1
|
Steinhagen E, Khan SZ, Ofshteyn A, Terhune K, Selby L, Miller-Ocuin J, Stein SL, Ammori JB. Creation and Implementation of an Online Tool for Feedback on Resident Teaching: A Pilot Study. J Surg Educ 2024; 81:713-721. [PMID: 38580499 DOI: 10.1016/j.jsurg.2024.01.010] [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: 06/12/2023] [Revised: 12/11/2023] [Accepted: 01/16/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE There are few assessments of the competence and growth of surgical residents as educators. We developed and piloted an observation-based feedback tool (FT) to provide residents direct feedback during a specific teaching session, as perceived by medical students (MS). We hypothesized that residents' performance would improve with frequent, low stakes, observation-based feedback. SETTING This prospective study took place at an academic general surgery program. PARTICIPANTS Focus groups of MS, surgical residents, and faculty informed FT development. MS completed the FT regarding resident teaching. DESIGN The FT utilized 5 slider-bar ratings (0 to 100) about the teaching encounter and a checklist of 16 desirable teaching behaviors. QR codes and weekly email links were distributed for 12 months (6 clerkship blocks) to promote use. Residents were sent their results after each block. A survey after each block assessed motivation for use and gathered feedback on the FT. Descriptive statistics were used for analysis (medians, IQRs). Primary measures of performance were median of the slider-bar scores and the number of teaching behaviors. RESULTS The FT was used 111 times; 37 of 46 residents were rated by up to 65 MS. The median rating on the slider-bars was 100 and the median number of desirable teaching behaviors was 12; there were no differences based on gender or PGY level. 10 residents had 5 or more FT observations during the year. Four residents had evaluations completed in 4 or more blocks and 19 residents had evaluations completed in at least 2 blocks. Over time, 13 residents had consistent slider-bar scores, 1 resident had higher scores, and 5 residents had lower scores (defined as a more than 5-point change from initial rating). Frequency of use of the FT decreased over time (38, 32, 9, 21, 7, 5 uses per block). The post-use survey was completed by 24 MS and 19 residents. Most common reasons for usage were interest in improving surgical learning environment, giving positive feedback (MS), and improving teaching skills (residents). Most common reasons for lack of usage from residents were "I did not think I taught enough to ask for feedback," "I forgot it existed," and "I did not know it existed." CONCLUSIONS The FT did not lead to any meaningful improvement in resident scores over the course of the year. This may be due to overall high scores, suggesting that the components of the FT may require reevaluation. Additionally, decreased utilization of the instrument over time made it challenging to assess change in performance of specific residents, likely due to lack of awareness of the FT despite frequent reminders. Successful implementation of observation-based teaching assessments may require better integration with residency or clerkship objectives.
Collapse
Affiliation(s)
- Emily Steinhagen
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES).
| | - Saher-Zahra Khan
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES)
| | - Asya Ofshteyn
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES)
| | - Kyla Terhune
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Luke Selby
- University of Kansas Medical Center, Department of Surgery, Kansas City, Kansas
| | | | - Sharon L Stein
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES)
| | - John B Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| |
Collapse
|
2
|
Baboolal SO, Singaram VS. Implementation and Impact of an Adapted Digital Perioperative Competency-Building Tool to Enhance Teaching, Learning And Feedback in Postgraduate Competency-Based Medical Education. J Surg Educ 2024; 81:722-740. [PMID: 38492984 DOI: 10.1016/j.jsurg.2024.01.015] [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: 07/17/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES The purpose of this educational intervention was to introduce, iteratively adapt, and implement a digital formative assessment tool in a surgical speciality. The study also evaluated the intervention's impact on perioperative teaching, learning, feedback, and surgical competency. DESIGN A participatory action research model with a mixed methods approach. SETTING This study was performed over 10 months in an institutional hospital in South Africa with a general surgery department. PARTICIPANTS Twelve supervising surgical trainers/faculty and 12 surgical trainees/residents consented to participate in the intervention. RESULTS The first 4 months of the intervention focused on relationship building, a multi-stakeholder contextual needs assessment and training sessions to support a shared mindset and shift in the teaching and learning culture. The final adapted perioperative competency-building tool comprised a 23-item assessment with four open-text answers (Table 1). Over the following 6-month period, 48 workplace-based competency-building perioperative evaluations were completed. Most trainees took less than 5 minutes to self-assess (67%) before most trainers (67%) took less than 5 minutes to give oral feedback to the trainee after the perioperative supervised learning encounter. On average, the digital tool took 6 minutes to complete during the bidirectional perioperative teaching and learning encounter with no negative impact on the operational flow. All trainers and trainees reported the training and implementation of the digital tool to be beneficial to teaching, learning, feedback, and the development of surgical competency. Analysis of the completed tools revealed several trainees showing evidence of progression in surgical competency for index procedures within the speciality. The focus groups and interviews also showed a change in the teaching and learning culture: more positively framed, frequent, structured, and specific feedback, improved accountability, and trainee-trainer perioperative readiness for teaching. Highlighted changes included the usefulness of trainee self-assessment before perioperative trainer feedback and the tool's value in improving competency to Kirkpatrick Level 4. CONCLUSION Implementing an adapted digital Workplace-Based Assessment (WBA) tool using a participatory action research model has proven successful in enhancing the effectiveness of supervised perioperative teaching and learning encounters. This approach has improved teaching and feedback practices, facilitated the development of surgical competency, and ultimately impacted the overall culture to Kirkpatrick level 4. Importantly, it has positively influenced the trainee-trainer relationship dynamic. Based on these positive outcomes, we recommend using this effective method and our relationship-centred framework for implementing formative competency-building tools in future studies. By doing so, larger-scale and successful implementation of Competency-Based Medical Education (CBME) could be achieved in various contexts. This approach can potentially enhance teaching and learning encounters, promote competency development, and improve the overall educational experience for surgical trainees and trainers.
Collapse
Affiliation(s)
- Sandika O Baboolal
- School of Clinical Medicine College of Health Sciences University of KwaZulu Natal 719 Umbilo Road, Umbilo Durban 4001 South Africa; Ophthalmology Department, Division of Surgery, James Paget University Hospital NHS Foundation Trust, United Kingdom.
| | - Veena S Singaram
- School of Clinical Medicine College of Health Sciences University of KwaZulu Natal 719 Umbilo Road, Umbilo Durban 4001 South Africa
| |
Collapse
|
3
|
Tanaka P, Soo Park Y, Chen CY, Yumul R, Macario A. Domains Influencing Faculty Decisions on the Level of Supervision Required for Anesthesiology EPAs with Analysis of Feedback Comments. J Surg Educ 2024; 81:741-752. [PMID: 38553368 DOI: 10.1016/j.jsurg.2024.02.003] [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: 10/19/2023] [Revised: 12/30/2023] [Accepted: 02/02/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE The purpose of this qualitative study was to examine responses related to entrustment and feedback comments from an assessment tool. DESIGN Qualitative analyses using semi-structured interviews and analysis of narrative comments. SETTING Main hospital OR suite at a large academic medical center. PARTICIPANTS faculty, and residents who work in the OR suite. RESULTS Seven of the 14 theoretical domains from the Theoretical Domains Framework were identified as influencing faculty decision on entrustment: knowledge, skills, intention, memory/attention/decision processes, environmental context, and resources, beliefs of capabilities, and reinforcement. The majority (651/1116 (58.4%)) of faculty comments were critical/modest praise and relevant, consistent across all 6 EPAs. The written in feedback comments for all 1,116 Web App EPA assessments yielded a total of 1,599 sub-competency specific responses. These responses were mapped to core competencies, and at least once to 13 of the 23 ACGME subcompetencies. CONCLUSIONS Domains identified as influencing faculty decision on entrustment were knowledge, skills, intention, memory/attention/decision processes, environmental context, and resources, beliefs of capabilities, and reinforcement. Most narrative feedback comments were critical/modest praise and relevant, consistent across each of the EPAs.
Collapse
Affiliation(s)
- Pedro Tanaka
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.
| | - Yoon Soo Park
- Associate Professor, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Chien-Yu Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Humanities in Medicine, School of Medicine, College of Medicine, Taipei
| | - Roya Yumul
- Professor, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alex Macario
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
4
|
Clanahan JM, Han BJ, Klos CL, Wise PE, Ohman KA. Use of Simulation For Training Advanced Colorectal Procedures. J Surg Educ 2024; 81:758-767. [PMID: 38508956 DOI: 10.1016/j.jsurg.2024.01.017] [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] [Revised: 12/16/2023] [Accepted: 01/30/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Simulation training for minimally invasive colorectal procedures is in developing stages. This study aims to assess the impact of simulation on procedural knowledge and simulated performance in laparoscopic low anterior resection (LLAR) and robotic right colectomy (RRC). DESIGN LLAR and RRC simulation procedures were designed using human cadaveric models. Resident case experience and simulation selfassessments scores for operative ability and knowledge were collected before and after the simulation. Colorectal faculty assessed resident simulation performance using validated assessment scales (OSATS-GRS, GEARS). Paired t-tests, unpaired t-tests, Pearson's correlation, and descriptive statistics were applied in analyses. SETTING Barnes-Jewish Hospital/Washington University School of Medicine in St. Louis, Missouri. PARTICIPANTS Senior general surgery residents at large academic surgery program. RESULTS Fifteen PGY4/PGY5 general surgery residents participated in each simulation. Mean LLAR knowledge score increased overall from 10.0 ± 2.0 to 11.5 ± 1.6 of 15 points (p = 0.0018); when stratified, this increase remained significant for the PGY4 cohort only. Mean confidence in ability to complete LLAR increased overall from 2.0 ± 0.8 to 2.8 ± 0.9 on a 5-point rating scale (p = 0.0013); when stratified, this increase remained significant for the PGY4 cohort only. Mean total OSATS GRS score was 28 ± 6.3 of 35 and had strong positive correlation with previous laparoscopic colorectal experience (r = 0.64, p = 0.0092). Mean RRC knowledge score increased from 9.4 ± 2.2 to 11.1 ± 1.5 of 15 points (p = 0.0030); when stratified, this increase again remained significant for the PGY4 cohort only. Mean confidence in ability to complete RRC increased from 1.9 ± 0.9 to 3.2 ± 1.1 (p = 0.0002) and was significant for both cohorts. CONCLUSIONS Surgical trainees require opportunities to practice advanced minimally invasive colorectal procedures. Our simulation approach promotes increased procedural knowledge and resident confidence and offers a safe complement to live operative experience for trainee development. In the future, simulations will target trainees on the earlier part of the learning curve and be paired with live operative assessments to characterize longitudinal skill progression.
Collapse
Affiliation(s)
- Julie M Clanahan
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
| | - Britta J Han
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Coen L Klos
- Department of Surgery, Veterans Affairs Medical Center, John Cochran Division, St. Louis, Missouri
| | - Paul E Wise
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Kerri A Ohman
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Surgery, Veterans Affairs Medical Center, John Cochran Division, St. Louis, Missouri
| |
Collapse
|
5
|
Carsky K, Rindskopf D, Patel VM, Ansari P, Dechario SP, Giangola G, Coppa GF, Antonacci AC. Using Concurrent Complication Reporting to Evaluate Resident Critical Thinking and Enhance Adult Learning. J Surg Educ 2024; 81:702-712. [PMID: 38556440 DOI: 10.1016/j.jsurg.2024.02.002] [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: 07/13/2023] [Revised: 12/26/2023] [Accepted: 02/02/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Critical thinking and accurate case analysis is difficult to quantify even within the context of routine morbidity and mortality reporting. We designed and implemented a HIPAA-compliant adverse outcome reporting system that collects weekly resident assessments of clinical care across multiple domains (case summary, complications, error analysis, Clavien-Dindo Harm, cognitive bias, standard of care, and ACGME core competencies). We hypothesized that incorporation of this system into the residency program's core curriculum would allow for identification of areas of cognitive weakness or strength and provide a longitudinal evaluation of critical thinking development. DESIGN A validated, password-protected electronic platform linked to our electronic medical record was used to collect cases weekly in which surgical adverse events occurred. General surgery residents critiqued 1932 cases over a 4-year period from 3 major medical centers within our system. These data were reviewed by teaching faculty, corrected for accuracy and graded utilizing the software's critique algorithm. Grades were emailed to the residents at the time of the review, collected prospectively, stratified, and analyzed by post-graduate year (PGY). Evaluation of the resident scores for each domain and the resultant composite scores allowed for comparison of critical thinking skills across post-graduate year (PGY) over time. SETTING Data was collected from 3 independently ACGME-accredited surgery residency programs over 3 tertiary hospitals within our health system. PARTICIPANTS General surgery residents in clinical PGY 1-5. RESULTS Residents scored highest in properly identifying ACGME core competencies and determining Clavien-Dindo scores (p < 0.006) with no improvement in providing accurate and concise clinical summaries. However, residents improved in recording data sufficient to identify error (p < 0.00001). A positive linear trend in median scores for all remaining domains except for cognitive bias was demonstrated (p < 0.001). Senior residents scored significantly higher than junior residents in all domains. Scores > 90% were never achieved. CONCLUSIONS The use of an electronic standardized critique algorithm in the evaluation and assessment of adverse surgical case outcomes enabled the measure of residents' critical thinking skills. Feedback in the form of teaching faculty-facilitated discussion and emailed grades enhanced adult learning with a steady improvement in performance over PGY. Although residents improved with PGY, the data suggest that further improvement in all categories is possible. Implementing this standardized critique algorithm across PGY allows for evaluation of areas of individual resident weakness vs. strength, progression over time, and comparisons to peers. These data suggest that routine complication reporting may be enhanced as a critical thinking assessment tool and that improvement in critical thinking can be quantified. Incorporation of this platform into M&M conference has the potential to augment executive function and professional identity development.
