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Mahamid, Mochammad Nginwanun Likullil, and Marjoko Santoso. "Transition in Building Function of the Former Official Residences for Residents and Resident Assistants from the Dutch Colonial Heritage of the 19-20th Century in Madiun Raya." JUSPI (Jurnal Sejarah Peradaban Islam) 7, no. 1 (July 19, 2023): 82. http://dx.doi.org/10.30829/juspi.v7i1.15928.
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<em>Resident and resident assistants</em><strong> </strong><em>are designations for colonial officials assigned to assist the Governor-general of the Dutch East Indies in the administrative area of the residency level. This research aims to trace the existence of Dutch colonial heritage buildings in the administrative area of the Madiun Residency, now termed Madiun Raya, consisting of Madiun, Ponorogo, Pacitan, Ngawi, and Magetan. This research is obtained through a unit analysis research with the main subject being Dutch colonial buildings and a historical approach. The stages are heuristics (gathering sources), source criticism, interpretation, and historical writing. This research results in four findings in the form of official residences for Residents and Resident Assistants who have ruled Madiun Raya from 1830 to 1942, including the official residence of Madiun Resident, official residence of Ponorogo Resident Assistant, official residence of Pacitan Resident Assistant, and official residence of Ngawi Resident Assistant. Then, it explains the transition function of the four buildings in the present.</em>
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Azevedo, Patrícia Anjos. "Critério da Residência das Pessoas Singulares Enquanto Fator de Conexão para Efeitos de Tributação." Revista de Ciências Jurídicas e Empresariais 18, no. 1 (November 3, 2017): 11–15. http://dx.doi.org/10.17921/2448-2129.2017v18n1p11-15.
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O critério da residência determina que a tributação do rendimento deverá ser levado a cabo, independentemente do local da fonte de tal rendimento. A condição de residente supõe a presença (real ou presumida) no território de um determinado local. Os Estados, com vista à legitimação da tributação, com base no critério da residência, costumam se basear no fato de que os contribuintes deverão contribuir para a obtenção de receitas, por parte do Estado, no qual são considerados residentes, o que se verifica em virtude de uma conexão de natureza pessoal. O critério da residência se materializa em uma tributação universal ou ilimitada, já que o Estado da residência tem o direito de tributar os rendimentos obtidos pelos seus residentes, independentemente do local de onde sejam originários. Ora, a tributação de acordo com o critério da residência é uma construção, que permite tributar o rendimento dos contribuintes considerados residentes em determinada jurisdição, independentemente do local da sua obtenção. Todavia, quer o direito fiscal da União Europeia (através de diretivas), quer as Convenções de Dupla Tributação, remetem a definição de residente para os diferentes ordenamentos jurídicos, não existindo assim um conceito de residente autonomamente considerado. O problema é que, não sendo uniformes os critérios utilizados para determinar a residência, é possível que um contribuinte seja considerado residente em mais de um Estado, o que se traduz em um conflito positivo de residência. Palavras-chave: Direito Fiscal da União Europeia. Convenções de Dupla Tributação. Conflito Positivo de Residência.AbstractThe residence criterion determines that income taxation must be carried out irrespective of the place of source of such income. The resident status assumes the presence (real or presumed) in a certain territory. The States, with a view to legitimizing taxation on the basis of the criterion of residence, usually base it on the fact that taxpayers are expected to contribute towards obtaining income from the State in which they are considered residents, which is due to a connection of a personal nature. The residence criterion brings a universal or unlimited taxation, since the State of residence has the right to tax the income obtained by its residents, irrespective of the place of origin. However, taxation according to the residence criterion is a construction which allows taxation of taxpayers’ income who are resident in a particular jurisdiction, irrespective of the place where they are obtained. But, both the European Union tax law (through directives) and the Double Taxation Conventions refer to the domestic definition of resident of different legal systems, so, there is no autonomous concept of resident. The problem is that, since the criteria used to determine residence are not uniform, it is possible for a taxpayer to be considered as resident in more than one State, which results in a positive tax conflict of residence.Keywords: Tax Law of the European Union. Double Taxation Conventions. Positive Tax Conflict of Residence.
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Starosta, Kaitlin, Susan L. Davis, Rachel M. Kenney, Michael Peters, Long To, and James S. Kalus. "Creating objective and measurable postgraduate year 1 residency graduation requirements." American Journal of Health-System Pharmacy 74, no. 6 (March 15, 2017): 389–96. http://dx.doi.org/10.2146/ajhp160138.
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Abstract Purpose The process of developing objective and measurable postgraduate year 1 (PGY1) residency graduation requirements and a progress tracking system is described. Summary The PGY1 residency accreditation standard requires that programs establish criteria that must be met by residents for successful completion of the program (i.e., graduation requirements), which should presumably be aligned with helping residents to achieve the purpose of residency training. In addition, programs must track a resident’s progress toward fulfillment of residency goals and objectives. Defining graduation requirements and establishing the process for tracking residents’ progress are left up to the discretion of the residency program. To help standardize resident performance assessments, leaders of an academic medical center–based PGY1 residency program developed graduation requirement criteria that are objective, measurable, and linked back to residency goals and objectives. A system for tracking resident progress relative to quarterly progress targets was instituted. Leaders also developed a focused, on-the-spot skills assessment termed “the Thunderdome,” which was designed for objective evaluation of direct patient care skills. Quarterly data on residents’ progress are used to update and customize each resident’s training plan. Implementation of this system allowed seamless linkage of the training plan, the progress tracking system, and the specified graduation requirement criteria. Conclusion PGY1 residency requirements that are objective, that are measurable, and that attempt to identify what skills the resident must demonstrate in order to graduate from the program were developed for use in our residency program. A system for tracking the residents’ progress by comparing residents’ performance to predetermined quarterly benchmarks was developed.
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Woods, Suzanne K., Leigh Burgess, Catherine Kaminetzky, Diana McNeill, Sandro Pinheiro, and Mitchell T. Heflin. "Defining the Roles of Advisors and Mentors in Postgraduate Medical Education: Faculty Perceptions, Roles, Responsibilities, and Resource Needs." Journal of Graduate Medical Education 2, no. 2 (June 1, 2010): 195–200. http://dx.doi.org/10.4300/jgme-d-09-00089.1.
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Abstract Background Residency program directors rely on an informal network of faculty mentors to provide guidance for residents. Faced with increasingly sophisticated competency-based evaluation systems and scrutiny of patient safety and resident well-being in today's environment, residency programs need more structured mechanisms for mentoring. Objective To clarify the role of resident advisors and mentors so that residents receive the right combination of direction and oversight to ensure their successful transition to the next phase of their careers. Methods The Duke Internal Medicine Residency Program undertook a formal assessment of the roles, responsibilities, and resource needs of its key faculty through a focus group made up of key faculty. A follow-up focus group of residents and chief residents was held to validate the results of the faculty group assessment. Results The distinction between advising and mentoring was our important discovery and is supported by literature that identifies that mentors and advisors differ in multiple ways. A mentor is often selected to match resources and expertise with a resident's needs or professional interests. An advisor is assigned with a role to counsel and guide the resident through the residency processes, procedures, and key learning milestones. Conclusion The difference between the role of advisor and that of mentor is of critical importance and allowed for the evolution of faculty participants' role as resident advisors, including the formulation of expectations for advisors, and the creation of an advisor toolkit. Our modifiable toolkit can enhance the advising process for residents in many disciplines. We saw an improvement in resident satisfaction from 2006 to 2009.
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Cruz, Maria Lourdes Carmela, Joshua B. Utay, and Ashley H. Mullen. "Entrustment trends in orthotic and prosthetic residencies." Prosthetics and Orthotics International 44, no. 2 (March 5, 2020): 73–80. http://dx.doi.org/10.1177/0309364620909236.
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Background: Orthotic and prosthetic residency preceptors have little guidance transitioning residents between observing and performing patient care. Understanding current entrustment trends and factors can help guide resident progression during residency. Objectives: To identify entrustment trends and factors within an orthotics and prosthetics residency affecting a supervisor’s decision to entrust residents with independent patient care. Study design: Cross-sectional study Methods: In this cross-sectional study, 831 National Commission of Orthotic and Prosthetic Education preceptors were invited to complete a 26-question, online questionnaire that examined possible entrustment factors. Results: A total of 77 preceptors completed the questionnaire. The top-reported behavioral qualities impacting entrustment were recognition of limitations and willingness to ask for help ( n = 45) and competence ( n = 37). Preceptors ranked evaluation ( n = 27) as the professional skill which most affected entrustability; technical skill least affected entrustability ( n = 4). Preceptors of 12-month residencies entrust residents to indirect supervision when they have completed approximately 75% (i.e. 9 months) of the program. Preceptors of 18-month residencies reported that they entrust their residents by the time they reach 50% (i.e. 9 months) of their training. A small number of preceptors ( n = 19) never allow a resident to independently perform practice management. Conclusion: Residency supervisors value interpersonal and evaluation skills when making entrustment decisions. Residency mentors can use these findings to inform their entrustment decisions and support a resident’s progression toward independent practice. Clinical relevance This study presents information which can inform clinical preceptors and residents on what factors contribute to the decision to progress a resident from observation to independent patient care. These findings may influence clinical education standards which aim to promote both resident training and patient access to quality care.
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Brown, Jamie N., Kelsey A. Tiemann, and Jared L. Ostroff. "Description of a Medical Writing Rotation for a Postgraduate Pharmacy Residency Program." Journal of Pharmacy Practice 27, no. 2 (December 27, 2013): 169–73. http://dx.doi.org/10.1177/0897190013516366.
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Purpose: To provide a description of a pharmacy residency rotation dedicated to medical writing developed at a tertiary care academic medical center. Summary: Contribution to the medical literature is an important component of professional pharmacy practice, and there are many benefits seen by practitioners actively involved in scholarly activities. Residency programs have an opportunity to expand beyond the standard roles of postgraduate pharmacist training but rarely is there formal instruction on medical writing skills or are scholarship opportunities provided to residents. In order to address this deficiency, a residency program may consider the implementation of a formal Medical Writing rotation. This rotation is designed to introduce the resident to medical writing through active discussion on medical writing foundational topics, engage the resident in a collaborative review of a manuscript submitted to a peer-reviewed professional journal, and support the resident in the design and composition of manuscript of publishable quality. Conclusion: A structured Medical Writing rotation during a pharmacy resident’s training can help develop the skills necessary to promote scholarly activities and foster resident interest in future pursuit of professional medical writing.
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Rowe, Katherine A., Alexander Carbo, Joel T. Katz, and Lisa Rotenstein. "Customised knowledge-sharing platform to foster resident quality improvement activities, tracking and scholarship." BMJ Open Quality 13, no. 1 (February 2024): e002428. http://dx.doi.org/10.1136/bmjoq-2023-002428.
