1st-year Residents Research Articles

Dental education development reflection from an objective structured clinical examination

Background/purposeRecently, dental education has put emphasis on the assessment of clinical competencies using an objective structured clinical examination (OSCE). The purpose of this study was to assess several clinical competencies required for dental graduates by having dental students and residents of different levels take the same set of OSCEs. Materials and methodsTwelve 5th-grade dental students (D5), 12 dental interns (Ri), and 12 1st-year dental residents (R1) were recruited to take the same set of OSCEs composed of six stations: Station 1, explanation of a treatment plan for restoration of a missing tooth; Station 2, taking a study cast impression with alginate; Station 3, explanation of a treatment plan for restoration of an inlay; Station 4, explanation to a mother for taking a radiograph of her child's tooth; Station 5, placement of a rubber dam on a designated tooth and Station 6, explanation of pulpitis diagnosis and treatment. The examinee's performance was graded using both global rating and checklist scores. ResultsThere were significant differences in the mean global rating and checklist scores of Stations 3, 5, and 6 among the three groups. In Stations 3 and 5, Ri performed best, followed by R1 and D5. In Station 6, R1 performed best, followed by Ri and D5. In Stations 1, 2, and 4, there were no significant differences among the three groups. However, Ri performed better than R1 in Station 1. ConclusionMore emphasis should be placed on professional communication skills in the resident training program.

The Effects of Deliberate Practice and Feedback to Teach Standardized Handoff Communication on the Knowledge, Attitudes, and Practices of First-Year Residents

Background: Residents’ shift length reduction and communication errors in transitions of care necessitate educating residents on handoff communication. Purpose: We examined the change in knowledge, attitudes, and practices of 1st-year residents after implementing a curriculum using deliberate practice to teach handoff communication. Methods: First-year residents completed a needs assessment survey and a video assessment of handoff practices. They participated in a brief curriculum using lecture and deliberate practice with feedback to teach a standardized approach to handoff communication. Change in knowledge, attitudes, and practices were measured with survey and video assessments. Results: Eleven 1st-year residents completed the course and final assessments. Residents’ comfort with performing handoffs and their perceived efficiency indicated improvement. Practices improved, with increased inclusion of important features of handoffs (6.31 to 7.64, p < .001). Conclusions: A brief curriculum utilizing deliberate practice is an effective way to improve handoff practices of 1st-year residents.

The Responsible Use of Online Social Networking: Who Should Mentor Medical Students

Background: As medical students become more active in online social networking (OSN), there are increasing concerns regarding violations of patient privacy and a lack of professionalism. Purpose: Students need to be mentored, but who is best suited to the task? We hypothesized that residents are closer to students in usage and attitudes toward online communication than are faculty. If so, they would be more credible as mentors. Methods: We surveyed faculty (N = 16), 1st-year residents (N = 120), and 3rd-year medical students (N = 130) to compare attitudes about OSN and the online usage patterns. Results: We found residents to be more like students in usage patterns of personal electronic media and in their choice of the mentoring techniques that should be used. Conclusion: Residents say they were not prepared to mentor students without additional guidance but were more confident than faculty members that they had the knowledge to do so.

Does gender predict performance of novices undergoing Fundamentals of Laparoscopic Surgery (FLS) training?

BackgroundThis study was performed to assess the hypothesis that performance levels for Fundamentals of Laparoscopic Surgery (FLS) tasks were not dependent on trainee gender. MethodsInitial and final task completion times for 4 FLS tasks performed by 132 novices (4th-year medical students and 1st-year residents) were collated by task type and compared by gender. ResultsAll novices improved significantly with training (P > .001) on all tasks. Initial performance by men was better than by women but only reached significance for peg transfer and intracorporeal knot tying (P > .05). With training, women's performance became equivalent to that of men but showed a comparable or greater response to training. ConclusionsThe gender-related differences noted in initial FLS task performance disappeared after training. Gender displayed no effect on FLS training outcomes. The use of initial FLS task performance levels, seemingly objective selection criteria, would introduce gender bias into the ranking process.

