Resident Competency Research Articles

Addressing the Behavioral and Mental Health Educational Gap in Pediatric Residency Training.

* Abbreviations: ABP — : American Board of Pediatrics B/MH — : behavioral and mental health In the study “Competency of Future Pediatricians Caring for Children With Behavioral and Mental Health Problems” in this issue of Pediatrics , Green et al1 describe the continued deficit in pediatric resident competence in assessing and treating behavioral and mental health (B/MH) conditions based on survey questions asked during the 2018 initial pediatrics certifying examination application. B/MH concerns in pediatric practice are rising in prevalence. Approximately 13% to 20% of children in the United States experience a mental health disorder each year, and suicide is now the second leading cause of death for children ages 10 to 14 and adolescents and young adults ages 15 to 24.2 Nearly 25% of pediatric primary care visits involve a concern for B/MH issues.3 Throughout the pediatric education and training community, there has been a call for action to address the gap in trainee education on B/MH issues. The American Board of Pediatrics (ABP) entrustable professional activity 9 states that care of patients with B/MH concerns requires that a pediatrician be competent in (1) identifying and managing common B/MH issues; (2) referring and comanaging … Address correspondence to Sue E. Poynter, MD, MEd, Pediatric Residency Training Program, Cincinnati Children’s Hospital Medical Center, MLC 5018, 3333 Burnet Ave, Cincinnati, OH 45229. E-mail: sue.poynter{at}cchmc.org

Breastfeeding Education in Family Medicine Residencies: A 2019 CERA Program Directors Survey.

Breastfeeding counseling is an integral skill for all family physicians, regardless of whether they ultimately practice maternal child health (MCH). Evidence on time spent in breastfeeding education and resident competence is lacking. This study aimed to identify program characteristics associated with an increase the amount of breastfeeding education and program directors' (PDs) perceived competence of residents' breastfeeding counseling skills. A national survey of family medicine PDs including breastfeeding questions was conducted as part of the 2019 CERA survey. We specifically sought to identify variables that correlate with increased breastfeeding education time and perceived competence. Family medicine programs with greatest breastfeeding education time and perceived resident competence included lactation consultants, had more MCH visits in resident continuity clinic, more graduates that practice MCH, and included competency evaluations by faculty. There was more volume of breastfeeding education in programs with group prenatal care and an academic affiliation. There was greater perceived competence among programs with more hours of breastfeeding training overall. This study defines associations with curricular targets for improved breastfeeding counseling competence among family medicine residents. Inclusion of lactation consultants, regular faculty observation of counseling skills, and group prenatal care may be gradually introduced in programs to strengthen resident education and skills in breastfeeding counseling. The body of evidence in this field remains lacking, and further research is needed to characterize curricular interventions that increase resident competence in this important skill.

ҚАЗТЕСТ: тыңдалым тапсырмалары — талап жəне тəжірибе

Мақалада тілдік білімді бағалаудың отандық жүйесінің тыңдалым блогы тапсырмалары функционалдық тұрғыда қарастырылған. ҚАЗТЕСТ республика тұрғындары мен Қазақстанда жұмыс істейтін шетелдік азаматтардың мемлекеттік тілді меңгеру деңгейін бағалау үшін халықаралық тестілеу жүйелері негізінде құрылған. Бұл бағалау жүйесі сөйлеу əрекетінің төрт түрі — айтылым, тыңдалым, оқылым жəне жазылым — бойынша тест тапсырмаларын қамтиды. Авторлар тест тапсырмалары тілдік білімді тек бағалау ғана емес, жетілдіру қызметін де атқарады, яғни тілдік білімді бағалаушы үшін ғана емес, тіл үйренуші үшін де өзекті екенін атап көрсетеді. Əр блоктағы тест тапсырмаларын дайындауға қойылатын жалпы талаптар болады. Тыңдалым тапсырмаларына таңдалып алынатын аутентті мəтіндер үшін оны түсініп, қабылдау ерекше маңызды, бұл үшін тіл үйренушінің (тестіленушінің) белсенді, рецессивті, əлеуетті сөздік қоры, тілдік жорамалға бейімділігі, жады айрықша рөл атқарады. ҚАЗТЕСТ жүйесі түсіну классификациясының түрлі типтерін ұштастырған. Тыңдалым тапсырмаларының дұрыс түсінілуіне лингвистикалық жəне экстралингвистикалық (психологиялық, əлеуметтік-мəдени, техникалық) себептер əсер етеді.Авторлар ҚАЗТЕСТ жүйесін талдай келе, оның барлық блогындағы тест тапсырмаларын республикадағы оқу ұйымдары мен мекемелерінің оқыту бағдарламасымен ұштастыру мемлекеттік тілді қолдау, оның қолдану аясын кеңіту тетіктерінің бірі бола алады деген қорытынды жасайды.

