activities are also presented. RESULTS The administrative costs for current residency selection processes are substantial, ranging from $45,000 to $148,000 for each program per year. Approximately 30% of residents require at least 1 remediation intervention, costing programs $3400 to $5300 per episode, and typically involve concerns around nontechnical skills. Attrition rates range from 20% to 40%. CONCLUSIONS This review suggests that additional methodologies may allow surgery residency programs to identify best-fit candidates more efficiently and effectively, while also decreasing remediation and attrition rates. Possible solutions include incorporation of structured interviews, personality inventories, and situational judgment tests. Resources dedicated to current interview practices, remediation efforts, and attrition management can be redirected to support these methodologies. By applying the science of selection and assessment to the recruitment process, programs may be able to make more data-driven decisions to identify candidates who will be successful at their institution.
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Affiliation(s)
- Aimee K Gardner
- Department of Surgery, School of Allied Health Sciences, Baylor College of Medicine, Houston, Texas; SurgWise Consulting, Houston, Texas.
| | | | - Brian J Dunkin
- SurgWise Consulting, Houston, Texas; Department of Surgery, Houston Methodist Hospital, Houston, Texas
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Raman HS, Limbrick DD, Ray WZ, Coble DW, Church S, Dacey RG, Zipfel GJ. Prevalence, management, and outcome of problem residents among neurosurgical training programs in the United States. J Neurosurg 2018; 130:322-326. [DOI: 10.3171/2017.8.jns171719] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/28/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe challenging nature of neurosurgical residency necessitates that appropriate measures are taken by training programs to ensure that residents are properly progressing through their education. Residents who display a pattern of performance deficiencies must be identified and promptly addressed by faculty and program directors to ensure that resident training and patient care are not affected. While studies have been conducted to characterize these so-called “problem residents” in other specialties, no current data regarding the prevalence and management of such residents in neurosurgery exist. The purpose of this study was to determine the rate and the outcome of problem residents in US neurosurgical residency programs and identify predictive risk factors that portend a resident’s departure from the program.METHODSAn anonymous nationwide survey was sent to all 108 neurosurgical training programs in the US to assess a 20-year history of overall attrition as well as the management course of problem residents, including the specific deficiencies of the resident, management strategies used by faculty, and the eventual outcome of each resident’s training.RESULTSResponses were received from 36 centers covering a total of 1573 residents, with the programs providing a mean 17.4 years’ worth of data (95% CI 15.3–19.4 years). The mean prevalence of problem residents among training programs was 18.1% (95% CI 14.7%–21.6%). The most common deficiencies recognized by program directors were poor communication skills (59.9%), inefficiency in tasks (40.1%), and poor fund of medical knowledge (39.1%). The most common forms of program intervention were additional meetings to provide detailed feedback (93.9%), verbal warnings (78.7%), and formal written remediation plans (61.4%). Of the identified problem residents whose training status is known, 50% graduated or are on track to graduate, while the remaining 50% ultimately left their residency program for other endeavors. Of the 97 residents who departed their programs, 65% left voluntarily (most commonly for another specialty), and 35% were terminated (often ultimately training in another neurosurgery program). On multivariable logistic regression analysis, the following 3 factors were independently associated with departure of a problem resident from their residency program: dishonesty (OR 3.23, 95% CI 1.67–6.253), poor fund of medical knowledge (OR 2.54, 95% CI 1.47–4.40), and poor technical skill (OR 2.37, 95% CI 1.37–4.12).CONCLUSIONSThe authors’ findings represent the first study to characterize the nature of problem residents within neurosurgery. Identification of predictive risk factors, such as dishonesty, poor medical knowledge, and/or technical skill, may enable program directors to preemptively act and address such deficiencies in residents before departure from the program occurs. As half of the problem residents departed their programs, there remains an unmet need for further research regarding effective remediation strategies.
