Beginning Of Residency Research Articles

Gender and Inconsistent Evaluations: A Mixed-methods Analysis of Feedback for Emergency Medicine Residents.

Objectives: Prior research has demonstrated that men and women emergency medicine (EM) residents receive similar numerical evaluations at the beginning of residency, but that women receive significantly lower scores than men in their final year. To better understand the emergence of this gender gap in evaluations we examined discrepancies between numerical scores and the sentiment of attached textual comments. Methods: This multicenter, longitudinal, retrospective cohort study took place at four geographically diverse academic EM training programs across the United States from July 1, 2013-July 1, 2015 using a real-time, mobile-based, direct-observation evaluation tool. We used complementary quantitative and qualitative methods to analyze 11,845 combined numerical and textual evaluations made by 151 attending physicians (94 men and 57 women) during real-time, direct observations of 202 residents (135 men and 67 women). Results: Numerical scores were more strongly positively correlated with positive sentiment of the textual comment for men (r = 0.38, P < 0.001) compared to women (r = -0.26, P < 0.04); more strongly negatively correlated with mixed (r = -0.39, P < 0.001) and negative (r = -0.46, P < 0.001) sentiment for men compared to women (r = -0.13, P < 0.28) for mixed sentiment (r = -0.22, P < 0.08) for negative; and women were around 11% more likely to receive positive comments alongside lower scores, and negative or mixed comments alongside higher scores. Additionally, on average, men received slightly more positive comments in postgraduate year (PGY)-3 than in PGY-1 and fewer mixed and negative comments, while women received fewer positive and negative comments in PGY-3 than PGY-1 and almost the same number of mixed comments. Conclusion: Women EM residents received more inconsistent evaluations than men EM residents at two levels: 1)inconsistency between numerical scores and sentiment of textual comments; and 2)inconsistency in the expected career trajectory of improvement over time. These findings reveal gender inequality in how attendings evaluate residents and suggest that attendings should be trained to provide all residents with feedback that is clear, consistent, and helpful, regardless of resident gender.

Development of an instrument for medical students’ self-assessment of facets of competence for patient-centred care

ObjectiveTo develop a facets of competence self-assessment instrument (FOCSI) with operationalised items for ten competence facets required for patient-centred care at the beginning of residency. MethodsWe conducted focus groups and cognitive interviews with final-year medical students to develop items that match students’ clinical experience. We tested 50 items in two samples and analysed model fit and internal consistency of all possible combinations to identify the optimal ten-item-solution. Item analysis was performed as well as correlation with six personality traits. ResultsAn optimal ten-item solution for the self-assessment instrument emerged for sample 1 (n = 101, 27.2 ± 3.5 years, 75.2 % female). We validated the model fit with sample 2 (n = 135, 27.7 ± 3.9 years, 66.7 % female): χ2(35) = 49.3, p = .055, CFI = .94, RMSEA = .055, SRMR = .058, Cronbach’s alpha = .78. The personality factors ‘Conscientiousness’ and ‘Extraversion’ correlate positively with most FOCSI items. ConclusionThe operationalised FOCSI items support undergraduate medical students close to graduation in realistic self-assessment of facets of competences for patient-centred care in their transition to residency. Practice implicationsRealistic self-assessment of facets of competence will provide medical students with the opportunity to monitor their competence development as part of self-directed learning for gaining adaptive expertise in professional, patient-centred care.

External Ventricular Drain Training in Medical Students Improves Procedural Accuracy and Attitudes Toward Virtual Reality

Neurosurgery residents face a learning curve at the beginning of residency. Virtual reality (VR) training may alleviate challenges through an accessible, reusable, anatomical model. Medical students performed external ventricular drain placements in VR to characterize the learning curve from novice to proficient. Distance from catheter to foramen of Monro and location with respect to ventricle were recorded. Changes in attitudes toward VR were assessed. Neurosurgery residents performed external ventricular drain placements to validate proficiency benchmarks. Resident and student impressions of the VR model were compared. Twenty-one students with no neurosurgical experience and 8 neurosurgery residents participated. Student performance improved significantly from trial 1 to 3 (15mm [12.1-20.70] vs. 9.7 [5.8-15.3], P= 0.02). Student attitudes regarding VR utility improved significantly posttrial. The distance to foramen of Monro was significantly shorter for residents than for students in trial 1 (9.05 [8.25-10.73] vs. 15 [12.1-20.70], P= 0.007) and trial 2 (7.45 [6.43-8.3] vs. 19.5 [10.9-27.6], P= 0.002). By trial 3 there was no significant difference (10.1 [8.63-10.95 vs. 9.7 [5.8-15.3], P= 0.62). Residents and students provided similarly positive feedback for VR in resident curricula, patient consent, preoperative practice and planning. Residents provided more neutral-to-negative feedback regarding skill development, model fidelity, instrument movement, and haptic feedback. Students showed significant improvement in procedural efficacy which may simulate resident experiential learning. Improvements in fidelity are needed before VR can become a preferred training technique in neurosurgery.

