Accreditation Council Of Graduate Medical Education Research Articles

Variation in pediatric orthopaedic case volume and type during residency: An updated report after Accreditation Council of Graduate Medical Education case volume minimums

BackgroundIn 2013, the Accreditation Council of Graduate Medical Education (ACGME) instituted a case minimum requirement for orthopaedic residents. It is unknown how pediatric orthopaedic case volume and variability have been affected by this change. MethodsThe ACGME orthopaedic surgery case log data from 2007 to 2020 were used to evaluate the number and type of pediatric orthopaedic procedures logged by graduating residents. The mean and median number of cases logged were compared for the years before (2007-2013) and after (2014-2020) the case minimum implementation using a Student t-test. ResultsIn the period after case minimum implementation, there were significant decreases in both overall cases (2080.6-1639.2; P < .001) and pediatric cases (328.7-264.7; P < .001) logged by residents. However, pediatric case volumes in certain areas significantly increased. Pediatric humerus/elbow procedures went up by 19.7% (29.4-35.2; P < .001), driven by an increase in fracture and dislocation treatments (21.5-28.17, 31.0%; P < .001). Similarly, pediatric forearm/wrist procedures went up by 31.7% (33.7-44.5; P < .001), driven by an increase in manipulation (19.0-31.9, 67.8%; P < .001). All other anatomic areas besides the shoulder experienced significant decreases in case volume, including spine procedures, which experienced the greatest decrease: 52.1% (28.4-13.5; P < .001). ConclusionsParadoxically, since the implementation of case minimums in 2013, residents have logged fewer overall cases and pediatric orthopaedic cases. One may hypothesize that, when residents are required to submit a certain minimum number of cases, there is little incentive to submit additional cases. Key Concepts1)The ACGME instituted a case minimum requirement for Orthopaedic surgery residents starting in 2013.2)Since 2013, residents have logged fewer pediatric orthopaedic cases.3)Since 2013, residents have logged fewer overall orthopaedic cases. Level of EvidenceIII, Cross-Sectional Study

Response to substance use during hospitalization: A survey study of current and ideal policies and practices.

People may use nonprescribed substances during an acute hospitalization. Hospital policies and responses can be stigmatizing, involve law enforcement, and lead to worse patient outcomes, including patient-directed discharge. In the United States, there is currently little data on hospital policies that address the use of substances during hospitalization. In this cross-sectional study, we surveyed clinicians at US hospitals with Accreditation Council of Graduate Medical Education (ACGME)-accredited addiction medicine fellowships about their current practices and policies and what they would include in an ideal policy. We had 77 responses from 55 out of 86 ACGME-addiction medicine fellowships (63.9%). Respondents identified policies at 21.8% of the institutions surveyed. Current responses to inpatient substance use vary, though most do not match what clinicians identify as an ideal response. Our results suggest that the use of nonprescribed substances during a hospitalization may be common, but a majority of hospitals likely do not have patient-centered policies to address this.

New ACGME Clinician Educator Milestones as a Roadmap for Faculty Development: a Position Paper from the Society of General Internal Medicine Education Committee.

Traditionally, clinician educators are tasked with the responsibility of training future physician workforce. However, there is limited identification of skills required to fulfill this responsibility and a lack of consensus on effective faculty development for career growth as a clinician educator. The newly released Accreditation Council of Graduate Medical Education (ACGME) Clinician Educator (CE) Milestones framework outlines important skills for clinician educators and provides the opportunity to create robust faculty development. In this paper, members of the Society of General Internal Medicine Education Committee discuss the importance of these CE Milestones, outline the novel themes highlighted in the project, and provide recommendations for proper application on both the individual and institutional levels to optimize faculty development. The paper discusses strategies for how to apply the CE Milestones as a tool to create a culture of professional growth and self-directed learning. Using a reflective approach, CE faculty and mentors can identify areas of proficiency and opportunities for growth, thereby creating individualized professional development plans for career success. Institutions should use aggregate CE Milestones data as a needs assessment of their faculty "population" to create targeted faculty development. Most importantly, institutions should not use CE Milestones for high-stakes assessments but rather encourage reflection by CE faculty and create subsequent robust faculty development programs. The ACGME CE Milestones present an exciting opportunity and lay an important foundation for future CE faculty development.

