Accreditation Council For Graduate Medical Education Research Articles

Imaging Informatics Education in Clinical Informatics Programs: Perspective from Imaging and Clinical Informatics Professionals.

Imaging and Clinical Informatics are domains of biomedical informatics. Imaging Informatics topics are often not covered in depth in most Clinical Informatics fellowships. While dedicated Imaging Informatics fellowships exist, they may not have the same rigor as ACGME (Accreditation Council for Graduate Medical Education) accredited Clinical Informatics fellowships and they do not provide a direct path toward subspecialty board certification. We compared published curricula and test content between Clinical and Imaging Informatics fellowship programs. We then highlighted differences between training programs and identified overlapping topics and opportunities for additional education for each type of trainee. Published consensus curricula and topics were extracted for each specialty. Two informaticists compared topics as shared or not shared between specialties. Next, test content outlines were compared for each specialty exam, extracted, and classified as shared or not shared content. A Venn diagram was created to highlight areas unique to each specialty as well as areas of overlap. There were 139 Clinical Informatics topics compared with 97 Imaging Informatics topics. Of the 139 Clinical Informatics topics, 115 (83%) were covered in the Imaging Informatics curriculum. Of the 97 Imaging Informatics topics, 74 (76%) were covered in the Clinical Informatics curriculum. When using test content outline data, 170 out of 397 (43%) Imaging Informatics topics matched to 64 out of 139 (46%) Clinical Informatics topics. We describe examples of overlapping topics and those unique to each program to identify potential areas to expand. Imaging Informatics and Clinical Informatics fellowship programs have some overlap with areas unique to each. Our review may help guide those seeking informatics education and potential certification. As enterprise imaging evolves, these differences may become more important and create knowledge gaps, if not systematically evaluated.

Peer review for handoff education in a transition to residency course: A prospective cohort study.

Association of American Medical Colleges (AAMC) and Accreditation Council for Graduate Medical Education (ACGME) mandate training in handoff delivery for students and residents. Communication errors, including errors during handoffs of patient care, account for over 2/3 of sentinel events. This study aims to assess the effectiveness of peer-assisted learning (PAL) in handoff education within a longitudinal framework. This study involved the analysis of fourth-year medical students (n = 67) enrolled in a transition to residency program designed to reinforce skills essential for success in internal medicine residencies. We modified the I-PASS handoff rubric for a single-encounter evaluation. Before attending the transitions of care workshop, students submitted one written handoff report. During high-fidelity simulation sessions, peers evaluated the written document as well as verbal handoffs, while faculty evaluated a recorded verbal version. The primary outcome measured was improvement in handoff quality and accuracy over time and secondary outcomes compared peer- and self-evaluations to faculty assessments. Overall, students demonstrated a statistically significant improvement in handoff quality and accuracy across all scoring criteria after completing the peer evaluation process. Peer evaluations did not demonstrate statistically significant differences in scores for quality or accuracy questions as compared to faculty. Peer evaluators effectively assessed handoff reports using the modified I-PASS checklist yielding outcomes similar to faculty while providing feedback. These findings provide exciting evidence that should prompt training programs to consider incorporating standardized peer review into handoff education for medical students and, potentially, residents. The detailed evaluation of individual handoff events fosters feedback skills essential for ongoing professional growth and clinical excellence.

Nurse perspectives on the assessment of emergency medicine residents: A qualitative study.

Multisource and 360-degree feedback are emerging methods in the medical education assessment literature. Nursing feedback in particular has been identified as a point of emphasis regarding what medical education leadership would most value for incorporating into their evaluations. There is no currently accepted tool for multisource feedback in the emergency department (ED). To answer this call, we conducted a qualitative study to elucidate nurse perspectives on evaluation of emergency medicine residents. We conducted individual semistructured interviews of ED nurses with experience working alongside residents via volunteer recruitment. Transcripts were coded independently by each author and then reviewed collaboratively to resolve differences. Codes were created by inductive thematic analysis and subsequently underwent constant comparison and classical content analysis. Recruitment continued until analysis of transcripts showed thematic saturation. We organized the interview transcript into chunks of information, arranging 407 quotes from the 10 interview transcripts into 17 codes and six themes regarding observable resident behaviors. Representative quotes and exemplar cases added detailed description to the meaning of these codes. The identified themes for observable resident behaviors included "general communication style," "medical knowledge," "efficiency," "patient communication," "nurse communication," and "professionalism." An additional 13 codes addressed the themes of barriers and catalysts for feedback. The identified themes on observable resident behaviors aligned well with prior literature and with the Accreditation Council for Graduate Medical Education (ACGME) Milestones. The interviews also highlighted nurse perspectives on barriers and catalysts for feedback that would be useful to incorporate into the design of an assessment tool.

