Chief Residents Research Articles

General surgery resident motivation: the effect of formative compared to summative simulated skills assessments

Surgical residents undergo numerous summative and formative assessments throughout training. However, it is unknown how perceptions of assessment intention and use impact trainee motivation and subsequent performance outcomes. We use goal orientation theory to explore how resident perception of assessment type influences motivation levels. We conducted a prospective cohort study of general surgery residents’ motivation, with residents completing an electronic survey before a simulated surgical skills assessment. Items included resident perception of assessment type (formative vs summative), motivation scores (average of responses, 1 = Strongly Disagree to 5 = Strongly Agree), and post-graduate year (PGY). Mastery and performance motivation scores were compared based on perceived assessment type and PGY level. Sixty of 63 residents (RR = 95%) completed the survey. Residents who felt the assessment was formative had significantly higher mastery motivation scores than those who felt it was summative (mean = 4.1 vs 3.4, p = 0.006). Motivation scores varied significantly between residents of differing PGY levels, specific to mastery motivation (p < 0.001) with no differences seen in performance motivation. PGY1 and PGY3 residents had significantly higher mean mastery motivation scores than PGY5 residents (PGY1: 4.4, PGY3: 4.0 vs PGY5: 2.8, p < 0.01). Trainees who believe they are completing a skills assessment with the goal of skill development are more likely to indicate they are motivated to master the skill. Further, we demonstrate that more junior trainees exhibit higher mastery motivation than chief residents.

Surgical Case Volume Needed to Achieve Stable Procedural Proficiency in the General Surgery Chief Resident Year

Introduction: We have previously reported using a resident’s learning curve based on operative time (OT) plateau could determine their procedural proficiency. In this study we hypothesize case volume in the chief resident (CR) year would influence whether a CR could achieve reproducible procedural proficiency based on OT. Methods: We extracted laparoscopic cholecystectomy (LCh), laparoscopic colectomy (LCo), laparoscopic inguinal hernia (LIH) and open inguinal hernia (OIH) performed by general surgery residents in the CR year from 7/2016 to 6/2020 through hospital records with OT, patient type, and case complexity assessed by DRG. We used variance component analyses as well as generalizability and decision studies (D-Study) to determine number of cases needed to achieve desired reliability (> 0.80). Results: In total 1514 cases (LCh=776, LCo=339, LIH=158, OIH=241) were included. On average, CR overall completed 38.3 LCh, 16.9 LCo, 7.8 LIH, and 11.8 OIH. After controlling for CR effect, case complexity (r=0.004) and procedure type (r<0.0001) significantly influenced OT. To achieve stable/reproducible OT in each procedure upon graduation, our CRs (N = 6) were estimated to perform on average 25 LCh, 30 LCo, 26 LIH, and 17 OIH per person. Individual CR had minimal impact on the estimation of case needed. Conclusion: The case volume needed to achieve stable procedural proficiency in LCo, LIH and OIH exceeds average CR case number in our program. This might be also true in other programs. Prospective measurement of OT may allow for individualized CR case assignments and enhance CR readiness for independent practice in general surgery.

A systematic review and meta-analysis comparing postoperative outcomes of laparoscopic versus open omental patch repair of perforated peptic ulcer.

