Graduate Medical Education Programs Research Articles

Impact of holistic review on diversity of interviewed and matriculating residents in graduate medical education: a systematic review protocol

IntroductionDiversity in the physician workforce improves patient-centred outcomes. Patients are more likely to trust in and comply with care when seeing gender/racially concordant providers. A current emphasis on standardised metrics...

A Homemade, Cost-Effective, Realistic Pelvic Exam Model.

This innovation is intended to instruct medical students, residents of all levels, and mid-level practitioners. Pelvic examinations are essential components to clinical practice but are challenging to teach, learn, and practice on live patients secondary to patient comfort because this is an invasive procedure.1 Resident physicians and medical students traditionally learn these methods through observation while actively working in their department or clinics.2 Simulation models can improve a provider's competency and confidence performing pelvic examinations which improve patient comfort and exam accuracy.3 One barrier to simulation training is the cost of the pelvic simulator models. A basic pelvic exam simulator costs $365.4 The cost is high, therefore limiting the availability of a simulation model accessible to residency programs across the country. This barrier to pelvic models was overcome by developing a homemade alternative for cervical examination and collection of screening swabs. The model created can be easily manufactured by students, residents, and faculty alike for less than $20 and approximately two hours of manufacturing time. A literature review was conducted to find similar products and other production methods for a pelvic examination model. No comparable models were found.This is a guide to utilizing supplies from a local dollar store combined with home recycling products and a few common crafting tools to create a realistic pelvic examination model. After utilizing this pelvic examination model, the learner will be able to: 1) demonstrate ability to perform a pelvic examination comfortably and safely, 2) demonstrate ability to obtain a cervical swab on female patients, and 3) show proficient understanding of female anatomy. The pelvic exam model is utilized to effectively teach proper technique for pelvic examinations. This model can be utilized to teach medical students, incoming residents, and new mid-levels. Senior residents, experienced mid-levels, or attendings who are experienced in completing pelvic examinations can easily utilize this model to teach proper technique. The data for this study was collected from a single graduate medical education program in Detroit, Michigan. This was designed as a single blind survey where the reviewer's identities were kept anonymous from the data collectors. Surveys were collected from attendings, residents, mid-level providers, and medical students across specialties of emergency medicine, family medicine, obstetrics and gynecology. A total of 77 individuals tested the homemade model and compared it to a pelvic exam on a live patient as well as a commercial pelvic exam model. Survey results showed the low-cost homemade model was just as effective as a commercially manufactured model, with some respondents saying the DIY model was more effective and more realistic. Comparing the commercial models to the homemade model, 54 of the 77 participants had experience with a commercial model. In the survey when compared to a commercial model, 57% of the participants felt the examination was the same, and 31% indicated the homemade model felt more realistic. Overall, the homemade cost-effective model is comparable if not more realistic to more expensive commercial models. The main take away of this innovation, to remember it is possible to create cost-effective models for realistic, educational learning. This model has one limitation because it is not suitable for a bimanual examination, but it can be expanded to allow for bimanual examination. Pelvic examination, cervical examination, creative simulation models.

Breaking Down Silos Between Medical Education and Health Systems: Creating an Integrated Multilevel Data Model to Advance the Systems-Based Practice Competency.

The complexity of improving health in the United States and the rising call for outcomes-based physician training present unique challenges and opportunities for both graduate medical education (GME) and health systems. GME programs have been particularly challenged to implement systems-based practice (SBP) as a core physician competency and educational outcome. Disparate definitions and educational approaches to SBP, as well as limited understanding of the complex interactions between GME trainees, programs, and their health system settings, contribute to current suboptimal educational outcomes elated to SBP. To advance SBP competence at individual, program, and institutional levels, the authors present the rationale for an integrated multilevel systems approach to assess and evaluate SBP, propose a conceptual multilevel data model that integrates health system and educational SBP performance, and explore the opportunities and challenges of using multilevel data to promote an empirically driven approach to residency education. The development, study, and adoption of multilevel analytic approaches to GME are imperative to the successful operationalization of SBP and thereby imperative to GME's social accountability in meeting societal needs for improved health. The authors call for the continued collaboration of national leaders toward producing integrated and multilevel datasets that link health systems and their GME-sponsoring institutions to evolve SBP.

The Influence of Anti-LGBTQIA+ Legislation on Graduate Medical Education

The Influence of Anti-LGBTQIA+ Legislation on Graduate Medical Education

Designing a User-Friendly Context-Specific Assessment Tool for Community-Based Teachers.

