Educational Experience For Residents Research Articles

Comparative effectiveness of virtual reality (VR) vs 3D printed models of congenital heart disease in resident and nurse practitioner educational experience

BackgroundMedical trainees frequently note that cardiac anatomy is difficult to conceive within a two dimensional framework. The specific anatomic defects and the subsequent pathophysiology in flow dynamics may become more apparent when framed in three dimensional models. Given the evidence of improved comprehension using such modeling, this study aimed to contribute further to that understanding by comparing Virtual Reality (VR) and 3D printed models (3DP) in medical education.ObjectivesWe sought to systematically compare the perceived subjective effectiveness of Virtual Reality (VR) and 3D printed models (3DP) in the educational experience of residents and nurse practitioners.MethodsTrainees and practitioners underwent individual 15-minute teaching sessions in which features of a developmentally typical heart as well as a congenitally diseased heart were demonstrated using both Virtual Reality (VR) and 3D printed models (3DP). Participants then briefly explored each modality before filling out a short survey in which they identified which model (3DP or VR) they felt was more effective in enhancing their understanding of cardiac anatomy and associated pathophysiology. The survey included a binary summative assessment and a series of Likert scale questions addressing usefulness of each model type and degree of comfort with each modality.ResultsTwenty-seven pediatric residents and 3 nurse practitioners explored models of a developmentally typical heart and tetralogy of Fallot pathology. Most participants had minimal prior exposure to VR (1.1 ± 0.4) or 3D printed models (2.1 ± 1.5). Participants endorsed a greater degree of understanding with VR models (8.5 ± 1) compared with 3D Printed models (6.3 ± 1.8) or traditional models of instruction (5.5 ± 1.5) p < 0.001. Most participants felt comfortable with modern technology (7.6 ± 2.1). 87% of participants preferred VR over 3DP.ConclusionsOur study shows that, overall, VR was preferred over 3DP models by pediatric residents and nurse practitioners for understanding cardiac anatomy and pathophysiology.

Processes of Health Care Delivery, Education, and Provider Satisfaction in Acute Care Surgery: A Systematic Review

In recent years, significant workload, high acuity, and complexity of emergency general surgery conditions have led hospitals to replace the traditional on-call model with dedicated acute care surgery (ACS) service models. A systematic search of Ovid, EMBASE, and MEDLINE was undertaken to examine the impact of ACS services on health-care delivery processes and cost, education, and provider satisfaction. From 1827 papers, reviewers identified 22 studies that met inclusion criteria and subsequently used The Evidence-Based Practice for Improving Quality method and Newcastle-Ottawa Scale to score quality and level of evidence. Most studies found an increase in daytime operating, improved patient transit from emergency department to operating room to home, and decreased length of stay. Higher and more diverse case volumes improved resident education and operative experience. ACS services enhanced the educational experience of residents on subspecialty services by offloading emergency work from those services. Finally, surgeons generally felt that ACS services improved job satisfaction, productivity, and billing. The ACS model has demonstrated improvement in timeliness of care, diversified case mix, decreased costs, improved trainee learning, and increased surgeon job satisfaction.

Residents Teaching Medical Students: How Do They Compare With Attending Educators?

Educating medical students is a core mission of academic radiology departments. In some programs, residents participate in student teaching. The aim of this study was to retrospectively compare medical student evaluations of radiology resident lectures with lecture evaluations of radiology faculty members. Numeric evaluations for lectures given by faculty members, fellows, and residents were collected over a 1-year period as part of routine course evaluations for a fourth-year medical student radiology elective. Faculty member, fellow, and resident lecture scores were compared, overall using analysis of variance and pairwise using Student's t test. A predefined low P-value threshold was used for the t tests to account for the multiple comparisons. To account for the inherent clustering of the data due to repeat lecturers, the data were reanalyzed on a "per lecturer" basis. Three hundred seven individual lecture scores were collected. There was no statistical difference between the lecture scores received by attending faculty members (mean, 9.10 on a scale of 10) and residents (mean, 8.99) (P = .08). Fellows, however, scored statistically significantly lower (mean, 8.45) than attending faculty members and residents (P <.001 for both comparisons). The per lecturer analysis yielded similar results. Lectures delivered by residents received similar evaluations as lectures delivered by faculty members. Given that teaching can be an educational experience for residents, involving radiology residents in medical student teaching may benefit students and residents alike.

Resident Perceptions of a Tele-Intensive Care Unit Implementation

Remote intensive care unit (ICU) monitoring (tele-ICU) may provide a means to address the shortage of intensive care physicians. However, the consequences of implementing a tele-ICU system for house staff education and clinical experience are unknown. The purpose of this study was to determine resident perceptions of the impact of a tele-ICU implementation on patient care, education, and the overall work environment. Cross-sectional survey of residents who rotated through the medical ICU within the first year after the implementation of a tele-ICU in a large, academically affiliated, community hospital. Each question was graded on a 5-point Likert scale. Thirty-five of 60 residents completed the survey (58% response rate). Sixty-three percent of residents reported that tele-ICU was associated with an improved ability to focus on urgent patient issues, and 46% thought that the tele-ICU helped them to feel less overwhelmed. Although most residents were neutral (51%), 37% agreed that the tele-ICU was a valuable educational experience. Seventy-seven percent reported that the tele-ICU integration was associated with improved patient safety, but many were concerned about the impact on continuity and communication. There was no perceived association with patient or family satisfaction. Our study suggests that a tele-ICU implementation in a medical ICU does not seem to have a negative impact on the educational experience of residents and is associated with perceived improvements in patient safety and quality. Future studies should objectively measure the educational impact of implementing a tele-ICU system.