The mainstay of surgical management of perforated peptic ulcer is omental patch repair. Advances in minimally invasive techniques have shown feasibility of laparoscopic omental patch repair (LOPR). Laparoscopic omental patch repair is limited by learning curve (LC), but there is a lack of reporting of LC in LOPR. This study aims to compare outcomes following LOPR versus open omental patch repair (OOPR) with reporting of LC. PubMed, Embase, The Cochrane Library, and Scopus were systematically searched from inception till January 2022 for randomized controlled trials (RCTs) and non-RCTs comparing LOPR and OOPR in perforated peptic ulcer. Exclusion criteria were primary repair without use of omental patch repair. Primary outcomes were 30-day mortality, postoperative leak, and LC analysis. There were a total of 29 studies including 5,311 patients (LOPR, n = 1,687; OOPR, n = 3,624), with 4 RCTs with 238 patients (LOPR, n = 118; OOPR, n = 120). Majority of ulcers were located in the duodenum (57.0%) followed by stomach (30.7%). Mean ulcer size ranged from 5 to 16.2 mm in LOPR and 4.7 to 15.8 mm in OOPR. Laparoscopic omental patch repair was associated with lower 30-day mortality (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.35-0.92; p = 0.02), overall morbidity (OR, 0.31; 95% CI, 0.18-0.53; p < 0.0001), surgical site infection (OR, 0.27; 95% CI, 0.18-0.42; p < 0.00001), and length of stay (mean difference, -2.84 days; 95% CI, -3.63 to -2.06; p < 0.00001). Postoperative leakage (OR, 1.06; 95% CI, 0.43-2.61; p = 0.90) was comparable between LOPR and OOPR. Only three studies analyzed the proportion of consultants to trainees; LOPR was performed mainly by consultants (range, 82.4-91.4%), while OOPR was mainly performed by trainees (range, 52.8-96.8%). One study showed that consultants who performed open conversion had shorter operating time compared with chief residents (85 vs. 186.6 minutes, p < 0.003). Laparoscopic omental patch repair has lower mortality, overall morbidity, length of stay, intraoperative blood loss, and postoperative pain compared with OOPR. More prospective studies should be conducted to evaluate LC in LOPR. Systematic Review and Meta-Analysis; Level IV.

Abstract 083: State Of Ambulatory Hypertension Education In U.S. Internal Medicine Residency Programs: A Needs Assessment Survey

Background: Hypertension is one of the most common chronic conditions encountered by internal medicine residents during their ambulatory training. However, little is known about the current state of hypertension education for residents. Objective: To determine internal medicine residents’ confidence and training in key hypertension topics, desire for future training, and preferred teaching methods for learning about hypertension. Methods: We developed our survey by reviewing the literature, seeking input from two content experts, and piloting questions with chief residents at our institution. From November 2021 to March 2022 we administered the survey to internal medicine residents attending scheduled didactic sessions at 14 programs in different U.S. regions. Surveys were completed online or on paper, participation was voluntary, and responses were anonymous. The survey asked residents to rate their confidence, on a 4-point Likert scale, in 19 hypertension topics, and inquired about the type of training they had received in these topics. Residents were also asked to list the top five hypertension topics they wanted to learn more about and to list their top three preferred teaching methods for future training. Results: Two-hundred eleven of 324 residents (65%) responded to the survey. Many reported lacking training (25-40%) and confidence (52-81%) in key topics (Table). Conclusions: U.S. internal medicine residents in our study report insufficient training on key aspects of hypertension management. They describe low confidence in these areas and desire to learn more about them. Further curriculum development is needed to improve residents’ hypertension knowledge.

The impact of a night float system on operative experience in neurosurgery residency.

Since the Accreditation Council for Graduate Medical Education (ACGME) implemented duty-hour restrictions in 2003, many residency programs have adopted a night float system to comply with time constraints. However, some surgical subspecialities have been concerned that use of a night float system deprives residents of operative experience. In this study, the authors describe their training program's transition to a night float system and its impact on resident operative experience. The authors conducted a single-program study of resident surgical case volume before and after implementing the night float system at 3 of their 5 hospitals from 2014 to 2020. The authors obtained surgical case numbers from the ACGME case log database. Junior residents received a concentrated educational experience, whereas senior residents saw a significant decrease from 112 calls/year to 17. Logged cases significantly increased after implementation of the night float system (8846 vs 10,547, p = 0.04), whereas cases at non-night float hospitals remained the same. This increase was concurrent with an increase in hospital cases. This difference was mainly driven by senior resident cases (p = 0.010), as junior and chief residents did not show significant differences in logged cases (p > 0.40). Lead resident cases increased significantly after implementation of the night float system (6852 vs 8860, p = 0.04). When normalized for increased hospital cases, resident case increases were not statistically significant. Transitioning to a night float call system at the authors' institution increased overall resident operative cases, particularly for lead resident surgeons. Based on the results of this study, the authors recommend the use of a night float call system to consolidate night calls, which increases junior resident-level educational opportunities and senior resident cases.

35301 Comfort in performing cosmetic and surgical procedures for skin of color patients: A national survey among U.S. dermatology residents

Disparities between patients with skin of color (SOC) and dermatology providers with SOC remain prominent. Graduating U.S. dermatology residents should be comfortable caring for this underserved population. We aimed to evaluate U.S. dermatology residents’ comfort in performing cosmetic and surgical procedures in their patients with SOC. 143 dermatology residency programs identified using the AMA-FREIDA online database. A survey link was sent to the program directors and chief residents to forward to all current residents.

