Accreditation Council For Graduate Medical Education-International Research Articles

Residents' Report of COVID-19 Associated Training Disruptions, Stressors, and Opportunities During the Pandemic-The Singapore Experience.

The COVID-19 pandemic has disrupted residency training. Several studies have been performed to investigate the impact of the pandemic on residency training in Accreditation Council for Graduate Medical Education-International (ACGME-I)-accredited institutions. However, these were either limited to certain specialties or failed to consider possible opportunities from the pandemic. To determine the stressors on residents as well as the opportunities that arose from the COVID-19 pandemic across multiple specialities in Singapore. A cross-sectional survey among SingHealth residents was conducted between July and September 2020. The survey assessed the balance between service and training during hospital postings, the pandemic's influence on examination and teaching, the psychological impact of the pandemic, the level of burnout, and the effect on morale of residents during the pandemic. The response rate was 27.1% (253 of 934). Out of the 253 residents, 136 (53.8%) felt stressed during the pandemic. Concerns about family's health and safety pertaining to potential COVID-19 infection, progression in training, and completion of examinations were the top 3 stressors. One-hundred and three residents (40.7%) had their training disrupted either by being placed in an interim posting not part of their residency requirements or being deployed to care for patients with COVID-19. Although administrative support and information for virtual teaching were sufficient, only 108 (42.7%) agreed it had the same value as face-to-face sessions. Despite the challenges, 179 (70.8%) thought that experiencing this crisis provided more meaning in their career. The COVID-19 pandemic has brought about challenges and learning opportunities for residents.

Detecting residents at risk of attrition – A Singapore pathology residency's experience

The SingHealth Pathology Residency Program (SHPRP) is a 5-year postgraduate training program in Singapore. We face the problem of resident attrition, which has a significant impact on the individual, program and healthcare providers. Our residents are regularly evaluated, using in-house evaluations as well as assessments required in our partnership with the Accreditation Council for Graduate Medical Education International (ACGME-I). We hence sought to determine if these assessments were able to distinguish residents who would attrite from residents who would graduate successfully. Retrospective analysis of existing residency assessments was performed on all residents who have separated from SHPRP and compared with residents currently in senior residency or graduated from the program. Statistical analysis was performed on quantitative assessment methods of Resident In-Service Examination (RISE), 360-degree feedback, faculty assessment, Milestones and our own annual departmental mock examination. Word frequency analysis of narrative feedback from faculty assessment was used to generate themes.Since 2011, 10 out of 34 residents have separated from the program. RISE, Milestone data and the departmental mock examination showed statistical significance in discriminating residents at risk of attrition for specialty-related reasons from successful residents. Analysis of narrative feedback showed that successful residents performed better in areas of organization, preparation with clinical history, application of knowledge, interpersonal communication and achieving sustained progress. Existing assessment methods used in our pathology residency program are effective in detecting residents at risk of attrition. This also suggests applications in the way that we select, assess and teach residents.

Implementing a Pediatric Residency Program in Central Asia in Compliance with ACGME-International Standards: First Experience from Kazakhstan

The Graduate Medical Education (GME) became an essential part of the physician’s professional curriculum all over the world, no matter the specific model developed across different countries. The “Residency” represents the main GME model in North America, where it is regulated and organized according to the standards of the Accreditation Council for Graduate Medical Education (ACGME). This model has been exported outside North America through the ACGME International (ACGME-I) program. This article reports the first experience of implementing an ACGME-oriented Pediatric Residency Program in Central Asia at the Nazarbayev University School of Medicine in the Republic of Kazakhstan. The vision, general project, main organizational aspects, and challenges of this Pediatric Residency Program are described and discussed in this article.

