Elective Rotations Research Articles

Crossing Boundaries: Mentorship in Global Health.

* Abbreviation: GH — : global health On my first day in the NICU in Malawi, I helped care for an infant who suffered from severe lack of oxygen and trauma due to a difficult birthing process. Before this experience, I had felt ready to work at a Malawian hospital as a pediatric resident. I had taken a tropical medicine course, and my home institution mentor had run simulations and led discussions addressing the practicalities and ethics of practicing medicine within resource-limited settings. But that afternoon, when the infant became apneic, personally experiencing what had only been simulated felt much harder. The 1 available nurse and I performed compressions and manual breaths, but he never recovered spontaneous respirations. My host institution mentor arrived soon after we discontinued resuscitative efforts. With his guidance, I spoke to our patient’s family and witnessed the Malawian expression of grief in the form of wailing songs and prayers. Afterward, he and I discussed questions with which I was struggling, namely, at what point would I be causing more harm than good by continuing to resuscitate this child, knowing the limited long-term care resources available in Malawi? Both home and host institution mentors helped me navigate this clinical situation and process my patient’s death, ultimately enriching my global health (GH) experience and … Address correspondence to Maya I. Brasher, MD, Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School, UT Health Science Center at Houston, 6431 Fannin St, Suite MSB 3.244, Houston, TX 77030. E-mail: maya.i.brasher{at}uth.tmc.edu

The Impact of a Virtual Radiology Medical Student Rotation: Maintaining Engagement During COVID-19 Mitigation.

ABSTRACTIntroductionThe purpose of this study is to introduce a virtual radiology rotation curriculum that is being used to safely maintain medical student and intern education and engagement with the Department of Radiology at Walter Reed National Military Medical Center during coronavirus disease 2019 (COVID-19) mitigation.Materials and MethodsThe curriculum is designed as a 4-week block with each week representing one of the four highest yield radiology subspecialties for medical students; neuroradiology, thoracic radiology, body radiology, and musculoskeletal radiology. A subspecialist radiologist from each section was identified as a primary mentor and tasked with designing a daily schedule for medical students and interns. The first 2 months of virtual rotators were surveyed to assess the effectiveness of the course.ResultsThirty-five of 41 rotators responded to the survey, a response rate of 85%. Thirty-one of 35 (89%) of the rotators gave this virtual elective rotation a positive rating, with 16 trainees scoring the course as 4 out of 5 and 15 trainees selecting 5 out of 5. Four respondents selected 3 out of 5. Five out of 5 respondents who had experienced an in-person radiology elective rotation before this virtual rotation rated the virtual elective as more educational than the in-person rotation. We found the 4-week subspecialist mentor-based structure to be highly versatile, allowing us to simultaneously accommodate multiple groups of full or partial block rotators throughout COVID-19 mitigation.ConclusionA virtual rotation curriculum is a viable method of maintaining medical student and intern education and engagement with the department of radiology during COVID-19 mitigation.

Zooming forward: An advanced pharmacy practice experience utilizing virtual case‐based learning in response to COVID‐19

AbstractIntroductionIn response to the coronavirus (COVID‐19) pandemic, Oregon State University College of Pharmacy designed and implemented a virtual six‐week case‐based learning elective rotation for advanced pharmacy practice experience (APPE).ObjectivesThe goal was to develop and refine students' knowledge, critical thinking skills, evaluation and assimilation of scientific evidence, and behavior to provide patient‐focused disease management.MethodsThis APPE experience was delivered via asynchronous independent work and synchronous video conferencing. A diverse team of pharmacy experts including faculty, preceptors, and administrators developed and implemented the APPE rotation. Seventy students were divided into three groups, with each group rotating every two weeks in each of the following sections: acute care, ambulatory care, and drug information/journal club. Formative and summative assessment activities were mapped to eight student learning outcomes (SLOs). Graded activities were used to assess the achievement of SLOs, with a target minimum average of 80% as an acceptable level for achieving outcomes. At the end of the rotation, students completed a retrospective pre‐ and post‐survey to reflect their ability level for each course outcome and provide qualitative feedback regarding this APPE rotation.ResultsSixty‐eight students completed the virtual APPE rotation. Two SLOs, one focused on the ability to evaluate and apply evidence‐based medicine and the other on the ability to establish patient‐specific goals, met the target at 80.42% and 81.14%, respectively. The average change in survey responses across all outcomes was positive with 12.35% increase. The largest increase from baseline was 15.22% in the students' ability to retrieve evidence‐based medicine and a 17.72% increase in developing drug‐related educational materials. Generally, qualitative feedback from students was positive.ConclusionThe combination of Zoom and a university‐supported learning management system was a feasible and successful option to design and deliver experiential education in the context of COVID‐19 limitations. Students identified the strengths of this rotation as its structured nature and learning from content experts.