A Consensus-Driven Revision of the Accreditation Council for Graduate Medical Education Case Log System: Pediatric Anesthesiology Fellowship Education.

Clinical experiences, quantified by case logs, are an integral part of pediatric anesthesiology fellowship programs. Accreditation of pediatric anesthesiology fellowships by the Accreditation Council of Graduate Medical Education (ACGME) and establishment of case log reporting occurred in 1997 and 2009, respectively. The specialty has evolved since then, but the case log system remains largely unchanged. The Pediatric Anesthesiology Program Directors Association (PAPDA) embarked on the development of an evidence-based case log proposal through the efforts of a case log task force (CLTF). This proposal was part of a larger consensus-building process of the Society for Pediatric Anesthesia (SPA) Task Force for Pediatric Anesthesiology Graduate Medical Education. The primary aim of case log revision was to propose an evidence-based, consensus-driven update to the pediatric anesthesiology case log system. This study was executed in 2 phases. The CLTF, composed of 10 program directors representing diverse pediatric anesthesiology fellowship programs across the country, utilized evidence-based literature to develop proposed new categories. After an approval vote by PAPDA membership, this proposal was included in the nationally representative, stakeholder-based Delphi process executed by the SPA Task Force on Graduate Medical Education. Thirty-seven participants engaged in this Delphi process, during which iterative rounds of surveys were used to select elements of the old and newly proposed case logs to create a final revision of categories and minimums for updated case logs. The Delphi methodology was used, with a two-thirds agreement as the threshold for inclusion. Participation in the Delphi process was robust, and consensus was almost completely achieved by round 2 of 3 survey rounds. Participants suggested that total case minimums should increase from 240 to 300 (300-370). Participants agreed (75.86%) that the current case logs targeted the right types of cases, but requirements were too low (82.75%). They also agreed (85.19%) that the case log system and minimums deserved an update, and that this should be used as part of a competency-based assessment in pediatric anesthesia fellowships (96%). Participants supported new categories and provided recommended minimum numbers. The pediatric anesthesiology case log system continues to have a place in the assessment of fellowship programs, but it requires an update. This Delphi process established broad support for new categories and benchmarked minimums to ensure the robustness of fellowship programs and to better prepare the pediatric anesthesiology workforce of the future for independent clinical practice.

Strategies and Best Practices to Improve Diversity, Equity, and Inclusion Among US Graduate Medical Education Programs

Closing the diversity gap is critical to ensure equity in medical education and health care quality. Nevertheless, evidence-based strategies and best practices to improve diversity, equity, and inclusion (DEI) in the biomedical workforce remain poorly understood and underused. To improve the culture of DEI in graduate medical education (GME), in 2020 the Accreditation Council of Graduate Medical Education (ACGME) launched the Barbara Ross-Lee, DO, Diversity, Equity, and Inclusion Award to recognize exceptional DEI efforts in US residency programs. To identify strategies and best practices that exemplary US GME programs use to improve DEI. This qualitative study performed an exploratory content analysis of award applications submitted to the ACGME over 2 cycles in 2020 and 2021, using the constant comparative method. The research team first acknowledged their own biases related to DEI, used caution to not overinterpret the data, and performed several cross-checks during data analysis to ensure confirmability of the results. A preliminary codebook was developed and used during regular adjudication sessions. Disagreements were discussed until agreements were reached. Foundational (ie, commonly cited, high-impact, and small-effort strategies considered achievable by all programs) and aspirational (ie, potential for high impact but requiring greater effort and investment) DEI strategies used by exemplary GME programs. This qualitative study included 29 award applications submitted between August 17, 2020, and January 11, 2022. Strategies spanned the education continuum from premedical students through faculty. Foundational strategies included working with schools, community colleges, and 4-year college campuses; providing structured support for visiting students; mission-driven holistic review for admissions and selection; interviewer trainings on implicit bias mitigation and on how racism and discrimination impact admission processes and advancement; interview-day DEI strategies; inclusive selection and DEI committees; mission statements that include DEI; and retention efforts to improve faculty diversity. Aspirational strategies included development of longitudinal bidirectional collaborations (eg, articulation agreements, annual workshops, funded rotations and/or research) with organizations working with applicants who were historically excluded and underrepresented in medicine, blinding metrics in residency applications, longitudinal curricula on DEI and health equity, and faculty mentoring such as affinity groups, mentored research, and joint academic-community recruitments. Findings provide residency program leadership with a menu of options at various inflection points to foster DEI within their programs. The findings of this qualitative study suggest that GME programs might adopt strategies of exemplary programs to improve DEI in residency, ensure compliance with accreditation standards, and improve health outcomes for all.

