Graduate Medical Education Community Research Articles

Vascular In-person for Students In the match Trial: An investigation of postinterview site visits to address the limitations of virtual interviews

PurposeThe graduate medical education community implemented virtual residency interviews in response to travel restrictions during the COVID-19 pandemic, and this approach has persisted. Although many residency applicants wish to visit in-person prospective training sites, such opportunities could bias programs toward those who are able to meet this financial burden, exacerbating equity concerns. One proposed solution is to offer applicants the opportunity to visit only after a program’s rank list is “locked,” avoiding favoritism to applicants who visit, but allowing applicants to experience some of the camaraderie, geography, and local effects of an in-person visit. As debate about the optimal format of residency interviews continues, it is important to investigate whether in-person program visits, completed after program rank list certification, provide meaningful benefits to applicants in the residency match process. MethodsAll vascular programs entering the 2023 integrated vascular surgery residency match were invited to participate. Programs agreed to certify their National Resident Matching Program rank lists by February 1, 2023. Applicants then had the opportunity to visit the programs at which they interviewed. The particulars of the visit were determined by the individual programs. Applicants completed their standard rank list and locked on the standard date: March 1, 2023. Applicants then completed a survey regarding the impact of the visits on their rank order list decision-making. Program directors (PDs) completed a survey regarding their experiences as well. Data were collected using REDCap. ResultsTwenty-one of the 74 (28%) programs participated. Nineteen PDs completed the postinterview site visit survey (response rate 90%). Applicants interviewing at the participating programs (n = 112) were informed of the study, offered the opportunity to attend postinterview site visits, and received the survey. Forty-seven applicants responded (response rate 42%). Eighty-six percent of applicants stated that the visit impacted their rank list. Most important factors were esprit de corps of the program (86%), the faculty/trainees/staff (81%), and the physical setting (62%). Seventy-one percent of those participating spent ≤$800 on their visit. Eighty-one percent were satisfied with the process. Twenty-one percent of PDs would have changed their rank list if they could have based on the applicants’ in-person visit. Sixty-three percent of the visit sessions cost the programs ≤$500, and 63% were satisfied with the process. ConclusionsThis study is the first to document the impact of in-person site visits by applicants on a graduate medical education match process in one specialty. Our results suggest that this process provides meaningful data to applicants that helped them with their decision-making evidenced by most altering their rank lists, while avoiding some of the critical equity issues that accompany traditional in-person interviews. This may provide a model for future interview processes for residency programs.

FOSTERING COMMUNITY ENGAGEMENT TO ADDRESS RACISM: DEVELOPMENT AND IMPLEMENTATION OF A SERVICE-LEARNING CURRICULUM FOR PEDIATRIC RESIDENTS.

In recent years, there has been a call for Academic Health Centers to increase community engagement to address racism. 1 Blanchard A.K. Blanchard J.C. Suah A. et al. Reflect and reset: Black academic voices call the graduate medical education community to action. Acad Med. 2022; 97: 967-972 Crossref PubMed Scopus (6) Google Scholar Alongside didactic education and building a diverse learning environment, community engagement allows trainees to better understand the structural underpinnings of inequities and better recognize their own biases to create a framework for how to improve care for marginalized populations. 2 Khazanchi R. Keeler H. Strong S. et al. Building structural competency through community engagement. Clin Teach. 2021; 18: 535-541 Crossref PubMed Scopus (8) Google Scholar Community-based service learning (CBSL), a teaching strategy that combines community service with “explicit learning objectives, preparation, and reflection,” 3 Seifer S.D. Hermanns K. Lewis J. Creating community-responsive physicians: Concepts and models for service-learning in medical education. American Association for Higher Education, 2000〈https://files.eric.ed.gov/fulltext/ED449734.pdf〉 Google Scholar is one methodology that can be used to give participants the opportunity to engage with the local community while also learning about the context in which the service is provided.

