Accredited Residency Programs Research Articles

Psychologists and Integrated Behavioral Health Simulation Training: A Survey of Medical Educators and Perspectives of Directors of Clinical Training.

It is well established that the integration of behavioral healthcare into the medical home model improves patient outcomes, reduces costs, and increases resident learning. As academic health centers increasingly integrate behavioral healthcare, targeted training for interprofessional collaboration around behavioral healthcare is needed. Simulation educational approaches potentially can provide this training. Health service psychologists are well-poised to support this because of their specialized training in integrated healthcare. The present exploratory study aimed to evaluate existing simulation programs and develop recommendations for integrated behavioral health training and evaluation. Directors of ACGME accredited residency programs that are high utilizers of the medical home model (Pediatrics, Internal Medicine, Medicine/Pediatrics, Family Medicine) as well as Psychiatry residencies and medical schools with membership in the Society for Simulation in Healthcare were recruited to complete a 26-item survey to assess program usage of psychologists as part of simulation training for integrated behavioral healthcare services. Of 79 participants who completed initial items describing their training program, only 32 programs completed the entire survey. While many academic health centers offered integrated team and behavioral health simulations, few utilized psychology faculty in design, implementation, and evaluation. Other behavioral health providers (psychiatrists, social workers) were often involved in medical school and pediatric residency simulations. Few institutions use standardized evaluation. Qualitative feedback and faculty-written questionnaires were often used to evaluate efficacy. Survey responses suggest that psychologists play limited roles in integrated behavioral healthcare simulation despite their expertise in interdisciplinary training, integrated behavioral healthcare, and program evaluation.

Specialty Certifications and Their Place Within the Practice of Athletic Training

Context Athletic training has evolved dramatically in the last decade. Professional education has changed to the graduate level. Advanced training has manifested itself in doctoral and residency programs. Clinical practice settings have also evolved along with the knowledge and skills required to care for the diverse patients in these settings. Athletic training specialties are accompanying these changes, and now athletic training has specialty certifications to formally validate a specialty and recognize the athletic trainer (AT) specialist. Objective This article conveys key information about credentialing, highlights historical events in the development of AT specialty certifications, and examines the concept of general practice. The purpose of conveying this information is to better understand and explore specialties and certifications in athletic training, which requires also conceptualizing athletic training as a general practice. Background One of the earliest documents mentioning specialty certifications within athletic training was published in 1997. In 2018, the Board of Certification formed the Specialty Council to validate athletic training specialties and oversee specialty certifications. Synthesis Earning a specialty certification is a rigorous process requiring the credentialed AT to gain, as well as maintain, postprofessional education and experience in a focused practice area. This education and training can come from an accredited residency program but also from on-the-job training and professional development. Results Practitioners of a validated athletic training specialty can become board-certified specialists with advanced clinical experience or after completing postprofessional education and training and passing the respective specialty certification examination. Recommendations We recommend conceptualizing athletic training as general practice so that we can differentiate the relationships of general, advanced, and specialty practices. Conclusions Athletic trainer specialty certifications are part of athletic training. Growing existing and creating new specialties and specialty certifications requires conceptualizing athletic training as general, advanced, and specialized practices.

A Novel REBOA Training Curriculum for Emergency Medicine Residents: A Pilot Study

BackgroundResuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a potentially life-saving intervention to treat noncompressible torso hemorrhage. Traditionally, REBOA use has been limited to surgeons. However, emergency physicians are often the first point-of-contact and are well-versed in obtaining rapid vascular access and damage control resuscitation, making them ideal candidates for REBOA training. Study ObjectivesTo fill this gap, we designed and evaluated a REBOA training curriculum for emergency medicine (EM) residents. MethodsParticipants enrolled in an accredited 4-year EM residency program (N = 11) completed a 12-hour REBOA training course. Day 1 included lectures, case studies, and hands-on training using REBOA task trainers and perfused cadavers. Day 2 included additional practice and competency evaluations. Assessments included a 25-item written knowledge exam, decision-making on case studies, REBOA placement success, and time-to-placement. Participants returned at 4 months to assess long-term retention. Data were analyzed using t-tests and nonparametric statistics at p < 0.05. ResultsScores on a 25-item multiple choice test significantly increased from pre-training (65% ± 5%) to post-training (92% ± 1%), p < 0.001. On Day 2, participants scored 100% on correct recognition of REBOA indications and scored 100% on correct physical placement of REBOA. Exit surveys indicated increased preparedness, confidence, and support for incorporating this course into EM training. Most importantly, REBOA knowledge, correct recognition of REBOA indications, and correct REBOA placement skills were retained by the majority of participants at 4 months. ConclusionThis course effectively teaches EM residents the requisite skills for REBOA competence and proper placement. This study could be replicated at other facilities with larger, more diverse samples, aiming to expand the use of REBOA in emergency physicians and reducing preventable deaths in trauma.

Current exposure to Female Pelvic Medicine and Reconstructive Surgery faculty during urology residency.

Contemporary US resident exposure to Female Pelvic Medicine and Reconstructive Surgery (FPMRS) faculty during urology residency is unknown. Accredited US urology residencies were identified through the American Urological Association (AUA). Accredited, urology-based FPMRS fellowships were identified through the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. The number of faculty and residency positions were obtained from program AUA profiles if they were last modified within the current application cycle; this information was obtained from program websites if AUA profiles were outdated. Data on faculty fellowship training was manually extracted from program websites. A quality control cross-check of program and faculty training characteristics was performed through direct communication with 5% of programs. Of 139 accredited residency programs assessed, 10.8% were affiliated with an accredited, urology-based FPMRS fellowship. In total, 29.5% of residency programs, representing 25% of US urology residents, had neither a FPMRS fellowship nor any FPMRS certified faculty. The national FPMRS faculty-to-resident ratio was 1:10.8, and 7.4% of faculty at all residency programs were FPMRS certified. In comparison, faculty-to-resident ratios for other subspecialties were: 1:4.7 for pediatrics, 1:3.6 for oncology, 1:5.9 for minimally invasive surgery/endourology, 1:14.2 for trauma/reconstruction, and 1:11.8 for andrology or male sexual/reproductive health. The FPMRS faculty-to-resident ratio was 1:5.1 in programs with a urology-based FPMRS fellowship compared with 1:13.4 in programs without a FPMRS fellowship. 30% of US urology residency programs lack FPMRS trained faculty. Even when FPMRS faculty are on staff, the field is often underrepresented relative to other urologic subspecialties. Further studies are required to ascertain if inadequate exposure to FPMRS cases and mentors during training contribute to the shortage of urology residents who choose to specialize in FPMRS. This link has important implications for the current shortage of FPMRS providers.

Trends in transgender healthcare curricula in graduate medical education

Background Recent studies have shown deficiencies in resident knowledge concerning transgender healthcare. However, there has not been an updated survey examining transgender healthcare training by medical residency directors. We assessed whether accredited residency programs in the United States and Canada were providing education on the healthcare needs of transgender patients. Methods We performed an exploratory descriptive survey study in 2022 of residency programs in the United States and Canada to assess residency education on transgender health using program directors listed in the website directory of the Accreditation Council for Graduate Medical Education. Results Out of 1680 residency program directors, 160 programs responded (response rate, 10%). Among the residency programs, education in transgender health was taught periodically throughout the curriculum (52.5%), in discrete modules (34.4%), or not taught at all (10.6%). However, 60% of residency program directors who responded reported that their program lacked any clinical rotation in which residents directly work with transgender patients. The most common areas of transgender care omitted from residency education on transgender health were barriers associated with chronic illness and mental health. Conclusion There remains a need for robust transgender medical training in residency programs through clinical rotations on transgender health.