Graduate medical education (GME) programs must ensure that they are able to collect accurate information about resident competence through assessment tools that are fit for purpose. An assessment form or process is called “fit for purpose” when there is good alignment between the tool (how something is assessed) and the intent (the specific knowledge, skill, or attitude/belief that is being assessed).In our family medicine GME program, we identified that the generic workplace-based summative assessment tool provided to community-based family medicine obstetrics (FMOB) clinical teachers was not fit for purpose. As a result, these teachers were uncertain about program expectations regarding competence, the assessment form was challenging and frustrating to complete, and our program struggled to extract useful assessment data from completed assessment forms. To address this issue, we took a systematic approach to develop a workplace-based assessment tool that was specific to the clinical context of FMOB and user-friendly for clinical teachers.Our goals were to develop: (1) a fit-for-purpose workplace-based assessment tool for community-based FMOB teachers that could be used for accurate assessment without the need for faculty development, and (2) an evidence-guided process for designing similar context-specific tools in the future. We met our first goal through designing the FMOB competence rubric (FMOB-CR) tool. The FMOB-CR is comprised of 2 elements. The first is a rubric containing specific statements and examples of resident performance. The rubric clearly outlines the expected level of competence on a 3-point rating scale (“cause for concern,” “acceptable competence,” “exemplary competence”), organized by the 6 Skill Dimensions of Family Medicine (similar to CanMEDS roles).1 The second element is a simple online assessment form in which FMOB teachers specify their resident's level of competence in each Skill Dimension, guided by the statements and examples in the rubric.The FMOB-CR uses plain language and context-specific clinical examples along with a simple online assessment form to clearly communicate expectations of competence to teachers (and residents) without additional faculty development. This user-friendly tool should make it easier for FMOB clinical teachers to better identify residents who are underperforming, which will allow the program to be more effective in intervening and supporting residents in difficulty.To meet our second goal, we developed an evidence-guided process for designing workplace-based assessment tools that are fit for purpose for specific clinical contexts. Our design process included: assembling a tool development team with relevant expertise, including a resident; consultations with FMOB teachers and residents; environmental scan and review of local assessment forms and assessments used by other FMOB GME programs; a modified Delphi process with local GME program faculty to develop and refine the table of competence statements; a consensus-building process within the research team to revise the statements for the rating scale; and implementation of the assessment rubric with concurrent collection of validity evidence. For both the FMOB-CR and the development process, we collected validity evidence according to Messick's unified concept of validity.2The Table details the validity evidence collected to date. Fifteen FMOB teachers surveyed showed strong agreement across 5 items about the utility of the rubric in allowing them to accurately assess residents (overall M=3.25/4, Likert scale 1=strongly disagree to 4=strongly agree), and across 3 items about the usefulness of the rubrics in helping them to understand program expectations of resident competence (overall M=3.36/4); 14 of 15 teachers preferred the new form to the old one.We hope that the worked example of the FMOB-CR and its development process may serve as a blueprint for other institutions to develop context-specific assessment tools.

Financial Leadership Skills Training: Can a Hybrid Didactic/Interactive Exercise Model Fill a Gap in Graduate Medical Education?

