Expansion Of Residency Programs Research Articles

Characteristics of Hospitals by Graduate Medical Education Expense Category: Implications for Rural Residency Program Expansion.

To describe how the characteristics of the hospitals and communities they serve vary across the 4 hospital graduate medical education (GME) expense categories (according to Section 131 of the Consolidated Appropriations Act of 2021) and identify the rurally located never claimer hospitals that are most similar to teaching hospitals, signaling that they might be good candidates for new rural GME programs. Hospital categories and characteristics were gathered from the March 2022 Medicare Cost Reports; 2022 County Health Rankings & Roadmaps data were used for community characteristics. Each acute hospital was classified into 1 of the following 4 mutually exclusive hospital categories: category A, category B, established teaching hospital (ETH), and never claimer. Multinomial logistic regressions were conducted to estimate the adjusted associations of hospital characteristics with hospital categories and to identify the never claimer hospitals in rural locations that have characteristics similar to teaching hospitals (category A, category B, and ETHs). Out of 3,590 hospitals, 2,075 (57.8%) were never claimer hospitals. After adjusting for multiple characteristics, rural hospitals had a similar probability of being in each hospital category to that of urban hospitals. Never claimer hospitals served an older population and were located in communities with more uninsured adults and children and less availability of primary care physicians, dentists, and mental health professionals. This study demonstrated that most hospitals in every category, but especially teaching hospitals (i.e., category A hospitals, category B hospitals, and ETHs), were concentrated in urban areas. Larger hospitals (measured by net patient revenue) were more likely to report GME expenses (i.e., be a category A hospital, a category B hospital, or an ETH). The study suggests that there are roughly 145 rural never claimer hospitals that might be strong candidates for initiating new residency programs.

The 2022 and 2023 Emergency Medicine Residency Match: A Cautionary Tale.

Introduction The emergency medicine (EM) match has undergone significant shifts in 2022 and 2023. While variation in specialty fill rates is expected over time, EM programs noted a significant increase in open positions starting in 2022. Utilizing National Resident Matching Program (NRMP) data over a 10-year period, we identified significant deviations in the emergency medicine match. Methods Shewhart control charts were used to plot the match results over time. A 10-year sample was used to establish the baseline value. From this value, the upper and lower control limits were established. Residency program expansion, decreasing applicant numbers, and changing applicant types were evaluated to detect any non-random changes to the process. Results While the number of EM PGY-1 positions added over time was within the expected range, both the number of unmatched positions and the change in the number of total US MD applicants were outside of this range and are considered to be "out of control." Conclusion It is not yet clear which contributing causes may underlie this sudden change. Several potential etiologies exist, including mismatches in supply and demand for positions, changes in perceptions of the specialty, the effects of COVID-19, and changing workforce needs. Historically similar experiences affecting other specialties, including anesthesia and radiation oncology, are analyzed. Potential solutions for returning to the necessary and usual success of the emergency medicine specialty match are explored.

Residents as a valuable asset: the financial benefits of residency program expansion

Residents as a valuable asset: the financial benefits of residency program expansion

Geographic Distribution of Otolaryngology Training Programs and Potential Opportunities for Strategic Program Growth.

To characterize the geographic distribution of US otolaryngology residents based on geographical population density to determine current status and identify potential opportunities for otolaryngology residency program expansion. The locoregional population of otolaryngology residency programs was analyzed (as defined by the US Census) and the number of resident trainees per 100,000 people in each region was calculated. Otolaryngology residency program location was determined by mailing address, and program size was determined by AAMC public data. The average metropolitan city in the United States contained 2.07 otolaryngology trainees per 100,000 people. Cities with low trainee numbers per population included Phoenix, AZ (0.20 trainees per 100,000 people); Las Vegas, NV (0.26 per 100,000); Dallas, TX (0.26 per 100,000), Atlanta, GA (0.33 per 100,000); and Miami, FL (0.34 per 100,000). Comparing otolaryngology to other surgical subspecialties demonstrated similar distributions. Metropolitan centers with a population over 1 million without full academic representation in otolaryngology were also identified and included Charlotte, NC; Orlando, FL; Austin, TX; Providence, RI; Jacksonville, FL; Raleigh, NC; and Grand Rapids, MI. Strategic residency training program expansion should be considered in cities that exhibit a low trainee to population ratio. Although many factors ultimately determine program expansion or development of new training programs, this study provides substantiated population data describing where expansion could be prioritized. NA Laryngoscope, 133:1600-1605, 2023.

