First Year Of Residency Training Research Articles

Development and Videographic Evaluation of a Vascular Access Simulation-Based Curriculum for Surgical and Medical Trainees.

There is a paucity of data evaluating femoral arterial access training, despite significant morbidity/mortality associated with incorrect femoral arterial access. The aim of this study was to develop and evaluate a novel 2-component simulation-based curriculum to address a lack of standardized access training and identify the most frequent errors in access. The femoral arterial access curriculum was developed through a multi-disciplinary collaboration and utilized in-person simulation sessions in conjunction with online and in-person didactic training. Access errors and curriculum efficacy were assessed using mixed-methodology evaluation of video recordings of trainee arterial access pre- and postcurriculum. All recordings were reviewed and scored by 2 blinded, independent investigators. Twenty-six participants completed the curriculum with pre- and postcurriculum recordings. Sixteen participants (62%) were in their first year of residency training. Fifteen participants (58%) belonged to general surgery residency, 9 (35%) to emergency medicine, 1 to vascular surgery, and 1 to interventional radiology residency programs. The global rating for the overall ability to obtain femoral arterial access under ultrasound guidance (0 = fail, 4 = excellent) improved following the curriculum (0.87 ± 0.15, 2.79 ± 1.26, P < 0.0001). Fourteen participants (54%) were unable to independently complete the procedure before training, compared to only 2 participants (8%) following the curriculum. Procedural completion time decreased from 7.14 ± 4.26 to 3.81 ± 2.53 minutes (P < 0.001). Most frequent errors, determined through qualitative analysis, included difficulty using the ultrasound and unsafe maneuvers. Before the curriculum, there were significant frequent errors in junior resident femoral arterial access with major patient safety concerns. A novel simulation-based femoral arterial access curriculum resulted in improved procedural skills across all metrics.

Subtyping of Performance Trajectory During Medical School, Medical Internship, and the First Year of Residency in Training Physicians: A Longitudinal Cohort Study.

Developmental trajectories of clinical skills in training physicians vary among tasks and show interindividual differences. This study examined the predictors of medical internship performance and residency entrance and found subtypes of performance trajectory in training physicians. This retrospective cohort study involved 888 training physicians who completed a medical internship between 2015 and 2019. After the internship, 627 physicians applied for residency training between 2016 and 2020. Finally, 160 of them completed their first-year residency in internal medicine, surgery, pediatrics, and psychiatry departments between 2016 and 2020. Pearson's correlation coefficients of internship performance and first year-residency performance (n = 160) were calculated. Latent profile analysis identified performance trajectory subtypes according to medical school grade point average (GPA), internship performance, English proficiency, and residency selection procedures. Multivariate logistic regression models of residency acceptance (n = 627) and performance in the top 30%/lower 10% in the first year of residency were also constructed. Medical internship performance showed a significant positive correlation with the medical school GPA (r = 0.194) and the written score for the medical licensing examination (r = 0.125). Higher scores in the interview (adjusted odds ratio [aOR], 2.57) and written examination (aOR, 1.45) of residency selection procedures and higher medical internship performance (aOR, 1.19) were associated with a higher chance of residency acceptance. The latent profile analyses identified three training physician subgroups: average performance, consistently high performance (top 30%), and adaptation to changes (lowest 10%). Higher scores in the interview for residency selection (aOR, 1.35) and lower scores for medical internship performance (aOR, 0.79) were associated with a higher chance of performing in the top 30% or lowest 10% in the first year of residency, respectively. Performance in the interview and medical internship predicted being among the top 30% and lowest 10% of performers in the first year of residency training, respectively. Individualized educational programs to enhance the prospect of trainees becoming high-functioning physicians are needed.

Racial and Gender Diversity of Physicians Accepted to American Military Orthopaedic and Surgical Residencies: An 18-Year Analysis.

