American College Of Graduate Medical Education Research Articles

Evaluation of Maternal-Fetal Medicine Fellowship Program Websites.

Introduction Due to the COVID-19 pandemic,the American Association of Medical Colleges (AAMC) recommended that all interviews for residencies and fellowships be conducted in a virtual format. As of March 2024, the Society of Maternal-Fetal Medicine (SMFM) continues to request that all fellowship interviews occur virtually. Without in-person interviews, prospective Maternal-Fetal Medicine (MFM) fellowship applicants must largely rely on program websites to gain insight into each program's offerings, culture, and application requirements. The purpose of this study was to evaluate the content of American College of Graduate Medical Education (ACGME)-accredited Maternal-Fetal Medicine (MFM) fellowship program websites and assess if regional differences exist among website content. Methods All ACGME-accredited MFM fellowship programwebsites were assessed for 21 defined criteria as of March 2024 and further compared by geographic regions (Midwest, Northeast, South, and West). Analyses were completed using chi-squared univariate tests, with a p < 0.05. Results Of the 108 accredited MFM fellowship programs, 106 programs had a dedicated website (98.15%). Most MFM programs (over 80%) included contact information (102/106), program director name (98/106), faculty names (95/106), application requirements (92/106), current fellow names (91/106), and the program coordinator name (89/106) on their website. Less programs (less than 30%) included diversity, equity, inclusion (DEI) content (28/106), interview dates (28/106), and current fellow research projects or publications (27/106). Western programs were less likely to include the program coordinator's name (12/18 (67%), p = 0.046), but more likely to include DEI content (10/18 (56%), p = 0.005). Northeastern programs were less likely to include their application requirements (24/32 (75%), p = 0.049) and less likely to include pictures of their current fellows (20/32 (63%), p = 0.045). Southern programs were more likely to include the yearly rotation schedule (19/32 (59%), p = 0.040). Midwestern programs were more likely to include information on fellowship benefits or salary (15/24 (63%), p = 0.046). Conclusion This study demonstrated that the content available on MFM fellowship websites varies greatly between programs and geographic regions. Efforts should be made by MFM training institutions to enhance website DEI content, curriculum information, recent fellow publications, and information on program alumni. A detailed and well-structured website may helpapplicants compare individual programs more equitablyin the age of virtual interviewing.

Improving patient safety through mandatory quality improvement (QI) education in a family medicine residency programme

Although the American College of Graduate Medical Education (ACGME) requires that medical trainees acquire competencies in patient safety and quality improvement (QI), no standard curriculum exists. We envisaged that a...

Acute Pulmonary Edema and NSTEMI.