Background With recent healthcare changes, competition for financial resources is increasing. Graduate medical education (GME) programs do not routinely prepare residents to understand the complexity of financial decisions that affect their practice. At our institution, we designed new sessions to explore personal and departmental financial education in our yearly Radiation Oncology (RO) leadership course. Methods Over the past five years, we have been piloting a longitudinal leadership course for our RO medical and physics residents, integrating a hybrid didactic/interactive exercise approach. The core RO faculty consists of the course director, the residency directors, and department leadership. The course structure includes an introduction to understanding how resource allocation is determined at the institutional level as well as a personal finance component. We recruited the RO Vice Chair, RO Department Administrator, and the MD, MBA Chair of the Vacancy Review Committee at our institution to teach these concepts over three sessions. The first was a didactic introduction to departmental finance by our Vice Chair to prepare attendees for the second interactive session, in which residents worked through a pro forma to determine the feasibility of hiring a new departmental faculty member. The final session was led by our MD, MBA colleague who taught residents how hiring decisions are made and explained what happens to the pro forma at the institutional level. The third session integrated an interactive exercise focusing on personal finance skills. Results At the end of the series, the ten resident attendees were informally surveyed regarding how effective and worthwhile the three finance sessions were. The verbal feedback regarding the curriculum was uniformly positive. All ten residents, including the physics resident, indicated that these classes were helpful and filled a gap in the current GME curriculum. Further feedback analysis noted that additional interactive exercises should be prioritized to reinforce understanding of these financial concepts. Discussion Financial education is lacking in most GME training programs. Targeted instruction for both personal and departmental financial decisions was well received in this novel course at our institution. Further studies are needed to determine effectiveness and optimal integration of financial leadership skill development in the GME setting. Future directions could be to determine the best balance of didactic instruction and interactive exercises to enhance resident understanding of these financial topics. With recent healthcare changes, competition for financial resources is increasing. Graduate medical education (GME) programs do not routinely prepare residents to understand the complexity of financial decisions that affect their practice. At our institution, we designed new sessions to explore personal and departmental financial education in our yearly Radiation Oncology (RO) leadership course. Over the past five years, we have been piloting a longitudinal leadership course for our RO medical and physics residents, integrating a hybrid didactic/interactive exercise approach. The core RO faculty consists of the course director, the residency directors, and department leadership. The course structure includes an introduction to understanding how resource allocation is determined at the institutional level as well as a personal finance component. We recruited the RO Vice Chair, RO Department Administrator, and the MD, MBA Chair of the Vacancy Review Committee at our institution to teach these concepts over three sessions. The first was a didactic introduction to departmental finance by our Vice Chair to prepare attendees for the second interactive session, in which residents worked through a pro forma to determine the feasibility of hiring a new departmental faculty member. The final session was led by our MD, MBA colleague who taught residents how hiring decisions are made and explained what happens to the pro forma at the institutional level. The third session integrated an interactive exercise focusing on personal finance skills. At the end of the series, the ten resident attendees were informally surveyed regarding how effective and worthwhile the three finance sessions were. The verbal feedback regarding the curriculum was uniformly positive. All ten residents, including the physics resident, indicated that these classes were helpful and filled a gap in the current GME curriculum. Further feedback analysis noted that additional interactive exercises should be prioritized to reinforce understanding of these financial concepts. Financial education is lacking in most GME training programs. Targeted instruction for both personal and departmental financial decisions was well received in this novel course at our institution. Further studies are needed to determine effectiveness and optimal integration of financial leadership skill development in the GME setting. Future directions could be to determine the best balance of didactic instruction and interactive exercises to enhance resident understanding of these financial topics.

National Pediatric Subspecialty Recruitment Sessions Increase Program Visibility and Impact Candidate Application Choices.

While the pediatric subspecialty applicant pool is increasing, so is the number of open positions, with an overall 1:1 ratio of applicant to position. Unfortunately, there is a wide disparity in this ratio dependent upon subspecialty, leaving many programs unfilled.1 Since 2020, recruitment has shifted to virtual, and while the impact on programs and applicants is not fully understood, some program leadership feel disadvantaged without the opportunity to showcase their programs in person. To satisfy the growing desire for pediatric subspecialty programs to be more visible to the applicant pool, a national virtual recruitment session was piloted for pediatric subspecialties using the virtual format created by FuturePedsRes.Individual subspecialty recruitment sessions were held during July 2022 from 8:00-9:30 pm ET featuring 2 to 3 subspecialties on 4 different dates. Prior to the evening, programs were given the option to post a slide on the Association of Pediatric Program Directors website describing their fellowship training program for applicant review. A representative for each participating subspecialty, identified through the Council of Pediatric Subspecialties, served as the communication director between programs and session organizers to coordinate logistics prior to the event. Each subspecialty had a unique virtual link on the night of their session, and each fellowship program within that subspecialty had an individual breakout room. Applicants rotated freely between program breakout rooms, with a suggestion to rotate every 10 minutes. A post-participation survey was sent to all participants.Eleven pediatric subspecialties participated, including 701 live participants representing programs and applicants (Table). Of the participating program leadership, 158 completed a post-participation survey, with half indicating the session increased the visibility of their program, several citing an appreciation of the intimate relationship with the applicants, and a majority wanting to participate again. Of the 49 applicants who responded to the survey, 100% felt the evening was a good use of their time, highlighting the face time with leadership and trainees and the opportunity to meet many programs in one setting as positives. Importantly, 92% (45 of 49) of applicants visited programs outside their current geographic location, 51% (25 of 49) visited programs they were not originally planning to apply to, and 42% (18 of 43) applied to new programs as a result of participating in the session. Challenges identified included: some programs having no applicants visit their breakout rooms, the late timing of sessions in this recruitment season, and some logistical issues during the sessions.The inaugural national pediatric subspecialty recruitment sessions were successful, resulting in increased visibility for programs and in applicants applying to programs they had not considered prior to the session. Applicants thought the accessibility of all programs on one platform simultaneously was helpful, and many visited programs they otherwise would not have had the opportunity to explore. In response to feedback, several logistical changes will be applied to subsequent sessions for the 2023 appointment year, including a shift to earlier in the year, prior to the submission of applications. This will allow for increased time for advertising the sessions and improved promotion of individual program information in advance. This model of training program informational sessions is applicable across graduate medical education programs and may serve to not only provide enhanced individual program visibility but also increase awareness about careers in subspecialities in general and potentially expand the applicant pool.