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Schwed AC, Lee SL, Salcedo ES, Reeves ME, Inaba K, Sidwell RA, Amersi F, Are C, Arnell TD, Damewood RB, Dent DL, Donahue T, Gauvin J, Hartranft T, Jacobsen GR, Jarman BT, Melcher ML, Mellinger JD, Morris JB, Nehler M, Smith BR, Wolfe M, Kaji AH, de Virgilio C. Association of General Surgery Resident Remediation and Program Director Attitudes With Resident Attrition. JAMA Surg 2018; 152:1134-1140. [PMID: 28813585 DOI: 10.1001/jamasurg.2017.2656] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Previous studies of resident attrition have variably included preliminary residents and likely overestimated categorical resident attrition. Whether program director attitudes affect attrition has been unclear. Objectives To determine whether program director attitudes are associated with resident attrition and to measure the categorical resident attrition rate. Design, Setting, and Participants This multicenter study surveyed 21 US program directors in general surgery about their opinions regarding resident education and attrition. Data on total resident complement, demographic information, and annual attrition were collected from the program directors for the study period of July 1, 2010, to June 30, 2015. The general surgery programs were chosen on the basis of their geographic location, previous collaboration with some coauthors, prior work in surgical education and research, or a program director willing to participate. Only categorical surgical residents were included in the study; thus, program directors were specifically instructed to exclude any preliminary residents in their responses. Main Outcomes and Measures Five-year attrition rates (2010-2011 to 2014-2015 academic years) as well as first-time pass rates on the General Surgery Qualifying Examination and General Surgery Certifying Examination of the American Board of Surgery (ABS) were collected. High- and low-attrition programs were compared. Results The 21 programs represented different geographic locations and 12 university-based, 3 university-affiliated, and 6 independent program types. Programs had a median (interquartile range [IQR]) number of 30 (20-48) categorical residents, and few of those residents were women (median [IQR], 12 [5-17]). Overall, 85 of 966 residents (8.8%) left training during the study period: 15 (17.6%) left after postgraduate year 1, 34 (40.0%) after postgraduate year 2, and 36 (42.4%) after postgraduate year 3 or later. Forty-four residents (51.8%) left general surgery for another surgical discipline, 21 (24.7%) transferred to a different surgery program, and 18 (21.2%) exited graduate medical education altogether. Each program had an annual attrition rate ranging from 0.73% to 6.0% (median [IQR], 2.5% [1.5%-3.4%]). Low-attrition programs were more likely than high-attrition programs to use resident remediation (21.0% vs 6.8%; P < .001). Median (IQR) Qualifying Examination pass rates (93% [90%-98%] vs 92% [86%-100%]; P = .92) and Certifying Examination pass rates (83% [68%-84%] vs 81% [71%-86%]; P = .47) were similar. Program directors at high-attrition programs were more likely than their counterparts at low-attrition programs to agree with this statement: "I feel that it is my responsibility as a program director to redirect residents who should not be surgeons." Conclusions and Relevance The overall 5-year attrition rate of 8.8% was significantly lower than previously reported. Program directors at low-attrition programs were more likely to use resident remediation. Variations in attrition may be explained by program director attitudes, although larger studies are needed to further define program factors affecting attrition.
