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Doddi S, Khalafi M, Shimoura E, Shanbhogue KP, Tirumani SH. Female and underrepresented minority representation in radiology. Curr Probl Diagn Radiol 2024:S0363-0188(24)00082-3. [PMID: 38705772 DOI: 10.1067/j.cpradiol.2024.05.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/01/2024] [Indexed: 05/07/2024]
Abstract
RATIONAL AND OBJECTIVE Diversity, equity, inclusion, and representation in various sectors have garnered increasing attention in the past two decades, including healthcare. In this report we investigate representation of females and underrepresented minorities (URM) in the field of radiology and asses for significant growth trends in representation in residency training programs in the United States. MATERIALS AND METHODS De-identified trainee demographic information for active radiology trainees from 2016 to 2021 was queried using the Accreditation Council for Graduate Medical Education (ACGME), and new radiology trainees using the National Resident Matching Program (NRMP)'s Main Residency Match Data and Reports databooks. RESULTS In 2021 females represented 26.7% of DR residency trainees and 22% of IR integrated trainees. In the same year URM trainees represented 11.3% of trainees and 8.7% of IR integrated trainees. From 2017 to 2021, diagnostic radiology had a compound average growth rate (CAGR) 1% (p <0.01) of female representation and 1.12% (p<0.01) of URM representation. CONCLUSION This study quantifies female and underrepresented minority representation among radiology trainees for diagnostic radiology and radiology subspecialities, identifying modest uptrends in representation within both demographics.
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Affiliation(s)
- Sishir Doddi
- University of Toledo College of Medicine, 440-497-8119, 3000 Arlington Ave, Toledo, OH 43614, USA.
| | - Mona Khalafi
- University of Toledo College of Medicine, 440-497-8119, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Elizabeth Shimoura
- University of Toledo College of Medicine, 440-497-8119, 3000 Arlington Ave, Toledo, OH 43614, USA
| | | | - Sree Harsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Foley J, Mulcaire J, Jee M, Patton A, Umana E. The Irish Trainee Emergency Research Network (ITERN): five years of collaboration. Ir J Med Sci 2024; 193:1015-1018. [PMID: 37584818 PMCID: PMC10961277 DOI: 10.1007/s11845-023-03499-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
In 2018, a group of Irish emergency medicine (EM) trainees recognised their common interest in collaborative research and the difficulties that trainees can encounter when trying to broaden their research capacity, prompting the beginning of the Irish Trainee Emergency Research Network (ITERN) journey. Trainee-led collaboratives have been shown to be feasible and have the potential to deliver impactful research projects, generating an evidence base that may not have been possible without collaboration. This article describes the successes and achievement of ITERN and describes the processes and challenges that a trainee-led research network can encounter. The authors believe that trainee-led collaboratives can deliver powerful and impactful research for patients and broaden the research capacity of individuals, hospitals, and groups of healthcare professionals.
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Affiliation(s)
- James Foley
- Irish Trainee Emergency Research Network (ITERN), Dublin, Ireland.
- Emergency Department, North Bristol Trust NHS, Bristol, UK.
| | - Jeffrey Mulcaire
- Irish Trainee Emergency Research Network (ITERN), Dublin, Ireland
- Emergency Department, Cork University Hospital, Cork, Ireland
| | - Marcus Jee
- Irish Trainee Emergency Research Network (ITERN), Dublin, Ireland
- Emergency Department, Galway University Hospital, Galway, Ireland
| | - Andrew Patton
- Irish Trainee Emergency Research Network (ITERN), Dublin, Ireland
- Emergency Department, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Etimbuk Umana
- Irish Trainee Emergency Research Network (ITERN), Dublin, Ireland
- Emergency Department, Mater Misericordiae Hospiztal, Dublin 7, Ireland
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Vu L, Jeganathan C, Ponniah K, Ofri A. Trainees as primary operators do not significantly impact perioperative complication rates in breast surgery. Surgeon 2024; 22:121-124. [PMID: 38105134 DOI: 10.1016/j.surge.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND There is a trend for specialist care in breast surgery resulting in fewer primary operative cases for general surgery trainees; and subsequently that trainees performing advanced oncoplastic techniques in breast surgery may negatively impact patient morbidity. We have reviewed the complication rates between Australian general surgery trainees and Breast Consultants. METHODS A retrospective analysis was performed over a 5-year period (January 2016-December 2021). The key endpoints measured were relative complication rates for consultants compared to trainees, subdivided by surgery type. Surgeries were categorised as either benign, primary breast cancer surgery or re-excision. RESULTS A total of 2646 operative cases were performed with the primary operator rate for consultants 58.35 % (n = 1544) and for trainees 41.65 %% (n = 1102). The overall complication rate was 2.83 % (n = 75); the overall rate for the consultants was 2.65 % and 3.08 % for the trainees. The complication rates were not statistically significant (p = 0.59) between the two groups. The mastectomy only complication rate was higher in the consultant group with a result of 7.3 % compared to 2.8 % for the trainees however was not statistically significant (p = 0.18). The most common complication was haematoma formation for both groups. CONCLUSIONS This study has demonstrated that trainees can safely perform advanced oncoplastic techniques without statistically elevated morbidity. In an era where breast surgery caseloads are increasing, but the exposure to breast surgery during training are decreasing, it is necessary to implement a practice where trainees can perform breast operations under supervision at a specialized unit.
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Affiliation(s)
- Linda Vu
- Breast Clinic, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
| | - Chaithanya Jeganathan
- Breast Clinic, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
| | - Kallyani Ponniah
- Breast Clinic, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Adam Ofri
- Breast Clinic, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; Department of Surgery, Mater Hospital, North Sydney, NSW 2060, Australia; Central Clinical School, University of Sydney, Sydney, NSW 2050, Australia; Royal Prince Alfred Hospital Institute of Academic Surgery, Camperdown, NSW 2050, Australia
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Fischer NM, Handelsman R, Schointuch M, Vitez S, Szczupak A, Sanfilippo J. An Assessment of Business of Medicine Knowledge in Obstetrics and Gynecology Fellows: A Pilot Study. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00180-3. [PMID: 38301796 DOI: 10.1016/j.jpag.2024.01.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
STUDY OBJECTIVE To identify knowledge gaps in business education among obstetrics and gynecology fellows METHODS: An online anonymous survey was distributed to obstetrics and gynecology subspecialty fellows, including pediatric and adolescent gynecology, minimally invasive gynecologic surgery, and reproductive endocrinology and infertility fellows. RESULTS Of the 483 fellows who received the questionnaire, 159 completed the surveys, resulting in a response rate of 32.9%. A total of 80 reproductive endocrinology and infertility fellows (50.3%), 47 minimally invasive gynecologic surgery fellows (29.6%), and 32 pediatric and adolescent gynecology (20.1%) fellows completed the survey. Over half reported debt from either undergraduate or medical school (52.2%). Over half (58.5%) reported 0 hours of finance education in their residency or fellowship training. In general, fellows reported relatively higher levels of confidence in nonmedical aspects of business, such as purchasing a home (63.9%), life and disability insurance (57.2%), and making financial plans for the future (57.9%). Conversely, a large portion of fellows reported feeling "not at all confident" in business topics related to the field of medicine, including contract negotiation (24.7%), non-competes (27.1%), relative value units system-based pay (32.0%), general office practice management (58.2%), legal aspects of business (71.8%), accounting and billing (54.4%), and marketing (55.7%). CONCLUSION Our survey demonstrates an unmet demand among obstetrics and gynecology fellows to learn topics related to the business of medicine. Knowledge of these topics is critical for those pursuing private practice or academic medicine. Future initiatives should evaluate other subspecialties and prioritize creating a standardized education tool to better prepare trainees entering medical practice.
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Affiliation(s)
- Nicole Mercado Fischer
- University of Pittsburgh Medical Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, Pennsylvania.
| | - Roy Handelsman
- University of Pittsburgh Medical Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, Pennsylvania
| | - Monica Schointuch
- University of Pittsburgh Medical Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, Pennsylvania
| | - Sally Vitez
- University of Pittsburgh Medical Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, Pennsylvania
| | - Alexandra Szczupak
- University of Pittsburgh Medical Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, Pennsylvania
| | - Joseph Sanfilippo
- University of Pittsburgh Medical Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, Pennsylvania
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Alele PE, Kiptoo J, Hill-Besinque K. Postgraduate medical trainees at a Ugandan university perceive their clinical learning environment positively but differentially despite challenging circumstances: a cross-sectional study. BMC Med Educ 2023; 23:965. [PMID: 38102623 PMCID: PMC10724882 DOI: 10.1186/s12909-023-04933-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE The clinical learning environment is an essential component in health professions' education. Data are scant on how postgraduate trainees in sub-Saharan Africa perceive their medical school learning environments, and how those perceptions contribute to their engagement during training, their emotional wellbeing, and career aspirations. This study examined perceptions of postgraduate medical trainees (residents) in a resource-limited setting, regarding their learning environment and explored perceptual contributions to their career engagement during training. The data reported contribute to understanding how clinical learning environments can be improved in low-resource settings in Uganda and elsewhere. METHODS This study was done at the Faculty of Medicine of Mbarara University of Science and Technology in Uganda. We used a descriptive cross-sectional design involving sequential mixed methods. Quantitative data were collected using the Postgraduate Hospital Educational Environment Measure (PHEEM). Qualitative data were collected using focus group discussions. RESULTS Ninety of the 113 eligible residents responded (79.6%). Of these, 62 (68.9%) were males, 51 (56.7%) were third-year trainees, and the majority (40%) of the residents were aged between 30 and 34 years. Overall PHEEM scored 98.22 ± 38.09; Role Autonomy scored 34.25 ± 13.69, Teaching scored 39.7 ± 13.81, and Social Support scored 24.27 ± 10.59. Gender differences occurred in the perceptions of teaching and social support. Cronbach's alpha coefficient was 0.94 for the overall PHEEM. Five major themes were identified from the qualitative data (trainee support, supervision environment, engagement with overall learning environment, preparation for future practice, and challenges that impede training). CONCLUSIONS Overall, this study suggests that postgraduate trainees at the institution perceived the clinical learning environment positively amidst challenges of limited resources. Trainees' insights provided data that propose improvements on a number of domains in the learning environment.
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Affiliation(s)
- Paul E Alele
- Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Joshua Kiptoo
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kathleen Hill-Besinque
- Department of Pharmacy Practice, School of Pharmacy, Chapman University, California, USA
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Williams R, Kemp V, Burgess J, Murray E, Stokes S, Wood A, Batt-Rawden S, Bland L, Lockey D. Practical psychosocial care for providers of pre-hospital care: a summary of the report 'valuing staff, valuing patients'. Scand J Trauma Resusc Emerg Med 2023; 31:77. [PMID: 37946286 PMCID: PMC10636848 DOI: 10.1186/s13049-023-01141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Caring for people who are ill or injured in pre-hospital environments is emotionally draining and physically demanding. This article focuses on the Psychosocial and Mental Health Programme commissioned by the Faculty of Pre-Hospital Care (FPHC) at the Royal College of Surgeons of Edinburgh (RCSEd) in 2018 to investigate the experiences and needs of responders to pre-hospital emergencies and make recommendations. It summarises the report to FPHC published in 2022, and adds material from research published subsequently. METHOD FPHC appointed a team to undertake the work. Team members conducted a literature review, and a systematic review of the literature concerning the impacts on the mental health of pre-hospital practitioners. They conducted fieldwork, participated in training and had conversations with trainees and established practitioners, and took evidence from the Pre-hospital Emergency Medicine Trainees Association (PHEMTA). RESULTS The Results summarise the evidence-based theoretical background derived from the programme and practical guidance for practitioners, professional organisations, and employers who deliver pre-hospital care on the implications of, preventing and intervening with pre-hospital providers who experience psychosocial and mental health problems. CONCLUSION This paper summarises the outputs from a multidisciplinary programme of scholarship, research, and fieldwork. The authors condense the findings and the guidance developed by the Programme Team to provide a summary of the report and guidance on implementation. They believe that the recommendations are applicable to all healthcare organisations and particularly those that employ responders to emergencies and provide pre-hospital care.