Collapse
Affiliation(s)
- Katie Carsky
- Lenox Hill Hospital, Northwell Health, New York, New York.
| | - David Rindskopf
- City University of New York, Graduate School And University Center, New York, New York
| | - Vihas M Patel
- Northwell North Shore University Hospital/Long Island Jewish Medical Center Department of Surgery, Manhasset, New York; Zucker School of Medicine at Hofstra/Northwell Department of Surgery, Hempstead, New York
| | - Parswa Ansari
- Lenox Hill Hospital, Northwell Health, New York, New York
| | | | - Gary Giangola
- Lenox Hill Hospital, Northwell Health, New York, New York
| | - Gene F Coppa
- Lenox Hill Hospital, Northwell Health, New York, New York
| | | |
Collapse
|
6
|
Goldhamer MEJ, Pusic MV, Nadel ES, Co JPT, Weinstein DF. Promotion in Place: A Model for Competency-Based, Time-Variable Graduate Medical Education. Acad Med 2024; 99:518-523. [PMID: 38285547 DOI: 10.1097/acm.0000000000005652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
PROBLEM Competency-based medical education is increasingly regarded as a preferred framework for physician training, but implementation is limited. U.S. residency programs remain largely time based, with variable assessments and limited opportunities for individualization. Gaps in graduates' readiness for unsupervised care have been noted across specialties. Logistical barriers and regulatory requirements constrain movement toward competency-based, time-variable (CBTV) graduate medical education (GME), despite its theoretical benefits. APPROACH The authors describe a vision for CBTV-GME and an implementation model that can be applied across specialties. Termed "Promotion in Place" (PIP), the model relies on enhanced assessment, clear criteria for advancement, and flexibility to adjust individuals' responsibilities and time in training based on demonstrated competence. PIP allows a resident's graduation to be advanced or delayed accordingly. Residents deemed competent for early graduation can transition to attending physician status within their training institution and benefit from a period of "sheltered independence" until the standard graduation date. Residents who need extended time to achieve competency have graduation delayed to incorporate additional targeted education. OUTCOMES A proposal to pilot the PIP model of CBTV-GME received funding through the American Medical Association's "Reimagining Residency" initiative in 2019. Ten of 46 residency programs in a multihospital system expressed interest and pursued initial planning. Seven programs withdrew for reasons including program director transitions, uncertainty about resident reactions, and the COVID-19 pandemic. Three programs petitioned their specialty boards for exemptions from time-based training. One program was granted the needed exemption and launched a PIP pilot, now in year 4, demonstrating the feasibility of implementing this model. Implementation tools and templates are described. NEXT STEPS Larger-scale implementation with longer-term assessment is needed to evaluate the impact and generalizability of this CBTV-GME model.
Collapse
|
7
|
Mann DR, Thomas CS, Parrado RH, Rives GT, Talley CL. Future Surgical Leaders: Resident Perception Of Longitudinal Leadership And Non-Technical Skills Curriculum. J Surg Educ 2024; 81:696-701. [PMID: 38402094 DOI: 10.1016/j.jsurg.2024.01.007] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE A paucity of formal leadership training programs exists for residents, and outcomes of those are limited in reporting. Based on a robust needs assessment, our program created a longitudinal cohort curriculum, Future Surgical Leaders, for residents and fellows of all levels to provide training in nontechnical skills. Our objective was to evaluate surgical resident short-term outcomes and satisfaction with the Future Surgical Leaders (FSL) curriculum. DESIGN Participants were sent a brief survey after each session of the curriculum from October 2020 to February 2022. The data was compiled after seventeen months of delivery. Likert Scale responses and text comments were analyzed with a 2-sample t-test and 2-way analysis of variance. SETTING Academic tertiary institution. PARTICIPANTS General surgery residents. RESULTS Survey response rate from 54 sessions among all postgraduate year levels was 73%. Overall, 96% of residents/fellows either "agreed" or "strongly agreed" that the topics of the FSL curriculum were important to learn during surgical training. Only 24% of learners knew "a lot" or "a great deal" about the topics prior to the session which rose to 73% afterwards (p < 0.01). Each postgraduate year class showed statistically significant increase in knowledge. About 80% of learners wanted to investigate these topics further. Open comment questions identified themes requesting delivery of specific sessions earlier in residency training and positive overall attitudes toward the FSL curriculum. CONCLUSIONS FSL is a satisfactory means of teaching leadership skills to surgical residents. Residents recognize the need to develop leadership skills prior to entering practice and want to learn more. The FSL curriculum may be considered for application at other surgical training programs.
Collapse
Affiliation(s)
- David R Mann
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Christopher S Thomas
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Raphael H Parrado
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - G Tyler Rives
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Cynthia L Talley
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina.
| |
Collapse
|
8
|
Toale C, Morris M, Konge L, Nayahangan LJ, Roche A, Heskin L, Kavanagh DO. Generating a Prioritized List of Operative Procedures for Simulation-based Assessment of General Surgery Trainees Through Consensus. Ann Surg 2024; 279:900-905. [PMID: 37811854 DOI: 10.1097/sla.0000000000006118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To develop appropriate content for high-stakes simulation-based assessments of operative competence in general surgery training through consensus. BACKGROUND Valid methods of summative operative competence assessment are required by competency-based training programs in surgery. METHOD An online Delphi consensus study was conducted. Procedures were derived from the competency expectations outlined by the Joint Committee on Surgical Training Curriculum 2021, and subsequent brainstorming. Procedures were rated according to their perceived importance, perceived procedural risk, how frequently they are performed, and simualtion feasibility by a purposive sample of 30 surgical trainers and a 5-person steering group. A modified Copenhagen Academy for Medical Education and Simulation Needs Assessment Formula was applied to the generated data to produce ranked procedural lists, which were returned to participants for re-prioritization. RESULTS Prioritized lists were generated for simulation-based operative competence assessments at 2 key stages of training; the end of 'phase 2' prior to the development of a sub-specialty interest, and the end of 'phase 3', that is, end-of-training certification. A total of 21 and 16 procedures were deemed suitable for assessments at each of these stages, respectively. CONCLUSIONS This study describes a national needs assessment approach to content generation for simulation-based assessments of operative competence in general surgery using Delphi consensus methodology. The prioritized procedural lists generated by this study can be used to further develop operative skill assessments for use in high-stakes scenarios, such as trainee progression, entrustment, and end-of-training certification, before subsequent validity testing.
Collapse
Affiliation(s)
- Conor Toale
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie Morris
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Copenhagen, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Copenhagen, Denmark
| | - Adam Roche
- Department of Simulation, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leonie Heskin
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Simulation, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dara O Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
9
|
Franchek-Roa K, Vala A, Goldman J, Dell A, Presson AP, Eppich K, Hobson WL. Patient Abuse, Neglect, and Exploitation: Why Physicians Need to Be Trauma-Informed. MedEdPORTAL 2024; 20:11391. [PMID: 38654890 PMCID: PMC11035495 DOI: 10.15766/mep_2374-8265.11391] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/18/2023] [Indexed: 04/26/2024]
Abstract
Introduction Many people experience trauma, and its cumulative effects throughout the life span can alter health, development, and well-being. Despite this, few publications focusing on interpersonal trauma include a holistic understanding of the nature and widespread exposure of trauma experiences for patients. We developed an educational resource to teach residents about identifying and intervening with patients who experience trauma across the life span using a trauma-informed care (TIC) perspective. Methods We created a 4-hour educational session for residents that included didactics, a virtual visit with a domestic violence shelter, a discussion with a person who had experienced trauma, and role-playing. A pretest/posttest retrospective survey assessed resident confidence level in identifying and intervening with patients who may have experienced trauma. We used the Wilcoxon signed rank test to compare pretest and posttest scores and the Kruskal-Wallis test to compare responses by residency type and year. Free-text questions were analyzed for thematic content. Results During the 2021-2022 academic year, 72 of 90 residents (80%) from four residency programs attended and evaluated the session. More than 90% of respondents reported the session met their educational needs and provided them with new ideas, information, and practical suggestions to use in their clinical endeavors. The results demonstrated significantly increased confidence on most of the metrics measured. Discussion This session significantly improved residents' confidence in identifying and intervening with patients who have had trauma experiences using a TIC perspective, which may lead them to provide improved patient care to those who have experienced trauma.
Collapse
Affiliation(s)
- Kathleen Franchek-Roa
- Associate Professor, Department of Pediatrics, University of Utah School of Medicine
| | - Aarti Vala
- Lead Physician, Pediatrics, Mission Neighborhood Health Center, San Francisco, CA
| | - Jennifer Goldman
- Associate Professor, Department of Pediatrics, University of Utah School of Medicine
| | - Adam Dell
- Adjunct Associate Professor, Department of Pediatrics, University of Utah School of Medicine
| | - Angela P. Presson
- Research Professor, Division of Epidemiology, University of Utah School of Medicine
| | - Kaleb Eppich
- Biostatistician, Department of Internal Medicine, University of Utah School of Medicine
| | - Wendy L. Hobson
- Professor, Department of Pediatrics, and Associate Vice President of Health Sciences Education, University of Utah School of Medicine
| |
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Kim Y, Cui CL, Williams ZF, Long CA. Impact of Integrated Vascular Surgery Residency on General Surgery Resident and Vascular Fellow Operative Volume: A National Analysis. Vasc Endovascular Surg 2024; 58:302-307. [PMID: 37918823 DOI: 10.1177/15385744231213299] [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] [Indexed: 11/04/2023]
Abstract
BACKGROUND The impact of integrated vascular surgery (VS) residency (0 + 5) programs on general surgery (GS) resident and VS fellow (5 + 2) operative volume has not been investigated on a national scale. METHODS Accreditation Council for Graduate Medical Education (ACGME) case logs were reviewed for GS resident, VS resident, and VS fellow operative volume from 2001-2021. Integrated VS resident data was available from 2012-2021, corresponding with the introduction of the 0 + 5 paradigm. Trends in operative volume were evaluated via linear regression analysis. RESULTS The national cohort of chief GS resident graduates increased from 1005 to 1357 per year. Total operative volume also increased from 932 to 1039 cases (+7.4 cases/yr, R2 = .80, P < .0001) among GS residents. Major vascular cases decreased among GS residents from 138 to 101 cases (-2.4 cases/yr, R2 = .58, P < .0001) with a decrease in proportion of chief-level vascular cases from 30.4% to 11.9% (-1.0%/yr, R2 = .92, P < .0001). Palliative procedures (amputations and hemodialysis access) comprised a significant proportion of GS cases (median 44.7%). Concurrently, integrated VS graduates increased from 11 to 37 per year, with an increase in major vascular case volume from 506 to 658 cases (+18.4 cases/yr, R2 = .63, P = .01). Total VS fellow major case volume also increased from 369 to 444 cases (+3.5 cases/yr, R2 = .73, P < .0001). CONCLUSIONS The introduction of the 0 + 5 intgrated VS residency paradigm has correlated with a significant decrease in GS operative experience in major vascular procedures on a national level. Traditional VS fellow case volume does not appear to be impacted by 0 + 5 integrated residents. Further analysis with program-level data may help to explain the causative relationship of these findings.
Collapse
Affiliation(s)
- Young Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Christina L Cui
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Zachary F Williams
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| |
Collapse
|
12
|
Enver N, Axiotakis LG, Sulica L, Pitman MJ. Quality of Office-based Procedure Training During Laryngology Fellowship. Laryngoscope 2024; 134:1802-1806. [PMID: 37747121 DOI: 10.1002/lary.31068] [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: 04/15/2023] [Revised: 08/17/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES The primary objective was to assess the perspectives of recent laryngology fellowship graduates on office-based procedure training, with a secondary objective to compare this with previous research on perspectives of fellowship directors. METHODS Recent laryngology fellowship graduates were surveyed via an online survey platform regarding post-fellowship practice and various aspects of office-based procedure training, including perceived competence, mentorship, and barriers. RESULTS There were 51 respondents. Seventy-six percent of respondents felt they "definitely" received adequate office procedure training. Number of procedures as primary surgeon was significantly associated with perception of adequate training (OR 1.54, 95% CI: 1.08-2.19, p = 0.018) and high post-fellowship office procedure volume (OR 1.56, 95% CI: 1.02-2.39, p = 0.040). Fellows reported a lower percentage of procedures as primary surgeons compared with program directors (46.8% vs. 61.9%, p = 0.028). Fellows and directors agreed that informal debriefs were more commonly employed than more structured training elements such as checklists and simulators. Of nine office procedures, laryngeal electromyography, KTP laser, and transnasal esophagoscopy had the greatest decreases in practice after training. CONCLUSION Although most recent laryngology fellowship graduates endorse adequate office-based procedure training, a range of individual experiences exists, and office procedure volume, both overall and across individual procedures, may decrease after fellowship. Fellows performing office procedures as primary surgeons may be linked to perceived quality of training and post-fellowship volume. LEVEL OF EVIDENCE NA Laryngoscope, 134:1802-1806, 2024.
Collapse
Affiliation(s)
- Necati Enver
- Department of Otolaryngology-Head and Neck Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Lucas G Axiotakis
- The Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian Hospital, Columbia University Irvine Medical Center, New York City, New York, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York-Presbyterian Hospital, New York City, New York, U.S.A
| | - Lucian Sulica
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York-Presbyterian Hospital, New York City, New York, U.S.A
| | - Michael J Pitman
- The Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian Hospital, Columbia University Irvine Medical Center, New York City, New York, U.S.A
| |
Collapse
|
13
|
Loeb D, Lautz A, Fleck J, Zackoff M. Experience informed procedural skills training. Clin Teach 2024; 21:e13719. [PMID: 38175794 DOI: 10.1111/tct.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/24/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Paediatric critical care (PCC) physicians must perform several emergent procedures independently and competently-requiring transition from novice to competent over a 3-year fellowship. However, skill acquisition is not uniform. Individualised training, adapted to the unique experiences and requirements of each trainee, may enhance competency. APPROACH An individualised, longitudinal critical procedure course was initiated at a large academic paediatric medical centre in July 2022 for PCC fellows (n = 5). The course, informed by procedural performance profiles (P3) generated through real-time clinical assessments in the paediatric intensive care unit (PICU), was split into three phases: (1) an Initial Simulation Bootcamp-a 2-day introductory session; (2) Quarterly Structured Booster Sessions (QSBS)-spaced repetition of deliberate practice training individualised to each fellow; and (3) an Annual Refresher Training-a core skills and advanced technique training day. EVALUATION Fellows began with minimal experience, which formed their initial P3s. Ninety-two percent (166/180) of bedside procedures received real-time feedback, enabling longitudinal P3 modification, which identified focus areas for the QSBS. The sessions were well attended and received. Eighty-nine percent (QSBS #1 5/5, QSBS #2 3/4) of respondents reflected positively on the course's impact on procedural understanding. The course was perceived as more effective than traditional modalities, except bedside training. IMPLICATION Implementation of a spaced repetition, deliberate practice course informed by longitudinally tracked real-life performance data is feasible for educators and preferred by trainees. This educational construct can be applied to other clinical skills, bringing precision medicine approach to training.