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Affiliation(s)
- Alexander C Schwed
- Department of Surgery, Harbor-UCLA (University of California, Los Angeles) Medical Center, Torrance
| | - Steven L Lee
- Department of Surgery, Harbor-UCLA (University of California, Los Angeles) Medical Center, Torrance.,Los Angeles BioMedical Research Institute, Torrance, California
| | | | - Mark E Reeves
- Department of Surgery, Loma Linda University, Loma Linda, California
| | - Kenji Inaba
- Department of Surgery, University of Southern California, Los Angeles
| | - Richard A Sidwell
- Department of Surgery, Central Iowa Health System, Iowa Methodist Medical Center, Des Moines
| | - Farin Amersi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chandrakanth Are
- Department of Surgery, University of Nebraska Medical Center, Omaha
| | - Tracey D Arnell
- Department of Surgery, Columbia University, New York, New York
| | | | - Daniel L Dent
- Department of Surgery, University of Texas Health Science Center at San Antonio
| | | | - Jeffrey Gauvin
- Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California
| | - Thomas Hartranft
- Department of Surgery, Mount Carmel Health System, Columbus, Ohio
| | - Garth R Jacobsen
- Department of Surgery, University of California, San Diego, San Diego
| | - Benjamin T Jarman
- Department of Surgery, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin
| | - Marc L Melcher
- Department of Surgery, Stanford University, Palo Alto, California
| | - John D Mellinger
- Department of Surgery, Southern Illinois University School of Medicine, Springfield
| | - Jon B Morris
- Department of Surgery, University of Pennsylvania, Philadelphia
| | - Mark Nehler
- Department of Surgery, University of Colorado, Denver, Aurora
| | - Brian R Smith
- Department of Surgery, University of California, Irvine, Irvine
| | - Mary Wolfe
- Department of Surgery, University of San Francisco at Fresno, Fresno, California
| | - Amy H Kaji
- Los Angeles BioMedical Research Institute, Torrance, California.,Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Christian de Virgilio
- Department of Surgery, Harbor-UCLA (University of California, Los Angeles) Medical Center, Torrance.,Los Angeles BioMedical Research Institute, Torrance, California
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Gardner AK, Steffes CP, Nepomnayshy D, Nicholas C, Widmann WD, Fitzgibbons SC, Dunkin BJ, Jones DB, Paige JT. Selection bias: Examining the feasibility, utility, and participant receptivity to incorporating simulation into the general surgery residency selection process. Am J Surg 2017; 213:1171-1177. [DOI: 10.1016/j.amjsurg.2016.09.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/14/2016] [Accepted: 09/16/2016] [Indexed: 11/28/2022]
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Turner JA, Fitzsimons MG, Pardo MC Jr, Hawkins JL, Huang YM, Rudolph MD, Keyes MA, Howard-Quijano KJ, Naim NZ, Buckley JC, Grogan TR, Steadman RH. Effect of Performance Deficiencies on Graduation and Board Certification Rates: A 10-yr Multicenter Study of Anesthesiology Residents. Anesthesiology 2016; 125:221-9. [PMID: 27119434 DOI: 10.1097/ALN.0000000000001142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This multicenter, retrospective study was conducted to determine how resident performance deficiencies affect graduation and board certification. METHODS Primary documents pertaining to resident performance were examined over a 10-yr period at four academic anesthesiology residencies. Residents entering training between 2000 and 2009 were included, with follow-up through February 2016. Residents receiving actions by the programs' Clinical Competency Committee were categorized by the area of deficiency and compared to peers without deficiencies. RESULTS A total of 865 residents were studied (range: 127 to 275 per program). Of these, 215 residents received a total of 405 actions from their respective Clinical Competency Committee. Among those who received an action compared to those who did not, the proportion graduating differed (93 vs. 99%, respectively, P < 0.001), as did the proportion achieving board certification (89 vs. 99%, respectively, P < 0.001). When a single deficiency in an Essential Attribute (e.g., ethical, honest, respectful behavior; absence of impairment) was identified, the proportion graduating dropped to 55%. When more than three Accreditation Council for Graduate Medical Education Core Competencies were deficient, the proportion graduating also dropped significantly. CONCLUSIONS Overall graduation and board certification rates were consistently high in residents with no, or isolated, deficiencies. Residents deficient in an Essential Attribute, or multiple competencies, are at high risk of not graduating or achieving board certification. More research is needed on the effectiveness and selective deployment of remediation efforts, particularly for high-risk groups.