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Affiliation(s)
- Richard Williams
- Welsh Institute for Health and Social Care, Faculty of Pre-Hospital Care, University of South Wales, Edinburgh, UK
- Director of the Psychosocial Care and Mental Healthcare Programme for the Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh 2018-2022, Edinburgh, UK
| | - Verity Kemp
- Psychosocial Care and Mental Healthcare Programme for the Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh 2018-2022, Edinburgh, UK
| | - Jennifer Burgess
- Cumbria, Northumberland, Tyne and Wear NHS Trust and Newcastle University, Newcastle Upon Tyne, UK
| | - Esther Murray
- Institute for Health Sciences Education, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Suzy Stokes
- Emergency Medicine and Pre-Hospital Emergency Medicine, Oxford University Hospitals and Thames Valley Air Ambulance, Stokenchurch, UK
| | - Andrew Wood
- Anaesthesia and Pre-Hospital Emergency Medicine, Barts Health NHS Trust, London, UK
| | - Samantha Batt-Rawden
- Intensive Care Medicine and Pre-Hospital Emergency Medicine, Ashford and St Peter's NHS Foundation Trust, Cambridge, UK
| | - Laura Bland
- Pre-Hospital and Emergency Medicine, Somerset Foundation Trust and Dorset and Somerset Air Ambulance, Henstridge, UK
- Faculty of Pre-Hospital Care, Intercollegiate Board for Training in Pre-Hospital Emergency Medicine, Edinburgh, UK
| | - David Lockey
- Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh, Edinburgh, UK.
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Celentano C, Prefumo F, Matarrelli B, Mastracchio J, Mauri S, Rosati M. Comparison of practice vs theory model training for vacuum-assisted delivery: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2023; 290:109-114. [PMID: 37776704 DOI: 10.1016/j.ejogrb.2023.09.024] [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: 07/20/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE To assess the effect of two modalities of simulation training on acquisition/retention of skills for performing operative vaginal delivery. DESIGN Randomized, controlled, single-centre study. SETTING A tertiary referral hospital in Italy. PARTICIPANTS Twenty residents from a single university programme and two young specialists. INTERVENTION Group 1 had an individual training session with a single senior specialist using a fixed simulator model. After the session, trainees watched a pre-recorded 1-h lecture on vacuum-assisted operative vaginal delivery. Group 1 repeated the simulator session using the same test after 8-12 weeks and 12 months. Group 2 watched the pre-recorded lecture then undertook the same sessions as Group 1. Video recordings of all test performances were evaluated by five specialists in a blinded manner. MAIN OUTCOME MEASURE Each procedure was evaluated using a Global Rating Scale (GRS), scored with 0-5 points for each item on an Objective Structured Assessment of Technical Skills (OSATS) dataset with seven items (total 35 points). OSATS were evaluated over time, compared for the whole population, and weighted for route and year of residency. The primary outcome was comparison of the effectiveness of training between the two groups based on year of residency by assessing videos of the baseline test and GRS for OSATS scores. The secondary outcome was overall retention of skills at 8-12 weeks and 12 months. RESULTS Twenty-two participants were recruited and randomized to either Group 1 (n = 11) or Group 2 (n = 11). Five participants did not complete follow-up. The primary outcome of GRS for OSATS scores at time 0 differed significantly between groups for total GRS score, and 'Call for help' and 'Explanation to woman and relatives' item scores (p = 0.002 and p = 0.007, respectively). In a multiple linear regression analysis, OSATS scores were not independently influenced by year of residency. At 8-12-week follow-up, the 'Call for help' item score showed a significant improvement in Group 1 (p = 0.018), although this was not confirmed when year of residency was included as an independent variable. At 12-month follow-up, none of the item scores demonstrated a significant change (p = 0.033). Year of residency did not influence the difference between groups. One-way analysis of variance found significant differences between the groups for 'Localization of the flexion point' (p = 0.005), 'Traction of vacuum cup' (p = 0.039) and 'Use of second hand of the operator' (p = 0.009) item scores and total GRS score (p = 0.007). The values weighted by year of residency did not demonstrate any significant difference. The secondary outcomes evaluated all the candidates of both groups for retention of technical skills over time. A significant effect of time was found for total GRS score (p < 0.001) and OSATS item scores. CONCLUSIONS Independent of the sequence of theoretical teaching and simulation training, trainees demonstrated high retention - and, actually, improvement - of technical skills for operative vaginal delivery at 12-month follow-up.
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Affiliation(s)
- Claudio Celentano
- Department of Obstetrics and Gynaecology, Santo Spirito Hospital, Pescara, affiliated to University G. d'Annunzio Chieti-Pescara, Pescara, Italy; Emergency Advanced Simulation Centre, Santo Spirito Hospital, Pescara, Italy.
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Barbara Matarrelli
- Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, Chieti, affiliated to University G. d'Annunzio Chieti-Pescara, Pescara, Italy
| | - Jacopo Mastracchio
- Department of Obstetrics and Gynaecology, Santo Spirito Hospital, Pescara, affiliated to University G. d'Annunzio Chieti-Pescara, Pescara, Italy; Emergency Advanced Simulation Centre, Santo Spirito Hospital, Pescara, Italy; Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, Chieti, affiliated to University G. d'Annunzio Chieti-Pescara, Pescara, Italy
| | - Serena Mauri
- Department of Obstetrics and Gynaecology, Santo Spirito Hospital, Pescara, affiliated to University G. d'Annunzio Chieti-Pescara, Pescara, Italy; Emergency Advanced Simulation Centre, Santo Spirito Hospital, Pescara, Italy; Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, Chieti, affiliated to University G. d'Annunzio Chieti-Pescara, Pescara, Italy
| | - Maurizio Rosati
- Department of Obstetrics and Gynaecology, Santo Spirito Hospital, Pescara, affiliated to University G. d'Annunzio Chieti-Pescara, Pescara, Italy; Emergency Advanced Simulation Centre, Santo Spirito Hospital, Pescara, Italy
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Fawaz AS, O'Connell C, Manecksha RP, Redmond EJ, Nason G, Dowling C, O'Kelly F. Women in Irish urology: An examination of female representation amongst attendees of the Irish Society of Urology annual meeting (2008-2020). Surgeon 2023; 21:308-313. [PMID: 36935272 DOI: 10.1016/j.surge.2023.03.001] [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: 12/21/2022] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND There is underrepresentation of women at surgical conferences. We examine the representation of women in Irish urology by looking at gender balance within the Irish Society of Urology (ISU) conference. AIMS ISU programmes over thirteen years from 2008 to 2020 were assessed and female representation in session chairs, guest speakers, poster and oral presentations identified. Gender distributions of authors for each year was examined. To investigate changes in female representation temporally, the period of this study (2008-2020) was subdivided and compared: 2008-2013 and 2014-2020. RESULTS 76 sessions were presided over by 138 chairs, of which 6 (4.3%) were female. Eight conferences had zero female chairs. 62 guest lectures were given, 6 (9.6%) by women. Of total 340 poster and 434 oral presentations, women delivered 24.9% (0-47.5%) of posters and 31.6% (10.3-59.4%) of oral presentations. We found no significant difference in the percentage of female poster presentations between the time periods 2008-2013 (m = 18.2, sd = 13.7) and 2014-2020 (m = 34.3, sd = 17.8), t(11) = -1.4, p > 0.05. However, we found a significant difference in the percentage of female oral presentations between the periods 2008-2013 (m = 18.7, sd = 14.2) and 2014-2020 (m = 40.6, sd = 14.5), t(11) = -2.8, p < 0.05. CONCLUSIONS Our study is the second to examine female representation in Irish urology. Session chairs and guest speakers were grossly overrepresented by males as were oral and poster presentations. Despite lacking female influence overall, in more recent years there was an increased representation of women. Societies should strive to increase female representation, as this perpetuates a positive feedback loop, encouraging future female trainees to pursue urological surgery.
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Affiliation(s)
- A S Fawaz
- Cork University Hospital, Cork, Ireland.
| | | | | | | | - G Nason
- Mater Misercordiae University Hospital, Dublin, Ireland
| | - C Dowling
- University Hospital Galway, Galway, Ireland
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Harada ND, Traylor L, Rugen KW, Bowen JL, Smith CS, Felker B, Ludke D, Tonnu-Mihara I, Ruberg JL, Adler J, Uhl K, Gardner AL, Gilman SC. Interprofessional transformation of clinical education: The first six years of the Veterans Affairs Centers of Excellence in Primary Care Education. J Interprof Care 2023; 37:S86-S94. [PMID: 29461131 DOI: 10.1080/13561820.2018.1433642] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 06/09/2017] [Revised: 10/24/2017] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
This paper describes the Centers of Excellence in Primary Care Education (CoEPCE), a seven-site collaborative project funded by the Office of Academic Affiliations (OAA) within the Veterans Health Administration of the United States Department of Veterans Affairs (VA). The CoEPCE was established to fulfill OAA's vision of large-scale transformation of the clinical learning environment within VA primary care settings. This was accomplished by funding new Centers within VA facilities to develop models of interprofessional education (IPE) to teach health professions trainees to deliver high quality interprofessional team-based primary care to Veterans. Using reports and data collected and maintained by the National Coordinating Center over the first six years of the project, we describe program inputs, the multicomponent intervention, activities undertaken to develop the intervention, and short-term outcomes. The findings have implications for lessons learned that can be considered by others seeking large-scale transformation of education within the clinical workplace and the development of interprofessional clinical learning environments. Within the VA, the CoEPCE has laid the foundation for IPE and collaborative practice, but much work remains to disseminate this work throughout the national VA system.
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Affiliation(s)
- Nancy D Harada
- Office of Academic Affiliations, Department of Veterans Affairs (VA), Washington, DC, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Laural Traylor
- Office of Academic Affiliations, Department of Veterans Affairs (VA), Washington, DC, USA
- Department of Social Work, California State University, Long Beach, Long Beach, CA, USA
| | - Kathryn Wirtz Rugen
- Jesse Brown VA Medical Center, Chicago, IL, USA
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Judith L Bowen
- Schools of Medicine and Nursing, Oregon Health and Science University, Portland, OR, USA
| | - C Scott Smith
- Boise VA Medical Center, Boise, ID, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Bradford Felker
- VA Puget Sound Healthcare System, Seattle, WA, USA
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Deborah Ludke
- Office of Academic Affiliations, Department of Veterans Affairs (VA), Washington, DC, USA
| | | | - Joshua L Ruberg
- VA San Diego Healthcare System, San Diego, CA, USA
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Jayson Adler
- Office of Academic Affiliations, Department of Veterans Affairs (VA), Washington, DC, USA
| | - Kimberly Uhl
- Office of Academic Affiliations, Department of Veterans Affairs (VA), Washington, DC, USA
| | - Annette L Gardner
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Stuart C Gilman
- Office of Academic Affiliations, Department of Veterans Affairs (VA), Washington, DC, USA
- School of Medicine, University of California, Irvine, Irvine, CA, USA
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Tran JH, Loebel E, Edouard M, Quehl T, Walsh E, Ginsburg R, Frempong T, Fredrick D, Stein LK, Fara MG, Farouk SS, Chadha N. Creating ophthalmology experiences in undergraduate medical education: pilot of a cased-based learning ophthalmology tool. BMC Med Educ 2023; 23:559. [PMID: 37559068 PMCID: PMC10410917 DOI: 10.1186/s12909-023-04514-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE To evaluate medical student perceptions of a novel ophthalmology resource delivered through facilitated workshops in the core clerkship curriculum. METHODS We created www.2020sim.com, a free case-based learning (CBL) ophthalmology tool, adapted from NephSIM (www.nephsim.com). The tool was first piloted with the internal medicine (IM) residents. After confirming a need, we focused on undergraduate medical education (UME) by expanding the 20/20 SIM content and partnering with the neurology (pilot academic year [AY] 2020-2021) and pediatric clerkships (pilot AY 2021-2022) to deliver a facilitated one-hour ophthalmology workshop within each clerkship's didactic curriculum. We evaluated the tool using pre- and post-surveys and knowledge assessments. RESULTS Of 80 IM residents, 33 (41.3%) completed the needs assessment. Of the 25 residents who attended the workshop, 23 (92.0%) completed the exit survey. IM residents reported discomfort in several ophthalmology domains (9 of 14 rated mean score < 3.0), confirming a need. Most (n = 21/23, 91.3%) rated the tool as good/excellent. Of 145 neurology clerkship students, 125 (86.2%) and at least 88 (60.7%) students completed the pre- and post-test/exit surveys, respectively. On average, participants highly rated the tool, perceiving 20/20 SIM to be relevant to their education [4.1 (0.8)]. Mean pre- to post-test knowledge scores increased from 7.5 to 8.5/10.0 points (p < 0.001). Of the 136 pediatric clerkship students, 67 (49.3%) and 51 (37.5%) completed the pre- and post-surveys, respectively. Respondents perceived increased comfort with ophthalmology topics after the facilitated workshop [3.8 (0.8)]. Mean pre- to post-test knowledge scores trended from 1.8 to 2.0/5.0 points (p = 0.30). Collectively, 20/139 (14.4%) of exit survey respondents visited www.2020sim.com within 1 month after the workshop. CONCLUSION After identifying areas of greatest need with residents, we partnered with core clerkships to deliver cross-disciplinary ophthalmology content in UME. We found high engagement with 20/20 SIM, with trends toward increased knowledge.