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IntroductionMeeting accreditation requirements to train resident physicians in quality improvement (QI) may require more than education. Barriers to resident QI engagement underscore the need to demonstrate the impact and value of resident QI work. It is not known whether a platform to track and publicise resident QI projects and scholarship is feasible or acceptable to implement within a residency programme. We aimed to create a searchable online platform and associated programming to promote resident QI work.MethodsThis intervention targeted resident physicians in an internal medicine residency training programme at a tertiary, academic medical centre. We designed an intervention to track resident QI and related scholarship in a searchable online platform, including practical details of implementing each project. Newsletters and events were used to publicise these project profiles.ResultsDuring the 2020–2021 academic year, 104 projects were profiled from 238 sourced projects. Average readership was 31.5% across 11 newsletters sent to residents and key faculty.DiscussionA platform to track and share resident QI work and scholarship can be feasibly and acceptably implemented within a residency programme, serving as a novel way to engage residents around QI.
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Kwan, Benjamin Y. M., Benedetto Mussari, Pam Moore, Lynne Meilleur, Omar Islam, Alexandre Menard, Don Soboleski, and Nicholas Cofie. "A Pilot Study on Diagnostic Radiology Residency Case Volumes From a Canadian Perspective: A Marker of Resident Knowledge." Canadian Association of Radiologists Journal 71, no. 4 (February 10, 2020): 490–94. http://dx.doi.org/10.1177/0846537119899227.
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Purpose: New guidelines from the Accreditation Council for Graduate Medical Education (ACGME) have proposed minimum case volumes to be obtained during residency. While radiology residency programs in Canada are accredited by the Royal College of Physicians and Surgeons of Canada, there are currently no minimum case volumes standards for radiology residency training in Canada. New changes in residency training throughout Canada are coming in the form of competency-based medical education. Using data from a pilot study, this article examines radiology resident case volumes among recently graduated cohorts of residents and determines whether there is a correlation between case volumes and measures of resident success. Materials and Methods: Resident case volumes for 3 cohorts of graduated residents (2016-2018) were extracted from the institutional database. Achievement of minimum case volumes based on the ACGME guidelines was performed for each resident. Pearson correlation analysis (n = 9) was performed to examine the relationships between resident case volumes and markers of resident success including residents’ relative knowledge ranking and their American College of Radiology (ACR) in-training exam scores. Results: A statistically significant, positive correlation was observed between residents’ case volume and their relative knowledge ranking ( r = 0.682, P < .05). Residents’ relative knowledge ranking was also statistically significant and positively correlated with their ACR in-training percentile score ( r = 0.715, P < .05). Conclusions: This study suggests that residents who interpret more cases are more likely to demonstrate higher knowledge, thereby highlighting the utility of case volumes as a prognostic marker of resident success. As well, the results underscore the potential use of ACGME minimum case volumes as a prognostic marker. These findings can inform future curriculum planning and development in radiology residency training programs.
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Mai, Mark, Brooke Luo, Evan Orenstein, and Anthony Luberti. "A Model for Clinical Informatics Education for Residents: Addressing an Unmet Need." Applied Clinical Informatics 09, no. 02 (April 2018): 261–67. http://dx.doi.org/10.1055/s-0038-1641735.
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AbstractOpportunities for education in clinical informatics exist throughout the spectrum of formal education extending from high school to postgraduate training. However, physicians in residency represent an underdeveloped source of potential informaticians. Despite the rapid growth of accredited fellowship programs since clinical informatics became a board-eligible subspecialty in 2011, few resident physicians are aware of their role at the intersection of clinical medicine and health information technology or associated opportunities. In an effort to educate and engage residents in clinical informatics, Children's Hospital of Philadelphia has developed a three-pronged model: (1) an elective rotation with hands-on project experience; (2) a longitudinal experience that offers increased exposure and mentorship; and (3) a resident founded and led working group in clinical informatics. We describe resident participation in these initiatives and lessons learned, as well as resident perceptions of how these components have positively influenced informatics knowledge and career choices. Since inception of this model, five residents have pursued the clinical informatics fellowship. This educational model supports resident involvement in hospital-wide informatics efforts with tangible projects and promotes wider engagement through educational opportunities commensurate with the resident's level of interest.
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Worley, Brandon, Luvneet Verma, and Jillian Macdonald. "Aesthetic Dermatologic Surgery Training in Canadian Residency Programs." Journal of Cutaneous Medicine and Surgery 23, no. 2 (November 16, 2018): 164–73. http://dx.doi.org/10.1177/1203475418814228.
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Background: The public and other physicians expect dermatologists to be experts on aesthetic dermatology services. In Canada, current challenges may limit residents from achieving competency in aesthetic dermatology during their training. This may adversely affect patient safety, create medicolegal risks, and deter graduates from offering aesthetic procedures. Objectives: The objective of this article is to characterize the curriculum, hands-on learning opportunities, and perceptions of aesthetic dermatologic training in Canadian dermatology residency training programs. Methods: An online survey of faculty and residents within Canadian dermatology residency programs was performed. The main outcome measures were the hours of formal aesthetic dermatology teaching, the frequency of hands-on dermatology resident training with injectables and devices, and comparing faculty and resident perspectives regarding resident aesthetic dermatology training. Results: Thirty-six faculty members (40%) and 47 residents (34%) responded to the survey. Lasers, fillers, neuromodulators, and mole removal were most commonly taught in the 10 hours or fewer of formal instruction. Residents commonly observed rather than performed procedures. High dissatisfaction among residents was reported with the quality and quantity of aesthetic dermatology training. Faculty and resident respondents supported increasing aesthetic dermatology education, and approximately 70% of residents plan to offer aesthetic services. Discounted pricing or resident-led clinics were felt to be ways to increase resident hands-on experience. Conclusions: The standardization of core competencies in aesthetic dermatologic procedures is essential to ensure patient safety and practitioner competence. At present, formal aesthetic dermatology training in residency may be insufficient for hands-on training. The majority of dermatology faculty and resident respondents support increasing aesthetic dermatology training.
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Faville, Elizabeth, Suzanne Turner, and John A. Armitstead. "Strengths in numbers: Assessing the use of StrengthsFinder 2.0 in a pharmacy residency program." American Journal of Health-System Pharmacy 77, Supplement_3 (July 28, 2020): S66—S70. http://dx.doi.org/10.1093/ajhp/zxaa156.
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Abstract Purpose To quantify the trends of StrengthsFinder 2.0 domains and traits in pharmacy residents within a single residency program. To recognize and discuss the application of resident StrengthsFinder 2.0 traits within a residency program. Methods This is a retrospective review of StrengthsFinder 2.0 domains and traits among first- and second-year postgraduate year (PGY) pharmacy residents over the past 6 years in a community-based health system. Perspectives on the utility of the StrengthsFinder 2.0 assessment within a residency program, from the viewpoints of a residency program director, a system director of pharmacy, and a current resident, were also obtained and recorded. Results A total of 34 residents with 170 StrengthsFinder 2.0 traits were included in this data analysis. The top StrengthsFinder 2.0 domains of all pharmacy residents were Strategic Thinking and Relationship Building, being exhibited by 36% and 28%, respectively. Learner, Achiever, Harmony, Input, and Restorative were found to be the most frequently reported StrengthsFinder 2.0 traits among all pharmacy residents examined. Learner and Harmony were found to be the top traits of first-year pharmacy residents (11% and 9%), while Achiever and Learner were the most common traits found in the second-year pharmacy residents (13% and 10%). The system pharmacy director, residency program director, and current resident agreed that the assessment tool enhances the resident experience. However, each has their own perspective on the benefits of the StrengthsFinder assessment with respect to the residency program. Conclusion Overall, the top 5 StrengthsFinder 2.0 traits seen in pharmacy residents who have completed a PGY1 or PGY2 residency at Lee Health were: Learner (18%), Achiever (9%), Harmony (7%), Input (6%), and Restorative (6%). Achiever, Harmony, Learner, Input, and Restorative were found to be the most common traits across all categories reported. These trends are similar to those reported in previous studies of StrengthsFinder 2.0 assessment of pharmacy students and residents. Evaluating individual StrengthsFinder 2.0 traits at the start of the residency year provides a framework for each resident to complete ongoing self-evaluations. In addition, familiarity with the common traits seen within residents allows residency leadership members to make more thoughtful decisions regarding resident assignments for learning experiences or committee appointments.
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Di Rocco, Jennifer R., Chieko Kimata, Masihullah Barat, and Samantha Kodama. "Paediatric resident workflow observations in a community-based hospital." BMJ Open Quality 11, no. 1 (March 2022): e001607. http://dx.doi.org/10.1136/bmjoq-2021-001607.
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ObjectiveResidency graduates need to demonstrate competence in prioritising safe patient care through appropriate management of multiple competing tasks and workflow interruptions. This pilot study aimed to characterise and correlate interruptions in paediatric resident workflow at an academically affiliated, community-based hospital.MethodsOne of three trained observers followed a resident physician during a convenience sample of 1–2 hour increments, either in the emergency department or on the wards, and recorded all observed activities and interruptions using an established time-motion tool. All participants completed a baseline Multi-Tasking Ability Test (MTAT) and pre-observation and post-observation surveys. Statistical approach included descriptive statistics, logistic regression, mixed model and ORs.Results18 paediatric residents were observed for 57.5 total hours (an average of 3.2 hours/resident) which included 329 interruptions, defined as any external event drawing the resident’s attention away from a primary task. Interruptions occurred an average of 5.9 times per resident per hour. Interrupted primary tasks were not resumed during the observation period 11% of the time. A personal/social-related interruption yielded an OR of 0.29 that the resident will return to a primary task within 5 min (p=0.007) when compared with patient-related verbal interruptions by the medical team. The MTAT Score indicated decreased efficiency for interns versus postgraduate year 2 residents (p=0.029). Residents’ MTAT Scores did not correlate with their time to return to a primary task following an interruption (p=0.11).ConclusionsPaediatric resident workflow interruptions in the hospital were observed to occur frequently and should be expected. Personal/social interruptions were most likely to delay prompt return to a primary task. The MTAT Score, although improved between the first 2 years of residency training, did not correlate with efficient return to a primary task. Interruption management and mitigation strategies should be developed as part of a standardised residency task management curriculum.
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Fliotsos, Michael J., Sidra Zafar, Fasika A. Woreta, Peter M. Ugoh, and Divya Srikumaran. "A Comparative Analysis of Ophthalmology Resident Physician Performance Based on Use of Parental Leave." Journal of Academic Ophthalmology 13, no. 01 (January 2021): e1-e4. http://dx.doi.org/10.1055/s-0040-1721465.
