Beginning Of Residency Training Research Articles

Components of educational and professional adaptation of residents: self-assessment of experience

Introduction. The relevance of ensuring the quality of training in residency as the main stage of training highly qualified medical personnel is beyond doubt, but the need for such provision is widely discussed at the level of both theory and practice. Only a combination (addition) of a number of factors can ensure the success of educational and professional adaptation in residency and, accordingly, its quality. The opinion and self-assessment of the data compiled by the residents themselves as full-fledged subjects of the educational and professional process require clarification and consideration. Purpose of the study: having identified and ranked the residents’ assessment of the main factors (components) of their own educational and professional adaptation, compare the assessment data and identify the most “vulnerable” factors that require correction and prevention. Research methods. analysis of domestic and foreign scientific literature revealing issues of training of residents and their adaptation; survey (724 first-year residents from 4 Russian medical universities: Altai (ASMU), Kazan (KSMU), Siberian (SSMU), Tyumen (TSMU)); generalization, ranking and analysis of data based on the results of the survey. Research results. Among the components of the educational and professional adaptation of first-year residents, they especially highly value the presence of awareness of the professional, ethical and deontological values of the doctor, his responsibility to patients, colleagues and satisfaction with training (noted by about 90% of respondents). The level of emotional comfort in residency was rated somewhat lower (“good” and “excellent” by almost 70% of respondents). The degree of independence in making medical decisions at the beginning of residency training is not highly rated (about 40%). One of the solutions to increase these indicators is employment based on internships. At the same time, the overwhelming majority of beginning residents were not ready to make proposals to improve the organization of their training. Conclusion. The most “vulnerable” factor in educational and professional adaptation (according to residents’ self-assessment of their own experience) is their lack of independence in making medical decisions. There are obvious problems in organizing residency training, mainly related to mentoring, which requires a comprehensive study of both the models of this organization and its assessment by all subjects of the educational and professional process in residency.

Results of a mixed-methods study on barriers to physician recruitment in Newfoundland and Labrador.

Like many rural and remote parts of Canada, the province of Newfoundland and Labrador (NL) struggles to maintain a skilled healthcare workforce. As many as 20% of people in the province are thought to be without a primary care physician. The purpose of this study was to determine the barriers recent Memorial University of Newfoundland medical alumni have faced in establishing medical practice in NL. An online survey followed by question-standardised focus group sessions. Two hundred and ninety-one physicians who graduated from Memorial University of Newfoundland medical school between the years of 2003 and 2018 completed the survey. Nearly 80% of respondents recalled that NL was their preferred practice location at some point during training: 79.4% (n = 231) at the beginning of medical school and 77.7% (n = 226) at the beginning of residency training. However, at the time of the survey, only 160 (55.0%) respondents were working in NL. Respondents reported significant cultural and systemic barriers in trying to work in NL, including ineffective recruitment offices, lack of transparency in communication with health authorities, inequitable distribution of resources and workloads, lack of appropriate resources to support new positions, and return-of-service agreements that are not honoured or followed-up. Our study outlines a number of ways in which recruitment and retention could be improved, ultimately improving provincial health care and helping to fulfil the mandate of the medical school.

Depression, quality of life and coping style among Thai doctors before their first year of residency training

ObjectivesDepression and suicide often affect young physicians coping with the demands of residency training. To support effective prevention programmes, we aim to assess depression, quality of life (QoL) and coping...

Analysis of national trends in neurosurgical resident attrition.