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van Mook WNKA, van Luijk SJ, Zwietering PJ, Southgate L, Schuwirth LWT, Scherpbier AJJA, van der Vleuten CPM. The threat of the dyscompetent resident: A plea to make the implicit more explicit! Adv Health Sci Educ Theory Pract 2015; 20:559-74. [PMID: 24927810 DOI: 10.1007/s10459-014-9526-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/28/2014] [Indexed: 05/26/2023]
Abstract
Although several examples of frameworks dealing with students' unprofessional behaviour are available, guidance on how to deal locally or regionally with dysfunctional residents is limited (Hickson et al. in Acad Med 82(11):1040-1048, 2007b; Leape and Fromson in Ann Intern Med 144(2):107-115, 2006). Any 'rules' are mostly unwritten, and often emerge by trial and error within the specialty training programme (Stern and Papadakis in N Engl J Med 355(17):1794-1799, 2006). It is nevertheless of utmost importance that objectives, rules and guidelines comparable to those existing in undergraduate training (Project Team Consilium Abeundi van Luijk in Professional behaviour: teaching, assessing and coaching students. Final report and appendices. Mosae Libris, 2005; van Mook et al. in Neth J Crit Care 16(4):162-173, 2010a) are developed for postgraduate training. And that implicit rules are made explicit. This article outlines a framework based on the lessons learned from contemporary postgraduate medical training programmes.
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Affiliation(s)
- Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands,
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Badran KW, Kelley K, Conderman C, Mahboubi H, Armstrong WB, Bhandarkar ND. Improving applicant selection: Identifying qualities of the unsuccessful otolaryngology resident. Laryngoscope 2014; 125:842-7. [DOI: 10.1002/lary.24860] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 07/02/2014] [Accepted: 07/07/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Karam W. Badran
- Department of Otolaryngology-Head and Neck Surgery; University of California-Irvine; Irvine California U.S.A
| | - Kanwar Kelley
- Department of Otolaryngology-Head and Neck Surgery; University of California-Irvine; Irvine California U.S.A
| | - Christian Conderman
- Department of Otolaryngology-Head and Neck Surgery; University of California-Irvine; Irvine California U.S.A
| | - Hossein Mahboubi
- Department of Otolaryngology-Head and Neck Surgery; University of California-Irvine; Irvine California U.S.A
| | - William B. Armstrong
- Department of Otolaryngology-Head and Neck Surgery; University of California-Irvine; Irvine California U.S.A
| | - Naveen D. Bhandarkar
- Department of Otolaryngology-Head and Neck Surgery; University of California-Irvine; Irvine California U.S.A
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Visconti A, Gaeta T, Cabezon M, Briggs W, Pyle M. Focused Board Intervention (FBI): A Remediation Program for Written Board Preparation and the Medical Knowledge Core Competency. J Grad Med Educ 2013; 5:464-7. [PMID: 24404311 PMCID: PMC3771177 DOI: 10.4300/jgme-d-12-00229.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 01/08/2013] [Accepted: 02/04/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Residents deemed at risk for low performance on standardized examinations require focused attention and remediation. OBJECTIVE To determine whether a remediation program for residents identified as at risk for failure on the Emergency Medicine (EM) Written Board Examination is associated with improved outcomes. INTERVENTION All residents in 8 classes of an EM 1-3 program were assessed using the In-Training Examination. Residents enrolled in the Focused Board Intervention (FBI) remediation program based on an absolute score on the EM 3 examination of <70% or a score more than 1 SD below the national mean on the EM 1 or 2 examination. Individualized education plans (IEPs) were created for residents in the FBI program, combining self-study audio review lectures with short-answer examinations. The association between first-time pass rate for the American Board of Emergency Medicine (ABEM) Written Qualifying Examination (WQE) and completion of all IEPs was examined using the χ(2) test. RESULTS Of the 64 residents graduating and sitting for the ABEM examination between 2000 and 2008, 26 (41%) were eligible for the program. Of these, 10 (38%) residents were compliant and had a first-time pass rate of 100%. The control group (12 residents who matched criteria but graduated before the FBI program was in place and 4 who were enrolled but failed to complete the program) had a 44% pass rate (7 of 16), which was significantly lower (χ(2) = 8.6, P = .003). CONCLUSIONS The probability of passing the ABEM WQE on the first attempt was improved through the completion of a structured IEP.
