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Chen F, Belgique ST, Canter C, Boscardin CK, Willie C, Mitchell JD, Sullivan K, Martinelli SM. Unprofessionalism in anesthesiology: A qualitative study on classifying unprofessional behavior in anesthesiology residency education. J Clin Anesth 2024; 95:111429. [PMID: 38460412 DOI: 10.1016/j.jclinane.2024.111429] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/16/2024] [Accepted: 02/24/2024] [Indexed: 03/11/2024]
Abstract
STUDY OBJECTIVE This study aims to identify the domains that constitute behaviors perceived to be unprofessional in anesthesiology residency training programs. DESIGN Qualitative study. SETTING Anesthesiology residency training programs. PATIENTS Not applicable. The participants involved residents, fellows, and faculty members purposefully sampled in four US-based anesthesiology residency programs. INTERVENTIONS Participants were asked to submit examples of unprofessional behavior they witnessed in anesthesiology residents, fellows, or faculty members via a Qualtrics link. MEASUREMENTS Not applicable. The behavior examples were independently reviewed and categorized into themes using content analysis. MAIN RESULTS A total of 116 vignettes were collected, resulting in a final list of 111 vignettes after excluding those that did not describe behavior exhibited by anesthesiology faculty or trainees. Fifty-eight vignettes pertained to unprofessional behaviors observed in faculty members and 53 were observed in trainees (residents and fellows). Nine unprofessionalism themes emerged in the analysis. The most common themes were VERBAL, SUPERVISION, QUALITY, ENGAGEMENT, and TIME. As to the distribution of role group (faculty versus trainee) by theme, unprofessional behaviors falling into the categories of BIAS, GOSSIP, LEWD, and VERBAL were observed more in faculty; whereas themes with unprofessional behavior primarily attributed to trainees included ENGAGEMENT, QUALITY, TIME, and SUPERVISION. CONCLUSION By reviewing reported professionalism-related vignettes within residency training programs, we identified classification descriptors for defining unprofessional behavior specific to anesthesiology residency education. Findings from this study enrich the definition of professionalism as a multi-dimensional competency pertaining to anesthesiology graduate medical education. This framework may facilitate preventative intervention and timely remediation plans for unprofessional behavior in residents and faculty.
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Affiliation(s)
- Fei Chen
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, United States.
| | | | - Courtney Canter
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, United States
| | - Christy K Boscardin
- Department of Anesthesiology and Perioperative Care, University of California San Francisco, San Francisco, CA, 94143, United States
| | - Chelsea Willie
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
| | - John D Mitchell
- Department of Anesthesiology, Pain Management, and Perioperative Care, Henry Ford Health, Detroit, MI, 48105, United States; Department of Anesthesiology, Michigan State University College of Human Medicine, Grand Rapids, MI, 49503, United States
| | - Kristina Sullivan
- Department of Anesthesiology and Perioperative Care, University of California San Francisco, San Francisco, CA, 94143, United States
| | - Susan M Martinelli
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, United States
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Conway SE, Wang W, Prasad S. Barriers to increasing paid parental leave in U.S. neurology residencies: a survey of program directors. BMC Med Educ 2024; 24:387. [PMID: 38594709 PMCID: PMC11003009 DOI: 10.1186/s12909-024-05333-1] [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: 08/21/2023] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The American Board of Psychiatry and Neurology (ABPN) and the Accreditation Council for Graduate Medical Education (ACGME) require that residency programs allow at least 6 weeks of parental leave. The American Medical Association (AMA) recommends 12 weeks of paid parental leave. Despite these recommendations, there is little information about parental leave policies across U.S. neurology residencies. The objective of our study was to assess parental leave policies in U.S. adult neurology residencies and barriers to increasing the duration of leave. METHODS We distributed an anonymous online survey to U.S. adult neurology program directors (PDs) to assess demographics, components and length of parental leave, perceived impact on residents' clinical training and academic development, and barriers to increasing the length of leave. RESULTS We contacted 163 PDs and received 54 responses (response rate of 33%). 87% reported policies for both childbearing and non-childbearing residents. The average maximal length of leave allowed without extension of training was 8.5 weeks (range 0-13) for childbearing and 6.2 weeks (range 0-13) for non-childbearing residents. Most PDs felt that parental leave had a positive impact on resident wellness and neutral impact on clinical competency, academic opportunities, and career development. The most common barriers to providing a 12-week paid policy were concerns about equity in the program (82%), staffing of clinical services (80%), and impact on clinical training (78%). CONCLUSIONS Although most programs in our study have parental leave policies, there is significant variability. Policies to improve parental leave should focus on addressing common barriers, such as additional solutions to staffing clinical services.
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Affiliation(s)
- Sarah E Conway
- Department of Neurology, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Wei Wang
- Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Sashank Prasad
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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McGourty CA, Castillo F, Donzelli G, Keenan BP, Gilbreth M, Santhosh L. Creation of a sustainable longitudinal women in Leadership Development (WILD) curriculum focused on graduate medical education trainees. BMC Med Educ 2024; 24:374. [PMID: 38580971 PMCID: PMC10996076 DOI: 10.1186/s12909-024-05369-3] [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: 07/14/2023] [Accepted: 03/28/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Although women comprise the majority of medical students, gender disparities emerge early and remain at the highest levels of academia. Most leadership courses focus on faculty or students rather than women graduate medical education (GME) trainees. AIM To promote the leadership development of women GME trainees through empowerment, community building, networking and mentorship, and concrete leadership skills development. SETTING University of California, San Francisco. PARTICIPANTS 359 women residents and fellows from 41 specialties. PROGRAM DESCRIPTION A longitudinal curriculum of monthly workshops designed to support leadership development for women trainees. Sessions and learning objectives were designed via needs assessments and literature review. PROGRAM EVALUATION A mixed-methods evaluation was performed for 3 years of WILD programming. Quantitative surveys assessed participant satisfaction and fulfillment of learning objectives. Structured interview questions were asked in focus groups and analyzed qualitatively. DISCUSSION 23% of invited participants attended at least one session from 2018 to 2021, despite challenging trainee schedules. Surveys demonstrated acceptability and satisfaction of all sessions, and learning objectives were met at 100% of matched sessions. Focus groups highlighted positive impact in domains of community-building, leadership skills, mentorship, and empowerment. This program has demonstrated WILD's longitudinal sustainability and impact for women trainees.
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Affiliation(s)
- Colleen A McGourty
- University of California, San Francisco, 505 Parnassus Ave., 94143, San Francisco, CA, USA
| | - Francine Castillo
- University of California, San Francisco, 505 Parnassus Ave., 94143, San Francisco, CA, USA
| | - Grace Donzelli
- University of California, San Francisco, 505 Parnassus Ave., 94143, San Francisco, CA, USA
| | - Bridget P Keenan
- University of California, San Francisco, 505 Parnassus Ave., 94143, San Francisco, CA, USA
| | - Margaret Gilbreth
- University of California, San Francisco, 505 Parnassus Ave., 94143, San Francisco, CA, USA
| | - Lekshmi Santhosh
- University of California, San Francisco, 505 Parnassus Ave., 94143, San Francisco, CA, USA.
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Chan S, Cho JS, Andrew C, Hao D. The modern anesthesiologist's manual: the development and maintenance of an anesthesia case reference application. J Clin Monit Comput 2024:10.1007/s10877-024-01153-2. [PMID: 38561556 DOI: 10.1007/s10877-024-01153-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
Anesthesia clinicians care for patients undergoing a wide range of procedures, making access to reliable references crucial. However, existing resources have key limitations. This technical report describes the development of an in-house anesthesia case reference application designed for use in a tertiary academic hospital. Additionally, it details our experiences in maintaining this system over a 22-month period and compares this system to alternative resources. Utilizing JavaScript and the React library, we developed a cross-platform perioperative reference application. Over fifty articles, encompassing anesthetic considerations for various surgical disciplines, have been created. Furthermore, we conducted a preliminary analysis of analytics data. In the 22 months since the application's inception, the application has garnered over 22,000 views from local users. While there are more than 150 registered users, the number of unregistered users accessing the application on the hospital network remains unknown. Notably, 70% of users accessed the application through a mobile device. The most popular articles centered around procedures with diverse and specific surgeon preferences. Currently, the reported case reference application is routinely utilized by anesthesia clinicians at our institution. Future endeavors will concentrate on establishing a robust content management workflow to broaden the coverage of topics.
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Affiliation(s)
- Stephanie Chan
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- St. George's University, St. George's, Grenada
| | - James S Cho
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Caroline Andrew
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David Hao
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Musa A, Hall H, Johnson SC, Alchammas J, Badawy M, Harb A. The role of moonlighting in radiology residency. Clin Imaging 2024; 108:110083. [PMID: 38340436 DOI: 10.1016/j.clinimag.2024.110083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/13/2023] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Arif Musa
- Department of Radiology, Detroit Medical Center, Detroit, MI 48201, United States of America.
| | - Hunter Hall
- Department of Radiology, Detroit Medical Center, Detroit, MI 48201, United States of America
| | - Samuel C Johnson
- Department of Radiology, Detroit Medical Center, Detroit, MI 48201, United States of America
| | - Jorge Alchammas
- Department of Radiology, Detroit Medical Center, Detroit, MI 48201, United States of America
| | - Mohamed Badawy
- Department of Radiology, Detroit Medical Center, Detroit, MI 48201, United States of America
| | - Ali Harb
- Department of Radiology, Detroit Medical Center, Detroit, MI 48201, United States of America
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Hunt AA, Calderon C, Bishop JA. Factors affecting residency selection for underrepresented minorities pursuing orthopaedic surgery. J Natl Med Assoc 2024; 116:139-144. [PMID: 38195326 DOI: 10.1016/j.jnma.2023.12.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/23/2023] [Accepted: 12/05/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND The United States is increasingly diverse and there are many benefits to an equally diverse physician workforce. Despite this, the percentage of under-represented minorities in orthopaedic surgery has remained stagnant. The purpose of this study was to describe the characteristics underrepresented minorities pursuing orthopaedic surgery value most when evaluating residency programs. METHODS The contact information of current underrepresented minority orthopaedic surgery residents were obtained through professional society databases, residency program coordinators and residency program websites. Individuals were sent a survey through which they evaluated the importance of a variety of program characteristics. RESULTS The most influential program characteristics were resident happiness and camaraderie, program reputation, geographic location, and relationships between residents and attendings. The least influential characteristics were sub-internship scholarship opportunities for minorities, program affiliation with diversity organizations, word of mouth from others, number of fellows, and centralized training sites. CONCLUSIONS There is a need to diversify the field of orthopaedic surgery, which begins by selecting more diverse trainees. This study demonstrates that underrepresented applicants are most influenced by many of the same characteristics as their well-represented peers. However, diversity-related factors still play an important role in the decision-making process. Many residents highlighted the impact microaggressions and mistreatment played in their residency experience, emphasizing the need for residency programs to focus not only on recruitment, but also on the successes and retention of their residents. Only once this is done will the field of orthopaedic surgery find sustained improvement in its diversification efforts.
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Affiliation(s)
- Anastasia A Hunt
- Stanford University, Department of Orthopedic Surgery, Stanford, CA, USA.
| | - Christian Calderon
- Stanford University, Department of Orthopedic Surgery, Stanford, CA, USA
| | - Julius A Bishop
- Stanford University, Department of Orthopedic Surgery, Stanford, CA, USA
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Mahlknecht A, Engl A, Barbieri V, Bachler H, Obwegeser A, Piccoliori G, Wiedermann CJ. Attitudes towards career choice and general practice: a cross-sectional survey of medical students and residents in Tyrol, Austria. BMC Med Educ 2024; 24:294. [PMID: 38491385 PMCID: PMC10943776 DOI: 10.1186/s12909-024-05205-8] [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: 10/26/2023] [Accepted: 02/21/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND The global primary healthcare workforce is declining, leading to a shortage of general practitioners. Although various educational models aim to increase interest in general practice, effective interventions are limited. The reasons for this low appeal among medical graduates remain unclear. METHODS This cross-sectional study surveyed medical students' and residents' attitudes towards general practice in Tyrol, Austria. The online questionnaire addressed professional values, general practice-related issues, personal professional intentions, and demographics. Data analysis employed chi-square tests and multivariate logistic regression to explore predictors of interest in general practice. RESULTS The study included 528 students and 103 residents. Key values identified were stable positions, assured income, and work-family reconciliation. General practice was recognised for long-term patient relationships and patient contact, with students attributing more positive work-environmental characteristics and higher reputation to it than residents. Few participants (students: 3.2%, residents: 11.7%) had opted for general practice; about half were considering it as career option. Reasons not to choose general practice were preferences for other specialties, intrinsic characteristics of general practice, workload, insufficient time for the patients, financial pressures, low reputation, and perceived mediocre training quality. Predictors of interest in general practice included perception of independent decision-making, importance of work-family balance (students), better practical experiences in general practice during medical school (students and residents), younger age, and perceiving general practice as offering a promising future (residents). Both groups felt underprepared by medical school and/or general practice training for general practice roles. The attractiveness of specialist medicine over general practice was related to clearer content boundaries, better career opportunities, and higher incomes. CONCLUSIONS According to these results, measures to improve attractiveness of general practice should focus on (i) high-quality undergraduate education including practical experiences, and (ii) on ensuring professional autonomy, work-family reconciliation, and job stability. Efforts to encourage more graduates to pursue this essential healthcare sector are crucial for strengthening primary healthcare and public health services. TRIAL REGISTRATION The study has not been registered as it did not include a direct medical intervention on human participants.
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Affiliation(s)
- Angelika Mahlknecht
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz-Boehler-street 13, Bolzano, 39100, Italy.
| | - Adolf Engl
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz-Boehler-street 13, Bolzano, 39100, Italy
| | - Verena Barbieri
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz-Boehler-street 13, Bolzano, 39100, Italy
| | - Herbert Bachler
- Institute of General Practice, Medical University Innsbruck, Christoph-Probst-square 1, Innsbruck, 6020, Austria
| | - Alois Obwegeser
- Department of Neurosurgery, University Hospital of Innsbruck, Anich-street 35, Innsbruck, 6020, Austria
| | - Giuliano Piccoliori
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz-Boehler-street 13, Bolzano, 39100, Italy
| | - Christian J Wiedermann
- Institute of General Practice and Public Health, College of Health Care Professions, Lorenz-Boehler-street 13, Bolzano, 39100, Italy.
