Final Year Of Training Research Articles

Assessment of Learning, for Learning: Operationalizing Milestones Data for Program-Level Improvement.

Assessment of Learning, for Learning: Operationalizing Milestones Data for Program-Level Improvement.

Developing Student Teachers’ Reflexivity Toward Their Course Planning: Implementation of a Training Program Focused on Writing and Reflective Skills

Recent literature has shown the low levels of reflexivity student teachers exhibit when doing reflective writing and the lack of a training program in their initial training to help them. A training program that was developed to support future teachers’ reflective writing was implemented and the program’s results were evaluated. The program was based on a combination of theories from the fields of teacher training and writing instruction. The training program was offered to a class of 16 future primary school teachers in French-speaking Belgium (three males and 13 females, averaging 20 years old) who were in their final year of training. They rewrote a reflective text several times and the 64 texts produced were analyzed quantitatively. The results showed that the training program enabled participants to make major progress from one draft to another and thus improve their reflective writing skills. In addition, a qualitative single case study showed how one student’s writing evolved during the training program. Among the practical implications that emerged from this study were the recommendations to include time in the training curricula dedicated to the teaching of reflective writing and to train trainers to support the writing of reflective texts.

Milestone achievements in a national sample of pediatric emergency medicine fellows: impact of primary residency training.

Pediatric emergency medicine (PEM) fellowships recruit trainees from both pediatric and emergency medicine (EM) residencies. The Accreditation Council for Graduate Medical Education (ACGME) defines separate training pathways for each. The 2015 PEM milestones reflect a combination of subcompetencies from the two residencies. This project aims to compare the milestone achievement of PEM fellows based on their primary residency training. We hypothesize that fellows trained in pediatrics achieve PEM milestones at different rates than EM-trained fellows in the ACGME domains of patient care, medical knowledge, systems-based practice, practice-based learning, professionalism, and interpersonal and communication skills. This is a multicenter, retrospective cohort study of fellows from a national sample of U.S. PEM fellowship programs. Basic demographic information and deidentified, biannual milestone scores for 23 competencies were collected for fellows training between 2015 and 2018. Subcompetencies are scored on a 5-point milestone scale. Descriptive and multivariable analyses for longitudinal data were performed to compare milestone assessments by primary residency training. Complete data were obtained for 600 fellows; 95% (570) and 5% (30) completed pediatric and EM residency, respectively. In both year 1 and year 2 of fellowship, the mean milestone scores of EM-trained fellows were statistically higher than pediatrics-trained fellows across the majority of subcompetencies. By the final year of training, there were no statistically significant differences in milestone scores for any of the subcompetencies. Fellow milestone achievement between groups was not significantly different by graduation. However, fellows entering PEM training from an EM background attained higher scores on the milestones than fellows from a pediatric background in the first year of fellowship.

Digital Rectal Examination of Prostrate : Does Examiner's Experience influence the Results ?

There is lack of uniformity in grading the size or assessing the consistency of prostate gland with Digital Rectal Examination (DRE) when done by different clinicians during evaluation of prostate pathology. This study was to compare the results of DRE findings in prostate pathology performed by Urologists at three different levels of clinical practice in the same set of patients and assess the accuracy of the findings with respect to their clinical experience. Materials and Methods: 200 patients with clinical features of prostatomegaly having no documented Urinary Tract Infection were subjected to DRE separately by one Resident in his Final year of training, Junior Consultant (5 years post degree) and Senior Consultant with more than 10 years clinical experience. Their findings were correlated with USG Abdomen estimated volume. Patients with DRE detected hard area in the prostate underwent Trans-rectal tru-cut biopsy of the hard area in the prostate and the biopsy reports were again correlated with the clinical findings. Results: DRE grades assessed by Final year Resident correlated with USG Abdomen estimated volume in 63%, while the same for Junior Consultant was 69% and that for Senior Consultant was 71%. The percentage correlation was better with smaller clinical size of the prostate when the overall DRE assessment of the prostate volume by the three sets of observers was compared to USG Abdomen prostate volume. There was also error in diagnosing abnormal texture of the prostate by Final year Resident in a significant number of patients. Conclusions: There were significant variations in DRE findings of prostate among clinicians, with the accuracy improving with increase in clinician’s experience. DRE findings should always be supplemented with other investigations before a final conclusion regarding the prostate pathology is made.