Initial Validity Evidence for the American Board of Emergency Medicine Emergency Medical Services Certification Examination

Objectives The American Board of Emergency Medicine (ABEM) Emergency Medical Services Medicine (EMS) subspecialty was approved by the American Board of Medical Specialties on September 23, 2010. Subspecialty certification in EMS was contingent on two key elements—completing Accreditation Council for Graduate Medical Education (ACGME)-accredited EMS training and passing the subspecialty certification examination developed by ABEM. The first EMS certification examination was offered in October 2013. Meaningful certification requires rigorous assessment. In this instance, the EMS certification examination sought to embrace the tenets of validity, reliability, and fairness. For the purposes of this report, the sources of validity evidence were anchored on the EMS core content, the examination development process, and the association between fellowship training and passing the certification examination. Methods We chose to use validity evidence that included: 1) content validity (based on the EMS core content); 2) response processes (test items required intended cognitive processes); 3) internal structure supported by the internal relationships among items; 4) relations to other variables, specifically the association between examination performance and ACGME-accredited fellowship training; and 5) the consequences of testing. Results There is strong content validity evidence for the EMS examination based on the core content and its detailed development process. The core content and supporting job-task analysis was also used to define the examination blueprint. Internal structure support was evidenced by Cronbach’s coefficient alpha, which ranged from 0.82 to 0.92. Physicians who completed ACGME-accredited EMS fellowship training were more likely to pass the EMS certification examination (chi square, p < 0.0001; Cramér’s, V = 0.24). Finally, there were two sources of consequential validity evidence—use of test results to determine certification and use of the resulting certificate. Conclusions There is substantial and varied validity evidence to support the use of the EMS certifying examination in making summative decisions to award certification in EMS. Of note, there was a statistically significant association between ACGME-accredited fellowship training and passing the examination.

Characteristics Associated with Successful Residency Match in General Surgery.

To evaluate characteristics of matched and unmatched general surgery residency (GSR) applicants. Given the recent change of the United States Medical Licensing Exam Step 1 grading to pass/fail, understanding the factors that influence GSR match success is integral to identifying potential interventions to improve match rates for diverse medical students. Retrospective review of GSR National Residency Matching Program (NRMP) applicant and Accreditation Council for Graduate Medical Education (ACGME) active resident data between 2011 and 2022. Data included application characteristics for United States ("US") and "independent" applicants, factors cited by program directors in the interview and ranking process, paths pursued if applicants went unmatched, and racial/ethnic representation. A total of 9149 US and 3985 independent applicants applied to GSR between 2011 and 2021. Matched versus unmatched applicants had higher step 1 scores (US: 236 vs 218, P = 0.005; independent: 237 vs 228, P = 0.001), higher step 2 scores (US: 248 vs 232, P = 0.006; independent: 245 vs 234, P < 0.001), more likely to belong to alpha omega alpha (US: 17.1% vs 1.6%, P = 0.002) or to attend a top 40 National Institutes of Health-funded school (US: 31.0% vs 19.4%, P = 0.002) compared to unmatched applicants. Program directors heavily factored step 1 and step 2 scores, letters of recommendation, interactions with faculty and trainees, and interpersonal skills when interviewing and ranking applicants. The proportion of active general surgery residents versus applicants was lower for Asians (12.3% vs 20.9%, P < 0.001), Black/African American (5.0% vs 8.8%, P < 0.001), Hispanic/Latino (5.0% vs 9.4%, P = 0.001), and underrepresented in medicine students (10.3% vs 19.1%, P < 0.001). In the pass/fail step 1 era, factors including step 2 score and other subjective metrics may be more heavily weighted in the GSR match process.