Emergency medicine residents and medical students on emergency medicine rotation. Acute pulmonary edema is a common and potentially fatal presentation in the emergency department. More than 1 million patients are admitted annually with a diagnosis of pulmonary edema secondary to cardiac causes.1 Pulmonary edema is broadly split into two main categories: cardiogenic and noncardiogenic. Cardiogenic pulmonary edema is characterized by acute dyspnea caused by the accumulation of fluid within the lung's interstitial and/or alveolar spaces, which is the result of acutely elevated cardiac filling pressures.2 Noncardiogenic pulmonary edema is characterized by fluid accumulation within the alveolar space in the absence of elevated pulmonary capillary wedge pressure.2 These patients often present critically ill, and rapid identification and aggressive management is paramount in caring for patients with pulmonary edema. Dyspnea is the most common presentation with a sensitivity of 89% but a low specificity of 51%.3 Workup of pulmonary edema often includes laboratory testing, electrocardiogram (EKG), chest x-ray (CXR), and often bedside ultrasound (US) and echocardiography.4 Pulmonary edema management depends on the etiology but is often focused on preload and afterload reduction. Diuretics, nitrates, and optimizing ventilatory support through non-invasive and invasive strategies are the mainstay of treatment. At the end of this practice oral boards case, the learner will:1) recognize unstable vital signs (VS) and intervene to stabilize ventilation and oxygenation, 2) demonstrate the ability to obtain a complete medical history including the important characteristics of chest pain, 3) demonstrate an appropriate exam on a patient, 4) order the appropriate evaluation studies for a patient with complaints of dyspnea, 5) interpret the results of diagnostic evaluation and diagnose Non- ST elevation myocardial infarction (NSTEMI) and pulmonary edema, 6) order appropriate management of pulmonary edema and NSTEMI, and 6) demonstrate effective communication with patient and family members. Practice oral boards. Immediate Feedback was solicited from the learners and observers participating in the case both by verbal discussion and completion of a rating for the case following the debriefing. The efficacy of the educational content was assessed by comparing scoring measures across residents based on the training year. Scoring measures of the American College of Graduate Medical Education (ACGME) core competencies were performed using a scale from 1 - 8, 1-4 being unacceptable performance and 5 - 8 being acceptable. Efficacy was assumed based on full completion of the case by the residents who acted as practice oral board candidates, and a debriefing session followed to discuss the key components of the case. This case was presented to twelve Emergency Medicine Residents, seven PGY 1 and five PGY 2 at a relatively new residency program. The overall average score for the residents was 5.62. The PGY 1 Residents' average on the case was 5.56, and the average for the PGY 2 Residents was slightly better at 5.70. The slight improvement noted by the PGY 2 Residents is likely attributable to more clinical experience; however, both classes did not have any prior exposure to the oral board format until this simulated experience. Six residents completed all critical actions in the case. Of those who missed a critical action, failing to diagnose NSTEMI and consulting cardiology were the most common. All learners found educational value in the case with an overall rating of 4.83 (1-5 Likert scale, 5 being excellent). Acute pulmonary edema and NSTEMI are common diagnoses that will be frequently encountered for most emergency physicians. This case highlights the need for early identification and aggressive management of the patient presenting with respiratory distress. The differential for respiratory distress is large, but most learners were able to quickly identify pulmonary edema based on the exam findings of jugular vein distention (JVD), rales, and lower extremity edema. Most learners quickly escalated to a non-rebreather mask and ultimately to BPAP (bilevel positive airway pressure) without requesting to intubate the patient. There was notable variation in the approach to administering nitrates, but most ordered an intravenous (IV) nitroglycerin (NTG) drip and requested pharmacy assistance in dosing. Diuretics were ordered by all the learners, but some were hesitant to start early because they felt the effect would be delayed. Some of the residents did not identify ischemic changes on the EKG at first glance but did request to review a second time when the troponin result was positive. All residents gave aspirin after noting the positive troponin, but not all were able to make a clear diagnosis of NSTEMI or consult cardiology. Although the case was relatively straightforward, residents enjoyed early diagnosis and aggressive management of the patient with impending respiratory failure. Many residents are asking for an ultrasound early in the workup of this patient presenting in respiratory distress. Although not a critical action in this case, it highlights the emphasis placed on ultrasonography in the current emergency medicine curriculum. Pulmonary Edema, Cardiovascular emergencies, NSTEMI.

MP66-10 VARIABILITY IN PARENTAL LEAVE POLICIES FOR UROLOGY RESIDENTS ACROSS UNITED STATES ACADEMIC MEDICAL INSTITUTIONS

You have accessJournal of UrologyCME1 Apr 2023MP66-10 VARIABILITY IN PARENTAL LEAVE POLICIES FOR UROLOGY RESIDENTS ACROSS UNITED STATES ACADEMIC MEDICAL INSTITUTIONS Alice Chu, Farah Abaza, Simone Thavaseelan, Lindsey Hartsell, and Akanksha Mehta Alice ChuAlice Chu More articles by this author , Farah AbazaFarah Abaza More articles by this author , Simone ThavaseelanSimone Thavaseelan More articles by this author , Lindsey HartsellLindsey Hartsell More articles by this author , and Akanksha MehtaAkanksha Mehta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003329.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Parental leave is a significant consideration for resident physicians when considering family planning during training. While the American College of Graduate Medical Education (ACGME) recently mandated a 6-week paid parental leave policy, there is no standardized parental leave policy across urology residency programs. This study sought to evaluate the availability and accessibility of parental leave for urology residents at academic medical institutions in the United States. METHODS: A non-validated 8-question survey was developed to capture the current status of parental leave policies (e.g. duration of leave, maternal vs paternal leave, birth vs adoptive children, compensation status). All ACGME-accredited urology residency programs were contacted via email. Data were collected via telephone/video interview, email, or online survey response. Program characteristics and demographic information were collected from the residency program website and Fellowship and Residency Electronic Interactive Database Access (FREIDA). Fisher’s exact test was used to determine association between program characteristics and favorable parental leave policies (i.e., >6 weeks). RESULTS: We successfully contacted 132 (93.6%) academic urology programs. A total of 35 (27%) programs responded. Maximum allowed weeks of parental leave ranged 3-18 weeks for birthing parents (median 6 weeks, mean 8.26+/-3.78 weeks) and 0-18 weeks for non-birthing parents (median 6 weeks, mean 7.06+/-3.83 weeks). Most institutions provided fully paid leave and did not require exhaustion of other time away from training (i.e., vacation or sick leave; 74.3% and 71.4% respectively). Having >30% female faculty was associated with resident parental leave time >6 weeks (OR 10.3, p<0.05). Geographic region, program type (university- vs community-based), program size, number of program years, and resident gender complement were not associated with parental leave time. CONCLUSIONS: There is large variability in the maximum amount of parental leave allowed and amount of paid leave among academic urology residency programs across the United States. Standardization of these policies may increase equity across urology residencies in the U.S. and alleviate fears of financial burden and need to extend training. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e935 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alice Chu More articles by this author Farah Abaza More articles by this author Simone Thavaseelan More articles by this author Lindsey Hartsell More articles by this author Akanksha Mehta More articles by this author Expand All Advertisement PDF downloadLoading ...