Thoracic Surgery In-Training Exam Predicts Written But Not Oral Board Pass Rates: A 15-Year Single-Center Analysis

The purpose of the Thoracic Surgery Director's Association In-Training Exam (ITE) is to gauge competency and progression of thoracic surgery residents and to prepare residents for the American Board of Thoracic Surgery (ABTS) examinations. We sought to identify the relationship between traditional resident ITE scores and success at passing the written or oral portion of the ABTS examinations. ITE and ABTS examination records from 2003 to 2019 were examined for all 2-year traditional cardiothoracic surgery residents at a single institution. Paired t tests were carried out between residents on their first- and second-year ITE. Bivariate logistic regression was performed on each of the second ITE component with written or oral board passing rate as the outcome of interest. Sixty residents completed training and took both written and oral boards. First attempt board pass rates were 90% for written and 75% for oral board examination. There was a significant improvement in test scores for each resident between the first the second ITE (P< 0.001 for all scores). Both increasing overall raw (odds ratio 1.26, P = 0.022) and scaled (odds ratio 1.08, P = 0.006) ITE scores were associated with passing the written boards on first attempt. There were no associations identified for oral board passing rates. Traditional residents improved ITE scores from first to second attempt. Increasing ITE scores were associated with improved written but not oral ABTS component pass rates. The ITE serves prepare residents for the ABTS qualifying (written) exam and assists programs with gauging resident readiness for taking this exam.

Validation of an Objective Assessment Tool for Tonsillectomy in Otolaryngology Resident Training.

Create and validate an objective structured assessment of technical skills (OSATS) for otolaryngology residents learning how to perform a tonsillectomy. Multicenter prospective longitudinal validation study. A multi-institutional study at six tertiary academic otolaryngology residency programs from July 2009 to May 2012. Using the modified Delphi technique, a panel of pediatric otolaryngologists created a tonsillectomy task-based checklist (TBC) for a tonsil OSATS using a 5-point Likert-type scale. Residents were assessed by pediatric otolaryngology staff at the time of surgery with the TBC and a global rating scale. Procedure time, patient age, number of previously performed tonsillectomies, and surgical technique were also collected. One hundred sixty-seven tonsil OSATS were completed for 38 residents, and competency was recorded for 99 (59.2%). Residents scored as competent had performed significantly more previous tonsillectomies than those deemed noncompetent, 44.4 ± 35.6 and 13.5 ± 11.6, respectively (P < .001). The mean overall score on the tonsil TBC was 4.0 ± 0.8 and 2.6 ± 1.0 for competent and noncompetent, respectively (P < .001). Higher number of tonsillectomies performed and mean tonsil TBC score significantly increased the likelihood of competency (P < .001). Each additional tonsillectomy performed increased the likelihood of achieving competency by 6.3% (P = .006, 95% confidence interval (CI): 1.330-1.110), and each 1.0 point increase in mean tonsil TBC score increased the likelihood of competency by a factor of 2.71 (P = .006, 95% CI:1.330-5.513). There is a 95% likelihood of competency at 48 tonsillectomies or a tonsil TBC score of 4.91. The tonsil OSATS is a valid and feasible instrument to assess resident competency with tonsillectomy and provides timely objective feedback. 4. Laryngoscope, 131:E359-E366, 2021.