We performed a retrospective cohort study evaluating matriculation into first year of residency training in US military surgical training programs between 2002 and 2020. In total, 9,124 applicants were reviewed. We collected matriculant self-reported race/ethnicity and sex and the medical/specialty program. We considered under-represented minorities as those who reported their race as African American, Indian/Alaskan Native, and Native, other, or who reported ethnicity as Hispanic. We calculated changes in persons accepted to training positions over time and used linear regression to model trends in diversity among orthopaedic matriculating residents when compared with other surgical subspecialities over time. Across all surgical subspecialities, the average change in percent women was 0.94% per year for the study period (p < 0.01). The average annual percent women entering orthopaedic surgery residency programs was 14% for the 18-year study period. Across all surgical subspecialties, the average change for accepted applicants from groups underrepresented in medicine (URiM) was 1.01% per year for the study period (p < 0.01). The average annual percent URiM entering orthopaedic surgery residency programs was 17% for the 18-year study period. The annual change of women and URiM entering military orthopaedic residencies was 0.10% and 1.52%, respectively. Despite statistically significant improvements, recruitment efforts as used to date fall far short of reversing sexual, racial, and ethnic disparities in military orthopaedic residencies. Orthopaedics has a lower representation of both women and physicians with minority backgrounds when compared with many surgical subspecialties. Additional interventions are still necessary to increase diversity for military orthopaedic surgeons.

Features of burnout amongst pathologists: A reassessment

There has been little rigorous assessment of burnout among pathologists and pathology trainees. Given this relative dearth of relevant literature on pathologist burnout, this report aims to raise awareness of the issue among those working in and around this specialty. Our results are based on a survey given in conjunction with the American Board of Pathology's (ABPath) biennial Continuing Certification (CC) reporting of activities required of diplomates to maintain certification. The survey was voluntary, open to all diplomates participating in CC, and conducted over two consecutive years (2019 and 2020), with alternate years comprising different sets of diplomates. The data are based on 1256 respondents (820 from 2019 to 436 from 2020). The three highest aggregate reported rates of burnout (reported as experienced nearly all of the time, most of the time, or part of the time) occurred when respondents were in their first year of residency training (41.1%) and when they were in (47.6%) and beyond (46.6%) their first three years of practice. We considered this high-low-high, or U-shaped distribution in recollected burnout over time among pathologists a notable finding and investigated its distribution among respondents. Conversely at every point in their training and practice, from half to three-quarters of respondents reported never or infrequently experiencing burnout. This study represents the largest pathologist cohort survey to date about pathologists’ burnout. Importantly, especially for those considering pathology as a career, these data are on the low end of the distribution of burnout among specialties for those in practice.

Experiences of Work-Family Conflict and Mental Health Symptoms by Gender Among Physician Parents During the COVID-19 Pandemic

The COVID-19 pandemic has placed increased strain on health care workers and disrupted childcare and schooling arrangements in unprecedented ways. As substantial gender inequalities existed in medicine before the pandemic, physician mothers may be at particular risk for adverse professional and psychological consequences. To assess gender differences in work-family factors and mental health among physician parents during the COVID-19 pandemic. This prospective cohort study included 276 US physicians enrolled in the Intern Health Study since their first year of residency training. Physicians who had participated in the primary study as interns during the 2007 to 2008 and 2008 to 2009 academic years and opted into a secondary longitudinal follow-up study were invited to complete an online survey in August 2018 and August 2020. Work-family experience included 3 single-item questions and the Work and Family Conflict Scale, and mental health symptoms included the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 scale. The primary outcomes were work-to-family and family-to-work conflict and depressive symptoms and anxiety symptoms during August 2020. Depressive symptoms between 2018 (before the COVID-19 pandemic) and 2020 (during the COVID-19 pandemic) were compared by gender. Among 215 physician parents who completed the August 2020 survey, 114 (53.0%) were female and the weighted mean (SD) age was 40.1 (3.57) years. Among physician parents, women were more likely to be responsible for childcare or schooling (24.6% [95% CI, 19.0%-30.2%] vs 0.8% [95% CI, 0.01%-2.1%]; P < .001) and household tasks (31.4% [95% CI, 25.4%-37.4%] vs 7.2% [95% CI, 3.5%-10.9%]; P < .001) during the pandemic compared with men. Women were also more likely than men to work primarily from home (40.9% [95% CI, 35.1%-46.8%] vs 22.0% [95% CI, 17.2%-26.8%]; P < .001) and reduce their work hours (19.4% [95% CI, 14.7%-24.1%] vs 9.4% [95% CI, 6.0%-12.8%]; P = .007). Women experienced greater work-to-family conflict (β = 2.79; 95% CI, 1.00 to 4.59; P = .03), family-to-work conflict (β = 3.09; 95% CI, 1.18-4.99; P = .02), and depressive (β = 1.76; 95% CI, 0.56-2.95; P = .046) and anxiety (β = 2.87; 95% CI, 1.49-4.26; P < .001) symptoms compared with men. We observed a difference between women and men in depressive symptoms during the COVID-19 pandemic (mean [SD] PHQ-9 score: 5.05 [6.64] vs 3.52 [5.75]; P = .009) that was not present before the pandemic (mean [SD] PHQ-9 score: 3.69 [5.26] vs 3.60 [6.30]; P = .86). This study found significant gender disparities in work and family experiences and mental health symptoms among physician parents during the COVID-19 pandemic, which may translate to increased risk for suicide, medical errors, and lower quality of patient care for physician mothers. Institutional and public policy solutions are needed to mitigate the potential adverse consequences for women's careers and well-being.