- UMIT - Private University for Health Sciences, Medical Informatics and Technology - Tyrol, Eduard- Wallnöfer-center 1, Hall in Tirol, 6060, Austria.
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Thomas LR, Ripp JA, Duncan JG. Graduate medical education well-being directors in the United States: who are they, and what does the role entail? BMC Med Educ 2024; 24:254. [PMID: 38459448 PMCID: PMC10921812 DOI: 10.1186/s12909-024-05243-2] [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: 10/12/2023] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Institutional Graduate Medical Education (GME) Well-being Director (WBD) roles have recently emerged in the United States to support resident and fellow well-being. However, with a standard position description lacking, the current scope and responsibilities of such roles is unknown. This study describes the scope of work, salary support, and opportunities for role definition for those holding institutional leadership positions for GME well-being. METHODS In November 2021, 43 members of a national network of GME WBDs in the United States were invited to complete a cross-sectional survey that included questions about job responsibilities, percent effort, and dedicated budget, and a free text response question about unique leadership challenges for GME WBDs. The survey was analyzed using descriptive statistics for quantitative data and thematic analysis for qualitative data. RESULTS 26 members (60%) responded. Most were physicians, and the majority identified as female and White. Median percent effort salary support was 40%. A small minority reported overseeing an allocated budget. Most respondents worked to improve access to mental health services, oversaw institution-wide well-being programs, designed or delivered well-being content, provided consultations to individual programs, met with trainees, and partnered with diversity, equity, and inclusion (DEI) efforts. GME WBDs described unique challenges that had implications for perceived effectiveness related to resources, culture, institutional structure, and regulatory requirements in GME. DISCUSSION There was high concordance for several key responsibilities, which may represent a set of core priorities for this role. Other reported responsibilities may reflect institution-specific needs or opportunities for role definition. A wide scope of responsibilities, coupled with limited defined budgetary support described by many GME Well-being Directors, could limit effective role execution. Future efforts to better define the role, optimize organizational reporting structures and provide funding commensurate with the scope of work may allow the GME Well-being Director to more effectively develop and execute strategic interventions.
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Affiliation(s)
- Larissa R Thomas
- Department of Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco School of Medicine, 1001 Potrero Ave 5H, 94110, San Francisco, USA.
| | - Jonathan A Ripp
- Departments of Medicine, Medical Education, Geriatrics, and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Jennifer G Duncan
- Department of Pediatrics, Washington University in St. Louis School of Medicine, Missouri, USA
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Butt A, Christian J, Kress A, Lu BY, Hurwitz ME, Goldberg SB, Podoltsev NA, Gilkes L, Lee AI. Providing 0.1 Full-Time Equivalent (FTE) Support to Fellowship Core Faculty Improves Faculty Involvement in Fellowship Education and Recruitment. J Cancer Educ 2024:10.1007/s13187-024-02414-z. [PMID: 38430454 DOI: 10.1007/s13187-024-02414-z] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
In 2022, the American Council for Graduate Medical Education (ACGME) recommended that core faculty (CF) in medical subspecialty fellowships receive at least 0.1 full-time equivalent (FTE) salary support, with plans to enforce compliance in July 2023. After early feedback raised concerns about potential unintended consequences, ACGME deferred enforcement to July 2024. Hence, there is an urgent need to understand the ramifications of providing FTE support for CF. In 2020, the Yale hematology and medical oncology (HO) fellowship program began providing 0.1 FTE support to all CF. Perceptions regarding this were assessed via surveys distributed to all CF in 2021 and 2022 and to all HO fellows in 2021. The vast majority (83.3%) of CF survey respondents reported improved job satisfaction and an increased sense of involvement in the fellowship program as a result of the new 0.1 FTE-supported CF program. Most CF increased attendance at fellowship conferences, devoted more time to mentorship, and increased participation in recruitment. In free text comments, CF respondents described that providing 0.1 FTE support made them "feel rewarded," gave them "a sense of commitment" to the fellowship, and helped "offset clinical requirements." HO fellows reported "a positive impact" of the new program with faculty being "more present at lectures." The median number of times faculty were available to interview fellowship applicants rose markedly after introduction of the program. The FTE-supported CF program was viewed enthusiastically by fellows and faculty, resulting in increased CF involvement in fellowship education and recruitment.
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Affiliation(s)
- Ayesha Butt
- Section of Hematology, Yale School of Medicine, 333 Cedar St., P.O. Box 208028, New Haven, CT, 06520-8028, USA
| | | | - Anna Kress
- Section of Hematology, Yale School of Medicine, 333 Cedar St., P.O. Box 208028, New Haven, CT, 06520-8028, USA
| | | | - Michael E Hurwitz
- Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Sarah B Goldberg
- Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Nikolai A Podoltsev
- Section of Hematology, Yale School of Medicine, 333 Cedar St., P.O. Box 208028, New Haven, CT, 06520-8028, USA
| | | | - Alfred Ian Lee
- Section of Hematology, Yale School of Medicine, 333 Cedar St., P.O. Box 208028, New Haven, CT, 06520-8028, USA.
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Chang C, Fleires A, Alshaikhli A, Arredondo H, Gavilanes D, Cabral-Amador FJ, Cantu J, Bazan D, Oliveira KO, Verduzco R, Pedraza L. Improving inpatient hyperglycaemia in non-critically ill adults in resident wards through audit and feedback. BMJ Open Qual 2024; 13:e002480. [PMID: 38429063 PMCID: PMC10910419 DOI: 10.1136/bmjoq-2023-002480] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/11/2024] [Indexed: 03/03/2024] Open
Abstract
Inpatient hyperglycaemia is associated with an increase in morbidity and mortality, number of rehospitalisations and length of hospitalisation. Although the advantages of proper glycaemic control in hospitalised patients with diabetes are well established, a variety of barriers limit accomplishment of blood glucose targets. Our primary aim was to decrease the number of glucose values above 180 mg/dL in non-critical care hospitalised patients using an audit and feedback intervention with pharmacy and internal medicine residents. A resident-led multidisciplinary team implemented the quality improvement (QI) project including conception, literature review, educating residents, iterative development of audit and feedback tools and data analysis. The multidisciplinary team met every 5 weeks and undertook three 'plan-do-study-act' cycles over an 8-month intervention period (August 2022 to March 2023) to educate residents on inpatient hyperglycaemia management, develop and implement an audit and feedback process and assess areas for improvement. We performed 1045 audits analysing 16 095 accu-checks on 395 non-duplicated patients. Most audits showed compliance with guidelines. The monthly run-on chart shows per cent of glucose values above 180 mg/dL in our non-ICU hospitalised patients and an overall pre-to-post comparison of 25.1%-23.0% (p value<0.05). The intervention was well accepted by residents evidenced by survey results. We did not meet our primary aim to reduce hyperglycaemia by 30% and this combined with the audits showing mostly compliance with guidelines suggests that prescribing behaviour was not a key driver of inpatient hyperglycaemia in our population. This internal medicine resident and pharmacy interprofessional collaboration with audit and feedback for inpatient hyperglycaemia was feasible, well accepted and had a statistically significant yet small improvement in inpatient hyperglycaemia. The project may be helpful to others wishing to explore inpatient hyperglycaemia, interprofessional QI with pharmacists, resident-led QI and audit and feedback.
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Affiliation(s)
- Chelsea Chang
- Internal Medicine, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | - Alcibiades Fleires
- Internal Medicine, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | - Alfarooq Alshaikhli
- Internal Medicine, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | - Hector Arredondo
- Internal Medicine, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | - Diana Gavilanes
- Internal Medicine, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | - Francisco J Cabral-Amador
- Internal Medicine, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | | | - Daniela Bazan
- DHR Health, Edinburg, Texas, USA
- Irma Lerma Rangel School of Pharmacy, Texas A&M Health Science Center, College Station, Texas, USA
| | | | - Rene Verduzco
- DHR Health, Edinburg, Texas, USA
- Irma Lerma Rangel School of Pharmacy, Texas A&M Health Science Center, College Station, Texas, USA
| | - Lina Pedraza
- Internal Medicine, The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
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Brian R, Rodriguez N, Zhou CJ, Casey M, Mora RV, Miclau K, Kwok V, Feldman LS, Alseidi A. "Doing well": Intraoperative entrustable professional activity assessments provided limited technical feedback. Surg Open Sci 2024; 18:93-97. [PMID: 38435485 PMCID: PMC10907196 DOI: 10.1016/j.sopen.2024.02.008] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Background Entrustable Professional Activities (EPAs) allow for the assessment of specific, observable, essential tasks in medical education. Since being developed in non-surgical fields, EPA assessments have been implemented in surgery to explore intraoperative entrustment. However, assessment burden is a significant problem for faculty, and it is unknown whether EPA assessments enable formative technical feedback. EPAs' formative utility could inform how surgical programs facilitate technical feedback for trainees. We aimed to assess the extent to which narrative comments provided through the Fellowship Council (FC) EPA assessments contained technical feedback. Methods The FC previously collected EPA assessments for subspecialty surgical fellows from September 2020 to October 2022. Two raters reviewed assessments' narrative comments for inclusion of each skill area that makes up part of the Objective Structured Assessment of Technical Skills (OSATS). A third rater reconciled discrepant ratings. Results During the study period, there were 3302 completed EPA assessments, including 1191 fellow self-assessments, 1124 faculty assessments, and 987 assessments without an identified assessor role. We found that assessments' narrative comments related to a median of two of the seven OSATS areas (IQR:1-2). There were no comments relevant to any of the seven OSATS areas in 16.0 % of all assessments. Conclusions In this review of narrative comments for EPA assessments from the FC, we found that limited technical feedback of the kind included in the OSATS was provided in many assessments. These results suggest benefit to adjusting the EPA form, enhancing faculty development, or continuing additional types of targeted technical assessment intraoperatively. Key message This analysis of narrative comments from fellowship EPA assessments showed that many assessments included limited technical feedback. To allow for continued technical feedback for fellows, these results highlight the need for further refinements of the EPA assessment form, additional faculty development, or ongoing use of other types of technical assessment.
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Affiliation(s)
- Riley Brian
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Natalie Rodriguez
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Connie J. Zhou
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Megan Casey
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rosa V. Mora
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Katherine Miclau
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Vivian Kwok
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Liane S. Feldman
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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Gaffley M, Hernandez S, Riera KM, Anzola S. Survey on the Perceptions of Pregnancy and Parenthood in Trainees: Advances, Obstacles, and Growth Opportunities. J Surg Res 2024; 295:477-486. [PMID: 38070262 DOI: 10.1016/j.jss.2023.10.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 10/06/2023] [Accepted: 10/27/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Despite national policy changes, perspective changes on pregnancy and parenting in training are often lacking. We evaluated current viewpoints regarding pregnancy, parenthood, leave needs, and perceptions of support across trainees at our institution. METHODS A cross-sectional survey was sent to all residents and fellows at a tertiary care academic center with >700 trainees. Demographic information, opinions on maternity and paternity leave, and opinions on institutional support and career goals were collected. The survey was sent via the Graduate Medical Education Office listserv -- 66 Accreditation Council for Graduate Medical Education (ACGME) programs and 40 non-ACGME programs. RESULTS Seven hundred and forty-seven house officers received the survey with a response rate of 21.9% (n = 164). Of respondents, 81% were residents and 99 respondents were female (representing 31% of female trainees at our institution). Thirty-seven point two percent of respondents reported being parents. Twenty-five point three percent of respondents had been pregnant while a trainee with no statistical difference by specialty type (P = 0.0817). Statistically significant difference was noted in having children based on sex with men becoming parents at twice the rate of women (56% vs 26%, P < 0.001). No difference was noted between specialties on perceived support while pregnant and peripartum. Thirty percent of parent respondents reported thinking about leaving medical training after having children given family stressors. Statistical difference in thoughts of leaving medicine overall between females (46%) and males (17.6%; P = 0.0238). CONCLUSIONS Men and women need support as they navigate becoming parents at a naturally stressful transition period. Females consider leaving medicine at twice the rate of males after becoming parents. Our institution and other ACGME programs need greater transparency and consistent leave practices that reflect changing times.
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Affiliation(s)
- Michaela Gaffley
- Wake Forest School of Medicine, General Surgery, Winston-Salem, North Carolina; Orlando Health, Colorectal Surgery, Orlando, Florida.
| | - Sean Hernandez
- Wake Forest School of Medicine, Internal Medicine, Winston-Salem, North Carolina; Orlando Health, Internal Medicine, Orlando, Florida
| | - Katherine M Riera
- Wake Forest School of Medicine, Acute Care Surgery, Winston-Salem, North Carolina
| | - Saskia Anzola
- Wake Forest School of Medicine, Anesthesiology, Winston-Salem, North Carolina
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Minton LE, Duncan ZN, Tzabari JH, Haynes W, Patel OU, Burge K, Van Wagoner N, Burgan CM. Assessing the debt and current state of financial literacy in a cohort of diagnostic & interventional radiology residents. Clin Imaging 2024; 107:110082. [PMID: 38246085 DOI: 10.1016/j.clinimag.2024.110082] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/16/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study is to assess diagnostic and interventional radiology resident physicians' knowledge of core facets of financial literacy: loans, real estate, investments and retirement, and insurance, with the goal of determining the need for formal financial literacy education within radiology residency programs. METHODS From May 2021 to March 2022, surveys were sent to 196 diagnostic and 90 interventional radiology residency programs. Residents were asked 10 knowledge multiple choice questions to assess areas of financial literacy. Custom R programming was used to evaluate responses. RESULTS A total of 149 diagnostic radiology residents and 49 interventional radiology residents responded to portions of the survey, for a total of 198 respondents. Of the cohort with demographic data collected, 84 out of 141 residents (60 %) had over $100,000 of debt following medical school graduation, with 115 out of 146 DR residents (79 %) and 41 out of 47 (87 %) IR residents reporting no coursework in finance. CONCLUSIONS Many radiology resident physicians have a significant debt burden, no official financial education, and clear knowledge gaps in areas of financial literacy. A structured financial education curriculum could better prepare residents for the financial realities of post-residency life.