Sailing the boat together: Co-creation of a model for learning during transition

Purpose Medical students’ transition to postgraduate training, given the complexity of new roles and responsibilities, requires the engagement of all involved stakeholders. This study aims to co-create a transition curriculum and determine the value of involving the key stakeholders throughout such transition in its design process. Methods We conducted a mixed-methods study involving faculty/leaders (undergraduate/postgraduate), final-year medical students, and chief residents. It commenced with eight co-creation sessions (CCS), qualitative results of which were used to draft a quantitative survey sent to non-participants, followed by two consensus-building CCS with the original participants. We applied thematic analysis for transcripts of all CCS, and mean scores with standard deviations for survey analysis. Results We identified five themes: adaptation, authenticity, autonomy, connectedness, and continuity, embedded in the foundation of a supportive environment, to constitute a Model of Learning during Transition (MOLT). Inclusion of various stakeholders and optimizing their representation brought rich perspectives to the design process. This was reinforced through active students’ participation enabling a final consensus. Conclusions Bringing perspectives of key stakeholders in the transition spectrum enriches transition curricula. The proposed MOLT can provide a guide for curriculum designers to optimize the final year of undergraduate medical training in preparing students for postgraduate training with essential competencies to be trained.

A mentorship model for neurosurgical training: the Mayo Clinic experience.

Neurosurgical education is a continually developing field with an aim of training competent and compassionate surgeons who can care for the needs of their patients. The Mayo Clinic utilizes a unique mentorship model for neurosurgical training. In this paper, the authors detail the historical roots as well as the logistical and experiential characteristics of this teaching model. This model was first established in the late 1890s by the Mayo brothers and then adopted by the Mayo Clinic Department of Neurological Surgery at its inception in 1919. It has since been implemented enterprise-wide at the Minnesota, Florida, and Arizona residency programs. The mentorship model is focused on honing resident skills through individualized attention and guidance from an attending physician. Each resident is closely mentored by a consultant during a 2- or 3-month rotation, which allows for exposure to more complex cases early in their training. In this model, residents take ownership of their patients' care, following them longitudinally during their hospital course with guided oversight from their mentors. During the chief year, residents have their own clinic, operating room (OR) schedule, and OR team and service nurse. In this model, chief residents conduct themselves more in the manner of an attending physician than a trainee but continue to have oversight from staff to provide a "safety net." The longitudinal care of patients provided by the residents under the mentorship model is not only beneficial for the trainee and the hospital, but also has a positive impact on patient satisfaction and safety. The Mayo Clinic Mentorship Model is one of many educational models that has demonstrated itself to be an excellent approach for resident education.

Developing a Comprehensive Resident-driven Research Training Pathway: A Chief Resident's Perspective

Wide variation exists in research training, experience, opportunities, and exposure across various radiology residency training programs, ranging from having a dedicated research track to no exposure to hypothesis driven projects. Studies conducted at different residency training programs with varied resources and National Institutes of Health funding have shown that resident-driven research initiatives and mentorship programs have the potential to improve research experience during residency training, engage more medical students in research, increase departmental peer-reviewed publications and increase peer-reviewed publications of early-career faculty physicians. In an attempt to standardize the research training during radiology residency, we propose a standardized resident-led program which institutions may adapt, as well as resources that the American Alliance of Academic Chief Residents in Radiology (A3CR2) might compile in collaboration with other national organizations to improve trainee's research experience during their radiology residency training.

Impact of the COVID-19 pandemic on the burnout rates of graduating Canadian Urology residents.