Resident attrition creates a profound burden on trainees and residency programs. This study aims to analyze trends in resident attrition in neurological surgery. This study followed a cohort of 1275 residents who started neurosurgical residency from 2005 to 2010. Data obtained from the American Association of Neurological Surgeons (AANS) included residents who matched in neurosurgery during this time. Residents who did not finish their residency training at the program in which they started were placed into the attrition group. Residents in the attrition group were characterized by one of five outcomes: transferred neurosurgery programs; transferred to a different specialty; left clinical medicine; deceased; or unknown. A thorough internet search was conducted for residents who did not complete their training at their first neurosurgical program. Variables leading to attrition were also analyzed, including age, sex, presence of advanced degree (Ph.D.), postgraduate year (PGY), and geographical region of program. Residents starting neurosurgical residency from 2005 to 2010 had an overall attrition rate of 10.98%. There was no statistically significant difference in attrition rates among the years (p = 0.337). The outcomes for residents in the attrition group were found to be as follows: 33.61% transferred neurosurgical programs, 56.30% transferred to a different medical specialty, 8.40% left clinical medicine, and 1.68% were deceased. It was observed that women had a higher attrition rate (18.50%) than men (10.35%). Most attrition (65.07%) occurred during PGY 1 or 2. The attrition group was also observed to be significantly older at the beginning of residency training, with a mean of 31.69 years of age compared to 29.31 in the nonattrition group (p < 0.001). No significant difference was observed in the attrition rates for residents with a Ph.D. (9.86%) compared to those without a Ph.D. (p = 0.472). A majority of residents in the attrition group pursued training in different medical specialties, most commonly neurology, radiology, and anesthesiology. Factors associated with an increased rate of attrition were older age at the beginning of residency, female sex, and junior resident (PGY-1 to PGY-2). Resident attrition remains a significant problem within neurosurgical training, and future studies should focus on targeted interventions to identify individuals at risk to help them succeed in their medical careers.

A quality improvement intervention to enhance performance and perceived confidence of new internal medicine residents

ABSTRACTBackground: Orientation for new medical residents is challenging due to the diversity of prior experiences and cultural backgrounds and is compounded by a lack of orientation curricula that adequately addresses the needs of the medical residents to allow them to perform their duties in an efficient manner from the start. The beginning of residency training is associated with reduced quality of healthcare widely referred to as the ‘July effect’.Objective: To assess the impact of a peer-led orientation for new interns on (a) self-reported confidence level, (b) improvement in performance of first-year residents in appropriate clinical documentation and efficient discharge procedures and protocols.Design/methods: In June 2016, a hybrid of interactive teaching and simulation exercises was used to teach documentation of critical information, such as discharge medication reconciliation and discharge summary. A handout of an intern guide/manual was also provided. The previous year’s data served as comparison/control data. Comparison data were obtained for both groups from hospital’s utilisation review department.Results: Twenty-one of 23 expected new interns (91%) participated in the intervention. There was a significant decrease in non-compliance for clinical documentation in the intervention group compared to the control group. The self-reported confidence level in the intervention group increased 34%.Conclusions: Such peer-to-peer orientation has the potential to effectively improve appropriate documentation and discharge process by new residents and may help to reduce the ‘July effect’.

Health and wellness among incoming resident physicians: A multi-domain survey.

IntroductionBurnout and depression are well-described in medical students and physicians and can lead to adverse personal and patient outcomes; however, their time course and risk factors remain understudied. Here, we measured multiple domains of mental and physical health and wellness and assessed gender differences among incoming physician trainees beginning residency at an academic medical center.MethodsUsing a cross-sectional study design, all incoming trainees (i.e. housestaff) at Johns Hopkins Hospital received a questionnaire assessing depression, burnout, sleep, exercise, and alcohol consumption, among other domains. Standardized instruments were utilized for questionnaire development. Tests of significance were two-tailed.Results196 of 229 incoming housestaff (86%) completed the survey, and 49% were female. A history of depression was reported in 8%, and 5.4% met criteria for at least moderate depression by Patient Health Questionnaire (PHQ-9). Females were more likely to report a history of depression than males (13% vs. 3%, p=0.02) but had similar PHQ-9 scores. Four percent of participants reported feeling they were in the wrong profession. Goal and mean sleep were 7 and 6.7 hours/night, respectively. Forty-seven percent reported exercising once/week or not at all. While mean reported weekly alcohol consumption was three drinks, participants reported consuming ≥5 drinks in one sitting on average 1.6 times in the prior 6 months, and 4% used alcohol to sleep.ConclusionsIncoming housestaff reported generally favorable mental and physical health at the beginning of residency training. However, exercise rates were low, and ill-suited alcohol consumption was noted, though infrequent. The few areas of possible improvement were largely similar between males and females. Wellness interventions might capitalize on the relatively high morale and health at the completion of medical school by helping to promote healthy habits, including regular exercise and avoidance of excess alcohol consumption, throughout future training and practice.