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Affiliation(s)
- Laura E Minton
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35233, USA
| | - Zoey N Duncan
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35233, USA.
| | - Jordan H Tzabari
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35233, USA
| | - Will Haynes
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35233, USA
| | - Om U Patel
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35233, USA
| | - Kaitlin Burge
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35233, USA
| | - Nicholas Van Wagoner
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL 35233, USA
| | - Constantine M Burgan
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35294, USA
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14
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Rappaport C, Schwartz A, McConomy B, Choice S, Ten Eyck P, Smock J. Implementing a 3 year, longitudinal point of care ultrasound curriculum in an internal medicine residency program. J Ultrasound 2024; 27:123-127. [PMID: 37973677 PMCID: PMC10908930 DOI: 10.1007/s40477-023-00838-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE Point-of-care ultrasound (POCUS) is highly utilized in the critical care setting. There is also growing evidence supporting use of POCUS by internal medicine (IM) physicians as an extension of traditional physical diagnostic skills. As part of the newly formed curriculum at our residency program, we performed pre and post curriculum assessment of the residents' ability to acquire focused cardiac, lung, pleural, abdominal and vascular images. METHODS The POCUS instruction was delivered as a combination of pre-workshop self-study learning materials (monthly textbook chapters, online modules etc.), with short didactic sessions, and hands-on-scanning of healthy, male volunteers at 10-week intervals. RESULTS A total of 62 residents (23 Post-Graduate Year 1 (PGY), 24 PGY2, 15 PGY3) participated in the year-long curriculum. When pretest and post test data were analyzed at the end of the curriculum, we calculated the odds ratio for acquiring the correct image (score of 1) vs partial/incorrect acquisition (scores of 2 and 3). Significant differences were found in acquisition of most views including para-sternal short (OR 7.7, 95% CI 2.86-20.74, p < 0.001), Inferior vena cava (IVC) (OR 5.05, 95% CI 1.91-13.35, p = 0.001) and bladder (OR 5.06, 95% CI 1.76-14.55, p = 0.003). Non-significant differences were found in acquisition of apical 4 chamber, pl (A-Line) and internal jugular vein (IJV). CONCLUSION We found that the implementation of a longitudinal POCUS curriculum resulted in significant improvement in image acquisition for many common bedside ultrasound views. Future directions include advancing our bedside echocardiography curriculum for upper-level residents to include quantitative left ventricular and right ventricular function analysis, and including more case based pathologic image review.
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Affiliation(s)
- Charles Rappaport
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Andrei Schwartz
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Bryan McConomy
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Samuel Choice
- University of Iowa Roy J. and Lucille A. Carver College of Medicine, 375 Newton Rd, Iowa City, IA, 52242, USA.
| | - Patrick Ten Eyck
- University of Iowa Roy J. and Lucille A. Carver College of Medicine, 375 Newton Rd, Iowa City, IA, 52242, USA
| | - Justin Smock
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
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McGrail M, Woolley T, Pinidiyapathirage J, Paton K, Smith D, Brumpton K, Teague PA. Exploring recent trends (2014-21) in preferencing and accepting Queensland medical internships in rural hospitals. BMC Health Serv Res 2024; 24:236. [PMID: 38395849 PMCID: PMC10885368 DOI: 10.1186/s12913-024-10683-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Medical internship is a key transition point in medical training from student to independent (junior) doctor. The national Regional Training Hubs (RTH) policy began across Australia in late 2017, which aims to build medical training pathways for junior doctors within a rural region and guide students, interns and trainees towards these. This study aims to explore preferencing and acceptance trends for rural medical internship positions in Queensland. Moreover, it focuses on internship preference and acceptance outcomes prior to and following the establishment of RTHs, and their association with key covariates such as rural training immersions offered by medical schools. METHODS Data from all applicants to Queensland Health intern positions between 2014-2021 were available, notably their preference order and location of accepted internship position, classified as rural or metropolitan. Matched data from Queensland's medical schools were added for rural training time and other key demographics. Analyses explored the statistical associations between these factors and preferencing or accepting rural internships, comparing pre-RTH and post-RTH cohorts. RESULTS Domestic Queensland-trained graduates first preferencing rural intern positions increased significantly (pre-RTH 21.1% vs post-RTH 24.0%, p = 0.017), reinforced by a non-significant increase in rural acceptances (27.3% vs 29.7%, p = 0.070). Rural interns were more likely to have previously spent ≥ 11-weeks training in rural locations within medical school, be rurally based in the year applying for internship, or enrolled in the rural generalist pathway. CONCLUSIONS The introduction of the RTH was associated with a moderate increase of graduates both preferencing and accepting a rural internship, though a richer understanding of the dominant reasons for and against this remain less clear. An expansion of graduates who undertook longer periods of undergraduate rural training in the same period did not diminish the proportion choosing a rural internship, suggesting there remains an appetite for these opportunities. Overall, domestic graduates are identified as a reliable source of intern recruitment and retention to rural hospitals across Queensland, with entry to the rural generalist pathway and extended rural placement experiences enhancing uptake of rural practice.
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Affiliation(s)
- Matthew McGrail
- The University of Queensland, Rural Clinical School, Rockhampton, QLD, 4700, Australia.
| | - Torres Woolley
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
| | - Janani Pinidiyapathirage
- Griffith University, School of Medicine and Dentistry, Southport, QLD, 4222, Australia
- Rural Medical Education Australia, Toowoomba, QLD, 4350, Australia
| | - Kath Paton
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
| | - Deborah Smith
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
| | - Kay Brumpton
- Griffith University, School of Medicine and Dentistry, Southport, QLD, 4222, Australia
- Rural Medical Education Australia, Toowoomba, QLD, 4350, Australia
| | - Peta-Ann Teague
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
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Rowe KA, Carbo A, Katz JT, Rotenstein L. Customised knowledge-sharing platform to foster resident quality improvement activities, tracking and scholarship. BMJ Open Qual 2024; 13:e002428. [PMID: 38307702 PMCID: PMC10840027 DOI: 10.1136/bmjoq-2023-002428] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/09/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Meeting accreditation requirements to train resident physicians in quality improvement (QI) may require more than education. Barriers to resident QI engagement underscore the need to demonstrate the impact and value of resident QI work. It is not known whether a platform to track and publicise resident QI projects and scholarship is feasible or acceptable to implement within a residency programme. We aimed to create a searchable online platform and associated programming to promote resident QI work. METHODS This intervention targeted resident physicians in an internal medicine residency training programme at a tertiary, academic medical centre. We designed an intervention to track resident QI and related scholarship in a searchable online platform, including practical details of implementing each project. Newsletters and events were used to publicise these project profiles. RESULTS During the 2020-2021 academic year, 104 projects were profiled from 238 sourced projects. Average readership was 31.5% across 11 newsletters sent to residents and key faculty. DISCUSSION A platform to track and share resident QI work and scholarship can be feasibly and acceptably implemented within a residency programme, serving as a novel way to engage residents around QI.
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Affiliation(s)
- Katherine A Rowe
- Massachusetts General Hospital Department of Surgery, Boston, Massachusetts, USA
| | - Alexander Carbo
- Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Joel T Katz
- Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Lisa Rotenstein
- Harvard Medical School, Boston, Massachusetts, USA
- Advanced Primary Care Associates, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Armstrong AG, Fraser KW, Nix SN, Zackula R, Brown R, Macaluso M. What Can You Learn About Psychiatry Programs from Their Website? A Content Evaluation for Potential Applicants. Acad Psychiatry 2024; 48:29-35. [PMID: 38066297 DOI: 10.1007/s40596-023-01916-0] [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: 05/22/2023] [Accepted: 11/22/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE This project aimed to assess the information contained on general psychiatry program websites and identify common themes that may be useful and informative for residency applicants. METHODS A survey study design was used to evaluate all US general psychiatry program websites as listed in the FREIDA database. The evaluation form included 44 binary (yes or no) items. Two reviewers rated each item on all program websites between September 2021 and January 2022. Item discrepancies were settled by a third reviewer. Fisher's exact tests evaluated differences between geographic regions and program types. Multidimensional scaling and Rasch modeling were conducted to examine clustering and the probability of items reported on program websites. RESULTS A total of 285 websites were identified; 13 were excluded. Internal consistency was high among reviewers, Cronbach's Alpha = 0.927; κ = 0.863. Websites varied considerably in quality. Significant inconsistent reporting was observed by region for current residents' photos and alumni careers (fellowship/jobs); p<0.001. Program types varied regarding information about program faculty, which included significant differences for faculty photo, faculty research interest, and faculty research publications; p<0.001. CONCLUSIONS While inter-rater reliability was high, considerable variation among websites was observed. Residency programs could be improved by consistently reporting resident and faculty information. Results show that applicants may encounter issues finding pertinent information, as programs' FREIDA link did not direct the user to the residency program website two-thirds of the time.
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Affiliation(s)
| | - Kenneth W Fraser
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Shelby N Nix
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Rosalee Zackula
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Rachel Brown
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
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18
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Karlapudi A, Rible R, Vinekar K. Transparency around abortion training on obstetrics and gynecology residency program websites. Contraception 2024; 130:110296. [PMID: 37739304 DOI: 10.1016/j.contraception.2023.110296] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES The availability of family planning and abortion training in residency is a concern for applicants, particularly following the overturning of Roe v Wade. We aimed to characterize public information on abortion training in obstetrics and gynecology residency programs in states with and without abortion bans. STUDY DESIGN We abstracted residency program data using a publicly available database of obstetrics and gynecology residency programs. We performed a systematic internet search of each program's website to identify information on abortion training. We defined states with abortion bans as those with total or near-total bans as of November 2022. Using Stata SE 16, we used Student t tests and Fisher exact tests to characterize differences between programs with public abortion training information and those without. RESULTS Of 293 obstetrics and gynecology residency programs, 197 (67.2%) included online information regarding abortion training. Of 64 programs in states with abortion bans, 34 (53%) had public information regarding abortion training, compared to 163 (71%) of the 229 programs in states with legal abortion. Programs with publicly available abortion training information were more likely to be academic (49.8% vs 26%, p < 0.001) and have a higher percentage of female residents (86.6% vs 82.9%, p = 0.003). Programs in states with legal abortion were more likely to use words like "abortion" (36.2% vs 17.7%, p = 0.05). CONCLUSIONS Only two-thirds of obstetrics and gynecology residency programs publicize abortion training information. Almost half of all programs in states with abortion bans do not share this information, revealing a need for improved transparency to better inform residency applicant decision-making. IMPLICATIONS During the 2022-2023 academic cycle, one-third of obstetrics and gynecology residency programs did not include information about family planning or abortion training online. In states with abortion bans, this number increased to almost one-half. These findings serve as a call to action for programs to clarify their commitment to abortion training.
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Affiliation(s)
- Aishwarya Karlapudi
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California, Los Angeles, CA, United States.
| | - Radhika Rible
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | - Kavita Vinekar
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
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Tischendorf JS, Krecko LK, Filipiak R, Osman F, Zelenski AB. Gender influences resident physicians' perception of an employee-to-employee recognition program: a mixed methods study. BMC Med Educ 2024; 24:109. [PMID: 38302913 PMCID: PMC10835820 DOI: 10.1186/s12909-024-05083-0] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Burnout is prevalent in medical training. While some institutions have implemented employee-to-employee recognition programs to promote wellness, it is not known how such programs are perceived by resident physicians, or if the experience differs among residents of different genders. METHODS We used convergent mixed methods to characterize how residents in internal medicine (IM), pediatrics, and general surgery programs experience our employee-to-employee recognition ("Hi-5″) program. We collected Hi-5s received by residents in these programs from January 1, 2021-December 31, 2021 and coded them for recipient discipline, sex, and PGY level and sender discipline and professional role. We conducted virtual focus groups with residents in each training program. MAIN MEASURES AND APPROACH We compared Hi-5 receipt between male and female residents; overall and from individual professions. We submitted focus group transcripts to content analysis with codes generated iteratively and emergent themes identified through consensus coding. RESULTS Over a 12-month period, residents received 382 Hi-5s. There was no significant difference in receipt of Hi-5s by male and female residents. Five IM, 3 surgery, and 12 pediatric residents participated in focus groups. Residents felt Hi-5s were useful for interprofessional feedback and to mitigate burnout. Residents who identified as women shared concerns about differing expectations of professional behavior and communication based on gender, a fear of backlash when behavior does not align with gender stereotypes, and professional misidentification. CONCLUSIONS The "Hi-5" program is valuable for interprofessional feedback and promotion of well-being but is experienced differently by men and women residents. This limitation of employee-to-employee recognition should be considered when designing equitable programming to promote well-being and recognition.
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Affiliation(s)
- Jessica S Tischendorf
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Medical Foundation Centennial Building Room 5263, 1685 Highland Avenue, Madison, WI, 53705, USA.
| | - Laura K Krecko
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Rachel Filipiak
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Medical Foundation Centennial Building Room 5263, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Fauzia Osman
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Amy B Zelenski
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705, USA
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Brown RF, St John A, Hu Y, Sandhu G. Differential Electronic Survey Response: Does Survey Fatigue Affect Everyone Equally? J Surg Res 2024; 294:191-197. [PMID: 37913726 DOI: 10.1016/j.jss.2023.09.072] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 09/08/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Survey fatigue, a phenomenon where respondents lose interest or lack motivation to complete surveys, can undermine rigorously designed studies. Research during the COVID-19 pandemic capitalized on electronic surveys for maximum distribution, but with lower response rates. Additionally, it is unclear how survey fatigue affects surgical education stakeholders. This study aims to determine how response rates to an electronic survey, as a proxy for survey fatigue, differ among medical students (MS), surgery residents, and surgery faculty. METHODS Electronic surveys evaluating the surgical clerkship educational environment were distributed to third year MS, residents, and faculty at three academic institutions. Two reminder emails were sent. Groups with low response rates (<30%) received additional prompting. Response rates were compared using a chi-square test. Demographics of all survey respondents were collected and discussed. Baseline characteristics of the MS class, residency program, and Department of Surgery faculty from one institution were gathered and compared to respondents. RESULTS Surveys were sent to 283 third year MS, 190 surgery residents, and 374 surgical faculty. Response rates were 43%, 27%, and 20%, respectively (P < 0.0001). Male respondents, respondents of color, midlevel residents, and assistant professors had lower response rates compared to the baseline cohort. CONCLUSIONS Our results demonstrate a statistically significant difference in survey response rates among MS, residents, and faculty, and have identified various targets for further investigation. Loss of interest in these groups should be further evaluated with a goal of decreasing survey fatigue, increasing survey response rates, and improving the quality of survey data collected.
