Core Faculty Research Articles

Children's syntax is supported by the maturation of BA44 at 4years, but of the posterior STS at 3years of age.

Within the first years of life, children learn major aspects of their native language. However, the ability to process complex sentence structures, a core faculty in human language called syntax, emerges only slowly. A milestone in syntax acquisition is reached around the age of 4years, when children learn a variety of syntactic concepts. Here, we ask which maturational changes in the child's brain underlie the emergence of syntactically complex sentence processing around this critical age. We relate markers of cortical brain maturation to 3- and 4-year-olds' sentence processing in contrast to other language abilities. Our results show that distinct cortical brain areas support sentence processing in the two age groups. Sentence production abilities at 3years were associated with increased surface area in the most posterior part of the left superior temporal sulcus, whereas 4-year-olds showed an association with cortical thickness in the left posterior part of Broca's area, i.e. BA44. The present findings suggest that sentence processing abilities rely on the maturation of distinct cortical regions in 3- compared to 4-year-olds. The observed shift to more mature regions involved in processing syntactically complex sentences may underlie behavioral milestones in syntax acquisition at around 4years.

Improving Diversity, Equity, and Inclusion Education in Hematology/Oncology Training

PURPOSE: Diversity, equity, and inclusion (DEI) are core principles in medical education and essential elements in eliminating health and workforce disparities. Over the past several years, institutional DEI initiatives have led to increases in the numbers of underrepresented trainees and faculty at Yale School of Medicine (YSM) and Yale Cancer Center (YCC). In 2021, the Yale Hematology/Oncology (HO) Fellowship Program created a DEI curriculum for Yale HO Fellows, designed by the HO Chief Fellows with guidance from Fellowship Program Leadership and the Vice Chair of DEI for YCC. The goals of the DEI curriculum were to foster a programmatic culture of inclusion and empower fellows to identify and respond to discrimination events in the workplace. METHODS: A baseline needs-based assessment was performed with online anonymized surveys. The six-question survey was designed to assess topic preferences and witnessed discrimination events; all HO fellows (n = 27) were emailed a link to the survey. Based on the needs assessment, a five part DEI curriculum was designed, which included 1) an interactive session with the Vice Chair of DEI, 2) a journal club with the Deputy Dean and Chief Diversity Officer at YSM, 3) an interactive session on advancing gender equity through allyship and awareness led by external consultants, 4) an interactive session on gender identity with two experts on LGBTQIA2S+ issues in medicine following a YCC Grand Rounds seminar, and 5) a Chief Fellow-led interactive session on upstander training. The DEI curriculum was mandatory for all fellows. Evaluations of the curriculum at its completion were collected via a separate online anonymous survey that included 11 questions about comfort level in addressing discrimination and harassment (Kirkpatrick level 2). Perceptions of DEI among HO fellows and Core Faculty were further gauged using annual trainee and faculty surveys distributed by the American Council of Graduate Medical Education (ACGME) in 2021 and 2022, and a separate survey designed and distributed by the Program Leadership to gauge perceptions of DEI among HO Core Faculty in 2021 and 2022. RESULTS: In total, 17 fellows (68%) responded to the pre-curriculum needs assessment survey. The majority of respondents witnessed (>75%) or experienced (>64%) some form of harassment during medical training. All respondents reported being under-equipped to navigate these scenarios. Inclusion of DEI into the fellowship curriculum was perceived as very important (mean 8.19/10, range 2-10). All fellows completed the five-part DEI curriculum. A total of 8 fellows (32%) responded to the post-curriculum survey; respondents reported an increase in comfort level navigating discrimination events (Figure 1). In ACGME trainee and faculty surveys prior to (2021) and following (2022) initiation of the DEI curriculum, compliance with DEI efforts increased above national means after initiation of the DEI curriculum (2021 mean scores, HO fellowship program vs national: faculty, 4.6 vs 4.4, fellows 4.2 vs 4.3; 2022: faculty 4.8 vs 4.5, fellows 4.6 vs 4.3). In surveys prior to and following the institution of the DEI, the percentages of HO Core Faculty who agreed that the HO Fellowship Program treats DEI as being core to its mission, on par with clinical excellence and investigative pursuits, increased from 71.4% to 80%. Those who agreed that DEI topics are formally or informally discussed as part of the educational experience of HO fellows increased from 28.5% to 50%. CONCLUSION: A DEI curriculum for HO fellows may lead to significant improvements in fellow upstander responses to discrimination in the workplace and may augment institutional perceptions of DEI among fellows and faculty. We plan to continue our fellow-led DEI curriculum in perpetuity as part of our fellowship program and institution's commitment to DEI efforts. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Respiratory emergency simulation teaching (REST) in a multidisciplinary team (MDT)

