First Year Of Postgraduate Training Research Articles

Multi-source feedback following simulated resuscitation scenarios: a qualitative study.

BackgroundThe direct observation and assessment of learners’ resuscitation skills by an attending physician is challenging due to the unpredictable and time-sensitive nature of these events. Multisource feedback (MSF) may address this challenge and improve the quality of assessments provided to learners. We aimed to describe the similarities and differences in the assessment rationale of attending physicians, registered nurses, and resident peers in the context of a simulation-based resuscitation curriculum.MethodsWe conducted a qualitative content analysis of narrative MSF of medical residents in their first postgraduate year of training who were participating in a simulation-based resuscitation course at two Canadian institutions. Assessments included an entrustment score and narrative comments from attending physicians, registered nurses, and resident peers in addition to self-assessment. Narrative comments were transcribed and analyzed thematically using a constant comparative method.ResultsAll 87 residents (100%) participating in the 2017-2018 course provided consent. A total of 223 assessments were included in our analysis. Four themes emerged from the narrative data: 1) Communication, 2) Leadership, 3) Demeanor, and 4) Medical Expert. Relative to other assessor groups, feedback from nurses focused on patient-centred care and communication while attending physicians focused on the medical expert theme. Peer feedback was the most positive. Self-assessments included comments within each of the four themes.ConclusionsIn the context of a simulation-based resuscitation curriculum, MSF provided learners with different perspectives in their narrative assessment rationale and may offer a more holistic assessment of resuscitation skills within a competency-based medical education (CBME) program of assessment.

The early experience of doctors training in pediatrics: patient safety culture and the role and influence of the registrar.

Postgraduate medical training incorporates education, both formal and informal, combined with clinical service. This study explored the early training experience of pediatricians in Ireland and its potential impact on patient safety. We sought to identify factors that contribute to the patient safety experience of new entrant pediatric trainees. Trainees, or senior house officers (SHOs), in their first year of postgraduate training, participated in an interview conducted using a critical interview technique (CIT). They described an adverse event where the medical care delivered to the patient was not ideal. Thematic analysis identified themes that influenced the described event. Thirteen trainees participated in the interviews. This study identified influences on the relationship between the SHO and patient safety, including the SHO themselves, teamwork and communication. Colleagues within the workplace, including consultants, registrars, and nurses, also affect this relationship. The registrar is described as a central figure holding an active role in clinical care in 11 of the 13 stories told. In the participants' experience, the registrar was the senior decision-maker, teacher, team builder, and communication intermediary within the teams' hierarchical structure. The registrars' previous clinical experience, communication style, along with their ability to supervise and provide feedback shaped the SHO experience. Through a process designed to focus on exploring patient safety, it emerged that the registrar plays a crucial role in the working experience of their junior colleagues. The influence of the registrar needs to be recognized within clinical teams and by postgraduate training bodies.

Are We Meeting the Demand for Pharmacist-Led Antimicrobial Stewardship Programs during Postgraduate Training-Year 1 (PGY1)?

In the United States of America, pharmacists play a pivotal role in antimicrobial stewardship; training from postgraduate residency may hone knowledge and skills gained from didactic pharmacy education. Specifically, the first year of postgraduate training, the learner may become an “everyday steward in training” and may go on to complete a second year in infectious diseases. However, there are a limited number of second year infectious diseases programs. The current demand for pharmacist to participate in and or lead stewardship is disproportionate to available specialized training. The first year of post-graduate training has to be setup to ensure appropriate preparation, so newly trained pharmacist may help meet the demand. Currently, no clear standards exist for training in the first year. The purpose of this study is to survey the nature of stewardship training performed by first year residents from the perspective of residency program directors and preceptors. A 13-question online survey was distributed to examine resident exposure to antimicrobial stewardship activities. Survey data from targeted residency directors and preceptors were analyzed. A third of the programs required it as a mandatory rotation. Resident’s stewardship activities ranged from program to program; there was not consensus of the training activities.

A mixed-methods examination of the nature and frequency of medical error among junior doctors

Purpose of the studyTo examine junior doctors’ experience and perceptions of medical errors in which they had been involved.Study designA mixed-methods design, consisting of an error survey and critical incident...

Defining Endodontic Residents' Clinical Experiences: A National Survey.