A Model Curriculum for an Emergency Medicine Residency Rotation in Clinical Informatics.

This curriculum is designed for emergency medicine residents at all levels of training. The curriculum covers basic foundations in clinical informatics for improving patient care and outcomes, utilizing data, and leading improvements in emergency medicine. The curriculum is designed for a four-week rotation. The American College of Graduate Medical Education (ACGME) mandated that all Emergency Medicine (EM) residents receive specific training in the use of information technology.1,2 To our knowledge, a clinical informatics curriculum for EM residents does not exist. We propose the following standardized and reproducible educational curriculum for EM residents. The aim of this curriculum is to teach informatics skills to emergency physicians to improve patient care and outcomes, utilize data, and develop projects to lead change.3 These goals will be achieved by providing a foundational informatics elective for EM residents that follows the delineation of practice for Clinical Informatics outlined by the American Medical Informatics Association (AMIA) and the American Board of Preventive Medicine (ABPM).4-6. The educational strategies used in this curriculum include asynchronous learning via books, papers, videos, and websites. Residents attend administrative sessions (meetings), develop a project proposal, and participate in small group discussions.The rotation emphasizes the basic concepts surrounding clinical informatics with an emphasis on improving care delivery and outcomes, information systems, data governance and analytics, as well as leadership and professionalism. The course focuses on the practical application of these concepts, including implementation, clinical decision support, workflow analysis, privacy and security, information technology across the patient care continuum, health information exchange, data analytics, and leading change through stakeholder engagement. An initial version of the curriculum was introduced to two separate institutions and was completed by three rotating resident physicians and one rotating resident pharmacist. A brief course evaluation as well as qualitative feedback was solicited from elective participants by the course director, via email following the completion of the course, regarding the effectiveness of the course content. Learner feedback was used to influence the development of this complete curriculum. The curriculum was graded by learners on a 5-point Likert scale (1=strongly disagree, 5 = strongly agree). The mean response to, "This course was a valuable use of my elective time," was 5 (sd=0). The mean response to, "I achieved the learning objectives," and "This rotation helped me understand Clinical Informatics," were both 4.75 (sd=0.5). Overall, participants reported that the content was effective for achieving the learning objectives. During initial implementation, we found that the preliminary asynchronous learning component worked less effectively than we anticipated due to a lower volume of content. In response to this, as well as resident feedback, we added significantly more educational content.In conclusion, this model curriculum provides a structured process for an informatics rotation for the emergency medicine resident that utilizes the core competencies established by the governing bodies of the clinical informatics specialty and ACGME. Clinical informatics key concepts, including definitions, fundamental terminology, history, policy and regulations, ethical considerations, clinical decision support, health information systems, data governance and analytics, process improvement, stakeholder engagement and change management.

317 Interprofessional Simulation Event Improved Learner Familiarity and Confidence With Emergency Medical Services

Emergency medical services (EMS) are an integral component of the health care system. Interaction with EMS and transition of patient care is a daily occurrence in emergency medicine (EM). EM learners present to residency with diverse levels of prior exposure and familiarity with EMS. Though the American College of Graduate Medical Education (ACGME) requires EM residents to have experience with EMS, emergency preparedness, and disaster management, there is significant variability in EMS curricula and training among residency programs.

Impact of Patient Load on the Quality of Electronic Medical Record Documentation.

Objective:American College of Graduate Medical Education (ACGME) recommends ongoing care of 10 patients per resident however its implication is unclear. We hypothesized EMR quality to vary based on patient load and call status.Methods:We conducted a double-blind, single-center, retrospective observational study between 2017 and 2019 to investigate the quality and accuracy of resident documentation using the Responsible Electronic Documentation (RED) Checklist, a validated scoring system.Results:A total of 234 independent charts were analyzed and 80 met scoring criteria. Average patients per residents was 4, 9.1, 7.2, and 5.5 on “call” day (D0), “post-call” day (D1), “mid-call” day (D2), and “pre-call” day (D3), respectively. Mean RED checklist scores were 68.1%, 57%, 68.6%, and 72.1% on the above call status. The difference in score between D3 and D1 was statistically significant (P = .00042). There was a negative correlation between score and number of patients per resident (r = −0.286, P = .010).Conclusion:EMR documentation quality is directly impacted by patient load and resident call status with the lowest documentation quality on post-call day, correlating with patient load.