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Affiliation(s)
- Rebecca F Brown
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Ace St John
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Yinin Hu
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Carter B, Sidrak J, Wagner B, Travis C, Nehler M, Christian N. Preliminary Development of a Program ABSITE Dashboard (PAD) to Guide Curriculum Innovation. J Surg Educ 2024; 81:226-242. [PMID: 38195275 DOI: 10.1016/j.jsurg.2023.10.014] [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: 09/14/2023] [Accepted: 10/20/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE Medical Knowledge for general surgery residents' is assessed by the American Board of Surgery In- Training Examination (ABSITE). ASBITE score reports contain many metrics residency directors can utilize to assess resident progress and perform program evaluation. The purpose of this study was to develop a framework to evaluate program effectiveness in teaching specific subtest and subtopic areas of the ABSITE, using ABSITE score reports as an indicator. The aim is to demonstrate the identification of topic areas of weakness in program-wide performance on the ABSITE to guide proposed modification of the general surgery residency program curriculum, and to initiate development of a data visualizing dashboard to communicate these metrics. METHODS A single institution retrospective study was performed utilizing ABSITE score reports from general surgery residents at a large academic training program from 2017 to 2020. ABSITE performance metrics from 320 unique records were entered into a database; statistical analysis for linear trends and variance were conducted for standard scores, subtest standard scores, and incorrect subtest topics. Deviation from national average scores were calculated by subtracting the national average score from each subtest score for each trainee. Data were displayed as medians or proportions and are displayed to optimize visualization as a proof-of-concept for the development of a program dashboard. RESULTS Trends and variance in general surgery program and cohort performance on various elements of the ABSITE were visualized using figures and tables that represent a prototype for a program dashboard. Figure A1 demonstrates one example, in which a heatmap displays the median deviation from national average scores for each subtest by program year. Boxplots show the distribution of the deviation from national average, range for national average scores, and the recorded scores for each subtest by program year. Trends in median deviation from the national average scores are displayed for each program year paneled by subtest or for each exam year paneled by cohort. Median change in overall test scores from one program year to another in a cohort is visualized as a table. Bar graphs show the most often missed topics across all program years and heatmaps were generated showing the proportion of times each topic was missed for each subtest and exam year. CONCLUSIONS We demonstrate use of ABSITE reports to identify specific thematic areas of opportunities for curriculum modification and innovation as an element of program evaluation. In this study we demonstrate, through data analysis and visualization, feasibility for the creation of a Program ABSITE Dashboard (PAD) that enhances the use of ABSITE reports for formative program evaluation and can guide modifications to surgery program curriculum and educational practices.
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Affiliation(s)
- Brian Carter
- University of Colorado School of Medicine, Aurora, Colorado
| | - Jason Sidrak
- University of Colorado School of Medicine, Aurora, Colorado
| | - Brandie Wagner
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Claire Travis
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Mark Nehler
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Nicole Christian
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado.
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Vinekar K, Karlapudi A, Bauer CC, Steinauer J, Rible R, Brown K, Turk JK. Abortion training in U.S. obstetrics and gynecology residency programs in a post-Dobbs era. Contraception 2024; 130:110291. [PMID: 37729959 DOI: 10.1016/j.contraception.2023.110291] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVES The Accreditation Council for Graduate Medical Education requires all obstetrics and gynecology residents have access to abortion training. The impact of Dobbs on training remains unknown. We aimed to describe residency programs affected by abortion bans and those lacking abortion training despite permissive state policies. We considered demographic data to understand the impacts on residents under-represented in medicine. STUDY DESIGN We used residency databases and websites to abstract data. We identified programs offering routine abortion training as either those with Ryan Programs or those with website or email acknowledgment of training. We defined states with abortion bans as those with either complete or 6-week bans as of December 2022. We used χ2 and Student's t tests in descriptive analyses and performed a logistic regression to adjust for demographic and program-specific variables. RESULTS Of 286 residency programs included, 140 (49%) offered routine abortion training prior to Dobbs. As of December 2022, 19 of these (14%) had lost the ability to provide routine in-state abortion training. Of 223 residency programs in states with legal abortion, 102 (46%) programs lacked routine abortion training. These sites were more likely to be community or community-university programs, with graduates more likely to practice as generalists. Resident race/ethnicity did not differ between residents in states with legal abortion vs abortion bans. CONCLUSIONS Nearly half of obstetrics and gynecology residency programs in states with legal abortion do not appear to provide routine abortion training. Further work is needed to understand this paucity of training and maximize access in legislatively permissible environments. IMPLICATIONS Following Dobbs, 14% of residency programs lost in-state abortion training. Notably, in states with legal abortion, 46% of programs lack routine abortion training despite permissive legislation. This presents a window of opportunity for expansion of abortion training, particularly at community and community-university hybrid residency sites.
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Affiliation(s)
- Kavita Vinekar
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA 19107, United States.
| | - Aishwarya Karlapudi
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, United States
| | - Callie Cox Bauer
- Department of Obstetrics and Gynecology, Aurora Sinai Medical Center, 12th Street, Milwaukee, WI 53233, United States
| | - Jody Steinauer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, 2356 Sutter Street, San Francisco, CA 94115, United States
| | - Radhika Rible
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, United States
| | - Katherine Brown
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, 2356 Sutter Street, San Francisco, CA 94115, United States
| | - Jema K Turk
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, 2356 Sutter Street, San Francisco, CA 94115, United States
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Please H, Narang K, Bolton W, Nsubuga M, Luweesi H, Richards NB, Dalton J, Tendo C, Khan M, Jjingo D, Bhutta MF, Petrakaki D, Dhanda J. Virtual reality technology for surgical learning: qualitative outcomes of the first virtual reality training course for emergency and essential surgery delivered by a UK-Uganda partnership. BMJ Open Qual 2024; 13:e002477. [PMID: 38286564 PMCID: PMC10826552 DOI: 10.1136/bmjoq-2023-002477] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/07/2024] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION The extensive resources needed to train surgeons and maintain skill levels in low-income and middle-income countries (LMICs) are limited and confined to urban settings. Surgical education of remote/rural doctors is, therefore, paramount. Virtual reality (VR) has the potential to disseminate surgical knowledge and skill development at low costs. This study presents the outcomes of the first VR-enhanced surgical training course, 'Global Virtual Reality in Medicine and Surgery', developed through UK-Ugandan collaborations. METHODS A mixed-method approach (survey and semistructured interviews) evaluated the clinical impact and barriers of VR-enhanced training. Course content focused on essential skills relevant to Uganda (general surgery, obstetrics, trauma); delivered through: (1) hands-on cadaveric training in Brighton (scholarships for LMIC doctors) filmed in 360°; (2) virtual training in Kampala (live-stream via low-cost headsets combined with smartphones) and (3) remote virtual training (live-stream via smartphone/laptop/headset). RESULTS High numbers of scholarship applicants (n=130); registrants (Kampala n=80; remote n=1680); and attendees (Kampala n=79; remote n=556, 25 countries), demonstrates widespread appetite for VR-enhanced surgical education. Qualitative analysis identified three key themes: clinical education and skill development limitations in East Africa; the potential of VR to address some of these via 360° visualisation enabling a 'knowing as seeing' mechanism; unresolved challenges regarding accessibility and acceptability. CONCLUSION Outcomes from our first global VR-enhanced essential surgical training course demonstrating dissemination of surgical skills resources in an LMIC context where such opportunities are scarce. The benefits identified included environmental improvements, cross-cultural knowledge sharing, scalability and connectivity. Our process of programme design demonstrates that collaboration across high-income and LMICs is vital to provide locally relevant training. Our data add to growing evidence of extended reality technologies transforming surgery, although several barriers remain. We have successfully demonstrated that VR can be used to upscale postgraduate surgical education, affirming its potential in healthcare capacity building throughout Africa, Europe and beyond.
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Affiliation(s)
- Helen Please
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | | | - William Bolton
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | - Mike Nsubuga
- African Center of Excellence in Bioinformatics & Data Sciences, Kampala, Uganda
| | | | | | - John Dalton
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | | | - Mansoor Khan
- Brighton and Sussex Medical School, Brighton, UK
| | - Daudi Jjingo
- African Center of Excellence in Bioinformatics & Data Sciences, Kampala, Uganda
- Department of Computer Science, Makerere University, Kampala, Uganda
| | - Mahmood F Bhutta
- Brighton and Sussex Medical School, Brighton, UK
- Department of ENT, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Dimitra Petrakaki
- ESRC-funded Digital Futures at Work Research Centre, University of Sussex Business School, Brighton, UK
| | - Jagtar Dhanda
- Brighton and Sussex Medical School, Brighton, UK
- Queen Victoria Hospital, East Grinstead, UK
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Hicks ED, Heft ME, Hameed MY, Jackson KE, Kaukis N, Jensen HK, Wong K. Factors for which radiology residents choose fellowship. Curr Probl Diagn Radiol 2024:S0363-0188(24)00025-2. [PMID: 38302302 DOI: 10.1067/j.cpradiol.2024.01.025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE The objective of this study is to assess factors that influence radiology residents' decision to pursue fellowship. Historically a large majority of Diagnostic Radiology (DR) residents have pursued fellowship, but with changes in the job market and the Covid-19 pandemic, this study analyzes the current trends associated with radiology fellowship choice. MATERIALS AND METHODS An anonymous 28-question survey was constructed based on literature review and pilot feedback from university radiology residents. The survey was distributed through APDR and to all program coordinators to be distributed to residents. Demographic information and questions related to fellowship choice were assessed. The survey was conducted through RedCap and consisted of multiple choice and sliding scale questions. RESULTS 214 radiology residents responded, representing 4.6 % of US DR residents across 199 programs. The top fellowship choices included neuroradiology (20.5 %), musculoskeletal imaging (17.3 %), body imaging (16.8 %), and breast imaging (16.4 %). Most influential factors for fellowship selection were strong personal interest, enjoyable rotation, work hours, job security, and compensation. Least influential factors were research opportunities and specific group practice. CONCLUSION The decision to pursue fellowship remains almost unanimous among US DR residents. Strong personal interest, enjoyable rotations, and favorable work hours were rated as the most important factors in the decision to pursue fellowship. Neuroradiology, musculoskeletal, and body imaging remained the most popular specialties, with a notable increase in interest in breast radiology compared to literature. To attract prospective fellows, residency and fellowship programs should emphasize aforementioned factors and offer more early exposure to subspecialties during residency.
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Affiliation(s)
- Evan D Hicks
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Mallory E Heft
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Muhammad Y Hameed
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kyle E Jackson
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Nicholas Kaukis
- Department of Biomedical Informatics, Little Rock, AR 72205, USA
| | - Hanna K Jensen
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Kevin Wong
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Klein R, Snyder ED, Koch J, Volerman A, Alba-Nguyen S, Julian KA, Thompson V, Ufere NN, Burnett-Bowie SAM, Kumar A, White BAA, Park YS, Palamara K. Analysis of narrative assessments of internal medicine resident performance: are there differences associated with gender or race and ethnicity? BMC Med Educ 2024; 24:72. [PMID: 38233807 PMCID: PMC10795394 DOI: 10.1186/s12909-023-04970-2] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Equitable assessment is critical in competency-based medical education. This study explores differences in key characteristics of qualitative assessments (i.e., narrative comments or assessment feedback) of internal medicine postgraduate resident performance associated with gender and race and ethnicity. METHODS Analysis of narrative comments included in faculty assessments of resident performance from six internal medicine residency programs was conducted. Content analysis was used to assess two key characteristics of comments- valence (overall positive or negative orientation) and specificity (detailed nature and actionability of comment) - via a blinded, multi-analyst approach. Differences in comment valence and specificity with gender and race and ethnicity were assessed using multilevel regression, controlling for multiple covariates including quantitative competency ratings. RESULTS Data included 3,383 evaluations with narrative comments by 597 faculty of 698 residents, including 45% of comments about women residents and 13.2% about residents who identified with race and ethnicities underrepresented in medicine. Most comments were moderately specific and positive. Comments about women residents were more positive (estimate 0.06, p 0.045) but less specific (estimate - 0.07, p 0.002) compared to men. Women residents were more likely to receive non-specific, weakly specific or no comments (adjusted OR 1.29, p 0.012) and less likely to receive highly specific comments (adjusted OR 0.71, p 0.003) or comments with specific examples of things done well or areas for growth (adjusted OR 0.74, p 0.003) than men. Gendered differences in comment specificity and valence were most notable early in training. Comment specificity and valence did not differ with resident race and ethnicity (specificity: estimate 0.03, p 0.32; valence: estimate - 0.05, p 0.26) or faculty gender (specificity: estimate 0.06, p 0.15; valence: estimate 0.02 p 0.54). CONCLUSION There were significant differences in the specificity and valence of qualitative assessments associated with resident gender with women receiving more praising but less specific and actionable comments. This suggests a lost opportunity for well-rounded assessment feedback to the disadvantage of women.