Post-Graduation Anesthesiology Program in Qatar, Viewpoints and Future Challenges

Qatar is a country located on the east shores of the Arabian Peninsula. In the past three decades, Qatar has experienced significant changes in its educational and healthcare systems. At the time of writing this paper, there are two accredited Faculties of Medicine, which offer students from all over the world the possibility of becoming doctors. Residency Programs are taught in English and are accredited by Accreditation Council for Graduate Medical Education-International (ACGME-I). In this paper, we outline the organisation of Qatar medical education at undergraduate and postgraduate levels, with particular emphasis on the postgraduate anaesthesiology residency program. We outline the opportunities for curriculum development and its future challenges.

An eLearning program to prepare residents for a rotation in pediatric emergency medicine: A qualitative study

Background: To meet ACGME-I (Accreditation Council for Graduate Medical Education–International) training and duty hour requirements, we converted our 3-week-long pediatric emergency medicine induction program to an eLearning program. Objectives: The study aimed to identify areas of the eLearning program residents perceived useful and the components that helped them prepare for clinical work. Methods: The qualitative study took place in a tertiary pediatric emergency department. Twenty-seven residents from family medicine, emergency medicine, and pediatric medicine participated in focus group discussions to explore how they perceived the eLearning program helped prepare them for work. The interviews were audio-recorded, and transcripts were analyzed and coded into categories and themes. Results: Four themes emerged from the data analysis: residents’ access to the eLearning program, instructional methods, eLearning design elements, and supplementary learning. Residents valued autonomy to control their pace of learning and use online features that matched their preferred learning styles. Design features such as the use of questions and quizzes helped stimulate learning, but attention had to be paid to the order of questions in the modules and the format of the questions. Written guidelines served as a good reference for learners and face-to-face sessions accompanying the eLearning program helped reinforce knowledge and offered opportunities to interact with faculty members to clarify questions. Conclusion: Systematic planning focusing on access, instructional methods, and design is essential when creating eLearning programs for residency training. eLearning programs can be enhanced by the incorporation of team-based learning and having accompanying written content to reference.

Determining Competence in Performing Obstetric Combined Spinal-epidural Procedures in Junior Anesthesiology Residents: Results From a Cumulative Sum Analysis

(Int J Obstet Anesth. 2020;44:33–39) Epidural techniques can be challenging to master and require practice. The required number of cases to demonstrate competency in epidural procedures varies widely. Residents must complete 40 epidural or combined spinal-epidurals (CSEs) to show competency according to Accreditation Council for Graduate Medical Education International (ACGME-I) requirements. At the study center, CSE training consists of didactic teaching, 10 one-on-one supervised sessions using a model, and 10 supervised and coached CSEs, followed by 3 Direct Observation of Procedures assessments. This study used cumulative sum (CUSUM) analysis, a tool for defining failure rates, plotting learning curves and mapping levels of competence, to determine the minimum experience needed to demonstrate competency in obstetric CSE procedures among junior residents.

International Residency Program Directors on Implementing Educational Transformation: A Qualitative Study of Their Experiences and Strategies for Overcoming Challenges.

Residency program directors (PDs) need to navigate diverse roles and responsibilities as clinical teachers, administrators, and drivers of educational improvement. Little is known about the experience of PDs leading transformation of international residency programs. We explored the lived experiences of international residency PDs and developed an understanding of how PDs manage educational program transformation. Using a phenomenological approach, semi-structured interviews were conducted with current and former PDs involved in the transformation to competency-based medical education in the first international settings to be accredited by the Accreditation Council for Graduate Medical Education-International (ACGME-I). Thirty-three interviews with PDs from Qatar, Singapore, and the United Arab Emirates were conducted from September 2018 to July 2019, audio-recorded, and transcribed. Data were independently coded by 2 researchers. A thematic analysis was conducted and patterns that reflected coping and managing educational reform were identified. PDs described distinctive patterns of navigating the educational transformation. Five themes emerged: PDs (1) embraced continuous learning and self-development; (2) managed change in the context of their local settings; (3) anticipated problems and built support networks to effectively problem-solve; (4) maintained relationships with stakeholders for meaningful and constructive interactions; and (5) focused on intrinsic qualities that helped them navigate challenges. International PDs were presented with significant challenges in implementing educational transformation but coped successfully through distinctive patterns and methods.