Analysing the Operative Experience of Paediatric Surgical Trainees in Sub-Saharan Africa Using a Web-Based Logbook

BackgroundThe expansion of local training programmes is crucial to address the shortages of specialist paediatric surgeons across Sub-Saharan Africa. This study assesses whether the current training programme for paediatric surgery at the College of Surgeons of East, Central and Southern Africa (COSECSA) is exposing trainees to adequate numbers and types of surgical procedures, as defined by local and international guidelines.MethodsUsing data from the COSECSA web-based logbook, we retrospectively analysed numbers and types of operations carried out by paediatric surgical trainees at each stage of training between 2015 and 2019, comparing results with indicative case numbers from regional (COSECSA) and international (Joint Commission on Surgical Training) guidelines.ResultsA total of 7,616 paediatric surgical operations were recorded by 15 trainees, at different stages of training, working across five countries in Sub-Saharan Africa. Each trainee recorded a median number of 456 operations (range 56–1111), with operative experience increasing between the first and final year of training. The most commonly recorded operation was inguinal hernia (n = 1051, 13.8%). Trainees performed the majority (n = 5607, 73.6%) of operations recorded in the eLogbook themselves, assisting in the remainder. Trainees exceeded both local and international recommended case numbers for general surgical procedures, with little exposure to sub-specialities.ConclusionsTrainees obtain a wide experience in common and general paediatric surgical procedures, the number of which increases during training. Post-certification may be required for those who wish to sub-specialise. The data from the logbook are useful in identifying individuals who may require additional experience and centres which should be offering increased levels of supervised surgical exposure.

What do speech pathology students gain from virtual patient interviewing? A WHO International Classification of Functioning Disability and Health (ICF) analysis

BackgroundVirtual patients have an established place in medical education but do virtual patient interviews train holistic clinicians or just diagnosticians? This study explored speech pathology students’ virtual patient interviews using...

Teacher Educators’ and Teacher Trainees’ Perspective on Teacher Training for Sustainable Development

Abstract In accordance with Sustainable Development Goal 4 (SDG 4), countries across the globe are striving to ensure equitable access to inclusive, quality and lifelong educational opportunities for all children, youth and adults by 2030. Teacher education has been identified as one of the key factors in the achievement of the SDG 4 targets. As part of the effort to ensure sustainable teacher education for the achievement of SDG 4 in Ghana, this study applied the four key concepts in the SDG 4: quality, equity, inclusion and lifelong learning, to determine the progress with regards to SDG 4 in the context of teacher education in Ghana. The specific objectives of this study were to determine the inclusive pedagogical practices, values, and knowledge that trainees acquire from the Diploma in Basic Education’s Special Education Needs (SEN) course, the adequacy of the course for preparing teachers to create inclusive classrooms and the challenges associated with the delivery of the SEN course. In this study, 167 final-year trainees and 13 teacher educators from Diploma in Basic Education Program in three colleges of education in Ghana were surveyed about their views on the SEN teacher preparation course. The study found out that the SEN course placed much emphasis on medical model view of SEN and only a minority of trainees acquired the requisite inclusive knowledge, values and pedagogical practices. The paper discusses key barriers to the development of inclusive knowledge, pedagogical practices and values among trainees as well as factors that can promote the effective training of inclusive teachers.

Impact of the New McGill Undergraduate Medical Curriculum on Medical Students' Diagnostic Accuracy of Common Dermatoses Encountered in Primary Care.

The McGill Faculty of Medicine implemented a new undergraduate medical curriculum in 2013 with additional preclinical lectures in dermatology. At the time of writing, no Canadian prospective study has been published on undergraduate dermatology training in the context of a complete curricular renewal. Our study was designed to determine the impact of increasing preclinical teaching in dermatology on medical students' diagnostic accuracy and learning retention of common dermatoses encountered in primary care. A standardized questionnaire was administered to the Classes of 2015, 2016, 2017, and 2018 in 6 versions for a total of 6 times over their 4 years of training. Each version featured 10 photographs of common dermatoses encountered in primary care. Students were invited to participate anonymously and on a voluntary basis. A small absolute, but statistically significant difference, of 3% was detected in the fourth and final year of training between the old curriculum (average score = 70%, standard deviation = 15%) and the new curriculum (average score = 73%, standard deviation = 15%), P = .03. Furthermore, the Class of 2018's performance improved year by year over the entire 4 years of the new curriculum. Additional preclinical lectures in dermatology do improve medical students' diagnostic accuracy of common dermatoses encountered in primary care. Furthermore, they do retain their learning throughout the preclinical and clerkship years.