Depression, quality of life and coping style among Thai doctors before their first year of residency training

ObjectivesDepression and suicide often affect young physicians coping with the demands of residency training. To support effective prevention programmes, we aim to assess depression, quality of life (QoL) and coping...

Training cardiothoracic surgeons of the future: The UK experience

ObjectiveThe study aimed to assess targeted simulation courses, including live animal operating, as complementary training tools with regard to 2 key surgical skills in early cardiothoracic surgeon training. MethodsTwenty UK surgical trainees (equivalent to cardiothoracic surgery resident physicians in the United States) in their first year of residency training were evaluated. Assessment of skills in pulmonary wedge resection and cardiopulmonary bypass were undertaken before and after 2 boot camp-style courses, including live animal operating (boot camp 1 and boot camp 2). Resident performance was evaluated by surgical trainers using objective structured assessment of technical skills matrices. Trainers completed a survey on skill development and trainer confidence in the trainee precourse and postcourse. ResultsTrainee assessment scores pre- and postcourses were analyzed using a 2-tailed Wilcoxon signed-rank test demonstrating a significant improvement in trainee performance in boot camp 1 in performing cardiopulmonary bypass (median score, 21 precourse and 28 postcourse; P = .001) and pulmonary wedge resection (median score, 25 precourse and 32 postcourse; P = .012), and in boot camp 2, in performing cardiopulmonary bypass (median score, 28 precourse and 30.5 postcourse; P = .018) and pulmonary wedge resection (median score, 31.5 precourse and 37 postcourse; P = .018). Trainers reported increased confidence and decision-making competency of residents and increased confidence of trainers to allow more participation in management. It was found that 83.3% of trainers would support trainee attendance in subsequent years. ConclusionsLive animal operating as a component of targeted cardiothoracic surgery skill training courses significantly improves technical skills, builds confidence of surgical trainers in resident physicians’ practice, and should be supported by the surgery community.

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.

Evaluating Validity Evidence for USMLE Step 2 Clinical Skills Data Gathering and Data Interpretation Scores

To add to the small body of validity research addressing whether scores from performance assessments of clinical skills are related to performance in supervised patient settings, the authors examined relationships between United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) data gathering and data interpretation scores and subsequent performance in history taking and physical examination in internal medicine residency training. The sample included 6,306 examinees from 238 internal medicine residency programs who completed Step 2 CS for the first time in 2005 and whose performance ratings from their first year of residency training were available. Hierarchical linear modeling techniques were used to examine the relationships among Step 2 CS data gathering and data interpretation scores and history-taking and physical examination ratings. Step 2 CS data interpretation scores were positively related to both history-taking and physical examination ratings. Step 2 CS data gathering scores were not related to either history-taking or physical examination ratings after other USMLE scores were taken into account. Step 2 CS data interpretation scores provide useful information for predicting subsequent performance in history taking and physical examination in supervised practice and thus provide validity evidence for their intended use as an indication of readiness to enter supervised practice. The results show that there is less evidence to support the usefulness of Step 2 CS data gathering scores. This study provides important information for practitioners interested in Step 2 CS specifically or in performance assessments of medical students' clinical skills more generally.

Clinical skills assessment of procedural and advanced communication skills: performance expectations of residency program directors