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Affiliation(s)
- Jessica H Tran
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye & Ear Infirmary, Eye and Vision Research Institute, New York, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Emma Loebel
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mark Edouard
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of General Preventative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Thomas Quehl
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye & Ear Infirmary, Eye and Vision Research Institute, New York, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Erin Walsh
- Department of Ophthalmology & Visual Science, Yale School of Medicine, New Haven, USA
| | - Robin Ginsburg
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye & Ear Infirmary, Eye and Vision Research Institute, New York, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Tameisha Frempong
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye & Ear Infirmary, Eye and Vision Research Institute, New York, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Douglas Fredrick
- Kaiser Permanente Medical Group South San Francisco, San Francisco, USA
| | - Laura K Stein
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Michael G Fara
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Samira S Farouk
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
- Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Nisha Chadha
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye & Ear Infirmary, Eye and Vision Research Institute, New York, USA.
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA.
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11
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Nagamoto T, Kubono H, Kawamura M, Suzuki K. A custom-made vitreoretinal surgical simulator using a silicone mold. BMC Ophthalmol 2023; 23:311. [PMID: 37434127 DOI: 10.1186/s12886-023-03070-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/05/2023] [Indexed: 07/13/2023] Open
Abstract
PURPOSE We constructed a custom-made vitreoretinal surgical simulator using a silicone mold and described its practicality. METHODS We obtained spherical silicone molds, mannequins, and spray material from an internet-based vendor and combined them with expired surgical instruments to complete the simulator. Vitreoretinal experts confirmed the practicality of the simulator after simulated vitrectomy, and the results of the questionnaires were confirmed by nonvitreoretinal experts. RESULTS Vitreoretinal experts observed that the simulated eyeball and the actual eyeball were similar in size and rigidity and that the intraocular practice swing seemed to be useful for the prevention of complications. The semitransparency and open-sky structure of the silicone material ensured visibility. The simulated membrane, which was spray glue, provided an excellent peeling sensation. In the results of the nonvitreoretinal experts' questionnaires, the average scores of all items were generally high, which supported the claims of the simulator's usefulness. CONCLUSION This report describes the simplicity and cost-effectiveness of our custom-made simulator and its contribution in creating an ideal training environment that does not necessitate travel to special facilities that offer a large number of pig eyes and vitreous surgical machines. The simple shape seems to allow many possibilities, and further verification at multiple facilities is necessary.
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Affiliation(s)
- Takashi Nagamoto
- Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-city, 220-8521, Kanagawa, Japan.
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| | - Hirohisa Kubono
- Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-city, 220-8521, Kanagawa, Japan
| | - Mari Kawamura
- Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-city, 220-8521, Kanagawa, Japan
| | - Kotaro Suzuki
- Department of Ophthalmology, Keiyu Hospital, 3-7-3 Minatomirai, Nishi-ku, Yokohama-city, 220-8521, Kanagawa, Japan
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Tawfik DS, Rovnaghi C, Profit J, Cornell TT, Anand KJ. Prevalence of burnout and its relation to the neuroendocrine system among pediatric residents during the early Covid-19 pandemic: A pilot feasibility study. Compr Psychoneuroendocrinol 2023; 14:100174. [PMID: 36742128 PMCID: PMC9890933 DOI: 10.1016/j.cpnec.2023.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Background Measuring burnout relies on infrequent and subjective surveys, which often do not reflect the underlying factors or biological mechanisms that promote or prevent it. Burnout correlates with cortisol levels and dysregulation of the hypothalamic-pituitary-adrenal axis, but the chronology and strength of this relationship are unknown. Objective To determine the prevalence and feasibility of studying burnout in pediatric residents using hair cortisol and hair oxytocin concentrations. Design /Methods: Longitudinal observational cohort study of pediatric residents. We assessed burnout using the Stanford Professional Fulfillment Index and hair cortisol (HCC), and hair oxytocin concentrations (HOC) at four 3-month intervals from January 2020-January 2021. We evaluated test-retest reliability, sensitivity to change using Pearson product-moment correlations, and relationships between burnout and hair biomarkers using hierarchical mixed-effects linear regression. Results 17 Pediatrics residents provided 78 wellness surveys and 54 hair samples. Burnout symptoms were present in 39 (50%) of the surveys, with 14 (82%) residents reporting burnout in at least one time point. The lowest (41%) and highest (60%) burnout prevalence occurred in 04/2020 and 01/2021, respectively. No significant associations between burnout scores and HCC (β -0.01, 95%CI: 0.14-0.13), HOC (β 0.06, 95%CI: 0.06-0.19), or the HCC:HOC ratio (β -0.04, 95%CI: 0.09-0.02) were noted in separate analyses. Intra-individual changes in hair cortisol concentration were not associated with changes in burnout score. Conclusions Burnout was prevalent among Pediatrics residents, with highest prevalence noted in January 2021. This pilot longitudinal study demonstrates the feasibility of evaluating burnout with stress and resilience biomarkers in Pediatrics residents.
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Affiliation(s)
- Daniel S. Tawfik
- Corresponding author. 770 Welch Road, Suite 435, Palo Alto, CA, 94304, USA.
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13
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Pang BW, Obayashi J'O, Schreiner B, Unger R, McCartney S, Dingman J, Selden NR, Cetas JS, Dogan A, Ciporen JN. Innovative growth and development of a neurological surgery residency cadaveric skull base simulation training program: A single institution experience. Clin Neurol Neurosurg 2023; 225:107585. [PMID: 36634568 DOI: 10.1016/j.clineuro.2023.107585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/29/2022] [Accepted: 01/01/2023] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Neurosurgical cadaveric and simulation training is a valuable opportunity for residents and fellows to develop as neurosurgeons, further neuroanatomy knowledge, and develop decision-making and technical expertise. The authors describe the growth and development of Oregon Health & Science University (OHSU) Department of Neurological Surgery (NSG) resident hands-on simulation skull base course and provide details of course layout and setup. METHODS A three-part surgical simulation series was created to provide training in cadaveric skull base procedures. Course objectives were outlined for participants. Residents participated in NSG hands-on simulation courses (years 2015-2020) and completed annual course curriculum and anonymous course evaluations, which included free text reviews. Courses were evaluated by Likert scale analysis within Python, and free text was quantified using Valence Aware Dictionary for sEntiment Reasoning (VADER). Descriptive statistics were calculated and plotted using Python's Seaborn and Matplotlib library modules. RESULTS Analysis included 162 skull base (anterior fossa, middle fossa and lateral, and endoscopic endonasal-based) simulation course evaluations. Resident responses were overwhelmingly positive. Likert responses demonstrated high average responses for each question (4.62 ± 0.56 and above). A positive attitude about simulation courses is supported by an average compound sentiment value of 0.558 ± 0.285. CONCLUSION This is the first time Likert responses and sentiment analysis have been used to demonstrate how neurosurgical residents view a comprehensive, multi-year hands-on simulation training program. We hope the information presented serves as a guide for other institutions to develop their own residency educational curriculum in cadaveric skull base procedures.
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Affiliation(s)
- Brandi W Pang
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
| | - James 'Obi' Obayashi
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Bryan Schreiner
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Robert Unger
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Shirley McCartney
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Jackie Dingman
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Nathan R Selden
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Justin S Cetas
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Aclan Dogan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Jeremy N Ciporen
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States.
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Topcu EG, Khattak H, Boekhorst F, Horala A, Henriques MG, Roos EJ. Postgraduate Training in Pediatric and Adolescent Gynecology: Trainees' Perspectives. J Pediatr Adolesc Gynecol 2023; 36:18-24. [PMID: 35691506 DOI: 10.1016/j.jpag.2022.06.001] [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: 09/29/2021] [Revised: 05/18/2022] [Accepted: 06/02/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate resident trainees' perspectives on the pediatric and adolescent gynecology (PAG) training in obstetrics and gynecology training programs in Europe. STUDY DESIGN This study was a cross-sectional survey using an online questionnaire, on the basis of the PAG training in obstetrics and gynecology section of the European Board & College of Obstetrics and Gynaecology Project of Achieving Consensus in Training curriculum. We aimed to survey the national programs in 35 European Network of Trainees in Obstetrics and Gynaecology (ENTOG) member countries. Taking part in the survey was voluntary. The questionnaire was shared on the ENTOG online platforms. RESULTS Ninety obstetrics and gynecology trainees in 33 of 35 countries responded to our questionnaire. Of the 35 ENTOG member countries, 33 participated in the survey, and a total of 90 responses were collected, giving a response rate of 9% of all European trainees and representing 94% of the member countries. Only 27% of trainees reported having a PAG rotation during their training program, and a PAG elective was only available to 34% of the trainees. Forty-one percent reported that PAG training was not included in their curriculum (no official rotations or lectures planned). Despite the lack of formal training, 72% of trainees felt able to diagnose and manage prepubertal vaginal bleeding and adnexal masses in children and adolescents by the end of their training. Most (58%) also confirmed that they could determine indications for treatment of vulval, vaginal, perineal, and rectal conditions. However, despite scoring positively for the management and counseling of subjects that often overlap with adult patients, such as "contraception in adolescents with health problems," "acute abdominal pain," "menstrual abnormalities," and "vaginal discharge," the study revealed poorer scores when the trainees were asked about more specific PAG topics such as "premature puberty" and "developmental disorders of the genital tract." CONCLUSION Most core training programs across Europe do not include formal PAG training, and trainees reported a need to improve the provision of core PAG training in Europe.
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Affiliation(s)
| | - Hajra Khattak
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Ferry Boekhorst
- Haaglanden Medical Center, Lijnbaan 32, 2512VA, The Hague, The Netherlands
| | - Agnieszka Horala
- Gynecologic Oncology Department, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Poznan, Poland
| | | | - Eveline J Roos
- Tergooi MC, Department of Obstetrics and Gynecology, van Riebeeckweg 212, 1213 XZ, Hilversum, The Netherlands
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15
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Alsowayan OS, Al Zahrani AM. Validity of the Rezum Simulator for Trainees. Acta Inform Med 2023; 32:82-87. [PMID: 38585599 PMCID: PMC10997172 DOI: 10.5455/aim.2024.32.82-87] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/28/2024] [Indexed: 04/09/2024] Open
Abstract
Background Simulations have revolutionized surgical training and are an invaluable adjunct tool for augmenting the proficiency of surgeon and patient safety. Before being included in a practical assessment process, simulators need to be using various validity inference frameworks. Objective We examine the construct validity and reliability of the Rezum simulator. Methods Seventeen candidates of different professions voluntarily participated in the Rezum simulation workshop. The simulator provides a variety of variable metrics and challenges. Each candidate performed three cases of different difficulty levels with three trials of each case. Validity was measured statistically through a one-way analysis of variance (ANOVA) test, and a p-value of < 0.05 was considered significant. Additional reliability tests were provided, including intraclass correlation coefficients, a Cronbach test (0.7 is considered acceptable), and standard error of measurement. Results The ANOVA of total scores among candidates was significant (p = 0.029). Senior registrars and consultants had the highest total scores. Procedure times did not differ significantly among candidates (p = 0.169). The reliability test for the total score was 0.899 (0.831-0.942), with a standard error value of 2.75, a standard deviation of 8.67, and a Cronbach alpha value of 0.915. Conclusion We confer the primer evidence of Rezum simulation as a valid, reliable simulator of most of its metrics.
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Affiliation(s)
- Ossamah Saleh Alsowayan
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah Mousa Al Zahrani
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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16
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Rodgers CJ, O'Leary BP, Fernandez R, Rutherford J. The acquisition of clinical experience during GP training - how can we mitigate for the impact of COVID-19? Educ Prim Care 2022; 33:360-363. [PMID: 36066115 DOI: 10.1080/14739879.2022.2116730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic has profoundly impacted the way general practice is run and this is expected to have had a knock-on effect upon GP training. A questionnaire-based study was designed to investigate what was happening to GP trainees 16 months into the pandemic in terms of opportunities to develop clinical experience and clinical decision-making. We also asked trainers and trainees for ideas on how we might mitigate for the effects of COVID-19. In particular, there has been decreased exposure to clinical examination during the pandemic and there appear to be gaps in opportunities to learn from urgent and unscheduled care settings and to develop skills in rapid clinical decision-making. It is interesting to consider what general practice will look like when the pandemic is over and how this will this affect the GP training curriculum going forwards. Although response rates were low, we were able to determine some emerging themes for national, local and educational review going forwards to help shape and improve GP training for the future.
