Resident Competency Research Articles

Attitudes of the Third-Year Clinical Anesthesiology Residents Toward an Independent Clinical Practice Rotation in COVID-19 Pandemic in Iran.

BackgroundCOVID-19 was a worldwide pandemic with international health emergencies and great challenges; health care personnel shortage and physician burnout is a potential major challenge that should be planned and managed; especially in those countries with a high COVID-19 occurrence.ObjectivesThis study was designed to assess the attitudes of 3rd-year anesthesiology residents toward an independent one month-length clinical care course for patients with COVID-19.MethodsA closed self-administered questionnaire was developed to assess the attitudes of 3rd-year clinical anesthesiology residents. A self-administered closed questionnaire was developed. Cronbach’s alpha was calculated to measure the reliability of the questionnaire; added with a factor analysis process.ResultsAll 19 clinical anesthesiology residents took part in the study, with a 100% response rate. Cronbach’s alpha for the reliability of the questionnaire was 0.678. The eigenvalue for 8 factors was equal to 1; however, further assessment led us to 7 factors.ConclusionsThis one-month period could improve the competencies of the 3rd year clinical anesthesiology residents based on their viewpoints. Since the COVID-19 pandemic is ongoing health and social problem worldwide, 3rd-year anesthesiology residents could help the health system to recover health care delivery faults regarding manpower; a promising point for crisis preparedness in the COVID-19 pandemic. Besides, there were many constructive results for the clinical anesthesiology residents regarding their training and clinical service delivery.

Factors of public well-being of residents of the Russian province

The article analyzes the features of the social well-being of the residents of the Russian province, examines the relevant factors that influence its level and direction. The author points out that the socio-cultural features of the periphery are essential for people’s subjective perception of the success of their lives. The article concludes that the social well-being of residents of the Russian province is largely determined by the age of the respondents. Middle-aged and older Russians are much less likely to perceive their social status as high, rarely have high self-esteem, and see opportunities for self-realization in the future. The social well-being of residents of the Russian province is also significantly influenced by the level of education, readiness for continuous self-development and education throughout life, subjective assessment of their own material well-being, as well as the degree of social integration of a person and support from the immediate environment and the local community. Based on the analysis, the author concludes that the social policy of the Russian state and society is not very effective, and that it is necessary to develop social institutions that focus on the formation of “self-care” competencies for Russian residents throughout their lives.

Teaching and assessment of core residency competencies by Ophthalmic Clinical Evaluation Exercise (OCEX)

Introduction: The Ophthalmic Clinical Evaluation Exercise (OCEX) checklist is like mini-CEX developed for ophthalmology by American Board of Internal Medicine’s Clinical Evaluation Exercise. It is a validated checklist used to observe resident-patient interactions. Most of the assessments during residency program are based on cognitive domain and lack psychomotor and affective domain. The present study assessed the utility of OCEX as a learning and assessment tool for ophthalmology residents. Material and Methods: This study was carried out in ophthalmology department of NKP SIMS & LMH Nagpur for a period of six months. It was a Quasi Experimental (Before and after) study. Seven ophthalmology residents (second or third year of residency) participated in the study. Each resident had three OCEX encounters, four weeks apart over the period of three months. Two faculty members were assessors for OCEX encounters. Data was collected on interview skills, clinical examination, interpersonal skills (professionalism) and case presentation. The performance was rated and feedback was shared with resident after every encounter. Results: On analysing the results, it was found that there was a significant difference in the performance of residents between initial and final OCEX encounter. Statistical significance was measured using Friedman ANOVA test for difference in mean performance score between initial and final encounter. Faculty and students had good satisfaction with OCEX system of learning cum assessment tool. Conclusion: The present study demonstrated that OCEX leads to clinical competency improvement in ophthalmology residents by providing critical formative feedback immediately after the encounter. The resident feedback towards OCEX was favourable. Keywords : OCEX, Ophthalmology, Residents, Assessment tool, Competency.

Assessing leadership in junior resident physicians: using a new multisource feedback tool to measure Learning by Evaluation from All-inclusive 360 Degree Engagement of Residents (LEADER)

BackgroundThe multifaceted nature of leadership as a construct has implications for measuring leadership as a competency in junior residents in healthcare settings. In Canada, the Royal College of Physicians and...