Empathy in Korean psychiatric residents

Introduction: This study investigated the relationship between empathy and grades, marital status and personality in psychiatric residents. Methods: We sent a questionnaire package to 592 psychiatric residents in 82 psychiatric residency training hospitals. The questionnaire package collected socio-demographic data, and included the Jefferson Scale of Empathy, HP-version, Korean edition (JSE-HP-K), and Temperament and Character Inventory (TCI). Results: Fourth-year residents had significantly higher scores on the JSE-HP-K than 1st-year residents. Marital status and empathy had significant correlation. Married residents showed significantly higher scores on the JSE-HP-K. There were no significant differences in empathy with regard to age, sex, motivation towards medical science (entering medical school and psychiatry) and club activity. There was no significant correlation between subscales of the TCI and JSE-HP-K score. Discussion: These results suggest that empathy is associated with marital status and that psychiatry residency program contributes incrementally to empathy for residents.

Learning Social Medicine in the Bronx: An Orientation for Primary Care Residents

Background: Primary care educators face the challenge of teaching the social context of health and disease to clinicians. Description: Since 1975, the Residency Program in Social Medicine has trained clinicians to practice in urban underserved communities. During Orientation Month, 1st-year residents are relieved of inpatient duties and participate in learning activities addressing social and cultural aspects of health. Learning objectives include understanding patients’ social context, their community, and the role of physicians as professionals. Recent innovations include incorporating an overall theme, weekly case studies, “triple jump” exercises, community mapping projects, patient-led community tours, and theme-specific visits to community institutions (e.g., prisons). Evaluation: Residents complete weekly formative evaluations, a summative evaluation, and narrative reflections. Faculty complete an evaluative questionnaire. Conclusions: Orientation is a highly rated and valued part of our curriculum. Its success derives from ongoing curricular innovation and evolution, a departmental commitment to social medicine, and positive community response to our learners’ interest and energy.

Konzept und Evaluierung der Münchner Prüfarztkurse

The growing importance of clinical research in Germany requires physicians who are adequately trained to conduct clinical trials. In November 2007, the Coordination Centre for Surgical Studies at the University of Munich organised its third course for clinical investigators. The course was evaluated by the participants. PARTICIPANTS AND PROGRAMME: Participants included 1st-year residents as well as specialists mostly from surgical departments; many already possessed significant experience with clinical trials. In our course, special emphasis was put on the practical aspects of conducting clinical trials. On a scale from 1 to 6 (in German grading, 1 is the best score), participants rated content at 1.5, understanding at 1.6, and learning effect at 1.8. Careful preparation and a clearly structured curriculum resulted in significantly better evaluation of this course than of preceding courses (content P=0.015, understanding P=0.007, learning effect P=0.018). To realise projects of translational investigation and to participate in interdisciplinary clinical trials, surgeons in academic centres should obtain basic knowledge on clinical and pharmaceutical trials. Participants' statements on their own experience as clinical investigators underline the need for adequate training in this field. This course conveys essential knowledge of good medical practice and critical review of medical literature. We view this knowledge as a basic skill for modern medical practice and have therefore integrated the course into basic surgical training at our department. The concept of training for clinical investigation conducted at a surgical department is well established, and the participants' positive feedback motivates us to continue organising such courses.

Discrepancy Rates of Radiology Resident Interpretations of On-Call Neuroradiology MR Imaging Studies

To determine the discrepancy rates of radiology residents interpreting emergent neuroradiology magnetic resonance (MR) imaging studies and to assess any adverse clinical outcomes. Three hundred sixty-one brain and spine MR imaging and MR angiographic examinations that were ordered emergently after hours and given preliminary interpretations by radiology residents were retrospectively reviewed from December 1, 2006 to May 31, 2007 with institutional review board approval. Discrepancies between the interpretations of radiology residents and the final reports of attending neuroradiologists were classified as either false-negative (FN, failure to recognize abnormalities) or false-positive (FP, misinterpreting normal images as abnormal). Discrepancies that could affect patient care or clinical outcome were considered major. Overall, the agreement rate was 92.8%, the overall discrepancy rate was 7.2%, the major disagreement rate was 4.2%, and the minor disagreement rate was 2.2%. Misinterpretations among 1st-year residents on call were significant (P < .04) when compared with more senior-level residents. There were 23 FN interpretations. The most common misses were acute stroke (n = 3), aneurysm (n = 3), vascular occlusion (n = 3), and disk herniation (n = 2). There were only three FP interpretations (misdiagnoses of syrinx, arachnoiditis, and acute infarct). There was no adverse clinical outcome as a result of misinterpretations, owing in part to rapid turnaround time for final reporting. Level of residency training has a significant effect on the rate of discrepancy, which may be mitigated by recent changes regarding 1st-year radiology residents' overnight call.

