Didactic Conferences Research Articles

ABR Core Examination Preparation: Results of a Survey of Fourth-Year Radiology Residents Who Took the 2013 Examination

A survey was administered to fourth-year radiology residents after receiving their results from the first American Board of Radiology (ABR) Core examination in 2013. The purpose was to gather information regarding resources and study strategies to share with program directors and future resident classes. An online survey was distributed to examinees nationwide. The survey included free-response and multiple choice questions that covered examination results, perceived value of enumerated study resources, case-based and didactic teaching conferences, board reviews, study materials for noninterpretive skills, multidisciplinary conference attendance, and free-form comments. Two hundred sixty-six of 1186 residents who took the Core examination responded to the survey. Some resources demonstrated a significant difference in perceived value between residents who passed the examination and residents who failed, including internal board reviews (1.10, P<.01), daily didactic conferences (1.51, P<.01), and daily case conferences (1.43, P<.01). Residents who passed reported that conferences and review sessions at their institutions were modified with multiple choice questions, audience response, and integration of clinical physics and patient safety topics compared to residents who failed. Radiology residents and residency programs have adapted their preparations for the ABR Core examination in a variety of ways. Certain practices and study tools, including daily conferences and internal board reviews, had greater perceived value by residents who passed the examination than by residents who failed. This survey provides insights that can be used to assess and modify current preparation strategies for the ABR Core examination.

Standardized Evaluation of Didactic Conference Content in Neurology Residency: A New Approach (P1.316)

Standardized Evaluation of Didactic Conference Content in Neurology Residency: A New Approach (P1.316)

Exploring the Relationship Between the American Board of Emergency Medicine In-Training Exam Scores and Mandatory Didactic Attendance for Emergency Medicine Residents

Exploring the Relationship Between the American Board of Emergency Medicine In-Training Exam Scores and Mandatory Didactic Attendance for Emergency Medicine Residents

PEARLs of Wisdom: Impact of a New Block Conference on Pediatrics Resident Attendance, Satisfaction, and Learning

Resident attendance and participation at didactic conferences is often limited owing to time demands. In 2010, University of Wisconsin-Madison pediatrics residency eliminated all noon conferences and implemented a new block format, PEARL (Pediatric Education and Active Resident Learning). The purpose of this study was to assess whether changes in a conference structure improved resident attendance, distractibility, satisfaction, perception of clinical relevance, and connection. Pediatrics residents were surveyed to compare experiences in 2 different conference structures: a traditional noon conference and an interactive case-based PEARL conference. Pediatrics residents from the 2008-2010 classes were surveyed about noon conference experiences and 2009-2011 classes were surveyed about PEARL conference experiences. Participants included 32 residents in the 2010 presurvey and 36 in the 2011 postsurvey. All measures of attendance, distractibility, and satisfaction showed positive changes. For example, the average proportion of conferences attended was 73% with noon conferences and 98% with PEARL (P = .001). However, measures of perceived clinical relevance and resident participation did not change significantly. For example, on average 47% of residents reported contributing comments in a noon conference, whereas 56% of residents reported contributing in a block conference (P = .199). PEARL conference significantly improved resident attendance, lowered distractibility, and improved resident satisfaction. However, these structural changes did not lead to changes in perceived clinical relevance of information learned or resident participation. Further content changes or faculty teaching strategies should be considered.

Conference report. The 22nd Didactic Conference on Teaching Quality Evaluation Methods

The 22nd edition of Polish nationwide Didactic Conference was titled Teaching Quality Evaluation Methods (Metody oceny jakości nauczania) and was held in Łódź from 10th to 11th June 2013. The Conference was organized by the Institute of Statistics and Demography of the University of Łódź, with the cooperation of the Institute of Econometrics of the University of Łódź, under the honorary auspices of the President of the City of Łódź, Ms. Hanna Zdanowska.

Increasing Faculty Attendance at Emergency Medicine Resident Conferences: Does CME Credit Make a Difference?