Resident Performance Evaluations May Be Biased Toward Whites

Resident Performance Evaluations May Be Biased Toward Whites

Reaching underserved domestic and international populations through Physical Medicine & Rehabilitation Residency training: A survey of residents and program directors.

In 2015, the World Health Organization (WHO) reported that over 400 million individuals worldwide lack access to medical care. In addition, clinicians are more likely to treat underserved patients during their careers if they have exposure to these populations during their training. To analyze what forms of didactic experiences are available and which opportunities are the most valuable with domestic/international underserved populations in Physical Medicine & Rehabilitation (PM&R) residency programs in the United States. Cross-sectional survey using REDCap software. PM&R residency programs in the United States. A total of 137 participants in Accreditation Council of Graduate Medical Education (ACGME)-accredited PM&R residencies in the United States (24 program directors and 113 residents). Not applicable. Surveys collected information regarding demographic data, prior global health training experiences, current residency training experiences involving domestic/international underserved populations being offered, participants' perceived importance of training experiences with domestic/international underserved population, barriers that impede these experiences, and if availability of these opportunities affected resident recruitment. Participants reported that their PM&R programs did not offer global health simulations (91.2%), educational tracks (75.2%), international electives (71.5%), or rotations with domestic underserved populations (48.9%). Residents viewed exposure to simulation labs (3.25/5), educational tracks (3.42/5), and electives (4.02/5) more importantly than attending physicians. Conversely, attending physicians viewed lectures (3.92/5), journal clubs (3.58), and rotations treating domestic underserved populations (4.42/5) more favorably. Both residents and attending physicians endorse lack of financial support and mentorship as barriers to these opportunities. Participants from all regions outside the Midwest reported that these educational opportunities would affect residency recruitment (56% vs. 31%). This is the first study assessing the current state of global health training opportunities for PM&R residents as well as the perceived value of such experiences. Many PM&R medical trainees desire exposure to global health medicine curriculum, and many would alter their residency selection based on its availability.

Rheumatology Milestones 2.0: A Roadmap for Competency-Based Medical Training of Rheumatology Fellows in the 21st Century.

Since 2014, rheumatology fellows have been assessed not only based on their ability to provide patient care and possession of medical knowledge but also on their skill in serving as patient advocates, navigators of health systems, and members of a health care team. Such assessments have been carried out through the use of competency-based milestones from the Accreditation Council of Graduate Medical Education (ACGME). However, a needs assessment has demonstrated interest in more context validity and subspecialty relevance since the development of the ACGME internal medicine (IM) subspecialty reporting milestones. The ACGME thus created a milestones working group, and the present study was undertaken to develop Rheumatology Milestones 2.0 as well as a supplemental guide to assist with implementation. The working group, consisting of 7 rheumatology program directors, 2 division directors, a community practice rheumatologist, a rheumatology fellow in training, and a public member who is a rheumatology patient, was overseen by the ACGME vice president for milestones development and met through three 12-hour, in-person meetings to compose the rheumatology specialty milestones and supplemental guide within the ACGME Milestones 2.0 project. Informed by the needs assessment data and stakeholders, the working group revised and adapted the ACGME IM subspecialty reporting milestones to create a rheumatology-specific set of milestones and a supplemental guide for their implementation. The Rheumatology Milestones 2.0 provides a specialty-specific, competency-based evaluation tool that can be used by program directors, clinical competency committees, and others to assess the competencies of rheumatology fellows during training and help measure readiness for independent practice.