Anesthesia Resident Training Experience Minimally Impacts Emergence Time, Making Correlation of Resident Competency With This Operational Metric Difficult.

Anesthesia residents are deemed competent based on subjective and objective metrics. Knowledge acquisition and procedural skill is often difficult to accurately measure. Inspecting tangible metrics of perioperative efficiency may provide a source for reliable evaluation. Retrospective case-log database review yielded 3072 surgical cases involving residents over 5 years. Primary variable investigated was the time from surgery completion to exit from operating room. Other variables recorded included day of week, attending anesthesiologist name, attending surgeon name, patient age, sex, American Society of Anesthesiologists physical status (ASA PS) classification, and inpatient versus day surgery status. After controlling for procedure duration time, inpatient status, ASA PS, surgeon, and attending anesthesiologist, resident training time had high statistical significance. In the fully adjusted model, 1 year of resident training was associated with a reduction in emergence time by 28 seconds. A 1-hour increase in procedure time was associated with an increase in emergence time of 34 seconds. Although a statistically significant correlation between anesthesia resident training time and emergence time was demonstrated, the clinical significance is likely low given the relatively small amount of actual time saved. We caution the value of using perioperative metrics (e.g., emergence time) for evaluating anesthesia resident competency, until such metrics have undergone significant validation.

Teaching professionalism in medical residency programs: a scoping review protocol

BackgroundProfessionalism is a core competency of medical residents in residency programs. Unprofessional behavior has a negative influence on patient safety, quality of care, and interpersonal relationships. The objective of this scoping review is to map the range of teaching methods of professionalism in medical residency programs (in all specialties and in any setting, whether in secondary, primary, or community care settings). For doing so, all articles which are written in English in any country, regardless of their research design and regardless of the residents’ gender, year of study, and ethnic group will be reviewed.MethodsThis proposed scoping review will be directed in agreement with the methodology of the Joanna Briggs Institute for scoping reviews. The six steps of Arksey and O’Malley methodological framework for conducting scoping reviews, updated by Levac et al. (Implement. Sci. 5(1): 69, 2010) will be followed. The findings from this study will be merged with those of the previous Best Evidence Medical Education (BEME) systematic review. All published and unpublished studies from 1980 until the end of 2019 will be reviewed, and the previous BEME review will be updated by the findings of the articles from the beginning of 2010 until the end of 2019. All research designs and all credible evidence will be included in this review.ConclusionsConducting this scoping review will map the teaching methods of professionalism and will provide an inclusive evidence base to help the medical teachers in the choosing for proper teaching methods for use in their teaching practice.Systematic review registrationNot registered.

Anesthesia Resident Training Experience Minimally Impacts Emergence Time, Making Correlation of Resident Competency With This Operational Metric Difficult

Anesthesia Resident Training Experience Minimally Impacts Emergence Time, Making Correlation of Resident Competency With This Operational Metric Difficult

Abstract IA11: Improving Cultural Humility Training for Oncology Clinicians

Abstract Background: High quality communication skills are an essential part of the patient-clinician encounter. In 2001, the Accreditation Council for Graduate Medical Education (ACGME) began to require communication skills as core competencies for medical residents and fellows. Poor communication skills among clinicians are associated with reduced patient satisfaction, reduced patient understanding of their disease, poorer quality treatment decisions, increased patient anxiety and depression, and also higher individual- and societal-level monetary costs. Thus communication skills have become core competencies required by ACGME. With the recent NIH and ASCO classification of Sexual and Gender minority (SGM) patients as a population experiencing health disparities, increased attention has been placed on communication skills and cultural competency to provide care for SGM patients. However, the majority of literature on SGM cancer care has focused on highlighting health disparities, risk factors, poor outcomes or experiences or HIV/AIDS research. While recent medical school graduates may have received education on SGMs, mid and senior level physicians likely did not. There is need to develop communication skills with SGM patients with cancer. Such skills are particularly relevant for SGM patients as their status may be “invisible.” Practice settings do not always collect sexual orientation and gender identity (SOGI) data and even when they do, some clinicians may be unaware how to apply that information to the patient’s care or communication about care. Methods: This presentation will: 1) provide an overview of clinician knowledge and practice behaviors regarding SGM patients with cancer and health disparities; 2) list current education efforts to improve clinician communication; 3) describe the COLORS © training program; 4)identify training opportunities; 5) provide additional resources to create a welcoming environment for SGM patients with cancer. Results: An SGM patient who feels understood and accepted by their oncology clinicians may be more likely to disclose important facts about their health and behaviors. This may allow clinicians to make more timely diagnoses and/or more relevant treatment recommendations. Patients who feels acknowledged by their clinician may be more likely to stay in care and experience less cancer-related distress. Training and welcoming environment are only part of the solution. Health care policies can also reinforce clinician and practice changes. Conclusions: The field of SGM cultural humility training is in its infancy. Although there is much promise in improving structural, organizational, and clinical aspects of oncology care to meet the needs of SGM patients, frameworks for evaluation and specific measures of change are also needed. Citation Format: Gwendolyn P. Quinn, Ash Alpert, Megan E. Sutter, Julia Seay, Matthew B. Schabath. Improving Cultural Humility Training for Oncology Clinicians [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr IA11.