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Affiliation(s)
- C J Rodgers
- East of England Primary Care School, HEE East of England, Cambridge, UK
| | - B P O'Leary
- East of England Primary Care School, HEE East of England, Cambridge, UK
| | - R Fernandez
- East of England Primary Care School, HEE East of England, Cambridge, UK
| | - J Rutherford
- East of England Primary Care School, HEE East of England, Cambridge, UK
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Suresh NV, Shah VN, Fritz CG, Griff JR, Shah S, Watane A, Parikh RS, Nicolli EA. Medical malpractice litigation involving otolaryngology residents and fellows: A case-based 30-year review. World J Otorhinolaryngol 2022; 9:1-11. [DOI: 10.5319/wjo.v9.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/09/2022] [Accepted: 08/18/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Errors, misdiagnoses, and complications can occur while trainees are involved in patient care. Analysis of such events could reveal areas for improvement by residency and fellowship programs.
AIM To examine lawsuits tried at the state and federal level involving otolaryngology trainees.
METHODS The LexisNexis database, an online legal research database containing state and federal case records from across the United States, was retrospectively reviewed for malpractice cases involving otolaryngology residents or fellows from January 1, 1990 to December 31, 2020. Case data collected: Plaintiff/trainee/defendant characteristics, allegations, medical outcomes, and legal outcomes.
RESULTS Over the study period, 20 malpractice lawsuits involving otolaryngology trainees were identified. Plaintiffs raised numerous allegations including procedural error (n = 12, 25.5%), incorrect diagnosis and/or treatment (n = 8, 17.0%), and lack of knowledge of trainee involvement (n = 6, 12.8%). Nine cases (45%) had verdicts in favor of the plaintiff, whereas 5 cases (25%) had verdicts in favor of the defense. Six cases (30%) ended in a settlement. Awards to plaintiffs were heterogenous, with a median of $617,500 (range $32K-17M) for settled cases and verdicts favoring plaintiffs.
CONCLUSION The findings enclosed herein represent the first published analysis of trainee involvement in otolaryngology malpractice cases held at the state/federal level. Otolaryngology trainees can be involved in lawsuits for both procedural and nonprocedural events. This study highlights the importance of education specifically in the domains of procedural errors, informed consent, proper diagnosis/management, and clear communication within patient care teams. Training programs should incorporate these study findings into effective simulation courses and didactic sessions. Educating trainees about common pitfalls holds the promise of decreasing healthcare systems costs, reducing trainee burnout, and, most importantly, benefiting patients.
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Affiliation(s)
- Neeraj V Suresh
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19107, United States
| | - Viraj N Shah
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Christian G Fritz
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19107, United States
| | - Jessica R Griff
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Shreni Shah
- Morsani College of Medicine, University of South Florida, Tampa, FL 33612, United States
| | - Arjun Watane
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT 06510, United States
| | - Ravi S Parikh
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Elizabeth A Nicolli
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, United States
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18
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Revue E, Woods R. Our duty to learners in the emergency department. CAN J EMERG MED 2022; 24:561-562. [PMID: 36071323 DOI: 10.1007/s43678-022-00375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/05/2022] [Indexed: 11/24/2022]
Affiliation(s)
| | - Rob Woods
- Department of Emergency Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada.
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Goncalves-Henriques M, Horala A, Topcu EG, Boekhorst F, Khattak H. The implementation of the European Working Time Directive in Europe and its impact on training in obstetrics and gynaecology: A ten year follow-up. Eur J Obstet Gynecol Reprod Biol 2022; 278:1-5. [PMID: 36108448 DOI: 10.1016/j.ejogrb.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To reassess the compliance with the European Working Time Directive (EWTD) in the member countries of the European Network of Trainees in Obstetrics and Gynaecology (ENTOG) and to investigate the impact of the EWTD on training. STUDY DESIGN In this observational, cross-sectional study, an online questionnaire, containing multiple-choice questions and open questions, was distributed among Obstetrics and Gynaecology trainees in 33 ENTOG member countries. The questionnaire was designed as a follow-up of a similar survey conducted by ENTOG in 2009 and assessed the overall compliance with the EWTD, the adaptations needed to achieve this compliance, the impact of the EWTD on the quality of training and the well-being of trainees. The answers were analysed using descriptive statistics in Microsoft Excel. RESULTS 59 responses from 28/33 (84.8%) ENTOG member countries were collected. Only 5 out of 28 (17.9%) countries were found to be nationally compliant with EWTD. There were no clear differences in the compliance between different types of the hospitals (university/teaching/district), but a trend was observed towards higher rate of implementation in smaller hospitals (<1500 deliveries per year). Regarding the changes needed to become EWTD-compliant and yet maintain high-quality training, the most common suggestions were: hiring extra junior doctors, restructuring training, having less doctors on duty simultaneously, consultants performing more hands on work, dedicated training sessions, reduction of administrative tasks and simulation training for surgical skills. The majority of trainees, 7 out of 12, (58.3%) in the EWTD-compliant hospitals experienced a positive effect on their training, whereas the majority of trainees in non-compliant hospitals, 31 out of 47, (66%) were uncertain about the impact of the EWTD on the quality of training. Among the positive changes, better work-life balance and more consultants available out of the daily working hours were listed. CONCLUSIONS Despite the introduction and implementation of the EWTD over two decades ago, the compliance rates across Europe remain low and seem not to have altered in the last ten years. In order to ensure the quality of training and, most importantly patient safety, we suggest that European nations keep striving to implement the EWTD for doctors in training. We also suggest for nations that have yet to implement this directive to use the strategies as an exemplar in countries that follow EWTD.
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Shao CC, Kennedy GE, Rentas CM, Chen H, Fazendin JM. Leadership Development Among Junior Surgery Residents: Communication and Perception. J Surg Res 2022; 277:A18-A24. [PMID: 35428484 PMCID: PMC9678243 DOI: 10.1016/j.jss.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Leadership is necessary for effective health care teams, particularly for surgeons. Trainees similarly must acquire foundational leadership skills to maximize effectiveness. However, surgical leadership is rarely formally assessed, particularly for junior trainees. We aimed to establish themes of communication, perception and engagement styles, as well as strengths and weaknesses among junior surgical residents at a single institution. METHODS The Data Dome Inc. (datadome.com) DISC personality assessment was administered in 2018-2021 to junior residents at an academic general surgery training program at a single institution. Resident demographics were recorded, and themes from deidentified reports were analyzed by year (PGY-1 and PGY-2) using JMP 16 Pro Text Explorer. RESULTS PGY-1 communication was most frequently described as "accomplished best by well-defined avenues" with "duties and responsibilities of others who will be involved explained" in "friendly terms." PGY-2 communication involved "deal [ing] with people," "strong feelings about a particular problem," and being "good at giving verbal and nonverbal feedback." In ideal environments, PGY-1s self-perceived as "good listener [s]," "good-natured," and "team player [s]." However, under stress, PGY-1s were perceived by others as "poor listener [s]," "self-promoter [s]," "detached," and "insensitive." In ideal environments, PGY-2s were also "good listener [s]," "good-natured," and "team player [s]." However, under stress, PGY-2 external perception was "overly confident," "poor listener [s]," and "self-promoter [s]." CONCLUSIONS Clear expectations, friendly work environments, and opportunities to succeed are key to effectively train junior surgical residents. In environments where time is often a limited resource, surgical simulation, stress training, and standardized teaching methods from attending surgeons are needed to develop competent trainees.
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Affiliation(s)
- Connie C Shao
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Grace E Kennedy
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Courtney M Rentas
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica M Fazendin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Lagunes-Cordoba E, Lagunes-Cordoba R, Fresan-Orellana A, Gonzalez-Olvera J, Jarrett M, Thornicroft G, Henderson C. Mexican Psychiatric Trainees' Attitudes Towards People with Mental Illness: A Qualitative Study. Community Ment Health J 2022; 58:982-991. [PMID: 34716830 PMCID: PMC9187538 DOI: 10.1007/s10597-021-00907-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 10/19/2021] [Indexed: 11/27/2022]
Abstract
Despite their training, psychiatrists have been found to have negative attitudes towards people with mental illness, including the patients they treat. Similarly, studies focused on service users have identified psychiatrists as a source of stigma. Even though negative attitudes in psychiatrists have been identified in different countries and settings, in Mexico the attitudes of these professionals have never been assessed. Because of this, we invited psychiatric trainees from a hospital in Mexico to participate in individual interviews to describe their opinions regarding mental health-related stigma, to evaluate their attitudes towards people with mental illness and to identify factors that could be influencing their attitudes. Interviews were audio recorded, transcribed and analysed using thematic analysis. A total of 29 trainees participated in the study. The results suggested that trainees recognised psychiatrists can have negative attitudes towards people with mental illness, such as poor empathy, judgement and labelling, and mainly towards patients considered difficult and with borderline personality disorder. Participants recognised these attitudes can influence their relationship with patients, and considered it is necessary to develop interventions to improve their own attitudes and reduce mental health stigma. From this study we concluded Mexican psychiatrists are not free from stigma towards people with mental illness. However, Mexican psychiatric trainees are interested in improving their attitudes and reactions towards their patients.
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Affiliation(s)
- Emmeline Lagunes-Cordoba
- Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
| | - Roberto Lagunes-Cordoba
- Instituto de Investigaciones Psicológicas, Universidad Veracruzana, Xalapa, Veracruz, Mexico
| | - Ana Fresan-Orellana
- Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Mexico City, Mexico
| | - Jorge Gonzalez-Olvera
- Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñíz", Mexico City, Mexico.,Comisión Nacional Para la Prevención de Adicciones, Mexico City, Mexico
| | - Manuela Jarrett
- School of Health Sciences, City, University of London, London, UK
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Claire Henderson
- Centre for Global Mental Health and Centre for Implementation Science, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Brown SA, Yang EH, Branch M, Beavers C, Blaes A, Fradley MG, Cheng RK. Training and Career Development in Cardio-Oncology Translational and Implementation Science. Heart Fail Clin 2022; 18:503-14. [PMID: 35718422 DOI: 10.1016/j.hfc.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cardiovascular disease is a leading cause of death in cancer survivors, after recurrence of the primary tumor or occurrence of a secondary malignancy. Consequently, the interdisciplinary field of cardio-oncology has grown rapidly in recent years to address the cardiovascular care needs of this unique population through clinical care and research initiatives. Here, the authors discuss the ideal infrastructure for training and career development in cardio-oncology translational and implementation science and emphasize the importance of the multidisciplinary cardiovascular team for both research and patient care. Cardio-oncology training opportunities in general cardiology, hematology/oncology, and specialized cardio-oncology clinical and research fellowships are also considered.
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H A H, Vajawat B, Banerjee D, Desai G. Perceived Barriers in the Assessment and Management of Female Sexual Dysfunction: a Survey Among Resident Trainees in Psychiatry. Acad Psychiatry 2022; 46:347-351. [PMID: 34694591 DOI: 10.1007/s40596-021-01551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The authors examined the perceived barriers in the assessment and management of female sexual dysfunction among resident trainees in psychiatry. METHODS An online survey was conducted among 148 resident trainees in psychiatry at a tertiary academic psychiatry center in India. It consisted of nine items with responses rated on a Likert scale. The anonymity of the responses was maintained. RESULTS A total of 73 residents (49.3%) responded to the survey. Spontaneous reporting of sexual functioning, which is patient-driven, and spontaneous inquiry, which is resident-driven, were lacking. Specific barriers identified in the majority were lack of time, privacy, linguistic challenges, limited knowledge, and sociocultural background of the patient. The gender of the resident was not perceived as a major barrier in a majority. Marital discord appeared as a common response for inquiries into sexual functioning, while the use of psychotropics, the presence of medical comorbidities, and the postmenopausal state did not attract a majority to inquire about the same. Furthermore, a response that there was a lack of intervention in those reporting sexual dysfunction was commonly noted. Only 5.5% of the participants reported having received adequate formal training in the management of female sexual dysfunction. CONCLUSION Female sexual dysfunction is common, adds to psychiatric morbidity, and affects the quality of life. It is important to impart training on female sexual dysfunction as a part of their residency program with cultural appropriateness. A future direction would be to evaluate the effectiveness of a formal training program for assessing and managing female sexual dysfunction.