Efficacy of simulation-based training on transoesophageal echocardiography learning in a multicentre randomised controlled trial: SIMULATOR study

Abstract Background Evidence on the impact of simulation-based training in transesophageal echocardiography (TEE) is scarce. Purpose We aimed to assess the efficacy of simulation-based versus traditional teaching on TEE knowledge and skills for cardiology residents. Methods Between November 2020 and November 2021, all consecutive cardiology residents inexperienced from TEE were randomised (1:1, n=324) through 42 French University Centers into two groups with or without simulation support (either a simulation group or a traditional group). The coprimary outcomes were the scores in the final theoretical and practical tests 3 months after the training. TEE duration and the feelings of residents were also assessed. An economic analysis was also performed. Results While the theoretical and practical test scores were similar between the two groups before the training (respectively P=0.80 and P=0.51), the residents in the simulation group displayed higher theoretical test and practical test scores after the training than those in the traditional group (respectively 47.2±15.6% vs. 38.3±19.8%, P&amp;lt;0.0001 and 74.5±17.7% vs. 59.0±25.1%, P&amp;lt;0.0001). Subgroups analyses showed that the efficacy of the simulation training was even greater when performed at the beginning of residency (P&amp;lt;0.0001). After the training, the duration to perform a complete TEE was significantly lower in the simulation group than in the traditional group (respectively 8.3±1.4 min vs. 9.4±1.2 min, P&amp;lt;0.0001). Finally, residents' feelings were better in the simulation group than in the traditional group across all components (P&amp;lt;0.0001). Compared to the traditional group, the average additional cost per resident of the simulation program was respectively €1,785, €942 or €662 for 20, 40 and 60 residents. Conclusion Simulation-based teaching on TEE showed a significant improvement in knowledge, skills, and feelings of cardiology residents as well as a reduction in the duration to complete the examination. Funding Acknowledgement Type of funding sources: None.

Impact of a postgraduate year one (PGY-1) otolaryngology bootcamp on procedural skill development

Background: To measure the impact of an intensive eight-week postgraduate year one (PGY-1) otolaryngology bootcamp on the acquisition and retention of otolaryngology residents’ procedural skills compared to the traditional method of skill acquisition through clinical exposure. Methods: Residents at our institution were evaluated on their performance of flexible laryngoscopy, suture ligature, and rigid bronchoscopy setup at three time points: pre-bootcamp, one-week post-bootcamp, and one-year post-bootcamp. Video recordings were scored by two blinded faculty reviewers using a multipoint rating system. A control group of rising postgraduate year two (PGY-2) residents who did not participate in bootcamp were recorded performing these same skills. Scores in the three skills were compared between groups via t-tests. The eight-week bootcamp curriculum for PGY-1s was held at the Montefiore Einstein Center for Innovation in Simulation at Albert Einstein College of Medicine/Montefiore Medical Center. The participants were two classes of PGY-1 residents (n=8) at our institution who participated in a bootcamp at the beginning of residency, and one class of rising PGY-2 residents (n=3) who did not participate in a bootcamp (control group). Results: A comparison of pre-bootcamp scores to one-week post-bootcamp scores showed significant improvement in suture ligature ( P<0.05) and rigid bronchoscopy ( P<0.05), but no difference in flexible laryngoscopy ( P=0.54). Suture ligature ( P=0.09) and rigid bronchoscopy ( P=0.25) skills were not significantly different from one-week post-bootcamp to one-year post-bootcamp; however, a significant skill improvement was observed in flexible laryngoscopy ( P<0.05). By June of PGY1 year, the two bootcamp cohorts were similar to controls in all three skills: flexible laryngoscopy ( P=0.05), rigid bronchoscopy ( P=0.26), and suture ligature ( P=0.10). Conclusions: Participation in PGY-1 bootcamp was associated with improved acquisition and short-term retention of basic procedural skills, suggesting that bootcamps can be an effective arena to teach basic skills in otolaryngology. PGY-1 bootcamp is a promising arena for multi-institutional development.