Intern Orthopedic Rotation Versus Emergency Medicine Procedure Month: Which one Derives More Opportunity?

INTRODUCTIONThe American College of Graduate Medical Education (ACGME) defines 18 “key procedures” as requirements in emergency medicine (EM) residency programs. The post-graduate year-1 (PGY-1) curriculum provides an early foundation for EM trainees to gain procedural experience, but traditional PGY-1 rotations may not provide robust procedural opportunities. Our objective was to replace a traditional orthopedic rotation with a 4-week rotation that emphasized EM procedure acquisition and comprehension. Although all residents met ACGME procedural requirements before the curricular modification, the purpose of this month was to increase overall procedure numbers. The block contained dedicated procedure shifts in the emergency department as well as an asynchronous, self-directed learning course. We sought to compare the number of procedures performed by PGY-1 residents during their orthopedic rotation (the year before implementation), to the number of procedures performed during their procedure rotation (the year after implementation).METHODSThe total number of procedures performed and logged by PGY-1 residents during the traditional orthopedic rotation (during the year prior to implementation of the new procedure rotation) were compared to the total number of procedures by the first class to undergo the new procedure rotation the following year. Thirty resident logs were reviewed (15 per class). Data were analyzed using SAS NPAR1WAY; Z < 0.05 was considered significant.RESULTSWhen compared to the orthopedic rotation, the procedure rotation had statistically significant higher numbers of procedures per resident (22, standard deviation [SD] 12, vs 11.4, SD 7.6; Z = 0.0177). A wide variety of nonorthopedic procedures accounted for the increased numbers, (13.6, SD 10.3, vs 0.9, SD 0.9; Z < 0.001). While the average number of orthopedic procedures was slightly less on the procedure rotation, there was no statistical difference (orthopedic rotation 10.13, procedure rotation 8.26; Z = 0.4605). Notably, fewer procedures were performed when 2 residents were on the procedure rotation at the same time (21 vs 10.1).CONCLUSIONThis analysis demonstrated a larger number and a wider variety of procedures performed by PGY-1 residents during a dedicated procedure rotation compared to a traditional orthopedic rotation. Furthermore, exposure to orthopedic procedures did not decline significantly. Limitations of the study include a modest number of subjects. Data may be limited by the consistency of procedure logging by individual residents. Further studies may assess procedural competency after PGY-1 year of training.

North American pediatric surgery fellows' preparedness for humanitarian surgery

IntroductionThe overwhelming burden of pediatric surgical need in humanitarian settings has prompted mutual interest between humanitarian organizations and pediatric surgeons. To assess adequate fit, we correlated pediatric surgery fellowship case mix and load with acute pediatric surgical relief efforts in conflict and disaster zones. MethodsWe reviewed pediatric (age < 18) cases logged by the Médecins Sans Frontières Operational Centre Brussels (MSF-OCB) from a previously validated and published database spanning 2008–2014 and cases performed by American College of Graduate Medical Education (ACGME) pediatric surgery graduates from 2008 to 2018. Non-operative management for trauma, endoscopic procedures, and basic wound care were excluded as they were not tracked in either dataset. ACGME procedures were classified under 1 of 32 MSF pediatric surgery procedure categories and compared using chi-squared tests. ResultsACGME fellows performed procedures in 44% of tracked MSF-OCB categories. Major MSF-OCB pediatric cases were comprised of 62% general surgery, 23% orthopedic surgery, 9% obstetrical surgery, 3% plastic/reconstructive surgery, 2% urogynecologic surgery, and 1% specialty surgery. In comparison, fellows' cases were 95% general surgery, 0% orthopedic surgery, 0% obstetrical surgery, 5% urogynecologic surgery, and 1% specialty surgery. Fellows more frequently performed abdominal, thoracic, other general surgical, urology/gynecologic, and specialty procedures, but performed fewer wound and burn procedures (all p < 0.05). Fellows received no experience in Cesarean section or open fracture repair. Fellows performed a greater proportion of surgeries for congenital conditions (p < 0.05). ConclusionWhile ACGME pediatric surgical trainees receive significant training in general and urogynecologic surgical techniques, they lack sufficient case load for orthopedic and obstetrical care – a common need among children in humanitarian settings. Trainees and program directors should evaluate the fellow's role and scope in a global surgery rotation or provide advanced preparation to fill these gaps. Upon graduation, pediatric surgeons interested in humanitarian missions should seek out additional orthopedic and obstetrical training, or select missions that do not require such skillsets. Level of evidenceIII