The Value of Signaling an Orthopaedic Surgery Program: A Survey to Orthopaedic Surgery Programs.

A new system was implemented by the Association of American Medical Colleges called the preference signaling program for the 2022 to 2023 orthopaedic surgery residency match. Applicants were able to signal 30 orthopaedic surgery programs to indicate high interest in a specific program. The purpose of this study was to address how important signaling was to an orthopaedic surgery program this 2022 to 2023 application cycle. A five-question survey was sent to orthopaedic surgery residency programs participating in the Electronic Residency Application Service this application cycle. Contact information was gathered through the Accreditation Council for Graduate Medical Education residency website and program websites. Responses were obtained from 69 of the 151 programs (46%) contacted. The average number of applicants per program was 727 (range, 372 to 1031, SD 155). Thirty-four of 61 respondents (56%) stated that 100% of their interviewees signaled their program. Fifty-five of 61 respondents (90%) indicated that their interviewee pool consisted of 75% or more applicants who signaled. Applicants who signaled had a 24.4% (range, 12.77 to 47.41, SD 8.04) chance of receiving an interview. Applicants who did not signal had just a 0.92% (range, 0 to 13.10, SD 2.08) chance of receiving an interview. Fifty-four of the 63 applicants (86%) answered that signaling played an important role in considering an applicant for an interview. Over half of the responding programs only interviewed applicants who signaled their program, and over 90% of programs' interview lists consisted of at least 75% of signaling applicants. Eighty-six percent of programs indicated that signaling played an important role in considering an applicant for an interview. Applicants who signaled were 26.5 times more likely to receive an interview than those who did not (P < 0.0001). With this information, applicants can narrow down their list of programs to apply to, knowing that their signal to a program will give them a better chance at receiving an interview.

The Everlasting Effects of the Covid-19 Pandemic on Oral and Maxillofacial Surgery Residency Match

The Everlasting Effects of the Covid-19 Pandemic on Oral and Maxillofacial Surgery Residency Match

Addressing HPSP Learner Needs: A Pilot Study of a "Fundamentals of Military Medicine" Course.

Military medicine is uniquely different from civilian medicine, and military physicians in the USA are primarily recruited through the Health Professions Scholarship Program (HPSP) and the Uniformed Services University of the Health Sciences (USUHS). Medical students at the USUHS receive more than 650 hours of military-specific curriculum and spend 21 days engaged in field exercises. HPSP students complete two 4-week officer training sessions during their 4 years of medical school. There is a clear discrepancy in preparation for military medicine between HPSP and USUHS students. The USUHS School of Medicine undertook an initiative to develop a fully online self-paced course on the fundamentals of military medicine topics to help HPSP students bridge the gap in their preparation. This article will describe how the online self-paced course was designed and present feedback from the pilot offering of this course. As proof of concept of the effectiveness of an online self-paced course for teaching the fundamentals of military medicine to HPSP students, two chapters from the "Fundamentals of Military Medicine" published by the Borden Institute were transferred to an online format. Each chapter was offered as a module. In addition to the chapters, an introduction and closing module were added to the pilot course. The pilot course was offered over 6 weeks. Data for this study were obtained from module feedback surveys, pre- and post-course quizzes, participant focus groups, and course evaluation surveys. Pre- and post-test scores were analyzed to evaluate content knowledge. The open-ended survey questions on the feedback forms and focus group transcripts were collated and analyzed as textual data. Fifty-six volunteers enrolled in the study, and 42 completed the pre- and post-course quizzes. This participant pool included HPSP students (79%, n = 44) and military residents in civilian graduate medical education programs (21%, n = 12). The module feedback surveys showed that most participants spent 1 to 3 hours on each of the modules, which they rated as extremely or quite reasonable (Module 1: 64%, Module 2: 86%, Module 3: 83%). There was not much difference between the overall quality of the three modules. The participants found content on application to the military-specific context very valuable. Of the different course elements, video content was rated as the most effective. Participant feedback clearly highlighted that HPSP students want a course that informs them about the fundamentals of military medicine and demonstrates how the information would apply to their lives. Overall, the course was effective. HPSP students showed knowledge gains and self-reported satisfaction with the course's objectives. They were able to locate information easily and understand the course expectations. This pilot study has shown that there is a need for a course that provides the fundamentals of military medicine to HPSP students. A fully online self-paced course provides flexibility for the students and improves access.