Collapse
Affiliation(s)
- Daniel Loeb
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew Lautz
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jacob Fleck
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Matthew Zackoff
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Center for Simulation Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| |
Collapse
|
14
|
Caretta-Weyer HA, Park YS, Tekian A, Sebok-Syer SS. The Inconspicuous Learner Handover: An Exploratory Study of U.S. Emergency Medicine Program Directors' Perceptions of Learner Handovers from Medical School to Residency. Teach Learn Med 2024; 36:134-142. [PMID: 36794363 DOI: 10.1080/10401334.2023.2178438] [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: 04/14/2022] [Revised: 01/13/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
Phenomenon: Central to competency-based medical education is the need for a seamless developmental continuum of training and practice. Trainees currently experience significant discontinuity in the transition from undergraduate (UME) to graduate medical education (GME). The learner handover is intended to smooth this transition, but little is known about how well this is working from the GME perspective. In an attempt to gather preliminary evidence, this study explores U.S. program directors (PDs) perspective of the learner handover from UME to GME. Approach: Using exploratory qualitative methodology, we conducted semi-structured interviews with 12 Emergency Medicine PDs within the U.S. from October to November, 2020. We asked participants to describe their current perception of the learner handover from UME to GME. Then we performed thematic analysis using an inductive approach. Findings: We identified two main themes: The inconspicuous learner handover and barrier to creating a successful UME to GME learner handover. PDs described the current state of the learner handover as "nonexistent," yet acknowledged that information is transmitted from UME to GME. Participants also highlighted key challenges preventing a successful learner handover from UME to GME. These included: conflicting expectations, issues of trust and transparency, and a dearth of assessment data to actually hand over. Insights: PDs highlight the inconspicuous nature of learner handovers, suggesting that assessment information is not shared in the way it should be in the transition from UME to GME. Challenges with the learner handover demonstrate a lack of trust, transparency, and explicit communication between UME and GME. Our findings can inform how national organizations establish a unified approach to transmitting growth-oriented assessment data and formalize transparent learner handovers from UME to GME.
Collapse
Affiliation(s)
- Holly A Caretta-Weyer
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Yoon Soo Park
- Department of Medical Education and Office of International Education, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ara Tekian
- Department of Medical Education and Office of International Education, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Stefanie S Sebok-Syer
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
15
|
Leng S, Chaudhry N, Pacilli M, Nataraja RM. Evaluation of a novel home-based laparoscopic and core surgical skills programme (Monash Online Surgical Training). Surg Endosc 2024; 38:1813-1822. [PMID: 38302757 PMCID: PMC10978607 DOI: 10.1007/s00464-023-10669-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/29/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Limitations to surgical education access were exacerbated during the COVID-19 Pandemic. In response, we created a national home-based comprehensive surgical skills course: Monash Online Surgical Training (MOST). Our aim was to evaluate the educational impact of this approach. METHODS A remote, 6-week course was designed with learning objectives aligned to the national surgical training. Participants received a personal laparoscopic bench trainer, instrument tracking software, live webinars, access to an online theoretical learning platform, and individualised feedback by system-generated or expert surgeons' assessments. Mixed method analysis of instrument tracking metrics, pre- and post-course questionnaires (11 core surgical domains) and participant comments was utilised. Data were analysed using the Mann-Whitney U test, and a p-value of < 0.05 was considered statistically significant. RESULTS A total of 54 participants with varied levels of experience (1 to > 6 years post-graduate level) completed MOST. All 11 learning-outcome domains demonstrated statistically significant improvement including core laparoscopic skills (1.4/5 vs 2.8/5, p < 0.0001) and handling laparoscopic instruments (1.5/5 vs 2.8/5, p < 0.0001). A total of 3460 tasks were completed reflecting 158.2 h (9492 min) of practice, 394 were submitted for formal feedback. Participants rated the course (mean 8.5/10, SD 1.6), live webinars (mean 8.9/10, SD 1.6) and instrument tracking software (mean 8.6, SD 1.7) highly. Qualitative analysis revealed a paradigm shift including the benefits of a safe learning environment and self-paced, self-directed learning. CONCLUSION The MOST course demonstrates the successful implementation of a fully remote laparoscopic simulation course which participants found to be an effective tool to acquire core surgical skills.
Collapse
Affiliation(s)
- Samantha Leng
- Department of Paediatric Surgery & Monash Children's Simulation, Monash Children's Hospital, Melbourne, Australia
| | - Noor Chaudhry
- Department of Paediatric Surgery & Monash Children's Simulation, Monash Children's Hospital, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery & Monash Children's Simulation, Monash Children's Hospital, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Science, Monash University, Melbourne, Australia
| | - Ramesh Mark Nataraja
- Department of Paediatric Surgery & Monash Children's Simulation, Monash Children's Hospital, Melbourne, Australia.
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences, Monash University, Melbourne, Australia.
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Science, Monash University, Melbourne, Australia.
| |
Collapse
|
16
|
Hoffert MM, Pfeiffer L, Hepke M, Brink W, Newman J, Passalacqua KD, Baker-Genaw K. Gathering Trainee Feedback to Improve Programs With Low Annual ACGME Survey Content Area Compliance: A Pilot Study. Acad Med 2024; 99:419-423. [PMID: 37748087 DOI: 10.1097/acm.0000000000005464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
PROBLEM Systematically investigating annual Accreditation Council for Graduate Medical Education (ACGME) Resident/Fellow Survey results by directly gathering trainee feedback could uncover training program problems and clarify misunderstandings as they arise, leading to faster corrective actions and program improvement. APPROACH The Focus Group Forum (FGF) was created based on the utilization-focused evaluation approach to systematically gather comprehensive, high-quality, actionable trainee feedback on specific annual ACGME survey results and involve trainees in program improvement (Henry Ford Hospital, 2021). Trainees from programs with survey results indicating <80% compliance within several content areas were invited to attend FGF sessions. During FGF sessions, neutral moderators experienced in conducting focus groups and creating psychologically safe spaces and neutral scribes gathered trainee feedback on survey results through structured, iterative discussions and an anonymous electronic polling system. Summaries of FGF findings were created, combined with actual annual ACGME survey data, and used to develop recommended corrective actions and monitoring plans. OUTCOMES In 2021, 6 training programs had survey results below the institution's compliance threshold for 4-8 of the 9 content areas. Of the 180 trainees (from the 6 programs) invited to attend an FGF session, 79 (44%) participated. Five key issues were identified: misinterpretation of several survey questions, lack of knowledge of institutional policies and procedures, perceived inability to share feedback with faculty, feelings of being overwhelmed with administrative duties, and lack of sufficient protected time for educational activities and requirements. NEXT STEPS The authors are developing an FGF process for faculty so that all stakeholders have a voice regarding annual ACGME survey results. They are also improving scheduling processes so that feedback from experienced trainees who are leaving the institution will not be missed and developing longer-term processes for tracking outcomes since time for implementing corrective actions before the next ACGME survey is limited.
Collapse
|
17
|
DeWaters AL, Miller EL, Haidet P, Gonzalo JD. Systems-Based Practice: Expert Perspectives on the Origin and Evolution of an Ambiguous Competency. Acad Med 2024; 99:424-429. [PMID: 37881916 DOI: 10.1097/acm.0000000000005478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
PURPOSE Systems-based practice (SBP) has been a core competency in graduate medical education in the United States since 1999, but it has been difficult to operationalize in residency programs due to its conceptual ambiguity. The authors explored the historical origin and subsequent development of the SBP competency from the perspective of individuals who were influential across critical phases of its implementation and ensuing development. The goal of this study was to elicit the history of SBP from the perspective of individuals who have expertise in it and to use those findings to inform the current SBP construct. METHOD Between March and July 2021, 24 physicians, nurses, educators, and leaders in the field of SBP were individually interviewed about the origin and meaning of SBP as practiced in U.S. medical education using a semistructured guide. Individuals were selected based upon their influence on the origin or evolution of the SBP competency. Data were iteratively collected and analyzed using real-time analytic memos, regular adjudication sessions with the research team, and thematic analysis. Researchers identified themes from participants' perspectives and agreed upon the final results and quotations. RESULTS Five themes were identified: SBP has many different definitions, SBP was intentionally designed to be vague, systems thinking was identified as the foundation of the SBP competency, the 6 core competencies established in the United States by the Accreditation Council for Graduate Medical Education were developed to be interdependent, and the SBP and practice-based learning and improvement competencies are uniquely related and synergistic. CONCLUSIONS Interview data indicate that since its inception, SBP has been a nuanced and complex competency, resulting in a lack of mutually shared understanding among stakeholders. This deliberate historical examination of expert perspectives provides insight into specific areas for improving how SBP is taught and learned.
Collapse
|
18
|
Bhate TD, Sukhera J, Litwin S, Chan TM, Wong BM, Smeraglio A. Systems-Based Practice in Graduate Medical Education: Evolving Toward an Ideal Future State. Acad Med 2024; 99:357-362. [PMID: 38113412 DOI: 10.1097/acm.0000000000005612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
ABSTRACT Systems-based practice (SBP) was first introduced as a core competency in graduate medical education (GME) in 2002 by the Accreditation Council for Graduate Medical Education as part of the Outcomes Project. While inclusion of SBP content in GME has become increasingly common, there have also been well-documented stumbling blocks, including perceptions that SBP has eroded the amount of curricular time available for more medically focused competencies, is not relevant for some practice contexts, and is not introduced early enough in training. As a result, SBP learning experiences often feel disconnected from medical trainees' practical reality. In this commentary, the authors provide guidance regarding potential changes that may facilitate the evolution of SBP toward an ideal future state where graduates bring a systems science mindset to all aspects of their work. Specific suggestions include the following: (1) expanding the SBP toolbox to reflect current-day health system needs, (2) evolve the teaching methodology, (3) broadening the scope of relevant SBP content areas, and (4) emphasizing SBP as an integrated responsibility for all health care team members. Levers to enact this transformation exist and must be used to influence change at the learner, faculty, program, and clinical learning environment levels.Physicians operate within an increasingly complex health care system that highlights the intersection of health care with complex social, environmental, and relational contexts. Consequently, the role of SBP in both physician work responsibilities and educational requirements continues to expand. To meet this growing demand, GME must adapt how it supports and trains the next generation of systems thinkers, ensuring they understand how levers in the health care system directly affect health outcomes for their patients, and integrate SBP into the foundation of GME curricula in an inclusive, holistic, and unrestrained way.
Collapse
|
19
|
Perri G, Siriwardena AK, Gilg S, Sparrelid E. European fellowship training opportunities for hepato-pancreato-biliary surgery: an international survey of fellows and program directors. HPB (Oxford) 2024; 26:503-511. [PMID: 38341286 DOI: 10.1016/j.hpb.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND There are no established training pathways for hepato-pancreato-biliary (HPB) surgery in Europe. This study aims to overview the current status of fellowship training from both fellows' and institutions' perspectives. METHODS A web-based snapshot survey was distributed to all members of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) to reach for former fellows and program directors of European HPB surgery fellowships held between 2013 and 2023. RESULTS A total of 37 fellows and 13 program directors replied describing 32 different programs in 13 European countries. The median (range) age at fellowship start was 34 (30-45 years). Fellowship duration was most commonly one (36 %) or two (40 %) years. Fellowships were funded in 70 % and fellows were required to learn a new language in 27 %. Most fellows performed between none and 10 pancreatic (68 %), major (67 %) and minor (60 %) liver resections as 1st surgeon, while the number of operations performed as 1st assistant were more heterogeneous. Program directors estimated a higher number of operations performed by fellows as first surgeons. The percentage of procedures performed minimally invasively did not exceed 10 %. CONCLUSION There is substantial heterogeneity between HPB fellowship programs in Europe. A wider standardization of clinical curriculum, including minimally invasive surgery, is desirable.
Collapse
Affiliation(s)
- Giampaolo Perri
- Karolinska University Hospital, Division of Surgery, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - Ajith K Siriwardena
- Hepatobiliary and Pancreatic Surgery Unit, Manchester Royal Infirmary, Manchester University NHS FT, Manchester, United Kingdom
| | - Stefan Gilg
- Karolinska University Hospital, Division of Surgery, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden
| | - Ernesto Sparrelid
- Karolinska University Hospital, Division of Surgery, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
| |
Collapse
|
20
|
Turner A, Huth K, Luff D, Zendejas B, Newman LR, Leichtner AM. Lack of standardization and faculty development in pediatric colonoscopy: A qualitative study. J Pediatr Gastroenterol Nutr 2024; 78:948-956. [PMID: 38591669 DOI: 10.1002/jpn3.12100] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 04/10/2024]
Abstract
A standard curriculum for pediatric colonoscopy training has neither been required nor universally implemented in North American fellowship programs. This qualitative study assessed the needs of colonoscopy training in pediatric gastroenterology to determine the standardized components of procedural teaching. Focus groups with pediatric gastroenterology attendings, fellows, procedural nurses, and interviews with advanced endoscopists, all practicing at a single institution, were conducted between March and June 2018. Data were analyzed using thematic analysis principles. Four themes emerged: (1) lack of standardization of colonoscopy performance, (2) lack of professional development of procedure teaching skills, (3) need for teaching behaviors that promote learner's performance, and (4) barriers to effective teaching and learning. A conceptual framework was created for developing a standardized "train-the-trainer" curriculum. Our needs assessment supports expansion of efforts to make this comprehensive training available to all pediatric gastroenterologists involved in procedure teaching.
