First-year Resident Physicians Research Articles

Posttraumatic Stress Disorder Symptoms Among First-Year Resident Physicians Working Before and During the COVID-19 Pandemic

This cohort study investigates differences in posttraumatic stress disorder (PTSD) symptoms among first-year resident physicians training before and during the first wave of the COVID-19 pandemic (March to June 2020).

Barriers to Disclosure of Disability and Request for Accommodations Among First-Year Resident Physicians in the US

Ensuring access to accommodations is critical for resident physicians and their patients. Studies show that a large proportion of medical trainees with disabilities do not request needed accommodations; however, drivers of nonrequests are unknown. To assess the frequency of accommodation requests among first-year resident physicians (ie, interns) with disabilities and to identify possible drivers of nonrequest for needed accommodations. As part of the Intern Health Study, a longitudinal cohort study of first-year resident physicians, residents at 86 surgical and nonsurgical residency programs in 64 US institutions provided demographic and training characteristics 2 months prior to matriculation (April-May 2021). At the end of their intern year (June 2022), participants completed a new survey with questions about disability-related information, including disability status, disability type, whether they received accommodations, and if not, reasons for nonaccommodation. Poststratification and attrition weights were used to estimate the frequency of accommodation requests and reasons for not requesting accommodations. Interns reporting at least 1 disability were included in the analysis. Prevalence of reported disabilities, residency specialties distribution, frequency of accommodation requests, and reasons for nonaccommodation among resident physicians with disabilities. Among the 1486 resident physicians who completed the baseline survey, 799 (53.8%) replied to the disability questions. Of those, 94 interns (11.8%; weighted number, 173 [11.9%]) reported at least 1 disability and were included in the present study (weighted numbers, 91 [52.6%] men, 82 [47.4%] women, mean [SD] age, 28.6 [3.0] years). Among interns with reported disability and need for accommodations (83 of 173 [48.0%]), more than half (42 [50.6%]) did not request them. The most frequently reported reasons for not requesting needed accommodations were fear of stigma or bias (25 [59.5%]), lack of a clear institutional process for requesting accommodations (10 [23.8%]), and lack of documentation (5 [11.9%]). Program directors should investigate cultural and structural factors within their programs that contribute to an environment where residents do not feel safe or supported in disclosing disability and requesting accommodation and review their disability policies for clarity.

Perceived Access and Appropriateness: Comparison of Teaching and Resident Family Physicians' Patients.

Teaching clinics aim to provide patients with care that is comprehensive, high quality, and timely. Since resident presence at the clinic is irregular, timely access to care and continuity remain challenging. The two main objectives of our study were to compare the experience of timely access by patients of family residents vs staff and to determine if there was a difference between resident and staff patients in reported appropriateness and patient-centeredness of the visit. This cross-sectional survey study was carried out in nine family medicine teaching clinics part of University of Montreal and McGill University Family Medicine Networks. Patients self-administered two anonymous questionnaires, before and after their consultation. We collected 1,979 preconsultation questionnaires. Teaching physician (staff) patients rated the usual wait time for an appointment as very good or excellent more frequently than resident patients (46% vs 35 %; P=.001). One out of five reported consulting another clinic in the last 12 months. Resident patients consulted elsewhere more often. In postconsultation questionnaires staff patients rated their visit experience better than resident physician patients and patients of second-year residents better than first-year residents. Although patients generally have a positive perception of access to care and adequacy of the consultations meet their needs, staff also face the challenge of providing better access to their patients. Finally, we found the patients' perceived visit-based patient centeredness was higher for visits of second-year than first-year resident physicians, supporting the impact of training efforts toward patient-centered best practices.

National improvements in resident physician-reported patient safety after limiting first-year resident physicians’ extended duration work shifts: a pooled analysis of prospective cohort studies

BackgroundThe Accreditation Council for Graduate Medical Education (ACGME) enacted a policy in 2011 that restricted first-year resident physicians in the USA to work no more than 16 consecutive hours. This...

Focused Assessment with Sonography for Trauma (FAST) training for first-year resident physicians at a university hospital in Japan: A longitudinal, observational study.