During the COVID-19 pandemic our respiratory high dependency unit (RHDU) increased bed capacity by 200%, recruited new staff to provide high flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP) support, and was relocated within the hospital. This created the need to upskill new staff to provide level 2 care to sick patients in a new environment [1]. We aimed to provide training to nurses, healthcare assistants (HCA), and junior doctors on RHDU via a multidisciplinary (MDT) simulation programmed to manage deteriorating respiratory patients. We also aimed to identify gaps in learning, policy, and procedures due to the relocation of RHDU. The pilot included 22 sessions of in-situ simulation, run weekly by a core faculty including a respiratory consultant, ward sister, senior HCA, and clinical educator. All scenarios focused on MDT working with effective assessments and handovers. All staff members on the ward wore the same scrubs making it challenging to identify the job role or seniority of staff, and this was noticeable during the simulations. Coloured lanyards identifying job role were purchased and are now worn by all RHDU staff. An anaphylaxis simulation identified a time delay in finding the key to access emergency medication. A key safe has been purchased by the ward to house this key, ensuring it is always available in an emergency. The themes identified were: an increase in the confidence, competence, and knowledge of the MDT in recognising, responding, and treating medical emergencies. It also developed the working relationships between MDT members by highlighting the skill set of different professions, allowing for an exchange of knowledge across all working levels. Simulation is an excellent resource in problem solving and teaching. It provides a safe place to practise new skills and breaks down the barriers to effective communication within the MDT by creating a cohesive learning environment. Simulation must be an ongoing development for staff to ensure that skills are honed resulting in the best outcomes for our patients in an acute emergency. A monthly training programme has been developed consisting of four hours of simulation-based training using different levels of fidelity. We will continue to employ the use of MDT working to reflect real life working conditions based on the success of this pilot. 1. Almomani E, Sullivan J, Hajjieh M, Leighton K. Simulation-based education programme for upskilling non-critical care nurses for COVID-19 deployment. BMJ Simulation & Technology Enhanced Learning. 2020;7(5): 319–322.

Abstract 15537: Complex Congenital Heart Patients: Education Program for Advanced Practice Providers

Introduction: With appropriate training and support, Advanced Practice Providers (APPs) offer value in specialty patient care in a congenital heart program (CHP) providing continuity, cost effective, and specialized care. Hypothesis: We hypothesized that APPs caring for patients in a CHP lack standard curriculum to quantify success and improvement. Developing a dedicated education program allows identification of knowledge gaps and improves focused learning. Integrating a shared model for education with pre/post-tests increases proficiency and professional development. Methods: 20 APPs were included in our CHP education model including 63 focused learning modules in pediatric cardiology with complex congenital heart disease (CHD) and cardiac intensive care with aspects of post-operative management, multi-disciplinary, APP-specific teaching sessions, APP-led journal clubs, research/QI projects, interactive lectures, visuals, and key articles. Knowledge of the core CHP learning objectives were measured through 514 individual pre/post module tests by utilizing and strategically combining peer reviewed resources in CHD/critical care for each learning module. APPs satisfaction was evaluated using a 5-point scale (outstanding, good, acceptable, fair, unsatisfactory) for core education, faculty support, and translation to clinical practice. Results: Increase in knowledge was observed with pre/post test scores of 67.2% and 97.6%, respectively (P<0.0001). Fetal, chest radiography, and cardiac output were identified with lower pre-test scores < 50% allowing refocused education, resulting in post-test scores > 96% (P<0.0001). Core education program, faculty support, and translation to clinical practice were scored as outstanding (n=10, 50%) or good (n=10, 50%). Conclusions: In conclusion, our APPs and multi-disciplinary specialists have successfully integrated an education program, improving performance in a rapidly growing department. The success in identifying educational opportunities via pretests and adapting our educational focus has provided an infrastructure to improve patient care and safety. Our efforts and bidirectional feedback have resulted in satisfaction and ideally long-term APPs retention.