Improving the Assessment of Resident Competency: Physical Medicine and Rehabilitation Milestones 2.0.

In 2015, the Accreditation Council for Graduate Medical Education published the Physical Medicine and Rehabilitation Milestones 1.0 as part of the Next Accreditation System. This was the culmination of more than 20 yrs of work on the part of the Accreditation Council for Graduate Medical Education to improve graduate medical education competency assessments. The six core competencies were patient care, medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills. While providing a good foundation for resident assessment, the Physical Medicine and Rehabilitation Milestones 1.0 was not without faults. With input from program directors, national organizations, and the public, the Physical Medicine and Rehabilitation Milestones 2.0 strives to further advance resident assessment, providing improvements through the integration of the harmonized Milestones and the addition of a supplemental guide.

Engaging Pathology Residents in Clinical Chemistry: The Essential Ingredient Is a Committed Teacher.

Pathology residents are thought to show a lack of interest in clinical chemistry, therefore potentially graduating from training programs unprepared to function as laboratory directors and clinical consultants. A structured program of tutorials based primarily on Henry's textbook, supplemented by recent review articles; a question bank of about 600 questions to emphasize key concepts; requirement for performing and presenting quality improvement projects; participation in on-site CAP inspections; review of reference laboratory test requests; and involving residents in scholarly activity have resulted in sustained, transferable, and significant improvements in engagement, knowledge, competence, and examination scores. The primary parameter for measuring change in resident competence and engagement were improvements in resident in-service examination (RISE) scores, publications in peer-reviewed journals, and receipt of awards. The revised program produced significant improvement in RISE scores in clinical chemistry, over and above the improvements in the general residency program. The residents were authors on 12 publications in peer-reviewed PubMed listed journals in the 5-year period since revision in the clinical chemistry curriculum compared to no publications in clinical chemistry in the 5-year period before the new curriculum. Over the past 2 years, 6 of the 11 publications by graduating residents were in clinical chemistry, and 6 of 7 awards for research were garnered by residents engaged in clinical chemistry investigations. All of the residents passed their clinical pathology boards on first attempt since the change compared to 2 failures in the prior 5-year period. The structured program described here is important as a template that could be adopted by any pathology training program. The question bank developed by this program is a valuable and transferable aid. However, success of such a program is dependent on the commitment of a knowledgeable, dedicated, and passionate teacher.

Tourism orientation as a business paradigm for the development of united territorial communities