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Affiliation(s)
- Robin Klein
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, 80 Jesse Hill Jr Dr SE, Atlanta, GA, 30303, USA.
| | - Erin D Snyder
- Department of Medicine, Division of General Internal Medicine, University of Alabama Birmingham School of Medicine, Birmingham, AL, USA
| | - Jennifer Koch
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, IL, USA
| | - Sarah Alba-Nguyen
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, CA, USA
| | - Katherine A Julian
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Vanessa Thompson
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Nneka N Ufere
- Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Anshul Kumar
- Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Bobbie Ann A White
- Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Yoon Soo Park
- Department of Medical Education, University of Illinois Chicago, Chicago, IL, USA
| | - Kerri Palamara
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Svendsen SS, Lewis T, Chiesa AE, Sirotnak AP, Lindberg DM. The role of fellowship experience in decreasing burnout for child abuse pediatricians. Child Abuse Negl 2024; 147:106532. [PMID: 37956502 DOI: 10.1016/j.chiabu.2023.106532] [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: 04/21/2023] [Revised: 09/28/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Compassion fatigue and burnout are important issues within the medical field, and may be an even bigger problem for Child Abuse Pediatricians (CAPs). While the Accreditation Council for Graduate Medical Education (ACGME) mandates educational activities focused on burnout and resilience, there is currently minimal data to inform the choice and implementation of these activities. OBJECTIVE Our objectives were to: determine the availability and perceived usefulness of educational activities related to burnout and resilience available in CAP fellowships; and explore the relationship between fellowship activities and burnout. PARTICIPANTS AND SETTING Surveys were distributed in 2016 to 133 participants in CAP fellowships since 2006. METHODS Burnout risk was measured using the Maslach Burnout Inventory - Human Services Survey (MBI-HSS). Logistic regression models were used to assess the association of burnout as measured by the MBI-HSS with specific educational activities. RESULTS Of 133 eligible individuals, 85 (64 %) responded. Of these, 40 (53 %) scored in the high-risk range for at least 1 of the three subscales. Activities perceived to be most useful in addressing burnout were: multidisciplinary team interactions, time spent with the team outside of work, and faculty/trainee one-on-one mentorship. Educational activities were only weakly associated with addressing burnout as measured by the MBI-HSS. CONCLUSIONS Moderate or high levels of burnout are present in a large proportion of practicing CAPs and more than one-third of participants felt that the quality of burnout training in fellowship did not meet their needs. These data support the need to more effectively address burnout education within the training experience of CAP fellows.
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Affiliation(s)
- Sasha S Svendsen
- UMass Memorial Children's Medical Center, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA; Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Terri Lewis
- Department of Pediatrics, University of Colorado School of Medicine, 13001 E 17(th) Pl, Aurora, CO 80045, USA; The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, 1635 Victor St, Aurora, CO 80045, USA.
| | - Antonia E Chiesa
- Department of Pediatrics, University of Colorado School of Medicine, 13001 E 17(th) Pl, Aurora, CO 80045, USA; The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, 1635 Victor St, Aurora, CO 80045, USA.
| | - Andrew P Sirotnak
- Department of Pediatrics, University of Colorado School of Medicine, 13001 E 17(th) Pl, Aurora, CO 80045, USA; The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, 1635 Victor St, Aurora, CO 80045, USA.
| | - Daniel M Lindberg
- The Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, 1635 Victor St, Aurora, CO 80045, USA; Department of Emergency Medicine, University of Colorado School of Medicine, 13001 E 17(th) Pl, Aurora, CO 80045, USA.
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Briles B, Kahl A, Anaissie J, Brettmann L, Pathak U, Staggers KA, Popat S, Agrawal A, Rose S, Taylor J. Levels and drivers of burnout during the COVID-19 pandemic among a diverse group of resident physicians. Postgrad Med 2024; 136:44-51. [PMID: 38193442 DOI: 10.1080/00325481.2024.2303974] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/04/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVES Evidence has shown significant impacts of the COVID-19 pandemic on physicians. We hypothesized that these effects would impact surgical and non-surgical resident education differently, with non-surgical specialties being more heavily impacted by frontline work and surgical specialties losing elective cases. METHODS We examined well-being and burnout among resident physicians in surgical and non-surgical specialties during the peak of the COVID-19 pandemic using the Mayo Physician Well-Being Index (WBI). RESULTS Completed surveys were received from 110 residents, 55% of whom were in a surgical training program. 35% of respondents were identified as 'at risk' for burnout. Increased demands from work (adj. OR 3.79, 95% CI 1.50, 9.59, p = 0.005) was associated with an increased likelihood for being 'at risk' compared to those without increased demands. Odds of having increased stress level were higher amongst residents with fear/anxiety of the unknown (adj. OR 4.21, 95% CI 1.63, 10.90, p = 0.003) and more demands outside work (adj. OR 10.54, 95% CI 2.63, 42.16, p = 0.001) but lower amongst residents with more time for studying (OR 0.23, 95% CI 0.09, 0.64, p = 0.005). Risk for burnout was not significantly different between surgical and non-surgical specialties when adjusting for increased demands from work (adj. OR 1.43, 95% CI 0.60, 3.37, p = 0.0.418). CONCLUSION Perceived effects of the COVID-19 pandemic upon residents' educational experience was mixed: reduced clinical volume had a negative impact, while increased time for study was perceived favorably. These findings suggest potential strategies and targets to mitigate the stress and burnout of a future crisis, whether large or small, among surgical and non-surgical trainees.
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Affiliation(s)
- Brenna Briles
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alyssa Kahl
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - James Anaissie
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Lindsay Brettmann
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ujval Pathak
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Shreeya Popat
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Anoop Agrawal
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Stacey Rose
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer Taylor
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Smith KR, Shah NK, Adamczyk AL, Weinstein LC, Kelly EL. Harm reduction in undergraduate and graduate medical education: a systematic scoping review. BMC Med Educ 2023; 23:986. [PMID: 38129846 PMCID: PMC10734177 DOI: 10.1186/s12909-023-04931-9] [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: 08/15/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Substance use increasingly contributes to early morbidity and mortality, which necessitates greater preparation of the healthcare workforce to mitigate its harm. The purpose of this systematic scoping review is to: 1) review published curricula on harm reduction for substance use implemented by undergraduate (UME) and graduate medical education (GME) in the United States and Canada, 2) develop a framework to describe a comprehensive approach to harm reduction medical education, and 3) propose additional content topics for future consideration. METHODS PubMed, Scopus, ERIC: Education Resources Information Center (Ovid), and MedEdPORTAL were searched. Studies included any English language curricula about harm reduction within UME or GME in the United States or Canada from 1993 until Nov 22, 2021. Two authors independently reviewed and screened records for data extraction. Data were analyzed on trainee population, curricula objectives, format, content, and evaluation. RESULTS Twenty-three articles describing 19 distinct educational programs across the United States were included in the final sample, most of which created their own curricula (n = 17). Data on educational content were categorized by content and approach. Most programs (85%) focused on introductory substance use knowledge and skills without an understanding of harm reduction principles. Based on our synthesis of the educational content in these curricula, we iteratively developed a Harm Reduction Educational Spectrum (HRES) framework to describe curricula and identified 17 discrete content topics grouped into 6 themes based on their reliance on harm reduction principles. CONCLUSIONS Harm reduction is under-represented in published medical curricula. Because the drug supply market changes rapidly, the content of medical curricula may be quickly outmoded thus curricula that include foundational knowledge of harm reduction principles may be more enduring. Students should be grounded in harm reduction principles to develop the advanced skills necessary to reduce the physical harm associated with drugs while still simultaneously recognizing the possibility of patients' ongoing substance use. We present the Harm Reduction Educational Spectrum as a new framework to guide future healthcare workforce development and to ultimately provide the highest-quality care for patients who use drugs.
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Affiliation(s)
- Kelsey R Smith
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St, Curtis Building, Philadelphia, PA, 19107, USA.
| | - Nina K Shah
- Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, #100, Philadelphia, PA, 19107, USA
| | - Abby L Adamczyk
- Scott Memorial Library, Thomas Jefferson University, 1020 Walnut St, Philadelphia, PA, 19107, USA
| | - Lara C Weinstein
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St, Curtis Building, Philadelphia, PA, 19107, USA
| | - Erin L Kelly
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St, Curtis Building, Philadelphia, PA, 19107, USA
- Center for Social Medicine and Humanities, University of California Los Angeles, B7-435, Semel Institute, Los Angeles, CA, 90095-1759, USA
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Klein R, Snyder ED, Koch J, Volerman A, Alba-Nguyen S, Julian KA, Thompson V, Ufere NN, Burnett-Bowie SAM, Kumar A, White BAA, Park YS, Palamara K. Exploring gender and thematic differences in qualitative assessments of internal medicine resident performance. BMC Med Educ 2023; 23:932. [PMID: 38066551 PMCID: PMC10709833 DOI: 10.1186/s12909-023-04917-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Evidence suggests gender disparities in medical education assessment, including differences in ratings of competency and narrative comments provided in resident performance assessments. This study explores how gender manifests within the content of qualitative assessments (i.e., narrative comments or performance feedback) of resident performance. METHODS Qualitative content analysis was used to explore gender-based differences in narrative comments included in faculty assessments of resident performance during inpatient medicine rotations at six Internal Medicine residency programs, 2016-2017. A blinded, multi-analyst approach was employed to identify themes across comments. Patterns in themes with resident gender and post-graduate year (PGY) were explored, focusing on PGY2 and PGY3 when residents are serving in the team leader role. RESULTS Data included 3,383 evaluations with narrative comments of 385 men (55.2%) and 313 women residents (44.8%). There were thematic differences in narrative comments received by men and women residents and how these themes manifested within comments changed with training time. Compared to men, comments about women had a persistent relationship-orientation and emphasized confidence over training including as interns and in PGY2 and PGY3, when serving as team leader. The relationship-orientation was characterized not only by the residents' communal attributes but also their interpersonal and communication skills, including efforts supporting others and establishing the tone for the team. Comments about women residents often highlighted confidence, including recommendations around behaviors that convey confidence in decision-making and team leadership. DISCUSSION There were gender-based thematic differences in qualitative assessments. Comments about women resident team leaders highlight relationship building skills and urge confidence and actions that convey confidence as team leader. Persistent attention to communal skills suggests gendered expectations for women resident team leaders and a lost opportunity for well-rounded feedback to the disadvantage of women residents. These findings may inform interventions to promote equitable assessment, such as providing feedback across the competencies.
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Affiliation(s)
- Robin Klein
- Emory University School of Medicine, Atlanta, GA, USA.
| | - Erin D Snyder
- Department of Medicine, Division of General Internal Medicine, University of Alabama Birmingham School of Medicine, Birmingham, AL, USA
| | - Jennifer Koch
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, IL, USA
| | - Sarah Alba-Nguyen
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Katherine A Julian
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Vanessa Thompson
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Nneka N Ufere
- Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Anshul Kumar
- Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | | | - Yoon Soo Park
- Department of Medical Education, University of Illinois, Chicago, IL, USA
| | - Kerri Palamara
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Mirabal SC, Wright SM, O'Rourke P. The selection of chief residents across residency programs at a large academic medical center. BMC Med Educ 2023; 23:931. [PMID: 38066491 PMCID: PMC10709969 DOI: 10.1186/s12909-023-04896-9] [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: 02/23/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Chief residents have a unique role in graduate medical education (GME). They not only connect residents with program and hospital leadership, but also advocate for the wellbeing and educational priorities of trainees. Previous studies have focused on describing the characteristics of chief residents (CRs), however little is known about how CRs are selected across GME programs. METHODS One-on-one semi-structured interviews with all (n = 21) GME program directors at the Johns Hopkins University School of Medicine were conducted from January to March 2022. Investigators independently coded the transcripts using an inductive approach to categorize meaningful segments of text; this culminated in the identification of explanatory themes. RESULTS From discussions with 21 program directors, four themes were identified: (1) identifying candidates: timing, recruitment, nominations, as well as desirable attributes and data considered; (2) applications: expression of intent and participation in interviews; (3) selections: voting, discussions leading to consensus, and program director intimately involved in the choice(s); and (4) confidence in processes and outcomes. CONCLUSIONS Our results provide a deeper understanding of the nuances associated with the selection of CRs. It is hoped that the descriptions of the similarities and differences across GME programs will prompt reflection about what is done at one institution such that all programs can consider what are the best practices to serve their individual goals and needs.
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Affiliation(s)
- Susan C Mirabal
- Medical Education Fellow in General Internal Medicine (GIM), Johns Hopkins University School of Medicine (SOM), Baltimore, MD, USA.
- Division of General Internal Medicine, 5200 Eastern Ave, MFL Center Tower Suite 2300, Baltimore, MD, 21224, USA.
| | - Scott M Wright
- Johns Hopkins University SOM, and GIM Division Chief, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Paul O'Rourke
- Johns Hopkins University SOM, and Associate Program Director, Johns Hopkins Bayview Internal Medicine Residency Program, Baltimore, MD, USA
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Jensen RM, Anand A, Kearse LE, Korndorffer JR. The domino effect: the impact of gender on operative self-efficacy. Surg Endosc 2023; 37:9461-9466. [PMID: 37697120 DOI: 10.1007/s00464-023-10378-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/30/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Studies suggest that there are key differences in operative experience based on a trainee's gender. A large-scale self-efficacy (SE) survey, distributed to general surgery residents after the American Board of Surgery In-Training Examination in 2020, found that female gender was associated with decreased SE in graduating PGY5 residents for all 4 laparoscopic procedures included on the survey (cholecystectomy, appendectomy, right hemicolectomy, and diagnostic laparoscopy). We sought to determine whether these differences were reflected at the case level when considering operative performance and supervision using an operative assessment tool (SIMPL OR). METHODS Supervision and performance data reported through the SIMPL OR platform for the same 4 laparoscopic procedures included in the SE survey were aggregated for residents who were PGY5s in 2020. Independent t-tests and multiple linear regression were used to determine the relationship between trainee gender and supervision/performance ratings. RESULTS For laparoscopic cases in aggregate (n = 2708), male residents rated their performance higher than females (3.57 vs. 3.26, p < 0.001, 1 = critical deficiency, 5 = exceptional performance) and reported less supervision (3.15 vs. 2.85, p < 0.001, 1 = show and tell, 4 = supervision only); similar findings were seen when looking at attending reports of resident supervision and performance. A multiple linear regression model showed that attending gender did not significantly predict resident-reported supervision or performance levels, while case complexity and trainee gender significantly affected both supervision and performance (p < 0.001). DISCUSSION Female residents perceive themselves to be less self-efficacious at core laparoscopic procedures compared to their male colleagues. Comparison to more case-specific data confirm that female residents receive more supervision and lower performance ratings. This may create a domino effect in which female residents receive less operative independence, preventing the opportunity to establish SE. Further research should identify opportunities to break this cycle and consider gender identity beyond the male/female construct.