Revisiting Differences in Fourth-Year Orthopaedic Away Rotation Opportunities and Fees Among Allopathic and Osteopathic Medical Students.

Fourth-year away rotations are an important modifiable variable proven to increase students' opportunities to match into orthopaedic surgery. The purpose of this study was to determine differences in away rotation eligibility requirements and cost of rotation between allopathic and osteopathic students during the 2023 application cycle. Eligibility requirements and fees were then compared with the 2021 application cycle. A cross-sectional study was performed during the 2023 application cycle of all nonmilitary, Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery residency programs (n = 194). Each program's website, affiliated school of medicine's website, visiting student application service portal, and Residency Explorer tool were searched for eligibility criteria, associated rotation fees, and other rotation requirements. Two-sample Z tests for proportions were utilized to compare differences in programs with differing requirements for students based on academic degree type. Data were compared statistically with previously reported data from the 2021 application cycle. In 2023, there were more programs that restricted osteopathic medical students from away rotations than programs that restricted allopathic medical students (12/194, 6.2% vs. 0/194, 0.0%; p < 0.001). All 12 programs were formerly ACGME-accredited before the integration into a single accreditation system. There was a decrease in the number of programs restricting osteopathic medical students from away rotations compared with the 2021 application cycle (18/194, 9.3% vs. 12/194, 6.2%; p = 0.254). Fees associated with away rotations ranged from $25 to $4,000 for both allopathic and osteopathic students. The number of programs that charged osteopathic medical students higher rotation fees than programs that charged allopathic students when compared with the 2021 application cycles decreased (1/194, 0.5% vs. 5/194, 2.6%; p = 0.049). While some programs continue to have away rotation eligibility requirements that prohibit osteopathic medical students from rotating, only one residency program currently charges osteopathic medical students a higher fee to rotate than allopathic medical students.

Rotation X: An Innovative Quality Improvement Focused Curriculum Built Into an Internal Medicine Residency

Background: The Accreditation Council for Graduate Medical Education (ACGME) states that resident physicians must participate in quality improvement (QI) and patient safety (PS) initiatives during their training. Furthermore, once residents enter the workforce as attending physicians, their performance is often based on metrics related to the quality of care provided and the patient’s experience while in the hospital. However, many internal medicine residency programs have a variation of curriculum that is focused on QI and PS. Methods: At our institution, we sought to incorporate education in QI and PS in a longitudinal and structures fashion throughout a resident’s three years of training. Hence, Rotation X was created as both a collaborative and innovative one-week long curriculum with targeted teaching across the continuum of residency training. Rotation X was implemented as a mandatory rotation for all post graduate year (PGY) 1 and 3 trainees in our internal medicine program. During this rotation, learners meet with the clinical documentation improvement (CDI) team, learn about the process of completing a root cause analysis, and review a case with the quality improvement team. Learners also participate in multidisciplinary meetings including a nursing-physician series, focused on improving communication in the hospital, and met with patients nearing discharge to learn about their unique perspective during inpatient hospital stay. Results: All residents participating in Rotation X were surveyed over the course of a year to ascertain their perspective on the rotation. We collated responses from the PGY-1s (interns) and PGY-3s (senior residents). Of the PGY-3 class, at least 80% found the heart failure/pharmacy session, RN-MD session, root cause analysis (RCA) session, CDI session, and catheter associated urinary tract infection (CAUTI) rounds either very or extremely useful. Of the intern class, more than 75% found all session at least somewhat useful with at least half finding the sessions very or extremely useful to their training. Conclusions: With the growing landscape of QI and PS in medicine, we sought out to seamlessly integrate a focused curriculum into our internal medicine residency program. Rotation X, a one-week long rotation embedded with collaborative sessions, was curated to engage our learners in these domains. We found that the curriculum was well received by both our interns and senior residents. Our curriculum is easily adaptable and can be integrated into existing programs, with the capacity to tailor Rotation X sessions to a program’s goals and focus points in the domain of quality improvement.