Percutaneous Exposure Incidents in U.S. Obstetrics and Gynecology Residents [12A

INTRODUCTION: To examine the self-reported incidence of percutaneous exposure incidents (PEIs) as well as injury reporting trends among U.S. Obstetrics and Gynecology residents. METHODS: IRB approval was obtained. This voluntary survey was distributed to all ACGME-accredited OB/GYN residency program leadership with instructions to forward to all residents in their programs. The online survey was IRB approved and open for responses from May-June 2019. Descriptive statistics were gathered, and variables were evaluated for significance by chi-square analysis. RESULTS: Among the 441 residents who responded, 355 (81%) reported ever experiencing a PEI. Sharps injuries were sustained by 321 (73%), and mucous membrane exposures (MMEs) were sustained by 255 (58%). By the final year of training, 96% of residents experienced at least one sharps injury, and 71% reported at least one MME. Most residents (258, 72%) did not reported an injury in the past. The most common reasons for not reporting included that the patient was perceived to be at low risk for infection (32%), the process was too cumbersome (24%), or the resident was too busy (12%). CONCLUSION: OBGYN residents experience a high rate of PEIs but infrequently report these injuries. Efforts to prevent PEIs are of utmost importance. Increased reporting of these injuries is needed to optimize post-exposure prophylaxis administration.

Impact of the COVID-19 pandemic on urology residency training in Italy.

In the global emergency scenario caused by COVID-19 pandemic, the Urology residents' training might be critically affected. To provide insights on this issue, a 25-item online Survey was sent to all Italian residents one month after the first case of COVID-19 in Italy, to evaluate their routine involvement in "clinical" (on-call duty, outpatient visits, diagnostic procedures) and "surgical" (endoscopic, open and minimally invasive surgery) training activities before and during the COVID-19 period. Overall, 351 of 577 (60.8%) residents completed the Survey. Before the COVID-19 pandemic, the proportion of residents routinely involved in "clinical" and "surgical" activities ranged from 79.8% to 87.2% and from 49.3% to 73.5%, respectively. In the COVID-19 period, the proportion of residents experiencing a severe reduction (>40%) or complete suppression (>80%) of training exposure ranged between 41.1% and 81.2% for "clinical" activities while between 44.2% and 62.1% for "surgical" activities. This reduction was even more pronounced for residents attending the final year of training. Our study is the first to provide real-life data on how Urology residency training can be impaired during an emergency period. To address this challenge, strategies aiming to increase the use of telemedicine, "smart learning" programs and tele-mentoring of surgical procedures, are warranted.

Socioeconomic Factors Associated With Burnout Among Oncology Trainees.

Burnout in the medical workforce leads to early retirement, absenteeism, career changes, financial losses for medical institutions, and adverse outcomes for patients. Recent literature has explored burnout in different specialties of medicine. This article examines burnout among medical oncology trainees and identifies factors associated with burnout and professional dissatisfaction, including socioeconomic factors. US medical oncology programs were sent a survey that included the Maslach Burnout Index-Human Services Survey as well as demographic, socioeconomic, and program-specific questions tailored to medical oncology fellowship. Primary binary end points included burnout, satisfaction with being a physician, and satisfaction with being a medical oncologist. Binomial logistic models determined associations between various characteristics and end points. Overall, 261 US fellows completed the survey. Seventy percent of international medical graduates reported no educational debt, whereas only 36% of US graduates reported no educational debt. Eighty-two percent of survey respondents reported their mother had at least a bachelor's degree, and 87% of respondents reported their father had at least a bachelor's degree. At least 27% of respondents had symptoms of burnout. Factors inversely associated with burnout on multivariable analysis included having a mother who graduated college (odds ratio [OR], 0.27), reporting an adequate perceived balance between work and personal life (OR, 0.22), feeling that faculty care about educational success (OR, 0.16), and being in the final year of training (OR, 0.45). Having debt ≥ $150,000 (OR, 2.14) was directly associated with burnout. Symptoms of burnout are common among medical oncology fellows and are associated with educational debt and socioeconomic factors.

Trainee Operative Autonomy in Plastic Surgery.