Resident Perception of Obstetrics and Gynecology Pelvic Anatomy Curriculum: A National Survey [ID: 1377994

INTRODUCTION: As a surgical subspeciality, mastering pelvic anatomy for the ob-gyn resident is imperative in performing successful surgical procedures. The objective of this study was to conduct a national survey to examine the ob-gyn resident perspective on their residency's pelvic anatomy curriculum. METHODS: An 18-question survey was distributed to all 241 Accreditation Council for Graduate Medical Education program coordinators. The survey was circulated electronically on four different dates, and all information was collected anonymous. All statistical analysis was done using SPSS 2.0. RESULTS: A total of 180 (31.0%) residents responded out of 582 possible residents from the 28 programs that responded to our survey. The majority of residents, 172 (95.5%), were between the ages 25 and 34, 155 (86.1%) identified as female, and 25 (69.4%) programs were academic. Out of the respondents, 104 (58.10%) experienced formal education on pelvic anatomy and 138 (77.53%) had a formal surgical simulation. There were 159 (88.83%) residents who had protected lecture time for pelvic anatomy, and only 100 (62.9%) found the lectures to be educational. On a scale of 1–10, the average was 7.5 when residents were asked whether they felt that obstetrics and gynecology programs should have time in an anatomy lab and 9.0 when asked if they felt that formal training in anatomy lab would help them become a better surgeon. On multivariable analysis, residents who had formal education on pelvic anatomy and a surgical simulation curriculum felt that their residency program was more likely to adequately train them in all aspects of obstetrics and gynecology (P&lt;.05). CONCLUSION: Pelvic anatomy education is a important for ob-gyn residents. Only 60% of programs have a formal pelvic anatomy curriculum and 89% had formal lectures on pelvic anatomy, with most residents finding pelvic anatomy lectures to be unhelpful. Residency programs should consider adding hands-on anatomy program to their curriculum to adequately train their residents in the field of obstetrics and gynecology.

0933 Sleep Specialists in Federally Qualified Health Centers: A Gap in Sleep Health Care Potentially Contributing to Sleep Disparities

Abstract Introduction Poor sleep is associated with adverse cardiometabolic health outcomes and increased risk of mortality. Although primary care providers recognize the importance of sleep, they report low comfort levels in diagnosing, treating, and managing sleep disorders; lack of clinical knowledge and skills is the most common barrier to recognizing insomnia in family practice. Furthermore, minoritized racial/ethnic groups are disproportionately affected by poor sleep health, likely due in part to structural and other forms of racism that result in limited access to sleep healthcare. Health Resources &amp; Services Administration (HRSA) has a variety of awards that support scholarships and loan repayment programs at colleges and universities to meet critical workforce shortages and diversify the health professions. We assessed the distribution of sleep specialists among clinicians who participated in a HRSA grant program because they tend to work for health care organizations that serve persons from lower socioeconomic and diverse racial-ethnic backgrounds. Methods Publicly available data were obtained from the HRSA data warehouse. Data were available for 44,199 clinicians (49% MD/DO and 16% Nurse Practitioner) who participated in a HRSA grant program between 2011 and 2021. We report data for those clinicians who endorsed sleep medicine as their subspecialty. Results Of the 44,199 clinicians, 27 (0.06%) physicians trained in a medical subspecialty of sleep medicine, and the majority (52%) were in Michigan. The remainder of sleep medicine specialists completed their program in Pennsylvania (33%), Ohio (7%), Minnesota (4%), and California (4%). Only the participants in the Children's Hospital Graduate Medical Education program designated their subspecialty as sleep medicine. None of the sleep medicine specialists currently practice in Health Professional Shortage Areas (HPSAs) or Medically Underserved Areas/Populations (MUA/P), and 1 physician currently practices in a rural area. Conclusion A marked paucity of trained sleep specialists in HRSA grant programs and an absence of such practitioners in HSPAs underscores the disparities in access to sleep specialty care. Initiatives are needed to incentivize sleep specialists to serve in under-resourced communities as well as to implement programs training primary care practitioners working in these areas to deliver sleep health care, supported by sleep specialists. Support (if any) Divisions of Intramural Research: NIMHD/NIEHS, NIH

Position Paper: SGIM Sex- and Gender-Based Women's Health Core Competencies.