Nephrology Program Director Protected Time for Program Administration in the United States.

The Accreditation Council for Graduate Medical Education (ACGME) required that program directors receive 10-20 h/wk of protected time for program administration (including didactic teaching). In July 2022, this was reduced for all internal medicine subspecialties on the basis of program size, with 8 h/wk required for programs with fewer than seven fellows, the majority of nephrology programs. We surveyed all 151 US adult nephrology program directors (ACGME Public List of Programs 2021-2022) to determine how much protected time they receive, how much they think is necessary, and the division of their professional time. The anonymous 20-question online survey was administered from March 31 to April 30, 2022. The analysis was descriptive. Response rate was 66% (99 of 151). Geographic distribution and approved fellow positions were similar to programs nationally; 59% had fewer than seven approved positions. Median protected time was 10 h/wk (interquartile range, 5-10), with 8 h/wk (interquartile range, 5-10) for those with fewer than seven positions. Program directors estimated needing 12 h/wk (interquartile range, 10-16) to effectively administer programs, including those with fewer than seven positions, a median 5 h/wk (interquartile range, 0-7) more than received. Of program directors reporting <10 h/wk for program administration, 62% provided >20 hours of direct patient care. Thirty-nine percent had no protected time for core faculty. Fellow recruitment (68%) was the most time-consuming task, and didactic teaching (80%) was the most professionally rewarding. Approximately half of the nephrology programs surveyed were not in compliance with the ACGME-stipulated 10-h/wk minimum protected time for the 2021-2022 training year. Program directors estimated a median of 12 h/wk are needed to effectively manage programs.

Simulation-Based Education in Physical Therapist Education: A Survey of Current Practice.

The purposes of this study were to describe the current use of (1) simulation in student physical therapist professional education programs and (2) standards of best practice (SOBP) for simulation-based education (SBE) in physical therapist education. Two surveys were created about current use of SBE in student physical therapist professional education programs in the United States. The first survey contained questions about the program, including the best contact person regarding simulation. The second survey investigated simulation use within the context of SOBP. Survey data were analyzed using descriptive statistics. Survey 1 was sent to the program director at all fully accredited physical therapist programs (N = 236), and 143 responses were returned (61% response rate). Survey 2 was sent to the 136 individuals identified in Survey 1, and we received 81 completed surveys (60%). Over 90% of programs reported including SBE in their curricula, with 86% providing 3 or more experiences. A median of 1 core faculty at each program reported training in SBE, but 23% reported no training. A lack of training in specific elements of the SOBP for SBE was reported by 40% to 50% of faculty. Limited use of SOBP was reported, and use of outcome measures without validation was common. Although SBE is commonly used in physical therapist education, many faculties (1) do not have training in SBE, (2) do not consistently follow the SOBP, and (3) utilize unvalidated outcome measures. Limited faculty training in SBE and inconsistent inclusion of the SOBP suggest student learning in simulation is not optimized. These results show that, despite increased use of simulation in physical therapist education programs, there is a dearth of faculty trained in SBE and inconsistent use of SOBP. Addressing these deficiencies could help to optimize the benefits of SBE in physical therapist education.

216 Impact of Proposed Core Faculty Protected Time Requirements: National Survey of Emergency Medicine Faculty on Work Hours and Associated Job Satisfaction

216 Impact of Proposed Core Faculty Protected Time Requirements: National Survey of Emergency Medicine Faculty on Work Hours and Associated Job Satisfaction

Socially situated artificial intelligence enables learning from human interaction

Regardless of how much data artificial intelligence agents have available, agents will inevitably encounter previously unseen situations in real-world deployments. Reacting to novel situations by acquiring new information from other people-socially situated learning-is a core faculty of human development. Unfortunately, socially situated learning remains an open challenge for artificial intelligence agents because they must learn how to interact with people to seek out the information that they lack. In this article, we formalize the task of socially situated artificial intelligence-agents that seek out new information through social interactions with people-as a reinforcement learning problem where the agent learns to identify meaningful and informative questions via rewards observed through social interaction. We manifest our framework as an interactive agent that learns how to ask natural language questions about photos as it broadens its visual intelligence on a large photo-sharing social network. Unlike active-learning methods, which implicitly assume that humans are oracles willing to answer any question, our agent adapts its behavior based on observed norms of which questions people are or are not interested to answer. Through an 8-mo deployment where our agent interacted with 236,000 social media users, our agent improved its performance at recognizing new visual information by 112%. A controlled field experiment confirmed that our agent outperformed an active-learning baseline by 25.6%. This work advances opportunities for continuously improving artificial intelligence (AI) agents that better respect norms in open social environments.