Prioritizing Health Literacy Educational Objectives for Pediatric Residents – A Delphi Study

ObjectiveChildren of caregivers with limited health literacy are at risk of poorer health outcomes. Thus, health literacy-informed communication tools are critical to achieving a more equitable health system. However, there is no agreement on the health literacy skills pediatric residents should attain. We used Delphi methodology to establish consensus on health literacy objectives to inform development of a pediatric resident curriculum. MethodsOur Delphi panel participated in three rounds of anonymous surveys to rank the importance of health literacy objectives in pediatric resident education. Consensus was defined as ≥70% of panelists identifying an objective as essential or 100% agreeing an objective was recommended or essential. ResultsThirteen pediatric health literacy experts comprised a racially, geographically, and professionally-diverse panel. After three survey rounds, 27 of the initial 65 objectives met consensus. All final objectives aligned with Accreditation Council for Graduate Medical Education (ACGME) core competencies. ConclusionsA panel of pediatric health literacy experts established consensus on health literacy objectives specific to pediatric resident training. These prioritized objectives align with ACGME core competencies, as well as evidence-based strategies like teach-back, and newer considerations like addressing organizational health literacy. They should inform future health literacy curricula and assessment within pediatric residency programs.

Subspecialty Choices Among Medicine-Pediatrics Graduates: Results From a Four-Year National Program Director Survey.

Background and objectives Dual-trained medicine-pediatrics physicians (med-peds) play an important role in the healthcare ecosystem.Little is known about the subspecialty choices of med-peds residency graduates.This study aims to characterize the subspecialty choices of med-peds residency graduates. Methods The Medicine-Pediatrics Program Directors Association (MPPDA) administers an annual survey to the program directors of all med-peds residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).This project represents aggregate survey data from 2020-2023. Results The number of program directors responding to the surveyranged from 80.8% (63/78) to 85.7% (66/77; mean response rate: 82.8%). About 465 of 1,245 (37%) graduates over the four years chose fellowship training, across 51 unique subspecialties. The top five selected pathways were: adult pulmonary and critical care 54 (11.6%), allergy and immunology 37 (7.9%), adult infectious diseases 30 (6.5%), adult cardiology 30 (6.5%), and pediatric cardiology 30 (6.5%). Conclusions Med-Peds residents pursue a diversity of subspecialty training and represent an important contribution to the subspecialty workforce.Improving combined subspecialty opportunities may increase participation by med-peds graduates and, in particular, may support the increasing need for pediatric subspecialists.

Educating Our Future Medical Leaders: An Innovative Longitudinal Course Across Surgical and Medical Specialties in Graduate Education.

Increasing healthcare system complexity, multidisciplinary care delivery, and the need to deliver high-quality, cost-effective care drive a critical need for leadership development. Currently, few examples of multidisciplinary leadership development exist in the medical education literature. The Accreditation Council for Graduate Medical Education (ACGME) has identified leadership domains as essential milestones in residency education, encompassing areas such as interpersonal communication, quality improvement, and systems-based practice. Presently, published GME leadership curricula vary widely in content, delivery, and duration and rarely include multispecialty cohorts. The study authors designed and implemented a longitudinal leadership curriculum for a multispecialty cohort of senior residents and fellows from multiple hospitals within a large integrated GME program. Between July 2022-June 2023, authors delivered 12 monthly sessions on core leadership concepts. Sessions delivered relevant work-based content via large-group didactics with embedded opportunities for small-group interactive experiential and reflective practice, critical thinking, and application. Thirty GME trainees participated in the longitudinal curriculum. Interval pre-/post-session assessments demonstrated significant improvement in composite scores for 6 of 9 sessions assessed. Participants rated each module's overall importance, applicability, and acceptability highly on a summative program evaluation. This longitudinal leadership curriculum adheres to best leadership development practices, demonstrates improvement in knowledge and self-reported attitudes and behaviors related to cognitive, character, and emotional leadership domains, and develops a psychologically safe community of practice for GME participants.

Location, location, location: How does residency program leadership vary according to geographic region?