The subject of the research is tourist orientation as a component of the business paradigm of development of territorial communities of Ukraine The purpose of the study is to substantiate the theoretical foundations and criteria for the formation of a new business paradigm of tourism orientation of rural communities. General scientific and special research methods are used. Scientific method - for systematization of existing theoretical approaches to the researched problem; analysis and synthesis (for detailing the object and subject of research and their generalization); abstract-logical (in the formation of generalizations, conclusions and proposals; the method of systematic approach - in considering tourist orientation as a system consisting of a number of interconnected elements, and, interacting, affects the communication and social efficiency of rural communities; the method of scientific abstraction - when allocating stable, typical connections in tourism orientation, which allowed to form criteria for assessing the tourist orientation of communities. Tourist orientation as a direction of formation of business paradigm of development of united communities is investigated. It is established that the strengthening of the tourism-oriented component will contribute to the creation of an innovative tourism product and attract new consumers. The main approaches to customer orientation are studied, the connection between the defined definition and tourist orientation is established. The own definition of tourist orientation of communities is offered. The stages of formation of a positive tourist-oriented environment are outlined. The principles of tourist orientation are described, cognitive marketing is defined as the basis for the formation of consumer loyalty. The criteria of tourist orientation are given and the indicators that characterize it are determined. The results of the study can be used to develop an effective strategy for rural development, taking into account and evaluating the criteria identified by the study at the stage of forming a business paradigm of tourism orientation of the community will increase investment in infrastructure, dissemination of information technology, restoration, reconstruction, objects of historical and cultural heritage, the formation of information, cognitive and tourist competencies of community residents. Key words: united communities, tourism orientation, tourism development, business paradigm, tourist impressions, cognitive marketing.

Impact of a 1-day urodynamic course on knowledge, perceptions, and attitudes of urology residents.

No evidence-informed educational curriculum is available for designing urodynamics (UDS) courses. We evaluated the learning outcomes of a short-lasting urodynamic course for urology residents. Urology residents of postgraduate years 4 and 5 (n = 13 and n = 1316, respectively) attended a 1-day urodynamic course. Learning objectives included patient preparation, indication and technique, terminology, trace interpretation, and impact on patient management. Instructional methods consisted of short lectures (3 h) and case-based discussions (7.5 h). Learners' reactions, modifications of perceptions and attitudes, and acquisition of knowledge and skills were assessed by three written tests with a single group, pretest, posttest 1, and posttest 2 design. Tests were conducted precourse, 1 week after, and 4 months after the course. All participants felt more confident in several urodynamic competencies after the course, including patient preparation, urodynamic indication and technique, terminology, trace interpretation, and impact for patient management. These perceptions remained unchanged after 4 months. Most became stricter in the indication of UDS, including 20 (87.0%) at posttest 1 and 8 (66.7%) at posttest 2. The mean number of correct answers in the knowledge evaluation was 52.2% versus 61.4% versus 56.7%, respectively at pretest, posttest 1, and posttest 2; p = 0.535). All participants rated the course as very useful or useful in both posttest evaluations. Our study demonstrates that a 1-day urodynamic course can promote lasting improvements in self-reported perceptions, attitudes, and urodynamic-related competencies of urology residents. Further studies using evidence-informed educational principles are needed to determine the effect of specific educational interventions on urodynamic competencies in different contexts.

Resident competencies before and after short intensive care unit rotations: a multicentre pilot observational study.

Residency programs need to understand the competencies developed by residents during an intensive care unit (ICU) rotation, so that curricula and assessments maximize residents' learning. The primary study objective was to evaluate the feasibility for training programs and acceptability by residents of conducting a multi-competency assessment during a four-week ICU rotation. We conducted a prospective, multicentre observational pilot study in three ICUs. During weeks 1 and 4 of an ICU rotation, we conducted repeated standardized assessments of non-critical care specialty residents' competencies in cognitive reasoning (script concordance test [SCT]), procedural skills (objective structured assessment of technical skills [OSATS]-global rating scale], and communication skills through a written test, two procedural simulations, and a simulated encounter with a "family member". The feasibility outcomes included program costs, the proportion of enrolled residents able to complete at least one three-station assessment during their four-week ICU rotation, and acceptability of the assessment for the trainees. We enrolled 63 (69%) of 91 eligible residents, with 58 (92%) completing at least one assessment. The total cost to conduct 90 assessments was CAD 33,800. The majority of participants agreed that the assessment was fair and that it measured important clinical abilities. For the 32 residents who completed two assessments, the mean (standard deviation) cognitive reasoning and procedural skill scores increased between weeks 1 and 4 [SCT difference, 3.1 (6.5), P = 0.01; OSATS difference for bag-mask ventilation and central line insertion, 0.4 (0.5) and 0.6 (0.8), respectively; both P ≤ 0.001]. Nevertheless, the communication scores did not change significantly. A monthly multi-competency assessment for specialty residents rotating in the ICU is likely feasible for most programs with appropriate resources, and generally acceptable for residents. Specialty residents' cognitive reasoning and procedural skills may improve during a four-week ICU rotation, whereas communication skills may not.