Endodontic residency programs across the U.S. vary in the exposure they provide to residents in procedures, protocols, and equipment. Having information on the range of clinical experiences provided in programs would be useful for program directors and for applicants who are seeking the best fit for their residency. The aim of this study was to collect information from residents in U.S. endodontic residency programs about the procedures and equipment they experienced in their programs. In January 2018, a 14-question survey was emailed to all 437 endodontic residents with an email address in the 2016-17 American Association of Endodontists Membership Directory. Survey items asked about the number of endodontic procedures, techniques employed, and products used in residents' programs. A total of 133 endodontic residents responded to all or part of the survey, for a 30% response rate. The majority reported completing 151-250 nonsurgical root canals, 26-50 nonsurgical retreatments, 0-10 surgical retreatments, and 0-10 regenerative endodontic procedures during their residencies. All respondents said they used a surgical operating microscope (SOM), and 82% reported using a multi-file rotary system for nonsurgical procedures. Respondents reported that the main instruments they used were Dentsply Sirona file systems, and the most commonly used obturation technique was warm vertical compaction/condensation, reported by 92% of respondents. These endodontic residents reported being exposed to a variety of procedures, products, and protocols during their residency. Based on information they provided, prospective endodontic residency applicants can expect to use the SOM for treatment, to gain extensive experience in primary nonsurgical endodontic treatment, and to not perform endodontic surgery during their first year of postgraduate training.

Development of a Web-based Curriculum to Prepare Diagnostic Radiology Residents during Post-Graduate Year 1 by Promoting Learning via Spaced Repetition and Interim Testing: If You Build It, Will They Come?

The purpose of this pilot project was to determine the feasibility of creating a single web-based resource to allow independent study for pre-radiology interns during their first post-graduate year of training, and to measure intern use of and satisfaction with this resource. A web-based curriculum, based on the principles of spaced learning and interim testing, was created and housed on an institutional learning management system. The curriculum consisted of narrated, interactive learning modules, electronic flashcards, and quizzes. We monitored the use of this curriculum by six pre-radiology interns. Surveys were completed to assess resident satisfaction. 73% of the total learning modules were completed. Of the completed modules, 90% were completed in either the first or the last three months of the study. The total hours spent reviewing the flashcards during the entire study period ranged from <1 to 7 hours. 67% of the quizzes were completed. Survey results showed that the learners perceived the course as a useful resource and reported high satisfaction with the curriculum. Creating a web-based curriculum capable of monitoring intern use is feasible. There was variable use of the different components of the curriculum with clear clustering of use at the beginning and end of the study period. The users perceived the course as a useful resource and reported high satisfaction with the curriculum.

Evaluation of Resident Confidence Performing Entrustable Professional Activities During the First Year of Residency Training

Background: Entrustable Professional Activities (EPAs) for medical students were designed to help prepare students for the clinical roles of residency training. To date, there have been no published studies examining resident confidence performing the EPAs across the first year of post-graduate training.&#x0D; Objective: To examine self-reported confidence levels of first-year residents performing the 13 activities included in the Core Entrustable Professional Activities for Entering Residency.&#x0D; Methods: Entering allopathic and osteopathic residents from seven residency programs were contacted at the start, and after 3, 6, and 12 months of training to complete an electronic survey self-assessing confidence performing EPAs.&#x0D; Results: All 46 (100%) eligible residents completed surveys at the four study time points for the 13 EPAs, which resulted in 2,392 data points. Residents reported a high level of confidence performing four EPAs (i.e., 1, 5, 6, and 9) at baseline. Conversely, more than two-thirds of residents reported a lack of confidence performing four EPAs (i.e., 4, 8, 12, and 13) at baseline. A significant positive trend in confidence from baseline to 12 months was seen in almost all EPAs. However, more than 10% of residents reported not being confident performing EPAs 12 and 13 at twelve months.&#x0D; Conclusions: Results revealed not all residents reported being confident performing EPAs at the beginning and end of the first year of training. Medical schools need to examine preparation of graduating students in the EPA areas. Residency programs need to assess entering resident competency to determine the need for increased initial supervision and remediation.&#x0D; &#x0D; Funding/Support: None&#x0D; Ethical approval: The study received approval from the Human Subjects Committee of UnityPoint Health – Des Moines.&#x0D; Conflict of Interest: The authors declare they have no competing interests.

Prevalence, Nature, Severity and Risk Factors for Prescribing Errors in Hospital Inpatients: Prospective Study in 20 UK Hospitals.