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Affiliation(s)
- Harshitha H A
- National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Bhavika Vajawat
- National Institute of Mental Health & Neurosciences, Bangalore, India.
| | - Debanjan Banerjee
- National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Geetha Desai
- National Institute of Mental Health & Neurosciences, Bangalore, India
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Tang L, Yang H, Mao Z, Li Q, Li S. The negative factors influencing the career intention of general practice trainees in eastern China: a qualitative study. BMC Med Educ 2022; 22:393. [PMID: 35597977 PMCID: PMC9124415 DOI: 10.1186/s12909-022-03456-x] [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: 07/01/2021] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND There is an acute shortage of general practitioners (GPs) in China, and GP trainees seem to be less willing to develop their career as a GP. This study aimed to investigate negative factors influencing the career intention of GPs in eastern China from the perspective of trainees taking standardized residency training, as to identify the barriers of GP trainees becoming registered GPs, and to provide a policy-making basis for GP recruitment and retention. METHODS A qualitative description design by the purposive sample was carried out in two training bases of Jinan and Qingdao in eastern China. Face-to-face, in-depth, semi-structured interviews were conducted, audiotaped, and transcribed using thematic analysis. RESULTS Twenty-one trainees participated in this study. Thematic analysis generated five major themes: (1) low social recognition, (2) low professional identity, (3) low remuneration level, (4) imperfect training system, and (5) influence of policy factors. CONCLUSIONS Our results identified various negative factors influencing the career intentions of trainees. In order to overcome the hurdles and increase the attractiveness of GP, it is recommended that the government and the public should create a supportive environment, which can be beneficial to the construction and development of GP.
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Affiliation(s)
- Lei Tang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 250012 Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, 250012 Jinan, China
- Center for Health Preference Research, Shandong University, 250012 Jinan, China
| | - Huan Yang
- Department of Human Resources, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, 322000 Yiwu, China
| | - Zhuxin Mao
- School of Public Administration, Southwestern University of Finance and Economics, 611130 Chengdu, China
| | - Quan Li
- Cheeloo College of Medicine, Shandong University, 250012 Jinan, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 250012 Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, 250012 Jinan, China
- Center for Health Preference Research, Shandong University, 250012 Jinan, China
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Higgins MC, Siddiqui AA, Kosowsky T, Unan L, Mete M, Rowe S, Marchalik D. Burnout, Professional Fulfillment, Intention to Leave, and Sleep-Related Impairment among Radiology Trainees across the United States (US): A Multisite Epidemiologic Study. Acad Radiol 2022; 29 Suppl 5:S118-S125. [PMID: 35241358 DOI: 10.1016/j.acra.2022.01.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine the prevalence of burnout among radiology trainees in the United States, and to study the relationships between burnout and professional fulfillment (PF), intent-to-leave (ITL), sleep-related impairment and self-compassion by gender. METHODS This cross-sectional study was conducted via an anonymous electronic survey sent to 11 large academic medical centers (Physician Wellness Academic Consortium) between January 2017 and September 2018. The survey included the Professional Fulfillment Index (PFI) and an abbreviated form of the PROMIS Sleep-related impairment (SRI) scale. Two-sample t-tests and chi-square exact tests were used for analysis (p < 0.05). RESULTS Two hundred forty-seven radiology residents responded to the survey. Out of these, 36.2% reported burnout, 37.4% endorsed PF, 64.8% reported sleep-related impairment, 7.6% expressed ITL. There were no significant differences between genders. Burnout was associated with reduced PF, increased sleep-impairment (p < 0.001 for both) and increased ITL (p = 0.02). Lower PF, peer support, perceived appreciation for and meaningfulness in work, alignment of organizational and personal values, self-compassion, and higher sleep impairment were associated with burnout (p < 0.001 for all). Burnout was associated with perceptions of less support from department leaders (p = 0.003), control over schedules (p = 0.001) and helpfulness of electronic health record systems (p = 0.01). ITL was associated with reduced PF, perceived work appreciation, and leadership support (p = 0.03, p = 0.04, and p = 0.007, respectively). DISCUSSION Burnout is prevalent among radiology residents. Many demonstrate sleep-impairment and reduced professional fulfillment, with a lesser fraction desiring to leave their institution. Key factors to burnout included peer and organizational support, electronic health record systems helpfulness, and personal factors like self-compassion and work appreciation.
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Cohrs S, Pehlke JR, Jordan W, Langosch JM, Kieser C, Pollmächer T. [Dramatic changes in the age structure for medical specialists in the field of mental health]. Nervenarzt 2022; 93:695-705. [PMID: 35254465 DOI: 10.1007/s00115-022-01268-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over the past 20 years the importance of treatment of people with mental and neurological disorders has greatly increased. Parallel to this development it has become more difficult to attract young physicians to this field. The aim of this study was to examine the development of the number of physicians specialized in the care of patients suffering from neurological, mental and psychosomatic disorders with special consideration of the age structure. MATERIAL AND METHODS The analyses were based on the number of professionally active physicians and specialized physicians published by the German Medical Association for the years 2000-2020. Separate age groups were looked at for psychiatry and psychotherapy (PPT), psychosomatic medicine and psychotherapy (PMPT), Nervenheilkunde (formerly psychiatry and neurology together, NHK) and neurology. RESULTS In comparison to the year 2000 the number of specialized physicians working in PPT (4736 vs. 12,053), neurology (2226 vs. 8355) and PMPT (3543 vs. 4130) increased in 2020, while the number of specialists actively working in NHK decreased (5184 vs. 2301). Parallel to this the proportion of women increased. Dramatic changes occurred concerning the age structure. Currently, 77.7% of specialists working in NHK and 59.7% working in PMPT are over 60 years old. In 2020 there were 2988 specialists aged over 60 years in the discipline of PPT compared to only 1070 under 40 years, which is dramatically different from 20 years earlier when only 181 were over 60 years but 1491 were under 40 years old. CONCLUSION The overaging of professional specialists and the shortage of junior physicians jeopardize modern and adequate provision of care for mentally ill patients. Possible solutions include a marked increase in medical school capacities as well as strategies to convince young physicians to work in the disciplines of PPT and PMPT.
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Affiliation(s)
- Stefan Cohrs
- Behandlungszentrum für Psychiatrie, Psychotherapie und Psychosomatik, Klinikum Reinkenheide gGmbH, Postbrookstr. 103, 27574, Bremerhaven, Deutschland.
| | - Jens Rainer Pehlke
- Behandlungszentrum für Psychiatrie, Psychotherapie und Psychosomatik, Klinikum Reinkenheide gGmbH, Postbrookstr. 103, 27574, Bremerhaven, Deutschland
- Arbeitsbereich Geschichte der Medizin, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Wolfgang Jordan
- Klinik für Psychiatrie und Psychotherapie, Klinikum Magdeburg gGmbH, Magdeburg, Deutschland
| | - Jens M Langosch
- Fachkrankenhaus für Psychiatrie, Psychosomatik und Psychotherapie, Ev. Krankenhaus, Bethanien, Greifswald, Deutschland
| | - Christian Kieser
- Klinik für Psychiatrie und Psychotherapie, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - Thomas Pollmächer
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt GmbH, Ingolstadt, Deutschland
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Lou SS, Liu H, Warner BC, Harford D, Lu C, Kannampallil T. Predicting physician burnout using clinical activity logs: Model performance and lessons learned. J Biomed Inform 2022; 127:104015. [PMID: 35134568 DOI: 10.1016/j.jbi.2022.104015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Burnout is a significant public health concern affecting more than half of the healthcare workforce; however, passive screening tools to detect burnout are lacking. We investigated the ability of machine learning (ML) techniques to identify burnout using passively collected electronic health record (EHR)-based audit log data. METHOD Physician trainees participated in a longitudinal study where they completed monthly burnout surveys and provided access to their EHR-based audit logs. Using the monthly burnout scores as the target outcome, we trained ML models using combinations of features derived from audit log data-aggregate measures of clinical workload, time series-based temporal measures of EHR use, and the baseline burnout score. Five ML models were constructed to predict burnout as a continuous score: penalized linear regression, support vector machine, neural network, random forest, and gradient boosting machine. RESULTS 88 trainee physicians participated and completed 416 surveys; greater than10 million audit log actions were collected (Mean [Standard Deviation] = 25,691 [14,331] actions per month, per physician). The workload feature set predicted burnout score with a mean absolute error (MAE) of 0.602 (95% Confidence Interval (CI), 0.412-0.826), and was able to predict burnout status with an average AUROC of 0.595 (95% CI 0.355-0.808) and average accuracy 0.567 (95% CI 0.393-0.742). The temporal feature set had a similar performance, with MAE 0.596 (95% CI 0.391-0.826), and AUROC 0.581 (95% CI 0.343-0.790). The addition of the baseline burnout score to the workload features improved the model performance to a mean AUROC of 0.829 (95% CI 0.607-0.996) and mean accuracy of 0.781 (95% CI 0.587-0.936); however, this performance was not meaningfully different than using the baseline burnout score alone. CONCLUSIONS Current findings illustrate the complexities of predicting burnout exclusively based on clinical work activities as captured in the EHR, highlighting its multi-factorial and individualized nature. Future prediction studies of burnout should account for individual factors (e.g., resilience, physiological measurements such as sleep) and associated system-level factors (e.g., leadership).
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Wilcox AR, Foster-Johnson L, Pinto-Powell R. The Effect of Implicit Bias and Role Misidentification in the Learning Environment. Med Sci Educ 2022; 32:31-37. [PMID: 35154892 PMCID: PMC8814075 DOI: 10.1007/s40670-021-01475-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Little is known about the impact of implicit bias our trainees experience in the form of role misidentification in the clinical learning environment. ACTIVITY We surveyed 540 residents and clinical medical students to determine the frequency and impact of role misidentification. RESULTS AND DISCUSSION Most respondents (85%, n = 162) experienced role misidentification, directly resulting in heightened emotions that led to guarded behavior. An additional indirect impact for trainees is transmitted through frequent non-promotional role misidentification and personalizing the incidents. Women and trainees with marginalized identities had significant impacts. These findings present an opportunity to improve our understanding of the trainee experience. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-021-01475-9.
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Affiliation(s)
| | - Lynn Foster-Johnson
- Department of Medical Education and The Dartmouth Institute at Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Hanover, USA
| | - Roshini Pinto-Powell
- Departments of Medicine and Medical Education at Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, 3 Rope Ferry Road, Hanover, NH 03756 USA
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Molinaro ML, Cheng A, Cristancho S, LaDonna K. Drawing on experience: exploring the pedagogical possibilities of using rich pictures in health professions education. Adv Health Sci Educ Theory Pract 2021; 26:1519-1535. [PMID: 34152494 DOI: 10.1007/s10459-021-10056-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/30/2020] [Accepted: 06/12/2021] [Indexed: 06/13/2023]
Abstract
In both clinical and health professions education research, rich pictures, or participant-generated drawings of complex phenomena, are gaining recognition as a useful method for exploring multifaceted and emotional topics in medicine. For instance, two recent studies used rich pictures to augment semi-structured interviews exploring trainees', health care professionals' (HCPs), and parents' experiences of difficult conversations in the Neonatal Intensive Care Unit (NICU)-an environment in which communication is often challenging, anxiety-provoking, and emotionally distressing. In both studies, participants were invited to draw a picture depicting how they experienced a difficult conversation in this setting. As part of the interview process, participants were asked to both describe how they engaged with rich pictures, and to share their perceptions about the affordances and limitations of this research method. Here, their perspectives are reported and the possibilities of using rich pictures to inform pedagogical innovations in health professions education and research are considered.
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Affiliation(s)
- Monica L Molinaro
- Health and Rehabilitation Sciences, University of Western Ontario, London, ON, Canada.
| | - Anita Cheng
- Department of Neonatal and Perinatal Medicine, London Health Sciences Centre, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Sayra Cristancho
- Department of Surgery, Faculty of Education, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Kori LaDonna
- Department of Innovation in Medical Education and Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Laupland KB, Edwards F, Dhanani J. Determinants of research productivity during postgraduate medical education: a structured review. BMC Med Educ 2021; 21:567. [PMID: 34753470 PMCID: PMC8579624 DOI: 10.1186/s12909-021-03010-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/01/2021] [Accepted: 10/29/2021] [Indexed: 05/28/2023]
Abstract
BACKGROUND Although formal participation in research is an integral and often mandatory component of clinical training programs, resulting productivity is highly variable. The objective of this review was to identify determinants of successful research performance among graduate medical education trainees. METHODS A structured review of the published literature was performed by searching PubMed, CINAHL, and EMBASE from inception through to 7 April, 2021. Articles examining graduate medical education trainee research productivity evidenced by publications in peer-reviewed journals were included. RESULTS Eighty-five articles were included of which most (66; 78%) were reported from the USA or Canada (10; 12%). A wide range of disciplines were represented with the most common being general surgery, internal medicine, orthopedic surgery, and pediatrics. Themes (number of reports) included trainee characteristics (n = 24), project characteristics (n = 8), mentoring/supervision (n = 11), and programmatic aspects (n = 57). Although variable results were observed, research productivity tended to be higher with prior research experience, later years of training, male gender, and pursuit of a postgraduate degree. Few project related aspects of success were identified. Trainee publication was associated with mentors with higher rank, publication productivity, and supportive academic environments. Training programs with organised programs/curricula including protection of time for research were associated with increased productivity as were provision of incentives or rewards but not mandatory requirements. CONCLUSION This review identifies several trainee characteristics, project and mentor aspects, and programmatic aspects associated with increased productivity that may serve as a useful resource for trainees and graduate medical education training programs.