MP66-16 CURRENT EXPOSURE TO FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY DURING UROLOGY RESIDENCY

You have accessJournal of UrologyCME1 Apr 2023MP66-16 CURRENT EXPOSURE TO FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY DURING UROLOGY RESIDENCY Connie Wang, Ariana Smith, Gina Badalato, and Doreen Chung Connie WangConnie Wang More articles by this author , Ariana SmithAriana Smith More articles by this author , Gina BadalatoGina Badalato More articles by this author , and Doreen ChungDoreen Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003329.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Historically, few urology programs have had Female Pelvic Medicine and Reconstructive Surgery (FPMRS) trained faculty. This analysis aimed to assess contemporary exposure to FPMRS faculty during residency training in the United States (US). METHODS: US urology residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) were identified from the American Urological Association’s (AUA) website and accredited, urology based FPMRS fellowships were identified by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. Number of faculty and residency positions per program were identified from AUA program profiles, if last modified within the past year, or manually extracted from program websites. Faculty with subspecialty fellowship training were identified from individual program websites. RESULTS: 9 programs (6%) were excluded from analysis due to incomplete information. Of 139 accredited residency programs assessed, 15 (10.8%) were affiliated with an accredited, urology based FPMRS fellowship. 41 (29.5%) programs had neither a FPMRS fellowship nor any FPMRS certified faculty. 7.4% of faculty at all programs were FPMRS certified. The national faculty to resident ratio was 1:0.8, whereas the national FPMRS faculty to resident ratio was 1:10.8. In comparison, national faculty to resident ratios for other subspecialties were: 1:4.7 for pediatrics, 1:3.6 for oncology, 1:5.9 for minimally invasive surgery/endourology, 1:14.2 for trauma/reconstruction, and 1:11.8 for andrology or male sexual/reproductive health (Table 1). Programs affiliated with a urology based FPMRS fellowship had a FPMRS faculty to resident ratio of 1:5.1 while programs not affiliated with a FPMRS fellowship had a FPMRS faculty to resident ratio of 1:13.4. CONCLUSIONS: 30% of US urology residency programs lack fellowship trained FPMRS faculty. Even when FPMRS faculty are on staff, the field is often underrepresented relative to other urologic subspecialties. Inadequate exposure to FPMRS cases and mentors during training may contribute to the shortage of urology residents who choose to specialize in FPMRS and may exacerbate the failure to meet growing FPMRS patient demands nationwide. The long-term effects of lower numbers of FPMRS faculty need further exploration. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e940 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Connie Wang More articles by this author Ariana Smith More articles by this author Gina Badalato More articles by this author Doreen Chung More articles by this author Expand All Advertisement PDF downloadLoading ...

Factors That Influence Orthopedic Women Residents’ Selection of Adult Reconstruction

BackgroundStereotypes may discourage women from going into the historically male-dominated field of Adult Reconstruction. Other factors such as interest, confidence, and a sense of belonging may influence subspecialty choice. The objective of this study was to survey orthopedic surgery residents regarding their perceptions about Adult Reconstruction. MethodsA validated survey evaluating social determinants of behavior was adapted to assess orthopedic surgery residents’ perceptions of Adult Reconstruction. The survey was electronically distributed to residents from 16 United States and Canadian Accreditation Council for Graduate Medical Education–accredited residency programs. There were 93 respondents including 39 women (42%) and 54 men (58%). Study data were collected and managed using an electronic data capture tool. Descriptive statistics were reported for all continuous variables. Percentiles and sample sizes were reported for categorical variables. ResultsWomen and men reported similar interest in Adult Reconstruction (46% versus 41%, P = .60). Fewer women reported that they were encouraged to go into Adult Reconstruction by faculty (62% versus 85%, P = .001). Women and men reported similar confidence in their own ability to succeed in the subspecialty of Adult Reconstruction. However, when asked about the ability of other residents, both sexes rated men as having higher levels of confidence. Women and men perceived other residents and faculty felt “men are better Adult Reconstruction surgeons,” but did not personally agree with this statement. ConclusionWomen and men residents expressed similar rates of interest and self-confidence in Adult Reconstruction, but there were social barriers including negative stereotypes that may prevent them from pursuing careers in Adult Reconstruction.

Trends in emergency medicine resident procedural reporting over a 10-year period.