Operative Time and Complication Rates of Resident Phacoemulsification Surgeries in a National University Hospital: A Five-Year Review.

PurposeTo determine the operative time and complication rates of resident phacoemulsification surgeries at different time points in training.MethodsRetrospective cross-sectional study at the Department of Ophthalmology of the Philippine General Hospital. All resident-performed elective adult phacoemulsification surgeries from January 1, 2014, to December 31, 2018, were included, while operations with planned anterior or posterior procedures were excluded. Cases were arranged chronologically and divided into time points with 25 cases each. Operative time and complication rates were computed for each time point. As defined by the ICO Ophthalmology Surgical Competency Assessment Rubric (OSCAR), 30 minutes was used to gauge competency based on operative time, while complications were compared to published rates for residents. Results for the first 50 cases, the minimum number required by graduation, were also compared with succeeding cases.ResultsA total of 4635 cases were included. Residents performed an average of 115.9 ± 30.4 cases, with no significant difference among residents (F(4,35)=2.64, p=0.12). Overall complication rate was 6% (n=276), similar to those reported internationally. Both median operative time and complication rates decreased significantly for every time point in training (p<0.001). After 50 cases, only 40% (n=16) of residents reached the operative time of 30 minutes. Median operative time is significantly lower when comparing the first 50 surgeries with the succeeding cases (37 minutes vs 29 minutes, p<0.001). Likewise, complication rate is also significantly lower (9.3% vs 3.5%, Χ2 (1, N=4635) = 68.481, p<0.001), with an odds ratio of 2.85 (p<0.001, 95% CI [2.2, 3.7]).ConclusionThere are significant improvements in both operative time and complication rates as more surgeries are performed. However, the minimum required 50 cases is not enough for resident competency based on operative time and complication rates.

Serious Illness Conversation-Evaluation Exercise: A Novel Assessment Tool for Residents Leading Serious Illness Conversations.

Background/Objectives: The serious illness conversation (SIC) is an evidence-based framework for conversations with patients about a serious illness diagnosis. The objective of our study was to develop and validate a novel tool, the SIC-evaluation exercise (SIC-Ex), to facilitate assessment of resident-led conversations with oncology patients.Design: We developed the SIC-Ex based on SIC and on the Royal College of Canada Medical Oncology milestones. Seven resident trainees and 10 evaluators were recruited. Each trainee conducted an SIC with a patient, which was videotaped. The evaluators watched the videos and evaluated each trainee by using the novel SIC-Ex and the reference Calgary-Cambridge guide (CCG) at months zero and three. We used Kane's validity framework to assess validity.Results: Intra-class correlation using average SIC-Ex scores showed a moderate level of inter-evaluator agreement (range 0.523–0.822). Most evaluators rated a particular resident similar to the group average, except for one to two evaluator outliers in each domain. Test–retest reliability showed a moderate level of consistency among SIC-Ex scores at months zero and three. Global rating at zero and three months showed fair to good/very good inter-evaluator correlation. Pearson correlation coefficients comparing total SIC-Ex and CCG scores were high for most evaluators. Self-scores by trainees did not correlate well with scores by evaluators.Conclusions: SIC-Ex is the first assessment tool that provides evidence for incorporating the SIG guide framework for evaluation of resident competence. SIC-Ex is conceptually related to, but more specific than, CCG in evaluating serious illness conversation skills.