Background: Faculty relationships are key to resident education. Residency applicants may find it more appealing to choose programs where the faculty have a similar background. With the addition of geographic preferences to the application process, applicants may find it beneficial to know general faculty makeup in each region. The purpose of this study was to evaluate the relationship of geographic location and orthopaedic residency leadership characteristics. Methods: The Accreditation Council for Graduate Medical Education (ACGME) and Doximity websites were queried in September 2022 to identify United States orthopaedic residency programs for the 2022-2023 cycle. Program attributes were categorized by region. Program leaders evaluated in this study consisted of Chairs, Vice Chairs, Program Directors (PDs), and Assistant PDs. Results: A total of 192 programs with 425 leaders were included. Leaders were mostly PDs (42.6%, n=181), men (88.7%, n=377), MDs (90.6%, n=385), and trained in the US (96.9%, n=412). The Northeast had the most programs (n=59, 30.7%) and leadership positions (n=136, 32.0%). The West had higher proportions of internationally-trained and women leaders (8.2%, P=0.046 and 18.0%, P=0.072), although the latter only trended towards significance. The South contained the lowest prevalence of internationally-trained leaders (0.8%, P=0.046). The Midwest exhibited the largest amount of DO leadership (16.0%, P=0.022). The Northeast had more surgeons subspecialized in hand/upper extremity (19.9% vs. 10.0%, P=0.033) yet relatively fewer in oncology (2.9% vs. 10.7%, P=0.041). Conclusions: Program attributes varied by region. This information is valuable to applicants and leaders as the field strives to strengthen and diversify its leadership.

Shifts in Religious and Cultural Diversity Support Across ObGyn Residencies with a Focus on Abortion Training: A Two-Year Follow-Up

Introduction: The Accreditation Council for Graduate Medical Education (ACGME) has recognized cultural competency as part of three out of six core competencies residency programs provide training in. Religion and culture are interwoven, and efforts to increase inclusivity by incorporating religious and culturally competent medical education has become a vital aspect of residency training. Inclusivity in healthcare has enhanced the recruitment of a racially, religiously, and culturally diverse workforce overall, thus enhancing the patient-provider experience through representation. Similarly, diversity among residency candidates has also improved. While current literature highlights the steps taken to ensure various forms of equity, there is little focus on religious or cultural support provided to OB/GYN residents. More recently, access to abortion training may impact which residency programs a candidate chooses to apply to, as ACGME requires such training opportunities to be provided without implications unless precluded by religious restrictions. However, minimal data exists on the training provided, institutional or alternative (outsourced services), and the methodology for abstention from abortion education. As program websites are often the primary source of information for residency applicants, this study aimed to identify shifts in cultural and religious support depicted on OB/GYN residency websites in the past two years while assessing the publicly-listed abortion training variations among such programs. Methods: During April 2022 and April 2023, websites of ACGME-accredited OB/GYN residency programs in the United States were evaluated using a novel 20-attribute collector tool that objectively benchmarks programs from religious/cultural diversity and incorporation of corresponding competency training into resident education. A religiously representative diverse focus group developed our tool. Items assessed included holistic reviews of applications, explicit interest in the recruitment of residents from diverse religious/cultural backgrounds, presence of religious/ethnic indicators depicted on the website, reported support for those with religious obligations, and if cultural/religious or diversity, equity, and inclusion (DEI) competency were cited. Additionally, the 2023 data collection focused on abortion references with guided support per ACGME-required training while providing an overview of protections and restrictions using the Guttmacher Institute website. Results: A total of 576 websites were analyzed, with 285 websites accessible for review in 2022 and 291 in 2023. Due to the program count discrepancy across both years, percentages were used to compare the data (as a result of an increase in accredited programs and website accessibility). An increase of 2% was noted in referencing holistic reviews and ethnic/religious support. Additionally, a 12% increase in spiritual and cultural-focused research was noted on websites with an additional 8% verbalizing such support. A 9% reduction in overall inclusivity advocacy was listed on websites, while an additional 10% reduction was explicitly noted in cultural competency. A 1% reduction in referencing religious diversity and a 2% reduction in websites referencing time allocations for religious holidays were identified. Furthermore, 12% had fewer stated opt-out options for religious obligations. There was a 7% increase in the discussion of religious or ethnic support, with a 5% increase in the focus on race. However, there was a 5% decline in referencing either concept. Although ACGME specifically suggested having Opt-Out options for programs, 1% had the Opt-In option, 12% stated the Opt-Out, 19% vaguely referenced either, and 68% did not mention abortion abstinence options or support on their website. Only 2% of websites suggested alternative sites for residents’ training due to legislation, whereas 27% referenced fellowship and supplementary post-residency training opportunities. Regarding the concept of abortion, 14% stated support for abortion, 14% mentioned abortion but provided limited details, and 72% did not reference it on the website. Concerning current state-specific legislature, 41% are distinctly protective of abortion rights, 46% are restrictive, with the remaining having both protections and restrictions. Conclusion: Our study suggests that the overall focus on religious and cultural diversity across OB/GYN residencies websites has become slightly accentuated over the past two years. The investment or deference of abortion training has not been adequately referenced to permit making informed decisions by prospective trainees. Having cultural and religious congruency of residents with program offerings may potentiate resident success while training.