Effort‐Reward Imbalance and Depression in Japanese Medical Residents

The effort-reward imbalance is an important psychosocial factor which is related to poor health among employees. However, there are few studies that have evaluated effort-reward imbalance among medical residents. The present study was done to determine the association between psychosocial factors at work as defined by the effort-reward imbalance model and depression among Japanese medical residents. We distributed a questionnaire to 227 medical residents at 16 teaching hospitals in Japan at the end of August 2005. We asked participants to answer questions which included demographic information, depressive symptoms, effort-reward imbalance, over-commitment and social support. Depression was evaluated using the Japanese version of the Center for Epidemiologic Studies-Depression (CES-D) scale. The effort-reward imbalance and over-commitment were assessed by the Effort-Reward Imbalance (ERI) questionnaire which Siegrist developed. Social support was determined on a visual analog scale. Logistic regression analysis was performed to determine the associations between effort-reward imbalance and depressive symptoms. Depressive symptoms were found in 35 (29.2%) 1st-year residents and 21 (27.6%) 2nd-year residents. The effort-reward ratio >1 (OR, 8.83; 95% CI, 2.87-27.12) and low social support score (OR, 2.77, 95% CI, 1.36-5.64) were associated with depressive symptoms among medical residents. Effort-reward imbalance was independently related to depression among Japanese medical residents. The present study suggests that balancing between effort and reward at work is important for medical residents' mental health.

Changing Morning Report: Evaluation of a Transition to an Interactive Mixed-Learner Format in an Internal Medicine Residency Program

Background: Morning report is an important conference for medical education, but direct comparisons of approaches to morning report have only rarely been reported. Description: During the 2003 to 2004 academic year, we conducted both our traditional single-learner-level morning report and a new highly interactive multiple-learner-level format. Attendees were rotating students, residents, and faculty on the inpatient general medicine services. Evaluation: We conducted anonymous surveys of participants to record their evaluations of the morning report formats. We received evaluations from 293 (60%) of 490 students, residents, and faculty. Students, 1st-year residents, and faculty preferred the mixed-learner model significantly more than did senior residents. Overall, more than 80% of participants rated the interactive multilevel format as good or very good when asked about content, discussion quality, level, and usefulness. Conclusions: An interactive morning report involving learners across multiple levels was well-received and has several educational benefits, with a greater emphasis on collaborative case discussion and active learning. Education leaders should remain open to experimenting with even the most well-established institutional traditions as they continuously reevaluate the effectiveness of teaching conferences.

RESEARCH BASIC TO MEDICAL EDUCATION: Comparison of Resident and Faculty Patient Satisfaction Surveys in a Pediatric Ambulatory Clinic

Background: Patient satisfaction is an important component of quality of care. To date, no studies have looked at differences in faculty and resident patient satisfaction in a pediatric practice. Purpose: The purpose was to compare physician measures of patient satisfaction among residents in training and faculty attendings. Methods: We conducted satisfaction surveys containing 4 questions related to physician performance at a children's health clinic. We compared satisfaction scores across training levels of physicians. Results: We analyzed 676 surveys. The 2nd-year and 3rd/4th-year residents had similar high scores on all questions compared to faculty preceptors. The 1st-year residents scored significantly lower than faculty preceptors, 3rd/4th-year residents, and 2nd-year residents on 1 question and the combined average of the 3 physician-specific questions. Conclusions: The 1st-year residents scored lower on patient satisfaction than physicians at higher levels of training. The 2nd-year and 3rd/4th-year residents achieved high satisfaction scores in a primary care clinic, comparable to scores of experienced practitioners.