Mentorship Through Research: A Novel Approach to Increasing Resident and Medical Student Research Competency Through an Institutional Database

We describe a novel research database development project to increase resident and medical student scholarly ability and mentorship skills. We collected data on 3147 facial fractures treated at our institution over a 12-year period. This data was used to publish novel research on multiple types of facial fractures and outcomes. We learned about key database aspects that led to its high level of research quality and output volume through over 6 years of database development and expanded research output. A retrospective review was completed to compile the total research produced during this time period. Research resulted in 20 manuscripts, 17 podium presentations, and 11 posters. 16 medical students, 5 residents and 3 faculty members were authors on at least one project. The average number of published manuscripts was 5.17 overall and 2.9, 7.0, and 14.0 for medical students, residents, and faculty, respectively. Four residents matched into fellowship, 7 medical students matched into residency, and one faculty member was promoted academically. A database focused on a common and under-researched pathology can result in a high volume of novel research output. Additional program benefits include increased scholarly and mentorship ability in engaged residents and medical students.

Resident Competency and Proficiency in Combined Spinal-Epidural Catheter Placement is Improved Using a Computer-Enhanced Visual Learning Program: A Randomized Controlled Trial

(Anesth Analg. 2019;128:999–1004) The apprenticeship model is still the most common method for residents to learn the technical skill of placing a spinal-epidural catheter. However, this method has its drawbacks, as on average it takes 45 to 60 attempts for a student to achieve a 90% success rate. While other methods have also been explored to teach this skill, such as watching videos of the procedure before attempting it, this study proposed that E-learning is a valid method to enhance anesthesiology education.

Full Resolution Simulation for Evaluation of Critical Care Imaging Interpretation; Part 2: Random Effects Reveal the Interplay Between Case Difficulty, Resident Competence, and the Training Environment

To further characterize empirical data from a full-resolution simulation of critical care imaging coupled with post hoc grading of resident's interpretations by senior radiologists. To present results from estimating the random effects terms in a comprehensive mixed (hierarchical) regression model. After accounting for 9 fixed effects detailed in Part 1 of this paper, we estimated normally distributed random effects, expressed in terms of score offsets for each case, resident, program, and grader. The fixed effects alone explained 8.8% of score variation and adding the random effects increased explanatory power of the model to account for 36% of score variation. As quantified by intraclass correlation coefficient (ICC = 28.5%; CI: 25.1-31.6) the majority of score variation is directly attributable to the case at hand. This "case difficulty" measure has reliability of 95%. Individual residents accounted for much of the remaining score variation (ICC = 5.3%; CI: 4.6-5.9) after adjusting for all other effects including level of training. The reliability of this "resident competence" measure is 82%. Residency training program influence on scores was small (ICC = 1.1%; CI: 0.42-1.7). Although a few significantly high and low ones can be identified, reliability of 73% militates for caution. At the same time, low intraprogram variation is very encouraging. Variation attributable to differences between graders was minimal (ICC = 0.58%; CI: 0.0-1.2) which reassures us that the method of scoring is reliable, consistent, and likely extensible. Full resolution simulation based evaluation of critical care radiology interpretation is being conducted remotely and efficiently at large scale. A comprehensive mixed model of the resulting scores reliably quantifies case difficulty and resident competence.

Are Obstetrics and Gynecology Residents Equipped to Care for Transgender Patients? A National Survey Study [04G