DOES RESTRUCTURING THE RESEARCH CURRICULUM OF ORTHOPEDIC TRAINING PROGRAM AFFECT THE RESEARCH PERFORMANCE? EVIDENCE FROM QATAR

Background: The participation of trainees and faculties in the research is an integral part of postgraduate medical training and education. The educational curriculum of the training program should be structured to support the learning of the trainees scholarly activities, address research barriers, foster a culture of inquiry, and improve their research performance. The Accreditation Council for Graduate Medical Education International (ACGME-I) standards include participation in scholarly activities by residents and faculties as an essential requirement of the training program.The possible effects of research-based curriculum after accreditation of postgraduate training program on the research performance was examined in a longitudinal study of the orthopedic training program. Methods: Web-based systematic review for all publicationsfrom our orthopedic training program and only pubmed index publications of other institutional programs before (2009-2013) and after (2014-2018) accreditation was conducted. Data for the type of publications, journal name, impact factors, dates published, orthopedic specialty, level of evidence,and the role of residents and faculties in the authorship were collected.The research academic degree of residents, number of residents applied and matched for a fellowship in North America and/or UK were collected from a residents portfolio. Results: The orthopedics training program published a total of 50 articles between 2009 and 2018, which represented 2% of all other institutional programs publications. There was a significant improvement in the number of publications from three (6%) to 47(94%) articles before and after accreditation, respectively. There were 19(38%) original researches, 17(34%) review articles, 13(26%) case reports, and one letter to the editor. International Orthopedics was the most commonly used journal with ten publications (25%). Most of the publications were in orthopedic trauma with 18 articles (36%), 10(20%) pediatric orthopedics, 7 (14%) foot and ankle and 7(14%) spine articles. The residents were the first author in 50% of publications, and at least one-third were published during their training. Conclusion: This study showed that the development of the structured research based educational curriculumof the residency training program after accreditation helped in enhancing the research performance and publications in our postgraduate training program. Restructuring of the research-based curriculum after accreditation of the program appears to increase the trainees and faculties chances of being an author or co-author of a scientific article.

Levels of burnout and its association with resilience and coping mechanisms among orthopaedic surgery residents: a single institution experience from Singapore.

Introduction:Burnout has implications for surgeon wellbeing and patient care. We aimed to: (a) describe burnout levels among orthopaedic surgery residents in an Accreditation Council for Graduate Medical Education-International (ACGME-I) accredited programme; and (b) determine associations between burnout levels and resident characteristics, resilience and coping mechanisms.Methods:This is a grant-funded, cross-sectional questionnaire-based study that included 44 orthopaedic surgery residents. Burnout was measured using Maslach Burnout Inventory and resilience was determined using the Short Grit Scale. Coping mechanisms were determined using the Brief Coping Orientation to Problems Experienced scale.Results:20 (45.5%) residents fulfilled the criteria for burnout. High levels of emotional exhaustion (EE) and depersonalisation (DP) correlated with stressors, such as inadequate sleep (EE: r = 0.43, P <0.01; DP: r = 0.33, P <0.05), conflict between family and work (EE: r = 0.40, P <0.01; DP: r = 0.40, P <0.01), financial pressure (DP: r = 0.46, P <0.01), and conflict with residents (EE: r = 0.35, P <0.05; DP: r = 0.34, P <0.05) and faculty (EE: r = 0.44, P <0.01; DP: r = 0.35, P<0.05). Severe burnout was associated with lower grit scores (p <0.05). Coping mechanisms, such as planning and positive reframing, were protective while behavioural disengagement and substance use may increase burnout risk.Conclusion:Burnout was high in our ACGME-I accredited programme. Stressors associated with higher burnout included feeling of inadequate sleep, poor work-life balance, poor relationships with fellow residents/faculty and financial pressures. Residents should be educated on protective coping mechanisms and regular screening to detect burnout should be performed.