Women's health care has evolved significantly since it was first acknowledged as an integral part of internal medicine training more than two decades ago. To update and clarify core competencies in sex- and gender-based women's health for general internists, the Society of General Internal Medicine (SGIM) Women and Medicine Commission prepared the following Position Paper, approved by the SGIM council in 2023. Competencies were developed using several sources, including the 2021 Accreditation Council for Graduate Medical Education Program Requirements for Internal Medicine and the 2023 American Board of Internal Medicine Certification Examination Blueprint. These competencies are relevant to the care of patients who identify as women, as well as gender-diverse individuals to whom these principles apply. They align with pivotal advances in women's health and acknowledge the changing context of patients' lives, reaffirming the role of general internal medicine physicians in providing comprehensive care to women.

Improving resident well-being: a narrative review of wellness curricula.

To improve wellness among residents, many graduate medical education programs have implemented formal wellness curricula. Curricular development has recently shifted focus from drivers of burnout to promotion of wellness. The specific components of successful wellness curricula, however, are not yet well defined. To review the published literature assessing core components of wellness curricula in graduate medical education programs. Searches were conducted through June 2020 in PubMed, Education Resources Information Center, Google Scholar and Web of Science using the search terms wellness curricula, wellness programs, well-being and graduate medical education. Additional articles were identified from reference lists. Curricula from primarily undergraduate medical education, singular interventions, non-peer-reviewed studies and non-English language studies were excluded. Eighteen articles were selected and reviewed by three authors. Critical drivers of success included support from program leadership and opportunities for resident involvement in the curriculum implementation. Most curricula included interventions related to both physical and mental health. Curricula including challenging components of professionalisation, such as critical conversations, medical errors and boundary setting, seemed to foster increased resident buy-in. The most frequently used curricular assessment tools were the Maslach Burnout Inventory and resident satisfaction surveys. Different specialties have different wellness needs. A resource or 'toolbox' that includes a variety of general as well as specialty-specific wellness components might allow institutions and programs to select interventions that best suit their individual needs. Assessment of wellness curricula is still in its infancy and is largely limited to single institution experiences.

When Abortion Is Illegal—Profound Effects on Resident Health and Well-being

This Viewpoint discusses the need for the leadership of hospital systems and graduate medical education programs to address the effects of abortion restrictions on medical residents’ health, well-being, and training.

Virtual Brunches to Enhance Recruitment of Residents and Fellows Who Self-Identify as Underrepresented in Medicine.

Our institution, along with many others, struggles to recruit residents and fellows who identify as underrepresented in medicine (UIM). There have been various program-level interventions implemented across the nation; however, little is known about graduate medical education (GME)-wide recruiting events for UIM trainees. We describe the development, implementation, and evaluation of a GME-wide recruitment program, Virtual UIM Recruitment Diversity Brunches (VURDBs), to meet this need. A virtual, 2-hour event was held 6 times on Sunday afternoons between September 2021 and January 2022. We surveyed participants on a rating of the VURDBs from excellent (4) to fair (1) and their likelihood of recommending the event to their colleagues from extremely (4) to not at all (1). We used institutional data to compare pre- and post-implementation groups using a 2-sample test of proportions. Across 6 sessions, 280 UIM applicants participated. The response rate of our survey was 48.9% (137 of 280). Fifty-eight percent (79 of 137) rated the event as excellent, and 94.2% (129 of 137) were extremely or very likely to recommend the event. The percentage of new resident and fellow hires who identify as UIM significantly increased from 10.9% (67 of 612) in academic year 2021-2022 to 15.4% (104 of 675) in academic year 2022-2023. The percentage of brunch attendees matriculating into our programs in academic year 2022-2023 was 7.9% (22 of 280). VURDBs are a feasible intervention associated with increased rates of trainees identifying as UIM matriculating in our GME programs.

A Call for Articles on Climate and Graduate Medical Education—JGME Supplement Issue