First-Year Internal Medicine Residents' Reflections on Nonmedical Home Visits to High-Risk Patients

ABSTRACTProblem: Patients who are high utilizers of care often experience health-related challenges that are not readily visible in an office setting but paramount for residents to learn. A nonmedical home visit performed at the beginning of residency training may help residents better understand social underpinnings related to their patient's health and place subsequent care within the context of the patient's life. Intervention: First-year internal medicine residents completed a nonmedical home visit to an at-risk patient prior to seeing the patient in the office for his or her first medical visit. Context: We performed a thematic analysis of internal medicine interns' (n = 16) written narratives on their experience of getting to know a complex patient in his or her home prior to seeing the patient for a medical visit. Narratives were written by the residents immediately following the visit and then again at the end of the intern year, to assess for lasting impact of the intervention. Residents were from an urban academic residency program in Baltimore, Maryland, USA. Outcome: We identified four themes from the submitted narratives. Residents discussed the visit's impact on future practice, the effect of the community and support system on health, the impact on the depth of the relationship, and the visit as a source of professional fulfillment. Whereas the four themes were present at both time points, the narratives completed immediately following the visit focused more on the themes of impact of future practice and the effect of the community and support system on health. The influence of the home visit on the depth of the relationship was a more prevalent theme in the end-of-the-year narratives. Lessons Learned: Although there is evidence to support the utility of learners completing medical home visits, this exploratory study shows that a nonmedical home visit can be rewarding and formative for early resident physicians. Future studies could examine the patient's perspective on the experience and whether a nonmedical home visit is a valuable tool in other patient populations.

Recovery from a depressive episode during postgraduate residency training is associated with senior doctors' support.

BackgroundDepression among doctors in residency training can have significant impacts on the health of the residents and on patient safety. This study aimed to investigate factors associated with recovery from a depressive episode experienced during postgraduate residency training.MethodsA questionnaire was administered to 2935 first‐year residents at the beginning of residency training in 2011; follow‐up surveys were conducted after 3 months and at the end of the training in 2013. The questionnaire included the Center for Epidemiologic Studies Depression Scale and the Senior Doctor's Support Scale (SDSS). Logistic regression was used to identify associations between factors that may have been related to recovery from depressive episodes.ResultsA total 182 residents experienced a depressive episode in the 3 months after starting residency training. When reassessed at the end of the 2‐year training, 102 (56%) residents had recovered from the episode and 80 (44%) had not. Increased odds of recovery were associated with a middle or high score on the SDSS (middle score odds ratios [OR] 4.45, 95% confidence interval [CI] 1.0‐18.0, P = .04; and high score OR 5.70, 95% CI 1.4‐23.4, P = .02).ConclusionsSupport from senior doctors should be enhanced to optimize recovery from depressive episodes experienced after the start of residency training.

Analysis of perception of training in graduates of the Faculty of Medicine at Universidad de Castilla-Mancha

IntroductionProblem-based learning has been a key component of the teaching method employed at the Faculty of Medicine at the University of Castilla La Mancha (UCLM) in Albacete, Spain since its creation. The aim of this study was to evaluate perceptions of training among residents who graduated from the first three years of the UCLM Degree in Medicine. MethodsUsing the Jefferson Medical College postgraduate rating form, residents rated their performance in four areas of clinical competency (medical knowledge, data gathering skills, clinical judgment, and professional attitudes) at the beginning of residency training in comparison with colleagues from other faculties. The construct validity of responses was evaluated using Cronbach's alpha and exploratory factor analysis. ResultsOver half the respondents (57.8%) considered that they had received better training than peers from other medical schools, and 98.5% felt that their general performance in the four competencies analyzed was similar or superior to that of their colleagues. Factor analysis revealed two major factors: “the physician as scientist” and “the physician as manager and communicator”. ConclusionsOur study shows that graduates from the UCLM Faculty of Medicine perceive their training, which is largely based on problem-based learning, as satisfactory.