Perceptions of a Remote Learning Pathology Elective for Advanced Clinical Medical Students

In mid-March 2020, our institution removed most medical students from in-person clinical clerkships due to the COVID-19 pandemic. The Department of Pathology responded by transitioning a fourth-year clinical elective to an all-remote format composed of synchronous didactics, daily clinical sign-out utilizing digital microscopy, and asynchronous learning materials. Thirty-seven medical students completed 2- or 4-week anatomic pathology electives tailored to meet their career goals and allowing them to progress toward graduation. Institutional Review Board approval was granted to survey students’ perceptions of engagement in the remote learning environment. Quantitative and qualitative data were collected using a standardized school-wide end-of-rotation survey, an online survey developed by the authors, and students’ self-directed learning goals. End-of-rotation data showed the remote pathology course performed well (4.88 of possible 5) when compared to all advanced clinical clerkships (4.51, n = 156 courses), all elective rotations (4.41, n = 50 courses), and the traditional in-person pathology elective (4.73). Core strengths in the virtual environment included high educational value, flexibility of content and schedule, organization, tailoring to an individual’s learning goals, and a positive education environment. Deficits included the inability to gross surgical specimens, inadequate observation or feedback about students’ skills, and impaired social connections. Areas for improvement included requests for in-person experiences and development of themed tracks for career exploration. Many aspects of anatomic pathology appear well-suited to the remote learning environment. While the remote model may not be sufficient for students pursuing careers in pathology, it can be adapted to increase nonpathologists’ understanding of interdisciplinary clinical collaboration with pathologists.

Impact of COVID-19 pandemic on the residency programs of the country: A multicentre study.

Objective:To provide an insight on the disruption of multiple facets of residency programs in a multi-centre study.Methods:This cross-sectional survey was carried out by enrolling the available residents from three teaching hospitals of the country by sending a questionnaire through email. The questionnaire comprised of three parts; 1) basic demographics, 2) effect on multiple facets of training and 3) the use of smart learning with the support provided by the hospitals. Data collection was started during the first week of June 2020 after acquiring ethical approval from the concerned department and the total duration of the study was one month. Data was analysed using SPSS v. 19.0.Results:A hundred-and-five completed responses were obtained with a response rate of 42%. Fifty-nine percent of the participants were female residents. Majority of the residents (69%) belonged to the age group 25-30 years. Fourth year residents (38%) showed maximum participation and the mean number of work days per month were 22±5.4. All of the aspects of training suffered complete or severe reduction except for the multi-disciplinary team (MDT) meetings, elective rotations and e-log book entries. Sixty seven to sixty-nine percent of the residents felt complete clinical, educational and psychological desertion in their departments, 59% used telemedicine and 90% reported non-availability of smart learning facilities.Conclusion:Overall, our study confirmed that the COVID-19 pandemic has substantially affected the clinical skills, teaching and personal growth of many trainees. There is a decrease in exposure to almost all of the aspects of training with no alternative in the form of smart learning provided to many. Clinical, educational and psychological support, although an extremely important part of healthcare staffing and management, has been largely neglected as well.

Patterns of Blood Products Utilization at a Tertiary Care Center in the Southern Region of Saudi Arabia

MATERIALS AND METHODS: A total of 457 blood transfusion requests for 244 patients were received over a 3-month period. Registered demographic characteristics (age, sex, and nationality), ward, type of blood, and hemoglobin concentration before transfusion for all the patients were collected. RESULTS: A total of 1328 blood products were requested, while 780 (59%) units were transfused. The cross-matched packed red cells/transfusion ratio was 1.8, while request/transfusion was 1.7 for the fresh frozen plasma and 1.23 for platelets. Packed red blood cells were the main blood product used in blood transfusion (BT). General surgery/orthopedics and intensive care unit were reported with a greater number of requests. The main indications noted for blood requisition were surgery and anemia. CONCLUSIONS: Current guidelines appear to be respected within services regarding BT decision criteria. However, about half of the requested blood is not transfused which suggest further improvement. Adherence to established guidelines seems variables among different departments. Elective transfusion medicine rotations for all trainees and specialized dedicated sessions for doctors may help in further betterment of utilization of blood bank services.

