An Ecosystem of Support: A U.S. State Government-Supported DIY-AT Program for Residents with Disabilities

The AAOS Resident Assembly.

GME on the Frontlines-Health Impacts of COVID-19 Across ACGME-Accredited Programs.

COVID-19 and the Radiology Match: A Residency Program's Survival Guide to the Virtual Interview Season

NEARLY HALF OF ALL PREGNANCIES IN THE UNITED STATES ARE unintended and approximately half of those are electively terminated. In 2000, approximately 1.31 million abortions were performed in the United States, but access to abortion services has decreased during the last 14 years. In 2000, 87% of US counties were found to have no abortion services and 99% of all facilities that perform more than 400 terminations per year were located in metropolitan areas. The uneven availability of abortion services influences the distance that women must travel to obtain an abortion, the cost, and the timing of termination, thereby creating barriers to access. This decrease in access has largely been attributed to a shortage of sites where abortion is provided. In 2000, there were a total of 1819 sites where abortion procedures were performed, representing an 11% decrease since 1996 and a 37% decrease since 1982. Legal restrictions, violence and harassment against clinicians who perform abortion, and the aging of clinicians who provide abortion have all been identified as factors influencing the decreased availability. The decline in abortion services has also coincided with a decline in routine abortion training in residency programs. The percentage of obstetrics and gynecology residency (OB/GYN) programs that routinely included firsttrimester abortion training decreased from 23% in 1985 to 12% in 1991. Second-trimester abortion training was routinely provided in 21% of programs in 1985 but only 7% of programs in 1991. The decision to provide abortions is multifactorial, with personal, moral/religious, experiential, situational, and professional influences. However, studies have shown that training opportunities correlate with future provision of abortion services, comprehensive options counseling, and referrals. Following the decline in routine abortion training in residency programs, medical students and professional organizations began to mobilize for reform. In 1993, in response to the shortage of abortion services and growing anti-choice activity, medical students mobilized to form Medical Students for Choice (MSFC), a grassroots organization with more than 7000 members in the United States and Canada. MSFC’s first organizing effort was to petition the Accreditation Council for Graduate Medical Education (ACGME) to make abortion training a required component of OB/GYN residency programs. In 1995, responding to both the decline in residency training opportunities and the increasing shortage of abortion services, the ACGME made more explicit the requirement that all OB/GYN residency programs seeking accreditation provide routine abortion training. The ACGME requirements differentiate between spontaneous abortion and induced abortion, mandating that all residents obtain training in the management of spontaneous abortion. With respect to induced abortion, residency programs are required to provide “access to experience” and residency programs and/or individual residents with religious or moral objections are allowed to opt out of induced abortion training. This “access” can be provided as either an elective or a required rotation and, unlike other OB/GYN procedures, the mandate does not require that residents perform induced abortion procedures. The ACGME mandate took effect January 1, 1996. A survey of program directors in 1998 suggested that as many as 46% include routine first trimester abortion training. However, all surveys of training programs have been limited by low response rates, lack of resident input, and the absence of clear distinctions between “routine” and “optional” abortion training. Thus the actual prevalence of abortion training remains unknown. Enforcement of the ACGME requirement was made more difficult when the US Congress adopted what has been termed the Coats Amendment. The Coats Amendment to the Omnibus Consolidated Rescissions and Appropriations Act of 1996 (Pub L 104-134) states that residency programs will be deemed accredited by the federal government, or any state or local government that receives federal funds, even if programs fail to comply with abortion training accreditation requirements. Thus, a residency program that chooses not to provide abortion training to its students either in its own facilities or through an arrangement with another facility is protected from loss of federal funding. Similarly, state and local governments that receive federal funding must also treat these program as accredited and cannot refuse them “legal status . . . financial funding, or other benefits.” In response to constituents’ requests for clarification, the ACGME rewrote its guidelines to require that residency programs with a moral or religious objection to abortion not impede students from seeking abortion training elsewhere. The Coats Amendment is not the only legislative initiative to challenge full implementation of the ACGME abortion training requirements. Several states have enacted legislation that prohibits public institutions from providing elective abortion services. Although these residency programs can still be in compliance with the ACGME requirements if they provide access to abortion training at an outside institution, these state initiatives make implementation of the ACGME requirements difficult. Recent initiatives in New York and California have attempted to increase abortion training opportunities in OB/ GYN residency programs and implement the ACGME man-

Virtual Recruitment: Experiences and Perspectives of Internal Medicine Program Directors

To describe the structure and role of morbidity and mortality rounds (MMR) in resident training programs of the American College of Veterinary Surgeons (ACVS). Cross-sectional analysis: survey. ACVS surgical resident program directors. Electronic surveys consisting of 27 questions were sent to the directors of 142 ACVS resident programs. Forty-five (31.6%) programs completed the survey, including 24 (53.3%) from small animal programs and 21 (46.7%) from large animal programs. Thirty-two (71.1%) programs incorporated regular MMR in their training. The primary goal of these rounds was improvement of patient care (63%) and education (31%). Selection of cases was based on unexpected mortality (80%), unexpected morbidity (77.4%), teaching value (65.7%), and review of medical errors (63%). Twenty-six percent of programs reported conducting formal follow-up for topics discussed during MMR. Ninety-five percent of programs believed that MMR were valuable. MMR are commonly incorporated in surgical resident training programs. The primary objectives of these rounds are to educate residents, refine hospital medical and operational policies, and to improve patient care. The majority of residency programs view MMR as worthwhile. However, the majority of veterinary residency programs fail to follow up MMR with formal initiatives for improvement and objective outcome assessments for issues identified during MMR.