The Impact of the COVID-19 Pandemic on Geographic Placement of Applicants to General Surgery Residency Programs

COVID-19 greatly influenced medical education and the residency match. As new guidelines were established to promote safety, travel was restricted, visiting rotations discontinued, and residency interviews turned virtual. The purpose of this study is to assess the geographic trends in distribution of successfully matched General Surgery applicants prior to and after the implementation of pandemic guidelines, and what we can learn from them as we move forward. This was a retrospective review of 129 Accreditation Council for Graduate Medical Education (ACGME) accredited, academic General Surgery Residency Programs across 46 states and the District of Columbia. Categorically matched residents' medical schools (i.e., home institutions), medical school states, and medical school regions as defined per the Association of American Medical Colleges (AAMC), were compared to the same geographic datapoints as their residency program. Preliminary residents were excluded. Residents in the 2018, 2019, and 2020 cycles were sub-categorized into the "pre-COVID" group and residents in the 2021 and 2022 applications cycles were sub-categorized into the "post-COVID" group. The percentages of residents who matched at their home institution, in-state, and in-region were examined. Multiple ACGME-accredited, university-affiliated General Surgery Residency Programs across the United States of America. A total of 4033 categorical General Surgery residents were included. Of 4033 categorical residents who matched between 2018 and 2022, 56.1% (n = 2,263) were in the pre-COVID group and 43.9% (n = 1770) were in the post-COVID group. In the pre-COVID group 14.4% (n = 325) of residents remained in-home (IH), 24.4% (n = 553) in-state (IS), and 37.0% (n = 837) in- region (IR), compared to 18.8% IH (n = 333), 27.8% IS (n = 492), and 39.9% IR (n = 706) in the post-COVID group, respectively. Significant increases for IH and IS resident matching at 4.5% and 3.4%, respectively, were noted in the post-COVID period (p < 0.05). The COVID-19 pandemic, and the ensuing changes adopted to promote safety, significantly impacted medical student opportunities and the General Surgery residency application process. General Surgery match data over the last 5 years reveals a statistically significant increase in the percentage of applicants matching at in-home and in-state institutions after the pandemic.

The state of vascular surgery education in the United States.

With the growing proportion of elderly population in the US and a relatively fixed supply of well-trained vascular surgeons, there is a serious concern that we will be facing a shortage of vascular surgery workforce in the near future. One of the main reasons why there is a shortage of vascular surgeons in the US is due to the fact that many students don't get exposed to this field throughout their student lives and a recent survey of medical students from a non-urban tertiary care academic institution showed that early exposure of the medical students to the surgical careers is correlated with an increased interest in the surgical field. This review of the state of vascular surgery education in the US at the undergraduate level describes in detail the importance of an early introduction to vascular surgery in the education curricula, the current state of the education, potential avenues to improve the exposure of students to the field of vascular surgery and the importance of this effort in matching the increasing need for vascular surgeons for an aging population which is likely to require dedicated care by vascular surgeons of the future. At the present time, the two pathways by the Accreditation Council for Graduate Medical Education (ACGME) to obtain dedicated vascular surgery training in the US include either enrolling in a two year clinical fellowship after completion of general surgery training or to match in a five year vascular surgery integrated residency program after successful completion of medical degree.

Assessment of the Educational and Training Modalities in Point-of-Care Ultrasound (POCUS) for Anesthesiologists.