Graduate Medical Education Accreditation Across Borders: Toward a Remote Alternative.

Graduate Medical Education Accreditation Across Borders: Toward a Remote Alternative.

Psychotherapy training for psychiatrists: an exploratory study of its impact on training, attitudes, and clinical care

ABSTRACT The introduction of the Accreditation Council for Graduate Medical Education International (ACGME-I) psychiatry residency in Singapore heralded unprecedented changes, including the inclusion of psychotherapy training. This study aims to examine the impact of psychotherapy training in residents compared to non-residents, who did not undergo formal psychotherapy training. This exploratory mixed-method study integrates data from a survey measuring self-rated competencies in psychotherapy (n=56) and focus-group discussions (n=10). Residents were more confident in cognitive-behavioural therapy (CBT: Cohen’s d 0.07 to 0.89) and psychodynamic therapy (PDP: Cohen’s d 0.61 to 1.11). Supervision and competing demands between service and training were cited as factors influencing learning experience. Further evaluation of the impact on patient care will strengthen understanding of psychotherapy on clinical outcomes.

Medical Education Reform in China: The Shanghai Medical Training Model.

Medical Education Reform in China: The Shanghai Medical Training Model.

Program Director Retention and Attrition Rates in International Graduate Medical Education.

Program directors (PDs) are integral to the education of the next generation of physicians. Yet, administrative burdens, substantial patient care responsibilities, and lack of protected time for teaching may contribute to work-life imbalance and physician burnout, leading to high rates of attrition. Data on international residency program leadership turnover are lacking. This study aimed to quantify PD turnover in Accreditation Council for Graduate Medical Education-International (ACGME-I) accredited programs in Singapore, United Arab Emirates (UAE), and Qatar, and to compare to US PD attrition rates. Data on PD turnover in international programs was extracted from the ACGME-I Accreditation Data System for academic years 2010-2011 through 2018-2019 for Singapore and 2013-2014 through 2018-2019 for UAE and Qatar. Rates of PD turnover were calculated by country and by ACGME-I medical-, surgical-, and hospital-based specialty groupings and compared using χ2 test. Annual US PD turnover data was extracted from the ACGME's Data Resource Book. Seventy programs met inclusion criteria. International PD attrition was high, with 56 programs (80%) changing PDs since program inception, and 16 programs (29%) having 2 or more PD turnovers. There was no significant difference between PD turnover rates in hospital (83%), medical (79%), or surgical (78%) specialties. International PD attrition rates varied from 7% to 20% annually and were comparable to PD turnover in US programs (range 12%-15%). High PD turnover rates in newly accredited international residency programs were noted, although annual attrition rates were comparable to US residency programs.

Review of Junior Resident Plain Film Reporting and Audit in Singapore.

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. We reviewed performance in PF reporting under the current teaching and audit framework. 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. 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. Structured residency training in Singapore has produced a high level of junior resident competency in PF interpretation.

Challenges and adaptations in training during pandemic COVID-19: observations by an orthopedic resident in Singapore

Orthopedic surgery training in Singapore is provided by 3 Accreditation Council for Graduate Medical Education International (ACGME-I) accredited residency programs. Mandatory clinical rotations in...

Trait Emotional Intelligence and Its Correlates in Oman Medical Specialty Board Residents.

As part of the globalization of medical education, residency programs in Oman have adopted competency-based standards by the Accreditation Council for Graduate Medical Education International (ACGME-I). Correctly perceiving the emotions of others and managing one's own emotions are essential to high-quality patient care. We tested the reliability and construct validity of the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), and assessed trait Emotional Intelligence (EI) in Oman Medical Specialty Board (OMSB) residents in multiple specialties. We explored for correlations with trainees' sociodemographic background data. We conducted a cross-sectional, observational study between February and August 2017. Participants were OMSB residents. We administered the TEIQue-SF and collected sociodemographic data from participants. Multiple linear regression analysis was conducted to identify independent predictors of trait EI. The present cohort scored high in the trait EI subscale of Well-being, followed by Sociability, Self-control, and Emotionality. Among sociodemographic factors, female gender and high income were significant predictors of TEIQue-SF's Well-being subscale and high income and living in a rented home were significant predictors of the Sociability subscale. This is the first study conducted among medical residents in Oman regarding trait EI and its correlates. Our findings of overall high EI and several socioeconomic predictors echo the literature on the assessment of EI in trainees. The findings add to the evidence of cross-cultural applicability of instruments to measure trait EI, and use assessments of EI in resident selection and education.