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Abstract Background Taking parental leave during ophthalmology residency may be perceived to negatively affect resident surgical volume and educational outcomes. However, limited data exist on whether taking parental leave is associated with objective measures of resident performance. The objective of the present study was to determine the association between taking parental leave and key measures of resident performance. Methods Educational records of ophthalmology resident physicians who graduated from 2015 to 2019 at the Johns Hopkins University School of Medicine Wilmer Eye Institute were reviewed. Measures of resident performance assessed were Ophthalmic Knowledge Assessment Program scores, number of publications during residency, Accreditation Council for Graduate Medical Education milestones scores, and surgical volumes. These outcomes were compared for residents who took parental leave compared with their peers who did not take parental leave. Results Twenty-five residents were included in the study. Four female residents (16%) took parental leave 8 weeks in duration. There were no significant differences between residents who did and did not take parental leave when considering mean Ophthalmic Knowledge Assessment Program scores (p = 0.27), number of publications during residency (p = 0.19), milestone scores (p-value range 0.09–0.40), and surgical volume by subspecialty category (p-value range 0.11–0.45). Conclusion Parental leave did not negatively influence any of the studied measures of resident performance.
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Madan, Atul K., Timothy C. Fabian, and David S. Tichansky. "Potential Financial Impact of First Assistant Billing by Surgical Residents." American Surgeon 73, no. 7 (July 2007): 652–57. http://dx.doi.org/10.1177/000313480707300703.
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General surgery residency involves a mixture of 1) education of residents and 2) service by residents. The service that residents provide is not directly reimbursed in our current healthcare system by private healthcare insurance companies. This investigation characterizes the amount of reimbursement a typical resident would be able to collect if residents were allowed to collect for their services as a first assistant. The case logs of residents who graduated over 2 years from our general surgery residency program were reviewed. Data from each resident's last 2 years (postgraduate years 4 and 5) were included in this study. Relative value units (RVUs) for each Current Procedural Terminology code were reviewed. Collections were calculated by multiplying the Medicare conversion factor of $36.7856/RVU, the corresponding RVU, and a “standard” collection rate of 16 per cent for first assistants. There were 13 general surgery residents. These residents provided first assistant help with 91,473 RVUs over 2 years. A total amount of $535,380 could have been collected on first assistant fees for the last 2 years of their residency. Each resident would have been able to collect an average at least $41,414 just for first assistant operative fees. Resident assistance in the operating room provides significant savings for private healthcare insurance companies each year by reducing the need for first assistants. The data demonstrate that private insurance companies receive a considerable amount of pro bono service from residents. Changes in the financing of the current healthcare system in the United States will require educators to examine other sources ( i.e., private insurance companies) for support of graduate medication education.
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Harper, Cierra N., Sonia Eden, and William W. Ashley. "Effect of online public domain representation in neurosurgical resident recruitment and decision-making." Neurosurgical Focus 55, no. 5 (November 2023): E5. http://dx.doi.org/10.3171/2023.8.focus23437.
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OBJECTIVE Over the past 20 years, female representation in neurosurgical residency programs has steadily increased. Still, the number of Black women and Black neurosurgical residents overall has remained stagnant. The authors aimed to understand the factors that led to this stagnation and how online public domain representation informs current and upcoming resident recruitment and decision-making. METHODS The authors performed a retrospective study using the following public domain sources: Doximity, neurosurgical residency program websites, and LinkedIn. The authors collected data from all neurosurgery residents who matriculated into a US neurosurgical residency program from 2015 to 2022. Variables, including name, race, gender, year of matriculation, medical school, and undergraduate institution, were recorded. RESULTS The authors analyzed resident data from 110/113 (97.3%) US neurological surgery residency programs. Of these programs, 106 (96.4%) matriculated and retained ≥ 1 female resident over the study period. There were 408 (22.6%) female neurosurgical residents, with 37 (33.6%) programs accounting for 57.8% of all female neurosurgical residents. For those states with a female resident, the lowest percentage of female residents by state was in Iowa (6.25%) and the highest was in New Hampshire (50%). Of all programs, 60 (54.5%) matriculated and retained ≥ 1 Black resident over the study period. There were 88 (4.9%) Black neurosurgical residents, with 19 (17.3%) programs accounting for 55.7% of all Black neurosurgical residents. For those states with a Black resident, the lowest percentage of Black residents by state was in Maryland (2.0%) and the highest was in Arkansas (23.1%). CONCLUSIONS Recruiting and retaining female and Black residents has increasingly become a focus of neurosurgical programs across the country. The authors’ data show that female and Black residents overwhelmingly choose to apply to and matriculate into programs that demonstrate a commitment to diversity via their online presence. Programs wishing to recruit more diverse residents should make efforts to relay their dedication to diversity, inclusion, and performance through their online presence.
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Reynolds, Kellin, Danny Barnhill, Jamie Sias, Amy Young, and Florencia Greer Polite. "Use of the QR Reader to Provide Real-Time Evaluation of Residents' Skills Following Surgical Procedures." Journal of Graduate Medical Education 6, no. 4 (December 1, 2014): 738–41. http://dx.doi.org/10.4300/jgme-d-13-00349.1.
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Abstract Background A portable electronic method of providing instructional feedback and recording an evaluation of resident competency immediately following surgical procedures has not previously been documented in obstetrics and gynecology. Objective This report presents a unique electronic format that documents resident competency and encourages verbal communication between faculty and residents immediately following operative procedures. Methods The Microsoft Tag system and SurveyMonkey platform were linked by a 2-D QR code using Microsoft QR code generator. Each resident was given a unique code (TAG) embedded onto an ID card. An evaluation form was attached to each resident's file in SurveyMonkey. Postoperatively, supervising faculty scanned the resident's TAG with a smartphone and completed the brief evaluation using the phone's screen. The evaluation was reviewed with the resident and automatically submitted to the resident's educational file. Results The evaluation system was quickly accepted by residents and faculty. Of 43 residents and faculty in the study, 38 (88%) responded to a survey 8 weeks after institution of the electronic evaluation system. Thirty (79%) of the 38 indicated it was superior to the previously used handwritten format. The electronic system demonstrated improved utilization compared with paper evaluations, with a mean of 23 electronic evaluations submitted per resident during a 6-month period versus 14 paper assessments per resident during an earlier period of 6 months. Conclusions This streamlined portable electronic evaluation is an effective tool for direct, formative feedback for residents, and it creates a longitudinal record of resident progress. Satisfaction with, and use of, this evaluation system was high.
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Ratan, Bani M., Grace J. Johnson, Amanda C. Williams, Jocelyn T. Greely, and Charlie C. Kilpatrick. "Enhancing the Teaching Environment: 3-Year Follow-Up of a Resident-Led Residents-as-Teachers Program." Journal of Graduate Medical Education 13, no. 4 (August 1, 2021): 569–75. http://dx.doi.org/10.4300/jgme-d-20-01167.1.
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ABSTRACT Background Previous faculty-driven residents-as-teachers (RAT) models have had limited efficacy and sustainability. Objective To evaluate the acceptability and effects of a resident-led RAT program on resident teaching. Methods In October 2016, obstetrics and gynecology (OB/GYN) residents at a large academic institution implemented a resident-led RAT program, consisting of a steering committee of peer-selected residents with 2 faculty mentors who planned education-focused resident didactics and journal clubs, organized resident involvement in clerkship activities, and recognized residents who excelled in teaching as Distinguished Educators (DEs). From July 2016 through June 2019, using the Kirkpatrick Model, we evaluated the program with annual resident surveys assessing self-perception of 13 teaching skills (5-point Likert scale) and value of RAT program, institutional end-of-clerkship student evaluations of resident teaching, and resident participation in DE award. Results Annual resident survey response rates ranged from 63% to 88%. Residents' self-reported teaching skills improved significantly in 11 of 13 domains from 2016 to 2018 (improvements ranging from 0.87–1.42; 5-point Likert scale; P < .05). Of the 2018 respondents, 80% agreed that the resident-led RAT program added value to the residency. For 2017–2018 and 2018–2019 academic years, 47% and 48% of medical students (100% response rate) strongly agreed that residents provided effective teaching compared to 30% in 2016–2017 (P < .05). Ten residents have graduated as DEs during this time period. Conclusions A resident-led RAT program increased residents' self-reported teaching skills, improved medical student perceptions of teaching quality, and was sustainable and acceptable over a 3-year period.
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Raju, Venkedesh, Kimberly Horack, Donna Bronson, Girish Deshpande, and Sandeep Tripathi. "Successful Development and Implementation of Pediatric Sedation-Analgesia Curriculum for Residents." Journal of Pediatric Intensive Care 07, no. 03 (January 28, 2018): 129–34. http://dx.doi.org/10.1055/s-0038-1624570.
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AbstractPediatric residency graduates are increasingly asked to provide procedural sedations. Currently, most programs provide minimal exposure to residents outside of PICU for procedural sedations. We describe the pediatric sedation and analgesia (PSA) evolution and resident experience over the past 6 years at our institution (fiscal year 2010–2015). Administrative database of the PSA team and resident evaluations obtained by respective residency programs were analyzed and presented with standard descriptive analysis. Commutative or where appropriate year-by-year data were analyzed. Over the past 6 years, 100 residents performed 1,742 sedations with 17 ± 6.4 sedations per resident. Lumbar puncture and MRI were the most frequent procedures for sedations performed by residents. There was no statistical difference in complication rates in sedations performed by residents (28.6 ± 16.6) versus those by attending only (36.2 ± 31.2). Overall, residents were satisfied with the educational experience with an average score of 6.1 ± 0.17 out of maximum 7. Resident involvement in PSA is well liked by residents and does not lead to an increase in sedation-related complications.
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Chen, Jenny X., Elliott Kozin, Jordan Bohnen, Brian George, Daniel G. Deschler, Kevin Emerick, and Stacey T. Gray. "Assessments of Otolaryngology Resident Operative Experiences Using Mobile Technology: A Pilot Study." Otolaryngology–Head and Neck Surgery 161, no. 6 (August 13, 2019): 939–45. http://dx.doi.org/10.1177/0194599819868165.
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Objectives Surgical education has shifted from the Halstedian model of “see one, do one, teach one” to a competency-based model of training. Otolaryngology residency programs can benefit from a fast and simple system to assess residents’ surgical skills. In this quality initiative, we hypothesize that a novel smartphone application called System for Improving and Measuring Procedural Learning (SIMPL) could be applied in an otolaryngology residency to facilitate the assessment of resident operative experiences. Methods The Plan Do Study Act method of quality improvement was used. After researching tools of surgical assessment and trialing SIMPL in a resident-attending pair, we piloted SIMPL across an otolaryngology residency program. Faculty and residents were trained to use SIMPL to rate resident operative performance and autonomy with a previously validated Zwisch Scale. Results Residents (n = 23) and faculty (n = 17) were trained to use SIMPL using a standardized curriculum. A total of 833 assessments were completed from December 1, 2017, to June 30, 2018. Attendings completed a median 20 assessments, and residents completed a median 14 self-assessments. All evaluations were resident initiated, and attendings had a 78% median response rate. Evaluations took residents a median 22 seconds to complete; 126 unique procedures were logged, representing all 14 key indicator cases for otolaryngology. Discussion This is the first residency-wide application of a mobile platform to track the operative experiences of otolaryngology residents. Implications for Practice We adapted and implemented a novel assessment tool in a large otolaryngology program. Future multicenter studies will benchmark resident operative experiences nationwide.