Impact of a postgraduate year one (PGY-1) otolaryngology bootcamp on procedural skill development.

Background: To measure the impact of an intensive eight-week postgraduate year one (PGY-1) otolaryngology bootcamp on the acquisition and retention of otolaryngology residents' procedural skills compared to the traditional method of skill acquisition through clinical exposure. Methods: Residents at our institution were evaluated on their performance of flexible laryngoscopy, suture ligature, and rigid bronchoscopy setup at three time points: pre-bootcamp, one-week post-bootcamp, and one-year post-bootcamp. Video recordings were scored by two blinded faculty reviewers using a multipoint rating system. A control group of rising postgraduate year two (PGY-2) residents who did not participate in bootcamp were recorded performing these same skills. Scores in the three skills were compared between groups via t-tests. The eight-week bootcamp curriculum for PGY-1s was held at the Montefiore Einstein Center for Innovation in Simulation at Albert Einstein College of Medicine/Montefiore Medical Center. The participants were two classes of PGY-1 residents (n=8) at our institution who participated in a bootcamp at the beginning of residency, and one class of rising PGY-2 residents (n=3) who did not participate in a bootcamp (control group). Results: A comparison of pre-bootcamp scores to one-week post-bootcamp scores showed significant improvement in suture ligature ( P<0.05) and rigid bronchoscopy ( P<0.05), but no difference in flexible laryngoscopy ( P=0.54). Suture ligature ( P=0.09) and rigid bronchoscopy ( P=0.25) skills were not significantly different from one-week post-bootcamp to one-year post-bootcamp; however, a significant skill improvement was observed in flexible laryngoscopy ( P<0.05). By June of PGY1 year, the two bootcamp cohorts were similar to controls in all three skills: flexible laryngoscopy ( P=0.05), rigid bronchoscopy ( P=0.26), and suture ligature ( P=0.10). Conclusions: Participation in PGY-1 bootcamp was associated with improved acquisition and short-term retention of basic procedural skills, suggesting that bootcamps can be an effective arena to teach basic skills in otolaryngology. PGY-1 bootcamp is a promising arena for multi-institutional development.

Racial/Ethnic Group Trajectory Differences in Exam Performance Among US Family Medicine Residents.

Racial/ethnic score disparities on standardized tests are well documented. Such differences on the American Board of Family Medicine (ABFM) certification examination have not been previously reported. If such differences exist, it could be due to differences in knowledge at the beginning of residency or due to variations in the rate of knowledge acquisition during residency. Our objective was to examine the residents' mean initial scores and score trajectories using the In-Training Examination (ITE) and certification examination. A total of 17,275 certification candidates from 2014 to 2019 were included in this study. Annual ITE scores and certification examination scores are reported on the same scale and serve as the outcome. We conducted multilevel longitudinal regression to determine initial knowledge and growth in knowledge acquisition during residency by race/ethnicity categories. The mean postgraduate year 1 (PGY-1) ITE score was 393.3, with minority residents scoring 16.2 to 36.0 points lower compared to White residents. The mean increase per year in exam performance from PGY-1 ITE to the certification exam was 39.9 points (95% CI, 38.7, 41.1) with additional change among race/ethnicity categories per year of -3.2 to 1.9 points. This study found that there were initial score disparities across race/ethnicity groups in PGY-1, and these disparities continued at the same rate throughout residency training, suggesting equality in acquisition of knowledge during family medicine residency training but with a persistent gap throughout training.