A Visiting Rotation for Underrepresented in Medicine Pediatric Residents Is Valuable for Recruitment Into Pediatric Fellowships

To truly build an equitable health care system, we need a diverse physician workforce that reflects the demographics of the general population. Diversity improves clinical care outcomes, improves patient satisfaction, and is associated with improved treatment adherence when patients are treated by race-concordant physicians. Additionally, Black, Indigenous, and Hispanic/Latinx physicians are more likely to focus their care efforts on the most vulnerable patient populations in the United States.1 A sense of urgency has developed as recent trends show a decreasing proportion of underrepresented in medicine (UIM) pediatric subspecialty fellows.2,3 The drivers causing this workforce issue have not been fully identified, with limited exposure to subspecialty experiences as a potential contributor. Increasing the numbers of UIM physicians requires deliberate action by academic institutions to recruit and support UIM applicants across various medical subspecialties.The Promoting Resident Experiences in the Subspecialties at Stanford (PRESS) program is a 4-week funded and mentored pediatric subspecialty rotation for UIM residents who will be applying for subspecialty fellowship in the next year. PRESS was created with the following goals: (1) to increase recruitment of UIM trainees into pediatric subspecialty fellowships and academic medicine; (2) to improve inclusion, belonging, and career development of the next generation of UIM subspecialists through coaching and mentoring; and (3) to enhance our learning community by increasing the diversity among our trainees and institution, both during the rotation and afterward. Visiting residents self-select a subspecialty experience, are assigned a faculty mentor and a fellow mentor within the division, and are invited to events within the division, the department, and the larger graduate medical education community. They receive individualized mentorship and coaching on creating a CV and personal statement as well as strategies to increase success in the fellowship application process. Each resident receives funding to cover travel and living expenses during the rotation.Our inaugural cohort consisted of 5 residents. Our residents identified as African American/Black, Hispanic/Latinx, Asian, and North African, and hailed from 4 different states. Our second cohort will include 7 residents (37% acceptance rate), identifying as African American/Black, Hispanic/Latinx, and Southeast Asian, coming from 4 different states.A survey of the first cohort determined that all residents (100%) found the program to be valuable, offering a unique experience and a network of colleagues in and out of their chosen subspecialty. All residents stated that participation in the PRESS program encouraged them to apply to our institution when they would not have otherwise. All residents found the mentorship and individualized coaching helpful. One resident remarked: “It was an absolutely invaluable experience and nothing I probably would have gotten to experience on my own. The support and mentorship was great and I loved the desire for change. I would love for other UIM to experience medicine at an elite center…and I've already recommended that several people I know apply for next year.”Program leadership and residents cited the program as an effective recruiting tool, and leaders felt the PRESS program allowed them to consider applicants that they might not have otherwise. As one fellowship leader highlighted, there is the benefit of “participating in developing opportunities for exposure/recruitment of UIM trainees, [and the] ability to gain new perspectives.” Excitedly, one resident from our inaugural cohort matched into the pediatric cardiology fellowship at our institution. All other residents matched into their desired specialties.The PRESS program represents a feasible and effective program to expose and recruit UIM trainees into programs they would not have otherwise considered and to help them develop a sense of belonging in their subspecialty. It may also help fellowship programs and institutions expand their recruitment base, encouraging a more diverse applicant pool.

Milestones Next Steps: Results of a Feedback Questionnaire

Milestones Next Steps: Results of a Feedback Questionnaire

The ACGME Framework for Medically Underserved Areas and Populations and Graduate Medical Education

The ACGME Framework for Medically Underserved Areas and Populations and Graduate Medical Education

A Call to Action for Standardizing Letters of Recommendation.

A Call to Action for Standardizing Letters of Recommendation.

Reflect and Reset: Black Academic Voices Call the Graduate Medical Education Community to Action.

The COVID-19 pandemic highlighted the great achievements that the biomedical community can accomplish, but raised the question: Can the same medical community that developed a complex vaccine in less than a year during a pandemic help to defeat social injustice and ameliorate the epidemic of health inequity? In this article, the authors, a group of Black academics, call on the graduate medical education (GME) community to reset its trajectory toward solutions for achieving diversity, improving inclusion, and combating racism using education as the new vector. Sponsoring institutions, which include universities, academic medical centers, teaching hospitals, and teaching health centers, are the center of the creation and dissemination of scholarship. They are often the main sources of care for many historically marginalized communities. The GME learning environment must provide the next generation of medical professionals with an understanding of how racism continues to have a destructive influence on health care professionals and their patients. Residents have the practical experience of longitudinal patient care, and a significant portion of an individual’s professional identity is formed during GME; therefore, this is a key time to address explicit stereotyping and to identify implicit bias at the individual level. The authors propose 3 main reset strategies for GME—incorporating inclusive pedagogy and structural competency into education, building a diverse and inclusive learning environment, and activating community engagement—as well as tactics that sponsoring institutions can adapt to address racism at the individual learner, medical education program, and institutional levels. Sustained, comprehensive, and systematic implementation of multiple tactics could make a significant impact. It is an academic and moral imperative for the medical community to contribute to the design and implementation of solutions that directly address racism, shifting how resident physicians are educated and modeling just and inclusive behaviors for the next generation of medical leaders.