Virtual Pathology Elective Provides Uninterrupted Medical Education and Impactful Pathology Education During the COVID-19 Pandemic

As students do not qualify as essential health care workers, medical education faced severe disruptions during the COVID-19 pandemic including initial suspension of all in-person lectures and on-site rotations. Our Pathology Department was among the first at Northwestern to offer a completely virtual rotation with the goals of: (1) providing a comprehensive introduction to the practice of anatomic and clinical pathology, (2) emphasizing uninterrupted and continued excellence in education, and (3) minimizing exposure risk during the pandemic. The innovative 2-week curriculum incorporated diverse teaching modalities including live and recorded lectures; live and recorded video demonstrations; interactive small group discussions; interactive virtual sign-outs; and written and multimedia assignments, quizzes, and projects. The virtual elective ran from March to July 2020 with 52 total participating medical students. On post-rotation evaluations, students rated the pathology virtual elective 4.7/5.0 compared to other virtual rotations and 4.0/5.0 compared to all rotations (including in-person and virtual). Furthermore, continual improvements were made to the established framework based on rotation feedback such that curriculum content was more abundant and more favorably rated by the last cohort when compared to the first. Finally, although students identified interest in over 10 different medical specialties, all participants expressed increased interest in choosing pathology as a specialty and better understanding of pathology’s role in patient care. We hope our detailed description of creating and evaluating a completely virtual elective rotation serves as a model for other departments to improve pathology education and visibility.

Cardio-Renal-Metabolic Care Models

Cardio-Renal-Metabolic Care Models

The Impact of a Multidisciplinary, 3rd-year Oncology Elective Rotation on Decisions to Pursue Oncologic Careers and Oncology Exposure: The University Experience

The majority of multidisciplinary oncologic care is provided in the outpatient setting, yet at many medical schools the dominant means of exposure occurs during inpatient rotations. Given the inherent multidisciplinary nature of the specialty, radiation oncology departments are well positioned to lead multidisciplinary outpatient oncology rotations within medical schools. Since 1992, the University of Cincinnati’s Department of Radiation Oncology has administered a two-week, 3rd year clinical elective that exposes students to most oncologic disciplines (medical oncology, surgical oncology, radiation oncology, pediatric oncology, and pathology). This study evaluates the impact of this rotation on oncology exposure and ultimate career choice over the last 10 years. A list of medical students who participated in the MS3 clinical oncology-specific elective rotation from 2008 to 2018 was reviewed. A search engine was used to identify all physicians’ medical specialty choices and their current location of practice. The American Society for Radiation Oncology’s (ASTRO) and American Society of Clinical Oncology’s (ASCO) website directories were used to obtain e-mail addresses for all physicians with oncology practice. A survey of six questions was distributed to the physicians to evaluate how the rotation influenced the students’ oncology exposure and ultimate career choice. Two-hundred forty-four medical students participated in the 3rd year Clinical Oncology Specialty Clerkship from 2008 to 2018. Thirty-eight students (15%) ultimately pursued oncologic subspecialties and contact information was found for 32 (84%) for survey. The overall survey response rate was 78% (n = 25). Eighty-eight percent of the physicians had a positive to very positive experience with the rotation. The rotation was the first clinical exposure to the field of oncology for 48% of the respondents and the first exposure to the field of radiation oncology for 69% of the physicians. Seventy-two percent of the oncologists attributed their 3rd year rotation as providing a moderate or great deal of early exposure to the field of oncology. The number of students who participated in the clerkship who ultimately matched into radiation oncology is 28 (11.5%). Ten of the 244 students (4.1%) matched into other oncologic specialties. Radiation Oncology Departments should be well positioned to lead multidisciplinary, ambulatory, oncology electives within US medical schools. An oncology-specific rotation introduces third-year medical students to the ambulatory setting of oncology care, which they may not be exposed to otherwise. These rotations provide all students with valuable clinical exposure to oncology disciplines and may shape their ultimate career choice. A majority of participating oncologists viewed the rotation positively and attributed the rotation with their entrance into oncologic subspecialties.