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Stohl, Hindi E., Nancy A. Hueppchen, and Jessica L. Bienstock. "Can Medical School Performance Predict Residency Performance? Resident Selection and Predictors of Successful Performance in Obstetrics and Gynecology." Journal of Graduate Medical Education 2, no. 3 (September 1, 2010): 322–26. http://dx.doi.org/10.4300/jgme-d-09-00101.1.
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Abstract Background During the evaluation process, Residency Admissions Committees typically gather data on objective and subjective measures of a medical student's performance through the Electronic Residency Application Service, including medical school grades, standardized test scores, research achievements, nonacademic accomplishments, letters of recommendation, the dean's letter, and personal statements. Using these data to identify which medical students are likely to become successful residents in an academic residency program in obstetrics and gynecology is difficult and to date, not well studied. Objective To determine whether objective information in medical students' applications can help predict resident success. Method We performed a retrospective cohort study of all residents who matched into the Johns Hopkins University residency program in obstetrics and gynecology between 1994 and 2004 and entered the program through the National Resident Matching Program as a postgraduate year-1 resident. Residents were independently evaluated by faculty and ranked in 4 groups according to perceived level of success. Applications from residents in the highest and lowest group were abstracted. Groups were compared using the Fisher exact test and the Student t test. Results Seventy-five residents met inclusion criteria and 29 residents were ranked in the highest and lowest quartiles (15 in highest, 14 in lowest). Univariate analysis identified no variables as consistent predictors of resident success. Conclusion In a program designed to train academic obstetrician-gynecologists, objective data from medical students' applications did not correlate with successful resident performance in our obstetrics-gynecology residency program. We need to continue our search for evaluation criteria that can accurately and reliably select the medical students that are best fit for our specialty.
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George, Paul, Shmuel Reis, Margaret Dobson, and Melissa Nothnagle. "Using a Learning Coach to Develop Family Medicine Residents' Goal-Setting and Reflection Skills." Journal of Graduate Medical Education 5, no. 2 (June 1, 2013): 289–93. http://dx.doi.org/10.4300/jgme-d-12-00276.1.
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Abstract Background Self-directed learning (SDL) skills, such as self-reflection and goal setting, facilitate learning throughout a physician's career. Yet, residents do not often formally engage in these activities during residency. Intervention To develop resident SDL skills, we created a learning coach role for a junior faculty member to meet with second-year residents monthly to set learning goals and promote reflection. Methods The study was conducted from 2008–2010 at the Brown Family Medicine Residency in Pawtucket, Rhode Island. During individual monthly meetings with the learning coach, residents entered their learning goals and reflections into an electronic portfolio. A mixed-methods evaluation, including coach's ratings of goal setting and reflection, coach's meeting notes, portfolio entries, and resident interviews, was used to assess progress in residents' SDL abilities. Results Coach ratings of 25 residents' goal-setting ability increased from a mean of 1.9 to 4.6 (P < .001); ratings of reflective capacity increased from a mean of 2.0 to 4.7 (P < .001) during each year. Resident portfolio entries showed a range of domains for goal setting and reflection. Resident interviews demonstrated progressive independence in setting goals and appreciation of the value of reflection for personal development. Conclusions Introducing a learning coach, use of a portfolio, and providing protected time for self-reflected learning allowed residents to develop SDL skills at their own pace. The learning coach model may be applicable to other residency programs in developing resident lifelong learning skills.
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Fauzi, Asra Al, Christrijogo Sumartono Waloejo, Abdulloh Machin, and Muhammad Ja'far Shodiq. "A Study on Knowledge Towards Brain Death among Residents in Indonesia." Folia Medica Indonesiana 56, no. 2 (August 6, 2020): 140. http://dx.doi.org/10.20473/fmi.v56i2.21235.
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This research was conducted to evaluate the knowledge and diagnosis of brain death among resident in Indonesia. This study used an observational analytic study with a cross-sectional study design using a questionnaire. The research subjects consisted of 132 level 2 (after 2 years of residency) and level 3 (after 4 years of residency) residents, the total sampling for which was taken from the departments of Neurosurgery, Anesthesiology, and Neurology at Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia. Data were taken from November 2018 to January 2019. A total of 132 residents of Neurosurgery, Neurology, and Anesthesiology participated in this study. From the series of studies, residents’ knowledge of the concept of brain death was in the sufficient category (41.7%), residents’ knowledge of the technical diagnosis of brain death was in the good category (40.2%), residents’ knowledge of brain death examination was in the less category (43.2%), and finally, it was found that the resident's knowledge of brain death was in a good category (35.6%). There were also significant differences in knowledge of brain death between Neurosurgery, Neurology, and Anesthesiologist Resident (P <0.001) and knowledge of brain death between level 2 and level 3 residents (P=0.032). In general, the Indonesian resident doctors’ knowledge of brain death is adequate, but knowledge of the clinical examination of brain death is still lacking. Further research must be carried out to promote knowledge of brain death in residents as well as professional doctors/specialists, so that the number of organ transplants, especially in Indonesia, will increase.
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Backeris, Mark E., Patrick J. Forte, Shawn T. Beaman, and David G. Metro. "Financial Implications of Different Interpretations of ACGME Anesthesiology Program Requirements for Rotations in the Operating Room." Journal of Graduate Medical Education 5, no. 2 (June 1, 2013): 315–19. http://dx.doi.org/10.4300/jgme-d-13-00075.1.
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Abstract Background The Accreditation Council for Graduate Medical Education (ACGME) standards for resident education in anesthesiology mandate required rotations including rotations inside the operating room (OR). When residents complete rotations outside the OR, other providers must be used to maintain the OR's clinical productivity. Objective We quantified and compared the costs of replacing residents by using two different working patterns that are compliant with the ACGME anesthesiology program requirements: (1) the minimum amount of time in the OR, and (2) working the maximum amount of time permitted in the OR. Methods We calculated resident replacement costs over a 36-month residency period in both a minimum and maximum OR time model. We used a range of Certified Registered Nurse Anesthetist (CRNA) pay scales determined by a local market analysis for cost comparisons. Results Depending on CRNA pay rates, the cost differentials to replace a resident in the OR between the minimum and maximum OR time models ranged from $236,000 to $581,876, assuming a 50-hour resident work week, and $373,400 to $931,001, assuming an 80-hour resident work week. This cost was per resident over the entire 3 years of their residency. Conclusions Varying the amount of time residents work in the OR (as allowed under ACGME program requirements) has significant financial implications over a 36-month anesthesiology residency. The larger the residency, the more significant will be the impact on the department and sponsoring institution.
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Liles, Campbell, Alan Ruigang Tang, Mark Petrovic, Robert J. Dambrino, Reid C. Thompson, and Lola Blackwell Chambless. "334 Resident Salary Compared to Living Wages at US Training Institutions." Neurosurgery 70, Supplement_1 (April 2024): 98. http://dx.doi.org/10.1227/neu.0000000000002809_334.
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INTRODUCTION: Resident physician salaries vary by region, though it is unknown how these variations compare to differences in living wages across the United States or what factors drive residency salary discrepancies. METHODS: Publicly available resident salary information was obtained from full-service training centers containing a neurosurgical residency program via institution-specific websites in February 2023 with information on post-graduate year (PGY)-1 through PGY-7 resident compensation for 2022-2023. Living wage calculations by city were generated via the Massachusetts Institute of Technology (MIT) Living-Wage Calculator. Resident salary to living-wage ratios were calculated using PGY-4 salary for each family composition living-wage. Univariate and multivariable analysis of PGY-4 resident salary on affordability was performed, accounting for proportion of expected living wages to taxes, transportation, housing, medical costs, childcare, and food as well as unionization and state income-tax status. RESULTS: 118 neurosurgery residency programs were included, 21 (17.9%) of which were unionized. Residents without children earned a salary greater than living-wage during all years, while single-parent families were unable to earn a living-wage until PGY-7. Residents with 1 child in in 2-adult (single-income) and 2-adult (double-income) families were unable to earn a living-wage until PGY-5 and PGY-3 respectively. Residents with more than 1 child failed to earn a living-wage. Multivariate regression analysis using PGY-4 salary:living-wage ratios in single-child, 2-parent homes showed food expenses and unionization status were always significant. On multivariate regression, unionization was significantly associated with lower living-wage ratios pre-stipend, improved post-stipend, and was again significantly lower after factoring in union dues. CONCLUSIONS: Current resident salaries often preclude a resident from earning a living-wage, especially among junior residents and those with children. Unionization is significantly associated with lower resident income to living-wage ratios.
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Al-Busaidi, Ibrahim S., Sultan Z. Al-Shaqsi, Awatif K. Al-Alawi, Siham Al-Sinani, and Ammar Al-Kashmiri. "Characteristics, Trends, and Factors Associated With Publication Among Residents of Oman Medical Specialty Board Programs." Journal of Graduate Medical Education 11, no. 4s (August 1, 2019): 104–9. http://dx.doi.org/10.4300/jgme-d-19-00259.
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ABSTRACT Background Research during residency is associated with better clinical performance, improved critical thinking, and increased interest in an academic career. Objective We examined the rate, characteristics, and factors associated with research publications by residents in Oman Medical Specialty Board (OMSB) programs. Methods We included residents enrolled in 18 OMSB residency programs between 2011 and 2016. Resident characteristics were obtained from the OMSB Training Affairs Department. In April 2018, MEDLINE and Google Scholar databases were searched independently by 2 authors for resident publications in peer-reviewed journals using standardized criteria. Results Over the study period, 552 residents trained in OMSB programs; 64% (351 of 552) were female, and the mean age at matriculation was 29.4 ± 2.2 years. Most residents (71%, 393 of 552) were in the early stages of specialty training (R ≤ 3) and 49% (268 of 552) completed a designated research block as part of their training. Between 2011 and 2016, 43 residents published 42 research articles (range, 1–5 resident authors per article), for an overall publication rate of 8%. Residents were the first authors in 20 (48%) publications. Male residents (odds ratio [OR] = 2.07; P = .025, 95% CI 1.1–3.91) and residents who completed a research block (OR = 2.57; P = .017, 95% CI 1.19–5.57) were significantly more likely to publish. Conclusions Research training during residency can result in tangible research output. Future studies should explore barriers to publication for resident research and identify interventions to promote formal scholarly activity during residency.