Neurosurgical Resident Exposure to Pediatric Neurosurgery: An Analysis of Resident Case Logs

Introduction: The purpose of this study is to identify the national trends of exposure to pediatric procedures during neurosurgical residency and to subsequently evaluate how neurosurgery residents’ experiences correlate with the minimum requirements set forth by the American College of Graduate Medical Education (ACGME). Methods: ACGME resident case logs from residents graduating between 2013 and 2017 were retrospectively reviewed. These reports were analyzed to determine trends in resident operative experience in pediatric procedures. The number of cases performed by residents was compared to the required minimums set by the ACGME within each pediatric surgical category. A linear regression analysis and t tests were utilized to analyze the change in cases performed over the study period. Results: A mean of 98.8 procedures were performed for each of the 877 residents graduating between 2013 and 2017. The total number of pediatric procedures declined at a rate of 1.7 cases/year (r² = 0.77, p = 0.05). Spine and cerebrospinal fluid diversion procedures showed decreasing trends at rates of 1.9 (r² = 0.70, p = 0.08) and 1.2 (r² = 0.70, p = 0.08) cases/year, respectively. The number of trauma and brain tumor cases were shown to have increasing rates at 1.0 (r² = 0.86, p = 0.02) and 0.3 (r² = 0.69, p = 0.08) cases/year, respectively, with trauma cases showing significant increases. There was also a trend of increasing cases logged as the lead resident surgeon by 12.9 cases/year (r² = 0.99, p < 0.001). The number of cases performed by the average graduating resident was also significantly higher than the minimums required by the ACGME; residents, on average, performed 3 times the required minimum number of pediatric cases. Conclusion: Neurosurgical residents graduating from 2013 to 2017 reported significantly higher volumes of pediatric neurosurgery cases than the standards set for by the ACGME. During this time, there was also a significant trend of increasing cases logged as the lead resident surgeon, suggesting more involvement in the critical portions of pediatric cases. There was also a significant, but not clinically impactful, decrease in pediatric case volumes during this time. However, the overall data indicate that residents are continuing to gain valuable pediatric experience during residency training.

Performance on the Obstetrics and Gynecology In-Training Examination After Implementation of a New Curriculum [7O

INTRODUCTION: The objective of this study is to determine the impact of a new academic curriculum on the Council on Resident Education in Obstetrics and Gynecology In-Training Examination (CREOG-ITE) scores in an American College of Graduate Medical Education (ACGME) accredited obstetrics and gynecology (OB/GYN) residency program. METHODS: This is a retrospective cohort analyzing the results of our scholastic preparation program. After scores from the January 2015 CREOG-ITE were released, all residents with a score one standard deviation below the mean, or &lt;180, were placed into the experimental group and met with the same attending every month to discuss key learning objectives. They were compared to the control group of residents with a score &gt;180 who had no additional formal education. Each resident served as her own matched paired internal control. RESULTS: Out of 18 possible residents, five were placed into the scholastic preparation program based on CREOG-ITE score &lt;180; two were PGY1 (post-graduate year), two were PGY2 and one was PGY3. The mean improvement in CREOG-ITE score from 2015 to 2016 for the experimental group was 23.2 points (95% CI 12.4-40.5 with P&lt;.001). CONCLUSION: The scholastic preparation program was associated with a substantial and statistically significant improvement in CREOG-ITE scores, even when accounting for PGY level. This demonstrates that improvement was not simply a by-product of inherent academic knowledge of a resident further along in training. Accountability to faculty members also played a large role in the program's success. This scholastic preparation program may serve as a model for improving OB/GYN resident education.

Visuospatial Aptitude Testing Differentially Predicts Simulated Surgical Skill

ObjectiveTo determine whether visuospatial perception (VSP) testing is correlated to simulated or intraoperative surgical performance as rated by the American College of Graduate Medical Education (ACGME) milestones. Design(Canadian Task Force classification II-2). SettingTwo academic training institutions. ParticipantsForty-one residents, including 19 from Brigham and Women's Hospital and 22 from the Mayo Clinic, from 3 different specialties: obstetrics and gynecology, general surgery, and urology. InterventionParticipants underwent 3 different tests: visuospatial perception testing (VSP), Fundamentals of Laparoscopic Surgery (FLS) peg transfer, and da Vinci robotic simulation peg transfer. Surgical grading from the ACGME milestones tool was obtained for each participant. Demographic and background information was also collected, including specialty, year of training, previous experience with simulated skills, and surgical interest. Standard statistical analyses were performed using Student's t test, and correlations were determined using adjusted linear regression models. Measurements and Main ResultsIn univariate analysis, Brigham and Women's Hospital and Mayo Clinic training programs differed in times and overall scores for both the FLS peg transfer and da Vinci robotic simulation peg transfer tests (p < .05 for all). In addition, type of residency training affected time and overall score on the robotic peg transfer test. Familiarity with tasks correlated with higher score and faster task completion (p = .05 for all except VSP score). There were no differences in VSP scores by program, specialty, or year of training. In adjusted linear regression modeling, VSP testing was correlated only to robotic peg transfer skills (average time, p = .006; overall score, p = .001). Milestones did not correlate to either VSP or surgical simulation testing. ConclusionVSP score was correlated with robotic simulation skills, but not with FLS skills or ACGME milestones. This suggests that the ability of VSP score to predict competence differs between tasks. Therefore, further investigation of aptitude testing is needed, especially before its integration as an entry examination into a surgical subspecialty.