Meeting the challenge of teaching bioethics: a successful residency curricula utilizing Team-Based Learning

ABSTRACT: Background Despite recognition by both the Accreditation Council of Graduate Medical Education (ACGME) and the American Board of Paediatrics (ABP) of the importance of bioethics education, curricular crowding, lack of perceived significance, and insufficient administrative support remain significant barriers to trainees gaining competency in bioethics. Few bioethics curricula at the graduate medical education level are evidence-based or comprehensive. We sought to develop and assess the effectiveness of a Team Based Learning (TBL) curriculum in improving residents’ bioethics knowledge and their ability to evaluate ethical dilemmas. Methods We integrated L. Dee Fink’s curricular design principles of “Significant Learning,” Jonsen et. al’s “Four-Box Method” of ethical analysis, and ABP bioethics content specifications to create 10 TBL bioethics sessions. Paediatric residents at a major academic centre then completed a 3-year longitudinal, integrated TBL-based bioethics curriculum. Primary outcomes included individual and group readiness assessment tests (iRAT/gRAT), pre-work completion, and satisfaction with sessions. Results The TBL-based bioethics curriculum contains 10 adaptable modules. Paediatric residents (n = 348 total resident encounters) were highly engaged and satisfied with the curriculum. gRAT scores (mean 89%) demonstrated significant improvement compared to iRAT scores (72%) across all TBLs and all post-graduate years (p < .001). Higher gRAT scores correlated with higher level of training. Although pre-work completion was low (28%), satisfaction was high (4.42/5 on Likert scale). Conclusions Our TBL-based bioethics curriculum was effective in improving knowledge, practical and flexible in its implementation, and well-received. We attribute its success to its grounding in ethical theory, relevance to ABP specifications, and a multi-modal, engaging format. This curriculum is easily modified to different specialties, virtual formats, or other specific institutional needs. Key messages Despite formidable challenges to teaching bioethics in residency education, evidence-based methods such as Team-Based Learning (TBL) can be employed to increase knowledge and satisfaction. This study reports the first successful TBL bioethics curriculum, planned and executed longitudinally over 3 years, with paediatric residents at a large academic children’s hospital in the US. TBL can be utilised to teach bioethics at the graduate medical education level and is adaptable to different situational factors, disciplines, and levels of clinical experience.

The Impact of the COVID-19 Pandemic on Resident Physicians Well-Being in the Surgical and Primary Care Specialties in the United States and Canada.

Purpose: The COVID-19 pandemic disrupted the professional, social, and spiritual activities of resident physicians around the world, impacting wellness and personal relationships. Moreover, social distancing caused significant limitations or shutdown of places of worship, including churches, synagogues, mosques, etc. Our goal was to survey resident physicians in primary care and surgical subspecialties in the United States (U.S.) and Canada and to examine the effect of the COVID-19 pandemic on their well-being.Methods: An international cross-sectional study was performed in November 2020, using an anonymous survey of programs in the U.S. and Canada, containing 20 questions to assess the impact of the pandemic on resident participation in social and spiritual activities and the effects on their wellness, and personal relationships. The emails with survey links attached were sent to individual program coordinators from accredited residency training programs in the United States and Canada. This consisted of programs accredited by the American Osteopathic Association (AOA), The Royal College of Physicians and Surgeons of Canada (RCPSC), and the Accreditation Council of Graduate Medical Education (ACGME). The survey was evenly divided among surgical programs (General Surgery, Neurological Surgery, Orthopedic Surgery, Urological Surgery, and Integrated Surgical Residency Programs such as Plastic Surgery, Cardiothoracic Surgery, Pediatric Surgery, and Vascular Surgery) as well as primary care programs (Internal Medicine and Family Medicine).Results: A total of 196 residents, 60 primary care residents, and 136 surgery residents participated in the study. Ninety-six participants (49%) were female, and 98 of the participants (50%) were male, with the remainder two residents identifying as “Other.” Of the primary care residents, the majority (39, 65%) were female. Conversely, the majority (77, 57%) of surgery residents were male.Conclusion: The COVID-19 pandemic has affected the social lives, relationships, and spiritual well-being of both surgical and primary care resident physicians. However, primary care residents reported significantly greater engagement in personal relationships and were more likely to express feelings of mental and physical exhaustion, prohibiting social attendance.