Impact of Expansion of PGY1 Pharmacy Residency Program From 2 to 4 Residents

Purpose: To evaluate the benefits of postgraduate year 1 (PGY1) pharmacy residency program expansion on clinical outcomes, pharmacy services, educational outreach, costs, and preceptor time at a community teaching hospital. Methods: During academic years 2014 to 2016, two PGY1 resident positions existed, expanding to four PGY1 resident positions during 2016 to 2018. Quantitative analyses comparing the aforementioned periods evaluated clinical interventions, adverse drug events prevented, community and hospital educational programs provided, departmental costs, and documented preceptor hours as a result of program growth. The outcomes were assessed using descriptive statistics. Results: The mean number of documented clinical interventions completed by the resident classes with two residents was 2906 when compared to 5324 with four residents. The mean number of prevented adverse drug events was 56 during the years with two residents and 220 in the years with four residents. The number of community outreach programs increased from 2 to 18 per year. The number of resident lectures provided to allied health professionals increased from 11 to 16 sessions per year. The net economic impact associated with two residents in 2014 was +$4661 USD, while in 2017 the net impact was −$5262 USD. The mean preceptor hours spent per year related to residency activities with two residents was 1005 hours compared to 1109.5 hours with four residents. Conclusion: Through strategic modification, expansion of the PGY1 residency program led to increased documentation of clinical interventions, prevented adverse drug events, and educational programs provided with minimal change in preceptor burden.

Nurse Residency Program Expansion to Ambulatory Care Areas.

Nurse Residency Program Expansion to Ambulatory Care Areas.

Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the Wright Center for Graduate Medical Education teaching health center curriculum experience.

Purpose. The effect of patient centered medical home (PCMH) curriculum interventions on residents’ self-reported and demonstrated knowledge, skills and attitudes in PCMH competency arenas (KSA) is lacking in the literature. This study aimed to assess the impact of PCMH curricular innovations on the KSA of Internal Medicine residents.Methods. Twenty four (24) Internal Medicine residents—12 Traditional (TR) track residents and 12 Teaching Health Center (THC) track residents—began training in Academic Year (AY) 2011 at the Wright Center for Graduate Medical Education (WCGME). They were followed through AY2013, covering three years of training. PCMH curricular innovations were focally applied July 2011 until May 2012 to THC residents. These curricular innovations were spread program-wide in May 2012. Semi-annual, validated PCMH Clinician Assessments assessing KSA were started in AY2011 and were completed by all residents.Results. Mean KSA scores of TR residents were similar to those of THC residents at baseline for all PCMH competencies. In May 2012, mean scores of THC residents were significantly higher than TR residents for most KSA. After program-wide implementation of PCMH innovations, mean scores of TR residents for all KSA improved and most became equalized to those of THC residents. Globally improved KSA scores of THC and TR residents were maintained through May 2014, with the majority of improvements above baseline and reaching statistical significance.Conclusions. PCMH curricular innovations inspired by Health Resources and Services Administration (HRSA’s) Teaching Health Center funded residency program expansion quickly and consistently improved the KSA of Internal Medicine residents.

Resources used to support postgraduate year 1 pharmacy residencies: Survey of residency program directors

The results of a survey to identify personnel time, funding, and other resources used to support existing postgraduate year 1 (PGY1) pharmacy residencies and to determine potential residency program expansion are reported. An electronic survey was distributed to PGY1 residency program directors (RPDs). Respondents were asked to provide demographic information and to characterize resources used to support their training programs. The survey response rate was 62%, representing 493 respondents. About 21% indicated their formal job descriptions identified them as a PGY1 RPD, and 8% replied that time expectations to perform the residency functions were specified. Up to 69% of respondents estimated that the time spent performing residency functions was 5-16 hours weekly. Other personnel who facilitated pharmacy residency logistics included administrative assistants, coordinators, and pharmacists, devoting approximately 1-8 hours weekly to the residency program. Half of respondents indicated their PGY1 programs received funding through the Centers for Medicare and Medicaid Services (CMS) pass-through reimbursement; 30% were not eligible, 11% had not considered such reimbursement due to the amount of work required, and 9% did not know if their sites received such funding. A survey of PGY1 RPDs collected a wide range of information about the resources used to support their programs and about future plans. Almost half of respondents anticipated expanding their PGY1 residency program capacity, and responses made it clear that adequate documentation was important for programs applying for CMS pass-through reimbursement and facing an audit.

Perspective

Orthopaedic research has advanced tremendously in parallel with accelerated progress in medical science. Possession of a fundamental understanding of basic and clinical science has become more essential than previously for orthopaedic surgeons to be able to translate advances in research into clinical practice. The number of medical graduates with prior education in scientific research who choose to pursue careers in orthopaedic surgery is small. Therefore, it is important that a core of research education be included during residency training to ensure the continued advancement of the clinical practice of orthopaedics. The authors examine some of the challenges to a comprehensive research experience during residency, including deficient priority, inadequate institutional infrastructure, financial strain on residency budgets, restricted time, and an insufficient number of mentors to encourage and guide residents to become clinician-scientists. They also present some strategies to overcome these challenges, including development and expansion of residency programs with clinician-scientist pathways, promotion of financial sources, and enhancement of opportunities for residents to interact with mentors who can serve as role models. Successful integration of research education into residency programs will stimulate future orthopaedic surgeons to develop the critical skills to lead musculoskeletal research, comprehend related discoveries, and translate them into patient care. Lessons learned from incorporating research training within orthopaedic residency programs will have broad application across medical specialties-in both primary and subspecialty patient care.