INTRODUCTION: Obstetricians and gynecologists (OB-GYNs) play an important role in the medical and surgical management of transgender and gender nonconforming (TGNC) patients. Our study aims to assess three self-reported outcomes: (1) comfort, (2) competency, and (3) curricular satisfaction of OB-GYN residents in TGNC care topics. METHODS: Our survey tool consisted of thirty questions on a 4-point Likert scale and was distributed electronically by program coordinators. The survey tool was deemed exempt by the Northwell Health Institutional Review Board. Descriptive statistics and Kruskal-Wallis test by ranks were performed using SPSS 26.0. RESULTS: One-hundred and six surveys were completed by OB-GYN residents (response rate=12.0%). Composite mean scores were calculated in the three self-reported outcome domains: comfort (2.8±0.7), competency (2.7±0.6), and satisfaction (2.4±0.7). No statistically significant difference in comfort, competency, and satisfaction scores between residency training level was observed. Male residents were more likely (χ2(1)=5.285, P=.022) to have higher self-reported competency scores than female residents (3.0±0.7 versus 2.5±0.6, respectively). LGBTQ residents were more likely (χ2(1)=5.509, P=.019) to have higher self-reported comfort scores than those who identified as heterosexual (3.1±0.6 versus 2.7±0.7, respectively). CONCLUSION: To our knowledge, this is the first study to assess the comfort, competency, and satisfaction of OB-GYN residents in TGNC care topics. Residents reported being more competent and comfortable than satisfied, which suggests that further curricular and clinical exposure is necessary to address the unique healthcare needs of this underserved patient population and to meet the educational needs of residents. LGBTQ residents may be able to share knowledge with peers to increase heterosexual residents’ comfort.

Evaluating Resident Procedural Skills: Faculty Assess a Scoring Tool.

Procedural skills assessment is critical in residency training. The Council of Academic Family Medicine recommends the Procedural Competency Assessment Tool (PCAT) for assessing procedure competence of family medicine residents. We sought to evaluate the reliability of the PCAT and to better identify its strengths and limitations. In this mixed-methods study conducted in 2017, 18 faculty members of an academic family medicine residency program watched a video of one of the authors performing a simulated shave biopsy with intentional errors. Faculty scored the procedure using the shave biopsy PCAT, then participated in a focus group discussion of the rationale for the scores given. Qualitative analysis assessed perceived benefits and challenges of the PCAT. Following the discussion, faculty scored the same procedure again, using a PCAT modified with additional objective criteria. On the original PCAT, 40% of respondents rated the physician as competent. This dropped to 21.4% on the modified PCAT (P=.035). Respondents scored competent even though procedure components were scored as novice. Score variability decreased with the checklist-based PCAT. Qualitative analysis revealed that the PCAT is subjective and interpretation of the tool varies widely. Further studies regarding PCAT validity and reliability are needed. The PCAT may require further norming with additional objective criteria to improve reliability. Residencies may train faculty on using the PCAT to improve interobserver agreement, or decide to use a more intuitive checklist evaluation tool.

Improving Pediatric Resident Confidence and Competence in Communication with Patients with Disabilities (2163)

Improving Pediatric Resident Confidence and Competence in Communication with Patients with Disabilities (2163)

An Innovative Learning Tool for Radiation Therapy Treatment Plan Evaluation: Implementation and Evaluation

To design, develop, and evaluate an interactive simulation-based learning tool for treatment plan evaluation for radiation oncology and medical physics residents to address gaps in learning. We first conducted a needs assessment for optimal learning tool design and case selection. Next, we generated a curated database of cases with clinically unacceptable treatment plans accessible through an in-house developed interactive web-based digital imaging and communications in medicine-radiation therapy viewer. We then developed an interactive user module that allows case selection, learner participation, and immediate feedback, including the final clinically acceptable plan. We pilot tested this case bank learning tool with current radiation oncology and medical physics residents within our institution. Afterward, residents completed an evaluation of tool design, content, and perceived impact on learning and provided suggestions for improvement. We generated 70 cases and learning modules for the case bank, encompassing various clinical sites, levels of difficulty, and classified errors. Residents positively endorsed the learning tool, including design, content, and perceived impact on learning. The learning tool's interactivity was perceived to provide increased educational value compared with other current learning methods. We created a high-fidelity simulation platform for treatment plan evaluation linked to a curated case bank. Evaluation of the pilot deployment demonstrated a benefit for resident learning and competency attainment. Future directions include external validation and expansion.

An Innovative Inexpensive Portable Pulmonary Edema Intubation Simulator.

An Innovative Inexpensive Portable Pulmonary Edema Intubation Simulator.