Psychometric properties of the mini peer assessment tools (Mini-PAT) in emergency medicine residents

Background: A few studies have been done regarding the validity and reliability of the Mini-Peer Assessment Tool across various specialties. This study was conducted to determine the reliability, content and construct validity of Mini-Peer Assessment Tool to assess the competency of emergency medicine residents. Methods: This study was carried out to investigate the psychometric properties of the mini-PAT tool to evaluate the professional competencies of emergency medicine residents in educational hospitals affiliated to Tehran University of Medical Sciences. The initial Mini-Peer Assessment Tool was translated into Persian. After that, the content validity index and content validity ratio determined by consulting 12 professors of emergency medicine. The construct validity was determined with exploratory factor analysis and investigation of the correlation coefficient on 31 self and 248 peer assessment cases. The reliability of the mini peer assessment tool was determined by internal consistency and item deletion by using Cronbach's alpha coefficient. Reliability was also assessed by determining the agreement between the two tools of self-assessment and peer assessment by using the diagram Bland and Altman. Results: The results showed content validity ratio (CVR) of the items ranged from 0.56 to 0.83, and the content validity index (CVI) of the items ranged from 0.72 to 0.90. The reliability of the self-assessment and peer-assessment tools were 0.83 and 0.95 respectively and there was a relative agreement between the self-assessment method and the peer assessment method. Finally, the tool underwent exploratory factor analysis resulting extraction into two factors namely 'clinical competencies' and 'human interactions' in the peer assessment tool. In the self-assessment tool, the factors of 'good practice' and 'technical competence' were extracted. Conclusion: The results of the present study provided evidence of the adequacy of content validity, reliability of the contextually customized mini-peer assessment tool in assessing the competencies of emergency medicine residents.

Aligning Urology Residency Training With Real-World Workforce Needs

ObjectiveResearch suggests recently graduated urology residents do not feel ready for independent practice. We conducted a study to determine if Accreditation Council for Graduate Medical Education (ACGME) minimum case requirements, resident case logs, and graduating resident perceived readiness for practice are aligned with the procedural demand and needs of the current urology workforce.DesignCorrelative study comparing the association between (1) workforce demand and ACGME case requirements, and (2) workforce demand and perceived resident competency. Three distinct datasets were used; (1) the 2017 Medicare Part B National Summary Data File; (2) the 2017 National Data Report published by the ACGME; and (3) a graduating resident survey from Okhunov et al.SettingN/A.ParticipantsN/A.ResultsIn 2017, there were a total of 6,784,696 urologic cases performed through Medicare. We found nonsignificant positive associations between resident case logs (rho = 0.16, p = 0.5784), ACGME minimum procedure requirements (rho = 0.42, p = 0.1255), and Medicare procedural demand. Our 15 index procedures accounted for 21.1% (n = 1,431,775) of all Medicare cases, with a median number of 7706 procedures. Endopyelotomy was the least common procedure (n = 98), while cystoscopy was the most common (n = 980,623). Medicare case volume was positively correlated with graduating residents’ procedural confidence (r = 0.86, p < 0.0001). We identified four categories with varied alignment of training and demand: (1) high volume and high confidence, (2) high volume and low confidence, (3) low volume and high confidence, and (4) low volume and low confidence.ConclusionsOptimizing urology residency training is time-sensitive and important. Using national Medicare data coupled with recently graduated urology resident survey results, we provide a guiding framework for improving the alignment of training with workforce demand. Informed by these results, we recommend altering training requirements to reflect these needs.

Plastic Surgery Resident Operative Volume and Milestones Performance: What Is the Correlation?

PURPOSE: The Milestones program was introduced by the Accreditation Council for Graduate Medical Education (ACGME) in 2014 as a means of standardizing resident evaluations across plastic surgery competencies. A previous study examined the relationship between operative volume and performance in the chief year of residency and found no correlation. We sought to further explore this relationship in order to discern whether operative volume could potentially be driving competency achievements during the earlier years of training. METHODS: A retrospective review of case log numbers performed by residents at our primary training institution was conducted for 13 residents from 2014 to 2018. The cases were grouped into categories based on the Milestone competencies. The association between operative volume and levels of achievement in respective Milestones competencies was performed using Spearman’s rank correlation coefficient (P < 0.05). RESULTS: The average operative volume and average performance on Milestones both increase across all categories as residents progress through their training years. However, no significant correlation exists between overall operative volume and Patient Care Milestones or Medical Knowledge Milestones across the majority of years of training when residents are compared to their peers at a given training level. Significance was reached with positive correlations between operative volume and Medical Knowledge milestone achievement at PGY3 (r = 0.8182; P = 0.0058) and between operative volume and Patient Care Milestone achievement at PGY5 (r = 0.7858; P = 0.0480). CONCLUSION: The lack of consistently significant association between operative volume and levels of achievement in Milestones possibly supports the belief that operative exposure does not alone drive competency achievement in surgical education throughout the early years of training. Alternatively, this could suggest that the way the Milestones are being applied is not fully capturing resident competency achievement. Our small sample size is a considerable limitation, and larger scale multi-institutional studies are needed to further investigate the relationship between operative volume and milestone achievement performance.