Appropriate, progressive trainee autonomy is critical for training competent plastic surgeons who are adequately prepared to enter independent practice. Evaluation and reporting of meaningful operative autonomy among trainees in plastic surgery are understudied. Parallel survey instruments were developed using the Zwisch metric for progressive operative autonomy and distributed electronically to trainees and faculties in all accredited training programs. Trainees were queried about their operative autonomy in 17 core plastic surgery procedures, associated approach to logging cases, and perceived readiness to enter practice. Faculties provided assessment of their final-year trainees using the same metrics. Trainees in 28 programs and faculties in 35 programs participated. Final-year trainees reported the most operative independence with breast tissue expander reconstruction and carpal tunnel release and the least with facelift and rhinoplasty. A mean of 40% of final-year trainees reached supervision only autonomy in the procedures queried; none achieved this with rhinoplasty. Faculties identified the highest final-year trainee operative autonomy with botulinum toxin injection and burn excision and grafting; the least trainee independence was reported with rhinoplasty, cleft lip repair, and facelift. Faculty perception of final-year trainee autonomy was higher than that of trainees for 82% of procedures queried. Although plastic surgery trainees endorse gradual operative autonomy overall, a majority of final-year trainees do not perceive supervision only independence in the majority of core procedures queried. Faculties perceive higher trainee operative autonomy than trainees for most procedures. Discordant approaches to case logging were identified both among trainees and between trainees and faculties. Standardization may improve both progression and assessment of operative autonomy in plastic surgery training.

Determinants of student nurses’ self-assessed TB/HIV coinfection care skill-competence in Accra, Ghana

BackgroundGraduating student nurses as the future workforce are expected to possess the requisite skill-competence to care for TB/HIV coinfected patients. However, few studies have investigated the self-assessed TB/HIV coinfection care skill-competence of graduating student nurses and its determinants in Accra, Ghana. PurposeThis study investigated final year student nurses’ self-assessed TB/HIV coinfection care skill-competence and its determinants. MethodsThis was a descriptive cross-sectional survey among Bachelor of Science in nursing (n = 112) and Diploma in nursing (n = 236) students in their final year of training in four (4) nursing training institutions using convenience sampling technique. Descriptive, independent t and Kruskal Wallis mean rank statistical tests were conducted to identify determinants. ResultsTB/HIV coinfection care skill-competencies were low. Determinants of TB/HIV coinfection care skill-competence were age (r = 0.110, p = .048), duration of managing patients (r = 0.219, p = .005) and ownership of nursing training institution (p = .005). Other factors included student nurses’ previous experience working in a TB health facility (p < .001), previous experience managing TB/HIV coinfection patients (p = .001), students’ level of education (p = .026), speciality in nursing (p = .013) as well as awareness of the World Health Organization’s taskshifting guidelines for HIV care (p < .001). ConclusionsStudent nurses still have skill-competence gaps in TB/HIV coinfection care. They may not be fully skilled to independently deliver health services to TB/HIV coinfected patients per World Health Organization taskshifting guidelines. Additional training and supervision prior to deployment is required.

Maintaining the knowledge and neonatal resuscitation skills of student midwives 6 months after an educational program

BackgroundTraining student midwives in neonatal resuscitation is essential because the midwife is present at every birth and must be able to perform resuscitation procedures when needed. The objective of this study was to evaluate student midwives’ retention of theoretical knowledge about resuscitation as well as their practical application of that knowledge 6 months after training. MethodA cross-sectional study was conducted for two consecutive years, 2015 and 2016, among 49 student midwives in the middle of their second and final year of training at the University of Applied Sciences in Western Switzerland. The study included assessments of both theoretical knowledge and practical skills regarding neonatal resuscitation 6 months after each participant had completed the training program. The students’ theoretical knowledge was evaluated using a multiple-choice question (MCQ) test, the results of which were compared with results from the same MCQ test that had been obtained 6 months earlier. The students’ practical skills were evaluated following a simulation workshop by analyzing recorded videos and applying scores using an adapted validated grid. ResultsThe MCQ pretest and MCQ posttest (after 6 months) scores showed no statistically significant difference (z=−1.583, P=0.113). In terms of the practical skills assessment, 25% of the students (11/44) were considered insufficiently skilled for the table preparation. During the simulation, 22 teams of students were available for analysis. Of these, 11 teams (50.0%) were considered insufficiently skilled. The skills observation findings showed an integration of technical gestures for the majority of the teams, but the items demonstrated a lack of organization and management. ConclusionNeonatal resuscitation training for student midwives shows that their theoretical knowledge seems to be well assimilated while practical skills are unevenly retained. Certain elements, as indicated by the detail of the analysis grid, need to be reinforced by additional workshops before the end of the training.