Narrative analysis to track the development of clinical reasoning during residency

Purpose: Reflective narratives are valuable pedagogical tools that document and develop clinical reasoning. The purpose of this study was to investigate (through thematic analysis of reflective narratives) whether residents who were exposed to a specific clinical reasoning strategy showed development in the type and number of reasoning strategies used over the course of residency training. Methods: This retrospective analysis used narrative research and thematic analysis of reflective narratives written by five residents over the course of a 12-month orthopaedic residency program. Narrative research involves the analysis of stories that are in text form. Residents were introduced into the clinical reasoning strategies (CRS) model, which describes eight types of reasoning strategies used by expert physical therapists: diagnostic, narrative, intervention procedures, interactive, collaborative, reasoning about teaching, predictive, and ethical reasoning. Researchers coded resident narratives for the types of CRS used by residents, and then analyzed the code frequency to describe the development of resident clinical reasoning. Results: Researchers identified seven of the eight CRS strategies in resident narratives: diagnostic, narrative, reasoning about intervention procedures, interactive, collaborative, reasoning about teaching, and predictive reasoning. Residents used an average of 4.8 CRS at the beginning of residency and 5.8 at the end of the residency training. Reasoning about diagnostic and intervention procedures were used most frequently. Collaborative reasoning showed the most development, with 100% of the residents leveraging collaborative reasoning by the end of the residency. Conclusion: Narratives serve as valuable pedagogical tools to help residents engage in reflective processes and understand the context of caring for their patients. This study illustrates using qualitative data analysis to evaluate the development of clinical reasoning skills throughout residency training. Clinical narratives can both foster and provide valuable insights into the development of clinical reasoning skills.

Can general surgery interns accurately measure their own technical skills? Analysis of cognitive bias in surgical residents’ self-assessments

BackgroundAccurate self-assessment of knowledge and technical skills is key to self-directed education required in surgical training. We aimed to investigate the presence and magnitude of cognitive bias in self-assessment among a cohort of surgical interns. MethodsFirst-year general surgery residents self-assessed performance on a battery of technical skill tasks (knot tying, suturing, vascular anastomosis, Fundamentals of Laparoscopic Skills peg transfer and intracorporeal suturing) at the beginning of residency. Each self-assessment was compared to actual performance. Bias and deviation were defined as arithmetic and absolute difference between actual and estimated scores. Spearman correlation assessed covariation between actual and estimated scores. Improvement in participant performance was analyzed after an end-of-year assessment. ResultsParticipants (N = 34) completed assessments from 2017 to 2019. Actual and self-assessment scores were positively correlated (0.55, P < .001). Residents generally underestimated performance (bias -4.7 + 8.1). Participants who performed above cohort average tended to assess themselves more negatively (bias -7.3 vs -2.3) and had a larger discrepancy between self and actual scores than below average performers (deviation index 9.7 + 8.2 vs 3.8 + 3.1, P < .05). End-of-year total scores improved in 31 (91.2%) participants by an average of 11 points (90 possible). Least accurate residents in initial self-assessments (deviation indices >75th percentile) improved less than more accurate residents (median 5 vs 16 points, P < .05). All residents with a deviation index >75 percentile underestimated their performance. ConclusionCognitive bias in technical surgical skills is apparent in first-year surgical residents, particularly in those who are higher performers. Inaccuracy in self-assessment may influence improvement and should be addressed in surgical training.

Impact of Elective Case Postponement Secondary to COVID-19 on General Surgery Residents’ Experience: Operative Cases Logged at Three Academic Teaching Hospitals

ObjectiveThis study aims to characterize changes in the total operative cases logged by general surgery residents across three residency programs.DesignRetrospective cohort study. De-identified case logs, divided by institution and post graduate year (PGY) level, were obtained from the general surgery training programs at three academic hospitals. Total cases logged were calculated over the pandemic period (start: beginning of residency, end: May 31st, 2020) and the control period (start: beginning of residency, end: May 31st, 2019).SettingThree academic tertiary hospitals (Mayo Clinic – Arizona, Mayo Clinic – Florida, and Mayo Clinic – Rochester)ParticipantsAll general surgery residents at these three hospitals, including 25 residents at Mayo Clinic – Arizona in both the pandemic and control period, 16 and 15 residents at Mayo Clinic – Florida in the control and pandemic period, respectively, and 81 and 77 residents at Mayo Clinic – Rochester in the control and pandemic period, respectively.ResultsOnly PGY 4 general surgery residents at Mayo Clinic – Rochester had a decrease in operative cases logged in the pandemic period (759 cases on average compared to 1010 cases, p = 0.005), with no other changes in operative cases logged noted.ConclusionsWhile elective cases were postponed secondary to the COVID-19 pandemic for around 1 month in the spring of 2020, the decrease in elective cases did not greatly impact overall resident operative cases logged for residents in three general surgery residency programs.