Procedural competency is expected of all emergency medicine (EM) residents upon graduation. The ACGME requires a minimum number of essential procedures to successfully complete training. However, data are limited on the actual number of procedures residents perform and prior studies are limited to single institutions over short time periods. This study sought to assess the number of Key Index Procedures completed during EM residency training and evaluate trends over time. We conducted a retrospective review of graduating EM resident procedure logs across eight ACGME accredited residency programs over the last 10 years (2013-2022). Sites were selected to ensure diversity of program length, program type, and geography. All data from EM residents graduating in 2013-2022 were eligible for inclusion. Data from residents from combined training programs, those who did not complete their full training at that institution (i.e., transferred in/out), or those who did not have data available were excluded. We determined the list of procedures based upon the ACGME Key Index Procedures list. Sites obtained totals for each of the identified procedures for each resident upon graduation. We calculated the mean and 95% CI for each procedure. We collected data from a total of 914 residents, with 881 (96.4%) meeting inclusion criteria. The most common procedures were point-of-care ultrasound, adult medical resuscitation, adult trauma resuscitation, and intubation. The least frequent procedures included pericardiocentesis, cricothyroidotomy, cardiac pacing, vaginal delivery, and chest tubes. Most procedures were stable over time with the exception of lumbar punctures (decreased) and point-of-care ultrasound (increased). In a national sample of EM programs, procedural numbers remained stable except for lumbar puncture and ultrasound. This information can inform residency training curricula and accreditation requirements.

Creation of a novel specialty residency in thrombosis and hemostasis management

AbstractAntithrombotic and hemostatic medications are essential, yet high‐risk therapies commonly used for the prevention and treatment of thrombosis and bleeding. Since first demonstrating the ability to improve the safety and quality of heparin and warfarin‐related care many years ago, pharmacists now play an important expanded role in more comprehensive and complex thrombosis and hemostasis management programs. Such programs encompass the prevention and treatment of thrombosis and bleeding across care settings, medical indications, and professional services. These programs impact not only appropriate use of antithrombotic medications, but also of antidotes, blood products, medical devices, laboratory testing, and other important aspects of care. In addition to providing direct patient care, pharmacists are increasingly involved in the development and implementation of system‐level processes and quality improvement activities that require technical knowledge, leadership skills, and effective multidisciplinary collaboration. Evolution in health care regulation and accreditation standards, along with national efforts to advance the concept of Anticoagulation Stewardship, will likely accelerate the growth and expansion of thrombosis and hemostasis management programs, increasing the demand for well‐trained and experienced clinical pharmacists. However, none of the existing accredited specialty pharmacy residency programs encompasses the full range of skills and experiences necessary for new pharmacists to practice effectively in this complex and rapidly evolving field. This manuscript describes the evolution of the Hemostasis and Antithrombotic Stewardship program at Brigham and Women's Hospital and the development of a novel postgraduate year 2 (PGY2) pharmacy residency in this specialty area. It provides details of the new PGY2 residency program curriculum and puts forth a vision of success for such programs at the local and national levels.

The journey to pharmacy residency program accreditation: The Children's Cancer Hospital-Egypt experience.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Starting a New Residency-The Early Years.

The social dimensions of residency are as essential as the scientific ones, particularly when starting a new program. Privileged to be the first-ever trainee in a newly accredited residency program, this reflection details the particulars defining my experience. In an attempt to balance humility with accomplishment, the following offers unique observation and insight on the many aspects we all share in training, in the aim of contributing something meaningful to them.

Association between academic degrees and research productivity: an assessment of Canadian academic general surgeons.