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Affiliation(s)
- Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Level 3 Ned Hanlon Building, Butterfield Street, Brisbane, Queensland, 4029, Australia.
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
| | - Felicity Edwards
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Jayesh Dhanani
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Level 3 Ned Hanlon Building, Butterfield Street, Brisbane, Queensland, 4029, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Alhassan RK, Ayanore MA, Diekuu JB, Prempeh EBA, Donkor ES. Leveraging e-Learning technology to enhance pre-service training for healthcare trainees in Ghana: evidence from a pilot project and pointers to policy reforms. BMC Health Serv Res 2021; 21:1209. [PMID: 34749726 PMCID: PMC8574931 DOI: 10.1186/s12913-021-07224-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND E-Learning solutions are increasingly being advocated to augment existing traditional teaching and learning efforts in health training institutions. Unfortunately, these emerging technologies rarely focus on health sciences education within the context of public universities, hence the need for this study. This project evaluated experiences of healthcare trainees with a pilot e-Learning project (SMART e-Learning project) initiated in one of Ghana's public universities in 2017. The study used a mixed methods cross-sectional approach among 363 healthcare trainees. Data collection was between 17th October, 2019 to 3rd December, 2019. Data was analysed descriptively and test for variable differences done using Pearson Chi-square and Fisher's Exact for categorical variables. Wilcoxon Mann-Whitney test was used to test for differences in the Likert scale items. Additionally, rotated varimax factor analysis was performed for the health trainees' rated satisfaction factors. RESULTS Out of 446 respondents who consented to participate in the study, 363 responses were complete and valid, representing a response rate of 81 %. Most frequently used e-learning facilities by healthcare trainees were: writing interim assessments (IAs) (82 %) while the least used function was live chating with faculty (5 %). Challenges associated with the e-learning pilot project were: limited workspace in the pilot computer laboratory (33 %), slow internet/intranet speed (29 %) and limited capacity of teaching and ICT staff to support users (28 %). CONCLUSIONS There is the need to engage relevant stakeholders at the University, ministries of health and education through policy dialogues to develop statutory e-Learning guidelines for health educational institutions of higher learning to complement existing traditional teaching and learning approaches.
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Affiliation(s)
- Robert Kaba Alhassan
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana.
| | | | - John-Bosco Diekuu
- Information Communication Technology (ICT) Directorate, University of Health and Allied Sciences, Ho, Ghana
| | - Emmanuel B A Prempeh
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
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Luque-Luna M, Morgado-Carrasco D. Surgical Simulation and Digital Tools for Surgical Training During the COVID-19 Pandemic. Actas Dermosifiliogr 2021; 112:926-927. [PMID: 34658380 PMCID: PMC8500681 DOI: 10.1016/j.adengl.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/14/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- M Luque-Luna
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Balhatchet B, Schütze H, Williams N, Ashford B. Factors that impact burnout and psychological wellbeing in Australian postgraduate medical trainees: a systematic review protocol. Syst Rev 2021; 10:257. [PMID: 34560887 PMCID: PMC8464131 DOI: 10.1186/s13643-021-01809-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 09/05/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The stressful nature of medical training and other work-related factors put postgraduate medical trainees at high risk of burnout and poor psychological wellbeing. This has negative implications for patient care and the effectiveness of the healthcare system. The structure of the healthcare system and postgraduate medical education in Australia is different to that of other countries. Whilst a significant body of research exists on burnout and wellbeing in trainees in the USA, evidence specific to Australian trainees is lacking. The aim of this review is to synthesise the current knowledge on the factors that impact burnout and psychological wellbeing in Australian postgraduate medical trainees. METHODS/DESIGN A systematic review will be conducted across eight digital databases: Academic Search Complete, MEDLINE, Embase, Web of Science, PsychInfo, Scopus, CINAHL Plus and Informit Health Collection. Peer reviewed empirical studies and relevant grey literature published after 2000 that address an aspect of burnout or psychological wellbeing in Australian postgraduate medical trainees will be included. Two reviewers will independently review each article against the inclusion and exclusion criteria, with disagreements resolved via discussion and consensus. Data will be extracted using a standard form and quality will be assessed using the assessment tools available from the Joanna Briggs Institute. A thematic narrative synthesis of the studies will be presented, along with an assessment of current gaps in the literature and areas for future research. DISCUSSION This review will be the first to integrate the evidence on burnout and psychological wellbeing specific to Australian postgraduate medical trainees. The findings will contribute to a better understanding of the factors that impact burnout and psychological wellbeing in this population and will lay the foundation for future research into appropriate strategic interventions. SYSTEMATIC REVIEW REGISTRATION This protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020203195 ).
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Affiliation(s)
- Belinda Balhatchet
- University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia. .,Australian Orthopaedic Association, Level 26, 201 Kent St, Sydney, NSW, 2000, Australia. .,Australian National University, ACT, Canberra, 0200, Australia.
| | - Heike Schütze
- University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia.,UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Nicole Williams
- University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia.,Australian Orthopaedic Association, Level 26, 201 Kent St, Sydney, NSW, 2000, Australia.,University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia.,Women & Children's Hospital, 72 King William Rd, North Adelaide, SA, 5006, Australia
| | - Bruce Ashford
- University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia.,Illawarra Shoalhaven Local Health District, Warrawong, NSW, 2505, Australia
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Rose A, Aruparayil N. Postgraduate Surgical Training in the UK: the Trainees' Perspective. Indian J Surg 2021; 84:306-310. [PMID: 34539123 PMCID: PMC8435189 DOI: 10.1007/s12262-021-03112-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 11/06/2022] Open
Abstract
Over the last 20 years, surgical training in the United Kingdom (UK) has changed dramatically. There have been considerable efforts towards creating a programme that delivers the highest standard of training while maintaining patient safety. However, the journey to improve the quality of training has faced several hurdles and challenges. Recruitment processes, junior doctor contracts, flexible working hours and equality and diversity have all been under the spotlight in recent times. These issues, alongside the extended surgical team and the increasingly recognised importance of trainee wellbeing, mean that postgraduate surgical training is extremely topical. Alongside this, as technology has evolved, this has been incorporated into all aspects of training, from recruitment to simulated training opportunities and postgraduate examinations. The coronavirus (COVID-19) pandemic has brought technology and simulation to the forefront in an attempt to compensate for reduced operative exposure and experience, and has transformed the way that we learn and work. In this article, we reflect on the UK surgical trainee experience and discuss areas of success as well as highlighting potential areas for improvement going forward.
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Affiliation(s)
- Anna Rose
- Canniesburn Department of Plastic & Reconstructive Surgery, Glasgow Royal Infirmary, Glasgow, UK.,Association of Surgeons in Training, London, UK.,Global Anaesthesia Surgery and Obstetrics Collaboration, London, UK
| | - Noel Aruparayil
- Global Anaesthesia Surgery and Obstetrics Collaboration, London, UK.,Barnsley District General Hospital, Barnsley, UK
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Jepson M, Lazaroo M, Pathak S, Blencowe N, Collingwood J, Clout M, Toogood G, Blazeby J. Making large-scale surgical trials possible: collaboration and the role of surgical trainees. Trials 2021; 22:567. [PMID: 34446065 PMCID: PMC8390009 DOI: 10.1186/s13063-021-05536-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/11/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Recruitment to surgical randomised controlled trials (RCTs) can be challenging. The Sunflower study is a large-scale multi-centre RCT that seeks to establish the clinical and cost effectiveness of pre-operative imaging versus expectant management in patients with symptomatic gallstones undergoing laparoscopic cholecystectomy at low or moderate risk of common bile duct stones. Trials such as Sunflower, with a large recruitment target, rely on teamworking. Recruitment can be optimised by embedding a QuinteT Recruitment Intervention (QRI). Additionally, engaging surgical trainees can contribute to successful recruitment, and the NIHR Associate Principal Investigator (API) scheme provides a framework to acknowledge their contributions. METHODS This was a mixed-methods study that formed a component part of an embedded QRI for the Sunflower RCT. The aim of this study was to understand factors that supported and hindered the participation of surgical trainees in a large-scale RCT and their participation in the API scheme. It comprised semi-structured telephone interviews with consultant surgeons and surgical trainees involved in screening and recruitment of patients, and descriptive analysis of screening and recruitment data. Interviews were analysed thematically to explore the perspectives of-and roles undertaken by-surgical trainees. RESULTS Interviews were undertaken with 34 clinicians (17 consultant surgeons, 17 surgical trainees) from 22 UK hospital trusts. Surgical trainees contributed to patient screening, approaches and randomisation, with a major contribution to the randomisation of patients from acute admissions. They were often encouraged to participate in the study by their centre principal investigator, and career development was a typical motivating factor for their participation in the study. The study was registered with the API scheme, and a majority of the trainees interviewed (n = 14) were participating in the scheme. CONCLUSION Surgical trainees can contribute substantial activity to a large-scale multi-centre RCT. Benefits of trainee engagement were identified for trainees themselves, for local sites and for the study as a whole. The API scheme provided a formal framework to acknowledge engagement. Ensuring that training and support for trainees are provided by the trial team is key to optimise success for all stakeholders.
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Affiliation(s)
- Marcus Jepson
- grid.5337.20000 0004 1936 7603QuinteT Research Group, Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Michelle Lazaroo
- grid.5337.20000 0004 1936 7603Clinical Trials and Evaluation Unit, University of Bristol Faculty of Medical and Veterinary Sciences, Bristol, UK
| | - Samir Pathak
- grid.5337.20000 0004 1936 7603Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Natalie Blencowe
- grid.5337.20000 0004 1936 7603Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- grid.410421.20000 0004 0380 7336University Hospitals Bristol and Weston NHS Foundation Trust, Trust Headquarters, Marlborough St, Bristol, BS1 3NU UK
| | - Jane Collingwood
- grid.5337.20000 0004 1936 7603Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Madeleine Clout
- grid.5337.20000 0004 1936 7603Clinical Trials and Evaluation Unit, University of Bristol Faculty of Medical and Veterinary Sciences, Bristol, UK
| | - Giles Toogood
- grid.443984.6Department of Hepatobiliary and Transplantation Surgery, St James’s University Hospital, Leeds, LS9 7TF UK
| | - Jane Blazeby
- grid.5337.20000 0004 1936 7603NIHR Biomedical Research Centre Bristol, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
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Gauci MO, Chammas PE, Johnston TR, Chelli M, Chaoui J, de Casson FB, Blasco L, Boileau P. Simulation in shoulder arthroplasty education using three-dimensional planning software: the role of guidelines and predicted range of motion. Int Orthop 2021. [PMID: 34383105 DOI: 10.1007/s00264-021-05155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
AIM To demonstrate how reverse shoulder arthroplasty (RSA) planning software could be used to improve how the trainees position glenoid and humeral implants and obtain optimal simulated range of motion (ROM). METHODS We selected four groups of five various level participants: medical student (MS), junior resident (JR), senior resident (SR), and shoulder expert (SE). Thereafter, the 20 participants planned five cases of arthritic shoulders for a RSA on a validated planning software following three phases: (1) no guidelines and no ROM feedback, (2) guidelines but no ROM feedback, and (3) guidelines and ROM feedback. We evaluated the final simulated impingement-free ROM, the choice of the implant (baseplate size, graft, glenosphere), and the glenoid implant positioning. RESULTS MS planning were significantly improved by the ROM feedback only. JR took the best advantage of both guidelines and ROM in final results. SR planning were less performant than SE into phase 1 regarding flexion, external rotation, and adduction (respectively - 10°, p = 0.03; - 11°, p = 0.003; and - 3°, p = 0,03), but reached similar results into phase 3 (respectively - 2°, p = 0.329; - 4°, p = 0.44; - 2°, p = 0.319). For MS, JR, and SR, we observed a systematic improvement in the agreement over the study course. The glenoid diameter remained highly variable even for SE. Comparing glenoid implant position to SE, the distance error decreased with advancing phases. CONCLUSION Planning software can be used as a simulation training tool to improve implant positioning in shoulder arthroplasty procedures.