Discussions about climate change, “the single biggest health threat facing humanity” according to the World Health Organization,1 are moving beyond the weather we see outside our windows. In 2022, the American Medical Association adopted a policy declaring “climate change a public health crisis” based on the substantial scientific evidence demonstrating its adverse effects on patients' health.2 Climate health effects include poor air quality (eg, fire particulates, ground-level ozone, allergens), extreme weather (eg, hurricanes with subsequent power interruptions, human displacements), rising temperatures (causing heat stress, poor water quality), and new vector-borne diseases.3 Worldwide, there are an estimated 5 million deaths annually attributed to climate effects, which are expected to balloon to 83 million by 2100.4 These numbers make the COVID-19 pandemic statistics—3.3 million estimated worldwide deaths up to January 2023—pale in comparison.5 The climate statistics do not include deaths in which climate change contributed to mortality, nor illnesses caused by climate change. Patients who are youngest, oldest, with chronic diseases, and historically marginalized are disproportionately experiencing climate change-related illnesses.6Future physicians and other health professionals must be prepared for these effects, yet a search for climate change-related educational tools for graduate medical education (GME) yields few samples. The percentage of US MD-granting medical schools with required curriculum on the health effects of climate change doubled from 27% in the 2019-2020 academic year to 55% in 2021-2022.7 Undergraduate climate change curricula tends to be generic in nature and limited in quantity. For GME training programs, each specialty and subspecialty is facing different patient health care challenges, thus tailored approaches are required. For example, emergency medicine trainees may need training to handle climate-enhanced disasters while obstetrics and gynecology trainees may focus on the effects of heat, pollution, and other factors on the developing fetus and pregnant women.8 Pulmonary fellows will consider how respiratory disease patterns are changing, as well as implementing anticipatory guidance for patients using oxygen, CPAP, and nebulizers during power losses. Pediatric residents need to respond to climate-related changes in infectious disease patterns, air quality, and heat-related illnesses, which are now affecting nearly every child worldwide.9,10 Anesthesiology programs are already discussing the effects of different inhalants on the ozone layer (Table).11New educational tools to prepare physicians for future climate-related health problems are urgently needed. How can these new materials—including curricula, resources, experiences, and assessments—be integrated into currently overfull GME programs? How can faculty quickly develop, teach, and evaluate this content? Many would argue that, as the most powerful factor influencing patients' health for the next half-century, actions in response to climate change may be one of the most powerful health promotion interventions in the physician's toolbox. Thus, we must ensure future physicians are prepared to anticipate, react to, and treat climate-related health problems in their patients.As a result of this gap in trainee education, the JGME Editorial Board is issuing a call for articles, in ALL categories, for a JGME supplement issue on climate change and GME, to be published in 2024. This initiative will be led by JGME and guest editors, with a peer-review process. The goal of this supplement is to provide tools for GME programs located throughout the world in the areas of curriculum, resources, assessments, and faculty development. Where there are gaps, articles providing specific research directions, for enhancing our understanding of the intersections of patients, trainees, training programs, and those marginalized or underserved by health care, are strongly encouraged.When submitting articles for the JGME climate supplement, please indicate the educational topic areas (eg, curriculum, resources, assessments, faculty development, other) in your cover letter. We look forward greatly to seeing your work on this urgent, vital topic. Please contact jgme@acgme.org with any questions.

Factors associated with emergency physician income.

Income fairness is important, but there are limited data that describe income equity among emergency physicians. Understanding the magnitude of and factors associated with income differences may be helpful in eliminating disparities. This study analyzed the associations of demographic factors, training, practice setting, and board certification with emergency physician income. We distributed a survey to professional members of the American College of Emergency Physicians. The survey included questions on annual income, educational background, practice characteristics, gender, age, race, ethnicity, international medical graduate status, type of medical degree (MD vs DO), completion of a subspecialty fellowship, job characteristics, and board certification. Respondents also reported annual income. We used linear regression to determine the respondent characteristics associated with reported annual income. From 45,961 members we received 3407 responses (7.4%); 2350 contained complete data for regression analysis. The mean reported annual income was $315,306 (95% confidence interval [CI], $310,649 to $319,964). The mean age of the respondents was 47.4 years, 37.4% were women, 3.2% were races underrepresented in medicine (Black, American Indian, or Alaskan Native), and 4.8% were Hispanic or Latino. On linear regression, female gender was associated with lower reported annual income; difference -$43,565, 95% CI, -$52,217 to -$34,913. Physician age, degree (MD vs DO), underrepresented racial minority status, and underrepresented ethnic minority status were not associated with annual income. Fellowship training was associated with lower income; Accreditation Council for Graduate Medical Education (ACGME) program difference -$30,048; 95% CI, -$48,183 to -$11,912, non-ACGME-program difference -$27,640, 95% CI, -$40,970 to -$14,257. Working at a for-profit institution was associated with higher income; difference $12,290, 95% CI, $3693 to $20,888. Board certification was associated with higher income; difference, $43,267, 95% CI, $30,767 to $55,767. This study identified income disparities associated with gender, practice setting, fellowship completion, and American Board of Emergency Medicine or American Osteopathic Board of Emergency Medicine certification.

A Qualitative Study on the Outcomes of Participation in a Longitudinal Clinician Educator Curriculum During Internal Medicine Residency.