Background:For academic hiring committees and surgical trainees, the benefits of a graduate degree are unclear. We sought to identify if graduate degrees or professorship status were associated with increased research productivity among Canadian academic surgeons.Methods:We included general surgeons from the largest hospitals associated with accredited residency programs. We classified staff surgeons active between 2013 and 2018 by degree (MD only, master’s degree, PhD) and professorship (assistant, associate, professor) status. We identified their publications from January 2013 to December 2018. Variables of interest included publications per year, citations per article, journal of publication, CiteScore, author’s Hirsch (h) index and the revised h-index (r-index). We used Kruskal–Wallis tests and the Dunn multiple comparison test to assess statistical significance.Results:We identified 3262 publications from 187 surgeons, including 78 (41.7%) with no graduate degree, 84 (44.9%) with master’s degrees and 25 (13.4%) with PhDs. Surgeons with graduate degrees had more publications per year, higher CiteScores, more citations per article, and higher h- and r-indices than those without graduate degrees. Surgeons with doctorates had the highest median values in all domains, but differences were not significant compared with surgeons with master’s degrees. Seventy-seven (41.8%) surgeons were assistant professors, 63 (34.2%) were associate professors and 44 (23.9%) were full professors. Statistically, full professors had a greater number of publications per year and higher h- and r-indices than their counterparts.Conclusion:Surgeons with graduate degrees or more advanced professorships had the greatest research productivity. Surgeons with doctorates trended toward greater research productivity than those holding master’s degrees.

Overview of the Revised Commission on Collegiate Nursing Education Entry-to-Practice Nurse Residency Program Accreditation Standards.

Overview of the Revised Commission on Collegiate Nursing Education Entry-to-Practice Nurse Residency Program Accreditation Standards.

The Leadership Landscape: The Role of Gender in Current Leadership Positions in Obstetrics and Gynecology Departments

To describe the proportion of female faculty in departmental administrative and educational leadership roles in Obstetrics and Gynecology departments. Cross-sectional observational study (II-3). Accredited Obstetrics and Gynecology residency programs. A total of 288 accredited residency programs were identified from 2019 to 2020 with 1237 individuals in leadership positions. Similar to a 2012 to 2013 survey by Hofler etal, residency program websites and corresponding fellowships (Maternal Fetal Medicine, Female Pelvic Medicine and Reconstructive Surgery, Reproductive Endocrinology and Infertility, and Gynecologic Oncology), departmental websites, and divisional websites were queried for those in administrative and educational leadership positions. Information regarding gender (as determined by the surrogates of name and photographic gender expression), medical and academic degrees, academic rank, and subspecialty certification was abstracted. Within administrative leadership roles, women comprised 29% of chairs, 46% of vice chairs, and 47% of division directors, all significantly lower than men in administrative leadership (p <.001). In educational leadership, women made up 71% of medical school clerkship directors, 58% of residency directors, and 50% fellowship directors. Women were more likely to hold educational leadership positions (56% vs 40%; p <.001), although men were more likely to hold administrative leadership positions (68% vs 52%; p <.001). Among subspecialties, there was greatest gender equity within Female Pelvic Medicine and Reconstructive Surgery. Female leaders were more likely to have received additional academic degrees (e.g. MBA, MPH) than their male counterparts (19% vs 13%; p=.002). Women continue to be underrepresented in administrative leadership positions. Compared with 2012 to 2013, there is only a 9% increase in proportion of women chairing and 10% vice chairing Obstetrics and Gynecology departments; however, the increase is more substantial in other positions, such as division directors (17%). Our findings demonstrate ongoing gender disparity in the highest levels of departmental leadership and the need to further improve on diversity and gender equity within leadership roles.

Internal Medicine Residency Program Director Support and Burnout During the COVID-19 Pandemic: Results of a National Survey.

Burnout is common among physicians and physician leaders, including residency program directors (PDs). The effects of the COVID-19 pandemic and other stressors in 2020 on PDs is unknown. To measure the prevalence of burnout among internal medicine (IM) residency PDs 6 months into the COVID-19 pandemic. A total of 429 IM PDs, representing 83% of accredited residency programs, were surveyed from August to December 2020. Burnout, using a 2-item screening tool, and self-reported consideration of resigning in 2020, were compared to their annual prevalence since 2012 and tested for possible associations with pandemic stressors and program characteristics. The survey response rate was 61.5% (264 of 429). One-third (33.6%, 87 of 259) of PD respondents met burnout criteria, and 45.1% (110 of 244) reported considering resigning in the past year, which were within the range of preceding years. PDs who reported feeling highly supported by institutional leadership were less likely to meet burnout criteria and to have considered resigning. There were no associations between burnout or consideration of resigning and the amount of clinical time PDs spent in their roles, duration of maximum stress on programs, budget cuts to programs, or geographic region. The prevalence of burnout among PDs in fall 2020 was similar to the prevalence of burnout in pre-pandemic years despite uniquely extreme stressors. PDs' perception of being highly supported by institutional leadership was associated with lower prevalence of burnout and consideration of resigning. Perceived leadership support may be a protective factor against burnout during periods of high stress.