Implementing Systematic Culture Change to Improve Diversity in Graduate Medical Education.

Diversity, equity, inclusion, and justice (DEIJ) are all pivotal elements in bettering our world. Yet, we have insufficiently understood the impact of these elements in health care and sparsely identified ways to prioritize them for eliminating health care disparities. As physicians and educators, we can no longer accept the status quo. Yet graduate medical education (GME) is embedded within sponsoring institutions (SIs), is challenged by funding limitations, and often struggles with recruitment and retention of diverse faculty and trainees. The task may seem insurmountable, and we may stagger along the way, but to transcend the existing barriers we must collaborate. We must persevere, identify solutions, and utilize metrics to restructure our organizations and change behaviors. This Rip Out summarizes critical steps in leading a systematic culture change to improve DEIJ in medicine.The reasons to address diversity in GME are clear: diversifying the health care workforce promotes more culturally responsive care, improves access to high-quality health care for underserved populations, and broadens research agendas, all components necessary to eliminate health care disparities. While some in GME see recruitment as a medical school issue, the culture of a GME program and its SI can have a strong influence on whether applicants, be they medical students or faculty, apply, interview, and accept a position. The GME community can be leaders in creating an inclusive DEIJ culture.Changing culture is a time-consuming, arduous, iterative process with each step of a change cycle resulting in progress toward achieving the aim. Yet culture is an amorphous concept that involves the intersection of individuals and their identities with the shared values and assumptions of those in a workplace or profession and the evolving practices.1 There are numerous change models available (eg, Kotter, ADKAR, Lewin, balanced scorecard, Gantt charts) based on policies, needs, values, and identities of individuals in one's organization, each rooted in a perspective (organization, identity, practice).1,2 Typically these models outline a stepwise sequence and have common elements: assessing the opportunity or problem motivating the change; creating a guiding change coalition and formulating and communicating a clear, transparent, and compelling vision of the change to empower others to act; identifying short-term wins to reinforce the change process; and monitoring (at individual, program, SI levels) and strengthening the change process over time toward institutionalization of the change.2 Skills in leadership, negotiation, collaboration, and conflict resolution combined with persistence, agility, tenacity, and sometimes a “thick” coat are required elements, as detractors may seek to disrupt progress in achieving DEIJ in GME.Kotter's 8-step model for organizational culture change3 has been utilized in its original form or an adapted version to transform businesses and health organizations alike and has been adapted to frame what GME faculty and leaders can do now as action steps.Culture change is not easy. It requires continuous investment and engagement. What factors can promote sustainability of DEIJ change in GME?

The Single Match: Reflections on the National Resident Matching Program's Sustained Partnership With Learners.

In 2020, the National Resident Matching Program (NRMP) sponsored the inaugural “Single Match”—the first time that seniors and graduates of U.S. MD-granting and DO-granting schools participated in one Match. In honor of the Single Match milestone, the authors examine the NRMP’s history, reflecting on the organization’s efforts since the 1950s to support learners and the graduate medical education community by fostering a responsive, robust matching program while remaining true to its founding principles to provide parity of experience for applicants and reduce coercive practices. The chaos and stress associated with the pre-Match days in the 1920s and 1930s that led to the call for a national clearinghouse are highlighted as are significant NRMP accomplishments, from the organization’s incorporation as a 501(c)(3) organization in 1953 as a simple internship placement system through the first Single Match. Recognizing that the current transition to residency is not without its stressors, the authors note that the NRMP remains committed and willing to continue to evolve and identify innovative and meaningful ways to address learner needs and improve the transition to residency.