Faculty involvement in resident teaching events is beneficial to resident education, yet evidence about the factors that promote faculty attendance at resident didactic conferences is limited. To determine whether offering continuing medical education (CME) credits would result in an increase in faculty attendance at weekly emergency medicine conferences and whether faculty would report the availability of CME credit as a motivating factor. Our prospective, multi-site, observational study of 5 emergency medicine residency programs collected information on the number of faculty members present at CME and non-CME lectures for 9months and collected information from faculty on factors influencing decisions to attend resident educational events and from residents on factors influencing their learning experience. Lectures offering CME credit on average were attended by 5 additional faculty members per hour, compared with conferences that did not offer CME credit (95% confidence interval [CI], 3.9-6.1; P < .001). Faculty reported their desire to "participate in resident education" was the most influential factor prompting them to attend lectures, followed by "explore current trends in emergency medicine" and the lecture's "specific topic." Faculty also reported that "clinical/administrative duties" and "family responsibilities" negatively affected their ability to attend. Residents reported that the most important positive factor influencing their conference experience was "lectures given by faculty." Although faculty reported that CME credit was not an important factor in their decision to attend resident conferences, offering CME credit resulted in significant increases in faculty attendance. Residents reported that "lectures given by faculty" and "faculty attendance" positively affected their learning experience.

NASPGHAN Guidelines for Training in Pediatric Gastroenterology

G.G.C. has received com M.C. has served on th served on the board o and Enteral Nutrition; her institution has rec collaborative and Prov pensation from Child L.A.G. has received c received compensatio employment, expert t stocks/stock options; LLC, consulted to No received or has grants Institutes of Health, th holds equity interest in has received compens Fibrosis Foundation; M Abbott Laboratories, Foundation, the Natio Diseases/National Ins ticals; E.A.R. has rece sionalism & Ethical institution has receive as the medical editor has received compen Pharmaceuticals, and Nutrition; J.T. has rec Pediatrics, Prometheu conflicts of interest. Copyright # 2012 by E Hepatology, and Nut Gastroenterology, He DOI: 10.1097/MPG.0b01

TF-9 Staying Out of Trouble: A Systematic Approach to a Failed Airway

TF-9 Staying Out of Trouble: A Systematic Approach to a Failed Airway

Integrating Quality Improvement Into Continuing Medical Education Activities Within a Community Hospital System

The integration of the Mercy Health System's quality improvement (QI) and continuing medical educational (CME) activities is described. With the implementation of computerized medical data, the opportunities for QI-focused CME are growing. The authors reviewed their regularly scheduled series and special CME programs to assess their impact on quality care processes. Clinical improvements were affected by combining national guidelines and advancements with local clinical data and interactions with physicians within interdisciplinary as well as specialty conferences. Case-based, multidisciplinary conferences lent themselves to this process to a greater extent than didactic conferences. The latter also could lead to QI when the topics were focused on specific quality initiatives that often are part of a national QI initiative. Although the authors consider these efforts to be at an intermediate stage of development, they have observed several QI/patient safety process improvements.

Donʼt Get A Car Made on a Monday…But What About a Colonoscopy?

Purpose: In recent GI literature, there has been much discussion regarding the adenoma detection rate (ADR) and various contributory factors. Recent studies have examined if time of day effects the ADR. Our study looked not only at the ADR during various times throughout the day, but also if the day of the week had any contribution. This study was performed through the Carl T. Hayden VA Medical Center's GI program, which has both clinical and academic responsibilities. The typical weekly schedule allows for procedures from approximately 8:00 am to 2:00 pm, on Mondays, Wednesdays and Fridays. Tuesday and Thursday afternoons are reserved for didactic conferences and outpatient clinic respectively. It was hypothesized that the ADR would be lower on Tuesdays and Thursdays given the external pressures from the didactic and clinical responsibilities on those afternoons. It was also hypothesized that the ADR would fall later on in the day. Methods: Using the Clinical Outcome Research Initiative (CORI) and the Computerized Patient Record System (CPRS) we obtained data from colonoscopies performed between April 1, 2010 and May 31, 2010, comprising 2 months of data and 619 endoscopies. We compared the ADR of each day during the week as well as if the time of day had any influence on the ADR. Results: The ADR was determined for each day, Monday through Friday, and the mean ADR was calculated. One-way analysis of variance (ANOVA) compared those means which found that the ADR stayed consistent throughout the days of the week (p: 0.12). This conclusion did not support the hypothesis that ADR is influenced by external scheduling responsibilities. Furthermore, after calculating mean ADR for time of day, one-way ANOVA also confirmed that the ADR remained stable (p: .23) and did not drop. Conclusion: The ADR can be affected by multiple factors, though the day of the week does not appear to be significantly contributory. Likewise, in the setting of our particular endoscopy unit, the ADR does not appear to be related to the time of day either.Figure: No Caption available.

Poster 276 Factors Affecting Resident Attendance at Didactic Teaching Conferences

Poster 276 Factors Affecting Resident Attendance at Didactic Teaching Conferences

Can Intervention Reduce Abuse of Proton Pump Inhibitors?