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Hervás C, Somovilla A, Gago-Veiga AB, Alonso J, Del Arco C, Vivancos J, Quintas S. Headache History-Taking in an Emergency Department: Impact Evaluation of a Training Session. Pain Med 2021; 22:1864-1869. [PMID: 33769531 DOI: 10.1093/pm/pnaa483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Headache represents about 25% of the total neurological consultations at the emergency department (ED). Up to 80% of these consultations are represented by primary headaches, in which an accurate and directed history-taking may help reach the specific diagnosis avoiding unnecessary complementary tests and reducing diagnostic latencies. METHODS We carried out a training session on headache management at the ED, focusing on history-taking and primary headaches' diagnoses and management. We retrospectively compared the number of variables included in the medical reports and the percentage of patients who were diagnosed and/or treated for a primary headache between two months before and two months after the training session. RESULTS A total of 369 medical histories were analyzed for this study (196 before and 173 after the training session). The number of essential variables regarding pain characteristics included in the medical reports showed a post-intervention increment from 4.34 ± 1.224 to 4.67 ± 1.079 (P = .007) and the number of total items registered also increased from 6.87 ± 1.982 to 7.53 ± 1.686 (P = 0.001). The percentage of patients that were given a specific diagnosis for primary headache showed an increment of 11.8% (P = .002) in the post-intervention group. CONCLUSION Educational interventions can improve history-taking in headache patients in the ED. This fact grants them as potential efficient measures to optimize patient management at Emergency Room.
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Affiliation(s)
- Carlos Hervás
- Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria, Madrid, Spain
| | - Alba Somovilla
- Neurology Department, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Beatriz Gago-Veiga
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - Jaime Alonso
- Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria, Madrid, Spain
| | - Carmen Del Arco
- Emergency Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Jose Vivancos
- Department of Neurology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria, Madrid, Spain
| | - Sonia Quintas
- Headache Unit, Department of Neurology, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
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Harpe JM, Safdieh JE, Broner S, Strong G, Robbins MS. The development of a diversity, equity, and inclusion committee in a neurology department and residency program. J Neurol Sci 2021; 428:117572. [PMID: 34265575 DOI: 10.1016/j.jns.2021.117572] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/27/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Diversity, Equity, and Inclusion (DEI) initiatives have been described in different academic and graduate medical education settings, but not specifically in neurology. OBJECTIVE To describe the development of a DEI committee within a neurology department and training program. METHODS The need to prioritize DEI as a critical focus within our neurology department led to the appointment of an initial task force who identified strategic priorities and stakeholders to establish a committee. DEI committee members included faculty, trainees, and staff, and this phase of the initiative took place from May 2019 through January 2021. RESULTS The DEI committee was established and has met monthly for over one year. Initial meetings formulated goals of the initiative. Specific objectives were developed in the domains of recruitment, education, engagement, training, conflict resolution, and recognition. Early outcomes included augmented resident recruitment efforts of UiM students, curriculum changes including frequent representation of DEI topics in Grand Rounds, and measures to reduce unconscious bias. CONCLUSIONS The creation of a DEI Committee within a specialty department such as neurology is feasible and can result in immediate and long-term actions related to recruitment and education in particular. Our blueprint that heavily involves graduate medical education stakeholders may be generalizable to other specialty departments in academic medicine.
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Affiliation(s)
- Jasmin M Harpe
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Joseph E Safdieh
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Susan Broner
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Greta Strong
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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Karia R, Miskry S, Fan K. Developing confidence in oral and maxillofacial dental core trainees: a national review of the trainee experience. Br J Oral Maxillofac Surg 2021:S0266-4356(21)00246-1. [PMID: 34670684 DOI: 10.1016/j.bjoms.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/23/2021] [Indexed: 11/22/2022]
Abstract
This study considers the confidence of dental core trainees (DCTs) as they mature and progress through their first six months in an oral and maxillofacial surgery (OMFS) training post. Trainees have different incentives for embarking on a year in OMFS: to develop additional skills before settling into general dental practice; as a step towards specialty training; and to help decide about their career direction. Traditionally, an OMFS year has been associated with creating well-rounded and confident clinicians. We surveyed 123 DCTs at three stages over a six-month period to monitor their confidence in 10 clinical domains: assessing dentofacial infection, mandibular fractures, midface fractures, intraoral/extraoral swellings, airway risks, intraoral/extraoral lesions (benign/malignant), CT/MRI scans, and performing intraoral/extraoral suturing. The study demonstrates an increase in trainee confidence across all domains over the first six months of an OMFS post, with a particularly significant increase in the assessment of dentofacial infection, mandibular/midface fracture, and both intraoral and extraoral lesions and swellings.
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Last K, Power NR, Dellière S, Velikov P, Šterbenc A, Antunovic IA, Lopes MJ, Schweitzer V, Barac A. Future developments in training. Clin Microbiol Infect 2021; 27:1595-1600. [PMID: 34197928 PMCID: PMC8280350 DOI: 10.1016/j.cmi.2021.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/16/2021] [Accepted: 06/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has demonstrated the value of highly skilled and extensively trained specialists in clinical microbiology (CM) and infectious diseases (ID). Training curricula in CM and ID must constantly evolve to prepare trainees for future pandemics and to allow trainees to reach their full clinical and academic potential. OBJECTIVES In this narrative review, we aim to outline necessary future adaptations in CM and ID training curricula and identify current structural barriers in training with the aim of discussing possibilities to address these shortcomings. SOURCES We reviewed literature from PubMed and included selected books and online publications as appropriate. There was no time constraint on the included publications. CONTENT Drawing from the lessons learnt during the pandemic, we summarize novel digital technologies relevant to CM and ID trainees and highlight interdisciplinary teamwork and networking skills as important competencies. We centre CM and ID training within the One Health framework and discuss gender inequalities and structural racism as barriers in both CM and ID training and patient care. IMPLICATIONS CM and ID trainees should receive training and support developing skills in novel digital technologies, leadership, interdisciplinary teamwork and networking. Equally important is the need for equity of opportunity, with firm commitments to end gender inequality and structural racism in CM and ID. Policy-makers and CM and ID societies should ensure that trainees are better equipped to achieve their professional goals and are better prepared for the challenges awaiting in their fields.
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Affiliation(s)
- Katharina Last
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany.
| | - Nicholas R Power
- Royal College of Physicians of Ireland, Setanta House, 1 Setanta Pl, Dublin 2, Ireland
| | - Sarah Dellière
- Université de Paris, Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Petar Velikov
- Infectious Diseases Hospital Prof. Ivan Kirov and Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Anja Šterbenc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ivana Antal Antunovic
- Department of Clinical Microbiology, University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Maria João Lopes
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Valentijn Schweitzer
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
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Saeed F, Duberstein PR, Epstein RM, Lang VJ, Liebman SE. Frequency and Severity of Moral Distress in Nephrology Fellows: A National Survey. Am J Nephrol 2021; 52:487-495. [PMID: 34153971 PMCID: PMC10073901 DOI: 10.1159/000516575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/02/2021] [Accepted: 04/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Moral distress is a negative affective response to a situation in which one is compelled to act in a way that conflicts with one's values. Little is known about the workplace scenarios that elicit moral distress in nephrology fellows. METHODS We sent a moral distress survey to 148 nephrology fellowship directors with a request to forward it to their fellows. Using a 5-point (0-4) scale, fellows rated both the frequency (never to very frequently) and severity (not at all disturbing to very disturbing) of commonly encountered workplace scenarios. Ratings of ≥3 were used to define "frequent" and "moderate-to-severe" moral distress. RESULTS The survey was forwarded by 64 fellowship directors to 386 fellows, 142 of whom (37%) responded. Their mean age was 33 ± 3.6 years and 43% were female. The scenarios that most commonly elicited moderate to severe moral distress were initiating dialysis in situations that the fellow considered futile (77%), continuing dialysis in a hopelessly ill patient (81%) and carrying a high patient census (75%), and observing other providers giving overly optimistic descriptions of the benefits of dialysis (64%). Approximately 27% had considered quitting fellowship during training, including 9% at the time of survey completion. CONCLUSION A substantial majority of nephrology trainees experienced moral distress of moderate to severe intensity, mainly related to the futile treatment of hopelessly ill patients. Efforts to reduce moral distress in trainees are required.
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Affiliation(s)
- Fahad Saeed
- Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Department of Public Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Paul R. Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Ronald M. Epstein
- Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
- Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Valerie J Lang
- Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Division of Hospital Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Scott E. Liebman
- Division of Nephrology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Khan A, Mao JZ, Soliman MAR, Rho K, Hess RM, Reynolds RM, Riley JP, Mullin JP, Siddiqui AH, Levy EI, Pollina J. The effect of COVID-19 on trainee operative experience at a multihospital academic neurosurgical practice: A first look at case numbers. Surg Neurol Int 2021; 12:271. [PMID: 34221602 PMCID: PMC8248555 DOI: 10.25259/sni_240_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/16/2021] [Indexed: 11/04/2022] Open
Abstract
Background COVID-19 has had a significant impact on the economy, health care, and society as a whole. To prevent the spread of infection, local governments across the United States issued mandatory lockdowns and stay-at-home orders. In the surgical world, elective cases ceased to help "flatten the curve" and prevent the infection from spreading to hospital staff and patients. We explored the effect of the cancellation of these procedures on trainee operative experience at our high-volume, multihospital neurosurgical practice. Methods Our department cancelled all elective cases starting March 16, 2020, and resumed elective surgical and endovascular procedures on May 11, 2020. We retrospectively reviewed case volumes for 54 days prelockdown and 54 days postlockdown to evaluate the extent of the decrease in surgical volume at our institution. Procedure data were collected and then divided into cranial, spine, functional, peripheral nerve, pediatrics, and endovascular categories. Results Mean total cases per day in the prelockdown group were 12.26 ± 7.7, whereas in the postlockdown group, this dropped to 7.78 ± 5.5 (P = 0.01). In the spine category, mean cases per day in the prelockdown group were 3.13 ± 2.63; in the postlockdown group, this dropped to 0.96 ± 1.36 (P < 0.001). In the functional category, mean cases per day in the prelockdown group were 1.31 ± 1.51, whereas in the postlockdown group, this dropped to 0.11 ± 0.42 (P < 0.001). For cranial (P = 0.245), peripheral nerve (P = 0.16), pediatrics (P = 0.34), and endovascular (P = 0.48) cases, the volumes dropped but were not statistically significant decreases. Conclusion The impact of this outbreak on operative training does appear to be significant based solely on statistics. Although the drop in case volumes during this time can be accounted for by the pandemic, it is important to understand that this is a multifactorial effect. Further studies are needed for these results to be generalizable and to fully understand the effect this pandemic has had on trainee operative experience.
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Affiliation(s)
- Asham Khan
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Jennifer Z Mao
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Mohamed A R Soliman
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States.,Department of Neurosurgery, Cairo University, Cairo, Egypt
| | - Kyungduk Rho
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Ryan M Hess
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Renée M Reynolds
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Jonathan P Riley
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Jeffrey P Mullin
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
| | - John Pollina
- Department of Neurosurgery, University at Buffalo, Buffalo, New York, United States
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Qayyum Z, AhnAllen CG, Van Schalkwyk GI, Luff D. "You Really Never Forget It!" Psychiatry Trainee Supervision Needs and Supervisor Experiences Following the Suicide of a Patient. Acad Psychiatry 2021; 45:279-287. [PMID: 33575964 DOI: 10.1007/s40596-020-01394-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Suicide is the second leading cause of death in children, adolescents, and young adults ages 10-34 and the rates continue to rise in the USA. An estimated 30-60% of Psychiatry Residents experience patient suicide during their training. This study aimed to understand trainee and supervisor experiences after the suicide of a patient in order to better inform the supervision and response to such an event. METHOD Twenty-seven participants were identified by criterion sampling and recruited from General Psychiatry residency, Consultation Liaison fellowship, and Child and Adolescent Psychiatry fellowship training programs in the New England region of the USA. Semi-structured interviews of trainees and supervisors were conducted and analyzed using inductive thematic analysis. RESULTS The death of a patient by suicide was described as a notable event with a significant impact on the professional lives of the participants. The event was typically characterized as having an immediate emotional impact, led to changes in self-efficacy, and a sense of responsibility for the patient's death. Responses to suicide were influenced by modifiable factors such as (1) unpreparedness of individuals, program, and institution and (2) mediating/complicating factors, including the credibility of the supervisor, societal expectations, and specific patient characteristics. CONCLUSIONS The death of a patient is a personal and emotional experience for the psychiatrist, for which they do not consistently feel well prepared. The institutional response may be misaligned, more analytical in character and prioritize assessment of risk. There is significant room to improve supervision and preparedness for the death of a patient by suicide.