A survey on student pharmacists' knowledge, attitude and perceptions about drug and poison information elective rotation in Saudi Arabia

Background: Drug and poison information (DPI) elective rotation develops interns into drug information experts, educators, and policymakers. DPI is an important pharmaceutical service built on technical skills, knowledge and expertise. Aim: A pre- and post-rotation survey to assess the current knowledge, attitude and perceptions of student pharmacists about DPI rotation. Methods: Three cohorts of student pharmacists responded to the survey, which was composed of closed- and open-ended questions. Descriptive statistics, McNemar's test, and Chi-square test were utilised for data analysis. Results: Knowledge of primary resources increased from 37.2% to 85.6% at the end of the rotation. In the beginning, only 13.8% were aware of Pharmacy and Therapeutic committee related activities, and 15.9% considered identification adverse drug reactions as auxiliary responsibilities. However, the proportion increased to 82% and 83.5% by the end of the rotation. Both at the beginning and the end, student pharmacists felt the training was essential to appraise literature. Twice the number of respondents expressed that there were job opportunities in the DPI centre post-rotation compared with the pre-rotation response (p<0.001). The perception of responding to queries at their own pace was significantly reversed post-rotation (p<0.001). A significant association was found between opportunities in DPI centre and motivation to choose this rotation (p<0.05). Also, knowledge of primary resources with previous research was significantly associated (p<0.05). Conclusion: Interventions such as journal club, guest lectures and visit to the DPI centre significantly improved the knowledge, attitude and perceptions of student pharmacists towards this DPI rotation.

Interactive Case-Based Childhood Adversity and Trauma-Informed Care Electronic Modules for Pediatric Primary Care.

IntroductionTraining health professionals for the skills and capacity to respond adequately to children and adults who have been exposed to adverse childhood experiences is recognized as an essential need in health care. Accessible opportunities to educate physicians and physician-trainees are limited.MethodsFour computer-based e-modules were created focusing on addressing childhood adversity and implementing trauma-informed care in the pediatric primary care setting. These childhood adversity and trauma-informed care (CA-TIC) e-modules were designed as an individualized, self-directed experience to allow for distance learning with flexibility to be embedded into existing coursework. To foster an engaging learning environment, we narrated the modules, prioritized images, and included the opportunity for participant interaction via multiple-choice and short-answer questions. Twenty-eight pediatric residents, two medical students, four attending physicians, and one fellow at Children's National Hospital completed the e-modules.ResultsOverall, participants rated the CA-TIC e-modules 4.6 (SD = 0.5) out of 5 for design and quality. Using paired t tests and Wilcoxon signed rank tests, we found statistically significant score increases from presession to postsession for participants' knowledge, attitudes, practice, and confidence related to CA-TIC. The most commonly cited learning points and practice changes included asking about trauma in practice and the seven C's of resilience.DiscussionA trauma-informed, strengths-based approach to care can assist health care providers in mitigating the link between adversity and related poor health outcomes. The CA-TIC e-modules provide an opportunity to train health professionals using an innovative, self-directed, and low-resource mechanism.

Reference letters for subspecialty medicine residency positions: are they valuable for decision-making? Results from a Canadian study