IntroductionIt has been suggested that doctors in their first year of post-graduate training make a disproportionate number of prescribing errors.ObjectiveThis study aimed to compare the prevalence of prescribing errors made by first-year post-graduate doctors with that of errors by senior doctors and non-medical prescribers and to investigate the predictors of potentially serious prescribing errors.MethodsPharmacists in 20 hospitals over 7 prospectively selected days collected data on the number of medication orders checked, the grade of prescriber and details of any prescribing errors. Logistic regression models (adjusted for clustering by hospital) identified factors predicting the likelihood of prescribing erroneously and the severity of prescribing errors.ResultsPharmacists reviewed 26,019 patients and 124,260 medication orders; 11,235 prescribing errors were detected in 10,986 orders. The mean error rate was 8.8 % (95 % confidence interval [CI] 8.6–9.1) errors per 100 medication orders. Rates of errors for all doctors in training were significantly higher than rates for medical consultants. Doctors who were 1 year (odds ratio [OR] 2.13; 95 % CI 1.80–2.52) or 2 years in training (OR 2.23; 95 % CI 1.89–2.65) were more than twice as likely to prescribe erroneously. Prescribing errors were 70 % (OR 1.70; 95 % CI 1.61–1.80) more likely to occur at the time of hospital admission than when medication orders were issued during the hospital stay. No significant differences in severity of error were observed between grades of prescriber. Potentially serious errors were more likely to be associated with prescriptions for parenteral administration, especially for cardiovascular or endocrine disorders.ConclusionThe problem of prescribing errors in hospitals is substantial and not solely a problem of the most junior medical prescribers, particularly for those errors most likely to cause significant patient harm. Interventions are needed to target these high-risk errors by all grades of staff and hence improve patient safety.Electronic supplementary materialThe online version of this article (doi:10.1007/s40264-015-0320-x) contains supplementary material, which is available to authorized users.

Views of UK-trained medical graduates of 1999–2009 about their first postgraduate year of training: national surveys

BackgroundIn the UK, doctors’ first year of medical work is also their first year of postgraduate training. It is very important that their experience of work and training is good.DesignSurveys...

Fundamental Skills for Entering Neurosurgery Residents: Report of a Pacific Region “Boot Camp” Pilot Course, 2009

Incorporation of the first postgraduate year of training into neurological surgery residencies in 2009 posed new challenges to neurosurgical educators. A "boot camp" course was held in August 2009 to introduce first year neurosurgical trainees to various fundamental cognitive and practical skills. The effectiveness of this course was evaluated by electronic survey of all trainees and faculty members. Eighteen trainees entering 5 western neurosurgical residencies (in either the first or second postgraduate year) participated in a course taught by 10 faculty members at a single host institution (Oregon Health & Science University) for 2 days. All trainees completed an online survey evaluating the relevance and quality of each didactic and hands-on course component and answered additional questions about the goals and design of the course. Faculty members were also surveyed. All trainees thought the course met its goals, provided relevant and useful information and experience, and was likely to improve patient care. In particular, hands-on procedural and operative course components were highly valued. A fundamental skills boot camp course for first year neurosurgical trainees seems valuable.

Initial Airway Management Skills of Senior Residents: Simulation Training Compared With Traditional Training

Scenario-based training (SBT) with a computerized patient simulator (CPS) is effective in teaching physicians to manage high-risk, low-frequency events that are typical of critical care medicine. This study compares the initial airway management skills of a group of senior internal medicine residents trained using SBT with CPS during their first year of postgraduate training (PGY) with a group of senior internal medicine residents trained using the traditional experiential method. This was a prospective, controlled trial that compared two groups of PGY3 internal medicine residents at an urban teaching hospital. One group (n = 32) received training in initial airway management skills using SBT with CPS in their PGY1 (ie, the simulation-trained [ST] group). The second group (n = 30) received traditional residency training (ie, the traditionally trained [TT] group). Each group was then tested during PGY3 in initial airway management skills using a standardized respiratory arrest scenario. The ST group performed significantly better than the TT group in 8 of the 11 steps of the respiratory arrest scenario. Notable differences were found in the ability to attach a bag-valve mask (BVM) to high-flow oxygen (ST group, 69%; TT group, 17%; p < 0.001), correct insertion of oral airway (ST group, 88%; TT group, 20%; p < 0.001), and achieving an effective BVM seal (ST group, 97%; TT group, 20%; p < 0.001). Traditional training consisting of 2 years of clinical experience was not sufficient to achieve proficiency in initial airway management skills, mostly due to inadequate equipment usage. This suggests that SBT with CPS is more effective in training medical residents than the traditional experiential method.