The Promise of Family Medicine: History, Leadership, and the Age of Aquarius

Family medicine began as a revolutionary movement with courageous leaders who had a compelling vision for the new specialty. Next came a growth era with the expansion of residency programs, medical school departments and community practices; organizationally adept, businesslike people managed family

Is there a doctor in the house? Comparing attendings, residents, and midlevel providers to increase clinician staffing in an academic emergency department: A cost-efficiency analysis

Study objectives: We developed a software-based model to determine the most cost-efficient way to provide incremental clinician staffing in an academic emergency department. Given the government's limits on graduate medical education funding, expansion of residency programs may need to be funded by the sponsoring institution. This study was designed to determine which combination of attending physicians working with residents or midlevel providers was most economical. Methods: A decision tree model using the Tree Age (Williamstown, MA) software package was created to compare the cost-effectiveness of different staffing configurations. It allows an emergency department (ED) administrator to vary the parameters in accordance to their specific productivities and costs and to determine the robustness of the conclusions. The productivity (patients/hour), salary, and working-hour data of different staffing configurations was determined using data from our ED, reported national attending and resident productivity data, and assumptions based on clinician experience. Salary plus benefits for attending physicians is $205,000 a year, for midlevel providers $95,000 a year, and for residents $54,000 a year. Attending physician productivity alone was assumed to be 2 patients per hour; each additional resident or midlevel providers was assumed to add smaller net productivity gains (first adds 0.75 patient/hour, second adds 0.5 patient/hour, third adds 0.25 patient/hour). Resident and midlevel providers productivity were assumed to be equivalent. Job satisfaction and quality of care were not factored into the model. Results: The base cost of an attending physician alone is approximately $68.15 per patient. The cost decreases when they are paired with 1 or 2 residents or 1 midlevel provider. When they are supervising 3 residents or 2 or more midlevel providers, the costs per patient increase (Table). The results are robust as long as attending physician productivity alone is less than 2.5 patients per hour at any physician salary range and, for midlevel provider productivities, up to 20% greater than that of residents. Resident productivity must increase by 30% to change the best model. Conclusion: According to our model, the most cost-efficient staffing configurations in an academic ED are those pairing each attending physician with residents. Substituting midlevel providers for residents in any staffing configuration increased the overall cost per patient. The model allows for the outcomes to vary according to parameters specific to other institutions.Table, abstract 56Cost efficiency results.Base Case Cost/pt, $MD Salary $180,000, $MLP Productivity+20%, $Resident Productivity+30%, $MD alone68.1559.8468.1568.15MD + 1 R64.3358.2864.3358.97MD + 2 R66.9261.8166.9254.38MD + 3 R68.8369.0073.7551.62MD + 1 MLP67.9460.3666.2567.94MD + 2 MLP73.0467.9268.8073.04MD + 3 MLP76.7777.5175.7676.77MD + 1 R + 1 MLP69.9864.8767.8964.98MD + 2 R + 1 MLP71.4871.8374.4667.01MD + 1 R + 2 MLPs74.1274.6775.1374.12 pt, Patient; MD, physician; MLP, midlevel provider; R, resident.

The need to educate primary care physicians to provide oncologic services: a changing focus.

The traditional role of primary care physicians (PCPs) in cancer care has been primarily cancer detection, and their training and education were similarly oriented. Propelled by the changing health care delivery system, this role is now expanding substantially. A survey of 31 health maintenance organizations active in the New York market area was performed. The HMOs were grouped into three main categories according to method of payment of the physician. Patient care responsibilities vary depending on the method of payment but stay constant within the group. Of 19 HMOs that responded to the survey, 13 had shifted much of the responsibilities for diagnosis and treatment decisions to the PCP. A national survey of all academic radiation oncology program directors in the United States, as well as training programs of primary care physicians, showed a unanimous lack of educational or training programs or opportunities to familiarize the PCP with radiation oncology as a therapeutic discipline and with its after-therapy requirements. This deficiency extended also to multimodality training and other aspects. The internal medicine programs surveyed scored only an average of 1.25 out of a possible 5 in education areas directly related to oncology training. These programs comprised 78% of the residents of all programs surveyed. The information gathered from these surveys reveals a shift towards mandating the provision of oncologic services by PCPs, who have inadequate training in oncology, with no system in place to remedy the deficiencies except on-the-job training. The inevitability of the changing role of the PCP must be accompanied by either an expansion of residency programs to encompass training in important aspects of oncology care or expansion and formalization of continuing education programs to achieve the same objective.