Training the Next Generation of Pediatrician-Advocates: A New Focus on the Inpatient Setting.

Training the Next Generation of Pediatrician-Advocates: A New Focus on the Inpatient Setting.

Factors influencing resilience and burnout among resident physicians - a National Survey

BackgroundResidency training exposes young physicians to a challenging and high-stress environment, making them vulnerable to burnout. Burnout syndrome not only compromises the health and wellness of resident physicians but has also been linked to prescription errors, reduction in the quality of medical care, and decreased professionalism. This study explored burnout and factors influencing resilience among U.S. resident physicians.MethodsA cross-sectional study was conducted through an online survey, which was distributed to all accredited residency programs by Accreditation Council of Graduate Medical Education (ACGME). The survey included the Connor-Davidson Resilience Scale (CD-RISC 25), Abbreviated Maslach Burnout Inventory, and socio-demographic characteristics questions. The association between burnout, resilience, and socio-demographic characteristics were examined.ResultsThe 682 respondents had a mean CD-RISC score of 72.41 (Standard Deviation = 12.1), which was equivalent to the bottom 25th percentile of the general population. Males and upper-level trainees were more resilient than females and junior residents. No significant differences in resilience were found associated with age, race, marital status, or training program type. Resilience positively correlated with personal achievement, family, and institutional support (p < 0.001) and negatively associated with emotional exhaustion and depersonalization (p < 0.001).ConclusionsHigh resilience, family, and institutional support were associated with a lower risk of burnout, supporting the need for developing a resilience training program to promote a lifetime of mental wellness for future physicians.

A Novel Virtual Emergency Medicine Residents-as-Teachers (RAT) Curriculum

Audience: The Residents-as-Teachers (RAT) curriculum is designed for emergency medicine (EM) residents of all years (PGY1-4).Length of Curriculum: The curriculum is divided into three hour-long sessions. The entire curriculum can be run as a single block or can be spread out over multiple days. Introduction: The Accreditation Council of Graduate Medical Education (ACGME) and the Liaison Committee on Medical Education (LCME) both require residents to receive training in teaching medical students and junior residents. They also require opportunities for residents to participate in teaching and be assessed on their effectiveness in this role.1,2 However, the ACGME does not provide guidance or require formal curricula on molding residents into effective teachers. Many programs and institutions have incorporated RAT curricula as a solution to provide residents with the skills necessary to create an excellent educational environment for junior learners. These curricula have been embraced by many specialties, including Emergency Medicine (EM).3-6 The effectiveness of the teaching received during the clinical rotations has important long-term effects on medical students, and may impact their future career choices in medicine.6The COVID-19 pandemic has also required education institutions to vastly alter the delivery of their didactics, including moving to a virtual platform. A completely online format has many benefits that extend beyond the pandemic, such as easier access to participants (including those off-service or at remote sites), no requirement for a physical space, and easier recording of sessions.Educational Goals: To provide residents with an introduction to teaching techniques that can be utilized on shift to facilitate an excellent educational experience for junior learners while balancing the resident’s patient care responsibilities.Educational Methods: The educational strategies used in this curriculum include PowerPoint (Redmond, WA) slideshows given by a live presenter via the telecommunications platform Zoom (San Jose, CA), viewing of videos demonstrating curriculum topics, simulation-based learning through role-play, and small-group discussions including simulation debriefing.Research Methods: A survey was distributed to residents before and following the completion of the three training sessions to assess resident satisfaction with the delivery of the content and comfort with the teaching tools discussed. Suggestions on potential improvements were also assessed to inform changes to future iterations of the curriculum. Comfort regarding the included teaching tools was assessed using a five-point Likert scale. After completion of the curriculum, rotating medical students were provided with an evaluation form to assess if residents were teaching using the techniques from the course.Results: Both the pre-curriculum and post-curriculum surveys had a response rate of 61.1%. Student’s t-test showed a statistically significant increase in mean resident comfort level with the teaching strategies postcurriculum (3.05 to 3.83, p < 0.01). Medical student evaluations have shown, overall, that the majority of residents are utilizing the education techniques on-shift. There were no significant differences found in medical student perception of resident use of taught skills between those who had and had not attended the sessions. However, all but one assessed skill showed higher utilization in those who had attended the correlating session.Discussion: The educational content was effective in improving the residents’ comfort with the teaching strategies presented, and residents are utilizing these techniques on-shift. Through implementation, we discovered that presenting a curriculum over video conferencing required additional administrative support to help ensure efficacy of break-out groups. Based on resident feedback after the first session, multiple changes were made, including providing residents with hand-out references for use during the role-playing sessions. The success of this curriculum demonstrated th feasibility and utility of running a RAT curriculum entirely in a virtual format.