Digital Footprint of Vascular Surgery Training Programs in the United States and Canada

Integrated cardiothoracic surgery: Developing a successful residency application

Trends in geographic and home program preferences in the dermatology residency match: A retrospective cohort analysis

The authors describe the impact of the Title VII, Section 747 Training in Primary Care Medicine and Dentistry (Title VII) grant program on the development, growth, and expansion of general and pediatric dentistry residency programs in the United States. They first briefly review the legislative history of the Title VII program as it pertains to dental education, followed by a historical overview of dental education in the United States, including a description of the differences between dental and medical education and the routes to professional practice. The authors then present an extensive assessment of the role of the Title VII grant program in building general and pediatric dental training capacity, diversifying the dental workforce, providing outreach and service to underserved and vulnerable populations, stimulating innovations in dental education, and engaging collaborative and interdisciplinary training with medicine. Finally, the authors call for broadening the scope of the Title VII program to allow for predoctoral training (dental student education) and faculty development in general and pediatric dentistry. In doing so, the Title VII program can more effectively address current and future challenges in dental education, dentist workforce, and disparities in oral health and access to care.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

The evolution and expansion of a school of pharmacy-sponsored resident teaching and learning program (RTLP) are described. Since its establishment in 2012, Auburn University Harrison School of Pharmacy's RTLP has grown to include up to 12 residency programs in Alabama and on the Gulf Coast of Mississippi and Florida. Program requirements include seminar attendance, teaching experiences and observations, and development of an electronic teaching portfolio. Residents are provided support and guidance from an assigned faculty mentor and from chosen teaching mentors in each teaching activity. A program satisfaction survey was developed to assess residents' reasons for RTLP participation and their views on the manageability of program requirements, the level of residency program support received, the usefulness of seminar content, and other aspects of the program. Resident feedback has been used by RTLP coordinators to modify and refine program requirements. Major changes have included a switch to alternative information delivery mechanisms, clarification of mentor roles and responsibilities, and a transition from longitudinal seminars to intensive workshop days. At the end of the 2016-17 residency year, the RTLP had hosted a total of 66 residents from 12 different residency programs, with a 93.9% retention rate and a more than 3-fold increase in total resident enrollment. Evolution of a school of pharmacy-sponsored RTLP was essential to meet the growing needs of affiliated residency programs while optimizing faculty resources.

Effect of COVID-19 on Urology Residency Training: A Nationwide Survey of Program Directors by the Society of Academic Urologists.

Integrated cardiothoracic surgery: Navigating interviews and the match

Introduction: With the globalization of higher education through online training, opportunities exist for collaboration between institutions to promote ongoing advancement of healthcare professionals in resource-limited countries. The success of these programs is dependent on the ability of the program to meet the educational needs of the student and assist with implementation of the new information into practice. A post graduate residency program for physical therapists was introduced to Kenya to promote the development of the profession of physical therapy. This study sought to explore barriers that affected participation in the residency program, and how participants perceived the residency program fostered the use of new skills in the clinical environment, as well as the limitations they faced in applying the skills gained through the residency program in a clinical setting.Methods and Materials: The participants in this study were in the third and fourth cohorts of the residency program (n = 27). One-on-one interviews were performed with the residents following completion of the program. A qualitative phenomenology research design was used to describe the manner in which the residency was experienced within the context of the environment in which the experience took place. Descriptions and narratives were obtained from the residents to provide a window into their lived experience.Results: Four themes were discovered: (1) The ongoing challenge to balance often conflicting responsibilities: family, work and education, (2) A need to educate patients and colleagues on newly acquired skills to gain acceptance, (3) Success in the program requires reliance on support networks, and (4) Increased confidence gained in delivery of patient care.Discussion: Although the residents faced obstacles for completing the residency and integrating newly acquired knowledge and skills into clinical practice, they were able to formulate strategies to meet these challenges. Understanding the barriers and facilitators that affect participants in international collaborative efforts may ultimately assist residency and other educational programs in designing new models of education, which will advance the physical therapy profession globally.

The designated institution official (DIO) is responsible for monitoring all residency programs within an institution. Although program-evaluation tools have been developed for residency program directors to use, there are currently no such published evaluation tools for DIOs. This manuscript describes the development and implementation of a standardized, dimensional program report card for the more than 60 residency and fellowship programs at our institution. This report card measures the theoretical construct of residency program performance and is divided into four sections: (1) quality of candidates recruited, (2) the resident educational program, (3) graduate success, and (4) overall house officer satisfaction. Each section is measured by objective and subjective metrics that allow the DIO to record programmatic strengths and weaknesses. These results are confidentially shared with the residency program director and encourage a partnership between the DIO and the program director. It is difficult to provide concrete construct validity with this instrument. The process used to develop the report card seems valid. The authors recognize that this report card is a surrogate for each program's RRC's perception of quality. In the future, the authors hope to work closely with the Accreditation Council for Graduate Medical Education and/or the group on resident affairs of the Association of American Medical Colleges to set national benchmark criteria for acceptable residency program performance for each medical discipline. They hope that DIOs and program directors will be able to compare residency programs objectively and identify areas for improvement at a local and national level.