Collapse
Affiliation(s)
- Amy Turner
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen Huth
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Donna Luff
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital Simulator Program, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin Zendejas
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lori R Newman
- Department of Education, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alan M Leichtner
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
21
|
Kam ASH, Zhao G, Huang CL, Husain A, Nyhof-Young J, Summers A, Fernandez N, Richardson D. Residency spiral concussion curriculum design. Clin Teach 2024; 21:e13707. [PMID: 38035665 DOI: 10.1111/tct.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Resident-focused concussion curricula that measure learner behaviours are currently unavailable. We sought to fill this gap by developing and iteratively implementing a Spiral Integrated Concussion Curriculum (SICC). APPROACH Programme elements of the concussion curriculum include academic half-days (AHDs) and three half-day clinics for first- and second-year family medicine residents. Our SICC utilises social cognitive learning principles, the constructivism paradigm and utilisation-focused evaluation. EVALUATION A mixed-method evaluation with a pre-/post-test design and interviews was utilised. Surveys and knowledge tests were used to measure knowledge and confidence pre-AHD and 6 months post-AHD. Interviews at 6 months explored programme perception and behaviour change. Of the 141 programme attendees, 114 (80%) participated in the pre-intervention knowledge test and 33 completed the pre- and post-AHD test. Immediate pre-/post-testing demonstrated statistically significant improvement in knowledge (p = 0.042). At 6 months post-AHD, residents in Cycle 1 (n = 5) had a knowledge decrease of 3.33% (p > 0.05). Residents in Cycle 2 (n = 7) had a knowledge increase of 11.6% (p > 0.05). Both cycles of residents had an increase in confidence (Cycle 1: 65.0% [p = 0.025]; Cycle 2: 62.8% [p = 0.0014]). Residents (5 out of 6) reported positive behavioural changes at 6 months. Valued programme elements included concussion diagnosis and management, the self-study guide resource and the organised structure. IMPLICATIONS The SICC enriched these residents' learning and fostered sustained knowledge improvement and behavioural change at 6 months post-intervention. This approach may provide a workable design for future competency-based curriculum development.
Collapse
Affiliation(s)
- Alice Sau Han Kam
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - George Zhao
- Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ching-Lung Huang
- Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Aisha Husain
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joyce Nyhof-Young
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Academics Program and Family Practice Health Centre, Women's College Hospital, Toronto, Ontario, Canada
| | - Alyson Summers
- Department of Anthropology, University of Toronto, Toronto, Ontario, Canada
| | - Nicolas Fernandez
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Department of Psychopedagogy and Andragogy, Faculty of Education, Université de Montréal, Montreal, Quebec, Canada
| | - Denyse Richardson
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Ontario, Canada
- Providence Care Hospital, Kingston, Ontario, Canada
| |
Collapse
|
22
|
Dagi AF, LaValley MN, Diaddigo SE, Wu JK, Bogue JT. Trends in orthoplastic operative exposure for plastic surgery residents in the United States. J Plast Reconstr Aesthet Surg 2024; 90:224-226. [PMID: 38387419 DOI: 10.1016/j.bjps.2024.02.037] [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: 12/27/2023] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Recent trials have demonstrated clinical benefits to a combined orthoplastic approach for complex reconstructive surgery of the hand, upper and lower extremity. PURPOSE We sought to assess recent trends in exposure to orthoplastic-type procedures among plastic surgery residents training in the United States. METHODS Independent plastic surgery residents' case logs were extracted from the Accreditation Council for Graduate Medical Education (2011-2022). Select reconstructive procedure were taken as proxies for orthoplastic-type cases and analyzed by descriptive statistical analysis. RESULTS The average number of orthoplastic-type cases completed per resident per year increased from 168.2 to 189.2 (12.5% increase) between 2011-2022. The greatest increase was in exposure to peripheral nerve injury repair of the hand and upper extremity (22.6 to 39.1, 73% increase). As a proportion of total procedures during the study period, orthoplastic-type procedures remained relatively unchanged (range 9.5-10.4%). CONCLUSIONS Our findings suggest that plastic surgery residents may be increasingly well-prepared to contribute to orthoplastic care during and following their training. The steady proportion of cases that orthoplastic-type procedures represented over the study period suggests the increase in relevant orthoplastic case volume may be incidental and secondary to an overall rise among all procedures. Given evidence of the benefits of an orthoplastic approach, we recommend consideration of explicit benchmarks for orthoplastic training among plastic surgery residents.
Collapse
Affiliation(s)
- Alexander F Dagi
- Division of Plastic and Reconstructive Surgery, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Myles N LaValley
- Division of Plastic and Reconstructive Surgery, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Sarah E Diaddigo
- Division of Plastic and Reconstructive Surgery, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - June K Wu
- Division of Plastic and Reconstructive Surgery, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Jarrod T Bogue
- Division of Plastic and Reconstructive Surgery, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
| |
Collapse
|
23
|
Petrides J, Jha S, Kowalski A, Hosein S, Collins PB, Coren J. Expansion of osteopathic medicine practitioner education on substance use disorders. J Osteopath Med 2024; 124:115-119. [PMID: 38175189 DOI: 10.1515/jom-2023-0123] [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: 12/04/2023] [Indexed: 01/05/2024]
Abstract
CONTEXT Medical school graduates are generally not well prepared to treat patients with substance use disorders (SUDs), even though opioid overdose deaths in the United States have increased in recent years. When it comes to training in SUDs, osteopathic medicine lags far behind allopathic medicine. It was only in 2019 that the American Osteopathic Association approved Board Certification in Addiction Medicine to help combat the opioid epidemic. Few articles have been published in the literature pertaining to substance use education for osteopathic students and trainees. OBJECTIVES The goal of this study was to expand the education of osteopathic medical students and primary care residents in SUDs and measure the effect that education had on the attitudes and knowledge of student and residents about SUDs. METHODS This study collected anonymous data in the form of a voluntary online survey from third- and fourth-year students at an osteopathic medical school and family medicine residents. The survey was completed by 115 students and 29 family medicine residents. Participants completed a pretest survey and then participated in the Physician Undergraduate and Resident Substance Use Education (PURSUE) curriculum developed by the researchers. This consisted of three online modules covering Screening, Brief Intervention, and Referral to Treatment (SBIRT), substance use assessments, and treatment of SUDs. Upon conclusion of the training modules, medical student participants then completed a posttest survey to assess for any changes in knowledge and attitude. Participants also answered questions related to clinical case scenarios involving patients at varying risk levels who were assessed utilizing SBIRT. RESULTS Students and residents who participated in the training demonstrated an increase in their average scores between the pretest and posttest, indicating effectiveness in learning from the modules. The overall increase in average scores on the pretest and posttest was 6.5 %, which was determined to be statistically significant (p<0.01). Interestingly, participants who reported growing up in underprivileged circumstances performed worse than those participants who reported not growing up in underprivileged circumstances. CONCLUSIONS The results of our project support the need and benefit of incorporating educational modules on this topic area within medical school curriculums and residency training. Expanding the number of healthcare workers proficient in providing this type of care in these types of settings will improve the quality of and access to medical care in some of our highest-need populations.
Collapse
Affiliation(s)
- Joanna Petrides
- Department of Family Medicine, Rowan-Virtua University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Stuti Jha
- Department of Political Science and Economics, Rowan University, Glassboro, NJ, USA
| | | | - Suzanna Hosein
- Einstein-Jefferson Family Medicine Residency, Philadelphia, PA, USA
| | - Philip B Collins
- Department of Family Medicine, Rowan-Virtua University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Joshua Coren
- Department of Family Medicine, Rowan-Virtua University School of Osteopathic Medicine, Stratford, NJ, USA
| |
Collapse
|
24
|
Joy MT, Applebaum MA, Anderson WM, Serletti JM, Capito AE. Impact of High-Fidelity Microvascular Surgery Simulation on Resident Training. J Reconstr Microsurg 2024; 40:211-216. [PMID: 37315933 DOI: 10.1055/a-2110-0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Microsurgery requires a high level of skill achieved only through repeated practice. With duty-hour restrictions and supervision requirements, trainees require more opportunities for practice outside the operating room. Studies show simulation training improves knowledge and skills. While numerous microvascular simulation models exist, virtually all lack the combination of human tissue and pulsatile flow. METHODS The authors utilized a novel simulation platform incorporating cryopreserved human vein and a pulsatile flow circuit for microsurgery training at two academic centers. Subjects performed a standardized simulated microvascular anastomosis and repeated this task at subsequent training sessions. Each session was evaluated using pre- and postsimulation surveys, standardized assessment forms, and the time required to complete each anastomosis. Outcomes of interest include change in self-reported confidence scores, skill assessment scores, and time to complete the task. RESULTS In total, 36 simulation sessions were recorded including 21 first attempts and 15 second attempts. Pre- and postsimulation survey data across multiple attempts demonstrated a statistically significant increase in self-reported confidence scores. Time to complete the simulation and skill assessment scores improved with multiple attempts; however, these findings were not statistically significant. Subjects unanimously reported on postsimulation surveys that the simulation was beneficial in improving their skills and confidence. CONCLUSION The combination of human tissue and pulsatile flow results in a simulation experience that approaches the level of realism achieved with live animal models. This allows plastic surgery residents to improve microsurgical skills and increase confidence without the need for expensive animal laboratories or any undue risk to patients.
Collapse
Affiliation(s)
- Matthew T Joy
- Section of Plastic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Matthew A Applebaum
- Section of Plastic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - William M Anderson
- Section of Plastic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Joseph M Serletti
- Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anthony E Capito
- Section of Plastic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| |
Collapse
|
25
|
Obayemi JE, Donkersloot J, Kim E, Thelander K, Byrnes M, Kim GJ. A needs assessment for simulation in African surgical education. Surg Endosc 2024; 38:1654-1661. [PMID: 38326586 DOI: 10.1007/s00464-023-10665-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/28/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION There is a critical need for comprehensive surgical training in African countries given the unmet surgical burden of disease in this region. Collaborative and progressive initiatives in global surgical education will have the greatest impact on trainees. Little is known about surgical education needs from the perspective of practicing surgeons and trainees in low-middle-income countries (LMICs). Even less is known about the potential role for simulation to augment training. METHODS A modified Delphi methodology with 2 rounds of responses was employed to survey program directors (PD) and associate program directors (APD) of Pan-African Association of Christian Surgeons (PAACS) general surgery residency programs across eight low-middle-income countries in Africa. 3 PD/APDs and 2 surgical residents participated in semi-structured interviews centered around the role of simulation in training. Descriptive analysis was performed to elicit key themes and illustrative examples. RESULTS The survey of program directors revealed that teaching residents the psychomotor skills need to perform intracorporeal suturing was both high priority and desired in multiple training sites. Other high priority skills were laparoscopic camera driving and medial visceral rotation. The interviews revealed a specific desire to perform laparoscopic surgery and a need for a simulation curriculum to familiarize staff and trainees with laparoscopic techniques. Several barriers to laparoscopic surgery exist, such as lack of staff familiarity with the equipment, lack of public buy in, and lack of generalizable and adaptable educational modules. Trainees saw utility in the use of simulation to optimize time in the operating room and sought opportunities to improve their laparoscopic skills. CONCLUSION Faculty and surgical trainees in LMICs have interest in learning advanced surgical techniques, such as laparoscopy. Developing a simulation curriculum tailored to the trainees' local context has the potential to fill this need.
Collapse
Affiliation(s)
- Joy E Obayemi
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA.
| | - John Donkersloot
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA
| | - Erin Kim
- University of Michigan Medical School, University of Michigan, Ann Arbor, USA
| | - Keir Thelander
- Pan-African Academy of Christian Surgeons, Palatine, IL, USA
| | - Mary Byrnes
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA
| | - Grace J Kim
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA
| |
Collapse
|
26
|
Raper JD, Khoury CA, Marshall A, Smola R, Pacheco Z, Morris J, Zhai G, Berger S, Kraemer R, Bloom AD. Rapid Cycle Deliberate Practice Training for Simulated Cardiopulmonary Resuscitation in Resident Education. West J Emerg Med 2024; 25:197-204. [PMID: 38596918 PMCID: PMC11000545 DOI: 10.5811/westjem.17923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 04/11/2024] Open
Abstract
Background Simulation-based medical education has been used in medical training for decades. Rapid cycle deliberate practice (RCDP) is a novel simulation strategy that uses iterative practice and feedback to achieve skill mastery. To date, there has been minimal evaluation of RCDP vs standard immersive simulation (IS) for the teaching of cardiopulmonary resuscitation to graduate medical education (GME) learners. Our primary objective was to compare the time to performance of Advanced Cardiac Life Support (ACLS) actions between trainees who completed RCDP vs IS. Methods This study was a prospective, randomized, controlled curriculum evaluation. A total of 55 postgraduate year-1 internal medicine and emergency medicine residents participated in the study. Residents were randomized to instruction by RCDP (28) or IS (27). Stress and ability were self-assessed before and after training using an anonymous survey that incorporated five-point Likert-type questions. We measured and compared times to initiate critical ACLS actions between the two groups during a subsequent IS. Results Prior learner experience between RCDP and IS groups was similar. Times to completion of the first pulse check, chest compression initiation, backboard placement, pad placement, initial rhythm analysis, first defibrillation, epinephrine administration, and antiarrhythmic administration were similar between RCDP and IS groups. However, RCDP groups took less time to complete the pulse check between compression cycles (6.2 vs 14.2 seconds, P = 0.01). Following training, learners in the RCDP and IS groups scored their ability to lead and their levels of anticipated stress similarly (3.43 vs 3.30, (P = 0.77), 2.43 vs. 2.41, P = 0.98, respectively). However, RCDP groups rated their ability to participate in resuscitation more highly (4.50 vs 3.96, P = 0.01). The RCDP groups also reported their realized stress of participating in the event as lower than that of the IS groups (2.36 vs 2.85, P = 0.01). Conclusion Rapid cycle deliberate practice learners demonstrated a shorter pulse check duration, reported lower stress levels associated with their experience, and rated their ability to participate in ACLS care more highly than their IS-trained peers. Our results support further investigation of RCDP in other simulation settings.