Introducing the Objective Structured Clinical Examination in Haiti.

Haiti, a nation of approximately 10.7 million people located in the western Caribbean,1 is a low-income country, with 59% of its population living below the poverty line (less than $2.41 per day), and 24% living in conditions of extreme poverty (less than $1.23 per day).2 Haiti has a history of political instability and natural disasters, and remains the country with the highest rate of poverty in the Americas.2The health care system in Haiti is regulated by the Ministry of Public Health and Population (MSPP). MSPP is under-resourced, spending only US $13 per person on health care each year. This represents a mere 6.1% of the national budget, and is significantly less than its neighboring countries of Cuba (US $781) and the Dominican Republic (US $180).3Six universities in Haiti offer degree programs in medicine. Upon graduation, medical school graduates are required to complete 1 year of social service, and then can practice medicine independently or apply for entrance into one of Haiti's 37 residency programs.Zanmi Lasante (ZL), a sister organization to Boston, Massachusetts-based Partners In Health, in partnership with MSPP, offers 1 residency program at Hospital St. Nicolas (HSN) in Saint-Marc and 5 programs at Hôpital Universitaire de Mirebalais (HUM) in Mirebalais. The programs that have been accepted are in the preapproval phase with the Accreditation Council for Graduate Medical Education International (ACGME-I).As part of its system of assessment in 2015, we introduced the objective structured clinical examination (OSCE) in the family medicine residency program at HSN, with the help of 2 Canadian fellows who volunteered in Haiti. Faculty members were trained on the new technique and were given opportunities to practice their new skills. These “pioneers” then trained other faculty at HUM. Although widely used in high-income countries, ZL was the first institution in Haiti to use the OSCE.The OSCE is a group of tests that includes a succession of stations with simulated clinical problems, involving standardized patients or mannequins, that learners need to solve in a limited time. Each station has clearly defined objectives, and a checklist for the evaluation of the candidates.4 It is considered the gold standard for evaluating clinical competencies, including the physician-patient relationship, the physical examination, and interpersonal and communication skills (box).4In 2016, the Director of Graduate Medical Education at ZL implemented an OSCE as a pre-assessment tool during the orientation month at the start of postgraduate year 1 (PGY-1). Based on this positive experience, the Graduate Medical Education Committee (GMEC) voted to implement the OSCE as part of the recruitment process for all ZL programs. In 2017, we conducted the first OSCE session during recruitment, with 90 candidates who aspired to enter 1 of the 6 ZL residency programs.Each session consisted of 4 themed stations with different objectives and a break station. The duration of each station was 10 minutes. The OSCE was scored by faculty, the training and research department director, and representatives from the school of medicine.The OSCE was a new evaluation tool for medical educators in Haiti, and implementation faced challenges. We needed to train faculty and the standardized patients (SPs). Because of a lack of funds, we used medical students and residents as SPs. The use of medical students as SPs was helpful in multiple ways, allowing the students to learn clinical portrayal and trainee performance. Candidates and student SPs were nervous at first, but by the end of the day, all said they had benefited from the experience.We are currently testing the OSCE as an evaluation tool in 2 residency programs (anesthesiology and pediatrics), and we intend to implement it in all ZL residency programs.

Roles, Responsibilities, and Needs of Institutional GME Leaders: A Multinational Characterization of Designated Institutional Officials.