Comparison of Quantitative Educational Metrics between Integrated and Independent Plastic Surgery Residents

The purpose of this study was to compare residents in the integrated and independent tracks of plastic surgery residency training using several quantitative educational metrics. The Harvard Combined Plastic Surgery Residency Training Program offers an ideal model for this comparison, as it is the largest in the country and operates both tracks simultaneously. The authors compared several quantitative educational metrics of all 22 independent and 24 integrated residents matched into the Harvard Program since its inception. These quantitative educational metrics include medical school reputation, United States Medical Licensing Examination (USMILE, Philadelphia, Pa.) step 1 scores, publication productivities during different educational periods (preresidency and pre-plastic surgery training), in-service scores, exit rankings (overall and operative skills), and percentage of M.D./Ph.D. residents. Integrated residents graduated from more highly ranked medical schools than independent residents (mean tier, 1.5 versus 2.3; p = 0.0345), had higher United States Medical Licensing Examination step 1 scores (mean, 235 versus 220; p = 0.0234), and had higher preresidency publication scores (mean, 68 versus 14; p = 0.015). There are more M.D./Ph.D. residents in the integrated than in the independent track (33.3 percent versus 4.4 percent; p = 0.027). Independent residents had higher pre-plastic surgery training publication scores (mean, 77 versus 6; p = 0.0003). In-training quantitative educational metrics were similar between the two tracks (p > 0.05 in all cases). To address potential caveats of the study, all publication scores were compared with and without correction for the presence of M.D./Ph.D. residents, which yielded similar results. The authors also compared the match ranks of all their residents and found them to be statistically comparable between the two tracks. In the Harvard Program, the integrated residents had better preresidency quantitative educational metrics, whereas the independent residents had better pre-plastic surgery training quantitative educational metrics. In training quantitative educational metrics were remarkably similar between the two tracks. In conclusion, this study, a systematic comparison between the two tracks, offers not only a valid foundation for future study of long-term outcome results but also a starting point from which to improve on the educational experience of residents in either track.

Evaluation of a women's safe shelter experience to teach internal medicine residents about intimate partner violence. A randomized controlled trial.

Although intimate partner violence (IPV) remains a major public health problem, physicians often fail to screen female patients. Reported IPV training approaches suffer from weak study designs and limited outcome assessments. We hypothesized that an educational experience for residents at a women's safe shelter would have significantly greater impact on IPV competencies, screening, and care for victims than a workshop seminar alone. In a pre-post randomized controlled trial, we compared residents exposed to the workshop seminar alone (controls) to residents exposed to these methods plus an experience at a women's safe shelter (cases). Competencies were assessed by written questionnaire and included knowledge, skills, attitudes, resource awareness, and screening behaviors. Of the 36 residents in the trial, 22 (61%) completed both pre- and postquestionnaires. Compared to controls, cases showed significantly greater pre-post improvement in the knowledge composite subscale. There were no significant differences between cases and controls in the subscales of skills, attitudes, or resource awareness. Cases increased their self-reported screening frequency but this did not differ significantly from the controls. Enhancing traditional IPV curriculum with a women's safe shelter educational experience may result in small improvements in residents' knowledge about IPV.

Obstetrics and gynecology

Basic science, clinical, and epidemiologic research is producing impressive advances in obstetrics and gynecology that will have a major effect on clinical practice. This review highlights research reported or published during 1999 about the demographics and educational experiences of residents, race as a prognostic factor in malignancy, hormone replacement therapy in women with malignancies, pregnancy and breast cancer, managed care, chemoprevention, and screening. The breadth, diversity, creativity, innovation, and controversy of these advances continue to characterize obstetrics and gynecology as a unique surgical specialty and reflect favorably on its vitality.

Moonlighting, a Good Educational Experience for Residents

Moonlighting, a Good Educational Experience for Residents

Two Years’ Experience with the Psychiatry Resident in-Training Examination

The annual Psychiatry Resident In-Training Examination (PRITE) was developed by a consortium of professional and educational organizations as a service available to residency training programs under policies intended to maximize standardization, minimize data bias, and prevent misuse. It provides a nonthreatening educational experience for residents through standardized administration, feedback to examinees based on comparisons with educational peers, detailed or summarized feedback to training directors, and availability of test questions and reference bibliographies as study aids. Each test resembles the written Psychiatry Board Examination in style, format, and method of administration, but differs in goals, content, method of construction, population tested, feedback provided, and manner in which results are used. Although initially controversial, the PRITE was very well accepted by the residents and training programs that participated in 1979 and 1980.

The on-Call Experience: Missed Opportunities for Resident Education

The on-call experience has been long neglected and devalued as an educational experience for residents in psychiatry. A program was instituted to reverse this trend. It included providing an academic orientation to emergency psychiatry, uniform morning-after supervision, mobilization of specially-prepared nursing staff to collaborate and follow through on contacts, and support for continuity of treatment of cases picked up while on-call. Results of before and after polling of residents and nurses demonstrated significant positive shifts in attitude toward the value of on-call work and perceptions of co-workers.

A faculty and house-staff group practice: report of an operational model.

The internal medicine group practice at Colorado General Hospital was formed in 1974 to improve patient care and educational experience for residents. Six residents, two faculty members, a nurse practitioner, a dietitian, and a group practice coordinator provide 24 hour-a-day, seven day-a-week care for 666 patients. The program features: a balanced degree of faculty and house staff involvement in direct patient care, a high level of accountability provided by the coordinator, and small group size. The first 19 months of operation are reviewed, and the program is contrasted with other group practices reported in the literature.