Background: High stakes medical licensing programs are planning to augment and adapt current examinations to be relevant for a two-decision point model for licensure: entry into supervised practice and entry into unsupervised practice. Therefore, identifying which skills should be assessed at each decision point is critical for informing examination development, and gathering input from residency program directors is important.Methods: Using data from previously developed surveys and expert panels, a web-delivered survey was distributed to 3,443 residency program directors. For each of the 28 procedural and 18 advanced communication skills, program directors were asked which clinical skills should be assessed, by whom, when, and how. Descriptive statistics were collected, and Intraclass Correlations (ICC) were conducted to determine consistency across different specialties.Results: Among 347 respondents, program directors reported that all advanced communication and some procedural tasks are important to assess. The following procedures were considered ‘important’ or ‘extremely important’ to assess: sterile technique (93.8%), advanced cardiovascular life support (ACLS) (91.1%), basic life support (BLS) (90.0%), interpretation of electrocardiogram (89.4%) and blood gas (88.7%). Program directors reported that most clinical skills should be assessed at the end of the first year of residency (or later) and not before graduation from medical school. A minority were considered important to assess prior to the start of residency training: demonstration of respectfulness (64%), sterile technique (67.2%), BLS (68.9%), ACLS (65.9%) and phlebotomy (63.5%).Discussion: Results from this study support that assessing procedural skills such as cardiac resuscitation, sterile technique, and phlebotomy would be amenable to assessment at the end of medical school, but most procedural and advanced communications skills would be amenable to assessment at the end of the first year of residency training or later.Conclusions: Gathering data from residency program directors provides support for developing new assessment tools in high-stakes licensing examinations.To access the supplementary material to this article please see Supplementary Files under Article Tools online.

Materials employed by medical students preparing for subject examinations: supporting collection development

Medical students in the United States are tested extensively throughout their four years of medical school, including both regular course examinations and standardized tests. The first standardized examination encountered by US medical students is the United States Medical Licensing Examination (USMLE) step one, produced by the National Board of Medical Educators (NBME), taken upon completion of the second year of training. Passing this examination is a significant milestone in the medical school curriculum, as most schools require students to pass before promotion to the third year [1]. The NBME produces not only the USMLE step exams but also produces standardized “subject examinations” [2]. In the United States, the American Association of Medical Colleges' (AAMC) Curriculum Management Information Tool (CurrMIT) database reports that 85% of US medical schools require their students to take subject examinations and pass them as a requirement to complete core clerkships [1]. At the University of Illinois College of Medicine located in Urbana-Champaign, students are required to pass subject examinations at the end of each core clerkship, occurring during the third and fourth years of medical school: family medicine, internal medicine, obstetrics and gynecology, surgery, psychiatry, and pediatrics. The subject examinations also serve in part to prepare students for the capstone examination to graduation and the granting of the medical doctor (MD) degree, the USMLE step two. Standardized examinations do not end with the granting of the MD. Resident physicians undergo a third and final board examination, the USMLE step three, after completion of the first year of residency training. Passing this examination in many states will earn resident physicians their permanent medical license [1]. Even after residency, passing standardized examinations continues to be a responsibility of practicing physicians. Many US hospitals only issue privileges to “board certified” (The American Board of Medical Specialties) physicians. Internists, for example, must pass the American Board of Internal Medicine on a recurring basis to maintain board certification status. Thus, test preparation retains its importance throughout a physician's career.

Management of Inpatient Hyperglycemia: Assessing Perceptions and Barriers to Care Among Resident Physicians

To develop insight into resident physician attitudes about inpatient hyperglycemia and determine perceived barriers to optimal management. As part of a planned educational program, a questionnaire was designed and administered to determine the opinions of residents about the importance of inpatient glucose control, their perceptions about what glucose ranges were desirable, and the problems they encountered when trying to manage hyperglycemia in hospitalized patients. Of 70 resident physicians from various services, 52 completed the survey (mean age, 31 years; 48% men; 37% in first year of residency training). Most respondents indicated that glucose control was "very important" in critically ill and perioperative patients but only "somewhat important" in non-critically ill patients. Most residents indicated that they would target a therapeutic glucose range within the recommended levels in published guidelines. Most residents also said they felt "somewhat comfortable" managing hyperglycemia and hypoglycemia and using subcutaneous insulin therapy, whereas most residents (48%) were "not at all comfortable" with use of intravenous administration of insulin. In general, respondents were not very familiar with existing institutional policies and preprinted order sets relating to glucose management. The most commonly reported barrier to management of inpatient hyperglycemia was lack of knowledge about appropriate insulin regimens and how to use them. Anxiety about hypoglycemia was only the third most frequent concern. Most residents acknowledged the importance of good glucose control in hospitalized patients and chose target glucose ranges consistent with existing guidelines. Lack of knowledge about insulin treatment options was the most commonly cited barrier to ideal management. Educational programs should emphasize inpatient treatment strategies for glycemic control.