Self-Reported Ability to Perform Procedures: A Comparison of Allopathic and International Medical School Graduates

Graduates of US allopathic and international medical schools comprise the majority of physicians who began family medicine residency in July 2011. Different procedural skills may be taught in allopathic and international medical schools leading to variation in the procedures that graduates can perform independently at the beginning of residency training. A mismatch between assigned resident tasks and procedural skills mastered during medical school may jeopardize patient safety. A survey was distributed nationwide to 3287 family medicine residents in July 2011 to determine the proportion of graduates of allopathic and international medical schools who self-reported the ability to perform each of 41 procedures independently. Surveys were completed by 681 residents (response rate = 21%). The proportion of allopathic and international graduates self-reporting the ability to perform 7 ambulatory, 4 inpatient and 4 maternity care procedures was statistically significantly different. All graduates self-reported the ability to perform few procedural skills independently upon entry to residency. More allopathic graduates self-reported the ability to perform ambulatory procedures, whereas more international graduates self-reported the ability to perform inpatient and maternity care procedures. Evaluation of individual resident competencies is key to tailor patient care responsibilities and supervision appropriately to resident abilities.

Gaps in Procedural Experience and Competency in Medical School Graduates

The goal of undergraduate medical education is to prepare medical students for residency training. Active learning approaches remain important elements of the curriculum. Active learning of technical procedures in medical schools is particularly important, because residency training time is increasingly at a premium because of changes in the Accreditation Council for Graduate Medical Education duty hour rules. Better preparation in medical school could result in higher levels of confidence in conducting procedures earlier in graduate medical education training. The hypothesis of this study was that more procedural training opportunities in medical school are associated with higher first-year resident self-reported competency with common medical procedures at the beginning of residency training. A survey was developed to assess self-reported experience and competency with common medical procedures. The survey was administered to incoming first-year residents at three U.S. training sites. Data regarding experience, competency, and methods of medical school procedure training were collected. Overall satisfaction and confidence with procedural education were also assessed. There were 256 respondents to the procedures survey. Forty-four percent self-reported that they were marginally or not adequately prepared to perform common procedures. Incoming first-year residents reported the most procedural experience with suturing, Foley catheter placement, venipuncture, and vaginal delivery. The least experience was reported with thoracentesis, central venous access, and splinting. Most first-year residents had not provided basic life support, and more than one-third had not performed cardiopulmonary resuscitation (CPR). Participation in a targeted procedures course during medical school and increasing the number of procedures performed as a medical student were significantly associated with self-assessed competency at the beginning of residency training. Recent medical school graduates report lack of self-confidence in their ability to perform common procedures upon entering residency training. Implementation of a medical school procedure course to increase exposure to procedures may address this challenge.

Concerning Neurologic Sequelae of Spinal Anesthesia

Concerning Neurologic Sequelae of Spinal Anesthesia

Interferences in Collaboration between Child Psychiatrists and Pediatricians

The relationship between pediatrics and child psychiatry has been discussed at length. Opportunities seem to exist for cooperation between the two specialties, and yet difficulties exist. This study compared attitudes toward childhood held by pediatricians and child psychiatrists, as well as by residents at the beginning and end of training in pediatrics, psychiatry, and child psychiatry. The attitudinal assessment tool was a 30-item questionnaire consisting of literary quotations with which respondents were asked to agree or disagree. The results suggest that pediatricians view childhood more positively than do child psychiatrists. These attitudinal differences exist at the beginning of residency training. Recommendations are made regarding how to facilitate better collaboration between pediatricians and child psychiatrists.