ObjectiveTo assess the impact of coronavirus disease 2019 (COVID‐19) on burnout rates in Canadian Urology trainees.Subjects and MethodsA total of 37 chief residents representing all 12 Canadian Urology residency programmes attended a preparatory examination in December 2019 pre‐pandemic and 39 chief residents attended virtually in November 2020 during the pandemic. The Maslach Burnout Inventory (MBI) for medical professionals’ questionnaire was administered anonymously to both groups. The MBI covers emotional exhaustion, depersonalisation, and personal accomplishment. Descriptive statistics were used to analyse the data.ResultsThere was a 100% response rate in the convenience sample (n = 37) in 2019 and 64.1% response rate (n = 25) in 2020. Overall, 70% of chief residents in Canadian Urology programmes showed evidence of burnout in 2019 compared to 88% in 2020 (P = 0.101). There was a statistically significant difference between the two cohorts in emotional exhaustion (mean [sd] 16.2 [5.6] in 2019 and 20.2 [6.2] in 2020, P = 0.011) and personal accomplishment scores (mean [sd] 32.2 [4.5] in 2019 and 30.6 [3.6] in 2020, P = 0.039).ConclusionsThis study is the first to examine the impact of the pandemic on burnout rates in Urology trainees. Burnout rates are high in trainees at baseline, and the pandemic appears to have exacerbated emotional exhaustion, and personal accomplishment, but not overall burnout rates. Vigilance and proactive steps need to be implemented to alleviate this crisis.

'Our real work': medicine and poetry with Dr Adam Possner.

Adam Possner MD (Figure 1) says that his life path can be categorized neatly in three different ways: the personal, the medical, and the poetic. Dr Possner was born in Florida, grew up in Kentucky, and settled down in North Bethesda, Maryland: he’s been married for 16 years and has two young boys. He went to medical school at the University of Michigan, residency and chief residency at Johns Hopkins Bayview Medical Center, taught at George Washington University, and established his own private practice in January 2021. As for poetry, he has no formal training. It was at some point in medical school that Possner discovered the poetry section in the Journal of the American Medical Association, and so began his foray into medical poetry. Soon after, he went through a several-year period in which he was very prolific. Dr Possner has always been enthralled with the power of words. ‘Words can change the world, they can be far more powerful than the most brutish physical force. I repeatedly tell my kids, ‘Words are powerful’. I’ve been telling them ever since they’ve been able to understand what I say’. He enjoys playing with words—he likes how there are some that have more than one meaning, and the way in which this quality can be leveraged in poetry to create layers of understanding.

The Impact of Covid-19 Pandemic on Obstetrics and Gynecology Residency Programs and Perspectives on Adaptive Ways of Training in Ethiopia

Background: The impact of Covid-19 on healthcare system and trainings has been tremendous and unpredictable. In addition to service re-organization, teaching institutions will have to devise adaptive mechanisms to cope up with the disruption in medical education and residency training. Objectives: to assess the effect of Covid-19 pandemic on obstetrics and gynecology residency program and explore residents’ &amp; program directors’ perspectives on alternative academic approaches in Ethiopia. Methods: This is a cross sectional mixed method study which was conducted at 12 institutions engaged in obstetrics and gynecology residency training in Ethiopia from May to June 2020. Quantitative data were collected from 240 residents employing an online platform (Google Forms) and focus group discussion was conducted using the ZOOM video-conferencing platform with eleven chief residents and eight program directors. Quantitative data analysis was performed using Stata 15 statistical software while thematic synthesis approach was used for the qualitative data analysis assisted by Atlas’s 7 for windows. Ethical clearance was obtained from IRB of Saint Paul’s Hospital Millennium Medical College. Results: All levels of residents from all residency sites were represented. The level of residents’ engagement in various routine clinical services vary depending on the type of service during COVID-19 pandemic period. Residents’ involvement in routine ANC, high risk clinics are “slightly” reduced while in Gynecology OPDs, the reduction was “severe”. There was no effort made to address the psychological impact of the pandemic on residents. The level of reduction in didactic and clinical teaching (rounds, case presentations, seminars, management sessions ranged from “some” to “complete interruption” for most of the residents at different years of training. Although the reduction in obstetric practical exposure (normal delivery, cesarean delivery) was “slight”, there was “sever” reduction to “complete suppression” (&gt;80%) in major gynecologic surgeries primarily affecting final year residents. Research activities are completely halted in most of the institutions. Generally, adaptive methods to sustain the residency training were implemented in very few of the institutions. Conclusions: There was significant disruption in all domains of the residency training following the report of the first case of COVID-19 in Ethiopia. The preparedness and response of the programs was very poor and there was limited effort in implementing adaptive teaching methods in almost all of the institutions.