Collapse
Affiliation(s)
- Jaron D. Raper
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Charles A. Khoury
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Anderson Marshall
- University of Alabama at Birmingham, Department of Internal Medicine, Birmingham, Alabama
| | - Robert Smola
- University of Alabama at Birmingham, Department of Internal Medicine, Birmingham, Alabama
| | - Zachary Pacheco
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| | - Jason Morris
- University of Alabama at Birmingham, Department of Internal Medicine, Birmingham, Alabama
| | - Guihua Zhai
- University of Alabama at Birmingham, Center for Clinical and Translational Science, Birmingham, Alabama
| | - Stephanie Berger
- University of Alabama at Birmingham, Department of Pediatrics, Birmingham, Alabama
| | - Ryan Kraemer
- University of Alabama at Birmingham, Department of Internal Medicine, Birmingham, Alabama
| | - Andrew D. Bloom
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, Alabama
| |
Collapse
|
27
|
Nabi W, Windish D, Beasley MH. Perceived Gaps in Knowledge for the Advanced Heart Failure and Transplant Cardiology Fellow: the Results of a National Needs-Assessment Survey. J Card Fail 2024; 30:516-519. [PMID: 38000732 DOI: 10.1016/j.cardfail.2023.11.015] [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: 10/15/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND The field of Advanced Heart Failure and Transplant Cardiology has evolved greatly since it was first established. We sought to elicit program directors' and fellows' viewpoints on potential curricular deficits so we can better meet the educational goals of current and future fellows. METHODS AND RESULTS We surveyed advanced heart failure and transplant cardiology program directors and fellows concerning their perceptions of the current adequacy of training and their desire for additional training needed to achieve medical competency in advanced heart failure and transplant cardiology at their institutions, as defined by the 2017 ACC Advanced Training Statement. Survey results identified key competencies deemed to be inadequately addressed during training and those in which a moderate or significant additional amount of training was desired. These competencies were identified within the 4 main domains of the fellowship: heart failure, pulmonary hypertension, mechanical circulatory support, and heart transplantation. CONCLUSIONS This study highlights key medical-knowledge competencies that are inadequately addressed by current fellowship training in advanced heart failure and transplant cardiology. Fellowship programs should develop curricula that focus on the integration of these competencies into training to ensure that fellows are well equipped to care for patients.
Collapse
Affiliation(s)
- Wafa Nabi
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT.
| | - Donna Windish
- Department of General Medicine, Yale School of Medicine, New Haven, CT
| | | |
Collapse
|
28
|
Cui CL, West-Livingston LN, Loanzon RS, Latz CA, Coleman DM, Long CA, Kim Y. Concerning Trends in Vascular Surgery Trainee Operative Experience in Venous Disease. Ann Vasc Surg 2024; 100:25-30. [PMID: 38122970 DOI: 10.1016/j.avsg.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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Comprehensive vascular care includes both arterial and venous disease management. However, operative training in venous disease is often significantly overshadowed by arterial procedures, despite the public health burden of acute and chronic venous disease. The purpose of this study is to evaluate the case-mix and volume of venous procedures performed by graduating integrated vascular surgery residents and fellows in the United States. METHODS Accreditation Council for Graduate Medical Education national operative log reports were compiled for graduating integrated VSR (vascular surgery residency) and traditional vascular surgery fellowship (VSF) trainees from academic years 2013 to 2022. Only cases categorized as "surgeon fellow", "surgeon chief", or "surgeon junior" were included. Linear regression analysis was utilized to evaluate trends in case-mix and volume. RESULTS Over the 10-year study period, total vascular cases increased for both VSR (mean 870.5 ± 9.3 cases, annual change +9.5 cases/year, R2 = 0.77, P < 0.001) and VSF (mean 682.1 ± 6.9 cases, annual change +6.7 cases/year, R2 = 0.85, P < 0.001) trainees. Concurrently, the proportion of venous cases in the VSR group decreased from 12.5% to 7.3% (annual change -3.7 cases/year, R2 = 0.72, P < 0.001). VSR trainees experienced an annual decrease in 4 of the top 5 venous case types performed, including venous angioplasty/stenting (-1.6 cases/year, P = 0.002), vena cava filter placement (-0.9 cases/year, P = 0.002), endoluminal ablation (-0.2 cases/year, P = 0.47), diagnostic venography (-1.7 cases/year, P < 0.001), and varicose vein treatment (-1.0 cases/year, P < 0.001). Venous cases proportions also decreased in the VSF group from 8.4% to 6.2% (annual change -2.2 cases/year, R2 = 0.54, P = 0.002). VSF trainees experienced an annual decrease in 4 of the top 5 venous case types, including venous angioplasty/stenting (-1.5 cases/year, P = 0.003), diagnostic venography (-1.2 cases/year, P < 0.001), vena cava filter placement (-0.2 cases/year, P = 0.44), endoluminal ablation (-0.6 cases/year, P < 0.001), and varicose vein treatment (-0.1 cases/year, P = 0.04). Both VSR and VSF trainee groups graduated with fewer than 5 cases for each of the following venous procedures-percutaneous mechanical thrombectomy, venous thrombolysis, open venous reconstruction, sclerotherapy, venous embolectomy, portal-systemic shunting, venous ulceration treatment, and arteriovenous malformation treatment. CONCLUSIONS Current vascular residents and fellows have limited exposure to venous procedures, in part due to a proportional decline in venous cases. More robust venous operative experience is needed during surgical training. Further studies are needed to understand whether this discrepancy in venous and arterial training impacts career progression and patient outcomes.
Collapse
Affiliation(s)
- Christina L Cui
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Lauren N West-Livingston
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Roberto S Loanzon
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Christopher A Latz
- Division of Vascular and Endovascular Surgery, Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Dawn M Coleman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Young Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
| |
Collapse
|
29
|
Mithoowani S, Khattak S, Lieberman S, Tseng EK, Zeller MP, van Merriënboer J. Learning From Clinical Supervisor Practice Variability: Exploring Medical Resident and Fellow Experiences and Interpretations. Acad Med 2024; 99:310-316. [PMID: 38039985 DOI: 10.1097/acm.0000000000005573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
PURPOSE Clinical practice variability is characterized by 2 or more clinicians making different treatment decisions despite encountering a similar case. This study explores how medical residents and fellows experience and interpret intersupervisor clinical practice variability and how these variations influence learning. METHOD Seventeen senior residents or fellows in internal medicine, hematology, or thrombosis medicine (postgraduate year 3 or above) participated in semistructured interviews after a clinical rotation in thrombosis medicine from December 2019 to March 2021. Data collection and analysis occurred iteratively and concurrently in a manner consistent with constructivist grounded theory. Variation theory was used to guide the development of some interview questions. A central tenet of this theory is that learning occurs by experiencing 3 sequential patterns of variation: contrast, generalization, and fusion. Participants were recruited purposively with respect to specialty until theoretical sufficiency was reached. RESULTS Clinical practice variability was experienced by all participants. Residents and fellows attributed practice variability to intrinsic differences among supervisors; interinstitutional differences; selection and interpretation of evidence; patient preferences, priorities, and fears; and their own participation in the decision-making process. Clinical practice variability helped residents and fellows discern key features of cases that influenced decision-making (contrast), group similar cases so that the appropriate evidence could be applied (generalization), and develop attitudes consistent with providing individualized patient care (fusion). Observing practice variability was more helpful for fifth- and sixth-year residents and less helpful for third- and fourth-year residents. CONCLUSIONS Clinical practice variability helped residents and fellows discern critical aspects, group similar patients, and practice individualized medicine. Future research should characterize how clinical practice variability influences learning across the spectrum of training, how supervisors could encourage learning from practice variability, and how curricula could be modified to allow learners greater opportunity to reflect on and consolidate the practice differences they observe.
Collapse
|
30
|
Vohra TT, Kinni H, Gardner-Gray J, Giles CD, Hamam MS, Folt JR. Teaching and Assessing Bedside Procedures: A Standardized Cross-Disciplinary Framework for Graduate Medical Education. Acad Med 2024; 99:266-272. [PMID: 38039977 DOI: 10.1097/acm.0000000000005574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
ABSTRACT Performing bedside procedures requires knowledge, reasoning, physical adeptness, and self-confidence; however, no consensus on a specific, comprehensive strategy for bedside procedure training and implementation is available. Bedside procedure training and credentialing processes across large institutions may vary among departments and specialties, leading to variable standards, creating an environment that lacks consistent accountability, and making quality improvement difficult. In this Scholarly Perspective, the authors describe a standardized bedside procedure training and certification process for graduate medical education with a common, institution-wide educational framework for teaching and assessing the following 7 important bedside procedures: paracentesis; thoracentesis; central venous catheterization; arterial catheterization; bladder catheterization or Foley catheterization; lumbar puncture; and nasogastric, orogastric, and nasoenteric tube placement. The proposed framework is a 4-stage process that includes 1 preparatory learning stage with simulation practice for knowledge acquisition and 3 clinical stages to guide learners from low-risk to high-risk practice and from high to low supervision. The pilot rollout took place at Henry Ford Hospital from December 2020 to July 2021 for 165 residents in the emergency medicine and/or internal medicine residency programs. The program was fully implemented institution-wide in July 2021. Assessment strategies encompass critical action checklists to confirm procedural understanding and a global rating scale to measure performance quality. A major aim of the bedside procedure training and certification was to standardize assessments so that physician trainers from multiple specialties could train, assess, and supervise any participating trainee, regardless of discipline. The authors list considerations revealed from the pilot rollout regarding electronic tracking systems and several benefits and implementation challenges to establishing institution-wide standards. The proposed framework was assembled by a multidisciplinary physician task force and will assist other institutions in adopting best approaches for training physicians in performing these critically important and difficult-to-perform procedures.
Collapse
|
31
|
Maddry JK, Mallory A, Araña AA, Morris MJ, Clemons MAR, Burdette AJ, True MW, Niemeyer D, Weitzel EK. Establishment of the Clinician-Scientist Investigator Opportunity Network to Develop Military Medical Research Leaders. Mil Med 2024; 189:e864-e870. [PMID: 37702367 DOI: 10.1093/milmed/usad332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/01/2023] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION The ability of military clinicians to conduct military medical research is often limited because of competing priorities and a lack of research mentorship. The Clinician-Scientist Investigator Opportunity Network (CSION) was developed with the intent of training clinicians how to engage in requirements-driven research within the DoD. MATERIALS AND METHODS Three to five academic medical faculties were selected from a pool of applicants each year to participate in a 2-year research fellowship. To be eligible for the CSION program, applicants had to meet the following criteria: (1) Completed residency graduate medical education training, (2) not be currently enrolled as a graduate medical education trainee, and (3) obtained permission from their department leadership to focus 25% of their duty hours on CSION participation to include didactic and research efforts. The remaining 75% of fellows' time was dedicated to clinical duties. Monthly didactics, intensive mentorship, and consistent support were offered to each fellow by the CSION leadership team. Metrics were recorded to include both research and clinical productivity. RESULTS Between January 2019 and December 2022, 12 CSION fellows graduated from the program (four in the class of 2020, three in 2021, and five in 2022). From 2019 to 2021, the 12 CSION fellows initiated 204 research protocols, generated 489 publications/presentations, and secured 33 research grants. All graduates of the program remain active in clinical research with multiple graduates currently assigned to research positions. CONCLUSIONS The CSION research education program is a 2-year additional duty research fellowship producing clinician-scientists conducting military-relevant medical research and publications and may be considered a low-cost/highly efficient alternative to achieve the reported benefits of the MD-PhD tract. The expansion of the CSION program may improve the quality of military medical research and health care.
Collapse
Affiliation(s)
- Joseph K Maddry
- United States Army Institute of Surgical Research, Joint Base San Antonio (JBSA) Ft Sam Houston, TX 78234, USA
- 59th Medical Wing (59 MDW)/Chief Scientist's Office, JBSA Lackland Air Force Base (AFB), TX 78236, USA
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- San Antonio Uniformed Services Health Education Consortium (SAUSHEC), Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Amber Mallory
- 59th Medical Wing (59 MDW)/Chief Scientist's Office, JBSA Lackland Air Force Base (AFB), TX 78236, USA
| | - Allyson A Araña
- 59th Medical Wing (59 MDW)/Chief Scientist's Office, JBSA Lackland Air Force Base (AFB), TX 78236, USA
| | - Michael J Morris
- San Antonio Uniformed Services Health Education Consortium (SAUSHEC), Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Melissa Ann R Clemons
- 59th Medical Wing (59 MDW)/Chief Scientist's Office, JBSA Lackland Air Force Base (AFB), TX 78236, USA
| | - Alexander J Burdette
- 59th Medical Wing (59 MDW)/Chief Scientist's Office, JBSA Lackland Air Force Base (AFB), TX 78236, USA
| | - Mark W True
- San Antonio Uniformed Services Health Education Consortium (SAUSHEC), Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Debra Niemeyer
- 59th Medical Wing (59 MDW)/Chief Scientist's Office, JBSA Lackland Air Force Base (AFB), TX 78236, USA
| | - Erik K Weitzel
- Air Force Research Laboratory 711HPW/IR, Wright-Patterson AFB, Dayton, TX 45433, USA
| |
Collapse
|
32
|
Williamson TK, Martinez VH, Ojo DE, Allen CB, Fernandez R, Larson J, Timoney M, Sees JP. An analysis of osteopathic medical students applying to surgical residencies following transition to a single graduate medical education accreditation system. J Osteopath Med 2024; 124:51-59. [PMID: 37921195 DOI: 10.1515/jom-2023-0118] [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: 05/12/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
CONTEXT Upon requests from osteopathic medical schools, the National Resident Matching Program (NRMP) Charting Outcomes were redesigned to include osteopathic medical school seniors beginning in 2018 and one joint graduate medical education (GME) accreditation system, the Accreditation Council for Graduate Medical Education (ACGME), formed in 2020. OBJECTIVES The goal of this study is to analyze the match outcomes and characteristics of osteopathic applicants applying to surgical specialties following the ACGME transition. METHODS A retrospective analysis of osteopathic senior match outcomes in surgical specialties from the NRMP Main Residency Match data from 2020 to 2022 and the NRMP Charting Outcomes data from 2020 to 2022 was performed. RESULTS For surgical specialties, results show matching increased as United States Medical Licensing Examination (USMLE) Step 2 CK (clinical knowledge) and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2 CE (cognitive evaluation) scores increased along with the number of contiguous rankings (p<0.001). The greatest indication for matching looking at scores alone were those who scored greater than 230 on Step 2 CK compared to below (p<0.001) and above 650 on Level 2 CE (p<0.001). However, those who scored 240 (p=0.025) on Step 2 CK were just as likely to match as those who scored 250 (p=0.022) when compared to those who scored below those scores. Increasing research involvement had little to no significance with the likelihood of matching across most surgical subspecialties. CONCLUSIONS Our study demonstrates that there are unique thresholds for Step 2 CK scores, Level 2 CE scores, and the number of contiguous ranks for each surgical specialty that, when reached, are significantly associated with match success. Although certain board score delineations are linked with higher match success rates, the rates level off after this point for most surgical specialties and do not significantly increase further with higher scores. In addition, thresholds within contiguous ranks for increasing match likelihood exist and vary across surgical specialties. Overall, this study highlights that the quantitative metrics utilized to assess applicants lack the correlation reported historically, and the data presently available need to be more substantiated.