Resident attendance at weekly conferences after implementation of an optional asynchronous learning curriculum.

Asynchronous learning (ASL) is a student-centered method of teaching utilizing online learning resources to overcome time and space constraints to facilitate information sharing and interaction amongst learners.1 Studies show it to be a valued and effective method of learning.2 As the availability of online educational resources for physicians has increased in recent years,3 Free Open Access Medical Education (FOAM) has become a familiar term to many. Some have suggested that ASL via FOAM can be a more flexible and cost-effective teaching method compared to conventional methods.4 In fact, FOAM may be preferred by the current generation of ‘millennial’ learners.5,6 Despite its increasing prevalence and utilization, FOAM is not a panacea. Educators who support a constructivist epistemology for education argue that the inherent isolation of ASL (studying alone at a private computer workstation) is a detriment. In addition, ASL can decrease learner satisfaction by diminishing a student’s sense of connection to peer learners.7 As such, blended learning, a hybrid combining classroom and online learning, creates a stronger sense of community amongst learners than either traditional or online courses alone.8 The Emergency Medicine (EM) Residency Review Committee (RRC) encourages programs to supplement the weekly educational conference curriculum with ASL in the form of “Individualized Interactive Instruction (III)”.9 In response, our EM residency program devised and implemented an optional, Web-based, asynchronous learning curriculum (ASYNC) to supplement our traditional planned weekly residency educational conferences, in essence creating an optional ”blended curriculum”. Consistent with RRC recommendations, we permitted residents to utilize ASYNC to obtain up to 20% of required residency educational conference attendance as extra credit (the equivalent of one hour out of the five offered each week within the extant didactic curriculum). The American College of Graduate Medical Education (ACGME)-mandated 70% conference attendance rate served as an inherent incentive to participate in ASYNC.9 There is no existing evidence to inform whether introducing an asynchronous learning curriculum will have unintended consequences such as lowering attendance to planned educational activities. Considering the current generation of ‘millennial’ learners’ preference for FOAM,5 it is conceivable that implementation of ASYNC would be associated with a reduction in attendance rates within the EM didactic curriculum. Such experiences may give educators and program directors pause before implementing an analogous curriculum. ASYNC Design and Implementation We implemented ASYNC in February 2015 at an urban, academic medical center which hosts a postgraduate year (PGY) 1-4 EM training program of 48 residents. ASYNC consists of two components, devised and supervised by residency program directors. The first portion incorporates Academic Life in Emergency Medicine’s (ALiEM) Approved Instructional Resources (AIR) series.10 Since most of the curated FOAM content from AIR comprises of high-yield evidence-based summaries of medical literature, we developed the second part of ASYNC to encourage the primary appraisal of the literature to promote self-directed assessment seeking and reflection. This second component of ASYNC consists of two monthly high-impact journal articles, selected by faculty. Learners are expected to read the articles and contribute to an online discussion board designed to encourage interaction amongst residents and faculty regarding if and how the literature can be translated into clinical practice.

History and Evolution of Anesthesia Education in United States

Resident education is both, a science and an art. Quality and homogeneity of resident education has a considerable correlation with patient safety. This article appraises how formal training in anesthesiology was started in United States and how it has evolved over the years. A comprehensive literature search was performed to identify journal articles, periodicals and historic documents that detailed the development and progression of academic anesthesiology. Various Anesthesiology Departments were also consulted. In 1927 Dr. Waters established the first ever academic department of Anesthesiology at the University of Wisconsin, Madison. The graduates from that residency programs, the so called “Aqualumni” went on to establish residency programs throughout the country. In 1938 American Board of Anesthesiology was formed, elevating the level of anesthesiology to a distinct specialty. World War II and post war era was a period of rapid growth in anesthesiology in general and academic anesthesiology in particular. In late 1970’s and early 80’s American College of Graduate Medical Education (ACGME) closely regulated the anesthesiology residency programs by recommending minimum program requirements. Over the years the training model has transformed from a relatively heterogeneous one to a uniform outcome based model with focus on learning and teaching of 6 core competencies. This article explores how the anesthesiology education evolved throughout 20th century to its present form.