A Trainee-Led Way to Help International Medical Graduates Meet the Challenges of a U.S. Residency.

To the Editor: Transitions during training are stressful for all physicians. This is especially the case for international medical graduates (IMGs) making the transition to a U.S. residency. In addition to the steep learning curve at the outset of residency, these physicians often face being away from their families, having visa-related complications, and experiencing culture shock and racial disparities. The University of Minnesota IMG support group was started in 2019 to build a community for these physicians to connect with others going through similar challenges so they can learn from each other and thrive despite the above stressors. The group was created and executed by residents and fellows across disciplines. As a first step, the group partnered with the graduate medical education (GME) office. That office helped create a list of all the IMGs at the medical school’s residencies and sent an initial email requesting volunteers for a core leadership group. Eleven trainees responded. This core team meets regularly online to discuss initiatives that could be undertaken by the group, and began by conducting informal social gatherings and potlucks. IMG participants reported that these events helped them build connections and better navigate practical aspects of living in the United States. In particular, the events improved their sense of well-being and helped them better cope with stress and adapt more easily to the local culture. In the setting of the COVID-19 pandemic, virtual meetings replaced in-person events. Recently, the group conducted a virtual social event to welcome the incoming IMG trainees to the medical school and university. This event included short talks by IMG panelists on topics they wished they had known about at the beginning of residency, such as culture shock, adapting and thriving in residency, and imposter syndrome. Feedback from new residents indicated that this event helped their anxiety about starting their residencies. Going forward, we hope that this social club of IMGs will grow into a mentoring network among the residencies at the University of Minnesota. Short-term goals are to continue to host social events and to work with the GME office in updating an intern survival handbook for IMGs. The long-term goal is to share the social group model on a national platform with the hope that it is replicated in other residency programs. The GME office continues to support this endeavor by sponsoring some of the events and advertising all the group’s events in the monthly resident–fellow newsletter. Building learner communities from shared experiences has the potential to ease the stressors of medical training. Especially with the challenges our country is facing with the pandemic, it is crucial to enact measures to ensure the well-being of our residents, who are at the front lines of care. These measures are particularly important for IMGs, who are an integral part of the U.S. health care workforce. Residency programs should do all they can to enable these physicians to succeed and achieve their highest potential. Acknowledgments: The authors would like to acknowledge the University of Minnesota Graduate Medical Education Office and Kaz Nelson, MD, associate designated institutional officer, for their continued support.

Repercussions of the COVID-19 pandemic on the well-being and training of medical clerks: a pan-Canadian survey

BackgroundThe COVID-19 pandemic has been an unprecedented and potentially stressful event that inserted itself into the 2019–2020 Canadian medical curriculum. However, its impact on stress and subsequent professional pathways is not well understood. This study aims to assess the impact of the COVID-19 pandemic on the mental well-being, training, and career choices of Canadian medical clerks within the first three months of the pandemic. It also aims to assess their use of university support systems and their appreciation of potential solutions to common academic stressors.MethodsAn electronic survey composed of four sections: demographics, stressors experienced during the pandemic, World Health Organization (WHO) well-being index, and stress management and resources was distributed to Canadian clerks.ResultsClerks from 10 of the 17 Canadian medical faculties participated in this study (n = 627). Forty-five percent of clerks reported higher levels of stress than usual; 22% reconsidered their residency choice; and 19% reconsidered medicine as a career. The factors that were most stressful among clerks were: the means of return to rotations; decreased opportunities to be productive in view of residency match; and taking the national licensing exam after the beginning of residency. The mean WHO well-being index was 14.8/25 ± 4.5, indicating a poor level of well-being among a considerable proportion of students. Clerks who reconsidered their residency choice or medicine as a career had lower mean WHO well-being indices. Most clerks agreed with the following suggested solutions: training sessions on the clinical management of COVID-19 cases; being allowed to submit fewer reference letters when applying to residency; and having protected time to study for their licensing exam during residency. Overall, clerks were less concerned with being infected during their rotations than with the impact of the pandemic on their future career and residency match.ConclusionThe COVID-19 pandemic had a considerable impact on the medical curriculum and well-being of clerks. A number of student-identified solutions were proposed to reduce stress. The implementation of these solutions throughout the Canadian medical training system should be considered.