Call for Collaboration: The Role of Accreditation in the Transformation, Accountability, and Sustainability of Education in Social Determinants of Health.

Call for Collaboration: The Role of Accreditation in the Transformation, Accountability, and Sustainability of Education in Social Determinants of Health.

From Crisis to Growth: A Guiding, Pragmatic Model During a Global Pandemic

We draw on articles about adaptive leadership during a sustained crisis, 8 and on theories for promoting a growth mindset for leaders, faculty, and trainees At the individual level, adopting a growth mindset is important to prepare leaders, faculty, and trainees for ongoing work and future crises - Kurt Lewin 1 T he COVID-19 pandemic has changed individuals and health care institutions and is testing the graduate medical education (GME) community's collective adaptability and potential for growth under adversity and uncertainty Woodson Scott Jones, MD Ingrid Philibert, PhD, MA, MBA Lyuba Konopasek, MD Frederic W Hafferty, PhD There is nothing as practical as a good theory [Extracted from the article] Copyright of Journal of Graduate Medical Education is the property of Accreditation Council for Graduate Medical Education and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

The Milestones 2.0 Development Process.

The Milestones 2.0 Development Process.

A Validity Framework for Effective Analysis and Interpretation of Milestones Data.

A Validity Framework for Effective Analysis and Interpretation of Milestones Data.

Navigating Academic Law in Competency Decisions.

Navigating Academic Law in Competency Decisions.

A Systematic Review of the Relationship Between In-Training Examination Scores and Specialty Board Examination Scores.

In-training examinations (ITEs) are intended for low-stakes, formative assessment of residents' knowledge, but are increasingly used for high-stake purposes, such as to predict board examination failures. The aim of this review was to investigate the relationship between performance on ITEs and board examination performance across medical specialties. A search of the literature for studies assessing the strength of the relationship between ITE and board examination performance from January 2000 to March 2019 was completed. Results were categorized based on the type of statistical analysis used to determine the relationship between ITE performance and board examination performance. Of 1407 articles initially identified, 89 articles underwent full-text review, and 32 articles were included in this review. There was a moderate-strong relationship between ITE and board examination performance, and ITE scores significantly predict board examination scores for the majority of studies. Performing well on an ITE predicts a passing outcome for the board examination, but there is less evidence that performing poorly on an ITE will result in failing the associated specialty board examination. There is a moderate to strong correlation between ITE performance and subsequent performance on board examinations. That the predictive value for passing the board examination is stronger than the predictive value for failing calls into question the "common wisdom" that ITE scores can be used to identify "at risk" residents. The graduate medical education community should continue to exercise caution and restraint in using ITE scores for moderate to high-stakes decisions.

Correlations between Accreditation Council for Graduate Medical Education Obstetrics and Gynecology Milestones and American Board of Obstetrics and Gynecology qualifying examination scores: an initial validity study