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Sobel, Halle G., Rachel Swigris, Karen M. Chacko, Alison Landrey, Monica McNulty, Kaitlyn Vennard, Susan Michelle Nikels, Kathleen Suddarth, Edward N. Murphy, and Eva Aagaard. "Resident and Preceptor Perceptions of Preceptor Integration Into Resident Clinic Scheduling Templates." Journal of Graduate Medical Education 9, no. 4 (August 1, 2017): 497–502. http://dx.doi.org/10.4300/jgme-d-16-00609.1.
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ABSTRACT Background Some internal medicine residency programs on X+Y schedules have modified clinic preceptor schedules to mimic those of the resident cohort (resident matched). This is in contrast to a traditional model, in which preceptors supervise on the same half-day each week. Objective We assessed preceptor and resident perceptions of the 2 precepting models. Methods We surveyed 44 preceptors and 97 residents at 3 clinic sites in 2 academic medical centers. Two clinics used the resident-matched model, and 1 used a traditional model. Surveys were completed at 6 months and 1 year. We assessed resident and preceptor perceptions in 5 domains: relationships between residents and preceptors; preceptor familiarity with complex patients; preceptor ability to assess milestone achievements; ability to follow up on results; and quality of care. Results There was no difference in perceptions of interpersonal relationships or satisfaction with patient care. Preceptors in the resident-matched schedule reported they were more familiar with complex patients at both 6 months and 1 year, and felt more comfortable evaluating residents' milestone achievements at 6 months, but not at 1 year. At 1 year, residents in the resident-matched model perceived preceptors were more familiar with complex patients than residents in the traditional model. The ability to discuss patient results between clinic weeks was low in both models. Conclusions The resident-matched model increased resident and preceptor perceptions of familiarity with complex patients and early preceptor perceptions of comfort in assessment of milestone achievements.
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Hays, Annette, Manorama Khare, David Pluta, Rhonda Verzal, and Joseph P. Garry. "First-Year Resident Perceptions of Virtual Interviewing." Family Medicine 54, no. 10 (November 1, 2022): 814–19. http://dx.doi.org/10.22454/fammed.2022.364201.
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Background and Objectives: Virtual interviews (VI) for residency programs present a relatively new paradigm for recruitment. To date, studies have been small, largely descriptive, and focused on surgical and subspecialty areas. The purpose of the study was to assess residents’ perceptions about their VI experience and to compare those in primary care versus non-primary care specialties. Methods: An electronic survey was sent to 35 designated institutional officials in Illinois with a resulting snowball sample to assess first-year residents’ perceptions of their virtual interviewing experience. A total of 82 postgraduate year-1 residents responded to the survey. We used descriptive analysis and χ2 tests to analyze results. Results: Respondents were mostly female (52.4%), White (79%), non-Hispanic (76%), attending a university residency program (76.3%), and in a primary care specialty (61.7%). In general, most respondents (54.8%-75.3%) felt their VI accurately portrayed their residency program experience. Resident morale, resident-faculty camaraderie, and educational opportunities were perceived as being best portrayed in the VI. Compared to non-primary care residents, primary care residents felt that their program’s VI more accurately portrayed the patient population served (P=.0184), resident morale in the program (P=.0038), and the overall residency experience (P=.0102). Still, 25.7% of respondents felt they were not accurately represented in the VI. Conclusions: Respondents reported that the VI portrays the residency experience fairly well, yet there is opportunity to improve the overall experience. The more difficult experiences to convey (morale, camaraderie, and the overall resident experience) may be areas in which primary care programs are outpacing other training programs.
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Patel, Mitesh, Jasneet S. Bhullar, Gokulakkrishna Subhas, and Vijay Mittal. "Present Status of Autonomy in Surgical Residency—a Program Director's Perspective." American Surgeon 81, no. 8 (August 2015): 786–90. http://dx.doi.org/10.1177/000313481508100816.
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As surgery residents graduate and begin their careers as junior attending surgeons, the question of whether a surgeon can complete a case alone still lingers. Allowing autonomy during residency answers this question. The purpose of this study was to gather input from general surgery residency program directors on how they achieve autonomy for residents in their programs. An online survey of 18 questions was sent to all general surgery residency program directors in the United States between April and June of 2013 via e-mail. Questions were asked regarding classification of autonomy, percentage of case completed by the resident independently, and in what area a resident worked with minimal supervision. Of the 202 delivered, 85 program directors were responded (42%). Seventy-eight per cent of programs classified a resident as surgeon junior whether the resident completed more than 50 per cent of the case. Most classified autonomy as either the resident completing >75 per cent of a case (41%) or completing the critical steps of a surgery (41%). Eighty-eight per cent stated that chief residents completed the majority of cases under supervision, whereas only 12 per cent stated the chief had autonomy in the operating room and also acted as teaching assistant. While, 60 per cent stated their chief residents did not work in any area of the hospital independently. Despite differences in how autonomy is defined among programs, most program directors feel that their chief residents do not achieve complete autonomy. Programs should allow their residents to work in a progressive responsibility as they progress into their fourth and fifth years of residency to achieve autonomy.
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Fernandes, Marcelo Nunes da Silva, Carmem Lúcia Colomé Beck, Teresinha Heck Weiller, Viviani Viero, Paula Hubner Freitas, and Francine Cassol Prestes. "Suffering and pleasure in the process of forming multidisciplinary health residents." Revista Gaúcha de Enfermagem 36, no. 4 (December 2015): 90–97. http://dx.doi.org/10.1590/1983-1447.2015.04.50300.
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Objective: to identify situations of pleasure and suffering in the process of training multidisciplinary health resident. Method: qualitative research, developed in the Multiprofessional Residence Program in Health at a university from the south of Brazil. Data was collected in 2013 through focus groups with nine residents, and analyzed according to a thematic analysis. Results: The situations of suffering were stimulated by negative situations undergone by the health workers such as difficulties in participating in other professional training activities, excessive number of activities the residents commit to as health workers, lack of knowledge and hindered integration in the areas of Residency. The situations of pleasure were a result of the multiprofessional activities developed and the resident's larning possibility. Conclusion: The situations of pleasure and suffering identified can help in the planning of institutional actions that contribute to a professional training process and the overall wellbeing of the residents.
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Miller, Nancy H., David J. Miller, and Melissa Chism. "Breastfeeding Practices Among Resident Physicians." Pediatrics 98, no. 3 (September 1, 1996): 434–37. http://dx.doi.org/10.1542/peds.98.3.434.
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Objective. To determine how employment as a resident physician (resident) affects breastfeeding practices and experiences. Design. Cross-sectional questionnaire survey. Setting. US resident physicians in the second half of their postgraduate year three (PGY3). Participants. 1500 questionnaires were mailed at random to female 1990 graduates of American medical schools. After eliminating unusable surveys, an adjusted response rate of 45% produced 450 surveys; 60 delivered a child during residency. Interventions. None. Measurement/Main Results. Forty-eight (80%) of 60 residents who delivered initiated breastfeeding, and continued for the duration of their maternity leave (mean, 7 weeks). With a return to residency half (24) of those who had initiated breastfeeding discontinued breastfeeding. The breastfeeding rate dropped to 15% (9/60) at 6 months. Residency work schedule was the most common reason (80%) for discontinuing breastfeeding. Of the 24 residents who continued breastfeeding while working, 83% pumped breast milk during their work shifts; 79% felt there was insufficient time during work, and 42% reported no appropriate place at work to express milk. Only 54% who continued felt supported by their attending physicians for their efforts to breastfeed; 67% felt colleagues were supportive. Conclusions. The breastfeeding initiation rate for resident mothers was in compliance with the Healthy People 2000 guidelines, but the rate at infant age 6 months fell well below the goal of 50%. Modifiable factors in residents' work sites include both physical and emotional accommodations to encourage resident mothers to breastfeed.
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Vaa Stelling, Brianna, Andrew J. Halvorsen, Denise Dupras, Lisa Kearns, Michael Kisielewski, Shannon K. Martin, Brian Uthlaut, and Emily Leasure. "Management of the Electronic Health Record Inbox: Results From a National Survey of Internal Medicine Program Directors." Journal of Graduate Medical Education 15, no. 6 (December 1, 2023): 711–17. http://dx.doi.org/10.4300/jgme-d-23-00165.1.
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Background Internal medicine (IM) resident physicians spend a considerable amount of time managing their inbox as part of their longitudinal continuity clinic experience. There are no standardized guidelines for how programs should train, monitor, or supervise residents in this type of patient care. Objective To understand how IM residency programs educate, monitor, and supervise resident electronic health record (EHR) inbox management as part of their longitudinal continuity clinic and determine whether patient safety events have occurred due to EHR inbox-related patient care decisions made by unsupervised resident physicians. Methods In August 2021, 439 program directors at accredited US IM residency programs who were members of the Association of Program Directors in Internal Medicine (APDIM) were asked 12 questions developed by the study authors and APDIM survey committee members regarding resident EHR inbox management as part of the annual APDIM survey. Results Two hundred and sixty-seven (61%) PDs responded. The majority (224 of 267, 84%) of programs provided guidelines for expected message response times; less than half (115, 43%) monitored timeliness metrics. Only half (135; 51%) of programs required faculty supervision of inbox messages for all residents; 28% (76) did not require supervision for any residents. Twenty-one percent of PDs (56) reported awareness of a patient safety event occurring due to an unsupervised resident inbox-related patient care decision. Conclusions Substantial variability exists in how IM residency programs train, monitor, supervise, and provide coverage for resident inbox work. Program directors are aware of patient safety events resulting from unsupervised resident inbox management.
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Lin, Lisa Y., Grayson W. Armstrong, Matthew Gardiner, Alice Lorch, Suzanne K. Freitag, and Prashant Yadav. "Dedicated Chalazion Clinic as a Tool for Early Surgical Education in Ophthalmology Residency." Journal of Academic Ophthalmology 15, no. 01 (January 2023): e36-e40. http://dx.doi.org/10.1055/s-0043-1761275.
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Abstract Objective Ophthalmology residency programs aim to improve resident surgical teaching through increased surgical exposure over a 4-year period. Resident-centric surgical clinics across various surgical specialties have been established to help develop surgical autonomy and experience. We present the first demonstration of a resident-centric chalazion incision and drainage clinic (chalazion clinic) in an ophthalmology residency with the goal of increasing early surgical exposure to residents. Design The chalazion clinic was founded in July 2019. It is a once weekly procedure clinic conducted by an ophthalmology resident and supervised by an ophthalmology attending. Patients with chalazia were referred directly to this clinic for evaluation and management, rather than the oculoplastics clinic as they were in the past. Retrospective review of Accreditation Council for Graduate Medical Education (ACGME) case logs of all residents per academic year before and after establishment of the chalazion clinic was performed in order to assess the impact on residents' chalazion procedures numbers per academic year. Setting The study involved a single academic ophthalmology department. Participants Ophthalmology residents of all years were present. Results A resident of any year performed an average of 3.0 chalazion procedures per year in the 2018 to 2019 academic year, 3.8 in 2019 to 2020, and 8.4 in the 2020 to 2021, which represents a 180% increase in procedure numbers per resident. Among post-graduate-year 2s (PGY)2s, the average number of chalazion procedures increased from 2.1 procedure per year to 22.3 per year (961.9% increase). Conclusion To the best of our knowledge, this is the first description of a dedicated resident-centric chalazion clinic in an ophthalmology residency program. PGY2s demonstrated the largest increase in procedural numbers. While chalazion incision and drainage is a minor procedure, increased exposure to surgical procedures early in training could help improve residents' skills and confidence. This clinic provides a proof of concept of a dedicated minor procedure clinic for ophthalmology residents to increase early procedural volume.