Development, implementation, and evaluation of a competency-based didactic and simulation-focused boot camp for incoming urology residents: Report of the first three years.

The Royal College of Physicians and Surgeons of Canada's Competence by Design (CBD) initiative presents curricula challenges to ensure residents gain proficiency while progressing through training. To prepare first-year urology residents (R1s), we developed, implemented, and evaluated a didactic and simulation-focused boot camp to implement the CBD curriculum. We report our experiences and findings of the first three years. Urology residents from two Canadian universities participated in the two-day boot camp at the beginning of residency. Eleven didactic and six simulation sessions allowed for instruction and deliberate practice with feedback. Pre-and post-course multiple-choice questionnaires (MCQs) and an objective structured clinical exam (OSCE) evaluated knowledge and skills uptake. For initial program evaluation, three R2s served as historical controls in year 1. Nineteen residents completed boot camp. The mean age was 26.4 (±2.8) and 13 were male. Participants markedly improved on the pre- and post-MCQs (year 1: 62% and 91%; year 2: 55% and 89%; year 3: 58% and 86%, respectively). Participants scored marginally higher than the controls on four of the six OSCE stations. OSCE scores remained >88% over the three cohorts. All participants reported higher confidence levels post-boot camp and felt it was excellent preparation for residency. During its first three years, our urology boot camp has demonstrated high feasibility and utility. Knowledge and technical skills uptake were established via MCQ and OSCE results, with participants' scores near or above those of R2 controls. This boot camp will remain in our CBD curriculum and can provide a framework for other urology residency programs.

Acquisition and retention of surgical skills taught during intern surgical boot camp

BackgroundSurgical residencies have implemented boot-camps for early acquisition of basic technical skills for interns. However, educators worry that retention is poor. We hypothesized that a structured boot-camp curriculum would improve skills. MethodsInterns underwent eight boot-camp sessions at the beginning of residency. Interns completed pre-, post-boot-camp, and end-of-year skills assessments, as well as post-boot camp and end-of-year porcine procedure labs. Proficiency was measured on a 5-point scale and by completion time. ResultsAfter boot-camp, interns improved all domains of knot-tying. Median time decreased for skin-closure (8.3 vs 9.9 min, p < 0.01), peg transfer (57 vs 87 s, p < 0.01), intracorporeal (178 vs 300 s, p < 0.01), and extracorporeal knot-tying (140 vs 259 s, p < 0.01). At the end-of-year assessment, interns exhibited retention of all skills and improved in knot-tying and central line skills. During the retention porcine lab, interns progressed basic but not complex skills. ConclusionsAn eight-week boot-camp effectively improved technical skills among surgery interns. Interns retained all skills and improved upon techniques frequently practiced during intern year.

Neonatal Resuscitation: A Blended Learning Curriculum for Medical and Physician Assistant Students.

IntroductionDemonstration of competence in neonatal resuscitation is critical for health care providers who provide newborn care because each year, approximately 400,000 (10%) newborns require resuscitation in delivery rooms across the United States. Therefore, neonatal resuscitation skills certification is provided to graduates entering specific specialties at the beginning of residency and renewed biennially through the American Academy of Pediatrics and the American Heart Association. However, there is no formal curriculum to prepare medical (MD) and physician assistant (PA) students prior to graduation.MethodsWe developed a neonatal resuscitation curriculum for MD and PA students using a blended learning approach. The curriculum included web-based interactive teaching modules, a demonstration video of a mock neonatal resuscitation, and a neonatal resuscitation simulation. Final-year MD and PA students were evaluated using pre-/posttest, a neonatal resuscitation checklist, and an optional survey on interprofessional communication skills, roles, and responsibility.ResultsEighteen health professions learners completed the neonatal resuscitation curriculum. A paired-samples t test was conducted to compare pretest and posttest scores. There was a significant difference in pretest (M = 61.4, SD = 15.3) and posttest (M = 78.6, SD = 8.0) scores, t(17) = −4.7, p < .001. The mean score on the checklist was 79%. Learners strongly agreed/agreed that the simulation improved skills performance (100%), communication skills (92%), and understanding of roles and responsibilities (83%) during a neonatal resuscitation.DiscussionThere were improvements in knowledge, procedural, and interprofessional skills in learners who received the neonatal resuscitation curriculum.