Peripheral nerve surgical competency in plastic surgery and neurosurgery residents

ObjectiveTo assess the case volume and self-perceived competence of current mandatory skills in peripheral nerve surgery. DesignCross sectional survey based study examining case volume and self-reported competence in peripheral nerve surgery. SettingCanadian Neurosurgery and Plastic Surgery accredited residency programs ParticipantsAll Canadian Neurosurgery and Plastic Surgery senior trainees (PGY 3+) invited to participate ResultsMuch variability exists in both exposure to cases and perceived senior resident competence for both plastic and neurosurgery residents. Confidence in surgical ability as perceived competency is lower in trainees for more advanced peripheral nerve procedures. Self- reported confidence increased with post-graduate experience. ConclusionsOverall, the findings in this study highlight the importance of increasing operative experience in complex peripheral nerve surgery among surgical residents.

Athletic Training Residency Program Development and Assessment of Advanced Clinical Reasoning

Context Clinical reasoning is an inferential process of collecting and evaluating data in patient cases, necessary in all care. Athletic training residency programs are emerging rapidly as the industry standard for developing clinical specialists who possess advanced clinical reasoning needed for complex cases. Objective The purpose of this study was to explore current practices of advanced clinical reasoning development and assessment in athletic training residency programs. Design Inductive qualitative research. Setting Web-based teleconferencing platform (Zoom Video Communications). Patients or Other Participants Seven of 10 Commission on Accreditation of Athletic Training Education–accredited residency program directors (RPDs) (age = 46 ± 9 years, years as RPD = 5 ± 6). Data Collection and Analysis We used qualitative, semistructured interviews. Audio files were transcribed verbatim, checked for accuracy, deidentified, and member checked before analysis. We used a 2-person data analysis team and an inductive coding approach. The researchers reviewed the transcripts independently, met to develop a codebook, applied the codes, and conducted internal auditing. Trustworthiness was established through member checking, multiple-analyst coding, and auditing. Results Three themes emerged from the RPDs about developing advanced clinical reasoning: (1) defining clinical reasoning, (2) instructional tactics, and (3) assessment tactics. RPDs defined clinical reasoning as the process of the resident justifying their decision-making and the accuracy of their decisions. RPDs described both clinical and didactic instructional tactics, including mentoring, lectures and discussions, case presentations, and journal club. RPDs described assessing advanced clinical reasoning through patient and preceptor feedback in structured and unstructured formats, self-reflection, and knowledge testing to measure clinical reasoning. RPDs highly relied on preceptors and clinical mentoring, but also described a singular reliance on residents to appraise the clinical reasoning capacity of their own preceptors. Conclusions RPDs define clinical reasoning as rationalization and accuracy of decisions. Although the programs are engaged in effective clinical and didactic approaches to teach advanced clinical reasoning, they rely heavily on the subjectivity of preceptors and residents to assess these outcomes.

Forensic Psychiatry in Pakistan: An Update

Pakistan is a lower-middle income country in South Asia where forensic psychiatry is often not recognized as a distinct subspecialty of psychiatry. Although evolution toward this direction has begun, more development in this field is needed. Before Pakistan’s Mental Health Ordinance of 2001, much of the mental health legislation and intitutional infrastructure pertaining to the mentally ill offender can be traced back to the Indian Lunacy Act of 1912. The past two decades have witnessed important legal developments in the role of psychiatry in Pakistan’s criminal justice system. This has been seen through the devolution of health-care provision and by an extension of psychiatric service provision from the federation (federal government) to the four provinces. Despite the sparse resources allocated to psychiatry, competent yet scarce psychiatry residents are graduating from Pakistan’s accredited residency programs with an interest in forensic psychiatry. The objective of this article is to reflect on the past, while examining the current state of existing forensic mental health in Pakistan. This article will also address the future trajectory of forensic psychiatry in Pakistan and supports the establishment of forensic psychiatry as a subspecialty in Pakistan.