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Tan, Alexander Sheng Ming, Shaun Xavier Ju Min Chan, David Soon Yiew Sia, Daniel En Shen Wong, Winston Eng Hoe Lim, Andrew Gee Seng Tan, and Bien Soo Tan. "Review of Junior Resident Plain Film Reporting and Audit in Singapore." Journal of Graduate Medical Education 12, no. 4 (August 1, 2020): 493–97. http://dx.doi.org/10.4300/jgme-d-19-00678.1.
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ABSTRACT Background Graduate medical education in Singapore recently underwent significant restructuring, leading to the accreditation of residency programs by the Accreditation Council for Graduate Medical Education–International (ACGME-I). In radiology, this involved a change in teaching and quality assurance of plain film (PF) reporting. PF reported by junior residents (postgraduate year 1–3) are subject to a 50% random audit. To date, national data on junior resident performance in PF reporting have not been published. Objective We reviewed performance in PF reporting under the current teaching and audit framework. Methods Retrospective review of junior resident reported PF audit data from all 3 radiology residency programs in Singapore. The number of residents audited, number of PF reported and audited, and major discrepancy rates were analyzed. Results On average, 86 440 PF were audited annually nationwide from an estimated 184 288 junior resident-reported PF. Each program trained between 4 to 24 junior residents annually (mean 15), averaging about 44 each year nationwide. A mean of 28 813 PF were audited annually in each program (range 4355–50 880). An estimated mean of 4148 PF (range 1452–9752) were reported per junior resident per year, about 346 PF per month. The major discrepancy rate ranged from 0.04% to 1.13% (mean 0.34%). One resident required remediation in the study period. Conclusions Structured residency training in Singapore has produced a high level of junior resident competency in PF interpretation.
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Sepulveda, Debra, and Kalli Varaklis. "Implementing a Multifaceted Quality-Improvement Curriculum in an Obstetrics-Gynecology Resident Continuity-Clinic Setting: A 4-Year Experience." Journal of Graduate Medical Education 4, no. 2 (June 1, 2012): 237–41. http://dx.doi.org/10.4300/jgme-d-11-00158.1.
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Abstract Background Although many residency programs are instituting quality improvement (QI) curricula in response to both institutional and external mandates, there are few reports of successful integration of resident initiated projects into these QI curricula with documented impact on health care processes and measures. Intervention We introduced a multifaceted curriculum into an Obstetrics-Gynecology continuity clinic. Following a needs assessment, we developed a didactic session to introduce residents to QI tools and the how to of a mentored resident-initiated project. Resident projects were presented to peers and faculty and were evaluated. A postgraduation survey assessed residents' satisfaction with the curriculum and preparedness for involvement in QI initiatives after residency. We also assessed whether this resulted in sustained improvement in health care measures. Results The curriculum was presented to 7 classes of residents (n = 25) and 17 resident initiated projects have been completed. Twenty-one residents (84%) completed the preintervention survey and 12 of 17 (71%) residents who completed the entire curriculum completed the postintervention survey. Sustained change in surrogate health measures was documented for 4 projects focused on improving clinical measures, and improvement in clinical systems was sustained in 9 of the remaining 13 projects (69%). Most of the respondents (75%, n = 9) agreed or strongly agreed that the projects done in residency provided a helpful foundation to their current QI efforts. Conclusion This project successfully demonstrates that a multifaceted program in QI education can be implemented in a busy Obstetrics-Gynecology residency program, resulting in sustained improvement in surrogate health measures and in clinical systems. A longitudinal model for resident projects results in an opportunity for reflection, project revision, and a maintenance plan for continued clinical impact.
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Nishisaki, Akira, Aaron J. Donoghue, Shawn Colborn, Christine Watson, Andrew Meyer, Calvin A. Brown, Mark A. Helfaer, Ron M. Walls, and Vinay M. Nadkarni. "Effect of Just-in-time Simulation Training on Tracheal Intubation Procedure Safety in the Pediatric Intensive Care Unit." Anesthesiology 113, no. 1 (July 1, 2010): 214–23. http://dx.doi.org/10.1097/aln.0b013e3181e19bf2.
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Background Tracheal intubation-associated events (TIAEs) are common (20%) and life threatening (4%) in pediatric intensive care units. Physician trainees are required to learn tracheal intubation during intensive care unit rotations. The authors hypothesized that "just-in-time" simulation-based intubation refresher training would improve resident participation, success, and decrease TIAEs. Methods For 14 months, one of two on-call residents, nurses, and respiratory therapists received 20-min multidisciplinary simulation-based tracheal intubation training and 10-min resident skill refresher training at the beginning of their on-call period in addition to routine residency education. The rate of first attempt and overall success between refresher-trained and concurrent non-refresher-trained residents (controls) during the intervention phase was compared. The incidence of TIAEs between preintervention and intervention phase was also compared. Results Four hundred one consecutive primary orotracheal intubations were evaluated: 220 preintervention and 181 intervention. During intervention phase, neither first-attempt success nor overall success rate differed between refresher-trained residents versus concurrent non-refresher-trained residents: 20 of 40 (50%) versus 15 of 24 (62.5%), P = 0.44 and 23 of 40 (57.5%) versus 18 of 24 (75.0%), P = 0.19, respectively. The resident's first attempt and overall success rate did not differ between preintervention and intervention phases. The incidence of TIAE during preintervention and intervention phases was similar: 22.0% preintervention versus 19.9% intervention, P = 0.62, whereas resident participation increased from 20.9% preintervention to 35.4% intervention, P = 0.002. Resident participation continued to be associated with TIAE even after adjusting for the phase and difficult airway condition: odds ratio 2.22 (95% CI 1.28-3.87, P = 0.005). Conclusions Brief just-in-time multidisciplinary simulation-based intubation refresher training did not improve the resident's first attempt or overall tracheal intubation success.
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Cote, David, and Amr Hamour. "Career Mentoring Surgical Trainees in a Competitive Marketplace." Canadian Journal of Career Development 21, no. 2 (September 9, 2022): 19–27. http://dx.doi.org/10.53379/cjcd.2022.343.
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Resident trainees in Canadian Otolaryngology–Head & Neck Surgery (OHNS) programs have cited job prospects as the biggest stressor they face. Increased numbers of residency training positions combined with decreased employment opportunities have worsened competition for surgical positions. The purpose of this inquiry was to explore gaps in resident career planning and examine how leadership can prepare graduating residents to optimize employability. This mixed-methods prospective study was completed in two phases. A combination of online surveys and two focus group sessions were used to gather information from academic and clinical staff surgeons, resident trainees, and administrative leadership. Eleven of the potential 12 resident participants responded to the initial survey, seven of the 13 staff surgeons, and one administrative leader. Each of the resident and staff focus groups had five participants. This comprehensive inquiry led to the development of a conceptual framework describing domains of concern important to OHNS residents. Themes included lack of career mentoring, complex systemic limitations, inadequacy of exposure to community-based surgical practice, and a potentially stifling organizational culture. OHNS residents face significant stress regarding potential employability following residency. Solutions to address concerns must be collaborative in nature and begin with the existing leadership structure.
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Walsh, Laura, Natasha Chida, Sam Brondfield, Ross C. Donehower, Kristen Marrone, and Parul Agarwal. "Resident Inpatient Curriculum for Oncology (RICO): Results of a targeted needs assessment performed in the Osler Internal Medicine Residency Program." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 365. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.365.
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365 Background: An important factor contributing to a resident’s interest in oncology training is early and consistent exposure to the field. Currently, completing an inpatient oncology rotation is associated with a decreased interest in pursuing a career in oncology and low resident satisfaction. The reasons for this are multi-factorial, including high task burden and limited dedicated teaching time. Fortunately, prior work has revealed that interest in oncology fellowship training increases when residents receive targeted educational material during their oncology rotations. As part of a multifaceted approach to improve the inpatient curriculum, we conducted a targeted needs assessment at our institution. Our goal is to improve resident satisfaction, clinical competency, and interest in pursuing subspecialty training in oncology by implementing a focused educational intervention. Methods: The Johns Hopkins Hospital is an urban academic medical center where the Osler Internal Medicine Residency Program of approximately 156 housestaff complete their training. A majority of these residents rotate through the inpatient solid tumor service. We performed a targeted needs assessment designed with the ABIM Blueprint, the solid tumor service learning objectives, and ACGME data specific to our program. The survey was created using Qualtrics software and distributed via email to all PGY-1, PGY-2, and PGY-3 residents. Results: 42.9% of residents participated in the survey. 79% of participants indicated they planned to pursue subspecialty training after residency with 21% of those in oncology. Approximately half of participants (45%) had rotated on the solid tumor service. 51% of participants reported barriers to education; the most common barriers identified were patient census and high resident task burden. “On the fly teaching” was the preferred instructional strategy by 70% of participants, followed by in-person didactics and asynchronous videos. The top three areas of interest for content creation were: basics of antineoplastic therapy, tumor lysis syndrome, and immune checkpoint inhibitor toxicities. Conclusions: Resident educational experiences on subspecialty rotations plays a strong role in the ultimate decision to pursue further training. Given the rising need for oncologists nationally, it is imperative that programs identify and address gaps in the educational experience on oncology rotations. Our needs assessment identified several concrete ways to improve resident experience on the Johns Hopkins inpatient solid tumor service. Next steps will include development and implementation of a high-yield resident inpatient curriculum for oncology (RICO), with focused assessments planned throughout the academic year to measure clinical competency, resident satisfaction and ultimately identify areas for further improvement.
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Dabir, Aman, Vincent Arnone, Beebarg Raza, Umer Najib, and Gauri V. Pawar. "Education Research: Appraisal of Outpatient Clinical Experience During Neurology Residency." Neurology: Education 2, no. 1 (January 23, 2023): e200046. http://dx.doi.org/10.1212/ne9.0000000000200046.