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Kenny S, McInnes M, Singh V. Associations between residency selection strategies and doctor performance: a meta-analysis. Med Educ 2013; 47:790-800. [PMID: 23837425 DOI: 10.1111/medu.12234] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 02/04/2013] [Accepted: 03/21/2013] [Indexed: 05/17/2023]
Abstract
OBJECTIVES The purpose of this study was to use meta-analysis to establish which of the information available to the resident selection committee is associated with resident or doctor performance. METHODS Multiple electronic databases were searched to 4 September 2012. Two reviewers independently selected studies that met the present inclusion criteria and extracted data in duplicate; disagreement was resolved by consensus. Risk for bias was assessed using a customised bias assessment tool. Measures of association were converted to a common effect size (Hedges' g). Meta-analysis was performed using the random-effects model for each selection strategy and all outcomes without pooling. Sensitivity analysis for each selection strategy-outcome pair was performed with pooling of effect size. RESULTS Eighty studies involving a total of 41 704 participants were included in the meta-analysis. Seventeen different selection strategies and 17 outcomes were assessed across these studies. The strongest positive associations referred to examination-based selection strategies, such as the US Medical Licensing Examination (USMLE) Step 1, and examination-based outcomes, such as scores on in-training examinations. Moderate positive associations were present for medical school marks and both examination-based and subjective outcomes. Minimal or no associations were seen for the selection tools represented by interviews, reference letters and deans' letters. CONCLUSIONS Standardised examination performance and medical school grades show the strongest associations with current measures of doctor performance. Deans' letters, reference letters and interviews all show a lower than expected strength of association given the relative value often assigned to them during resident doctor selection. Objective selection strategies are potentially the most useful to residency selection committees based on current evaluative methods. However, reports in the literature of validated long-term doctor performance outcomes are scant.
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Affiliation(s)
- Stephanie Kenny
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Zbieranowski I, Takahashi SG, Verma S, Spadafora SM. Remediation of residents in difficulty: a retrospective 10-year review of the experience of a postgraduate board of examiners. Acad Med 2013; 88:111-6. [PMID: 23165267 DOI: 10.1097/acm.0b013e3182764cb6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To determine, through a 10-year review, (1) the prevalence of residents in difficulty, (2) characteristics of these residents, (3) areas of residents' weakness, and (4) outcomes of residents who undergo remediation. METHOD A retrospective review of resident records for the University of Toronto Faculty of Medicine's (UT-FOM) Board of Examiners for Postgraduate Programs (BOE-PG) was done from July 1, 1999 to June 30, 2009 using predetermined data elements entered into a standardized form and analyzed for trends and significance. Outcomes for residents in difficulty were tracked through university registration systems and licensure databases. RESULTS During 10 years, 103 UT-FOM residents were referred to the BOE-PG, representing 3% of all residents enrolled. The annual prevalence of residents referred to the BOE-PG ranged from 0.2% to 1.5%. The CanMEDS framework was used to classify areas of residents' weaknesses and organize remediation plans. All 100 residents studied had either medical expertise (85%) or professionalism (15%) weaknesses or both. Residents had difficulties with an average of 2.6 CanMEDS Roles, with highest frequencies of Medical Expert (85%) Professional (51%), Communicator (49%), Manager (43%), and Collaborator (20%). Often, there were multiple remediation periods, with an average of six months' duration. Usually, remediation was successful; 78% completed residency education, 17% were unsuccessful, and 5% remained in training. CONCLUSION Residents in difficulty have multiple areas of weakness. The CanMEDS framework is an effective approach to classifying problems and designing remediation plans. Successful completion of residency education after remediation is the most common outcome.