MP83-06 PROVIDING MEANINGFUL AND TIMELY RESIDENT ROTATION FEEDBACK: STRUGGLES AND SOLUTIONS

INTRODUCTION AND OBJECTIVE:Meaningful and timely resident feedback is an essential component for developing resident competency. With a department of more than two dozen clinical faculty, 5 trainin...

Using Simulation in Training Pediatric Residents on Neonatal Abstinence Syndrome Scoring: An Experimental Study.

Neonatal abstinence syndrome (NAS) is characterized by significant physiological and behavioral signs involving multiple-organ systems in neonates following a prenatal exposure to opioids and other nonopioid drugs. Neonatal abstinence syndrome can result in serious morbidity, and even death, if unrecognized and untreated. The purpose of this study was to develop a simulation model of a standard video training of the Finnegan Neonatal Abstinence Scoring System (FNAS) and investigate the perceptions of comfort and competency of pediatric residents undergoing video or simulation training. Thirty-one pediatric and medicine-pediatric residents participated in this single-blinded randomized intervention study. The experimental group completed demonstrated simulation while the control group received the traditional video instruction. Both groups completed FNAS scoring on a case of a neonate with NAS. The FNAS scores of residents were compared with the scores of 2 expert raters. Pre- and posttraining and preference surveys were obtained from all participants. Both experimental and control groups scored the FNAS scenario similarly and were also similar to the expert raters. Both groups also reported comparable levels of comfort and competency after the training, though first-year residents reported greater improvement than upper-level residents. The FNAS scores from expert raters were identical for the simulation and video scenarios. Although this study showed that a simulation training module can be used as a standardized teaching method to administer the FNAS, it can be cost-prohibitive and daunting to produce. Nursing professionals need to be aware of medical education training around FNAS due to the interdisciplinary nature of care for neonates with NAS. Institutions should consider implementing a diversity of practices and models with an interdisciplinary approach to training assessment of the neonate with NAS. A more hands-on, less cost-prohibitive simulation training needs to be developed to teach FNAS administration with a broader range of professionals including interdisciplinary teams of nursing and medical professionals.

Teledermatology in Medical and Continuing Education

Teledermatology improves access to dermatologic care and has the potential to lower health care costs. Although teledermatology use is increasing in practice, a minority of dermatology programs incorporate teledermatology into resident training. This review summarizes the current state of teledermatology education for both dermatologists and non-dermatologists. Less than half of dermatology residency programs include teledermatology in their curriculum. Teledermatology offers educational opportunities for dermatology and non-dermatology trainees and practitioners through both remote and in-person supervision. It may also serve as an objective core competency metric as concordance for diagnosis and management can be easily measured as a marker of trainee medical knowledge. Teledermatology can be used as an educational metric for measuring core competencies of dermatology residents. Dermatology residencies should integrate teledermatology education into their curriculum so that trainees are comfortable incorporating it into their future practice. Teledermatology has also been shown to improve dermatology knowledge among referring primary providers and residents. Further studies are needed to identify the perceived gaps in education regarding teledermatology and its ability to facilitate dermatology learning.

Should Wellness Be a Core Competency for Physicians?

There has been a recent rise in calls for action around wellness and physician health. In medical education, wellness has been proposed as a physician competency. In this article, the authors review the history of the "wellness as a competency" concept within U.S. and Canadian residency programs and medical schools. Drawing from literature on the discourses of wellness and competence in medical education, they argue that operationalizing wellness as a physician competency holds profound implications for curricula, admissions, evaluation, and licensure. While many definitions of "wellness" and "competency" are used within medical training environments, the authors argue that the definitions institutions ultimately use will have significant impacts for trainees who are considered "unwell." In particular, medical learners with disabilities-including those with mental health, chronic health, learning, sensory, and mobility disabilities-may not conform to dominant conceptions of "wellness," and there is a risk they will become further stigmatized or even be considered unsuitable to practice in the profession. The authors conclude that framing wellness as a competency has the potential to legitimize support-seeking and prioritize physician health, yet it may also have the potential unintended effect of excluding certain learners from the profession. They propose a universal design approach to understand wellness at a systems level and to remove barriers to wellness for all medical learners.