Purpose: We previously reported proton pump inhibitor (PPI) overuse in hospital patients, especially for stress ulcer prophylaxis (SUP). To evaluate the effectiveness of education, we examined the indication and frequency of PPI use in hospitalized patients again after intervention. Methods: We prospectively analyzed pharmacy orders of all adult patients admitted to the hospital who received a PPI in two separate phases. Phase 1 (P1) was for 45 days in 2005 and phase 2 (P2), after the intervention, was for 45 days in 2008. Indication for PPI use, hospital prescribing service and discharge PPI use were determined. Between P1 and P2, didactic conferences were conducted for the Internal Medicine (IM) residents on appropriate PPI prescribing and the IM admission template was updated to exclude routine SUP. Appropriate indications for PPI use included: maintenance of healed duodenal ulcers, H. pylori eradication, GERD, upper GI hemorrhage, maintenance/healing of erosive esophagitis, prevention/healing of NSAID-induced ulcers, relief from dyspepsia, SUP in high risk ICU patients, and continuation of home PPI. A two-proportion z- test was used to compare percentage of PPI use between the two phases. Results: Twenty-six percent (n=463) of adult patients admitted in P1 were prescribed a PPI and 36% (n=688) of patients in P2. Patients received a PPI for: SUP, GERD, not documented, GI bleed, continuation of home medication, peptic ulcer disease, esophagitis, and other. Inappropriate PPI administration decreased from 64% in P1 to 52% in P2 (p<0.0001). Inappropriate PPI use for SUP decreased from 86% to 76% (p<0.003). Importantly, in the intervention group, inappropriate use for SUP decreased from 62% to 41% (p<0.0001). Also, while 55% of patients in P1 were discharged on a PPI without appropriate indication, this decreased to 17% after the intervention in P2 (p<0.0001). Patients discharged on a PPI after being prescribed one for SUP decreased from 36% in P1 to 18% in P2 (p<0.0001). Although there was an overall increase in PPIs prescribed for inpatients in P2, a significant decrease was seen in PPIs prescribed for inappropriate reasons. Conclusion: Caution must be used when initiating PPI therapy in the hospital setting. Long-term therapy often continues unnecessarily at discharge leading to increased healthcare costs, polypharmacy, and increased risk for potential adverse effects. In conclusion, this study indicates that intervention through physician education can lead to a significant decrease in inappropriate inpatient PPI use.

Renewing Focus on Resident Education: Increased Responsibility and Ownership in Interventional Radiology Rotations Improves the Educational Experience

To enhance the educational experience among residents rotating through interventional radiology (IR) by encouraging ownership and responsibility. In May 2006, the authors implemented changes in resident education in IR that included increased clinical responsibilities, structured didactics, and greater hands-on experience, including call. Residents were assigned as first assistants, ownership of cases was encouraged, and assignment to a week on the consult service was instituted to help residents better understand all aspects of IR practice. Additional faculty recruitment and program expansion ensured the same high level of training for the fellowship program. Evaluations were reviewed every year (July 1, 2007-June 30, 2009) for hands-on training, daily teaching, didactic conferences, and overall effectiveness of the clinical service. A graduated scale of 1-5 was used. In 2009, 3 years after the curricular changes were made, the quality of hands-on training, daily case reviews and consults, didactics, and overall education had markedly improved with 89%, 71%, 65%, and 82% of the residents rating these respective aspects of the training as "above expectations" (4 on a scale of 5) or "superior" (5 on a scale of 5) compared with 77%, 23%, 20%, and 60% in 2005-2006. Three years after the changes, the impact of these changes on recruitment patterns also showed improvement, with 28.6% of the class of 2010 pursuing a fellowship in IR. Increasing resident ownership, responsibility, and hands-on experience improves resident education in IR, which, in turn, promotes interest in the field.

Comparison of General Surgery Research Resident Absite Scores to Their Clinical Peers Reveals Need for a General Surgery Curriculum during Dedicated Research Time

Background: Approximately 40% of surgical residents pursue one to three years of dedicated research during residency. Research residents continue to participate in didactic conferences, are occasionally responsible for patient care, and continue to take the American Board of Surgery In-training Exam (ABSITE) each year. Most programs have a dedicated research curriculum for these residents; however, many do not have a formal general surgery curriculum for research residents. We sought to compare research and clinical resident performance on the ABSITE to determine if there might be a need for a formal general surgery curriculum for research residents, to keep pace with their clinical peers.