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Affiliation(s)
- Ingrid Zbieranowski
- Laboratory Medicine and Pathobiology, University of Toronto Faculty of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Makhani L, Bradley R, Wong J, Krynski E, Jarvis A, Szumacher E. A Framework for Successful Remediation within Allied Health Programs: Strategies Based on Existing Literature. J Med Imaging Radiat Sci 2012; 43:112-120. [DOI: 10.1016/j.jmir.2011.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 11/14/2011] [Accepted: 12/05/2011] [Indexed: 10/14/2022]
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Dupras DM, Edson RS, Halvorsen AJ, Hopkins RH, McDonald FS. "Problem residents": prevalence, problems and remediation in the era of core competencies. Am J Med 2012; 125:421-5. [PMID: 22444106 DOI: 10.1016/j.amjmed.2011.12.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 12/22/2011] [Indexed: 10/28/2022]
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Roberts NK, Williams RG, Klingensmith M, Sullivan M, Boehler M, Hickson G, Kim MJ, Klamen DL, Leblang T, Schwind C, Titchenal K, Dunnington GL. The case of the entitled resident: a composite case study of a resident performance problem syndrome with interdisciplinary commentary. Med Teach 2012; 34:1024-32. [PMID: 22957508 DOI: 10.3109/0142159x.2012.719654] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Residents with performance problems create substantial burden on programs and institutions. Understanding the nature and quality of performance problems can help in learning to address performance problems. AIM We sought to illuminate the effects of resident performance problems and the potential solutions for those problems from the perspectives of people with various roles in health care. METHODS We created a composite portrait from several residents who demonstrated a cluster of common performance characteristics and whose chronic or serious maladaptive behavior and response to situations created problems for themselves, for their clinical colleagues, and for faculty of their residency program. The composite was derived from in-depth interviews of program directors and review of resident records. We solicited practitioners from multiple fields to respond to the portrait by answering a series of questions about severity, prognosis, and how and whether one could reliably remediate a person with these performance characteristics. We present their perspectives in a manner borrowed from the New England Journal of Medicine's "Case Records of the Massachusetts General Hospital." RESULTS We created a composite portrait of a resident whose behavior suggested he felt entitled to benefits his peers were not entitled to. Experts reflecting on his behavior varied in their opinion about the effect the resident would have on the health care system. They suggested approaches to remediation that required substantial time and effort from the faculty. CONCLUSION Programs must balance the needs of individual residents to adjust their behaviors with the needs of the health care system and other people within it.
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Affiliation(s)
- Nicole K Roberts
- Department of Medical Education, Southern Illinois University School of Medicine, P.O. Box 19681, Springfield, IL 62794-9681, USA.
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Williams RG, Roberts NK, Schwind CJ, Dunnington GL. The nature of general surgery resident performance problems. Surgery 2009; 145:651-8. [DOI: 10.1016/j.surg.2009.01.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 01/12/2009] [Indexed: 10/20/2022]
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Abstract
BACKGROUND This study sought to determine to what extent surgery programs are remediating residents who fail to achieve competency and to offer remediation strategies. METHODS A web-based survey was e-mailed to 253 program directors of all US surgery residency programs. Questions were asked about remediation and probation practices for residents failing to meet the competencies. RESULTS Programs seem to struggle the least with knowing how to remediate medical knowledge and patient care deficits and struggle more with professionalism and interpersonal communication skills. Most programs have no remediation methods in place for systems-based practice and practice-based learning and improvement deficits. CONCLUSIONS Surgery residency programs are cognizant of the reality that some residents perform unsatisfactorily. Most have remediation plans for residents and understand that a process needs to be in place. Remediation methods tend to vary depending on the deficit and are devised tailored to the resident's needs.
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Affiliation(s)
- Laura Torbeck
- Department of Surgery, Indiana University, Indianapolis IN 46202, USA.