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Affiliation(s)
- Rachel M Jensen
- Department of Surgery, Stanford University, Stanford, CA, USA.
| | - Ananya Anand
- Department of Surgery, Stanford University, Stanford, CA, USA
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Cassidy DJ, Clanahan JM, Wan F, Jeyarajah R, Brunt LM. The impact of virtual interviews on the Fellowship Council application and main match process. Surg Endosc 2023; 37:9601-9608. [PMID: 37749206 DOI: 10.1007/s00464-023-10424-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/31/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The COVID-19 pandemic led the Fellowship Council (FC) to transition rapidly from in-person to virtual interviews. We investigated the impact of this transition on the FC application and main match process. METHODS Five years (2018-2022) of deidentified FC applicant, program, and match rank data were used to assess differences between in-person (2018-2019) and virtual interview (2021-2022) cycles. Data are expressed as mean ± SD and one-way and two-way MANOVA tests were applied. RESULTS Trainees applied to an average of 30.4 ± 24.3 programs and ranked an average of 10.7 ± 9.7 programs with a 57% match rate and average rank position of 3.6 ± 3.3. Fellowship programs received an average of 64.9 ± 28.6 applications and ranked an average of 15.4 ± 8.8 applicants with a 95% match rate and average applicant rank position of 3.0 ± 3.4. Applicants who interviewed virtually applied to a greater number of programs (32.7 vs. 27.0; p < 0.001) and ranked a greater number of programs (11.5 vs. 10.0; p = 0.004) with no difference in match rates (58% vs. 55%, p = 0.291). Among matched applicants, there was a significant difference in average rank position (3.20 vs. 4.30, p < 0.001), favoring the in-person cohort. Fellowship programs had more applicants per program (69.2 vs. 57.8; p < 0.001) and ranked more applicants (17.4 vs. 13.3; p < 0.001) during the virtual interview cycles. No difference in either match rates (93% vs. 96%, p = 0.178) or applicant rank position (3.09 vs. 2.93, p = 0.561) was seen between in-person and virtual application cycles. CONCLUSION Virtual interviews were associated with an increased number of applications for fellowship and applicants ranked by programs but did not impact match rates of either group. Rank match position declined somewhat for applicants but not for fellowship programs. Virtual interviews offer more opportunities for applicants and a greater number of candidates for fellowship programs with only a slight decrement in fellow match rank position.
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Affiliation(s)
- Douglas J Cassidy
- Department of Surgery, Washington University in St. Louis, St. Louis, USA.
| | - Julie M Clanahan
- Department of Surgery, Washington University in St. Louis, St. Louis, USA
| | - Fei Wan
- Washington University School of Medicine St. Louis, St. Louis, MO, USA
| | - Rohan Jeyarajah
- TCU School of Medicine and Methodist Richardson Medical Center, Dallas, TX, USA
| | - L Michael Brunt
- Department of Surgery, Washington University in St. Louis, St. Louis, USA
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Patrick D, Rizzo K, Grasso S, Schriver J. Length of intraabdominal measurement of bowel (LIMB). Surg Open Sci 2023; 16:68-72. [PMID: 37818460 PMCID: PMC10561113 DOI: 10.1016/j.sopen.2023.09.018] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/16/2023] [Accepted: 09/17/2023] [Indexed: 10/12/2023] Open
Abstract
Background Laparoscopic Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed bariatric surgeries. The steep associated learning curve is dependent on the training facility, laparoscopic experience, and overall procedural volume. William Beaumont Army Medical Center (WBAMC) has been accredited as a bariatric center of excellence and trains resident surgeons in the performance of RYGB. Objective This study aimed to investigate the accuracy and precision of a bariatric center of excellence's training of surgical residents in terms of laparoscopic measurements of simulated small bowel. This will act as a surrogate for how well surgical residents learn to run the small bowel during bariatric procedures and how their accuracy and precision change over time in training. Setting This study took place at William Beaumont Army Medical Center, a bariatric center of excellence and training institution. Methods Participants included surgical residents from WBAMC. Participants used a laparoscopic trainer and two bowel graspers to measure both a collapsing garden hose (simulated bowel) and a nylon rope (control material) to 75 cm (cm) and 125 cm (cm), three times each, with recordings of time required to do so, actual distance measured, and technique used. Results Fifteen residents participated in the study. Residents displayed accuracy of 21.6 %. 33%of residents were precise for the 75 cm measurement, and 53 % of residents were precise for the 125-cm measurement. PGY-4 residents were the most accurate while PGY-3 residents were the most precise. There were no statistical differences between junior (PGY 1-4) and senior residents (PGY 5-6) in accuracy or precision in the measurement of 75-cm or 125-cm. No statistical differences were found measuring the hose versus rope in accuracy nor precision. PGY-4 residents completed the task in the least amount of time while PGY-2 residents took the longest to complete each task. Conclusions In general, residents are neither precise nor accurate in measurements of simulated bowel lengths, and experience does not contribute to either. Time in residency correlates with laparoscopic speed but not with accuracy nor precision. Extrapolating this data to attending surgeons suggests that estimated lengths of small bowel that are 'run' or measured during laparoscopic cases are neither accurate nor precise. More investigation must be performed in this area.
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Affiliation(s)
- Danielle Patrick
- William Beaumont Army Medical Center, 18511 Highlander Medics Street, El Paso, TX 79918, United States of America
| | - Kayla Rizzo
- William Beaumont Army Medical Center, 18511 Highlander Medics Street, El Paso, TX 79918, United States of America
| | - Sam Grasso
- William Beaumont Army Medical Center, 18511 Highlander Medics Street, El Paso, TX 79918, United States of America
| | - John Schriver
- William Beaumont Army Medical Center, 18511 Highlander Medics Street, El Paso, TX 79918, United States of America
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Bagian JP, Paull DE, DeRosier JM. Developing surgical and anesthesia resident patient safety competencies through systems-based event analysis. Guide to curricular development and evaluation of longer-term resident perceptions. Surg Open Sci 2023; 16:33-36. [PMID: 37766797 PMCID: PMC10520507 DOI: 10.1016/j.sopen.2023.09.007] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/17/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Previous studies have demonstrated that residents participating in patient safety event investigations become more engaged in future patient safety activities. Currently, there is a gap in resident participation in patient safety event analyses. The objective was to develop and implement a sustainable, faculty-led curriculum for resident participation in patient safety event investigations and to evaluate resident perceptions of the training at least one year following completion of the training. One hundred sixty-five residents from three specialties participated in a formal RCA2 training curriculum from 2013 to 2019. In November 2019, the same residents were asked to complete a survey which examined their perception of the training including the tools and techniques such as event mapping, cause-and-effect diagramming, and developing action plans for solving problems and unsafe conditions. The survey response rate was 36 % (60/165). Sixty-three percent (38/60) of the residents responding to the survey believed that RCA2 training should be provided to all residents. Former residents rated the RCA2 training tools and skills favorably, 3.6 median score (3.5-3.7, 95 % C.I.). Forty-eight percent of responding residents (29/60) believed that the previous RCA2 training improved the way they identify and solve problems. The curriculum and faculty development program provides an effective intervention to address the current, identified gaps in patient safety in graduate medical education.
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Affiliation(s)
- James P. Bagian
- Industrial Operations Engineering (IOE), University of Michigan, Ann Arbor, MI, USA
| | - Douglas E. Paull
- Department of Medicine at Georgetown University, Washington, DC, USA
- Accreditation Council for Graduate Medical Education (ACGME), Chicago, IL, USA
| | - Joseph M. DeRosier
- Industrial Operations Engineering (IOE), University of Michigan, Ann Arbor, MI, USA
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Haywood N, Scott J, Zhang A, Hallowell P, Schirmer B. Characterization of the robotic surgery experience in minimally invasive surgery fellowships from 2010 to 2021. Surg Endosc 2023; 37:9393-9398. [PMID: 37658200 DOI: 10.1007/s00464-023-10402-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Robotic surgery has experienced exponential growth in the past decade. Few studies have evaluated the impact of robotics within minimally invasive surgery (MIS) fellowship training programs. The purpose of our study was to examine and characterize recent trends in robotic surgery within MIS fellowship training programs. METHODS De-identified case log data from the Fellowship Council from 2010 to 2021 were evaluated. Percentage of operations performed with robot assistance over time was assessed and compared to the laparoscopic and open experience. Case logs were further stratified by operative category (e.g., bariatric, hernia, foregut), and robotic experience over time was evaluated for each category. Programs were stratified by percent robot use and the experience over time within each quartile was evaluated. RESULTS MIS fellowship training programs with a robotic platform increased from 45.1% (51/113) to 90.4% (123/136) over the study period. The percentage of robotic cases increased from 2.0% (1127/56,033) to 23.2% (16,139/69,496) while laparoscopic cases decreased from 80.2% (44,954/56,033) to 65.3% (45,356/69,496). Hernia and colorectal case categories had the largest increase in robot usage [hernia: 0.7% (62/8614) to 38.4% (4661/12,135); colorectal 4.2% (116/2747) to 31.8% (666/2094)]. When stratified by percentage of robot utilization, current (2020-2021) programs in the > 95th percentile performed 21.8% (3523/16,139) of robotic operations and programs in the > 50th percentile performed 90.0% (14,533/16,139) of all robotic cases. The median number of robotic cases performed per MIS fellow significantly increased from 2010 to 2021 [0 (0-6) to 72.5 (17.8-171.5), p < 0.01]. CONCLUSIONS Robotic use in MIS fellowship training programs has grown substantially in the past decade, but the laparoscopic and open experience remains robust. There remains an imbalance with the top 50% of busiest robotic programs performing over 90% of robot trainee cases. The experience in MIS programs varies widely and trainees should examine program case logs closely to confirm parallel interests.
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Affiliation(s)
- Nathan Haywood
- Division of General Surgery, Department of Surgery, University of Virginia Health, 1215 Lee St., Charlottesville, VA, 22903, USA.
| | - Joshua Scott
- Department of General Surgery, Sheridan Memorial Hospital, Sheridan, WY, USA
| | - Aimee Zhang
- Division of General Surgery, Department of Surgery, University of Virginia Health, 1215 Lee St., Charlottesville, VA, 22903, USA
| | - Peter Hallowell
- Division of General Surgery, Department of Surgery, University of Virginia Health, 1215 Lee St., Charlottesville, VA, 22903, USA
| | - Bruce Schirmer
- Division of General Surgery, Department of Surgery, University of Virginia Health, 1215 Lee St., Charlottesville, VA, 22903, USA.
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Wollney EN, Vasquez TS, Stalvey C, Close J, Markham MJ, Meyer LE, Cooper LA, Bylund CL. Are evaluations in simulated medical encounters reliable among rater types? A comparison between standardized patient and outside observer ratings of OSCEs. PEC Innov 2023; 2:100125. [PMID: 37214504 PMCID: PMC10194306 DOI: 10.1016/j.pecinn.2023.100125] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 12/20/2022] [Accepted: 01/20/2023] [Indexed: 05/24/2023]
Abstract
Objective By analyzing Objective Structured Clinical Examination (OSCE) evaluations of first-year interns' communication with standardized patients (SP), our study aimed to examine the differences between ratings of SPs and a set of outside observers with training in healthcare communication. Methods Immediately following completion of OSCEs, SPs evaluated interns' communication skills using 30 items. Later, two observers independently coded video recordings using the same items. We conducted two-tailed t-tests to examine differences between SP and observers' ratings. Results Rater scores differed significantly on 21 items (p < .05), with 20 of the 21 differences due to higher SP in-person evaluation scores. Items most divergent between SPs and observers included items related to empathic communication and nonverbal communication. Conclusion Differences between SP and observer ratings should be further investigated to determine if additional rater training is needed or if a revised evaluation measure is needed. Educators may benefit from adjusting evaluation criteria to decrease the number of items raters must complete and may do so by encompassing more global questions regarding various criteria. Furthermore, evaluation measures may be strengthened by undergoing reliability and validity testing. Innovation This study highlights the strengths and limitations to rater types (observers or SPs), as well as evaluation methods (recorded or in-person).
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Affiliation(s)
- Easton N. Wollney
- Dept. of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Taylor S. Vasquez
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Carolyn Stalvey
- Dept. of Internal Medicine, College of Medicine, University of Florida, Gainesville, FL USA
| | - Julia Close
- Dept. of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Merry Jennifer Markham
- Dept. of Hematology and Oncology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lynne E. Meyer
- Graduate Medical Education, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lou Ann Cooper
- Dept. of Medical Education, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Carma L. Bylund
- Dept. of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
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Krecko LK, Stalter LN, Quamme SRP, Steege LM, Zelenski AB, Greenberg CC, Jung S. Discussion-based interprofessional education: A positive step toward promoting shared understanding between surgical residents and nurses. J Interprof Care 2023; 37:974-989. [PMID: 37161400 PMCID: PMC10636242 DOI: 10.1080/13561820.2023.2206434] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/30/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023]
Abstract
Interprofessional education during medical training may improve communication by promoting collaboration and the development of shared mental models between professions. We implemented a novel discussion-based intervention for surgical residents and nurses to promote mutual understanding of workflows and communication practices. General surgery residents and inpatient nurses from our institution were recruited to participate. Surveys and paging data were collected prior to and following the intervention. Surveys contained original questions and validated subscales. Interventions involved facilitated discussions about workflows, perceptions of urgency, and technology preferences. Discussions were recorded and transcribed for qualitative content analysis. Pre and post-intervention survey responses were compared with descriptive sample statistics. Group characteristics were compared using Fisher's exact tests. Eleven intervention groups were conducted (2-6 participants per group) (n = 38). Discussions achieved three aims: Information-Sharing (learning about each other's workflows and preferences), 2) Interpersonal Relationship-Building (establishing rapport and fostering empathy) and 3) Interventional Brainstorming (discussing strategies to mitigate communication challenges). Post-intervention surveys revealed improved nurse-reported grasp of resident schedules and tailoring of communication methods based on workflow understanding; however, communication best practices remain limited by organizational and technological constraints. Systems-level changes must be prioritized to allow intentions toward collegial communication to thrive.