Who Gets the Benefit of the Doubt? Performance Evaluations, Medical Errors, and the Production of Gender Inequality in Emergency Medical Education.

Why do women continue to face barriers to success in professions, especially male-dominated ones, despite often outperforming men in similar subjects during schooling? With this study, we draw on role expectations theory to understand how inequality in assessment emerges as individuals transition from student to professional roles. To do this, we leverage the case of medical residency so that we can examine how changes in role expectations shape assessment while holding occupation and organization constant. By analyzing a dataset of 2,765 performance evaluations from a three-year emergency medicine training program, we empirically demonstrate that women and men are reviewed as equally capable at the beginning of residency, when the student role dominates; however, in year three, when the colleague role dominates, men are perceived as outperforming women. Furthermore, when we hold resident performance somewhat constant by comparing feedback to medical errors of similar severity, we find that in the third year of residency, but not the first, women receive more harsh criticism and less supportive feedback than men. Ultimately, this study suggests that role expectations, and the implicit biases they can trigger, matter significantly to the production of gender inequality, even when holding organization, occupation, and resident performance constant.

Non-technical skills progression during anesthesiology residency in Portugal: the impact of a National Pedagogical Plan

ABSTRACT Background Simulation is known as an important tool for the learning of technical and non-technical skills without endangering patient safety. In Portugal, a National Pedagogical Plan for Anesthesiology Residents was created based on simulation training. This plan was designed according to the objectives set forth by the Portuguese Board of Anesthesiology. This study aimed to evaluate the impact of simulation training courses on the non-technical skills of medical residents in Anesthesiology. Methods Confidential questionnaires, pre- and post-course, were answered by all the residents that attended the different modules of the simulation training program at Centro Hospitalar e Universitário de Coimbra Biomedical Simulation Centre, Portugal, from February 2011 to March 2018. Results A total of 344 questionnaires were answered. In the group of questions regarding the need for help, mistakes, and self-efficacy over time, students recognized an increase over time in the need for support and the self-assessment of the number of mistakes (p < 0.001). Regarding the self-evaluation of safety culture and communication skills, at the end of the residency, almost all the students recognized that they did not feel bad when asking for help or expressing their opinion, even when they disagreed with the consultant anesthesiologist. This was significantly different from the values of the self-assessment at the beginning of residency (p < 0.001). The evolution of preparation, knowledge, and training also showed a positive evolution over the simulation modules (p < 0.001). Finally, the evaluation of the behavioral component in the clinical setting showed a significant positive evolution over time (p < 0.001): in the end, all the students strongly agreed that behavioral competencies are crucial. Conclusions The impact of simulation on anesthesiology non-technical skills during residency is positive and recognized by the students. Moreover, simulation also helps in the recognition of error, enriching the value of self-confidence and the crucial role of behavioral skills. ABBREVIATIONS BSC-CHUC: Biomedical Simulation Centre from Centro Hospitalar e Universitário de Coimbra

Validation and educational impact study of the NANEP high-fidelity simulation model for open preperitoneal mesh repair of umbilical hernia.

The aim of the study was to develop, validate and analyze the educational impact of a high-fidelity simulation model for open preperitoneal mesh repair of an umbilical hernia. The number of surgical simulators available for training residents is limited. Primary for ethical reasons and secondary for the emerging pay-per-quality policies, practicing-on simulators rather than patients is considered gold standard. Validated full-procedural surgical models will become more and more important in training residents. Such models may assure that evidence-based standards regarding technical aspects of the procedures become integral part of the curriculum. Furthermore, they can be employed as a quality control of residents' skills (Fonseca et al. in J Surg Educ 70:129-137, 2013). In a repeated measures design, medical students, residents in their last year of training and attending surgeons performed an open preperitoneal mesh repair on the NANEP model [NANEP stands for the German acronym Nabelhernien-Netzimplatation-Präperitonal (English: Umbilical hernia mesh implantation preperitoneal)]. Subjects were categorized as "Beginners" (internship students) or "Experts" (residents and surgeons). Content validity was analyzed by criteria of subject-matter-experts. Blinded raters assessed surgical skills by means of the Competency Assessment Tool (CAT) using the online platform "CATLIVE". Differential validity was measured by group differences. Proficiency gain was analyzed by monitoring the learning curve (Gallagher et al. in Ann Surg 241:364-372, 2005). Post-operative examination of the simulators shed light on criterion validity. The NANEP model-proofed content and construct-valid significant Bonferroni-corrected differences were found between beginners and experts (p < 0.05). Beginners showed a significant learning increase from the first to the second surgery (p < 0.05). Post-operative examination data confirmed criterion validity. The NANEP model is an inexpensive, simple and efficient simulation model. It has highly realistic features, it has been shown to be of high-fidelity, full-procedural and benchtop-model. The NANEP model meets the main needs of surgical educational courses at the beginning of residency.