Background:Ultrasound training is an essential part of residency programs during emergency medicine rotations for first-year trainees (postgraduate year 1). The Focused Assessment with Sonography for Trauma examination used to assess for internal bleeding in trauma patients is one of the essential skills postgraduate year 1 residents must acquire during the emergency medicine rotation.Method:A prospective, longitudinal, observational study of postgraduate year 1 residents during a 2-month long emergency medicine rotation conducted from 1 April 2019 to 31 May 2021. The primary outcome was the mean difference between the hands-on Focused Assessment with Sonography for Trauma examination scores of the first week of the emergency medicine rotation and the same hands-on Focused Assessment with Sonography for Trauma examination scores of the last week of the emergency medicine rotation. All postgraduate year 1 residents had open access to the ultrasound machine to practice examining on other postgraduate year 1 residents or could use it on real patients under supervision of emergency medicine physicians.Result:A total of 91 postgraduate year 1 residents (65 male and 26 female) were recruited and submitted to the hands-on Focused Assessment with Sonography for Trauma test in both the first and last weeks of the rotation. The mean test score for the postgraduate year 1 residents in the first week was 7.81 (standard deviation = 2.11). The mean test score in the last week was 16.17 (standard deviation = 2.60). The primary outcome of this study was the score difference between the first and last weeks (mean = 8.35, 95% confidence interval = 7.73 to 8.94, p < 0.001, paired t-test).Conclusion:Hands-on practical Focused Assessment with Sonography for Trauma training for postgraduate year 1 residents during emergency medicine rotations significantly improved their Focused Assessment with Sonography for Trauma test scores.

A Nurse Shadowing Program for Physicians: Bridging the Gap in Understanding Nursing Roles.

A physician-nurse shadow program was established to improve interdisciplinary collaboration. Ineffective communication between physicians and nurses leads to poor outcomes in patient satisfaction, safety, and associate engagement. Physician unfamiliarity of the nursing process is identified as a root cause. First-year resident physicians shadowed nurses for a 4-hour shift. Residents did not function as a physician during the shadowing experience but participated in nursing workflow and tasks. Participants completed a Likert-scale rating and qualitative survey before and after the shift. The survey measured confidence in communication and perception of workflow. Confidence levels increased in all areas by 29% for residents and 34% for nurses. Data demonstrated improved physician understanding of nursing workflow and inspired recommendations to enhance communication. First-year resident physicians practiced direct communication skills and experienced hands-on nursing care during the shadow program. The initiative provided an environment for mutual learning and interdisciplinary relationship-building.

The Association Between Resident Physician Work-Hour Regulations and Physician Safety and Health

BackgroundIn 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted a 16-h limit on consecutive hours for first-year resident physicians. We sought to examine the effect of these work-hour regulations on physician safety. MethodsAll medical students matched to a US residency program from 2002 to 2007 and 2014 to 2017 were invited to participate in prospective cohort studies. Each month participants reported hours of work, extended duration shifts, and adverse safety outcomes, including motor vehicle crashes, percutaneous injuries, and attentional failures. The incidence of each outcome was compared before and after the 2011 ACGME work-hour limit. Hypotheses were tested using generalized linear models adjusted for potential confounders. ResultsOf all first-year resident physicians nationwide, 13% participated in the study, with 80,266 monthly reports completed by 15,276 first-year resident physicians. Following implementation of the 16-h 2011 ACGME work-hour limit, the mean number of extended duration (≥24-h) shifts per month decreased from 3.9 to 0.2. The risk of motor vehicle crash decreased 24% (relative risk [RR] 0.76; 0.67-0.85), percutaneous injury risk decreased more than 40% (relative risk 0.54; 0.48-0.61), and the rate of attentional failures was reduced 18% (incidence rate ratio [IRR] 0.82; 0.78-0.86). Extended duration shifts and prolonged weekly work hours were associated with an increased risk of adverse safety outcomes independent of cohort. ConclusionsThe 2011 ACGME work-hour limit was associated with meaningful improvements in physician safety and health. Surveillance is needed to monitor the ongoing impact of work hours on physician safety, health, and well-being.

The Saudi Medical Licensure Examination-Clinical Skills (SMLE-CS): A Call for Implementation.