BackgroundThe letter of recommendation is currently an integral part of applicant selection for residency programs. Internal medicine residents will spend much time and expense completing sub-specialty away electives to obtain a letter of recommendation. The purpose of this study was 1) to examine a large sample of reference letters in order to define essential components of a high-quality letter, and 2) to elucidate the relationship between quality of reference letter and the letter writer.MethodsWe conducted a two-phase study. In phase one, a large sample of letters of recommendation was examined using an audit tool as a coding framework. A 5-point composite endpoint of high-quality letter components was subsequently developed. In phase two, program director letters were compared to non-program director home institution and non-home institution elective letters based on inclusion of components of the 5-point composite endpoint using Chi square testing.Results715 letters were examined (398 non-program director home institution letters, 201 program director letters, and 116 non-home institution elective letters). High-quality letter components were: nature of relationship, duration of relationship, In Training Evaluation Report information, research involvement and comments on areas for improvement. Program director letters had a significantly higher proportion (10.4%) of all 5 high-quality components, compared to 0% in both non-program director home institution letters and elective letters (p < 0.001). A significantly higher proportion of program director letters had 4–5 high-quality components (62.5%) compared to 2% of non-program director home institution letters and 0% of elective letters (p < 0.0001).ConclusionsLetters of recommendation from elective rotations are of the poorest quality and such rotations should not be pursued for the sole purpose of obtaining a letter. The low quality of elective letters leads to the recommendation that writers should decline to write them, programs should not require them and trainees should not request them. Program directors write the highest quality letters and should be a resource for faculty development. Clinical supervisors can use the 5-point composite endpoint as a guide when writing letters for applicants.

220TF A Didactic Curriculum for the Emergency Medicine Sub-internship, Designed to Be Delivered by Residents

The emergency medicine (EM) sub-internship at OHSU is a popular and well-established four-week elective rotation for fourth-year medical students. The students are largely taught both on-shift and in didactic sessions by a third year EM resident on their “teach rotation,” which is also an educational experience for the residents. We aimed to create a didactic curriculum for the medical student rotation that provides an improved didactic experience for the medical students while still being feasible for the residents to facilitate. We sought to develop a curriculum that would prepare the students to: 1) demonstrate knowledge of introductory clinical concepts of EM; and 2) perform basic emergency department procedures under direct supervision. A secondary aim was to incorporate residents in small group didactic session and interactive workshop facilitation as part of our resident-as-teacher curriculum. We used Kern’s six-step approach to curriculum development. We started by reviewing the existing didactic material to identify opportunities for improvement and to develop strategies to optimize the materials for student learning (problem identification and targeted needs assessment). We tailored the material to meet the stated goals and objectives of the course; namely, to introduce basic clinical concepts of EM, and to teach suture, splint, and ultrasound skills. For our educational strategies, we combined a skills workshop with small group learning sessions. The workshop occurs on the first day of the clerkship and covers suture, splint, and ultrasound skills. We provide the teach resident with a PowerPoint that intersperses lecture-based teaching with opportunities for students to practice each skill. We also provide the resident with an outline of suggested teaching points that complements the slides and helps to ensure students are getting a consistent and comprehensive experience each time. After the workshop, students have a total of four two-hour didactic sessions led by the teach resident. We provide the teach resident with a repository of one-hour PowerPoint-based lectures from which they and students can choose based on interest and gaps of knowledge in the group. The expectation is that the resident will teach most, though not necessarily all, of the lectures included. The lectures are designed to be interactive in the small group setting, with many including a “pass the pointer” component to encourage student participation. We designed the slides to be self-explanatory with additional information provided in the “presenter’s comments” section so minimal advance preparation is required by the resident. The new curriculum was implemented in January 2020, and has been feasible to implement and acceptable to the learners. Student learning will be assessed on the clerkship final exam and in their shift assessment forms. Curriculum evaluation will be performed by collecting anonymous feedback from students using surveys distributed to students after they complete the clerkship, and the curriculum will be iteratively revised based on learner assessment and program evaluation data. This didactic curriculum developed for the EM sub-internship provides a consistent didactic experience for the medical students while being feasible to implement for the teach residents who are delivering the content.

Performance on an independent elective rotation in gynecologic oncology is associated with improved gynecologic oncology fellowship match rates

Performance on an independent elective rotation in gynecologic oncology is associated with improved gynecologic oncology fellowship match rates

A Structured Mentorship Elective Deepens Personal Connections and Increases Scholarly Achievements of Senior Surgery Residents