Extended Work Duration and the Risk of Self-reported Percutaneous Injuries in Interns

In their first year of postgraduate training, interns commonly work shifts that are longer than 24 hours. Extended-duration work shifts are associated with increased risks of automobile crash, particularly during a commute from work. Interns may be at risk for other occupation-related injuries. To assess the relationship between extended work duration and rates of percutaneous injuries in a diverse population of interns in the United States. National prospective cohort study of 2737 of the estimated 18,447 interns in US postgraduate residency programs from July 2002 through May 2003. Each month, comprehensive Web-based surveys that asked about work schedules and the occurrence of percutaneous injuries in the previous month were sent to all participants. Case-crossover within-subjects analyses were performed. Comparisons of rates of percutaneous injuries during day work (6:30 am to 5:30 pm) after working overnight (extended work) vs day work that was not preceded by working overnight (nonextended work). We also compared injuries during the nighttime (11:30 pm to 7:30 am) vs the daytime (7:30 am to 3:30 pm). From a total of 17,003 monthly surveys, 498 percutaneous injuries were reported (0.029/intern-month). In 448 injuries, at least 1 contributing factor was reported. Lapse in concentration and fatigue were the 2 most commonly reported contributing factors (64% and 31% of injuries, respectively). Percutaneous injuries were more frequent during extended work compared with nonextended work (1.31/1000 opportunities vs 0.76/1000 opportunities, respectively; odds ratio [OR], 1.61; 95% confidence interval [CI], 1.46-1.78). Extended work injuries occurred after a mean of 29.1 consecutive work hours; nonextended work injuries occurred after a mean of 6.1 consecutive work hours. Injuries were more frequent during the nighttime than during the daytime (1.48/1000 opportunities vs 0.70/1000 opportunities, respectively; OR, 2.04; 95% CI, 1.98-2.11). Extended work duration and night work were associated with an increased risk of percutaneous injuries in this study population of physicians during their first year of clinical training.

Specialized pediatric residency programs

Specialized residencies provide focused instruction in various areas of pharmacy practice. They are designed to follow a general pharmacy practice residency and build on the skills developed in the first year of postgraduate training. Practice sites encourage, and often require, residents to complete a general pharmacy residency before enrolling in a specialized residency. Much like general pharmacy practice residencies, specialized residencies are yearlong commitments of intensive training, with a much more specific scope of practice. At this time, ASHP-accredited specialized residencies and unaccredited residencies are not required to participate in the ASHP Resident Matching Program that is required of general pharmacy residency programs. Pediatric pharmacists have in-depth knowledge of drug pharmacokinetics and pharmacodynamics in a wide range of patients, from premature neonates to young adults. Pediatric pharmacists must account for changes in the absorption, distribution, metabolism, and elimination of medications, all of which depend on the child’s stage of organ development.1 Because many pediatric patients often receive medications for “off-label” use,2 the pediatric pharmacist must make clinical decisions based on the developmental status of the pediatric patient, while keeping in mind the basic pharmacology of medications.

New doctors' perceptions of their educational development during their first year of postgraduate training

The General Medical Council (GMC) in the UK describes a wide range of competences in which the new medical graduate should develop during the first postgraduate year. New graduates are known as pre-registration house officers (PRHOs). In this study, semi-structured open interviews with PRHOs approaching the end of their first postgraduate year were used to explore the trainees' perceptions of their development.After the interview their views on the importance given in their experience to the GMC's competences were explored though a questionnaire. Most noticeable from the interview data was the PRHOs'emphasis in the development of generic skills required of working in the ‘real world’—skills such as communication, team working and the ability to cope with responsibility. In some outcomes, their noticeable progression, e.g. communication, or lack of progression, e.g. health promotion, reflected their views on the importance given.With other outcomes there was a paradox, e.g. practical skills were rated highly but were not noticeably developed; the role of the doctor was noticeably developed but was not highly rated.Overall the PRHOs developed most strongly in the ‘professionalism’ domain with not all the skills in the ‘tasks’ domain being similarly developed. This study helps to define the benefits and opportunities of the PRHO year, as currently perceived by the trainees, and should be of interest to those involved in the planning and delivery of postgraduate training.