Map the Not Answer

Map the Not Answer Philip Metres (bio) —Mahmoud Darwish exists everything herebelonging except desire you meaninghave you what for owned neverdreams in except past future ajasmine of scent possibility in hidinggrounds reading holds life what formean that lines black out or in are youstories in locked you write to want thatkeys find to want you give to forgot eldersdays ask you or love make you doyou make loves do [End Page 249] disappearances consume youheaven to all offer [End Page 250] Philip Metres Philip Metres is the author of ten books, including Shrapnel Maps (2020), The Sound of Listening: Poetry as Refuge and Resistance (2018), Pictures at an Exhibition (2016), Sand Opera (2015). His work has garnered the Guggenheim Fellowship, the Lannan Fellowship, two NEAs, seven Ohio Arts Council Grants, the Hunt Prize, the Adrienne Rich Award, three Arab American Book Awards, the Lyric Poetry Prize, and the Cleveland Arts Prize. He is professor of English and director of the Peace, Justice, and Human Rights program at John Carroll University, and Core Faculty at Vermont College of Fine Arts. Copyright © 2022-2023 Pleiades and Pleiades Press

Maturational Indices of the Cognitive Control Network Are Associated with Inhibitory Control in Early Childhood.

Goal-directed behavior crucially relies on our capacity to suppress impulses and predominant behavioral responses. This ability, called inhibitory control, emerges in early childhood with marked improvements between 3 and 4 years. Here, we ask which brain structures are related to the emergence of this critical ability. Using a multimodal approach, we relate the pronounced behavioral improvements in different facets of 3- and 4-year-olds' (N = 37, 20 female) inhibitory control to structural indices of maturation in the developing brain assessed with MRI. Our results show that cortical and subcortical structure of core regions in the adult cognitive control network, including the PFC, thalamus, and the inferior parietal cortices, is associated with early inhibitory functioning in preschool children. Probabilistic tractography revealed an association of frontoparietal (i.e., the superior longitudinal fascicle) and thalamocortical connections with early inhibitory control. Notably, these associations to brain structure were distinct for different facets of early inhibitory control, often referred to as motivational ("hot") and cognitive ("cold") inhibitory control. Our findings thus reveal the structural brain networks and connectivity related to the emergence of this core faculty of human cognition.SIGNIFICANCE STATEMENT The capacity to suppress impulses and behavioral responses is crucial for goal-directed behavior. This ability, called inhibitory control, develops between the ages of 3 and 4 years. The factors behind this developmental milestone have been debated intensely for decades; however, the brain structure that underlies the emergence of inhibitory control in early childhood is largely unknown. Here, we relate the pronounced behavioral improvements in inhibitory control between 3 and 4 years with structural brain markers of gray matter and white matter maturation. Using a multimodal approach that combines analyses of cortical surface structure, subcortical structures, and white matter connectivity, our results reveal the structural brain networks and connectivity related to this core faculty of human cognition.

A Guide for Implementing Surgeon Resilience Initiatives: An Example of Surgical Peer Support.

A Guide for Implementing Surgeon Resilience Initiatives: An Example of Surgical Peer Support.

Residents Are Coming: A Faculty Development Curriculum to Prepare a Community Site For New Learners.