Hurricane Ida Emergency Medicine Resident Disaster Response.

This report describes the medical response, action plan, and after-action summary adopted by the Louisiana State University (LSU) New Orleans - Emergency Medicine (EM) Residency Program in response to Hurricane Ida which occurred in New Orleans, Louisiana (USA) late August through early September 2021. New Orleans has an estimated 385,000 people within the 350 square miles surrounding the metropolitan area, with greater than one million residents in all of Louisiana. In the two-week time span during and following the event, residents, nurses, attendings, ancillary staff, and Emergency Medical Services (EMS) managed a substantial intensification in daily EM activities due to a substantial lack of resources (ie, food, electricity, water, housing, medications, oxygen, and primary care). This report outlines the redistribution of emergency department (ED) residents within the primary clinical site, University Medical Center New Orleans (UMCNO); describes the daily communication flow from the chief residents and program director; describes the daily EM response; describes the pre- and post-action plans based on those efforts during hurricane operations; and summarizes the obtained information.

Effective Strategies for Planning and Facilitating Morning Report.

Effective Strategies for Planning and Facilitating Morning Report.

Resident integration with inpatient clinical documentation improvement: a quality improvement project

BackgroundClinical documentation improvement (CDI) is an increasing part of health system quality and patient care with clinical documentation integrity specialists (CDIS) expanding into daily physician workflow. This integration can be...

Telerehabilitation as a Method for Achieving Competencies in Physical and Rehabilitation Medicine Residency Training in a Developing Country: A Protocol for a Pilot Mixed-Methods Study.

BackgroundIn the second year of the COVID-19 pandemic, Physical and Rehabilitation Medicine (PRM) residents in a developing country continue to face a lack of in-person clinical exposure and learning opportunities. With the unprecedented shift to virtual care, it remains uncertain whether residents can achieve PRM competencies using telerehabilitation as a method of instruction.ObjectiveTo determine the PRM residents' ability to achieve competencies through telerehabilitation, as perceived by different stakeholders (residents, chief residents, training officers, and department heads).MethodsThis will be a pilot mixed-methods study, employing concurrent triangulation, in the Department of Rehabilitation Medicine in one large private medical center and one large government hospital in Manila, Philippines. There will be two phases of online data collection upon approval by their respective research ethics board. The first phase will involve an online Likert-scale questionnaire to obtain the residents' self-perceived attainment of competencies and learning of PRM topics and skills specified by the International Society of Physical and Rehabilitation Medicine and the Philippine Board of Rehabilitation Medicine. The results of the survey will then be summarized and presented in a focus group discussion (FGD) with the department heads, training officers, and chief residents of the two institutions in an attempt to explain the residents' perceptions on their competencies achieved through virtual care. Afterwards, the qualitative data obtained from the FGD will then be thematically analyzed, and mixed methods integration will be employed to generate knowledge and recommendations.DiscussionIt is hypothesized that the majority of the residents had little to no experience with telerehabilitation pre-pandemic. Suddenly telerehabilitation was used to augment clinical training during the pandemic. It is uncertain whether telerehabilitation can help residents achieve competencies in the different domains of training, namely: patient safety and quality patient care; medical knowledge and procedural skills; interpersonal and communication skills; practice- and systems-based learning and improvement; reintegration of people with disabilities into the society; medical ethics and public health; quality assurance; policies of care and prevention for disabled people; and professionalism. The study results can provide insights on the aspects of a PRM curriculum that may have to be modified to ensure the training program is sensitive and appropriate to the changing training needs of the residents amid the pandemic and similar crises that may disrupt in-person clinical encounters in the future.

Inguinal Hernia Repairs on the Chief's Service: A Safe Educational Model in Resident Entrustment