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Longo WE, Seashore J, Duffy A, Udelsman R. Attrition of categoric general surgery residents: results of a 20-year audit. Am J Surg 2009; 197:774-8; discussion 779-80. [PMID: 19178898 DOI: 10.1016/j.amjsurg.2008.06.038] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 06/25/2008] [Accepted: 06/25/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Attrition of general surgery residents is of continued concern in graduate medical education. It results in loss of morale and resources and often leaves programs scrambling to find replacement residents. The aim of this study was to evaluate the incidence of attrition of categoric general surgery residents as well as the fate of those who left the general surgery training program among a defined cohort of categoric general surgery residents in a university hospital residency training program. METHODS We retrospectively reviewed the files of all general surgery residents at the Yale University School of Medicine-Yale New Haven Hospital Surgery Program who began as categoric interns from July 1, 1986 to June 30, 2006. Ninety-nine residents were identified. Attrition of residents was divided into withdrawals (changed specialty or left graduate medical education), transfers (transferred to a different program in general surgery), and dismissals (dismissed from the program). RESULTS Among the 99 residents who began as categoric interns from 1986 to 2006, 66 of 99 (67%) were men. Thirty of 99 (30%) failed to complete the general surgery training program. Of these, 21 of 30 (70%) withdrew, 5 of 30 (17%) transferred, and 4 of 30 (13%) were dismissed. Attrition occurred before entering the third clinical year in 23 of 30 (77%). Two of 30 (7%) left graduate medical education. Thirteen of 21 (62%) who withdrew entered primary care or another nonsurgical specialty, whereas 7 of 21 (38%) matriculated into a surgical subspecialty. The attrition rate was 40% (12 of 30) since the academic year 2000. The overall annual attrition rate for the past 20 years was 6.7%. COMMENTS Attrition in our general surgery training remains low. Most who leave remain in graduate medical education and transfer to a different specialty. The overwhelming majority leave before beginning their third clinical year. Although our 6.7% annual attrition rate remains favorable (national attrition rate in general surgery 5.8%), we must continue to analyze the root causes and solutions.
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Abstract
BACKGROUND Professionalism is comprised of a set of values and behaviours that underpin the social contract between the public and the medical profession. Medical errors are reported to result in significant morbidity and mortality and are in-part related to underdeveloped professionalism. AIMS The aim was to determine whether specific aspects of professionalism were underdeveloped in medical students. METHOD A questionnaire with 24 vignettes was taken by Year 2, 4, and 6 medical students and their responses were compared to responses from practicing Medical Academics. RESULTS Second, fourth and sixth Year medical students' responses differed from Academics in two aspects of professionalism, firstly, high ethical and moral standards and secondly, humanistic values such as integrity and honesty. Only Year 2 medical students' responses were different from Academics when it came to responsibility and accountability. CONCLUSIONS Certain aspects of professionalism seem to be underdeveloped in medical students. These aspects of professionalism may need to be targeted for teaching and assessment in order that students develop as professionally responsible practitioners. In turn, students with well-developed professionalism may be less involved in medical error, and if involved they may have the personal values which can help them deal with error more honestly and effectively.