“I Find It Quite a Privilege to Be Involved in Their Lives”: A Multinational Qualitative Study of Program Directors’ Perspectives on Their Relationships with Residents

Phenomenon Program director (PD)-resident relationships are important in shaping resident experiences and educational outcomes. Yet, there is limited literature on the development or meaning of these relationships, particularly from the PD perspective. Through qualitative interviews, we explore how PDs navigate their role to develop and maintain relationships with their trainees, and elucidate how these relationships impact the PDs personally and professionally. Approach Qualitative study using individual semi-structured interviews of former and current PDs (n = 33) from multiple specialties and hospitals in accredited residency programs in Qatar, Singapore, and the United Arab Emirates. We used attachment theory and narrative analysis to investigate how PDs perceive and describe relationship building with their residents amidst tensions of familiarizing themselves with their new role. Findings PD-resident relationships are complex and multidimensional, shifting over time, changing patterns and evolving to respond to different contexts. PDs initially negotiate their own roles, while navigating their relationships with residents and other stakeholders to create their professional identities. PDs develop professional alliances, defining for the resident the profession and its expectations. As residents negotiate the various challenges of their training, the role of the PD emerges into one of providing emotional support and advocacy. The support and attachment are often enduring and extend beyond the period of residency training. Insights Our study examines the experiences of program directors as they negotiate complex educator-learner relationships. The PDs described roles that extended beyond their job description. Although all interviewees reported that the PD position was challenging, they focused on the rewarding aspects of the job and how their relationships helped sustain them through the difficulties. Through their reflections, the PDs described the personal satisfaction and benefits of their interactions with the residents, and how the engagement contributed to personal and professional success.

The Leadership Landscape: Characteristics of Current Faculty in Leadership Positions in Obstetrics and Gynecology Departments

<h3>Study Objective</h3> To describe the proportion of female faculty in departmental administrative and educational leadership roles in Obstetrics and Gynecology departments. <h3>Design</h3> Cross sectional observational study. <h3>Setting</h3> Accredited Obstetrics & Gynecology residency programs. <h3>Patients or Participants</h3> 288 accredited residency programs were identified from 2019 to 2020 with 1237 individuals in leadership positions. <h3>Interventions</h3> Similar to a 2012-2013 survey by Hofler et al., residency program websites and corresponding fellowships (Maternal Fetal Medicine, Female Pelvic Medicine and Reconstructive Surgery (FPMRS), Reproductive Endocrinology and Infertility (REI), Gynecologic Oncology), departmental, and divisional websites were queried for those in administrative and educational leadership positions. Information regarding gender (as determined by surrogates of name and photographic gender expression), medical and academic degrees, academic rank, and subspecialty certification was abstracted. <h3>Measurements and Main Results</h3> Within administrative leadership roles, women comprised 29% of chairs, 46% of vice chairs, and 47% of division directors; women held significantly fewer chair positions than men (p <.001). In educational leadership, women made up 71% of medical school clerkship directors, 58% of residency directors, and 50% fellowship directors. Women were more likely to hold educational leadership positions (56% vs 40%, p<.001) while men were more likely to hold administrative leadership positions (68% vs 52%, p <.001). There was greatest gender equity within FPMRS and least gender equity in Gynecologic Oncology and REI. Female leaders were more likely to have received additional academic degrees (ex. MBA, MPH) than their male counterparts (19% vs 13%, p=.002). <h3>Conclusion</h3> Women continue to be underrepresented in administrative leadership positions. Compared to 2012-2013, there is only a 9% increase in proportion of women chairing and 10% vice chairing Obstetrics and Gynecology departments; the increase is more substantial in other positions, such as division directors (17%). Our findings demonstrate ongoing gender disparity in the highest levels of departmental leadership and the need to further improve upon diversity and gender equality within leadership roles.