A Novel Virtual Emergency Medicine Residents-as-Teachers (RAT) Curriculum.

The Residents-as-Teachers (RAT) curriculum is designed for emergency medicine (EM) residents of all years (PGY1-4). The curriculum is divided into three hour-long sessions. The entire curriculum can be run as a single block or can be spread out over multiple days. The Accreditation Council of Graduate Medical Education (ACGME) and the Liaison Committee on Medical Education (LCME) both require residents to receive training in teaching medical students and junior residents. They also require opportunities for residents to participate in teaching and be assessed on their effectiveness in this role.1,2 However, the ACGME does not provide guidance or require formal curricula on molding residents into effective teachers. Many programs and institutions have incorporated RAT curricula as a solution to provide residents with the skills necessary to create an excellent educational environment for junior learners. These curricula have been embraced by many specialties, including Emergency Medicine (EM).3-6 The effectiveness of the teaching received during the clinical rotations has important long-term effects on medical students, and may impact their future career choices in medicine.6The COVID-19 pandemic has also required education institutions to vastly alter the delivery of their didactics, including moving to a virtual platform. A completely online format has many benefits that extend beyond the pandemic, such as easier access to participants (including those off-service or at remote sites), no requirement for a physical space, and easier recording of sessions. To provide residents with an introduction to teaching techniques that can be utilized on-shift to facilitate an excellent educational experience for junior learners while balancing the resident's patient care responsibilities. The educational strategies used in this curriculum include PowerPoint (Redmond, WA) slideshows given by a live presenter via the telecommunications platform Zoom (San Jose, CA), viewing of videos demonstrating curriculum topics, simulation-based learning through role-play, and small-group discussions including simulation debriefing. A survey was distributed to residents before and following the completion of the three training sessions to assess resident satisfaction with the delivery of the content and comfort with the teaching tools discussed. Suggestions on potential improvements were also assessed to inform changes to future iterations of the curriculum. Comfort regarding the included teaching tools was assessed using a five-point Likert scale. After completion of the curriculum, rotating medical students were provided with an evaluation form to assess if residents were teaching using the techniques from the course. Both the pre-curriculum and post-curriculum surveys had a response rate of 61.1%. Student's t-test showed a statistically significant increase in mean resident comfort level with the teaching strategies post-curriculum (3.05 to 3.83, p < 0.01). Medical student evaluations have shown, overall, that the majority of residents are utilizing the education techniques on-shift. There were no significant differences found in medical student perception of resident use of taught skills between those who had and had not attended the sessions. However, all but one assessed skill showed higher utilization in those who had attended the correlating session. The educational content was effective in improving the residents' comfort with the teaching strategies presented, and residents are utilizing these techniques on-shift. Through implementation, we discovered that presenting a curriculum over video conferencing required additional administrative support to help ensure efficacy of break-out groups. Based on resident feedback after the first session, multiple changes were made, including providing residents with hand-out references for use during the role-playing sessions. The success of this curriculum demonstrated the feasibility and utility of running a RAT curriculum entirely in a virtual format. Residents-as-teachers, distance learning, role-playing, virtual curriculum, video conferencing, One Minute Preceptor, feedback, "What if?" game, Aunt Minnie, SPIT, activated demonstration, self-directed teaching tools, teaching scripts, Post-It Pearls.