Internists Training Medical Residents in Pelvic Examination: Impact of an Educational Program

Background: Pelvic examination is an important component of the primary care of women by internists, but training beyond medical school is rare.Description: We created an internist-run educational program for 1st-year medical residents in pelvic examination. The program consisted of 4 weekly patient-care sessions with 2 to 3 patients seen by each resident each session. Internists supervised each exam and gave real-time feedback and utilized a skills-assessment checklist during the first and last exams of the program to give comprehensive, formative feedback.Evaluation: We evaluated the program using a self-assessment questionnaire concerning pelvic examination competency and attitudes, which utilized a 5-point Likert scale and was administered prior to, and 3 months after, the program. A total of 37 participants completed the program and reported improvements in competency and a trend toward an increased likelihood of performing exams.Conclusions: This program, in which internists trained medical residents in pelvic examination, utilized real patients, improved participants self-assessed competency, and may increase the likelihood of residents performing pelvic examination in primary care.

Online radiology appropriateness survey: results and conclusions from an academic internal medicine residency.

This study was performed to evaluate the ability of medical trainees to choose appropriate diagnostic imaging studies for patients with various clinical indications. Twelve clinical scenarios were excerpted from the 2000 edition of the American College of Radiology appropriateness criteria and arranged in multiple-choice question format. Summary answers based on the criteria were written. The questionnaire and answer key were placed online and linked; the answer key was viewable only after all 12 answers were submitted by the trainee. An invitation to participate in the online survey was forwarded to medical house staff. Sixty-five (43.3%) of 150 potential respondents completed the survey. The results were tabulated for all respondents and separately for each postgraduate-year class. Fewer than 50% of the respondents correctly answered more than half of the 12 questions. The average number of questions answered correctly by 1st-year residents was 7.02; by 2nd-year residents, 7.5; and by 3rd-year residents, 7.9. Medical house staff are not adequately prepared to choose appropriate imaging examinations for specific indications. Improvements in education could prevent inappropriate use of radiology resources. Imaging centers might want to consider developing online catalogs to assist clinicians in choosing appropriate imaging tests.

A Qualitative Assessment of 1st-Year Internal Medicine Residents' Perceptions of Evidence-Based Clinical Decision Making

Background: Residents' perceptions about evidence-based clinical decision making remain largely unexplored. Purpose: To understand how residents perceive and use evidence-based medicine in clinical decision making. Methods: Qualitative study using a semistructured questionnaire and focus group in a postgraduate training program in internal medicine at an academic U.S. medical center. Seventeen 1st-year internal medicine residents in their 1st postgraduate year were interviewed. Six additional 1st-year residents formed a validation group. Results: The interplay of time and expertise modified how physicians-in-training incorporate evidence into clinical decision making. When time was available, the residents preferred to answer their questions by searching and critically appraising the literature. This "self-acquired" expertise empowered them to help patients by using participatory decision-making styles. When time was limited, the residents turned to experts. Residents assumed that experts practiced evidence-based medicine. This "borrowed" expertise was thought to be the most efficient way of integrating evidence and clinical expertise, but it led to the use of a parental style when answers were taken back to the bedside. Conclusion: The practice of evidence-based medicine empowers 1st-year residents and appears to affect their choice of decision-making style. Further research is needed to better understand the link between decision-making style and evidence-based medicine.

Training with Ultrasonography in Palpation of the Thyroid Gland for 1st-Year Medical Residents

Training with Ultrasonography in Palpation of the Thyroid Gland for 1st-Year Medical Residents

Call obligations in radiology residency: A survey

The authors evaluated the initial assignment of call responsibilities during residency, the effect on call obligations of the number of residents, and the differences between private and university programs and level 1 and non-level 1 trauma centers. A survey was sent to all 203 diagnostic radiology residency programs accredited by the Accreditation Council for Graduate Medical Education. Chief residents at 21 institutions were surveyed by phone or in person. Directors of residency programs in the Graduate Medical Education Directory received the survey electronically. Responses were received from 99 (68 university, 31 private practice) of the 203 programs. Nine (9%) reported both a decreased number of residents and a subsequent increase in call obligations. First-year residents generally began to accept calls with a senior resident or alone at a median of 6 months, although 15 (48%) private practice programs required them to accept calls alone before this time. First-year residents at university programs (31%) were more likely to assume call duties during the first 6 months accompanied by a senior resident. Maximum time before 1st-year residents started going on call was 13 months. Call obligations remain a resident responsibility. University and private practice programs differ more than level 1 and non-level 1 trauma centers.