Failure to Thrive: Pediatric Residents Weigh In on Feasibility Trial of the Proposed 2008 Institute of Medicine Work Hour Restrictions

In December 2008 the Institute of Medicine (IOM) released a report recommending limits on resident hours that are considerably more restrictive than the current Accreditation Council for Graduate Medical Education duty hour standards. In March 2009, a large pediatric residency program implemented a 1-month trial of a schedule and team structure fully congruent with the IOM recommendations to study the implications of such a schedule. Comparison of the interns' experience in the trialed intervention schedule was made to interns working a traditional schedule with every fourth night call. The residents on the intervention schedule averaged 7.8 hours of sleep per 24-hour period compared to 7.6 hours for interns in a traditional schedule. Participation in bedside rounds and formal didactic conferences was decreased in the intervention schedule. Several factors contributed to increased perceived work intensity for interns in the intervention schedule. Redistribution of work during busy shifts altered the role of senior residents and attending physicians which may have a negative effect on senior residents' ability to develop skills as supervisors and educators. The trial implementation suggests it is possible to implement the proposed duty hour limits in a pediatric residency, but it would require a significant increase in the resident workforce (at least 25% and possibly 50%) to care for the same number of patients. Furthermore, the education model would need to undergo significant changes. Further trials of the IOM recommendations are needed prior to widespread implementation in order to learn what works best and causes the least harm, disruption, and unnecessary cost to the system.

Repeated testing improves long-term retention relative to repeated study: a randomised controlled trial

Laboratory studies in cognitive psychology with relatively brief final recall intervals suggest that repeated retrieval in the form of tests may result in better retention of information compared with repeated study. Our study evaluates if repeated testing of material taught in a real-life educational setting (a didactic conference for paediatric and emergency medicine residents) replicates these findings when measured at a more educationally relevant final recall interval of 6 months. Residents participated in an interactive teaching session on two topics: (i) status epilepticus, and (ii) myasthenia gravis. Residents were randomised to two counter-balanced groups which either took tests on status epilepticus and studied a review sheet on myasthenia gravis (SE-T/MG-S group) or took tests on myasthenia gravis and studied a review sheet on status epilepticus (MG-T/SE-S group). Testing and studying occurred immediately after teaching and then at two additional times at intervals of about 2 weeks. Residents received feedback after each test. Tests consisted of short-answer questions and the review sheets consisted of information identical to that on the answer sheets for the tests. At about 6 months residents took a final test on both topics. Nineteen residents in the SE-T/MG-S group and 21 residents in the MG-T/SE-S group completed the study. Collapsing across groups, repeated testing produced final test scores that were an average of 13% higher than those produced by repeated study (39% versus 26%) at > 6 months after the initial teaching session (t[78] = 3.93, standard error of the difference = 0.03, P < 0.001, d = 0.91). Repeated testing with feedback appears to result in significantly greater long-term retention of information taught in a didactic conference than repeated, spaced study. Testing should be considered for its potential impact on learning and not only as an assessment device.

Effect of an Integrated Public Health Curriculum in an Emergency Medicine Residency

Background: Emergency departments (EDs) serve as a central point of interaction between the public and the medical system. Emergency physicians need education in public health in order to optimize their clinical care and their ability to evaluate potential public health interventions in the ED. Methods: As part of the Centers for Disease Control and Prevention (CDC) and the Association of American Medical College's (AAMC) national initiative for “Regional Medicine‐Public Health Education Centers‐Graduate Medical Education”, we designed and implemented a new public health curriculum for the emergency medicine residents. Over four sessions during regular didactic time, we used a modular approach to link a basic public health principle, such as environmental hazard assessment, to a relevant clinical topic, such as violent patients and ED safety. Each session emphasized resident involvement, including small group work and role‐plays. Journal clubs and quality assurance projects supplemented the curriculum. We sought resident feedback through focus groups and anonymous online pre‐ and post‐tests for each session. Assessment: Both before and after the curriculum, 76% of responders felt it was important for physicians to receive training in public health. The program appeared to have a positive effect on residents’ comfort level with various public health topics, and felt the residency program had taught them the skills necessary to implement public health principles in clinical practice (23.8%, versus 11.5% before; p&lt;0.05). Conclusions: Integration of public health principles into existing clinical curricula in emergency medicine may increase resident interest and knowledge. Combining public health and emergency medicine topics in regular didactic conferences facilitates public health education for residents.

Hepatopancreaticobiliary (HPB) Surgery: What Is the Right Fellowship for the Right Training?