Collapse
Affiliation(s)
- Tyler K Williamson
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Victor H Martinez
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Desiree E Ojo
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Christian B Allen
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Roberto Fernandez
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Jason Larson
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Martin Timoney
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Julieanne P Sees
- National Academy of Medicine, American Osteopathic Association, Chicago, IL, USA
| |
Collapse
|
33
|
Burkhardt E, Adeeb N, Terrell D, Proctor C, Musmar B, Griessenauer CJ, Kosty JA, Guthikonda B. Factors impacting neurosurgery residents' operative case volume: a nationwide survey. J Neurosurg 2024; 140:570-575. [PMID: 37542439 DOI: 10.3171/2023.5.jns222861] [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: 12/20/2022] [Accepted: 05/30/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Neurological surgery residency remains one of the most competitive and longest specialties in terms of training in medicine. The Accreditation Council for Graduate Medical Education uses residents' case volume throughout residency as one of its measures for the quality of surgical training. The objective was to study the variability of residency case volume among US training programs and to analyze the factors that potentially influence that case volume. METHODS In line with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines, an online survey regarding department size, case volume, number of residents per year, number of dedicated research years, presence of fellows, and resident case volume by the time of graduation was created using Google Forms and distributed to all neurosurgery residency program directors and coordinators in the US. RESULTS A total of 97 of the 115 programs (84.3%) responded to the survey. Fifteen programs were excluded due to missing data or incomplete resident cohort at the time of the survey, and a total of 82 programs were included in the analysis. The average number of cases performed by residents as lead or senior surgeons by the time of graduation ranged from 900 to 2250 (median 1600 cases). The resident case volume did not have a significant correlation with the program case volume, number of operating attending neurosurgeons, number of residents, number of research years, or presence of fellows. The only factor that impacted the resident case volume was the number of cases performed per faculty. CONCLUSIONS The number of cases performed by residents throughout residency varied significantly between programs. Although other factors play important roles in the quality of training, including autonomy, variation, and complexity of cases, the resident case volume is one of the only measurable factors. This study sheds some light on the factors that potentially influence neurosurgical resident case volume.
Collapse
Affiliation(s)
- Edward Burkhardt
- 1Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana; and
| | - Nimer Adeeb
- 1Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana; and
| | - Danielle Terrell
- 1Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana; and
| | - Carlie Proctor
- 1Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana; and
| | - Basel Musmar
- 1Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana; and
| | - Christoph J Griessenauer
- 2Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Jennifer A Kosty
- 1Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana; and
| | - Bharat Guthikonda
- 1Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana; and
| |
Collapse
|
34
|
Fields BG, Kaur K, Dholakia S, Ioachimescu O. The COVID-19 pandemic's impact on sleep medicine fellowship telemedicine training: a follow-up survey of program directors. J Clin Sleep Med 2024; 20:201-210. [PMID: 37767791 PMCID: PMC10835784 DOI: 10.5664/jcsm.10828] [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: 06/19/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
STUDY OBJECTIVES Our 2019 survey of sleep medicine fellowship program directors (PDs) indicated that fellows' contact with telemedicine was limited. Within months, the coronavirus disease 2019 (COVID-19) pandemic significantly impacted the field. This survey describes fellows' telemedicine exposure, their PDs' attitudes toward it, and their formalized telemedicine training during the pandemic's third year. METHODS A 33-item SurveyMonkey questionnaire was developed. Many quantitative (Likert scale) items were identical to items on the 2019 survey for direct comparison. An open-ended question was added for qualitative analyses. All 91 sleep medicine fellowship PDs were invited to participate. The SurveyMonkey platform provided quantitative item descriptive statistics. Qualitative data underwent thematic analyses using codebook methodology. RESULTS Forty (97.5%) PDs indicated their program offers a telemedicine experience. Thirty-two (80%) PDs observed at least a 10% increase in sleep fellows' telemedicine encounters compared with prepandemic times. Although 27 (67.5%) PDs agreed that a national telemedicine curriculum could be useful, 8 (20%) of them offer a sleep telemedicine curriculum. Qualitative feedback revealed diverging attitudes toward telemedicine's place in sleep medicine practice, fellowship training, and the utility of a national curriculum. CONCLUSIONS Sleep telemedicine utilization during fellowship training was markedly higher on this 2022 survey (97.5%) compared with a similar 2019 survey (33.3%), and most PDs agreed a standardized curriculum could be useful. However, relatively few programs offer formalized telemedicine training. These findings imply that, while most sleep medicine fellows participate in telemedicine, they lack the formalized training that may optimize their utilization of the medium in their postfellowship careers. CITATION Fields BG, Kaur K, Dholakia S, Ioachimescu O. The COVID-19 pandemic's impact on sleep medicine fellowship telemedicine training: a follow-up survey of program directors. J Clin Sleep Med. 2024;20(2):201-210.
Collapse
Affiliation(s)
- Barry G. Fields
- Emory University School of Medicine, Atlanta, Georgia
- Atlanta VA Health Care System, Decatur, Georgia
| | - Komal Kaur
- Morehouse School of Medicine, Atlanta, Georgia
| | - Swapan Dholakia
- Emory University School of Medicine, Atlanta, Georgia
- Atlanta VA Health Care System, Decatur, Georgia
| | - Octavian Ioachimescu
- Medical College of Wisconsin, Milwaukee, Wisconsin
- Milwaukee VA Health Care System, Milwaukee, Wisconsin
| |
Collapse
|
35
|
Brown DC, Gonzalez-Vargas JM, Tzamaras HM, Sinz EH, Ng PK, Yang MX, Adhikary SD, Miller SR, Moore JZ. Evaluating the Impact of Assessment Metrics for Simulated Central Venous Catheterization Training. Simul Healthc 2024; 19:27-34. [PMID: 36378597 PMCID: PMC10185707 DOI: 10.1097/sih.0000000000000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Performance assessment and feedback are critical factors in successful medical simulation-based training. The Dynamic Haptic Robotic Trainer (DHRT) allows residents to practice ultrasound-guided needle insertions during simulated central venous catheterization (CVC) procedures while providing detailed feedback and assessment. A study was performed to examine the effectiveness of the DHRT in training the important skills of needle tip tracking and aspiration and how these skills impact procedural complications in simulated CVC. METHODS The DHRT data were collected for 163 residents at 2 hospitals for 6 simulated needle insertions. Users were given automated feedback on 5 performance metrics, which measure aspiration rate, arterial punctures, punctures through and through the vein, loss of access to the vein, and successful access to the vein. Aspiration rates and tip tracking rates were analyzed to determine their significance in preventing CVC complications and improving performance. RESULTS Tip tracking rates higher than 40% were 2.3 times more likely to result in successful venous access than rates less than 10%. Similarly, aspiration rates higher than 80% were 2.6 times more likely to result in successful venous access than rates less than 10%. Proper tip tracking and aspiration both reduced mechanical complications. Resident performance improved for all metrics except tip tracking. CONCLUSIONS Proper tip tracking and aspiration both reduced complications and increased the likelihood of success. However, the skill of tip tracking was not effectively learned through practice without feedback. Therefore, ultrasound-guided needle-based procedures, including CVC, can be improved by providing specific feedback to users on their ultrasound usage to track needle insertions.
Collapse
Affiliation(s)
- Dailen C Brown
- From the Departments of Mechanical and Nuclear Engineering (D.C.B., J.Z.M.) and Industrial and Manufacturing Engineering (J.M.G.-V., H.M.T.), The Pennsylvania State University; The Pennsylvania State University College of Medicine (E.H.S., S.D.A.), Hershey, PA; Cedars Sinai Medical Procedure Center and Vascular Access Services (P.K.N.); Cedars Sinai Medical Center (M.X.Y.), Los Angeles, CA; and Department of Engineering Design and Industrial Engineering (S.R.M.), The Pennsylvania State University, Hershey, PA
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Weissler EH, Williams ZF, Waldrop HW, Long CA, Tanious A, Kim Y. Surgical Specialty Impacts Quality of Operative Training in Carotid Endarterectomy. Ann Vasc Surg 2024; 99:298-304. [PMID: 37852361 DOI: 10.1016/j.avsg.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/06/2023] [Accepted: 08/19/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Carotid endarterectomy (CEA) is currently performed by multiple surgical specialties. The impact of surgical specialty and operative volume on post-CEA outcomes has been well described. However, it is unclear whether trainees of different surgical specialties have similar quality of operative training. METHODS Data from Accreditation Council for Graduate Medical Education annual reports were collected and compared between graduating vascular surgery (VS) residents, VS fellows, and neurological surgery (NS) residents. Only cases reported as chief/senior/lead resident, surgeon junior, or surgeon fellow were included in analysis. Linear regression analysis was utilized to evaluate trends in case-mix and volume. RESULTS From 2013 to 2022, total CEA case volume was higher among VS residents and fellows, compared to NS residents (52.8 ± 0.8 vs. 44.3 ± 1.4 vs. 12.9 ± 0.6, P < 0.0001). Additionally, VS residents and fellows performed other carotid operations including transfemoral or transcarotid artery stenting (11.1 ± 0.9 vs. 11.2 ± 0.8 vs. 0), carotid body tumor resection (0.7 ± 0.1 vs. 0.7 ± 0.0 vs. 0), and extracranial cervical bypass (6.7 ± 0.3 vs. 6.3 ± 0.3 vs. 0) that were not reported by the NS resident cohort (P < 0.0001 each). On linear regression analysis, total CEA procedures did not change for VS residents (R2 = 0.03, P = 0.62), decreased for VS fellows (-1.29 cases/yr, R2 = 0.75, P < 0.0001), and decreased among NS residents (-0.41 cases/yr, R2 = 0.44, P = 0.01) over the study period. CONCLUSIONS Although residents of multiple surgical specialties are trained in CEA, vascular training offers significantly greater numbers and diversity of extracranial carotid cases. It also appears that CEA volume is decreasing among neurosurgical trainees. In light of recent reports on the volume-outcome effect in carotid surgery, these data may have implications for future practice patterns in the domain of extracranial carotid artery disease.
Collapse
Affiliation(s)
- E Hope Weissler
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Zachary F Williams
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Heather W Waldrop
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC
| | - Adam Tanious
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Young Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC.
| |
Collapse
|
37
|
Braund H, Hanmore T, Dalgarno N, Baxter S. Using a rapid-cycle approach to evaluate implementation of competency-based medical education in ophthalmology. Can J Ophthalmol 2024; 59:40-45. [PMID: 36372134 DOI: 10.1016/j.jcjo.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/15/2022] [Accepted: 10/15/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE As competency-based medical education is being implemented across Canada, there is an increasing need to evaluate the progress to date, including identification of strengths and weaknesses, to inform program development. Ophthalmology is preparing for a national launch in coming years. The purpose of this study was to describe key stakeholders' lived experiences in the competency-based medical education foundation-of-discipline stage in one ophthalmology department. DESIGN Using a case-study approach, a qualitative rapid-cycle evaluation was conducted during the 2018-2019 academic year. PARTICIPANTS Residents, faculty, academic advisors, competence committee members, the program director, the program administrator, and the educational consultant were invited to participate in the program evaluation. METHODS The rapid-cycle evaluation consisted of 2 evaluation cycles, with the first round of interviews and focus groups occurring in October 2018 and the second round in March 2019. Recommendations were implemented in November 2019 and June 2019. All data were analyzed thematically using NVivo. RESULTS Three main themes emerged across all data sets: developing a shared understanding (e.g., role expectations and changes to assessment), refining assessment processes and tools (e.g., the need for streamlining and clarification), and feedback (e.g., perceived benefits and value of narrative comments). CONCLUSIONS Exploring lived experiences in this study resulted in positive and immediate improvements to the residency program. The recommendations and approach will be useful to other Canadian departments and institutions as they prepare for Competence by Design.