Objectives Surgery residents have few opportunities to work closely with attending surgeons or conduct research during clinical time. We hypothesized that a mentorship elective with a required research project would benefit residents’ career development, including their personal connections with faculty mentors, and would help them build their academic portfolio. Design We created a mentorship elective designed as a one-on-one apprenticeship. Completion of a scholarly project was a core component of the elective. Residents, faculty, and the most senior resident (‘non-mentee’) on the same service as the elective resident were interviewed after the completion of their rotation. Setting University-based surgery residency at Boston Medical Center, Boston, MA. Participants All 5 residents in postgraduate year 4 (PGY-4) participated in the mentorship elective during the 2019 to 2020 academic year. Residents identified their faculty mentor. All mentees (5/5), most mentors (4/5), and all non-mentees (4/4) were interviewed. Results All mentees reported interacting with their mentor daily, performing clinical duties or discussing their research project. For mentees, the top factor when selecting their mentor was the mentor's clinical expertise, and the most valuable aspect of the rotation was developing a relationship with their mentor. All mentors responded that their mentee gained an understanding of running an academic surgical practice and developed research skills. Four of 5 mentees completed critical portions of their scholarly project during the elective with one publishing in a peer-reviewed journal, 2 having their work accepted to a national conference, and one creating vascular surgery educational videos. All stated the elective was valuable. Conclusions A structured apprenticeship rotation allowed for closer relationships with attending surgeons and increased the scholarly achievement of PGY-4 surgery residents. We provide an example of how to incorporate a successful elective rotation into the surgery curriculum that strengthens resident career development and research productivity.

Novel MR-Guided Radiotherapy Elective Rotation for Radiation Oncology Trainees.

MR-guided adaptive radiation therapy (RT) is emerging as an integral treatment modality for certain applications and is poised to become an exciting opportunity for greater treatment precision and personalization. However, this is still a relatively nascent technology and only a few institutions and programs have access to this technology for clinical use and trainee education. To increase the diversity of elective offerings and improve the understanding of an MR-guided radiotherapy program, we initiated a unique MR-guided radiotherapy elective rotation for radiation oncology residents. During a representative four-week rotation, 21 simulations were completed by the resident on service. A plurality of simulations were for pancreas stereotactic body radiation therapy (SBRT; 48%) and a majority (71%) of simulations were for adaptive treatments. Additionally, 74 adaptive fractions were completed during this month, of which a significant majority (74%) were for pancreas SBRT. Of the non-adaptive fractions, the majority were for prostate SBRT and intensity-modulated radiation therapy (IMRT). Although many programs may offer training in some aspects of MR-guided radiotherapy as trainees rotate through certain disease sites, we hope this may serve as a blueprint to encourage programs with this technology to fully embrace training in essential competencies related to MR-guided radiotherapy. MR-guided radiotherapy has unique challenges that trainees need to understand to deliver treatment safely: geometric uncertainty, MRI to RT isocenter, and uncertainties with voxel size/tracking.

What affects medical students’ applications to five-year FRCPC emergency medicine programs?

Purpose: To compare the impact of institutional and epidemiologic factors on differences in application trends of Canadian medical graduates (CMGs) from different medical schools to FRCPC emergency medicine (EM) residency programs.&#x0D; Methods: This was a retrospective cohort study. Data from 2013-2018 were obtained from the Canadian Resident Matching Service (CaRMS) database and standardized questionnaires sent to Canadian medical schools.&#x0D; Results: CaRMS data were available for all schools and survey data was available for 76% schools. Five schools yielded significantly higher rates of applications to FRCPC-EM programs (8.8-13.1%, p&lt;0.05), and 5 schools had significantly lower rates compared to the national mean (2.9-5.1%, p&lt;0.05). Increased exposure to EM (a core rotation and/or elective rotation in EM in the third year of medical school at home-school) yielded 28-55% higher application rates (p&lt;0.001). The presence of an FRCPC-EM residency program at the applicant's home school, and a home school program with 5 or more CMG residency positions at a CMG’s increased the application rates by 39 and 17%, respectively (p&lt;0.05).&#x0D; Conclusion: These data demonstrate a significant difference in application rates of CMGs graduating from Canadian medical schools and certain factors may affect application rates. This information could be used by medical schools to modify curricula, increase exposure to EM, and contribute towards addressing the forecasted national shortage of EM physicians.

How Serious are we Regarding Resident Education and Wellness in Radiation Oncology Residency Programs?