Dermatology education in internal medicine residency programs: A nationwide survey of program directors

To the Editor: Skin diseases are commonly evaluated by primary care physicians and hospital-based internists. However, physicians-in-training in generalist fields often receive inadequate dermatology education,1 with up to 85% of internal medicine (IM) residents reporting feeling uncomfortable or very uncomfortable managing dermatologic issues in ambulatory clinics.2 The Accreditation Council of Graduate Medical Education (ACGME) mandates “opportunities for experience” in dermatology for IM residents3 but specifies neither the quality of these experiences nor methods to ensure curricular effectiveness.

ACGME Case Volume Minimums Decrease the Number of Shoulder and Knee Arthroscopies Performed by Residents

PurposeThe purpose of this study was to examine how the implementation of Accreditation Council of Graduate Medical Education (ACGME) case minimums in 2013 has affected the number of shoulder and knee arthroscopies performed by orthopaedic surgery residents during their clinical training.MethodsThe ACGME orthopaedic surgery case log data from graduation years 2007 to 2019 was used to evaluate the number of shoulder and knee arthroscopies performed. The mean and median number of cases performed per resident were compared for the years prior to implementation of the ACGME case minimum (2007-2012) and after (2013-2019).ResultsThe ACGME orthopaedic surgery case minimums resulted in a significant decrease in the mean number of shoulder and knee arthroscopies performed. The mean number of shoulder arthroscopies performed in the years before and after the case minimum requirement were 109.8 and 82.0 (P = .025), respectively. The mean number of knee arthroscopies performed in the years before and after the case minimum requirement were 178.6 and 124.8 (P = .006), respectively. Residents in the tenth percentile of cases performed still met the required ACGME case minimums each year. The mean total of all cases performed in the years before and after the case minimum requirement were 2045.5 and 1699.3 (P = .038), respectively.ConclusionsThe number of shoulder and knee arthroscopies performed by orthopaedic surgery residents significantly decreased after the implementation of ACGME case minimums, which may be due to underreporting of cases.Clinical RelevanceThis study may demonstrate the effect of the implementation of the ACGME case minimums on the number of shoulder and knee arthroscopies performed by orthopaedic surgery residents.

Educating Internal Medicine Residents on Palliative Medicine and Hospice Care at a Community Teaching Hospital.

The Accreditation Council of Graduate Medical Education (ACGME) currently requires Internal Medicine (IM) GME programs to incorporate educational opportunities for training and structured experiences in Palliative and Hospice Medicine. Miscomprehension of the differences between palliative medicine and hospice care is a barrier for IM residents ordering palliative consults as many residents may underutilize palliative medicine if a patient is not appropriate for hospice. This educational performance improvement (PI) project assessed 3 domains, including Medical Knowledge (MK) of palliative versus hospice medicine at baseline and following a single didactic session. Additionally, the number of palliative consults ordered was used as a surrogate for interpersonal and communication skills (ICS) and patient care (PC) domains. An 8-question survey and 30-minute didactic session were created based upon experientially-determined issues most confusing to IM residents. Participants included 33 IM residents (PGY-1s-3 s) from July 2018 (first cohort) and 32 (PGY-1 s and any PGY-2s-3 s who did not participate in the first cohort) from July 2019 (second cohort). 65 of a possible 73 residents participated (89% response rate) Pre-test Questions 5, 6, and 8 correct responses were <50% in both cohorts with average scores, respectively, of 43.1%, 35.4%, and 40%. Residents improved on the post-test for Q5, 6, 8 to, respectively, 80%, 86.7%, and 48.3% (t = 7.68, df = 59, p < 001). Correct Q1 responses declined in the first cohort, but clarification for the second cohort improved from pre-test (36.4%) to post-test (65.5%). The total number of palliative consults placed by IM residents increased as well. Baseline MK of palliative versus hospice medicine was <50% on 4/8 questions. A brief educational session significantly improved residents' short-term comprehension and increased the number of palliative consults.

Communication Skills of Grandview/Southview Medical Center General Surgery Residents.