Collapse
Affiliation(s)
- Heather Braund
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON
| | - Tessa Hanmore
- Departments of Ophthalmology, Physical Medicine and Rehabilitation, and Psychiatry, Queen's University, Kingston, ON
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON
| | - Stephanie Baxter
- Department of Ophthalmology, Queen's University and Kingston Health Sciences Centre, Kingston, ON.
| |
Collapse
|
38
|
Clement EA, Oswald A, Ghosh S, Hamza DM. Exploring the Quality of Feedback in Entrustable Professional Activity Narratives Across 24 Residency Training Programs. J Grad Med Educ 2024; 16:23-29. [PMID: 38304587 PMCID: PMC10829927 DOI: 10.4300/jgme-d-23-00210.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/15/2023] [Accepted: 11/27/2023] [Indexed: 02/03/2024] Open
Abstract
Background Competency-based medical education (CBME) has been implemented in many residency training programs across Canada. A key component of CBME is documentation of frequent low-stakes workplace-based assessments to track trainee progression over time. Critically, the quality of narrative feedback is imperative for trainees to accumulate a body of evidence of their progress. Suboptimal narrative feedback will challenge accurate decision-making, such as promotion to the next stage of training. Objective To explore the quality of documented feedback provided on workplace-based assessments by examining and scoring narrative comments using a published quality scoring framework. Methods We employed a retrospective cohort secondary analysis of existing data using a sample of 25% of entrustable professional activity (EPA) observations from trainee portfolios from 24 programs in one institution in Canada from July 2019 to June 2020. Statistical analyses explore the variance of scores between programs (Kruskal-Wallis rank sum test) and potential associations between program size, CBME launch year, and medical versus surgical specialties (Spearman's rho). Results Mean quality scores of 5681 narrative comments ranged from 2.0±1.2 to 3.4±1.4 out of 5 across programs. A significant and moderate difference in the quality of feedback across programs was identified (χ2=321.38, P<.001, ε2=0.06). Smaller programs and those with an earlier launch year performed better (P<.001). No significant difference was found in quality score when comparing surgical/procedural and medical programs that transitioned to CBME in this institution (P=.65). Conclusions This study illustrates the complexity of examining the quality of narrative comments provided to trainees through EPA assessments.
Collapse
Affiliation(s)
- Elizabeth A. Clement
- Elizabeth A. Clement, MSc, MD, is a General and Colorectal Surgeon, Division of General Surgery, Department of Surgery, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada, and Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anna Oswald
- Anna Oswald, MD, MMEd, is a Rheumatologist, Director of CBME Implementation, and Clinicia Educator, Division of Rheumatology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Soumyaditya Ghosh
- Soumyaditya Ghosh, PhD, is a Research Associate, Postgraduate Medical Education, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; and
| | - Deena M. Hamza
- Deena M. Hamza, PhD, is Innovations and Health Professions Education Scientist, Postgraduate Medical Education, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
39
|
Grossi S, Cattoni M, Filipponi L, Marzorati A, Rotolo N, Carcano G, Imperatori A. Training simulator efficacy in developing thoracic and general surgical skills in a residency programme: a pilot study. Eur J Cardiothorac Surg 2024; 65:ezae044. [PMID: 38331406 DOI: 10.1093/ejcts/ezae044] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/08/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES Virtual training simulators have been introduced in several surgical disciplines to improve residents' abilities. Through the use of the LapSim® virtual training simulator (Surgical Science, Göteborg, Sweden), this study aims to plan an effective learning path in minimally invasive thoracic and general surgery. METHODS All thoracic and general surgery trainees in their 1st and 2nd year of residency at the University of Insubria were enrolled and randomized into 2 groups: residents undergoing an intensive twice-a-week virtual training programme (group A: n = 8) and those undergoing a once-weekly non-intensive virtual training programme (group B: n = 9). The virtual training programme was divided into 4 modules, each of 12 weeks. In the 1st module, trainees repeated grasping, cutting, clip application, lifting and grasping, and fine dissection exercises during each training session. Seal-and-cut exercise was performed as the initial and final test. Data on surgical manoeuvres (time and on mistakes) were collected; intra- and inter-group comparisons were planned. RESULTS No significant differences were observed between groups A and B at the 1st session, confirming that the 2 groups had similar skills at the beginning. After 12 weeks, both groups showed improvements, but comparing data between initial and final test, only Group A registered a significant reduction in total time (P-value = 0.0015), left (P-value = 0.0017) and right (P-value = 0.0186) instrument path lengths, and in left (P-value = 0.0010) and right (P-value = 0.0073) instrument angular path lengths, demonstrating that group A acquired greater precision in surgical manoeuvres. CONCLUSIONS Virtual simulator training programme performed at least twice a week was effective for implementing basic surgical skills required for the trainee's professional growth. Additional virtual training modules focused on more complex exercises are planned to confirm these preliminary results.
Collapse
Affiliation(s)
- Sarah Grossi
- Center for Thoracic Surgery, Department of Medicine and Surgery (DMC), University of Insubria, Varese, Italy
| | - Maria Cattoni
- Center for Thoracic Surgery, Department of Medicine and Surgery (DMC), University of Insubria, Varese, Italy
| | - Luca Filipponi
- Center for Thoracic Surgery, Department of Medicine and Surgery (DMC), University of Insubria, Varese, Italy
| | - Alessandro Marzorati
- General, Emergency and Transplant Surgery, Department of Medicine and Innovation Technology (DiMIT), University of Insubria, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery, Department of Medicine and Surgery (DMC), University of Insubria, Varese, Italy
| | - Giulio Carcano
- General, Emergency and Transplant Surgery, Department of Medicine and Innovation Technology (DiMIT), University of Insubria, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery (DMC), University of Insubria, Varese, Italy
| |
Collapse
|
40
|
Liu DS, Mazurek MH, Whitehead DC, Hood MC, Choi P, Gupte A, Ottensmeyer MP, Fintelmann FJ, Uppot RN, Andriole KP, Gee MS, Brink JA, Succi MD. A Novel Design-Thinking, Hospital Innovation Core Certificate Curriculum for Radiologists and Trainees: Creation, Implementation, and Multiyear Results. Acad Radiol 2024; 31:417-425. [PMID: 38401987 DOI: 10.1016/j.acra.2023.11.018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 02/26/2024]
Abstract
RATIONALE AND OBJECTIVES Innovation is a crucial skill for physicians and researchers, yet traditional medical education does not provide instruction or experience to cultivate an innovative mindset. This study evaluates the effectiveness of a novel course implemented in an academic radiology department training program over a 5-year period designed to educate future radiologists on the fundamentals of medical innovation. MATERIALS AND METHODS A pre- and post-course survey and examination were administered to residents who participated in the innovation course (MESH Core) from 2018 to 2022. Respondents were first evaluated on their subjective comfort level, understanding, and beliefs on innovation-related topics using a 5-point Likert-scale survey. Respondents were also administered a 21-question multiple-choice exam to test their objective knowledge of innovation-related topics. RESULTS Thirty-eight residents participated in the survey (response rate 95%). Resident understanding, comfort and belief regarding innovation-related topics improved significantly (P < .0001) on all nine Likert-scale questions after the course. After the course, a significant majority of residents either agreed or strongly agreed that technological innovation should be a core competency for the residency curriculum, and that a workshop to prototype their ideas would be beneficial. Performance on the course exam showed significant improvement (48% vs 86%, P < .0001). The overall course experience was rated 5 out of 5 by all participants. CONCLUSION MESH Core demonstrates long-term success in educating future radiologists on the basic concepts of medical technological innovation. Years later, residents used the knowledge and experience gained from MESH Core to successfully pursue their own inventions and innovative projects. This innovation model may serve as an approach for other institutions to implement training in this domain.
Collapse
Affiliation(s)
- David S Liu
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - Mercy H Mazurek
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - David C Whitehead
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - Michael C Hood
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - Peter Choi
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.)
| | - Anu Gupte
- Mass General Brigham Innovation, Boston, Massachusetts (A.G., M.D.S.)
| | - Mark P Ottensmeyer
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - Florian J Fintelmann
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - Raul N Uppot
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - Katherine P Andriole
- Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Data Science Office, Mass General Brigham, Boston, Massachusetts (K.P.A.)
| | - Michael S Gee
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - James A Brink
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.)
| | - Marc D Succi
- Medically Engineered Solutions in Healthcare Incubator, Mass General Brigham, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., P.C., F.J.F., R.N.U., M.S.G., J.A.B., M.D.S.); Harvard Medical School, Boston, Massachusetts (D.S.L., M.H.M., D.C.W., M.C.H., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (D.S.L., M.H.M., M.C.H., M.P.O., F.J.F., R.N.U., K.P.A., M.S.G., J.A.B., M.D.S.); Mass General Brigham Innovation, Boston, Massachusetts (A.G., M.D.S.).
| |
Collapse
|
41
|
Lai S, Buchheit BM, Kitamura K, Cook MR, Yarris LM, Chen G, Kwon A, Jordan J. Five Key Articles on Curriculum Development for Graduate Medical Educators. J Grad Med Educ 2024; 16:75-79. [PMID: 38304593 PMCID: PMC10829921 DOI: 10.4300/jgme-d-23-00208.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/02/2023] [Accepted: 11/14/2023] [Indexed: 02/03/2024] Open
Abstract
Background Curriculum development is an essential domain for medical educators, yet specific training in this area is inconsistent. With competing demands for educators' time, a succinct resource for best practice is needed. Objective To create a curated list of the most essential articles on curriculum development to guide education scholars in graduate medical education. Methods We used a modified Delphi method, a systematic consensus strategy to increase content validity, to achieve consensus on the most essential curriculum development articles. We convened a panel of 8 experts from the United States in curricular development, with diverse career stages, institutions, gender, and specialty. We conducted a literature search across PubMed and Google Scholar with keywords, such as "curriculum development" and "curricular design," to identify relevant articles focusing on a general overview or approach to curriculum development. Articles were reviewed across 3 iterative Delphi rounds to narrow down those that should be included in a list of the most essential articles on curriculum development. Results Our literature search yielded 1708 articles, 90 of which were selected for full-text review, and 26 of which were identified as appropriate for the modified Delphi process. We had a 100% response rate for each Delphi round. The panelists narrowed the articles to a final list of 5 articles, with 4 focusing on the development of new curriculum and 1 on curriculum renewal. Conclusions We developed a curated list of 5 essential articles on curriculum development that is broadly applicable to graduate medical educators.
Collapse
Affiliation(s)
- Steven Lai
- Steven Lai, MD, is Assistant Professor of Clinical Emergency Medicine and Associate Director, Residency Training Program, Department of Emergency Medicine, University of California, Los Angeles (UCLA) Ronald Reagan/Olive View, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Bradley M. Buchheit
- Bradley M. Buchheit, MD, MS, is Assistant Professor of Family Medicine and Program Director, Addiction Medicine Fellowship, Oregon Health & Science University, Portland, Oregon, USA
| | - Kellie Kitamura
- Kellie Kitamura, MD, is Assistant Professor of Clinical Emergency Medicine and Assistant Director, Residency Training Program, Department of Emergency Medicine, UCLA Ronald Reagan/Olive View, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mackenzie R. Cook
- Mackenzie R. Cook, MD, is Assistant Professor of Surgery and Surgical Core Clinical Experience Director, Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Lalena M. Yarris
- Lalena M. Yarris, MD, MCR, is Professor of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA, and Deputy Editor, Journal of Graduate Medical Education
| | - Grace Chen
- Grace Chen, MD, is Assistant Professor of Anesthesiology and Perioperative Medicine and Program Director, Pain Medicine Fellowship, Oregon Health & Science University, Portland, Oregon, USA
| | - Amy Kwon
- Amy Kwon, MD, is Assistant Professor of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon, USA; and
| | - Jaime Jordan
- Jaime Jordan, MD, MAEd, is Associate Professor of Clinical Emergency Medicine and Associate Director, Residency Training Program, Department of Emergency Medicine, UCLA Ronald Reagan/Olive View, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| |
Collapse
|
42
|
Stippler M, Blitz SE, Quinsey C, Limbrick D, Byrne R, Zipfel G, Selden NR. Active Teaching Techniques Using Virtual Didactics: Novel Experience From a National Neurosurgery Resident Course. J Surg Educ 2024; 81:312-318. [PMID: 38160110 DOI: 10.1016/j.jsurg.2023.11.006] [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] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/11/2023] [Accepted: 11/03/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To investigate the attitudes of neurosurgery residents regarding active teaching techniques and virtual didactics based on a national neurosurgery resident sample. We also evaluated the relative cost and time commitment required for faculty participation in virtual versus in-person resident courses. DESIGN The Society of Neurological Surgeons (SNS) national junior resident courses (JRCs) were reformatted for active teaching in a virtual setting in 2020 due to the COVID-19 pandemic. We analyzed course evaluations from the virtual 2020 courses in comparison to the 2019 in-person SNS JRCs. We also compared course budgets and agendas from these courses to identify comparative costs and the time commitment for faculty participation using these 2 course models. SETTING Survey of nationwide participants in virtual junior resident courses. PARTICIPANTS A total of 122 residents from 80 ACGME neurosurgery residency training programs attended the 2020 virtual JRC. RESULTS The survey response rate of attendees was 36%. In-class engagement was thought to be good to great by 73% to 80% of the virtual learners. In-class activities and active learning techniques also were evaluated positively by 61% to 82% of respondents. Expenses were significantly lower for the virtual course, at $118 per course participant, than for the in-person course ($2722 per participant). There also was a 97.3% reduction of faculty hours and a 97.6% reduction of faculty cost for the virtual JRC compared to the in-person course. CONCLUSIONS Neurosurgeon residents embraced the active teaching techniques used to teach portions of the prepandemic JRCs in a virtual format. Other aspects of the course curriculum could not be replicated virtually. Virtual courses were dramatically less expensive to produce, used fewer faculty teachers and required less time per faculty member. The data from this study may inform the choice of active teaching techniques for other neurosurgery residency and continuing medical education courses to optimize learner engagement and participant satisfaction in the virtual setting. We recommend that the curriculum of in-person courses emphasize hands-on, experiential learning and professional enculturation that cannot be recreated in the virtual space. Curricular elements suitable to virtual learning should take advantage of lower costs, reduced faculty time requirements, and scalability. They should also utilize active teaching techniques to improve learner engagement.
Collapse
Affiliation(s)
- Martina Stippler
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | | | - Carolyn Quinsey
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - David Limbrick
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Pediatrics, Washington University, St. Louis, Missouri
| | - Richard Byrne
- Department of Neurosurgery, Rush Medical College, Chicago, Illinois
| | - Greg Zipfel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Nathan R Selden
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| |
Collapse
|
43
|
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.