This curriculum is designed for emergency medicine attendings in varying years of community practice to prepare them for Emergency Medicine (EM) residents. 15 months. Emergency medicine is a growing field with new residencies approved every year. A strong, competent cadre of clinical educators is essential to the success of any residency, and new programs have the challenge of developing their clinical faculty into outstanding teachers. There is minimal literature guidance for navigating this transition. Our site is a community tertiary care center in the process of applying for an EM residency. We focus on our experience designing a faculty development curriculum to accommodate the needs of a diverse group of physicians in all stages of their careers. We will demonstrate that a curriculum satisfying all stakeholders can easily be implemented in a way that allows for robust participation without excessive additional administrative burden. Our goal is to prepare community-based EM attendings to be outstanding educators to future residents by augmenting their knowledge of current educational practice and adult learning theory, literature review, and biostatistics. The educational strategies used in this curriculum included lectures, guided discussion, small group discussion, and asynchronous learning. This curriculum was implemented in the Geisinger Wyoming Valley Medical center targeted at staff physicians. This educational study was deemed exempt by the institutional review board (IRB). We electronically collected retrospective survey data using a 5-point Likert scale as well as free text responses. The primary measure was agreement with the statement, "Faculty development time makes me feel more prepared to be a clinical educator." We also surveyed whether this was felt to be an appropriate use of time, self-reported growth in key educational and biostatistical domains, and likeliness to change practice based on the material. Responses collected from core faculty after the sessions indicated a uniformly positive review of the series itself with the primary outcome receiving a 4.6 rating on a 5-point Likert scale (strong agreement). Faculty reported that these brief sessions improved the quality of the departmental staff meetings (average rating 4.7/5). Journal club sessions were rated as positive (4.7/5) and attendees self-reported growth in statistical literacy and security in clinical practice. We demonstrated successful implementation of a faculty development curriculum that was favorably assessed by all key stakeholders. Faculty self-reported growth in all educational and clinical domains evaluated. It was successfully implemented without substantially increasing the time burden for physicians with robust clinical and administrative schedules. We feel this is generalizable to other sites seeking to start an EM residency and is useful for sites with existing residencies to efficiently deliver content to junior faculty. Emergency medicine, faculty development, journal club, virtual learning.

A Model of Directorate of Students Welfare Scholarship that integrates Higher Education among the students of the Maharaja Sayajirao University of Baroda, Gujarat

Abstract: The Maharaja Sayajirao University, Baroda's flagship programme is the Directorate of Students' Welfare (DSW). It was established by the then Vice Chancellor, Prof. Yogesh Singh, and higher authorities to provide financial aid to the University's economically disadvantaged students. The primary goal of DSW is to provide financial assistance to 'genuine but economically disadvantaged' future assets of the country who are pursuing their studies at the Maharaja Sayajirao University of Baroda. DSW was established in the academic year 2012-13 with the goal of putting the haves and have-nots on an equal footing. Students who apply for a scholarship must have a family income of less than 3.5 lakh rupees per year and have received 55 percent in their previous year's exam. The online application can be made on the Maharaja Sayajirao University website (https://msubaroda.ac.in/dsw) with all the supporting papers such as Aadhar card, Bank Account details, Electricity bills, and so on. The DSW collaborates with members of its Core Committee and Faculty Coordinators. The Faculty Committee, which consists of the Dean, three professors, the dean of students, and the dean of sports, conducts the initial examination. The core committee then verifies the qualifications and assigns Recommendation, Strongly Recommendation, or Not Recommended ratings based on the students' merits. Each academic year, the committee meets to debate the agenda, make plans, and act in accordance with the Vice Chancellor sir's instructions. Every year, needy and genuine students are discovered through a methodical process that culminates in a personal interview in which the students are asked for personal information and all documents are verified. If during the interview the committee feels the need to go for home visit for further verification. After they are shortlisted, the funds are directly transferred to their bank accounts. For educational year 2020-21 the method was completely online due to Covid situation. Total 2925 students had done registration out of that 2621 application was completed with necessary documents. A total Rs. 90, 40, 490 Lakh has been given to 2004 students this educational year. If we see the data we have helped 1662 Grant in Aid students and 342 Higher payment students as they have received the scholarship. Also gender wise distribution is seen it is 1181 boys and 823 girls were benefitted with DSW scholarship. Keyword: Directorate of Students’ Welfare, Scholarship, Higher Education

The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States

The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States

Developing Awareness and Allies: Simulating Difficult Conversations about Microaggressions for Faculty and Students.