In the transition of osteopathic programs to the single-accreditation graduate medical education (GME) system, residents are required to demonstrate skill in a set of core competencies identified by the Accreditation Council of Graduate Medical Education (ACGME) prior to graduation. Included in those core competencies are interpersonal and communication skills along with professionalism. To assess strengths and weaknesses of residents' interpersonal communication skills and professionalism in the Grandview/Southview Medical Center (Dayton, OH) osteopathic general surgery program using the validated Communication Assessment Tool (CAT). From November 2014 to June 2018, all patients who presented for an appointment at the Cassano General Surgery Clinic were asked by a medical assistant to complete a CAT questionnaire following their encounter with a resident physician. Patients at Cassano, an outpatient office-based facility directed to the underserved local community, are seen first by an intern, then by a 4th or 5th year resident and later by an attending physician. Patients 18 years of age or older were included; patients were excluded if they were unable to understand or read English. Patient demographics were collected, including age, gender, race/ethnicity, and previous exposure to this resident physician. Each resident's name was replaced on the CAT with a number for data analysis. The resident variables collected for this study included year of training, gender, and native language. The mean response for all CAT items was 4.5 out of 5, indicating that responses to resident performance were largely positive. Patients responded to 4 of the 14 CAT items with only excellent, very good, or good responses and no fair or poor responses. Four items had only 1 fair or poor response. The remaining 6 items received more than 1 fair or poor response: "greeted me in a way that made me feel comfortable" (#1), "talked in terms I could understand" (#8), "encouraged me to ask questions" (#10), "involved me in decisions as much as I wanted" (#11), "showed care and concern" (#13), and "spent the right amount of time with me" (#14). Attending surgeons evaluate residents in multiple areas from a doctor's perspective, but there is a potential lack of correlation between that evaluation and a patient's experience, which is paramount in osteopathic medicine. Patient responses to the CAT questionnaire can be used by program directors to identify deficiencies in milestone/competency achievement and facilitate improvement both individually and programmatically for residents according to ACGME standards.

The future of health professions education: Emerging trends in the United States.

The future of health professions education: Emerging trends in the United States.

The New Ophthalmology Internship: A Trainee Curricular Survey

Abstract Background The American Academy of Ophthalmology, in conjunction with the Accreditation Council of Graduate Medical Education (ACGME), has mandated the creation of a linked ophthalmology internship year for all programs by 2021. This mandate provides a unique opportunity to tailor a curriculum specific to the ophthalmology trainee. This study reports the results of a national survey of ophthalmology residents and fellows regarding the relevance and applicability of extramural content to their ophthalmology training. Methods Using the online portal SurveyMonkey, an anonymous survey was sent to 119 ACGME-accredited ophthalmology residencies. It consisted of nine questions formulated to measure the perceived applicability and relevance of other specialties to ophthalmology training. Responses were summarized with descriptive statistics. Outcomes were compared by one-way analysis of variance with Tukey's post hoc analysis for between group differences and Benjamini–Hochberg for multiple comparisons. Results Ninety-four respondents (residents and fellows) completed the survey (January–February 2020); 52.1% completed an internal medicine internship, 42.6% transitional, and 5.3% general surgery. Overall, prior internship experience was rated favorably. Otolaryngology and radiology were deemed the most relevant to ophthalmology training. Intensive care unit (ICU) was considered the least beneficial, followed by general surgery, primary care, and pediatrics. Neuroradiology was overwhelmingly preferred over general radiology. The majority of respondents reported minimal exposure to oral and maxillofacial surgery (OMFS) in medical school/internship. When choosing a reason for inclusion in the new curriculum, respondents reported a high level of surgical overlap with otolaryngology, OMFS, and plastic surgery; clinical overlap with neurology; and ophthalmic consultation with emergency medicine. Conclusion Several specialties—notably otolaryngology, radiology, and neurology—were considered highly relevant but lacking in preresidency exposure. The preference for neuroradiology was almost unanimous. In contrast, general surgery and ICU were found to be minimally relevant. Overall, ophthalmology residents reported a high level of satisfaction with their internship experience, an important consideration when building a curriculum that will appeal to potential applicants. The findings of this survey provide a framework to build a curricular plan based on current resident and fellow experience.