Collapse
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
| |
Collapse
|
44
|
Yu JC, Rhee KE, Dworsky ZD, Larrow A, Passarelli P, Patel A. Improving Pediatric Fellows' Feedback Skills and Confidence Through Objective Structured Examinations. J Grad Med Educ 2024; 16:64-69. [PMID: 38304600 PMCID: PMC10829923 DOI: 10.4300/jgme-d-23-00332.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/20/2023] [Accepted: 11/27/2023] [Indexed: 02/03/2024] Open
Abstract
Background Medical trainees must learn how to provide effective feedback as an essential communication skill, yet few models exist for training and assessing these skills. Objective To develop an observed structured feedback examination (OSFE) to provide feedback training to pediatric fellows and assess changes in skills and self-reported confidence. Methods This educational study was conducted from 2019 to 2020 at an academic children's hospital. Our team developed the OSFE and trained standardized feedback recipients and faculty. Fellows completed baseline self-assessments (31 items) on prior exposure to feedback training, application of skills, and confidence. They then participated in the OSFE, giving feedback to a standardized recipient using a standardized scenario, and were scored by faculty and recipients using a 15-item checklist for performance. Next, fellows participated in feedback training and received individualized feedback, after which they repeated the OSFE and confidence self-assessment. Three months later, fellows completed self-assessments on confidence and application of skills and another OSFE to assess retention. Descriptive statistics and signed rank sum test were used for analysis. Results Of 60 eligible fellows, 19 participated (32%), with 100% follow-up. After training and individualized feedback, all fellows improved feedback skills as measured by OSFE performance (mean change +0.89). All items, measured on a 5-point Likert scale, were sustained 3 months later (mean change +0.92). All fellows reported improved confidence in feedback knowledge (mean change +2.07 post, +1.67 3 months post). Conclusions Feedback training using simulation and individualized feedback moderately improved fellows' performance, confidence, and 3-month retention of feedback skills.
Collapse
Affiliation(s)
- Jennifer C. Yu
- Jennifer C. Yu, MD, is Faculty, Department of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, San Diego, California, USA
| | - Kyung E. Rhee
- Kyung E. Rhee, MD, MSc, MA, is Faculty, Department of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, San Diego, California, USA
| | - Zephyr D. Dworsky
- Zephyr D. Dworsky, MD, at the time of the study was a Clinical Fellow, Department of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, San Diego, California, USA, and is now Faculty, Department of Pediatrics, Barbara Bush Children’s Hospital, Tufts University, Medford, Massachusetts, USA
| | - Annie Larrow
- Annie Larrow, MD, MS, at the time of the study was a Clinical Fellow, and is now Faculty, Department of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, San Diego, California, USA
| | - Patrick Passarelli
- Patrick Passarelli, MD, was Chief Resident, Department of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, San Diego, California, USA, and is now a Hospitalist, Department of Internal Medicine and Pediatrics, Arnot Ogden Medical Center, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA; and
| | - Aarti Patel
- Aarti Patel, MD, MEd, is Faculty, Department of Pediatrics, Rady Children’s Hospital San Diego, University of California San Diego, San Diego, California, USA
| |
Collapse
|
45
|
Wykowski JH, Merel S, Starks H, Berger G, Shepherd A, Gibbon L, Kritek PA, Hicks KG. An Embedded Curriculum to Teach Critical Incident Debriefing to Internal Medicine Residents. J Grad Med Educ 2024; 16:59-63. [PMID: 38304599 PMCID: PMC10829914 DOI: 10.4300/jgme-d-23-00273.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/23/2023] [Accepted: 11/10/2023] [Indexed: 02/03/2024] Open
Abstract
Background Internal medicine residents frequently experience distressing clinical events; critical event debriefing is one tool to help mitigate their effects. Objective To evaluate the effectiveness of a 1-hour workshop teaching residents a novel, efficient approach to leading a team debrief after emotionally charged clinical events. Methods An internal needs assessment identified time and confidence as debriefing barriers. In response, we created the STREAM (Structured, Timely, Reflection, tEAM-based) framework, a 15-minute structured approach to leading a debrief. Senior residents participated in a 1-hour workshop on the first day of an inpatient medicine rotation to learn the STREAM framework. To evaluate learning outcomes, participants completed the same survey immediately before and after the session, and at the end of their 4-week rotation. Senior residents at another site who did not complete the workshop also evaluated their comfort leading debriefs. Results Fifty out of 65 senior residents (77%) participated in the workshop. After the workshop, participants felt more prepared to lead debriefs, learned a structured format for debriefing, and felt they had enough time to lead debriefs. Thirty-four of 50 (68%) workshop participants and 20 of 41 (49%) comparison residents completed the end-of-rotation survey. Senior residents who participated in the workshop were more likely than nonparticipants to report feeling prepared to lead debriefs. Conclusions A brief workshop is an effective method for teaching a framework for leading a team debrief.
Collapse
Affiliation(s)
- James H. Wykowski
- James H. Wykowski, MD, is Chief Resident, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Susan Merel
- Susan Merel, MD, is Associate Professor, Department of Medicine, School of Medicine, University of Washington, and Director of Education, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Helene Starks
- Helene Starks, PhD, is Associate Professor, Department of Bioethics and Humanities, School of Medicine, University of Washington, and Co-Director, Graduate Certificate in Palliative Care, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Gabrielle Berger
- Gabrielle Berger, MD, is Clinical Associate Professor, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Amanda Shepherd
- Amanda Shepherd, MD, is Clinical Assistant Professor, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Lindsay Gibbon
- Lindsay Gibbon, MD, is Clinical Assistant Professor, Department of Medicine, School of Medicine, University of Washington, and Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Patricia A. Kritek
- Patricia A. Kritek, MD, EdM, is Professor, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, USA; and
| | - Katherine G. Hicks
- Katherine G. Hicks, MD, is Assistant Professor, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
46
|
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.
Collapse
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
| |
Collapse
|
47
|
Gloviczki P. The changing face of surgical education: transfer of surgical and endovascular knowledge to young surgeons. J Cardiovasc Surg (Torino) 2024; 65:64-68. [PMID: 38391236 DOI: 10.23736/s0021-9509.24.12791-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
The goal of vascular surgery education is to provide the best possible training to vascular residents and fellows and to assure the highest standards of care for patients with vascular disease. In the USA, the currently used Vascular Surgery Milestones Program includes milestones as set targets at five levels, from novice to expertise, to assess the trainees' performance in knowledge, skills, attitudes, and other attributes of competencies. Competencies are broad and foundational domains of ability, the most important being the care of the patient. The soon to be introduced Entrustable Professional Activities (EPA) Project, a competency-based assessment, appears to be the best way to evaluate that trainees are ready to practice independently. Transferring surgical and endovascular skills to trainees has been, however, a challenge, because of the decreased number of open surgical procedures, the increasing number of the endovascular interventions, the decreased work hours for residents and that learning on patients in the operating room is no longer acceptable. Simulation laboratories, using 3D reconstructions of real patient's aneurysms has been most helpful to teach even complex endovascular procedures. In open or endovascular simulation laboratories, deliberate practice with focused attention and specific goals of improving performance should be combined with expert feedback. Greatness is not coded into our DNA but comes from deliberate practice, dedication and perseverance.
Collapse
Affiliation(s)
- Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA -
| |
Collapse
|
48
|
Liaw FY, Chang YW, Tsai PF. Using cultural historical activity theory to understand how post-graduate residents perform discharge planning at a medical center in Taiwan. BMC Med Educ 2024; 24:91. [PMID: 38279173 PMCID: PMC10811894 DOI: 10.1186/s12909-023-05003-8] [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: 03/17/2023] [Accepted: 12/20/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Despite the importance of discharge planning in physicians' education, currently in most countries, no identical training is provided. Difficulties in promoting physician discharge planning education in Taiwan are still noted. This study aims to find the physicians' role of discharge planning training in educating post graduate year residents (PGY) in Taiwan. MATERIALS AND METHODS We took advantage of government and hospital policies that promote the discharge planning program to teach and implement it, beginning with PGY residents by incorporating it into their training program. We recruited 30 PGY residents who were attending their three-month general internal medicine training from 2018 to 2019. They were interviewed at the end of the program using cultural-historical activity theory (CHAT). Qualitative research methods were used to further understand how discharge planning and care was implemented. RESULTS Trainees initially believed that they did not have any role in discharge planning. Using the cycle of expansive learning, we found that the role of physicians in discharge planning was unclear. There were still some inconsistencies in the teaching and implementation of the discharge planning program for PGY residents that needed to be resolved, but this study also let participants learn through practice to improve their identification of discharge planning. CONCLUSIONS This study analyzed the impact of a discharge planning program for PGY physicians in Taiwan. It showed that the program affected physicians' practice and medical education, although some contradictions remain.
Collapse
Affiliation(s)
- Fang- Yih Liaw
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Humanities in Medicine, College of Humanities and Social Sciences, Taipei Medical University, Taipei, Taiwan
| | - Yaw-Wen Chang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Po-Fang Tsai
- Graduate Institute of Humanities in Medicine, College of Humanities and Social Sciences, Taipei Medical University, Taipei, Taiwan.
- School of Medicine, College of Life Sciences and Medicine, National Tsing Hua University, No. 101, Section 2, Kuang-Fu Road, Hsinchu City, 300044, Taiwan.
| |
Collapse
|
49
|
Thiel GE, Murtha CM, Dennis JF, Hopper M. The clinical anatomy fellowship: A participants' perspective. Anat Sci Educ 2024; 17:173-185. [PMID: 37700558 DOI: 10.1002/ase.2337] [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: 06/12/2023] [Revised: 08/01/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
Kansas City University offers a Clinical Anatomy Fellowship which enrolls nine medical students during each academic year and provides training in research, teaching, and advanced anatomical topics. The Fellows practice as novice educators, working alongside Anatomy faculty to teach medical students in the Gross Anatomy laboratory. However, little has been reported related to Fellowship participation and success outcomes. This survey-based study was designed to explore (1) student motivation(s) for pursuing the Fellowship, (2) benefits of participation, and (3) the perceived impact on residency applications and career success. Three unique populations were surveyed. The most important factors driving application to the Fellowship were a desire to increase competitiveness in the residency application process (Likert mean score 4.7-5.0) and a passion for Anatomy (Likert mean score 4.3-4.7). Taking a year away from the College of Osteopathic Medicine curriculum (Likert mean score 4.4) and delaying clinical exposure (Likert mean score 4.2) were the most important deterrents to application. The most reported benefits after program completion included opportunities to build a strong residency application (44% and 50% of Fellows), conduct research (44% and 45% of Fellows), and participate in teaching (11% and 50% of Fellows). 73% of past Fellows matched into their top specialty of choice. Flexibility in the program allows participants to individualize their Fellowship experience to address their personal goals related to residency applications and careers as future physicians. As the results suggest, the Clinical Anatomy Fellowship benefits Fellows, signaling other medical institutions to consider adopting a similar program.
Collapse
Affiliation(s)
- Grace E Thiel
- College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri, USA
| | - Celeste M Murtha
- College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri, USA
| | - Jennifer F Dennis
- Department of Pathology & Anatomical Sciences, Kansas City University, Kansas City, Missouri, USA
| | - Mari Hopper
- Department of Academic Affairs, Kansas City University, Kansas City, Missouri, USA
| |
Collapse
|
50
|
Ngo TL, Yanek L, Caglar D, Bailey J, Roskind CG, Langhan M. Medical Knowledge Acquisition during a Pandemic: Pediatric Subspecialty in-Training Examination and Board Certification Exam Passing Rate. Acad Pediatr 2024; 24:147-154. [PMID: 37245666 PMCID: PMC10219674 DOI: 10.1016/j.acap.2023.05.013] [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: 10/05/2022] [Revised: 05/09/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The COVID-19 pandemic resulted in training programs restructuring their curricula. Fellowship programs are required to monitor each fellow's training progress through a combination of formal evaluations, competency tracking, and measures of knowledge acquisition. The American Board of Pediatrics administers subspecialty in-training examinations (SITE) to pediatric fellowship trainees annually and board certification exams at the completion of the fellowship. The objective of this study was to compare SITE scores and certification exam passing rates before and during the pandemic. METHODS In this retrospective observational study, we collected summative data on SITE scores and certification exam passing rates for all pediatric subspecialties from 2018 to 2022. Trends over time were assessed using analysis of variance (ANOVA) analysis to test for trends across years within one group and t-test analysis to compare groups before and during the pandemic. RESULTS Data were obtained from 14 pediatric subspecialties. Comparing prepandemic to pandemic scores, Infectious Diseases, Cardiology, and Critical Care Medicine saw statistically significant decreases in SITE scores. Conversely, Child Abuse and Emergency Medicine saw increases in SITE scores. Emergency Medicine saw a statistically significant increase in certification exam passing rates, while Gastroenterology and Pulmonology saw decreases in exam passing rates. CONCLUSIONS The COVID-19 pandemic resulted in restructuring didactics and clinical care based on the needs of the hospital. There were also societal changes affecting patients and trainees. Subspecialty programs with declining scores and certification exam passing rates may need to assess their educational and clinical programs and adapt to the needs of trainees' learning edges.
Collapse
Affiliation(s)
- Thuy L Ngo
- Department of Pediatrics (TL Ngo), Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Lisa Yanek
- Department of Medicine (L Yanek), Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Derya Caglar
- Department of Pediatrics (D Caglar), Division of Pediatric Emergency Medicine, University of Washington School of Medicine/ Seattle Children's Hospital
| | - Jessica Bailey
- Department of Emergency Medicine (J Bailey), Division of Pediatric Emergency Medicine, Oregon Health & Science University
| | - Cindy G Roskind
- Department of Emergency Medicine (CG Roskind), Division of Pediatric Emergency Medicine, Columbia University Irving Medical Center, New York, NY
| | - Melissa Langhan
- Department of Pediatrics (M Langhan), Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT
| |
Collapse
|