Point-of-care ultrasound (POCUS) has been developed as a critical tool for diagnostic patient evaluation and clinical management. Its transcendence into anesthesiology necessitates appropriate and effective educational strategies to assist in the development of anesthesia POCUS learners. Several professional societies, including the American Society of Anesthesiologists (ASA), American Society of Regional Anesthesia (ASRA), and Accreditation Council for Graduate Medical Education (ACGME) for anesthesiology have established minimum training standards for POCUS education for anesthesiologists, residents, and fellows.1,4 The article at hand aims to summarize and provide insight into the various educational modalities utilized in POCUS training, incorporate these strategies in the established "Indication, Acquisition, Interpretation, and Medical decision-making" (I-AIM) framework, and include recommendations on the minimum number of POCUS exams to aid in achieving competency.3.

Implementation of a vascular acute care surgery service model is associated with decreased surgeon burnout

ObjectiveVascular surgeons have one of the highest rates of burnout among surgical specialties, often attributed to high patient acuity and clinical workload. Acute Care Surgery models are a potential solution used among general and trauma surgeons. MethodsThis is a retrospective analysis of prospectively collected Accreditation Council for Graduate Medical Education survey results from faculty and residents before and after implementation of a vascular Acute Care Surgery (VACS) model. The VACS model assigns a weekly rotation of an attending surgeon with no elective cases or clinic responsibilities and a monthly rotating resident team. Residents and attendings are in-house to cover all urgent and emergent vascular daytime consultations and procedures, whereas nights and weekend coverage remain a typical rotating schedule. Survey question results were binned into domains consistent with the Maslach Burnout Inventory. ResultsBoth residents and faculty reported an increase in median scores in Maslach Burnout Inventory domains of emotional exhaustion (Faculty: 2.9 vs 3.4; P < .001; Residents: 3.1 vs 3.6; P < .001) and faculty reported higher personal accomplishment scores (Faculty: 3.3 vs 3.8; P = .005) after the VACS model implementation. ConclusionsA VACS model is a tangible practice change that can address a major problem for current vascular surgeons, as it is associated with decreased burnout for faculty and residents through improvement in both emotional exhaustion and personal accomplishment. Improved longitudinal assessment of resident and faculty burnout is needed and future work should identify specific practice patterns related to decreased burnout.

Assessment of professional competencies of Peruvian physicians: A scoping review of published studies.

Evaluating the professional competencies of Peruvian doctors is crucial for proposing necessary improvements. However, there is a lack of knowledge regarding the specific characteristics and competencies that are assessed in these studies. The objective of this study is to characterize published studies focusing on the assessment of professional competencies among physicians in Peru. A comprehensive scoping review was conducted, encompassing scientific journal publications that evaluated the professional competencies of physicians in Peru. The search was performed in PubMed, Google Scholar, Scopus, and SciELO, with the review period extending until 2022. The identified competencies were classified using the Accreditation Council for Graduate Medical Education (ACGME) and the Ministry of Health of Peru (MINSA) frameworks. The findings were presented using absolute and relative frequency measures. A total of forty-nine studies focused on the assessment of professional competencies among physicians were identified, indicating an upward trend over the years. The primary focus of these studies was on evaluating competencies related to medical knowledge (79.6% according to ACGME classification) and the treatment of health problems (57.1% according to MINSA classification). However, there was a noticeable lack of emphasis on assessing behavioral competencies such as ethics, professionalism, and communication. Most of the included studies (65.3%) were exclusively conducted in Lima. Among the studies that disclosed their funding sources, 61% were self-funded. Most studies primarily concentrated on evaluating knowledge-based competencies, specifically in the areas of diagnosis and treatment. There is a scarcity of studies assessing other important competencies. Additionally, centralization and limited funding appear to be areas that require improvement in the evaluation of professional competencies among Peruvian physicians.

Estimating the size and scope of the academic emergency physician workforce.