Problem Based Learning (PBL) in an Infectious Diseases Fellowship

BackgroundProblem Based Learning (PBL) is an active learning process that adheres to key principles of adult learning theory. PBL is widely used in undergraduate medical education. To our knowledge there have been no published reports of PBL based curricula at the residency/fellowship level. Factors include time and labor for development, scheduling constraints, and competing clinical demands. We describe the implementation of a PBL based curriculum in an ID fellowship and its potential application to the American College of Graduate Medical Education (ACGME) Milestones.MethodsFrom 2003–5 a PBL-based core curriculum was developed for the ID fellowship at the Cleveland Clinic, replacing a didactic lecture-based curriculum. The PBL group consisted of 6–7 fellows and one preceptor, 2 hours per week. Cases were presented as diagnostic unknowns including radiographs, images, and pathologic materials. Course materials were presented through MOODLE, a web-based, interactive platform. Fellows worked separately and were allowed access to reference materials. Answers were submitted in a standardized short-essay format. For each case, the fellow listed his/her “top 3” differential diagnoses, described the pros and cons for each diagnosis, and then chose the single best answer. “Grade 1” was assigned if the actual diagnosis matched the fellow’s top choice; “grade 2” if the actual diagnosis was one of the top 3 diagnoses; grade “3” if the actual diagnosis was not within the top 3. Descriptive statistics and repeated-measures ANOVA was used to analyze test scores.Results32 fellows completed the PBL curriculum (2005–2015). Each trainee completed an average of 130 cases. About 60% of cases were derived from the preceptor’s patients, the remainder were abstracted from the literature. Year 2 fellows demonstrated significantly more grade 1 and 2 responses compared with Year 1 fellows. Diagnostic accuracy (grade 1 responses) increased for individual trainees when tracked serially over two years.ConclusionAn on-line PBL curriculum can be successfully integrated into an ID fellowship. A simple scoring system can be used to grade PBLs, and track development of medical knowledge and medical decision making, two of the ACGME Milestones.Disclosures All authors: No reported disclosures.

Ready for Discharge? A Survey of Discharge Transition-of-Care Education and Evaluation in Emergency Medicine Residency Programs.

This study aimed to assess current education and practices of emergency medicine (EM) residents as perceived by EM program directors to determine if there are deficits in resident discharge handoff training. This survey study was guided by the Kern model for medical curriculum development. A six-member Council of EM Residency Directors (CORD) Transitions of Care task force of EM physicians performed these steps and constructed a survey. The survey was distributed to program residency directors via the CORD listserve and/or direct contact. There were 119 responses to the survey, which were collected using an online survey tool. Over 71% of the 167 American College of Graduate Medical Education (ACGME) accredited EM residency programs were represented. Of those responding, 42.9% of programs reported formal training regarding discharges during initial orientation and 5.9% reported structured curriculum outside of orientation. A majority (73.9%) of programs reported that EM residents were not routinely evaluated on their discharge proficiency. Despite the ACGME requirements requiring formal handoff curriculum and evaluation, many programs do not provide formal curriculum on the discharge transition of care or evaluate EM residents on their discharge proficiency.

Evaluating the utility, reliability, and validity of a resident performance evaluation instrument.

The primary goal of this project was to create and evaluate the utility, validity, and reliability of an instrument assessing resident performance during child and adolescent psychiatry (CAP) training. In three stages, the instrument was developed and evaluated for utility in assessing skills critical to CAP. Items on the Global Assessment Evaluation (GAE) were derived from the six core competencies identified by the American College of Graduate Medical Education (ACGME). Secondary goals included producing an instrument that could be used by other CAP training programs and describing a process that could be followed by training programs to create their own assessment instruments. Faculty members developed a CAP resident performance evaluation instrument. In a three-stage process, faculty utilized the tool to evaluate residents during and after rotations. Statistical findings guided revisions to improve the utility and reliability of the instrument. For the final version of the GAE, intra-class correlation coefficients were calculated to assess inter-rater reliability, and Principal Components Analysis provided further insight into the dimensions of resident assessment. The final version of the GAE showed overall and construct validity by capturing significant differences among residents and matched faculty members' overall impressions of resident performance. Intra-class correlation coefficient values for the overall score (0.945) and individual scales showed good reliability. Resident performance was not correlated with rotation site or model of care. The GAE has proved a valuable instrument in tracking the progress, strengths, and weaknesses in resident performance over the course of training. Data from multiple evaluations over time provide useful information about resident performance in a way that one or few evaluations does not. This finding is consistent with the practice of semiannual reviews and the new Clinical Competency Committees, both of which are required by the ACGME.