Effect of Teaching Session on Resident Ability to Identify Anatomic Landmarks and Anterior Cruciate Ligament Footprint: A Study Using 3-Dimensional Modeling.

Background:Femoral tunnel positioning in anterior cruciate ligament reconstruction (ACLR) is an intricate procedure that requires highly specific surgical skills.Purpose:To report the ability of residents to identify femoral landmarks and the native ACL footprint before and after a structured formal teaching session as a reflection of overall surgical skill training for orthopaedic surgery residents in Canada.Study Design:Controlled laboratory study.Methods:A total of 13 senior orthopaedic residents were asked to identify a femoral landmark and an ACL footprint on ten 3-dimensional (3D)–printed knee models before and after a teaching session during the fall of 2018. The 3D models were made based on actual patients with different anatomic morphologic features. ImageJ software was used to quantify the measurements, which were then analyzed through use of descriptive statistics.Results:Before and after the teaching session, residents attempted to identify a specific anatomic location (bifurcate and intercondylar ridge intersection) with a mean error per participant ranging from 5.00 to 10.95 mm and 4.79 to 12.13 mm in magnitude, respectively. Furthermore, before and after the teaching session, residents identified the specific position to perform the surgical procedure (ACL femoral footprint), with a mean error per participant ranging from 4.58 to 8.80 mm and 3.87 to 11.07 mm in magnitude, respectively. The teaching session resulted in no significant improvement in identification of either the intersection of the bifurcate and intercondylar ridges (P = .9343 in the proximal-distal axis and P = .8133 in the anteroposterior axis) or the center of the femoral footprint (P = .7761 in the proximal-distal axis and P = .9742 in the anteroposterior axis).Conclusion:Although a formal teaching session was combined with a hands-on session that entailed real surgical instrumentation and fresh cadaveric specimens, the intervention seemed to have no direct impact on senior residents’ performance or their ability to demonstrate the material taught. This puts into question the format and efficacy of present teaching methods. Also, it is possible that the 3D spatial perception required to perform these skills is not something that can be taught effectively through a teaching session or at all. Further investigation is required regarding the effectiveness and application of surgical skill laboratories and simulations on the competencies of orthopaedic residents.

Evaluation of competency and willingness of junior residents to provide oral care for people living with HIV and AIDS in satellite treatment centers

Objectives: Oral health care to people living with HIV/AIDS (PLWHA) is usually neglected due to the social stigma and the fear of cross infection. Hence, this study aimed to assess the knowledge regarding HIV/AIDS and the attitude of junior residents in providing oral care to PLWHA. Materials and Methods: A cross-sectional questionnaire was administered to 96 junior dental residents in our institute, who were providing oral care at peripheral dental centers. Subjects answered a question “will you be willing to provide oral care on your free will if you knew the patient has HIV/AIDS” either “yes” or “no;” followed by questionnaire assessing knowledge on HIV/AIDS, and its oral manifestations and Medical Condition Regard Scale were used for assessing the attitude of residents. Results: Of the 96, only four reported to treat HIV/AIDS patients willingly; only 2% of residents have ever treated HIV/AIDS patients. More than 70% of them did not know the protocol in case of needle prick or blood splatter and post-exposure prophylaxis. However, the knowledge regarding oral manifestation of HIV/AIDS was satisfactory. The attitude of the residents was more negative (median=3.02) toward treating HIV/AIDS patients. Conclusion: Knowledge regarding post-exposure protocol was poor and it is high time that special care dentistry is included as part of the dental curriculum to increase awareness and knowledge regarding HIV/AIDS; and we do recommend compulsory postings for junior residents in tertiary hospitals to alleviate the fear, discrimination, and stigmatizing attitude toward HIV/AIDS.

Ophthalmology Resident Surgical Competence: A Survey of Program Directors

Abstract Many ophthalmology residents struggle with the acquisition of surgical skills, but a large majority are successfully remediated before graduation using supportive measures and modern ophthalmic surgical training.