Despite increasing prevalence of longitudinal clinician educator tracks (CETs) within graduate medical education (GME) programs, the outcomes of these curricula and how participation in these tracks affects early career development remains incompletely understood. To describe the experience and outcomes of participating in a CET and its effects on recent internal medicine residency graduates' perceived educator skills and early career development. We conducted a qualitative study between July 2019 and January 2020 using in-depth semi-structured interviews of recently graduated physicians from 3 internal medicine residencies at one academic institution who had participated in a CET, the Clinician Educator Distinction (CED). Iterative interviews and data analysis was performed via an inductive, constructionist, thematic analysis approach by 3 researchers to develop a coding and thematic structure. Results were sent electronically to participants for member checking. From 21 (out of 29 eligible) participants, thematic sufficiency was reached at 17 interviews. Four themes related to the CED experience were identified: (1) motivation to go beyond the expectations of residency; (2) educator development outcomes from Distinction participation; (3) factors enabling curricular efficacy; and (4) opportunities for program improvement. A flexible curriculum with experiential learning, observed teaching with feedback, and mentored scholarship allowed participants to enhance teaching and education scholarship skills, join a medical education community, transform professional identities from teachers to educators, and support clinician educator careers. This qualitative study of internal medicine graduates identified key themes surrounding participation in a CET during training, including positively perceived educator development outcomes and themes surrounding educator identity formation.

LBA01-06 DISCRIMINATION-BASED TRAUMA AS A RISK FACTOR FOR BURNOUT AMONG WOMEN TRAINEES IN MEDICINE

You have accessJournal of UrologyCME1 Apr 2023LBA01-06 DISCRIMINATION-BASED TRAUMA AS A RISK FACTOR FOR BURNOUT AMONG WOMEN TRAINEES IN MEDICINE Tyra Fainstad, Alexander Heilman, Pari Shah, Vall Vinaithirthan, Christine Jones, Adrienne Mann, and Kerri Thurmon Tyra FainstadTyra Fainstad More articles by this author , Alexander HeilmanAlexander Heilman More articles by this author , Pari ShahPari Shah More articles by this author , Vall VinaithirthanVall Vinaithirthan More articles by this author , Christine JonesChristine Jones More articles by this author , Adrienne MannAdrienne Mann More articles by this author , and Kerri ThurmonKerri Thurmon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Physician burnout starts early in training, disproportionately impacts women and those URM, and is detrimental personally and professionally. Recent data suggest burnout continues to be a growing problem in graduate medical education (GME), but is mainly specialty or institution specific. Our purpose is to describe the current prevalence and risk factors for burnout amongst female physician trainees across multiple institutions and specialties. METHODS: A multi-institutional randomized controlled trial involving 26 GME programs across America began in September 2022 to investigate the effectiveness of a professional coaching program. Baseline demographics and the Trauma Symptoms of Discrimination Scale (TSDS) of 1,017 volunteer female trainees were collected. The TSDS is a 21-item self-report measure focusing on trauma symptoms surrounding the experience of discrimination. All participants completed baseline surveys including the Maslach Burnout Inventory (MBI). Burnout was defined as scoring >27 for emotional exhaustion (EE) and/or >10 for depersonalization (DP). Multivariable logistic regression identified socio-demographic and/or professional covariates associated with burnout. RESULTS: All 1,017 trainees responded to the baseline survey. 207 were PGY-1, 198 were PGY-2, and 596 were PGY-3 and beyond, with 19% identifying as surgical trainees. Participants on average had high EE (m=30.58) and high DP (m=11.83). DP was more often present in higher PGYs (PGY2: OR 2.61, 95% Confidence Interval [CI] 1.52-4.52, p<0.001; >=PGY3: OR 2.33, 95% CI 1.45-3.78, p<0.001). Higher scores on the TSDS positively correlated with overall burnout (Odds Ratio [OR] 1.30 for 10 units of change, 95% CI 1.11-1.53, p=0.001), EE (OR 1.26 for 10 units of change, 95% CI 1.11-1.43, p<0.001), and DP (OR 1.12 for 10 units of change, 95% CI 1.00-1.26, p=0.058). CONCLUSIONS: Results from this large, multi-institutional cohort show ongoing and progressive burnout prevalence throughout medical training. There is also an association between discrimination-based trauma and burnout in trainees, which has been shown recently in practicing attending physicians as well. Interestingly, we found that EE seems to peak in PGY2 year, while DP increases with PGY level. Smaller studies have shown PGY2 as a burnout peak as well and may highlight a dark point in the GME training hierarchy, with more junior trainees being responsible for tedious tasks whilst taking more call and documentation burden. Future studies should explore interventions in trainee burnout, specifically in those who have experienced trauma from discrimination. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1178 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tyra Fainstad More articles by this author Alexander Heilman More articles by this author Pari Shah More articles by this author Vall Vinaithirthan More articles by this author Christine Jones More articles by this author Adrienne Mann More articles by this author Kerri Thurmon More articles by this author Expand All Advertisement PDF downloadLoading ...