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Background and ObjectivesOutpatient clinical experience is a key component of neurology residency. Understanding the educational environment for residents in the outpatient setting can inform educators to maximize teaching and learning opportunities, enhance resident exposure to subspecialty diagnoses and management, and deliver quality care. We studied the continuity clinic experience of 5 neurology residents over the course of their residency to determine the breadth of their ambulatory experience.MethodsWe used administrative health data from new and return patient visits scheduled with 5 neurology residents of the same class over 3 years of continuity clinic. International classification of disease codes pertaining to neurologic diagnoses and symptoms associated with these visits were analyzed. Frequency and proportions of the most commonly evaluated diagnoses and symptoms were tabulated. These were compared with previously published data about resident experience during training. We also analyzed resident experience over time.ResultsFive neurology residents evaluated 948 patients (mean 189.6; range 180–202; 59.2% female) during 2,699 clinic visits (mean 539.8; range 510–576) over 3 years in their continuity clinics. There were 6,555 international classification of disease codes associated with these visits (2,948 [44.9%] neurologic diagnoses, 2,249 [34.3%] neurologic symptoms, and 1,358 [20.8%] comorbidities). The most common neurologic diagnoses were as follows: headache disorders (24.5%), neuromuscular disorders (17.3%), movement disorders (12.1%), cerebrovascular disorders (11.5%), and epilepsy (7.5%). The most common neurologic symptoms evaluated by residents were as follows: seizure-like events (16.5%), sensory symptoms (12.4%), pain (10.3%), headache (9.7%), and motor symptoms (8.1%).DiscussionThe clinical experience of residents in the continuity clinic was diverse, but it was skewed toward headache, neuromuscular, and movement disorders, which constituted 54% of the workload. When compared with previous studies, the range of resident's outpatient clinical experience differed from that of inpatient experience. Based on the results of this study, we made changes to our outpatient curriculum by adding 2-month–long rotations in subspecialty clinics from postgraduate year 2 to 4 with the aim of boosting resident exposure to neurologic disorders in the outpatient setting.
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Loo, Lawrence, Nishant Puri, Daniel I. Kim, Anas Kawayeh, Samuel Baz, and Douglas Hegstad. "“Page Me if You Need Me”: The Hidden Curriculum of Attending-Resident Communication." Journal of Graduate Medical Education 4, no. 3 (September 1, 2012): 340–45. http://dx.doi.org/10.4300/jgme-d-11-00175.1.
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Abstract Background Discrepancies exist between what resident and attending physicians perceive as adequate supervision. We documented current practices in a university-based, categoric, internal medicine residency to characterize these discrepancies and the types of mixed messages that are communicated to residents, as well as to assess their potential effect on resident supervision and patient safety. Methods We surveyed residents and attending physicians separately about their current attitudes and behaviors regarding resident supervision. Both groups responded to 2 different measures of resident supervision: (1) 6 clinical vignettes that involved patient safety concerns, and (2) 9 frequently reported phrases communicated by attending physicians to residents before leaving the hospital during on-call admission days. Results There were clear and substantial differences between the perceptions of resident and attending physicians about when the supervising attending physician should be notified in each of the 6 vignettes. For example, 85% of attending physicians reported they wanted to be notified of an unexpected pneumothorax that required chest tube placement, but only 31% of resident physicians said they would call their attending physician during those circumstances. Common phrases, such as “page me if you need me,” resulted in approximately 50% of residents reporting they would “rarely” or “never” call and another 41% reporting they would only “sometimes” call their attending physicians. Conclusions Our study found that attending physicians reported they would want more frequent communication and closer supervision than routinely perceived by resident physicians. Although this discrepancy exists, commonly used phrases, such as “page me if you need me,” rarely resulted in a change in resident behavior, and attending physicians appeared to be aware of the ineffectiveness of these statements. These mixed messages may increase the difficulty of balancing the dual goals of appropriate attending supervision and progressive independence during residency training.
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El-Korazati, Adila, Erin Peebles, Michael Miller, and Bojana Babic. "(MED) RESIDENT SATISFACTION IN CANADIAN PEDIATRIC RESIDENT CONTINUITY CLINICS." Paediatrics & Child Health 23, suppl_1 (May 18, 2018): e57-e57. http://dx.doi.org/10.1093/pch/pxy054.144.
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Abstract BACKGROUND Resident continuity clinics (RCCs) provide an opportunity for residents to gain experience with longitudinal care in an outpatient setting. RCCs have become a part of almost all recognized residency training programs across specialties in North America. However, the structure, function, and effectiveness of RCCs vary widely. OBJECTIVES To determine resident perspective on the structure and function of paediatric RCCs and investigate which factors were associated with resident satisfaction with paediatric RCCs. DESIGN/METHODS A qualitative survey of Canadian paediatric resident trainees was conducted to assess their RCC experience. The survey was administered through the REDCap© database and distributed through the Canadian Pediatric Program Directors Consortium in June-July 2016. RESULTS There were 127 respondents. Approximately 40% participated in RCCs. The majority of respondents were likely to recommend RCCs to other programs. The most common structure reported was a monthly half-day clinic overseen by an academic paediatrician. Referrals were mainly from inpatient wards, emergency department or family physicians. The majority of residents were satisfied with their experience (n=33, 71.7%). Participants in resident-run RCCs had more positive views compared to participants in staff-run RCCs (all U≥25.0, p≤0.009). Contributing factors to a positive RCC experience included patient-resident continuity, being viewed as the main care provider, and learning to make independent management decisions. CONCLUSION Almost all respondents felt that RCCs should be part of paediatric residency training. Further research is needed to determine the optimal structure for paediatric RCCs. Understanding our current training environment is an important precursor for informing program leadership and national policymakers who wish to improve ambulatory care training
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Arnstead, Neil, Paolo Campisi, Susan Glover Takahashi, Chris J. Hong, Florence Mok, Christopher W. Noel, Jennifer Siu, Brian M. Wong, and Eric Monteiro. "Feedback Frequency in Competence by Design: A Quality Improvement Initiative." Journal of Graduate Medical Education 12, no. 1 (February 1, 2020): 46–50. http://dx.doi.org/10.4300/jgme-d-19-00358.1.
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ABSTRACT Background Otolaryngology–head and neck surgery is in the first wave of residency training programs in Canada to adopt Competence by Design (CBD), a model of competency-based medical education. CBD is built on frequent, low-stakes assessments and requires an increase in the number of feedback interactions. The University of Toronto otolaryngology–head and neck surgery residents piloted the CBD model but were completing only 1 assessment every 4 weeks, which was insufficient to support CBD. Objective This project aimed to increase assessment completion to once per resident per week using quality improvement methodology. Methods Stakeholder engagement activities had residents and faculty characterize barriers to assessment completion. Brief electronic assessment forms were completed by faculty on residents' personal mobile devices in face-to-face encounters, and the number completed per resident was tracked for 10 months during the 2016–2017 pilot year. Response to the intervention was analyzed using statistical process control charts. Results The first bundled intervention—a rule set dictating which clinical instance should be assessed, combined with a weekly reminder implemented for 10 weeks—was unsuccessful in increasing the frequency of assessments. The second intervention was a leaderboard, designed on an audit-and-feedback system, which sent weekly comparison e-mails of each resident's completion rate to all residents and the program director. The leaderboard demonstrated significant improvement from baseline over 10 weeks, increasing the assessment completion rate from 0.22 to 2.87 assessments per resident per week. Conclusions A resident-designed audit-and-feedback leaderboard system improved the frequency of CBD assessment completion.
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Pien, Lily C., Christine A. Taylor, Elias Traboulsi, and Craig A. Nielsen. "A Pilot Study of a “Resident Educator And Life-long Learner” Program: Using a Faculty Train-the-Trainer Program." Journal of Graduate Medical Education 3, no. 3 (September 1, 2011): 332–36. http://dx.doi.org/10.4300/jgme-03-03-33.
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Abstract Purpose We sought to create a resident educator program using a Train-the-Trainer (TTT) approach with adaptable curricula at a large tertiary health care center with a medical school and 60 accredited residency programs. Methods The Resident Educator And Life-long Learner (REALL) Program was designed as a 3-phase model. Phase 1 included centralized planning and development that led to the design of 7 teaching modules and evaluation tools for TTT and resident sessions. Phase 2 entailed the dissemination of the TTT modules (Learning Styles, Observational Skills, Giving Feedback, Communication Skills: The Angry Patient, Case-Based Teaching, Clinical Reasoning, Effective Presentations) to faculty trainers. In phase 3, specific modules were chosen and customized by the faculty trainers, and implemented for their residents. Evaluations from residents and faculty were collected throughout this process. Results A total of 45 faculty trainers representing 27 residency programs participated in the TTT program, and 97% of trainers were confident in their ability to implement sessions for their residents. A total of 20 trainers from 11 residency programs implemented 33 modules to train 479 residents, and 97% of residents believed they would be able to apply the skills learned. Residents' comments revealed appreciation of discussion of their roles as teachers. Conclusion Use of an internal TTT program can be a strategy for dissemination of resident educator and life-long learner curricula in a large academic tertiary care center. The TTT model may be useful to other large academic centers.
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Brown, John W. "Training cardiac surgeons: the Indiana University experience." Cardiology in the Young 26, no. 8 (December 2016): 1484–90. http://dx.doi.org/10.1017/s1047951116002420.
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AbstractIn this article, I will outline the origin of cardiothoracic surgical (CTS) training at Indiana University (IU) and its evolution to the present. I will describe my educational background, surgical training in this specialty, and my role as an educator of CT surgeons. I will describe our faculty and the structure of the CTS residency. Finally, I will describe a newly adopted smart phone “App” called SIMPL, which allows the resident and faculty to quickly (<4 minutes) evaluate the CTS resident’s performance for each surgical case they perform together. The tool prompts both parties to determine the resident’s level of involvement in >50% of the most critical aspects of each surgical procedure, the resident’s performance during the critical portion of the operation from poor to excellent, and the degree of difficulty of the operation from simple to complex. The attending surgeon and the resident data are then forwarded to the SIMPL database where the SIMPL software aggregates data for each resident and procedure producing a report at the end of the rotation of the resident’s performance relative to his peers. This additional evaluation process will better ensure that our CTS residents are “practice ready” when they complete their training.
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Raman, Hari S., David D. Limbrick, Wilson Z. Ray, Dean W. Coble, Sophie Church, Ralph G. Dacey, and Gregory J. Zipfel. "Prevalence, management, and outcome of problem residents among neurosurgical training programs in the United States." Journal of Neurosurgery 130, no. 1 (February 2018): 322–26. http://dx.doi.org/10.3171/2017.8.jns171719.