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Chambers JA. Preparing for the in-training service examination. Curr Surg 2006; 63:354-5. [PMID: 16971209 DOI: 10.1016/j.cursur.2006.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 04/12/2006] [Indexed: 05/11/2023]
Affiliation(s)
- James A Chambers
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
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Binenbaum G, Volpe NJ. Ophthalmology resident surgical competency: a national survey. Ophthalmology 2006; 113:1237-44. [PMID: 16725202 DOI: 10.1016/j.ophtha.2006.03.026] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Revised: 03/13/2006] [Accepted: 03/13/2006] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To describe the prevalence, management, and career outcomes of ophthalmology residents who struggle with surgical competency and to explore related educational issues. DESIGN Fourteen-question written survey. PARTICIPANTS Fifty-eight program directors at Accreditation Council on Graduate Medical Education-accredited, United States ophthalmology residency programs, representing a total of 2179 resident graduates, between 1991 and 2000. METHODS Study participants completed a mailed, anonymous survey whose format combined multiple choice and free comment questions. MAIN OUTCOME MEASURES Number of surgically challenged residents, types of problems identified, types of remediation, final departmental decision at the end of residency, known career outcomes, and residency program use of microsurgical skills laboratories and applicant screening tests. RESULTS One hundred ninety-nine residents (9% overall; 10% mean per program) were labeled as having trouble mastering surgical skills. All of the programs except 2 had encountered such residents. The most frequently cited problems were poor hand-eye coordination (24%) and poor intraoperative judgment (22%). Most programs were supportive and used educational rather than punitive measures, the most common being extra practice-laboratory time (32%), scheduling cases with the best teaching surgeon (23%), and counseling (21%). Nearly one third (31%) of residents were believed to have overcome their difficulties before graduation. Other residents were encouraged to pursue medical ophthalmology (22%) or to obtain further surgical training through a fellowship (21%) or a supervised practice setting (12%); these residents were granted a departmental statement of satisfactory completion of residency for Board eligibility. Twelve percent were asked to leave residency. Of reported career outcomes, 92% of residents were practicing ophthalmology, 65% as surgical and 27% as medical ophthalmologists. Ninety-eight percent of residency programs had microsurgical practice facilities, 64% had a formal teaching course, and 36% had mandatory practice time. Most programs (76%) did not perform applicant vision or dexterity screening tests; questions existed about the legality and validity of such tests. CONCLUSIONS The issue of ophthalmology residents who struggle to develop surgical competency appears common. Although many problems appear to be remediable with time, practice, and dedicated, patient teachers, more specific guidelines for a statement of surgical competency are likely necessary to standardize the Board certification process.
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Affiliation(s)
- Gil Binenbaum
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Abstract
The concept of a philosophy of surgical education provides a vehicle for ensuring that there is a united and comprehensive approach to surgical training. This is important because none of the current approaches to higher education provides a suitable model for surgical training and it is dangerous to uncritically adopt every prevailing fashion in education.
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Affiliation(s)
- John C Hall
- Department of Surgery, University of Western Australia, Royal Perth Hospital, Wellington St., Perth W.A. 6000, Australia.
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Scott DJ, Valentine RJ, Bergen PC, Rege RV, Laycock R, Tesfay ST, Jones DB. Evaluating surgical competency with the American Board of Surgery In-Training Examination, skill testing, and intraoperative assessment. Surgery 2000; 128:613-22. [PMID: 11015095 DOI: 10.1067/msy.2000.108115] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Evaluation of surgical competency should include assessment of knowledge, technical skill, and judgment. The purpose of this study was to determine the relationship between the American Board of Surgery In-Training Examination (ABSITE), skill testing, and intraoperative assessment. METHODS Postgraduate year 2 (PGY-2) and postgraduate year 3 (PGY-3) surgery residents (n = 33) were tested by means of (1) the ABSITE, (2) skill testing on a laparoscopic video-trainer, and (3) intra-operative global assessments during laparoscopic cholecystectomy. The Pearson correlation was used to determine the correlation between the ABSITE, skill testing, and intraoperative assessments. For the comparison of PGY-2 and PGY-3 resident performance, Wilcoxon rank sum tests were used. RESULTS The ABSITE scores did not correlate with skill testing or intraoperative assessments (not significant). Skill testing correlated with the intraoperative composite score and with 4 of 8 operative performance criteria (P<.05). The ABSITE scores and skill testing were not different for PGY-2 and PGY-3 residents (not significant). Intraoperative assessments were better in 5 of 8 criteria and the composite score for PGY-3 versus PGY-2 residents (P<.05), which demonstrated construct validity. CONCLUSIONS The ABSITE measures knowledge but does not correlate with technical skill or operative performance. Residency programs should use multiple assessment instruments to evaluate competency. There may be a role for both skill testing and intraoperative assessment in the evaluation of surgical competency.
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Affiliation(s)
- D J Scott
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9092, USA
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