The Saudi Commission for Heath Specialties (SCFHS) was founded in 1992 to nationally regulate healthcare-related practices and accreditation. Specifically, SCFHS is the official organization that principally oversees the postgraduate residency training programs (RTPs). A crucial aim of SCFHS is to warrant that medical graduates, prior to their enrollment into RTPs as first-year resident physicians, have national minimum entry standards of learning competencies to practice safe and effective healthcare. Generally, there are three primary domains of learning competencies that should be assessed, namely: theoretical clinical knowledge, practical clinical skills and professional attitudes. SCFHS primarily evaluates the theoretical clinical knowledge of applicants through the administration of the Saudi Medical Licensure Examination (SMLE) and we call on SCFHS to rename the conventional SMLE to SMLE-Clinical Knowledge (CK), or shortly abbreviated as SMLE-CK. On the other hand, to date, there is no examination administered by the SCFHS that assesses the applicants' competencies of practical clinical skills and professional attitudes prior to admission to RTPs. Herein, we call on SCFHS to formally incorporate a mandatory national practical licensure examination. The suggested name is the SMLE-Clinical Skills (CS), or shortly abbreviated as SMLE-CS. The purpose, structure, content, rationale, potential counteractive views and future research directions regarding the SMLE-CS are presented. This proposal is not limited to Saudi Arabia only, and it may be contemplated by the other countries, too.

Brief (

The Accreditation Council for Graduate Medical Education (ACGME) recently reinstated extended-duration (24-28 hr) work shifts (EDWS) for postgraduate year 1 (PGY-1) resident physicians. This study examined the relationship between overnight sleep duration during EDWS and subsequent "post-call" performance in PGY-1 resident physicians. Thirty-four PGY-1 resident physicians (23 males; 24-32 years) were studied between 2002 and 2004 during 3-week Q3 "on-call" rotation schedules in the Medical and Cardiac Intensive Care Units at Brigham and Women's Hospital in Boston. Daily sleep logs (validated by ambulatory polysomnography) were collected and the 10 min psychomotor vigilance task (PVT) was administered every ~6 hr during each EDWS. Generalized estimating equations were used to examine the relationship between overnight sleep duration and PVT performance "post-call" (0500-1900 hr). Postcall performance during EDWS was compared with sessions matched for time-of-day and weeks-into-schedule in the same resident physician during an intervention schedule that eliminated EDWS. Resident physicians obtained an average of 1.6 ± 1.5 hr cumulative sleep overnight during EDWS (<4 hr on 92% of nights). PVT attentional failures were significantly reduced only after >4 hr sleep (p = 0.027 versus no sleep). Despite this apparent improvement, the odds of incurring >1 attentional failure were 2.72 times higher during postcall following >4 hr sleep compared with matched sessions during non-EDWS. Even with >4 hr sleep overnight (8% of EDWS), performance remained significantly impaired. These findings suggest that even "strategic napping," a recommendation recently removed from ACGME guidelines, is insufficient to mitigate severe performance impairment introduced by extending duty beyond 16 hr.

Resident physicians’ attitudes and confidence in communicating with patients: A pilot study at a Japanese university hospital

ObjectiveThis study aimed to explore the relationships among physicians’ confidence in conducting medical interviews, their attitudes toward the patient–physician relationship, and undergraduate training in communication skills among resident physicians in Japan. MethodsParticipants were 63 first-year resident physicians at a university hospital in Tokyo. The Physician Confidence in the Medical Interview scale (PCMI) was constructed based on the framework of the Calgary–Cambridge Guide. Additionally, participants’ attitudes toward the patient–physician relationship (Patient–Practitioner Orientation Scale; PPOS), undergraduate experience of communication skills training, and demographic characteristics were assessed through a self-reported questionnaire. ResultsThe internal consistency of the PCMI and PPOS scales were adequate. As expected from the undergraduate curriculum for medical interviews in Japan, residents had relatively higher confidence in their communication skills with respect to gathering information and building the relationship, whereas less confident about sharing information and planning treatment. The PCMI was associated with a more patient-centered attitude as measured by the PPOS. ConclusionThese scales could be useful tools to measure physicians’ confidence and attitudes in communicating with patients and to explore their changes through medical education. Practice implicationsResidency programs should consider including systematic training and assessment in communication skills related to sharing information and planning treatment.