Residency is the time for education and training during which a medical student transforms into a capable physician to take care of the patients. Resident wellness and prevention of burnout has become an important objective of ACGME in recent years. Despite the efforts from ACGME to make sure the basic standards are met across the training programs, significant variations exist in educational and wellness resources among residency programs. The purpose of this research is to evaluate the educational and wellness resources for residents among Radiation Oncology residency programs across the United States. A list of accredited programs for the academic year 2018-2019 was collected using the ACGME website (www.acgme.org). Individual residency program websites were used as the main source of the data whereas Fellowship Residency Electronic Interactive Data Access System (FREIDA) website (www.freida.ama-assn.org) aided to complement the missing data. Information from all the 94 Radiation Oncology residency programs which are currently ACGME accredited, was up to date as of April 30th, 2019. Excel 2013 was used for analysis. Educational resources Only 53 radiation oncology residency programs reported the duration of protected education time per week on their websites. The median protected education time was 8 hours/week (range: 2 hours to 13 hours) including all the conferences the residents were supposed to attend. Seventy-five (80%) programs have reported the duration of dedicated research time on their websites. At least six months were allowed in 48 (51%) programs, whereas 27 (29%) programs have reported the dedicated research time is negotiable. Outstandingly, 20 (21.28%) programs allow one year of dedicated research time, and the median dedicated research time was nine months. Elective rotations outside the primary department or the primary training institutions help the residents improve their clinical skills and perspectives. From our study, only 13 (14%) residency programs reported to allow residents to rotate in other departments of the same institution. Fifty-nine (63%) of programs allow away rotations at other institutions (external electives). An international rotation was permitted only in 19 (20%) programs. Wellness resources Resident burnout and wellness are areas where ACGME and individual residency programs focus to improve the training for the residents. We evaluated the availability of wellness resources as presented in the radiation oncology program websites and found that there are a lot of variations across the programs. Fatigue management training was available in 50 (53%) programs. Twenty-four (26%) programs routinely organize resident retreat yearly. Thirty-nine (42%) programs reported that they have resident mentoring programs. Financial wellness is an important part of resident wellness and we evaluated the resident salary information across the programs. The salary information was obtainable for 63 institutions, and residents are reasonably well-compensated (range: 51000$ to 78,000 yearly) compared to the median family income in the United States. Moonlighting was allowed only in 28 (30%) of programs. Our study found that significant variations exist among radiation oncology residency programs in the United States with regards to educational and wellness resources for residents. This study reports the current status of these resources and significant improvements can be made from this baseline.

The Effects of Pass/Fail USMLE Step 1 Scoring on the Otolaryngology Residency Application Process.

To investigate how the decision to report United States Medical Licensing Examination (USMLE) Step 1 score as pass/fail will influence future otolaryngology residency application and match processes. Survey study. An anonymous and voluntary survey approved by the Otolaryngology Program Directors Organization was administered to academic faculty members from April 24, 2020 through May 19, 2020. Two hundred fifty-seven surveys were received from department chairs (17.5%), program directors (24.1%), associate program directors (12.5%), and department faculty (45.9%). USMLE Step 1 has been the most heavily weighted metric for offering interviews (44.0%), and it has correlated with residents' medical knowledge (77.0%) and in-service performance (79.8%) but not with surgical skills (57.6%) or patient care (47.1%). In total, 68.1% disagreed with the decision to make USMLE Step 1 pass/fail. This change is anticipated to lead to an increase in significance of USMLE Step 2 CK (89.1%), core clerkship grades (80.9%), elective rotation at the respective institutions (65.7%), Alpha Omega Alpha and other awards (64.6%), and letters of recommendation (63.8%). The new scoring is also anticipated to especially benefit students from top-ranked schools (70.8%), increase medical students' anxiety/uncertainty regarding obtaining interview invites (59.1%), and negatively affect international (51.4%), doctor of osteopathic medicine (45.9%), and underrepresented students (36.9%). Indication that USMLE Step 2 CK will significantly increase in weight varied according to department position (P = .049), geographic region (P = .047), years of practice (P < .001), and residency program size (P = .002). Most academic otolaryngologists disagreed with changing USMLE Step 1 scoring to pass/fail and believe that it will increase other objective/subjective metrics' weight and put certain student populations at a disadvantage. N/A. Laryngoscope, 131:E738-E743, 2021.

Michigan State University College of Human Medicine.

Michigan State University College of Human Medicine.