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Anderson DR, Blissett S, O'Sullivan P, Qasim A. Differences in echocardiography interpretation techniques among trainees and expert readers. J Echocardiogr 2021. [PMID: 34050902 DOI: 10.1007/s12574-021-00531-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/23/2021] [Accepted: 05/10/2021] [Indexed: 11/08/2022]
Abstract
Background Trainees learn transthoracic echocardiogram (TTE) interpretation through independently completing and reviewing selected portions of the study with experts. The diagnostic accuracy of novice TTE interpretation is known to be low and schema for reading TTEs systematically are lacking. The purpose of our study is to identify techniques experts use while reading TTEs which could be used to more effectively teach novice readers. Methods We performed a prospective qualitative case study to observe how experts and trainees interpret TTEs in an academic institution using a concurrent think aloud (CTA) method. Three TTEs of intermediate complexity were given to 3 advanced imaging fellows, 3 first year fellows and 3 expert TTE readers Participants filled out a report while reading and described aloud their thought processes. Sessions were video and audiotaped for analysis. Results Experts and advanced fellows used specific techniques that novices did not including: previewing studies, reviewing multiple images simultaneously, having flexibility in image review order and disease coding, and saving hardest elements to code for the end. Direct observation of TTE reading informed trainee inefficiencies and was a well-received educational tool. Conclusions In this single centered study we identified several unique approaches experts use to interpret TTEs which may be teachable to novices. Although limited in generalizability the findings of this study suggests that a more systematic approach to TTE interpretation, using techniques found in experts, might be of significant value for trainees. Further study is needed to evaluate teaching practices at other institutions and to assess whether implementation of these techniques by novices improves can improve their diagnostic accuracy and efficiency of reading at an earlier stage in their training.
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Mahmood K, Wahidi MM, Shepherd RW, Argento AC, Yarmus LB, Lee H, Shojaee S, Berkowitz DM, Van Nostrand K, Lamb CR, Shofer SL, Gao J, Davoudi M. Variable Learning Curve of Basic Rigid Bronchoscopy in Trainees. Respiration 2021; 100:530-537. [PMID: 33849039 DOI: 10.1159/000514627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite increased use of rigid bronchoscopy (RB) for therapeutic indications and recommendations from professional societies to use performance-based competency, an assessment tool has not been utilized to measure the competency of trainees to perform RB in clinical settings. OBJECTIVES The aim of the study was to evaluate a previously developed assessment tool - Rigid Bronchoscopy Tool for Assessment of Skills and Competence (RIGID-TASC) - for determining the RB learning curve of interventional pulmonary (IP) trainees in the clinical setting and explore the variability of learning curve of trainees. METHODS IP fellows at 4 institutions were enrolled. After preclinical simulation training, all RBs performed in patients were scored by faculty using RIGID-TASC until competency threshold was achieved. Competency threshold was defined as unassisted RB intubation and navigation through the central airways on 3 consecutive patients at the first attempt with a minimum score of 89. A regression-based model was devised to construct and compare the learning curves. RESULTS Twelve IP fellows performed 178 RBs. Trainees reached the competency threshold between 5 and 24 RBs, with a median of 15 RBs (95% CI, 6-21). There were differences among trainees in learning curve parameters including starting point, slope, and inflection point, as demonstrated by the curve-fitting model. Subtasks that required the highest number of procedures (median = 10) to gain competency included ability to intubate at the first attempt and intubation time of <60 s. CONCLUSIONS Trainees acquire RB skills at a variable pace, and RIGID-TASC can be used to assess learning curve of IP trainees in clinical settings.
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Affiliation(s)
- Kamran Mahmood
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, North Carolina, USA
| | - Momen M Wahidi
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, North Carolina, USA
| | | | - A Christine Argento
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lonny B Yarmus
- Department of Medicine, Interventional Pulmonology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hans Lee
- Department of Medicine, Interventional Pulmonology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Samira Shojaee
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - David M Berkowitz
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Keriann Van Nostrand
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Carla R Lamb
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Scott L Shofer
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, North Carolina, USA
| | - Junheng Gao
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Mohsen Davoudi
- Beckman Laser Institute, Division of Pulmonary and Critical Care Medicine, University of California Irvine, Irvine, California, USA
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Bono LK, Haverkamp CR, Lindsey RA, Freedman RN, McClain MB, Simonsmeier V. Assessing Interdisciplinary Trainees' Objective and Self-Reported Knowledge of Autism Spectrum Disorder and Confidence in Providing Services. J Autism Dev Disord 2021; 52:376-391. [PMID: 33725234 DOI: 10.1007/s10803-021-04948-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
The importance of accurate identification and high-quality intervention for individuals with autism spectrum disorder (ASD) is indisputable. Clinicians from multiple professions need adequate knowledge of ASD to make appropriate referrals to specialists, conduct thorough evaluations, and provide effective interventions. ASD knowledge development for many professionals may start at the pre-service training level. An interdisciplinary sample consisting of trainees from Leadership Education in Neurodevelopmental and Related Disabilities (LEND) programs and University Centers for Excellence in Developmental Disabilities (UCEDDs) across the country (N = 155) was evaluated on their objectively measured ASD knowledge using the ASKSP-R. Self-reported knowledge of ASD and self-reported confidence in providing services to individuals who have ASD was evaluated using a 0-100 scale. Results from an ANOVA demonstrated a significant difference in objectively measured knowledge across disciplines, F(7, 146) = 4.68, p < .001. Specifically, trainees in psychology had significantly higher levels of objectively measured ASD knowledge than trainees in physical/occupational therapy, social work, and non-clinical disciplines. Pre-service and professional development experiences predicted trainees' objectively measured ASD knowledge, self-reported ASD knowledge, and self-reported confidence. Implications and recommendations regarding interdisciplinary training to improve outcomes for individuals with ASD are discussed.
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Affiliation(s)
- Leciel K Bono
- Department of Dental Hygiene, Idaho State University, 921 S. 8th Ave. Stop 8048, Pocatello, ID, 83209, USA.
| | - Cassity R Haverkamp
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT, 84322-2810, USA
| | - Rebecca A Lindsey
- Department of Psychology, Washington State University, Johnson Tower 233, PO Box 644820, Pullman, WA, 99164-4820, USA
| | - Rachel N Freedman
- Idaho Center on Disabilities and Human Development, University of Idaho, 1187 Alturas Drive, Moscow, ID, 83843-8331, USA
| | - Maryellen Brunson McClain
- School of Psychology, Utah State University, 2810 Old Main Hill EDUC 488, Logan, UT, 84322-2810, USA
| | - Vicki Simonsmeier
- Sorenson Legacy Foundation Center for Clinical Excellence 496, Utah State University, 6405 Main Hill, Logan, UT, 84322-6405, USA
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Kana LA, Firn JI, Shuman AG, Hogikyan ND. Patient Perceptions of Trust in Trainees During Delivery of Surgical Care: A Thematic Analysis. J Surg Educ 2021; 78:462-468. [PMID: 32888849 DOI: 10.1016/j.jsurg.2020.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/09/2020] [Accepted: 08/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Trust is an essential element of an effective physician-patient relationship. There is limited literature examining trust between trainees and patients in the surgical setting. The goal of this study was to investigate how otolaryngology patients perceive trust in trainees during delivery of surgical care. DESIGN We extracted trainee-specific data from a larger, qualitative interview study examining trust in the surgeon-patient relationship. We then used realist thematic analysis to explore preoperative otolaryngology patients' perceptions of trust in trainees during delivery of surgical care. SETTING Department of Otolaryngology-Head and Neck Surgery at Michigan Medicine in Ann Arbor, MI, a tertiary academic medical center. PARTICIPANTS Using convenience sampling, adults 18 years or older scheduled to undergo elective otolaryngologic surgery between February and June 2019 were invited, and 12 agreed to participate in the study. RESULTS All participants (n = 12) self-identified as White/Caucasian with a mean age of 60 years (range, 28-82). Participants were 50% (n = 6) female and 50% (n = 6) male. Thematic analysis of participants' perspectives about trust in trainees during delivery of surgical care revealed 3 themes. Trust in trainees is conditional based on (i) level of trainee involvement; (ii) trust in the attending surgeon; and, (iii) trust in the institution. CONCLUSION Trust in trainees during delivery of surgical care is conditional on types of tasks trainees perform, bounded by trust in their attending surgeon, and positively influenced by institutional trust. Trainees and surgical educators must look to innovative methods to engender trust more efficiently in the clinic and immediate pre-operative setting. Such approaches can have a positive impact on patient outcomes, facilitate stronger trainee-attending interpersonal relationships, and empower surgeons to practice the professional values integral to surgical care.
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Affiliation(s)
- Lulia A Kana
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Janice I Firn
- University of Michigan Medical School, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan; Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrew G Shuman
- University of Michigan Medical School, Ann Arbor, Michigan; Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Norman D Hogikyan
- University of Michigan Medical School, Ann Arbor, Michigan; Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan.
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Luque-Luna M, Morgado-Carrasco D. RF-Surgical Simulation and Digital Tools for Surgical Training During the COVID-19 Pandemic. Actas Dermosifiliogr (Engl Ed) 2021; 112:S0001-7310(21)00099-5. [PMID: 33652008 PMCID: PMC7910661 DOI: 10.1016/j.ad.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/14/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- M Luque-Luna
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España.
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Jefferson IS, Robinson SK, Surprenant D, Whittington A, Arshanapalli A, Tung-Hahn E, Joyce C, Moy L, Lee K, O'Brien E, Tung R, Alam M. Surgical training tools for dermatology trainees: porcine vs. synthetic skin for excision and repair. Arch Dermatol Res 2021; 313:793-797. [PMID: 33433713 DOI: 10.1007/s00403-020-02181-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022]
Abstract
Since dermatologists routinely perform surgery in an outpatient setting, ensuring that dermatology trainees are provided with opportunities to develop sufficient proficiency in excisional surgery and suture technique is paramount. The objectives of this study are to assess trainee preference for silicone-based synthetic skin compared with porcine skin as a surgical training medium and to assess the ability of trainees to successfully demonstrate basic surgical skills using the simulated skin model. Participants were a convenience sample of dermatology residents from the greater Chicago area, who were asked to perform an elliptical excision and bilayered repair on a silicone-based synthetic skin model. Residents were then surveyed regarding their satisfaction with the model. Four blinded dermatologist raters evaluated digital photographs obtained during the performance of the procedures and graded the execution of each maneuver using a surgical task checklist. Nineteen residents were enrolled. Residents were more likely to prefer pig skin to simulated skin for overall use (p = 0.040) and tissue repair (p = 0.018), but the nominal preference for tissue handling was nonsignificant (p = 0.086). There was no significant difference between satisfaction with pig skin versus synthetic skin with regard to excision experience (p = 0.82). The majority of residents (10/19) performed all surgical checklist tasks correctly. Of those residents who did not perform all steps correctly, many had difficulty obtaining adequate dermal eversion and wound approximation. Synthetic skin may be conveniently and safely utilized for hands-on surgical practice. Further refinement may be necessary to make synthetic skin comparable in feel and use to animal skin.
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Affiliation(s)
- Itisha S Jefferson
- Stritch School of Medicine, Loyola University, Maywood, IL, USA.
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA.
| | - Shamika Kayo Robinson
- Stritch School of Medicine, Loyola University, Maywood, IL, USA
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
| | - David Surprenant
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
| | - Adam Whittington
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
- Division of Dermatology, Advocate Aurora Health, Fond du Lac, WI, USA
| | - Ashish Arshanapalli
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
- United Dermatology Associates, Mansfield, TX, USA
| | - Eleanor Tung-Hahn
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Cara Joyce
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
- Department of Statistics, Loyola University Medical Center, Maywood, IL, USA
| | - Lauren Moy
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
| | - Kristin Lee
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
| | - Ellie O'Brien
- Northwestern Simulation Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rebecca Tung
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
- Florida Dermatology and Skin Cancer Centers, Winter Haven, FL, USA
| | - Murad Alam
- Departments of Dermatology, Otolaryngology and Surgery, Feinberg School of Medicine, Northwestern University, 676 N St Clair Suite 1600, Chicago, IL, 60611, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Khan MJ, Zaghw A, Tageldin T, Elarref M. Advanced Anesthesiology and Perioperative Medicine (AAPM) Fellowship Program in Hamad Medical Corporation during COVID-19 Pandemic: Adapting and Redesigning the Fellowship Program. MedEdPublish (2016) 2021; 10:5. [PMID: 38486546 PMCID: PMC10939612 DOI: 10.15694/mep.2021.000005.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Health care systems, as well as graduate medical education and training, have experienced unprecedented disruption due to the COVID-19 pandemic. Many academic medical institutions have adopted innovative strategies, technology, and dramatic transformation to continuously provide education and training to physicians in training while providing utmost and urgent care to the growing number of COVID-19 patients. Furthermore, medical societies have prioritized personal well-being, flexibility, and support for the trainees. Herein, we share the experience, lesson learned, practical guidance, and highlight the challenges faced by the program director and fellows of the advanced anesthesiology fellowship program at Hamad Medical Corporation.
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