Participation of International Medical Graduates in Graduate Medical Education and Hospital Care for the Poor

To determine the impact of limiting international medical graduate (IMG) participation in US graduate medical education (GME) on the delivery of hospital care to the poor. To ascertain the pattern of IMG participation in GME and the degree to which the principal teaching hospitals with programs with large IMG enrollments provide care to the poor, we used data from the American Medical Association 1993 Annual Survey of Graduate Medical Education Programs and Teaching Institutions to analyze the pattern of IMG participation in GME in the six core specialties of internal medicine, family practice, obstetrics and gynecology, surgery, pediatrics, and psychiatry. Programs were identified as IMG dependent if at least 50% of the resident physicians enrolled in the first year of the program were IMGs. All programs were linked to their principal teaching hospitals, and hospitals were assessed according to the number of programs based at each institution, the number of IMG-dependent programs at the institution, and whether no-pay patients and/or Medicaid/public assistance beneficiaries constituted more than 20% of the patients served. Of the 20,170 first-year resident physicians in the six core specialties, 31.8% were IMGs. The proportion of programs dependent on IMG enrollment was 27.7%, ranging from 5.2% in obstetrics and gynecology programs to 49.5% in psychiatry programs. About 72% of all first-year IMGs were in IMG-dependent programs. Of the 688 hospitals serving as principal teaching sites for programs in at least one of the six core specialties, 106 were categorized as dependent on IMG programs, but only 77 of those provided a disproportionate amount of care to the poor. Finally, 40% of the IMG-dependent GME programs and 36% of first-year IMG residents were based in hospitals that did not provide a disproportionate amount of care to the poor. Based on this analysis, 77 hospitals can arguably be considered dependent on IMG resident physicians to provide care to the poor. Moreover, a large number of IMG residents and IMG-dependent programs are in hospitals that do not provide a disproportionate amount of care to the poor. These findings show the scale of the problem policymakers must address if they choose to limit IMG access to GME while maintaining access of the poor to needed hospital care.

A Validity Study of Part III of the National Board Examination

The purpose of this study was to investigate the validity of Part III of the National Board Examination, a certifying examination of medical knowledge and patient management abilities. The subjects were 1,866 first-year resident physicians who graduated from Jefferson Medical College between 1970 and 1984. Statistically significant correlations were found between scores on this examination on the one hand and measures of basic and clinical sciences in medical school and Parts I and II of the National Board Examination on the other hand. Also, graduates who were rated high on supervisors' ratings of clinical competence areas in residency obtained higher scores on the examination than those rated low on this scale even when their baseline knowledge (scores on Part II) was controlled by employing analysis of covariance. In addition, assumptions were made that graduates who were offered further residency training and those who pursued broader, less-specialized careers would score higher on this examination. Both assumptions were confirmed. This 15-year study not only provides unique information about the validity of one certifying examination, but it also presents a model that might be used to evaluate other certification tests. Improvements in validity produced by new testing methods, such as computerized administration, could be put into perspective by using similar validity studies.

Career paths of first-year resident physicians: a seven-year study.

Much policy formulation and research on physician manpower supply and demand are based upon historical data on physicians or on medical students' attitudes toward career choices and expectations about future career plans. Neither of these sources provides the kind of information about specialty and location choices or recent graduates that planner require to design and evaluate effective policy. In order to obtain information on career decisions of young physicians, all 1968 first-year resident physicians were identified and their career were followed through the seven-year period from 1968 through 1975. The career decisions of this cohort were compared with the activity, specialty, and geographic distribution of all physicians in 1975 in an attempt to discern changes, or trends, in these decisions. Results of this evaluation indicate that young physicians are attracted to nonprimary-care specialties in greater numbers than were physicians in the past and are continuing the trend away from rural practice locations. Increasing numbers of women physicians are affecting these trends, and changes in the sex-composition of the physician stock must be taken into account in future forecasting efforts and in policy formulation activity.