We hypothesized that a Chief Resident Service educational model provides safe care for patients compared to that received on standard academic services where rotating residents adopt the practices and preferences of their attending. We retrospectively identified patients undergoing inguinal hernia repairs from July 2016 through June 2019 and matched Chief's service patients to standard academic service patients 1:1 on CPT, sex and age. We compared patient characteristics, recurrence rates, outcomes and complications. Tertiary care center, single institution. Overall, 77 patients undergoing inguinal hernia repairs (66% open and 34% laparoscopic) on the Chief's service matched successfully to 77 standard academic service patients during the study period. Age, BMI and ASA were similar between the services, but Chief's service patients were less likely to be current smokers (1.3% vs. 24.7%) and more likely to be former smokers (59.7% vs. 26.0%) than standard academic service patients (p < 0.01). Patients presenting with incarcerated hernias (5.2% vs. 9.1%), recurrent (10.4% vs. 5.2%) and bilateral hernias (19.5% vs. 10.4%) were similar between the Chief's service and standard academic services, respectively (all p > 0.05). Operative times were longer for the Chief's service for open (123 min vs. 67, p < 0.01) and laparoscopic (112 min vs. 79, p = 0.02) repairs. Recurrence rates (6.5% vs. 3.9%, p = 0.47) and complications including infection, seroma or hematoma requiring evacuation and need for reoperation were similarly low (p > 0.05) between the Chief's and standard academic services, respectively. Despite low complication rates, Chief's service patients were more likely to present to the ED post-op (14.3% vs. 1.3%; p = 0.001), but readmission rates were similarly low (2.6% vs. 0%, p = 0.09). Providing general surgery chief residents with a supervised opportunity to direct, plan and provide surgical care in clinic and the operating room, as a transition to independent practice following graduation, is safe for patients presenting with inguinal hernias. Concerns about patient safety should not be a barrier to maximizing entrustment for the evaluation and operative management of select core general surgery diagnoses and operations.

Editorial introductions.

Current Opinion in Cardiology was launched in 1985. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of cardiology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Ali J. MarianAli J. MarianDr Ali J. Marian joined the faculty at the Department of Medicine (Cardiology) at Baylor College of Medicine, USA, in 1992 and was recruited to The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases at UTHealth, USA, in 2006. His colleagues nationally and internationally recognize him for his research achievements and expertise in genetics of cardiomyopathies. He received the Young Investigator Award from the American College of Cardiology, the Junior Faculty Award for research from the American Federation of Medical Research, the Award for Excellence in Research at Baylor College of Medicine, the Established Investigator Award by the American Heart Association, the Clinician-Scientist Award in Translational Research from Burroughs Wellcome Fund and the Best Editor Award from the American Heart Association. Dr Marian is an Associate Editor of Cardiovascular Research and Section Editor on Genetics for Current Opinion in Cardiology and Current Atherosclerosis Reports. He was a Deputy Editor of Circulation Research, Associate Editor for Circulation and an Associate Editor for European Journal of Clinical Investigation. He received the Best Editor Award from the American Heart Association for his work for Circulation Research. Dr Marian has co-authored ∼ 200 manuscripts in peer-reviewed journals. He has served as a reviewer for > 100 National Institute of Health, American Heart Association and other organizations study sections. Dr Marian's research is supported by grants from NHLBI-NIH, Leducq Foundation Trans-Atlantic Network of Excellence and local foundations. Rebecca CogswellRebecca CogswellDr Cogswell completed internal medicine residency, chief residency, and cardiology fellowship at the University of California, San Francisco, USA. While at UCSF, she also completed a year of advanced clinical research training. She then went on to complete Advanced Heart Failure fellowship at the University of Minnesota, USA. She has been on faculty at the University of Minnesota since 2013 and is presently the Medical Director of Mechanical Circulatory Support Program. Dr Cogswell's research focus is the skeletal muscle changes that occur in end stage heart failure. Specifically, she is interested in what these changes can reveal about optimal timing of advanced heart failure therapies and using these measures to predict outcomes after mechanical circulatory support. She has built a left ventricular assist device database at the University of Minnesota and is collaborating with other centers towards answering several clinical questions in the contemporary continuous flow LVAD population. She is presently the Advanced Heart Failure fellowship director and is an active reviewer for Journal of Heart Lung Transplant and Circulation Heart Failure. She is a principle investigator for several heart failure and LVAD related clinical trials. In 2017, she was appointed to the Medtronic Heart Failure Advisory Board. In addition, she developed and directs to the Infiltrative Cardiomyopathies Clinic at the University of Minnesota. Gene KimGene KimDr Kim is a cardiologist with the Advanced heart failure, Cardiac transplant, and Mechanical Circulatory Support Program at the University of Chicago Medicine, USA. He is an Assistant Professor of Medicine and the Advanced Heart Failure Fellowship Program Director. His medical school, residency, and fellowship training were completed at the University of Chicago. Dr Kim's research interests include the genetic and epigenetic regulation of heart failure and arrhythmogenesis with publications on the role of microRNAs in cardiomyopathy. His interests also include myocardial recovery, extracellular matrix in failing myocardium, and the role of inflammation and angiogenesis in LVAD patients. He has published over 80 articles and book chapters and is an investigator in numerous clinical trials.