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Affiliation(s)
- Laura K Krecko
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Lily N Stalter
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sudha R Pavuluri Quamme
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Linsey M Steege
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Amy B Zelenski
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Caprice C Greenberg
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sarah Jung
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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Gillespie C, Wilhite JA, Hanley K, Hardowar K, Altshuler L, Fisher H, Porter B, Wallach A, Zabar S. Addressing social determinants of health in primary care: a quasi-experimental study using unannounced standardised patients to evaluate the impact of audit/feedback on physicians' rates of identifying and responding to social needs. BMJ Qual Saf 2023; 32:632-643. [PMID: 35623722 DOI: 10.1136/bmjqs-2021-013904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 05/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although efforts are underway to address social determinants of health (SDOH), little is known about physicians' SDOH practices despite evidence that failing to fully elicit and respond to social needs can compromise patient safety and undermine both the quality and effectiveness of treatment. In particular, interventions designed to enhance response to social needs have not been assessed using actual practice behaviour. In this study, we evaluate the degree to which providing primary care physicians with feedback on their SDOH practice behaviours is associated with increased rates of eliciting and responding to housing and social isolation needs. METHODS Unannounced standardised patients (USPs), actors trained to consistently portray clinical scenarios, were sent, incognito, to all five primary care teams in an urban, safety-net healthcare system. Scenarios involved common primary care conditions and each included an underlying housing (eg, mould in the apartment, crowding) and social isolation issue and USPs assessed whether the physician fully elicited these needs and if so, whether or not they addressed them. The intervention consisted of providing physicians with audit/feedback reports of their SDOH practices, along with brief written educational material. A prepost comparison group design was used to evaluate the intervention; four teams received the intervention and one team served as a 'proxy' comparison (no intervention). Preintervention (February 2017 to December 2017) rates of screening for and response to the scripted housing and social needs were compared with intervention period (January 2018 to March 2019) rates for both intervention and comparison teams. RESULTS 108 visits were completed preintervention and 183 during the intervention period. Overall, social needs were not elicited half of the time and fully addressed even less frequently. Rates of identifying the housing issue increased for teams that received audit/feedback reports (46%-60%; p=0.045) and declined for the proxy comparison (61%-42%; p=0.174). Rates of responding to housing needs increased significantly for intervention teams (15%-41%; p=0.004) but not for the comparison team (21%-29%; p=0.663). Social isolation was identified more frequently postintervention (53%) compared with baseline (39%; p=0.041) among the intervention teams but remained unchanged for the comparison team (39% vs 32%; p=0.601). Full exploration of social isolation remained low for both intervention and comparison teams. CONCLUSIONS Results suggest that physicians may not be consistently screening for or responding to social needs but that receiving feedback on those practices, along with brief targeted education, can improve rates of SDOH screening and response.
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Affiliation(s)
- Colleen Gillespie
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Institute for Innovations in Medical Education, NYU Grossman School of Medicine, New York, New York, USA
| | - Jeffrey A Wilhite
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Kathleen Hanley
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Ambulatory Care, New York City Health + Hospitals, New York, New York, USA
| | - Khemraj Hardowar
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Lisa Altshuler
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Harriet Fisher
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Barbara Porter
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Andrew Wallach
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Ambulatory Care, New York City Health + Hospitals, New York, New York, USA
| | - Sondra Zabar
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Ambulatory Care, New York City Health + Hospitals, New York, New York, USA
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McCormick AD, Lim HM, Strohacker CM, Yu S, Lowery R, Vitale C, Ligsay A, Aiyagari R, Schumacher KR, Fifer CG, Owens ST, Cousino MK. Paediatric cardiology training: burnout, fulfilment, and fears. Cardiol Young 2023; 33:2274-2281. [PMID: 36691819 DOI: 10.1017/s1047951123000148] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Burnout is well characterised in physicians and residents but not in paediatric cardiology fellows, and few studies follow burnout longitudinally. Training-specific fears have been described in paediatric cardiology fellows but also have not been studied at multiple time points. This study aimed to measure burnout, training-specific fears, and professional fulfilment in paediatric cardiology fellows with the attention to time of year and year-of-training. METHODS This survey-based study included the Professional Fulfillment Index and the Impact of Events Scale as well as an investigator-designed Fellow Fears Questionnaire. Surveys were distributed at three-time points during the academic year to paediatric cardiology fellows at a large Midwestern training programme. Fellow self-reported gender and year-of-training were collected. Descriptive analyses were performed. RESULTS 10/17 (59%) of fellows completed all surveys; 60% were female, 40% in the first-year class, 40% in the second-year class, and 20% in the third-year class. At least half of the fellows reported burnout at each survey time point, with lower mean professional fulfilment scores. The second-year class, who rotate primarily in the cardiac ICU, had higher proportions of burnout than the other two classes. At least half of fellows reported that they "often" or "always" worried about not having enough clinical knowledge or skills and about work-life balance. CONCLUSIONS Paediatric cardiology fellows exhibit high proportions of burnout and training-specific fears. Interventions to mitigate burnout should be targeted specifically to training needs, including during high-acuity rotations.
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Affiliation(s)
| | - Heang M Lim
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Sunkyung Yu
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Ray Lowery
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Carolyn Vitale
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Andrew Ligsay
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Ranjit Aiyagari
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Carlen G Fifer
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Sonal T Owens
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
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Porras Fimbres DC, Jacobs J, Diamond C, Rundle CW, Rodriguez-Homs L, Presley C, Stamey C. Representation of Fitzpatrick skin phototype in dermatology surgical textbooks. Arch Dermatol Res 2023; 315:2463-2465. [PMID: 37452856 DOI: 10.1007/s00403-023-02667-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 05/31/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
Given the importance of skin of color (SoC) representation in dermatologic education and training, this study quantified representation of Fitzpatrick skin phototypes (FST) in core dermatology surgery textbooks. Images within Surgery of the Skin: Procedural Dermatology, Dermatologic Surgery, and Facial Reconstruction after Mohs Surgery were categorized according to the Fitzpatrick skin phototype (FST) depicted and the dermatologic surgery topic addressed. 1501 images were analyzed, with only 5.6% of the images categorized as FST IV-VI representing SoC. Several topics (11/29, 37.9%) identified did not include images with SoC. Increasing access to high-quality images of SoC can enhance appreciation of various skin conditions, especially those predominant in SoC, by dermatologic trainees and clinicians.
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Affiliation(s)
| | | | | | - Chandler W Rundle
- Department of Dermatology, Duke Health, Duke Wakefield Mohs Surgery, Duke University School of Medicine, Duke University, 11081 Forest Pines Dr, Raleigh, NC, 27614-7656, USA
| | - Larissa Rodriguez-Homs
- Department of Dermatology, Duke Health, Duke Wakefield Mohs Surgery, Duke University School of Medicine, Duke University, 11081 Forest Pines Dr, Raleigh, NC, 27614-7656, USA
| | - Colby Presley
- Department of Dermatology, Lehigh Valley Network, Allentown, PA, USA
| | - Christopher Stamey
- Department of Dermatology, Duke Health, Duke Wakefield Mohs Surgery, Duke University School of Medicine, Duke University, 11081 Forest Pines Dr, Raleigh, NC, 27614-7656, USA.
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Kang C, Shin CJ, Scott IU, Greenberg PB. Virtual supervision in ophthalmology: a scoping review. Graefes Arch Clin Exp Ophthalmol 2023; 261:2755-2762. [PMID: 37017740 PMCID: PMC10074343 DOI: 10.1007/s00417-023-06048-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/08/2023] [Accepted: 03/24/2023] [Indexed: 04/06/2023] Open
Abstract
PURPOSE The published information on virtual supervision (VS) in ophthalmology is not well described. This scoping review describes the evidence and potential role for VS in ophthalmic practice and education. METHODS A literature search strategy was developed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We included full-text articles published in an English-language peer-reviewed journal that involved physician-physician or physician-trainee VS in ophthalmology. We excluded studies with direct (in-person) supervision. Two investigators independently extracted from each article the year of publication and study location, design, participant characteristics, sample size, and outcomes. We appraised the methodological quality of the studies using the Mixed Methods Appraisal Tool (MMAT). RESULTS Seven articles were included in our qualitative synthesis. Supervisees ranged from physicians such as an ophthalmic surgeon and a general practitioner to medical trainees such as ophthalmology residents, vitreoretinal fellows, and emergency medicine residents. Study settings included emergency departments, operating rooms, eye clinics, and a rural hospital. All studies reported successful transmission of real-time images or videos of clinical examinations and surgical or in-office procedures. Various methods were used to ensure high image and video quality during VS, although some technical challenges remained. MMAT ratings revealed limitations in outcome measurement, statistical analysis, sampling strategy, and inclusion of confounding factors. CONCLUSION Virtual supervision in ophthalmology is technologically feasible and permits synchronous communication and transmission of clinical data, which can be used to formulate diagnostic and management plans and learn new surgical skills. Future studies with larger sample sizes and robust study designs should investigate factors that make VS effective in ophthalmic practice and education.
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Affiliation(s)
- Chaerim Kang
- Program in Liberal Medical Education, Brown University, Providence, RI, USA
- Division of Ophthalmology, Alpert Medical School, Brown University, Providence, RI, USA
| | - Christopher J Shin
- Division of Ophthalmology, Alpert Medical School, Brown University, Providence, RI, USA
| | - Ingrid U Scott
- Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Paul B Greenberg
- Division of Ophthalmology, Alpert Medical School, Brown University, Providence, RI, USA.
- Section of Ophthalmology, VA Providence Healthcare System, RI, Providence, USA.
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Hong J, Siddique U, Echevarria G, Patel A, Lai YH, Pai BP. Cross-sectional study on utilisation of social media by regional anaesthesia and acute pain medicine fellowship programs in the United States. J Anaesthesiol Clin Pharmacol 2023; 39:571-576. [PMID: 38269162 PMCID: PMC10805201 DOI: 10.4103/joacp.joacp_149_23] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/08/2023] [Accepted: 08/13/2023] [Indexed: 01/26/2024] Open
Abstract
Background and Aims Social media provides a platform for physicians helping them change the practice in anaesthesiology as it promotes both personal and professional growth. In this cross-sectional study, we identify social media presence and engagement of Accreditation Council for Graduate Medical Education (ACGME)-accredited Regional Anesthesia and Acute Pain Medicine (RAAPM) fellowship programs, specifically on Twitter (Twitter Inc., San Francisco, CA) and Instagram (Meta Platforms Inc., Menlo Park, CA). This article presents current evidence about social media presence and engagement of ACGME-accredited RAAPM fellowship programs on Twitter and Instagram. These findings could potentially help cultivate greater social media engagement in the RAAPM community and improve recruitment of prospective applicants. Material and Methods The list of ACGME-accredited RAAPM fellowship programs for the academic year 2020-2021 was obtained from the ACGME website. Accounts were searched by reviewing each program's website for profile links and by querying for the name of the program directly on Twitter and Instagram. Department of Anesthesiology, Perioperative and Pain Medicine accounts were analysed for posts pertaining to RAAPM elements, and RAAPM fellowship-specific accounts were investigated. Accounts that were solely focused on an anaesthesiology residency were excluded. All posts over the academic year period of 1 July 2020 to 30 June 2021 were analyzed. Results While many programs had active departmental social media accounts during our study, there was a dearth of RAAPM-related output (3.4% of tweets and 2.7% Instagram posts). Furthermore, only 10% of programs had RAAPM fellowship-specific Twitter accounts, of which only 5% of programs were active. Finally, there were no RAAPM fellowship-specific Instagram accounts. Conclusions While there is robust use of social media by departmental accounts, there is a paucity of RAAPM-related content and RAAPM fellowship-specific social media accounts. The current gap provides valuable opportunities for future investigations into the cyber footprint and innovative engagement strategies for the RAAPM community.
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Affiliation(s)
- Janet Hong
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai Medical Center, Mount Sinai West and Morningside Hospitals, Tenth Avenue, New York, NY, USA
| | - Usama Siddique
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai Medical Center, Mount Sinai West and Morningside Hospitals, Tenth Avenue, New York, NY, USA
| | - Ghislaine Echevarria
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai Medical Center, Mount Sinai West and Morningside Hospitals, Tenth Avenue, New York, NY, USA
| | - Alopi Patel
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai Medical Center, Mount Sinai West and Morningside Hospitals, Tenth Avenue, New York, NY, USA
| | - Yan H. Lai
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai Medical Center, Mount Sinai West and Morningside Hospitals, Tenth Avenue, New York, NY, USA
| | - B.H Poonam Pai
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai Medical Center, Mount Sinai West and Morningside Hospitals, Tenth Avenue, New York, NY, USA
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Read CE, Tracz JA, Mhaimeed N, Mainville RN, Elzie CA. Examination of residency program websites for the use of gendered language and imagery. BMC Med Educ 2023; 23:697. [PMID: 37752546 PMCID: PMC10523617 DOI: 10.1186/s12909-023-04677-4] [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: 01/06/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Significant disparity in gender distribution exists among medical specialties. Residency program websites are a main source of preliminary program information for candidates, and website content may influence a prospective applicant's sense of belongingness within a particular program. Given the importance of the residency program website as a recruiting tool, this study sought to examine and compare the presence of gendered language and imagery on residency program websites across various specialties. METHODS A list of words considered masculine or feminine was used to evaluate residency program websites of the two most male-dominated specialties (orthopedic and thoracic surgery), female-dominated specialties (pediatrics and obstetrics and gynecology), and gender-balanced specialties (dermatology and family medicine) in the United States in 2022. Forty-five residency programs were randomly selected from each specialty across different regions of the US, with the exception of thoracic surgery of which there are only 33 programs. Masculine and feminine words were evaluated using a parsing and scraping program. Representation of female and male-presenting team members in photos on program websites was also evaluated. RESULTS Masculine wording occurred more frequently in male-dominated specialties compared to gender-balanced (p = 0.0030), but not female-dominated specialties (p = 0.2199). Feminine language was used more frequently in female-dominated compared to male dominated fields (p = 0.0022), but not gender balanced (p = 0.0909). The ratio of masculine-to-feminine words used was significantly higher in male-dominated specialties compared to both gender-balanced (p < 0.0001) and female-dominated specialties. (p < 0.0001). There was an average of 1, 7, and 10 female-presenting residency team members pictured on each male-dominated, gender balanced, and female-dominated specialty RPW respectively, with significantly more female-presenting team members pictured in the photographs on female-dominated specialty websites when compared to male-dominated and gender-balanced specialty websites (p < 0.0001, p = 0.014). CONCLUSIONS The use of gendered language and female representation in photographs varies significantly across specialties and is directly correlated with gender representation within the specialty. Given that students' perceptions of specialty programs may be affected by the use of language and photos on residency program websites, programs should carefully consider the language and pictures depicted on their program websites.