Education Improves Musculoskeletal Radiology Interpretation by Trainees in a Low-Resource Setting

The aims of this study were to assess baseline musculoskeletal radiology knowledge among Haitian orthopedists and to determine the impact of an adult and pediatric musculoskeletal radiology lecture series. Participants were given lectures reviewing normal and abnormal elbow radiographs and received assessments before and after the intervention. Bivariate and multivariate analyses were used to identify factors associated with baseline and postintervention scores. This study was carried out as part of the 2018 Haitian Annual Assembly of Orthopaedic Trauma. This is an annual continuing medical educational conference in the capital city of Port-au-Prince open to all Haitian orthopedic surgeons and associated care providers, with a strong focus on resident training. Haitian orthopedic surgery residents and surgeons attending the 2018 Haitian Annual Assembly of Orthopaedic Trauma. Thirty-seven residents and faculty consented to participate in this study and 32 (86.5%) were male with a median age of 33 (interquartile rage: 30-35). On multivariate analysis controlling for the title (resident versus attending), total years of orthopedics (beginning of residency and beyond), and formal radiology teaching in medical school or residency, conference attendance in the past was significantly associated with higher preintervention assessment scores (odds ratio = 1.24, 95% confidence interval = 1.06-1.44, p = 0.010]. The mean total preintervention accuracy for correctly identification of pathology, if present, was 70% compared to 83% at the postassessment (p < 0.001). Overall, this study demonstrates that a brief lecture series at a continuing medical conference in Port-au-Prince, Haiti improved upper extremity radiographic interpretation based on pre and postassessments, and that prior conference attendance may be associated with higher baseline scores.

Objective Assessment of the Entrustable Professional Activity Handover in Undergraduate and Postgraduate Surgical Learners

This study used a virtual patient simulation (VPS) to quantifiably and objectively assess undergraduate (UG) to postgraduate (PG) medical learners' acquisition of the entrustable professional activity (EPA) "handover," focusing particularly on the transition to residency. This EPA is critical because it is part of a core competency for UG and PG training in both the United States and Canada, and is essential for patient safety and comprehensive professional communication. Data were collected from 3 separate groups of participants: 2 UG cohorts from an earlier study, as well as a PG cohort at the beginning of residency. All participants completed the same trauma VPS, which required a free text summary statement that was used as a surrogate for an oral handover. These were collected and scored independently, using previously developed validated rubrics, one procedural and the second semantic. All study participants were from one site. The VPS case was completed online. Two different UG groups, one designated junior (N = 52), was studied at the beginning of their clerkship year, a second group, designated senior (N = 30), was studied at the end of their clerkship year. These groups were compared to a third group of PG learners (N = 31) during the initial 2 weeks of their residency. Informed consent was obtained from all participants. A procedural rubric assessed learners' cognitive knowledge of trauma care-management. A semantic rubric assessed their use of the professional language necessary for a safe and succinct clinical handover communication. An Analysis of Variance comparing scores on the procedural rubric was highly significant with Tukey LSD tests indicating that all 3 groups were significantly different. Students increased their scores on the procedural rubric at each stage of their training. A parallel Analysis of Variance comparing students' scores on the semantic rubric revealed no significant increase in scores, indicating that students did not improve in their capacity to communicate professionally as they progressed through their training. Taken together, these results demonstrate that training was successful in teaching cognitive-based procedures, but not effective in teaching professional communication, which is critical to the EPA handover. Greater emphasis needs to be placed on ensuring the acquisition of professional communication skills throughout the continuum of UG and PG clinical activities. Faculty development should serve as a support to assist medical educators to address this requirement. These results also demonstrate that VPS with associated objective and validated rubrics can be used as an assessment methodology to quantifiably measure learner performance with respect to the EPA handover. A similar strategy should be considered across the UG and PG continuum for other EPAs and could form the nexus for further research.