Realizing Inclusion and Systemic Equity in Medicine: Upstanding in the Medical Workplace (RISE UP)-an Antibias Curriculum.

IntroductionRacism is a public health threat, and racist behaviors adversely affect clinicians in addition to patients. Medical trainees commonly experience racism and bias. More than half of pediatric residents at a single institution reported experiencing or witnessing discriminatory behavior at work; only 50% reported receiving training on implicit bias, delivering difficult feedback, or peer support. Our multispecialty team created Realizing Inclusion and Systemic Equity in Medicine: Upstanding in the Medical Workplace (RISE UP), an antibias, anti-racism communication curriculum composed of three hybrid (virtual and in-person) workshops.MethodsDuring the pediatric resident workshops, we introduced tools for addressing bias, presented video simulations, and led small-group debriefings with guided role-play. We also reviewed escalation pathways, reporting methods, and support systems. Residents completed an evaluation before and after each workshop to assess the curriculum's efficacy.ResultsThirty-nine residents participated in RISE UP, with 20 attending all three workshops. Ninety-six percent of participants indicated they would recommend the workshops to colleagues. After the third workshop, 92% reported having tools to respond to bias, and 85% reported knowing how to escalate concerns regarding discriminatory behavior. Chief residents were most frequently identified as sources of resident support when encountering discriminatory behavior.DiscussionThis curriculum was successful in developing and strengthening residents’ responses to discrimination, including upstander support. The curriculum is adaptable for virtual, in-person, and hybrid settings, allowing for flexibility. Establishing institutional support, promoting faculty development, and creating and disseminating escalation pathways are critical to addressing racism in health care.

Characterization of Internal Medicine Chief Resident Administrative, Educational, and Clinical Experiences

The internal medicine (IM) chief residency is a position of leadership and honor common in IM programs, but the goals, responsibilities, and experiences of those who undertake it can be highly variable. Studies assessing the experience and impressions of the chief resident (CR) position from the viewpoint of the IM CRs are lacking. To describe the structure, responsibilities, and perceptions of the IM CR role across IM residency programs. A cross-sectional, simple descriptive electronic survey for current CRs was administered between April and June 2018 across US IM residency programs accredited by US Accreditation Council for Graduate Medical Education. A 2-step nonrandom sampling approach was used: first, snowball sampling was performed using the authors' professional networks, and second, the survey was sent to the Association of Program Directors in Internal Medicine (APDIM) CR listserv. Data analysis was performed from June 2020 to August 2020. Participation as a CR for an IM residency program in the 2017 to 2018 academic year. Descriptive CR personal and program characteristics and CR perceptions of administrative, clinical, and leadership experiences. Among 169 unique responses, 77 participants (46%) were female and 89 (53%) were White. The response rate was 57% (70 of 122 surveys) in the snowball sample and 12% (99 of 842 surveys) in the APDIM listserv. The 2 sampled groups were combined for analysis. Most respondents (125 CRs [74%]) were from academic or university-based programs. Common across CR responses was responsibility for administrative tasks, clinical work, and educational efforts. Most CRs (111 of 157 respondents [71%]) reported being the primary schedulers for the residency program. Clinical work differed widely across respondents. Only 70 of 156 respondents (45%) reported having an academic title associated with the CR role. CRs reported inconsistent evaluation throughout the year, with high percentages reporting never receiving feedback on teaching (34 respondents [23%]), clinical abilities (67 respondents [45%]), or leadership abilities (60 respondents [40%]). Most CRs (107 respondents [69%]) agreed that they find work as a CR fulfilling and 117 (74%) agreed they would do chief residency again. Despite its ubiquity in training programs across the US, the IM CR experience is very different across programs. Recommendations are provided to consider for improvement of the CR experience, including structured feedback opportunities, maximizing educational and clinical experiences, and standardizing policies.