Reduced resident work hours over the last several years have led to inadequate exposure to hepatopancreaticobiliary (HPB) and complex upper gastrointestinal (UGI) surgical procedures. Therefore, residents are seeking additional training in this field. The purpose of this study is to determine the role of a new fellowship model in the training of general surgery residents in complex HPB/UGI diseases. We propose a surgical training model in benign as well as malignant diseases of the UGI tract. The proposed model would focus on an integrated approach that involves allied specialties such as gastroenterology (GI) and radiology. The fellowship was set as 1-year duration with 1-month rotations on interventional GI and transplantation. The fellow spent the remaining 10 months on a UGI laparoscopic and open surgery service caring for complex benign and malignant disease of the esophagus, stomach, bile duct, pancreas, and liver. Didactic conferences were focused specifically at an organ-based approach to diseases of these organs. During a 12-month fellowship, exposure to complex diseases of the UGI tract was accomplished without negatively impacting the general surgery residency program. This new mode of advanced training provides a bridge between surgical oncology and transplantation, and it is an excellent model for postgraduate surgical training in UGI diseases.

Narrative Medicine in Surgical Education

Narrative medicine is a patient-centered approach to the practice of medicine that rescues the patients' stories and integrates what is important to them into decisions regarding their health care. Our hypothesis is that narrative understanding enhances the patient-provider relationship and contributes to optimizing patient care. We propose to use written narrative reflection to capture and measure the general competencies of systems-based practice, practice-based learning, communication skills, and professionalism. DEVELOPMENT/METHODS: The development of this narrative-based project is based on a pilot study that we conducted at our institution with third-year surgical clerkship students. In the pilot, students produced in-depth narrative write-ups on a patient they had had the opportunity to "know." We plan a similar approach for surgical resident education. After a brief discussion of narrative medicine during our scheduled didactic conference, the residents are asked to initiate a written narrative reflection on a patient of their choosing. The narratives will be collected 1 week later. Our plan is to repeat this assessment quarterly so that 4 narratives will be generated annually from internship through the chief resident year. The narratives will be analyzed for content and recurring themes that capture the resident's communication skills, professionalism, as well as self-critique (practice-based learning) and value attributed to health-care teams (systems-based practice). After completion of the narratives, a 5-point Likert response survey will be given to the residents to assess their experience and the perceived value of written reflection. The written narratives will become part of the resident's ongoing portfolio. IMPLEMENTATION/EXPERIENCE TO DATE: Feedback from the medical student pilot study was favorable. When asked in a follow-up questionnaire, most students reported the experience to be valuable and recommended the use of narrative reflection in medical education. To assess the feasibility of this approach in surgical residency, we introduced the concept of narrative reflection to our residents during surgery grand rounds. Thirty-three narratives were collected 1 week later. CONCLUSION/NEXT STEPS: This preliminary experience suggests that acquisition of resident-authored narrative reflection is feasible during surgical residency. Use of this narrative-based approach in surgical resident education has the potential to capture and measure the general competencies of systems-based practice, practice-based learning, communication skills, and professionalism.

Expanding Resident Conferences While Tailoring Them to Level of Training: A Longitudinal Study

To evaluate the effect of changing a 1-hour weekly all-resident didactic conference to an expanded 4-hour bimonthly level-specific didactic conference. Prospective outcome measures included an anonymous 10-item perceptions survey administered at 4 time points (preintervention, 6 months postintervention, 1 year postintervention, and 2 years postintervention), mean attendance rates preintervention and postintervention, and mean ABSITE scores preintervention and postintervention. Large university-based surgical residency. Surgical residents (R1-R5, n = 75) were divided into junior (R1-R3, n = 56) and senior (R4-R5, n = 19) groups. Each group attended a session every other Wednesday. Significant improvements were observed in overall resident satisfaction (55% vs 80%, p < 0.005) and level-specific appropriateness of content (81% vs 94%, p < 0.001). Furthermore, resident attendance rates were improved substantially (33% vs 55%, p < 0.001). ABSITE scores were not affected significantly by the change in curriculum structure. An expanded, bimonthly level-specific didactic curriculum is more effective than a shorter, weekly all-resident conference as evidenced by resident attitudes and attendance. Additional benefits of the alternating schedule include a reduced number of residents in each conference and the availability of residents for clinical educational activities (eg, operative cases or clinic). Expanded educational time has allowed the introduction of nontraditional topics that include leadership, communication, practice management, professionalism, and technical skills training.