Interprofessional training for the delivery of community health services in Mexico: the experience of Partners in Health

ABSTRACTInterprofessional training in health is scarce in Mexico. Partners in Health (CES in Spanish), is the branch of an international civil society organization that provides health services to poor and rural populations. CES runs a set of ten health centers in Chiapas, Mexico, in partnership with the local Ministry of Health. A key component of the provision strategy is to train healthcare providers, mainly medical and nursing students in their final year of training, to create healthcare teams that work together while fostering their individual capacities. CES offers a diploma on Global Health and Social Medicine, where medical and nursing students -also called pasantes- interact to discuss jointly the effects of global and social determinants of health in local communities, as well as specific clinical topics. A qualitative study including interviews and nonparticipant observations was undertaken to identify initial achievements and challenges of the experience. CES has achieved important benefits related to teamwork as well as clinical capacities of individuals as healthcare providers. However, challenges have emerged: differences in social origin, personal development expectations, professional identity and institutional roles hinder team cohesion. Consequently, CES has introduced adjustments to reduce the negative impact of these differences. Although the training model needs further development, the possibility of transferring some of its good practices to non-CES scenarios should be seriously considered by health authorities.

Does a Structured Formative Feedback System Improve Learner Perception of the Obstetrics and Gynecology Clerkship? [16H

INTRODUCTION: Medical students are more likely to pursue specialty training in fields they perceived positively during their training. This can be influenced by their satisfaction with feedback during a rotation. We investigated whether a structured formative feedback system would improve learner perception of the Obstetrics and Gynecology clerkship. METHODS: This observational cohort study included medical students from the Class of 2017 (control cohort) and 2018 (intervention cohort). Institutional ethics board approval was obtained. A formative feedback system was implemented during Obstetrics and Gynecology rotations for the Class of 2018. It consisted of a set of electronic forms asking for strengths and requirements for improvement in the student's assessment of a patient with a particular presenting complaint. Students were invited to complete a survey about their overall rotation experience during their final year of training using Likert Scales. The primary outcome was the proportion of students who reported a positive experience during their rotation. Chi-squared analysis was used to compare the proportion of positive responses between each group. RESULTS: 190/286 (66.4%) students responded to the survey. 72/103 (70.6%) and 65/87 (74.7%) students reported a positive experience on their rotation (good, very good or excellent) in the control and intervention cohorts, respectively (P=.5). 27/83 (31.0%) of students felt the system positively influenced the rotation. CONCLUSION: Implementation of this structured formative feedback system did not improve learner perception of the rotation. Further research is needed to determine if mechanisms that ensure students receive specific and actionable feedback would affect this outcome during an Obstetrics and Gynecology rotation.

Douglas John Pearce

Douglas John Pearce was diagnosed with tuberculosis in his final year of training and had to take a year off for treatment. Before this he had been playing in the...

Pharmaceutical Care in Children: Self-reported knowledge, attitudes and competency of final-year pharmacy students in Jordan.

Pharmacists require a baseline level of knowledge in paediatric pharmaceutical care in order to be able to adequately care for paediatric patients and counsel their families. This study aimed to explore the self-reported knowledge, attitudes and competency of final-year pharmacy students in Jordan regarding paediatric pharmaceutical care. This study took place in Jordan between November 2016 and May 2017. A 28-item questionnaire was designed and administered to 400 students from all pharmacy programmes in Jordan during their final year of training. A total of 354 students agreed to take part in the study (response rate: 88.5%). Most respondents (95.2%) were aware of the term 'paediatrics'. However, almost one-third of the respondents (30.5%) reported never having taken paediatric dose calculation courses and more than half (55.6%) were unfamiliar with the term 'off-label medicines'. Moreover, most respondents (65.1%) had low knowledge scores (≤2 out of 5) when presented with realistic paediatric case scenarios. There were no significant differences in knowledge and attitudes between undergraduate and doctoral students or between those from public or private universities (P >0.05). The findings of this study highlight an alarming deficiency in paediatric pharmaceutical knowledge among final-year pharmacy students in Jordan. As such, paediatric-related content should be emphasised in the pharmacy curricula of Jordanian universities so that pharmacy students receive more formalised education and more extensive training in this area.

Shape of Training Review: an impact assessment for UK gastroenterology trainees

BackgroundPhysician training in the UK is undergoing considerable change due to the implementation of recommendations made in the Shape of Training Review. In particular, higher specialty training (HST), including gastroenterology,...

The Increasing Burden of StandardizedTesting: Going Overboard.

I am a third-year general cardiology fellow beginning my final year of training. As I plan my year, a constant stress of multiple board certification examinations looms in the distance. Although board certification is not technically mandatory, it is often used by hospitals, insurance companies, and