Discrimination and bias in clinical training often take the form of microaggressions, which, albeit unintentional, are detrimental to the learning environment and well-being of students. Although there are a few reports of medical schools training students to respond to microaggressions, none have included a complementery student-led faculty training module. The aim of this study was to develop and evaluate a case-based approach to improving student resilience and increasing faculty awareness of microaggressions in the clinical setting. We created four realistic cases of microaggressions and uncomfortable conversations, based on students' experiences on the wards, to implement training for incoming third-year students and their core faculty. Standardized patients were trained to effectively portray discriminatory faculty, residents, and patients. Institutional review board-approved surveys were administered and statistically analyzed to evaluate for efficacy. Students had greater mean confidence scores for responding to microaggressions immediately and at 6 months after the sessions (P < 0.05). Faculty showed improved mean confidence and understanding of the definition of a microaggression (P < 0.05). This approach had results similar to other studies, with the additional benefit of training faculty with the same scenarios. We believe that this method helped bridge the gap between students' notions of discrimination and faculty understanding of microaggressions.

A DESCRIPTION OF THE 2021 AFMRD SALARY SURVEY AND NEXT STEPS.

The Association of Family Medicine Residency Directors (AFMRD) biannually conducts a Salary Survey of membership as a member benefit. The survey asks program directors (PDs) to report total taxable annual income for themselves, associate program directors, core faculty, program coordinators/

Ahead of the Curve: The Arc Institute Aims to Reshape the Biomedical Research Landscape

Ahead of the Curve: The Arc Institute Aims to Reshape the Biomedical Research Landscape

About the Contributors

About the Contributors

Tying in Situational Awareness, Clinical Reasoning and Clinical Judgment through Cross-Training Using Case-Based Discussions in Emergency Medicine

Situational Awareness (SA) is knowing about what is going on around oneself, whether as an individual or as a team. It is the mental impression of where you are, what surrounds you and what lies ahead. SA has been noted to be one of the most important non-technical skills in medicine. It is a foundational concept in many high reliability organizations and industries for its importance in operational decision-making. Clinical Reasoning essentially summarises the process of making timely and accurate diagnosis. It goes through the steps of history taking, physical examination, performing diagnostic investigations, interpreting the results that are returned and planning management for patient care. It is a fundamental in the practice of medicine and even in today’s context of technology and Artificial Intelligence (AI) applications, these steps are incorporated into the algorithmic formulae. Clinical Judgment, on the other hand involves the process of “noticing, interpreting, responding and reflection” Just from the three definitions above, it can be seen that there may be overlaps between the three terms. They are also very often used almost interchangeably. Practitioners of academic medicine, educators and faculty, need to understand the similarities and differences between the three terms. They are often called upon to assess their learners in these domains. Thus, clarity on what each term exactly means is essential. In this paper, the author shares her experience as an educator and core faculty in Emergency Medicine Residency on the utilization of Case-Based Discussions (CBD) in the nurturing and inculcation as well as assessment of all these three domains. The ability to plan and use CBD in such a manner is time efficient and effective for emergency physicians, as it can be consciously prepared with the coverage of SA, CR and CJ skills all incorporated into the shared narrative or scenario management.

The Accreditation Council for Graduate Medical Education Milestones in Integrated Plastic Surgery Programs: How Competency-Based Assessment Has Been Implemented.

The plastic surgery milestones are a central component of resident assessment. The authors performed a survey to evaluate how milestones have been implemented across integrated plastic surgery programs and how faculty perceive the Milestones Project has impacted their program. A 25-question survey was directed to the head of the clinical competency committee of all 82 integrated plastic surgery programs through the American Council of Academic Plastic Surgeons. The survey queried the composition of the committee, how ratings are generated, and the data used in generating these ratings. Committee leaders from 57 programs (69.5 percent) responded to the survey. For most programs (73 percent), one faculty member completed milestone ratings for each resident and reviewed them with the residents. To determine milestone ratings, 92 percent utilized resident assessment after every rotation, and 63 percent utilized in-service examination scores. For documented resident assessment overall, 96 percent of programs assess residents after every rotation; 37 percent asses after every procedure. Feedback is most frequently provided to residents after every rotation (52 percent), rather than only during committee reviews (32 percent) or after every documented assessment (16 percent). Sixty-four percent of respondents did not believe that milestones have helped in the mentorship role. Implementation of the milestones has varied among integrated plastic surgery programs. Structured training for core faculty directed to methods of assessment will make milestones a more effective a tool by which to improve resident evaluation and education. These findings provide a key data set by which to revise the milestones for their second iteration.