Since 2012, several academic centers in the Middle East have attained accreditation by the Accreditation Council for Graduate Medical Education International (ACGME-I). An emerging group of GME leaders have assumed the role of designated institutional official (DIO), leading their institutions to accreditation. Despite these DIOs' key positions in driving GME reform, there is a lack of published studies on the roles, responsibilities, and needs of DIOs in international settings. We examined the characteristics, roles, responsibilities, and needs of DIOs in the Middle East. A questionnaire was electronically distributed from December 2018 to February 2019 to all current and former DIOs in ACGME-I accredited institutions in the Middle East. Of 16 surveys sent, 11 (69%) were returned. All DIOs were physicians; the majority were women less than 55 years of age, and assumed the role of DIO in the past decade. Most DIOs felt prepared for the position and well supported by their institution and their program directors. All reported having additional roles beyond the DIO position. Most identified the most challenging aspect of their role related to GME budgets, training for their responsibilities, sharing best practices and documents such as DIO job descriptions and other key documents, and DIO training. ACGME-I accreditation is a critical driver of efforts to define the DIO role. DIOs in the Middle East share common perceptions, experiences, and needs. Further research should identify professional development needs in an increasingly diverse international worldwide DIO community.

Sometimes Means Some of the Time: Residents' Overlapping Responses to Vague Quantifiers on the ACGME-I Resident Survey.

Vague quantifiers used in the Accreditation Council for Graduate Medical Education-International (ACGME-I) resident survey are open to interpretation, raising concerns about the validity of survey scores. Residency programs may be unduly cited if survey responses are affected by differing judgments of vague quantifiers. Through investigating frequency judgment overlap, we assessed the validity of vague quantifiers by quantifying variation in residents' frequency judgment of the following response options: never, rarely, sometimes, very often, and extremely often. We conducted a cross-sectional survey of residents in 2 ACGME-I accredited institutions in Singapore. Participants assigned a frequency judgment to response options in 8 questions in the ACGME-I Resident Survey. Overlap in frequency judgment was computed using the minimum and maximum frequency judgment for each response option. This was ascertained to have occurred when the maximum frequency of the preceding category exceeded the minimum frequency of the downstream categories. The percentage of participants whose frequency judgment overlapped was computed. Of 652 residents, 289 (44%) responded; after exclusions of incomplete and careless responses, 119 responses (18%) were included in the study. Frequency judgment overlap was more frequent for vague quantifiers that are adjacent, ranging from 11% to 50% for questions in faculty, evaluation, and resources domains. The percentage of frequency judgment overlap was greatest for duty hour questions, with an overlap between 21% and 47% for adjacent categories. Residents demonstrated wide variation in frequency judgment of vague quantifiers, especially on the duty hour questions in the ACGME-I resident survey.

Moving towards an interactive teaching and learning curriculum - Analysis of Qatar's Emergency Medicine Residency Training Program

Background: The Emergency Medicine Residency Training Program (EMRTP) conducts weekly didactic teaching activities to deliver the curriculum for the Arab Board of Emergency Medicine. Traditional teaching methods often serve to deliver content to the learner passively, while an interactive model engages the resident, and aligns with principles of adult learning. With the accreditation of the EMRTP by the Accreditation Council for Graduate Medical Education - International (ACGME-I), the mode of teaching has also been modified to a more interactive model. Methods: We analysed the EMRTP annual academic planner for 2015–2016 along with the format of teaching and broadly classified the topics and content into traditional vs interactive modes of delivery. Results: The results showed that in 2012–2013, 75% of the content was through lectures but in 2015–2016 this had diminished to 21%, with the remaining 79% being delivered through various interactive means such as multidisciplinary grand rounds, joint conferences, morbidity &amp; mortality meetings, journal clubs, oral board simulations, objective structured clinical examination (OSCE) slide presentations and faculty led clinical skills workshops. Conclusion: The analysis showed an impressive reversal from a traditional to an interactive educational format with clear demonstration of adult learning principles.