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Affiliation(s)
- Catherine E Read
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, 23507, USA
| | - Jovanna A Tracz
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, 23507, USA
| | - Nour Mhaimeed
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, 23507, USA
| | - Rylie N Mainville
- School of Medicine, Eastern Virginia Medical School, Norfolk, VA, 23507, USA
| | - Carrie A Elzie
- Department of Cell Systems and Anatomy/Medical Education, University of Texas Health Science Center at San Antonio, 78229, San Antonio, TX, USA.
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Durette L, Oden C, Rudig N, Parikh N. Clinicians' Experience with a Graduate Medical Education Implemented Child Psychiatry Access Program. Acad Psychiatry 2023:10.1007/s40596-023-01860-z. [PMID: 37749445 DOI: 10.1007/s40596-023-01860-z] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/29/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE The authors aim to measure differences in primary care clinicians' (PCC's) perceptions of managing pediatric mental health before and after launch of a child psychiatry access program (the access program) and identify the impact of engaging trainees from child psychiatry, pediatrics, and family medicine in administration and use of this program. METHODS Child psychiatry fellows provide coverage of a grant-funded state-wide access program and engage trainee-peers in learning how to use the program. A survey measuring PCC's experience managing children's mental health conditions was administered before and after the child psychiatry access program launched. Rotation evaluations collect trainee's feedback. RESULTS Statistically significant differences are identified before and after the program's launch in PCC's perception of access to child psychiatry (U = 294.5, p < 0.001) and between PCC's perceptions of the impact of behavioral health problems in their patients in those with less than 4 years post-residency training compared with those with 4 or more years post-residency (U = 524.5, p < .01). Trainee evaluation of the rotation is consistently positive (average 5:6 rating). CONCLUSION The authors conclude that (1) the presence of a state-wide access program positively impacts PCC's reported access to child psychiatry; (2) child psychiatry fellows rate the clinical rotation experience favorably; and (3) there appears to be an association between less time out of primary care residency training and perception of improved access to child psychiatry and less clinical burden from behavioral health issues. Further research is required to understand the impact of a training in this model.
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Affiliation(s)
- Lisa Durette
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA.
| | - Crystal Oden
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
| | - Nathan Rudig
- Center for Community Solutions, Las Vegas, NV, USA
| | - Nina Parikh
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
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Harmon DJ, Boscardin CK, Cohen NH, Braehler MR. The efficacy of an anatomy and ultrasonography workshop on improving residents' confidence and knowledge in regional anesthesia. BMC Med Educ 2023; 23:665. [PMID: 37710292 PMCID: PMC10500924 DOI: 10.1186/s12909-023-04653-y] [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: 01/18/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Ultrasound Guided Regional Anesthesia (UGRA) has become the standard for regional anesthesia practice, but there is not a standardized educational approach for training residents. The objective of this study was to evaluate the efficacy of an UGRA workshop utilizing the theoretical framework of embodied cognition for anesthesiology residents. METHODS A workshop was developed consisting of didactics, scanning training on standardized patients (SPs) and anatomy reviews on prosected cadavers that focused on the most common UGRA procedures for the upper and lower extremity. At the beginning of the workshop and at the end of the workshop residents completed pre-test and pre-confidence surveys, as well as post-test and post-confidence surveys, respectively to assess the impact of the workshop. RESULTS 39 residents (100% of the possible residents) participated in the workshop in 2019. Residents' confidence in identifying relevant anatomy for the most common UGRA procedures significantly increased in 13 of the 14 measurements. Residents' knowledge gain was also statistically significant from the pre-test to post-test (20.13 ± 3.61 and 26.13 ± 2.34; p < .0001). The residents found the course overall to be very useful (4.90 ± 0.38) and in particular the cadaveric component was highly rated (4.74 ± 0.55). CONCLUSIONS In this study, we developed a workshop guided by the embodied cognition framework to aid in shortening the overall learning curve of UGRA for anesthesiology residents. Based on our results this workshop should be replicated by institutions that are hoping to decrease the learning curve associated with UGRA and increase residents' confidence in identifying the relevant anatomy in UGRA nerve blocks.
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Affiliation(s)
- Derek J Harmon
- Division of Anatomy, Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, 320 W 10th Ave. B104 Starling Loving Hall, Columbus, OH, 43210, USA.
| | - Christy K Boscardin
- Department of Medicine and Anesthesia, University of California San Francisco, San Francisco, CA, USA
| | - Neal H Cohen
- Department of Anesthesia and Perioperative Care and Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Matthias R Braehler
- Department of Anesthesia and Perioperative Care and Medicine, University of California San Francisco, San Francisco, CA, USA
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Ramadurai D, Shea JA. Leveraging the health equity implementation framework to foster an equity focus in medical education. Adv Health Sci Educ Theory Pract 2023:10.1007/s10459-023-10277-0. [PMID: 37668934 PMCID: PMC10912357 DOI: 10.1007/s10459-023-10277-0] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/13/2023] [Indexed: 09/06/2023]
Abstract
Teaching equitable clinical practice is of critical importance, yet how best to do so remains unknown. Educators utilize implementation science frameworks to disseminate clinical evidence-based practices (EBP). The Health Equity Implementation Framework (HEIF) is one of these frameworks, and it delineates how health equity may be concomitantly assessed and addressed in planning the implementation of an EBP. The HEIF therefore lays a strong foundation to understand and explain barriers and facilitators to implementation through an equity lens, making it well-suited for use by medical educators. Three equity-focused frames of reference within the model include (1) the clinical encounter, (2) societal context, and (3) culturally relevant factors, herein referred to as domains. The HEIF provides a structure for prospective and retrospective assessment of how EBP are taught and ultimately incorporated into clinical practice by trainees, with specific attention to delivering equitable care. We present three examples of common topics in internal medicine, contextualized by the three equity domains of the HEIF. We additionally acknowledge the limitations of this framework as a research tool with complex features that may not be suitable for brief teaching in the clinical environment. We propose a 360-degree learner assessment to ensure implementation of this framework is successful. By encouraging trainees to explore the narrative experiences of their patients and examine their own implicit biases, the HEIF provides a structure to address gaps in knowledge about delivering equitable care.
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Affiliation(s)
- Deepa Ramadurai
- Division of Pulmonary, Allergy and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Judy A Shea
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Hirvonen J, Becker M, Aronen HJ. Resident education in radiology in Europe including entrustable professional activities: results of an ESR survey. Insights Imaging 2023; 14:139. [PMID: 37606861 PMCID: PMC10444922 DOI: 10.1186/s13244-023-01489-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023] Open
Abstract
Entrustable professional activity (EPA) is a tool for comprehensively evaluating the level of confidence in resident performances across various competencies in medicine. The application of and attitudes towards EPAs in radiology across the European Society of Radiology (ESR) national institutional member societies is still to be determined. An online survey was conducted among ESR national institutional member societies to assess the current use of EPAs and other resident assessment forms among different countries.Although the primary focus was on the use of EPAs, additional questions also addressed the adherence of training programs to the European Training Curriculum (ETC), other methods of continuous assessment, and examinations. A total of 65 responses were received from 38 countries (81% response rate among national institutional member societies). EPAs were being used in radiology in 21% of countries and planned to be used in 26%. Most responders considered EPAs suitable for radiology and, regarding the future, preferred European-level guidelines on EPAs over national or institutional levels. The majority (63%) of national training programs were reported to be similar to or following the content of the ETC, and the majority (95%) of countries rated the requirements of the European Training Curriculum (ETC) to be adequate. In conclusion, EPAs are beginning to be used in radiology resident training programs across Europe, and their use is expected to increase. There seems to be a positive attitude toward using EPAs in radiology and toward a common European framework.Critical relevance statement As a result of this survey, we found positive attitudes towards using entrustable professional activities (EPA) in radiology among the institutional member societies of the European Society of Radiology (ESR).Key points• Twenty-one percent of national member societies use entrustable professional activities (EPA) in radiology.• There is a positive attitude toward using EPAs in radiology.• Majority of respondents preferred a common European framework for EPAs.• Majority of radiology training curricula adhere to the European Training Curriculum (ETC).
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Stein JN, Gaddy JJ, Sorah JD, Wooten M, Gibson K, Collichio FA. Seeking Racial Equity in Hematology and Oncology: a Fellow-Led Educational Series to Promote Reflection and Action. J Cancer Educ 2023; 38:1241-1244. [PMID: 36598746 PMCID: PMC10463164 DOI: 10.1007/s13187-022-02255-8] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
The USA is experiencing a reckoning with racial injustice and graduate medical education programs are seeking ways to address this important topic in training. Fellows in hematology/oncology at the University of North Carolina recognized this important gap and adapted a curriculum for medical residents on racial equity to a subspecialty audience. Aims were (1) to improve knowledge and awareness about implicit bias and systemic racism and (2) introduce methods to address racial inequities. We used lived experiences and collated materials from scientific literature and lay media to illustrate key points. The course explored the effects of implicit bias on individual, clinical, and health system levels, anchored in Kahneman's two-system theory. Videos, journal articles, and group discussion were employed to appeal to many learning styles. A post-curriculum survey assessed perceptions of racial inequality in medicine and the series' effects using a Likert scale. Twenty-nine participants completed the survey (12 fellows), 71% reported improved awareness of racial inequities, and 61% reported improved comfort level in addressing racial inequities. All participants recognized at least "some" racial inequity in medicine, and over 75% of participants indicated interest in further sessions. Formulation of an educational curriculum by fellows and delivered in a division-wide setting was feasible and well received by participants, filling a key educational gap. We encourage other institutions to take similar steps to highlight issues of systemic racism and move our field in the right direction.
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Affiliation(s)
- Jacob N Stein
- UNC Lineberger Comprehensive Cancer Center, 170 Manning Drive, CB 7305, Chapel Hill, NC, USA.
- University of North Carolina at Chapel Hill School of Medicine, 101 Manning Dr, Chapel Hill, NC, USA.
| | - Jacquelyne J Gaddy
- UNC Lineberger Comprehensive Cancer Center, 170 Manning Drive, CB 7305, Chapel Hill, NC, USA
- University of North Carolina at Chapel Hill School of Medicine, 101 Manning Dr, Chapel Hill, NC, USA
| | - Jonathan D Sorah
- UNC Lineberger Comprehensive Cancer Center, 170 Manning Drive, CB 7305, Chapel Hill, NC, USA
- University of North Carolina at Chapel Hill School of Medicine, 101 Manning Dr, Chapel Hill, NC, USA
| | - Melissa Wooten
- University of North Carolina at Chapel Hill School of Medicine, 101 Manning Dr, Chapel Hill, NC, USA
| | - Keisha Gibson
- University of North Carolina at Chapel Hill School of Medicine, 101 Manning Dr, Chapel Hill, NC, USA
| | - Frances A Collichio
- UNC Lineberger Comprehensive Cancer Center, 170 Manning Drive, CB 7305, Chapel Hill, NC, USA
- University of North Carolina at Chapel Hill School of Medicine, 101 Manning Dr, Chapel Hill, NC, USA
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Finn EM, Zwemer EK, Stephens JR, Dancel R. The State of Internal Medicine Point-of-Care Ultrasound (POCUS) Fellowships in the United States and Canada. Am J Med 2023; 136:830-836. [PMID: 37116671 DOI: 10.1016/j.amjmed.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/22/2023] [Indexed: 04/30/2023]
Affiliation(s)
- Erin M Finn
- Department of Internal Medicine; Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill.
| | - Eric K Zwemer
- Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill
| | - John R Stephens
- Department of Internal Medicine; Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill
| | - Ria Dancel
- Department of Internal Medicine; Department of Pediatrics, Division of Hospital Medicine, University of North Carolina, Chapel Hill
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Benhamou D, Mercier FJ, Van de Velde M, Lucas N, Sng BL, Gaiser R. Education in obstetric anesthesiology: an international approach. Int J Obstet Anesth 2023; 55:103896. [PMID: 37270857 DOI: 10.1016/j.ijoa.2023.103896] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/26/2023] [Accepted: 04/24/2023] [Indexed: 06/06/2023]
Abstract
Competency-based training and active teaching methods are increasingly becoming accepted and utilized in medical schools and hospitals, and obstetric anesthesiology training is expected to follow this process. This article summarizes current modalities of obstetric anesthesiology training in five countries from various parts of the world. Analysis of these curricula shows that implementation of new educational methods is variable, incomplete, and lacking in data related to patient outcomes. Research in assessments and practical applications are required to avoid wide ranges of educational strategies.
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Affiliation(s)
- D Benhamou
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP.Université Paris Saclay, Hôpital Bicêtre, Le Kremlin Bicêtre Cedex, France.
| | - F J Mercier
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP.Université Paris Saclay, Hôpital Antoine Béclère, Clamart Cedex, France
| | - M Van de Velde
- Department of Cardiovascular Sciences, KU Leuven, and Department of Anaesthesiology, UZ Leuven, Leuven, Belgium
| | - N Lucas
- London North West Healthcare NHS Trust, United Kingdom
| | - B L Sng
- Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore and Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - R Gaiser
- Yale School of Medicine, New Haven, CT, USA
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