Simulated Umbilical Venous Catheter Placement Improves Resident Competence and Confidence.

BackgroundPediatric ACGME (Accreditation Council for Graduate Medical Education) requirements include demonstrated competence in umbilical line placement. Given a waning number of these procedures clinically available to residents, new methods of procedural teaching must be employed. We developed a simulation-based strategy, using adult-learning principles, to teach umbilical venous catheter (UVC) placement to pediatric residents. We also determined whether procedural teaching via simulation increased confidence and competence among pediatric residents in performing the procedure.MethodsOut of 23 first-year pediatric residents, eight participated in the study. Participants completed a survey evaluating their self-perceived competence and confidence in umbilical line placement. Their simulated umbilical line placement was assessed using a standardized checklist. Residents were then trained on simulated line placement in small groups by neonatologists. Six months later, residents completed a post-training survey and were assessed while placing simulated lines. Statistical analysis was completed using a paired t-test for parametric data, Wilcoxon signed-rank sum test for non-parametric data, and McNemar’s chi-squared test for categorical data. Spearman’s correlation was used for ordinal variables and Pearson’s correlation was used for continuous variables.ResultsNine PGY-1 (post-graduate year-1) residents completed the pre-training survey and simulation, while eight residents completed the post-training survey and simulation. There was an increase in resident confidence in placing umbilical lines six months after completion of the training session (p = 0.015) even though there was no difference in the number of umbilical lines that residents had placed in the intervening time. The residents performed a greater number of steps correctly after the training compared to their performance before the training (p=0.001). There was a statistically significant positive correlation between resident confidence and the number of steps performed correctly (rs(14)= 0.649, p = 0.006). There was no correlation between confidence and the number of umbilical lines placed on live subjects.ConclusionA teaching strategy that allows pediatric residents to struggle to perform UVC placement in a simulated setting, before receiving expert instruction, is effective at increasing their confidence and competence, even in the absence of exposure to human subjects.

380TF Mixed Asynchronous/Didactic ECG Curriculum to Increase Resident Competency

Emergency physicians are considered experts in the acute interpretation of the ECG. This occurs during shifts, and most commonly as an interruption during care on other patients. In some departments, interruptions in patient care can occur as often as once every 6 minutes. Our newer graduates routinely report anxiety regarding interpreting ECGs in this context. There are very few formalized ECG curricula available, the decision was made to design a mixed asynchronous and flipped classroom model to better equip residents to interpret ECGs during a shift. This curriculum is being developed to increase the ability to successfully interpret ECGs by the residents. After completing the course, the resident would be eligible to take a “credentialing” exam to be able to sign ECGs for patients. Successful completion of the course would be obtaining a score of >80% on the credentialing exam. The learners will initially watch one ECG video a month, then have an interactive in-class discussion of similar ECGs one week later. After one to two weeks, an online quiz will be given to assess their retention of the information presented. This lecture series will be a longitudinal experience, occurring once per four-week block. This will take approximately 2 hours per 4-week block, with 13 blocks per year. After completing the full course, the resident would be allowed to take a 1-hour ECG “credentialing” quiz. If they score greater than 80% on the examination, and without missing any STEMI designations, they would then be allowed to sign ECGs during shift. At time of initiation of this curriculum we will have 2 years of credentialing data which we could then compare to the trainees’ scores that undergo our curriculum. At the completion of a longitudinal one year mixed asynchronous and in class didactic training program on ECGs, the residents will successfully complete a “credentialing” examination to be able to sign ECGs during shift with attending oversight. Prior to the initiation of this curriculum, the entire residency was given the “credentialing” exam with a 28% (9/32) pass rate. Most of the residents that passed were seniors at the time and have graduated the program. This process should increase the comfort of signing ECGs as well as increase the overall ability to interpret the ECG in the correct clinical setting.