Academic emergency medicine (EM) is foundational to the EM specialty through the development of new knowledge and clinical training of resident physicians. Despite recent increased attention to the future of the EM workforce, no evaluations have specifically characterized the U.S. academic EM workforce. We sought to estimate the national proportion of emergency physicians (EPs) identified as academic and the proportion of emergency department (ED) visits that take place at academic sites. We performed a cross-sectional analysis of EPs and EDs using data from the American Hospital Association, the Centers for Medicare & Medicaid Services, and Doximity's Residency Navigator. EPs were identified as "academic" if they were affiliated with at least one facility determined to be academic, defined as EDs officially designated by the Accreditation Council for Graduate Medical Education (ACGME) as clinical training sites at accredited EM residency programs. Our primary outcomes were to estimate the national proportion of EPs identified as academic and the proportion of ED visits performed at academic sites. Our analytic sample included 26,937 EPs practicing clinically across 4920 EDs and providing care during 130,471,386 ED visits. Among EPs, 11,720 (43.5%) were identified as academic, and among EDs, 635 (12.9%) were identified as academic sites, including 585 adult/general sites, 45 pediatric-specific sites, and 10 sites affiliated with the Department of Veterans Affairs. In 2021, academic EDs provided care for 42,794,106 ED visits or 32.8% of all ED visits nationally. Approximately four in 10 EPs practice in at least one clinical training site affiliated with an ACGME-accredited EM residency program, and approximately one in three ED visits nationally occur in these academic EDs. We encourage further work using alternative definitions of an academic EPs and EDs, along with longitudinal research to identify trends in the workforce's composition.

Evaluation of radiology resident well-being at a single institution with a dedicated wellness curriculum

IntroductionIncreasing rates of physician burnout over recent years have resulted in the need for formal tools and programming dedicated to physician well-being. The Accreditation Council for Graduate Medical Education (ACGME) has taken measures to prioritize trainee well-being by revising its common program requirements. Widespread departmental initiatives have been developed in line with these changes. At the authors' institution, a committee was developed to design and implement a holistic wellness curriculum for radiology trainees. ObjectiveThe objective of this study was to assess overall well-being in a cohort of radiology residents at a training program with a dedicated wellness curriculum. MethodsA wellness curriculum for radiology residents was developed and implemented. Over a 3-year period, data was collected using the Maslach Burnout Inventory (MBI), Brief Resilience Scale (BRS). ResultsRates amongst respondents were low, compared to average, for emotional exhaustion (below 17, average 25.2), depersonalization (6, average 10), and of personal accomplishment were moderate to high (37.5, average 32.9). PGY-4 level residents had the highest rates of burnout (p = 0.042 for depersonalization, p = 0.006 for emotional exhaustion). PGY-4 residents also had the lowest rates of resilience based on the BRS, and PGY-3 the highest (p = 0.037). There were no statistically significant differences between gender or differing relationship status for MBI or BRS. The most commonly cited barriers to wellness practices included fatigue, competing responsibilities, and not knowing where to start. ConclusionRadiology residents at a single institution with a dedicated wellness curriculum demonstrated overall lower rates of burnout compared to their peers.

Assessment of Quality Improvement and Patient Safety Resources, including Event Reporting Systems, in Graduate Medical Education Training Programs - An Institutional National Survey

Background Quality improvement (QI) and patient safety (PS) education were requirements implemented in 2017 by the Accreditation Council for Graduate Medical Education (ACGME) for residents and fellows. Trainees must receive training and experience in QI processes, including an understanding of healthcare disparities, but how training and experience occur remains largely unknown. Our study aimed to determine how institutions have integrated these requirements into medical education. Methods A Google Forms survey was emailed to the Designated Institutional Officials (DIOs) of 650 United States’ institutions with ACGME accredited programs in September 2021. The survey consisted of 34 multiple choice questions related to QI and PS parameters and the event reporting system (ERS); a Likert scale was used. Results More than half (n=392) of the emails were undeliverable, leaving only 258 possible responders; 51 responses were received, and all but one met the inclusion criteria of having at least one training program, which translated to a response rate of 19% (=50/257). The survey found that while 90% of institutions had an institutional QI/PS Committee, only 30% of these institutions also had a Graduate Medical Education-specific QI/PS Committee as well. Most institutions provided QI (88%) or PS training (94%), but only 71% and 83%, respectively, had mandatory training. Most institutions utilized an ERS (96%). While one of the less common methods was education on the ERS, approximately two-thirds of responding DIOs believed that by providing education on the ERS, resident/fellow participation in event reporting would improve, as well as contribute to their total education. Conclusions Further ERS education is warranted to encourage resident/fellow participation to develop various protocols related to QI and PS parameters.