The relationship between assessment measures at Newcastle Medical School (Australia) and performance ratings during internship.

This study examined the utility of the domain assessment measures used in the final 2 years at Newcastle medical school in predicting performance ratings in the first year of postgraduate training (internship). Performance ratings were obtained from the clinical supervisors of two graduating classes of the University of Newcastle medical students during their five terms of internship. Three or more ratings were obtained from 57% of interns. Univariate analysis indicated that scores for three of the five domains (professional skills; identification, prevention and management of illness; self-directed learning) were significantly positively correlated with intern performance ratings. Multivariate analysis indicated that only the domain assessing identification, prevention and management of illness was predictive of higher intern performance ratings. The results support the notion that there is some value in the domain assessment model used at Newcastle in predicting the performance of junior doctors.

Objectives to direct the training of emergency medicine residents in in-patient pediatrics

This article outlines the objectives for a resident rotation in an in-patient pediatric service. The objectives can be successfully implemented in a 2-month sequential exposure to an in-patient ward service followed by an intensive care unit rotation in the first year of postgraduate training. These objectives are a part of a continuing series in the goals and objectives to direct emergency medicine resident training on off-service rotations.

Income expectations of first-year students at Jefferson Medical College as a predictor of family practice specialty choice.

The recent decline in the number of medical students choosing careers in the primary care specialties has engendered increasing concern that economic factors are becoming more important in influencing the career choices of medical students. In order to assess the relationship of first-year medical students' income expectations to whether they chose to specialize in family practice, the authors analyzed data from 532 graduates of Jefferson Medical College (classes of 1987-1989), using the Jefferson Longitudinal Study. At entrance to medical school, each student listed his or her initial specialty preference and future expected peak income; the determination of actual specialty choice was based on the first year of postgraduate training. Both expected peak incomes and freshman specialty choices were independent predictors of actual specialty choices. The students who entered family practice residencies had lower initial expected peak incomes than did the students entering other specialties, especially the surgery specialties. In addition, according to logistic regression analysis, the students with relatively lower income expectations and a freshman preference for family practice were predicted to be nine times more likely to enter family practice residencies than were students with higher income expectations and no initial family practice preference (56% versus 6%). This study suggests that a freshman's income expectation is an important predictor of family practice specialty choice, independent of age, sex, degree of indebtedness, and initial specialty preference. The authors discuss their results in light of the decline in the number of medical students choosing family practice and the other primary care specialties.

Results of the second Clinical Skills Assessment Examination of the ECFMG.

To test the hypothesis that the clinical skills of many foreign medical graduates entering residencies in the United States are deficient, the Educational Commission for Foreign Medical Graduates (ECFMG) administered a second, more extensive pilot examination called the Clinical Skills Assessment Examination. The test was constructed after identifying those clinical skills considered to be suitable for testing in a large-scale examination conducted at multiple locations. The test was given to 635 foreign medical graduates (including 53 U.S. citizens) who had been certified by the ECFMG and to a reference sample of 123 graduates of U.S. medical schools. All of the graduates took the test prior to their first postgraduate year of training. The results did not differ significantly from those of a previous test. The clinical skills of 28% of the graduates of foreign medical schools who took the examination were found to be inadequate when compared with those of graduates of U.S. schools. The conclusion reached was that a clinical skills examination is feasible for inclusion in the ECFMG certification process.

Prevalence of depression and distress in a large sample of Canadian residents, interns, and fellows.

Using data from 1,805 interns, residents, and fellows in Ontario, Canada, the authors report the prevalence of symptoms measured by the Center for Epidemiologic Studies Depression Scale (CES-D). They found that the proportion of subjects scoring as depressed was somewhat higher than that found in community studies. Women had higher depression scores than men. The proportion of unmarried house staff with moderate or severe depression scores was higher than that of married house staff. Considerable differences were found by specialty, and depression was most prevalent in the first year of postgraduate training. These findings have implications for those who direct postgraduate medical training or who seek to alleviate unnecessary stress in the postgraduate education experience.

An assessment of priority and educational value in a medical curriculum.

A randomly selected group of teachers, students, first-year graduates (junior doctors in the first year of postgraduate training after their final medical school examination), general practitioners and specialists responded to a postal questionnaire designed to assess their views on the priorities in medical curriculum and the educational value attributed to its content. Comparisons were made among the five participating groups and the outcome of the assessment was compared with the existing curriculum.