Since the launch of the Outcome Project in 2001, the graduate medical education community has been working to implement the 6 general competencies. In 2014, all Obstetrics and Gynecology residency programs implemented specialty-specific milestones to advance competency-based assessment. Each clinical competency committee of the Obstetrics and Gynecology program assesses all residents twice a year on the milestones. These data are reported to the Accreditation Council for Graduate Medical Education as part of a continuous quality improvement effort in graduate medical education. This study aimed to evaluate the correlation between the Accreditation Council for Graduate Medical Education Obstetrics and Gynecology Milestones and residency program graduates' performance on the American Board of Obstetrics and Gynecology qualifying (written) examination. We conducted a validity study of all graduating (postgraduate year 4) Obstetrics and Gynecology residents in 2017 within Accreditation Council for Graduate Medical Education-accredited United States training programs (1260 residents from 242 programs). This cohort of residents began receiving milestone assessments during their postgraduate year 2 in 2014; the first-year milestones were implemented for all Accreditation Council for Graduate Medical Education-accredited Obstetrics and Gynecology programs. This cohort completed their sixth and final milestone assessment at graduation in June 2017 for a total of 6 periods of milestone assessments. Data regarding each resident's milestone ratings in each of the 28 Accreditation Council for Graduate Medical Education subcompetencies for Obstetrics and Gynecology were assessed for their association with candidates' American Board of Obstetrics and Gynecology qualifying examination scores using a generalized estimating equation regression model. Data were available and analyzed from 1184 residents from 240 programs, representing 94% of the total academic year 2017 graduates of Obstetrics and Gynecology residency training programs. There was a substantial association between most milestone ratings at the 6 assessment points and candidates' performance on the American Board of Obstetrics and Gynecology qualifying examination. The strongest associations with the American Board of Obstetrics and Gynecology were within all 7 of the subcompetencies of Medical Knowledge (range of slope correlation coefficients at final milestone ratings 3.84-5.17; slope coefficients can be interpreted as the gain in qualifying examination points per unit increase in milestone level). At the final milestone assessment, but more modest associations with the American Board of Obstetrics and Gynecology qualifying examination scores were also seen with 9 of the 11 Patient Care and Procedural Skills subcompetencies, the 2 of 2 Practice-Based Learning and Improvement subcompetencies, the 2 of 2 Systems-Based Practice subcompetencies, and 2 of the 3 Professionalism subcompetencies. Only 1 of the 3 Interpersonal and Communication Skills subcompetencies was associated with American Board of Obstetrics and Gynecology qualifying examination scores. The pattern of associations between the qualifying examination scores and milestone ratings for the 2017 graduating cohort of Obstetrics and Gynecology residents followed a logical pattern, with the strongest associations seen in Medical Knowledge, and lower to no associations in subcompetencies not as effectively assessed on multiple-choice examinations. Although some positive associations were noted for non-Medical Knowledge milestones, these associations could be caused by correlational rating errors with further study needed to better understand these patterns.

The Hidden Curriculum of the COVID-19 Pandemic.

The Hidden Curriculum of the COVID-19 Pandemic.

A National Survey of Burnout and Depression Among Fellows Training in Pulmonary and Critical Care Medicine: A Special Report by the Association of Pulmonary and Critical Care Medicine Program Directors

The prevalence of burnout and depressive symptoms is high among physician trainees. What is the burden of burnout and depressive symptoms among fellows training in pulmonary and critical care medicine (PCCM) and what are associated individual fellow, program, and institutional characteristics? We conducted a cross-sectional electronic survey of fellows enrolled in pulmonary, PCCM, and critical care medicine training programs in the United States to assess burnout and depressive symptoms. Burnout symptoms were measured using the Maslach Burnout Index two-item measure. The two-item Primary Care Evaluation of Mental Disorders Procedure was used to screen for depressive symptoms. For each of the two outcomes (burnout and depressive symptoms), we constructed three multivariate logistic regression models to assess individual fellow characteristics, program structure, and institutional polices associated with either burnout or depressive symptoms. Five hundred two of the 976 fellows who received the survey completed it-including both outcome measures-giving a response rate of 51%. Fifty percent of fellows showed positive results for either burnout or depressive symptoms, with 41%showing positive results for depressive symptoms, 32%showing positive results for burnout, and 23%showing positive results for both. Reporting a coverage system in the case of personal illness or emergency (adjusted OR [aOR], 0.44; 95%CI, 0.26-0.73) and access to mental health services (aOR, 0.14; 95%CI, 0.04-0.47) were associated with lower odds of burnout. Financial concern was associated with higher odds of depressive symptoms (aOR, 1.13; 95%CI, 1.05-1.22). Working more than 70 hours in an average clinical week and the burdens of electronic health record (EHR) documentation were associated with a higher odds of both burnout and depressive symptoms. Given the high prevalence of burnout and depressive symptoms among fellows training in PCCM, an urgent need exists to identify solutions that address this public health crisis. Strategies such as providing an easily accessible coverage system, access to mental health resources, reducing EHR burden, addressing work hours, and addressing financial concerns among trainees may help to reduce burnout or depressive symptoms and should be studied further by the graduate medical education community.

Incoming International Medical Graduates and the COVID-19 Pandemic: More Than Meets the Eye.

Incoming International Medical Graduates and the COVID-19 Pandemic: More Than Meets the Eye.

COVID-19 - Considerations and Implications for Surgical Learners.

COVID-19 - Considerations and Implications for Surgical Learners.