Emergency Psychiatry Training and the Decision to Hospitalize

To assess the impact of a 6-month emergency psychiatry training program on emergency psychiatric decision making, we studied 577 emergency psychiatric patient evaluations conducted by 15 first-year psychiatry residents. By their fifth month of training, the residents' rates of emergency patient hospitalization declined from 33% to 19%. For residents in the early training phase, various clinical features, including psychosis, thought disorder, schizophrenic diagnosis, dangerousness, and overall symptoms, were associated with higher rates of patient hospitalization. By the end of training, only dangerousness and overall symptoms remained significantly related to the hospitalization decision. Specific training in emergency psychiatry may affect psychiatric decision-making practices as early as the first year of residency training.

In Search of the "Fundamental Rule" of Supportive Psychotherapy

Early in my first year of residency training in psychiatry, while working between acute-care inpatient units and a busy crisis service, it appeared that virtually every patient was said to have been treated with supportive psychotherapy, in conjunction with psychotropic medication. This appearance was deceiving, and if not for thorough supervision, reading, discussion with faculty and peers, and autocritical review, I might still believe that my earliest, and perhaps sickest, patients were indeed treated with supportive psychotherapy. In retrospect, some were and some were not; the explanation for this discrepancy came with the realization that I did not have very clear ideas about the nature of supportive psychotherapy, its indications and contraindications, its technical practice, its efficacy, or its derivation from psychoanalytic theory. Without this knowledge, I could not practice supportive psychotherapy.

Allegiance to the Corps

IN RESIDENCY training programs around the country, a wave of physicians with obligations to the National Health Service Corps (NHSC) is now cresting. These physicians held NHSC scholarships as medical students, and on completion of residency training approved by the Corps they must begin a period of service equal in years to the length of time that they were supported by the NHSC as medical students. The recipients of the last large batch of NHSC scholarships were freshmen in medical school four years ago and are now in their first year of residency training. The wave of NHSC scholarship students has already passed through the medical schools, and by 1987 it will have passed through most residencies as well. Thereafter, communities that would have trouble attracting physicians without the special inducement of the NHSC service obligation may find themselves medically abandoned. This article proposes a strategy for averting that predictable

Evaluation of a Residency Training Program in Behavioral Pediatrics

The impact of behavioral training upon first-year residents was evaluated by assessing attitudes with regard to 15 clinical "entities," including behavioral disorders, physical disorders, and "mixed" disorders. Each entity was rated at four times: beginning of the year, start of the behavioral rotation, end of the rotation, and end of the year. Multiple-choice questions were also included to assess knowledge regarding behavioral pediatrics. Data were collected from 37 residents, from 1977 to 1980. For behavioral disorders and mixed disorders, residents' self-reported competence increased with regard to diagnosis, management, advising parents, and knowledge of resources. Further, the greatest change occurred during the 2-month rotation. In contrast, change in perceived competence for physical disorders was not specific to the rotation but, rather, increased evenly over the year. Ratings of faculty and housestaff interest remained constant across testing points, and residents' "desire to learn more" and prediction of "future relevance" showed a slight decrease over time, for all disorders. Knowledge regarding behavioral pediatrics increased significantly from the beginning of the year to the start of the rotation, and also during the rotation. These data demonstrate that changes in residents' perceived competence are directly related to their rotation experience, and suggest that behavioral issues can be introduced successfully during the first year of residency training.

681 EVALUATION OF RESIDENCY TRAINING IN BEHAVIORAL PEDIATRICS

The Dept. of Pediatrics established a program in Behavioral Pediatrics, including a two-month required rotation during both the PL-1 and PL-2 years. The impact of this program on first-year residents was evaluated by administering a questionnaire, assessing attitudes with regard to 15 clinical “entities”. These included primarily behavioral disorders (e.g., conversion reaction), primarily physical disorders (e.g., pharyngitis) and “mixed” disorders (e.g., terminal illness). Each entity was rated at four points in time: beginning of the year, start of the behavioral rotation, end of the rotation, and end of the year. Data were collected from 37 residents, from 1977 to 1980. For behavioral disorders emphasized in the rotation, residents demonstrated a statistically significant increase in their self-reported competence with regard to diagnosis, management, advising parents, and knowledge of resources. Further, virtually all change occurred during the 2-month rotation. This was also the case for “mixed” disorders. In contrast, change in perceived competence for physical disorders was not specific to the rotation but, rather, increased evenly over the entire year. Ratings of faculty and housestaff interest remained constant across testing points, and residents' “desire to learn more” and prediction of “future relevance” showed a slight decrease over time (for all types of disorders). These data demonstrate that changes in residents' perceived competence are directly related to their rotation experience, and suggest that behavioral issues can be introduced successfully during the first year of residency training.