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OBJECTIVEThe challenging nature of neurosurgical residency necessitates that appropriate measures are taken by training programs to ensure that residents are properly progressing through their education. Residents who display a pattern of performance deficiencies must be identified and promptly addressed by faculty and program directors to ensure that resident training and patient care are not affected. While studies have been conducted to characterize these so-called “problem residents” in other specialties, no current data regarding the prevalence and management of such residents in neurosurgery exist. The purpose of this study was to determine the rate and the outcome of problem residents in US neurosurgical residency programs and identify predictive risk factors that portend a resident’s departure from the program.METHODSAn anonymous nationwide survey was sent to all 108 neurosurgical training programs in the US to assess a 20-year history of overall attrition as well as the management course of problem residents, including the specific deficiencies of the resident, management strategies used by faculty, and the eventual outcome of each resident’s training.RESULTSResponses were received from 36 centers covering a total of 1573 residents, with the programs providing a mean 17.4 years’ worth of data (95% CI 15.3–19.4 years). The mean prevalence of problem residents among training programs was 18.1% (95% CI 14.7%–21.6%). The most common deficiencies recognized by program directors were poor communication skills (59.9%), inefficiency in tasks (40.1%), and poor fund of medical knowledge (39.1%). The most common forms of program intervention were additional meetings to provide detailed feedback (93.9%), verbal warnings (78.7%), and formal written remediation plans (61.4%). Of the identified problem residents whose training status is known, 50% graduated or are on track to graduate, while the remaining 50% ultimately left their residency program for other endeavors. Of the 97 residents who departed their programs, 65% left voluntarily (most commonly for another specialty), and 35% were terminated (often ultimately training in another neurosurgery program). On multivariable logistic regression analysis, the following 3 factors were independently associated with departure of a problem resident from their residency program: dishonesty (OR 3.23, 95% CI 1.67–6.253), poor fund of medical knowledge (OR 2.54, 95% CI 1.47–4.40), and poor technical skill (OR 2.37, 95% CI 1.37–4.12).CONCLUSIONSThe authors’ findings represent the first study to characterize the nature of problem residents within neurosurgery. Identification of predictive risk factors, such as dishonesty, poor medical knowledge, and/or technical skill, may enable program directors to preemptively act and address such deficiencies in residents before departure from the program occurs. As half of the problem residents departed their programs, there remains an unmet need for further research regarding effective remediation strategies.
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Reardon, Claudia L., Greg Ogrinc, and Art Walaszek. "A Didactic and Experiential Quality Improvement Curriculum for Psychiatry Residents." Journal of Graduate Medical Education 3, no. 4 (December 1, 2011): 562–65. http://dx.doi.org/10.4300/jgme-d-11-0008.1.
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Abstract Background Quality improvement (QI) education in residency training is important and necessary for accreditation. Although the literature on this topic has been growing, some specialties, in particular psychiatry, have been underrepresented. Methods We developed a didactic and experiential QI curriculum within a US psychiatry residency program that included a seminar series and development of QI projects. Evaluation included resident knowledge using the Quality Improvement Knowledge Application Tool, implementation of resident QI projects, and qualitative and quantitative satisfaction with the curriculum. Results Our curriculum significantly improved QI knowledge in 2 cohorts of residents (N = 16) as measured by the Quality Improvement Knowledge Application Tool. All resident QI projects (100%) in the first cohort were implemented. Residents and faculty reported satisfaction with the curriculum. Conclusions Our curriculum incorporated QI education through didactic and experiential learning in a moderately sized US psychiatry residency program. Important factors included a longitudinal experience with protected time for residents to develop QI projects and a process for developing faculty competence in QI. Further studies should use a control group of residents and examine interprofessional QI curricula.
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Bergman, Martin, Karl Gotthard, David Berger, Martin Olofsson, Darrell J. Kemp, and Christer Wiklund. "Mating success of resident versus non-resident males in a territorial butterfly." Proceedings of the Royal Society B: Biological Sciences 274, no. 1618 (May 2007): 1659–65. http://dx.doi.org/10.1098/rspb.2007.0311.
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Male–male competition over territorial ownership suggests that winning is associated with considerable benefits. In the speckled wood butterfly, Pararge aegeria , males fight over sunspot territories on the forest floor; winners gain sole residency of a sunspot, whereas losers patrol the forest in search of females. It is currently not known whether residents experience greater mating success than non-residents, or whether mating success is contingent on environmental conditions. Here we performed an experiment in which virgin females of P. aegeria were allowed to choose between a resident and a non-resident male in a large enclosure containing one territorial sunspot. Resident males achieved approximately twice as many matings as non-residents, primarily because matings were most often preceded by a female being discovered when flying through a sunspot. There was no evidence that territorial residents were more attractive per se , with females seen to reject them as often as non-residents. Furthermore, in the cases where females were discovered outside of the sunspot, they were just as likely to mate with non-residents as residents. We hypothesize that the proximate advantage of territory ownership is that light conditions in a large sunspot greatly increase the male's ability to detect and intercept passing receptive females.
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Dabrow, Sharon M., Elizabeth J. Harris, Luis A. Maldonado, and Rani S. Gereige. "Two Perspectives on the Educational and Administrative Roles of the Pediatric Chief Resident." Journal of Graduate Medical Education 3, no. 1 (March 1, 2011): 17–20. http://dx.doi.org/10.4300/jgme-d-10-00039.1.
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Abstract Purpose To investigate pediatric chief residents' responsibilities and determine how chief residents and program directors view the scope of the chief resident's role. Survey We distributed a 20-item survey to program directors and chief residents at all US pediatric residency programs. Questions pertained to activities performed and the level of importance of administrative, clinical, and educational activities. The survey also investigated motivating factors to become chief resident, future career plans, and level of job satisfaction. Results We received responses from 127 program directors and 101 chief residents. Of the chief residents, 98% (99/101) felt administrative tasks were very/somewhat important, followed by education, service, and research. Significantly more program directors than chief residents felt chiefs' overall workload was well balanced. Program directors gave higher ratings than chief residents on chief's ability to develop clinical skills (79% [95/121] versus 61% [61/100]) and manage stress and burnout (86% [104/121] versus 72% [72/100]). Future career plans for chief residents in decreasing order included fellowship, outpatient practice, academic practice, and working as a hospitalist. The most significant problems reported by the chief residents were lack of administrative support and lack of time spent in educational/clinical activities. Conclusions The chief resident role is primarily administrative, but program directors and chiefs feel teaching and clinical responsibilities also are important. Although the 2 groups agreed in many areas, program directors underestimated the administrative demands placed on the chief residents, and our findings suggest the chief resident role may be more fulfilling if the balance was shifted somewhat toward teaching and clinical responsibilities.
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Joyce, Barbara L., Eric Scher, Timothy Steenbergh, and Mary J. Voutt-Goos. "Development of an Institutional Resident Curriculum in Communication Skills." Journal of Graduate Medical Education 3, no. 4 (December 1, 2011): 524–28. http://dx.doi.org/10.4300/jgme-d-10-00233.1.
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Abstract Objective We describe a collaboration between the graduate medical education office and the Henry Ford Health System's Office of Clinical Quality and Safety to create an institution-wide communication skills curriculum pertinent to the institution's safety and patient- and family-centered care initiatives. Methods A multidisciplinary committee provided oversight for the curriculum design and used sentinel event and other quality and safety data to identify specific target areas. The curriculum consisted of 3 courses: “Informed Consent,” “Sharing Bad News,” and “Disclosure of Unanticipated Events.” Each course included 3 components: a multimedia online module; small group discussions led by the program director that focused on the use of communication scripts; and 2 objective structured clinical examinations (OSCEs) requiring residents to demonstrate use of the communication scripts. All first-year residents (N = 145) and faculty (N = 30) from 20 residency programs participated in this initiative. Evaluation of the residents consisted of a self-assessment; the standardized patients' assessment of the residents' performance; and faculty assessment of resident performance with verbal feedback. Results Survey data showed that residents found the courses valuable, with residents identifying communication scripts they would use in clinical settings. Focus groups with faculty highlighted that the resident debriefing sessions provided them with insight into a resident's communication skills early in their training. Conclusion Our institutional curriculum was developed in a collaborative manner, and used an evidence-based approach to teach communication skills relevant to institutional safety and quality initiatives. Other institutions may wish to adopt our strategy of departmental collaboration and alignment of resident education with institutional initiatives.
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Wallace, Erik A., Julie E. Miller-Cribbs, and F. Daniel Duffy. "An Experiential Community Orientation to Improve Knowledge and Assess Resident Attitudes Toward Poor Patients." Journal of Graduate Medical Education 5, no. 1 (March 1, 2013): 119–24. http://dx.doi.org/10.4300/jgme-d-12-00015.1.
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Abstract Background Future physicians may not be prepared for the challenges of caring for the growing population of poor patients in this country. Given the potential for a socioeconomic “gulf” between physicians and patients and the lack of curricula that address the specific needs of poor patients, resident knowledge about caring for this underserved population is low. Intervention We created a 2-day Resident Academy orientation, before the start of residency training, to improve community knowledge and address resident attitudes toward poor patients through team-based experiential activities. We collected demographic and satisfaction data through anonymous presurvey and postsurvey t tests, and descriptive analysis of the quantitative data were conducted. Qualitative comments from open-ended questions were reviewed, coded, and divided into themes. We also offer information on the cost and replicability of the Academy. Results Residents rated most components of the Academy as “very good” or “excellent.” Satisfaction scores were higher among residents in primary care training programs than among residents in nonprimary care programs for most Academy elements. Qualitative data demonstrated an overall positive effect on resident knowledge and attitudes about community resource availability for underserved patients, and the challenges of poor patients to access high-quality health care. Conclusions The Resident Academy orientation improved knowledge and attitudes of new residents before the start of residency, and residents were satisfied with the experience. The commitment of institutional leaders is essential for success.
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Foerster, Katherine, Karl Fischer, Michael Nguyen, Brian Gilbert, Karson Quinn, Stephen Helmer, and George Philip. "The Effects of COVID-19 on General Surgery Residency Programs in the United States." Kansas Journal of Medicine 16, no. 3 (September 25, 2023): 228–33. http://dx.doi.org/10.17161/kjm.vol16.20094.
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Introduction. The COVID-19 pandemic impacted multiple aspects of surgical education. This survey delineates steps taken by General Surgery residency programs to meet changing patient-care needs while continuing to provide adequate education. Methods. A survey was administered to program directors and coordinators of all United States general surgery residency programs to assess the early effects of the pandemic on residents from March 1 – May 31, 2020. Results. Of 303 programs contacted, 132 (43.6%) completed the survey. Residents were asked to work in areas outside of their specialty at 27.3% of programs. Residency curriculum was changed in 35.6% of programs, and 76.5% of programs changed their academic conferences. Resident schedules were altered at a majority of programs to limit resident-patient exposure, increase ICU coverage, or improve resident utilization. Surgical caseloads decreased at 93.8% of programs; 31.8% of those programs reported concerns regarding residents’ achieving the minimum case numbers required to graduate. Conclusions. These results provide insight into the restructuring of general surgery residency programs during a pandemic and may be used to establish future pandemic response plans.