Current pediatric rheumatology fellowship training in the United States: what fellows actually do

BackgroundPediatric Rheumatology (PR) training in the US has existed since the 1970’s. In the early 1990’s, the training was formalized into a three year training program by the American College of Graduate Medical Education (ACGME) and American Board of Pediatrics (ABP). Programs have been evaluated every 5 years by the ACGME to remain credentialed and graduates had to pass a written exam to be certified. There has been no report yet that details not just what training fellows should receive in the 32 US PR training programs but what training the trainees are actually receiving.MethodsAfter a literature search, a survey was constructed by the authors, then reviewed and revised with the help members of the Executive Committee of the Rheumatology Section of the American Academy of Pediatrics (AAP) using the Delphi technique. IRB approval was obtained from the AAP and Nationwide Children’s Hospital. The list of fellows was obtained from the ABP and the survey sent out to 81 current fellows or fellows just having finished. One repeat e-mail was sent out.ResultsForty-seven fellows returned the survey by e-mail (58%) with the majority being 3rd year fellows or fellows who had completed their training. The demographics were as expected with females > males and Caucasians> > non-Caucasians. Training appeared quite appropriate in the number of ½ day continuity clinics per week (1–2, 71%), number of patients per clinic (4–5, 60%), inpatient exposure (2–4 inpatients per week, 40%; 5 or greater, 33%), and weekday/weekend call. Fellows attended more didactic activities than required, had ample time for research (54% 21-60/hours per week), and had multiple teaching opportunities. Seventy-seven percent of the trainees presented abstracts at national meetings, 41% had publication. Disease exposure was excellent and joint injection experience sufficient.ConclusionsMost US PR training programs as a whole provide an appropriate training by current ACGME, American College of Rheumatology (ACR), and ABP standards in: 1) number of continuity clinics; 2) sufficient on-call activities for weekday nights and weekends; 3) joint interdisciplinary conferences; 4) electives 5) didactic activities; 6) scholarly activities; and 7) exposure to diverse rheumatology diseases. Areas of concern were uniformity & standardization of training, need for a customized PR training curriculum, more mentorship, free electives, training in musculoskeletal ultrasound, need for a hands-on OSCE certification exam and more exposure to ACGME competencies.

Residency Training in Intensive Short-Term Dynamic Psychotherapy: Methods and Cost-Effectiveness

CME Educational Objectives 1. Understand the role of training in psychodynamic psychotherapy in psychiatry residency training programs. 2. Learn a potential model for training residents in a short-term model of psychodynamic psychotherapy. 3. Review the efficacy and cost-savings data in a study training residents in this model. Whereas psychiatry grows as a field through contributions from neuroscience, genetics, psychopharmacology, and diagnostic specificity, psychiatrists continue to value the importance of psychodynamic assessment and intervention. This is reflected in the current Royal College of Physicians and Surgeons of Canada 1 and American College of Graduate Medical Education (ACGME) guidelines in psychiatry, 2 requiring the demonstration of competency in psychodynamic psychotherapy. This has been further underscored through the roll out of the Next Accreditation System, 3 requiring faculty in psychiatry training programs to delineate the achievement of resident milestones in the area of psychodynamic psychotherapy.

Child Welfare Training in Child Psychiatry Residency: A Program Director Survey

This study surveys child psychiatry residency program directors in order to 1) characterize child welfare training experiences for child psychiatry residents; 2) evaluate factors associated with the likelihood of program directors' endorsing the adequacy of their child welfare training; and 3) assess program directors' familiarity with some existing child welfare training and information resources. Program directors of American College of Graduate Medical Education (ACGME)-accredited child psychiatry residency programs were surveyed anonymously. Participants characterized their program's child welfare training curriculum and indicated their awareness of selected child welfare information and training resources. In all, 68% of program directors responded; 90% of respondents indicated that their residents encounter child welfare-involved youth very frequently or frequently. Just over half of the respondents reported inadequate training materials, and half were aware of at least one of the three queried child welfare information resources. However, nearly 40% of respondents who were familiar with the queried child welfare resources still reported having inadequate training materials. Respondents with adequate training materials were more likely to classify their program as devoting enough time to child welfare training. Respondents at sites that spent less than 5 hours on non-didactic child welfare training during residency were more likely to indicate that not enough time was spent on training. The findings of this study suggest that increasing child psychiatry program director awareness of existing child welfare information resources and providing 6-or-more hours of non-didactic child welfare training, two feasible and relatively low resource actions, may improve child welfare training in child psychiatry residencies.