Research and Discussion Note The Relationship between English Language Proficiency and Success as a Medical Resident

Deficiencies in English have been considered a barrier to success for international medical residents (IMGs). This study examines the relationship between English language proficiency and three measures of success: patient satisfaction, faculty and colleague evaluations, and scores on an objective test of medical knowledge.Methods: IMGs in the IM residency program (n = 99) were invited to take two English proficiency tests (TOEIC: Test of English for International Communication and SPEAK: Speaking Proficiency in English Assessment Kit). Three clinic patient satisfaction surveys, evaluations from three faculty and colleagues who had recently been co-members of a ward team, and scores from a recent in-training exam were collected for each participant. Correlations between the scores on the English proficiency tests and the three measures of success were determined using a Spearman r.Results: 20 IMGs participated in the study. 17 were male, 3 female; 10 were 1st-year residents, six 2nd-year and four 3rd-year; 12 native languages were represented. Results showed a significant relationship between TOEIC and SPEAK (P = 0.01) and between patient satisfaction and proficiency in English (P = 0.004). More than 50% of faculty and colleague respondents identified language skills as the primary weakness of this group; strengths were medical knowledge, attitudes\\professional behavior and clinical judgment. No relationship was found between the in-training exam and the English tests.Conclusions: Despite demonstrated proficiency in English, patient satisfaction and faculty\\colleague evaluation of IMGs were shown to be related to English language skills. Therefore, assessment and training in English for Medical Purposes and English for Specific Purposes by professionals is recommended.

Orientation To Social Medicine and The Bronx: An Educational Experience For Adult Learners

Background: Little attention has been paid to the orientation process used to assist residents in their transition from student to physician. Description: The Residency Program in Social Medicine of the Montefiore Medical Center/Albert Einstein College of Medicine developed an innovative orientation for 1st-year residents in primary care internal medicine, pediatrics, and family practice, built on the principles of adult education. Evaluation: Formative evaluation questionnaires from four orientation cohorts, 1990-93, were analyzed (total residents = 77, respondents = 66, response rate = 86%), including both quantitative (Likert scale) and qualitative assessments of its goals and learning activities. Over the 4 years analyzed, 95%of the residents' median evaluation met or exceeded their expectations. More than 60%of the residents' median evaluations of all learning activities were rated very good to excellent. Qualitative evaluations highlighted both the special virtues and drawbacks of such an adult learning experience. Conclusions: This orientation conforms to the principles of adult education and has consistently achieved its goals in orienting residents to the history, organization, and culture of their clinical institutions and community.

Fundamentals course for 1st-year radiology residents.

The authors set out to provide 1st-year residents with basic knowledge to make conferences more useful, to make their knowledge more uniform, and to assess their competency to begin night call. Faculty taught three afternoon sessions a week in subspecialty areas of radiology, including physics, during the 1st 6 months of residency. Material selected was believed to be essential for the understanding of that subspecialty's didactic lecture series. Emphasis was also placed on diagnoses residents would be expected to make once they began taking night call. Material was presented through lectures, images, and unknown cases. An examination was administered at the end of the course. Residents were allowed to begin night call only after completing the course and passing the final examination. All 1st-year residents completed the course and passed the examination. Their scores ranged from 70% to 83.3%. Residents liked the course and reported feeling ready to begin call. Faculty reported the residents who completed the course were more knowledgeable prior to formal rotations than residents from previous years who had not taken the course.

Results of the 1996 survey of the American Association of Academic Chief Residents in Radiology.

Diagnostic radiology chief residents were surveyed on issues related to residency training to compare features and gauge trends in training. Questionnaires were mailed to accredited programs in the United States. A variety of demographic and common-interest questions were asked. Forty-three percent of surveys were returned. The percentage of female residents was similar to that reported in other recent surveys; however, the percentage of women among 1st-year residents had decreased. Resident salaries had increased, although the average salary for a 4th-year resident had decreased when adjusted for inflation. Most 1st-year residents started participating in overnight hospital coverage by their 12th month of residency, and the total number of call days during residency correlated inversely with the size of the residency program. Almost half of residency programs used a night-float resident to provide after-hours coverage. The information derived from the survey should be useful for program evaluation and future planning.