Graduate Medical Education Residency Review Research Articles

Toward a Consensus for Musculoskeletal Ultrasonography Education in Physical Medicine and Rehabilitation: A National Poll of Residency Directors.

The aims of the study were to evaluate integration of musculoskeletal ultrasonography education in physical medicine and rehabilitation training programs in 2014-2015, when the American Academy of Physical Medicine & Rehabilitation and Accreditation Council for Graduate Medical Education Residency Review Committee both recognized it as a fundamental component of physiatric practice, to identify common musculoskeletal ultrasonography components of physical medicine and rehabilitation residency curricula, and to identify common barriers to integration. Survey of 78 Accreditation Council for Graduate Medical Education-accredited physical medicine and rehabilitation residency programs was conducted. The 2015 survey response rate was more than 50%, and respondents were representative of programs across the United States. Most programs (80%) reported teaching musculoskeletal ultrasonography, whereas a minority (20%) required mastery of ultrasonography skills for graduation. Ultrasonography curricula varied, although most programs agreed that the scope of resident training in physical medicine and rehabilitation should include diagnostic and interventional musculoskeletal ultrasonography, especially for key joints (shoulder, elbow, knee, wrist, hip, and ankle) and nerves (median, ulnar, fibular, tibial, radial, and sciatic). Barriers to teaching included insufficient expertise of instructors, poor access to equipment, and lack of a structured curriculum. Musculoskeletal ultrasonography has become a required component of physical medicine and rehabilitation residency training. Based on survey responses and expert recommendations, we propose a structure for musculoskeletal ultrasonography curricular standards and milestones for trainee competency.

Program Director Survey: Attitudes Regarding Child Neurology Training and Testing

BackgroundAs a result of major clinical and scientific advances and changes in clinical practice, the role of adult neurology training for Child Neurology and Neurodevelopmental Disability (NDD) certification has become controversial. The most recently approved requirements for board eligibility for child neurology and neurodevelopmental disability residents still include 12 months in adult neurology rotations. The objective of this study was to assess United States child neurology and neurodevelopmental disability residency program directors' opinions regarding optimal residency training. MethodsThe authors developed an 18-item questionnaire and contacted all 80 child neurology and neurodevelopmental disability program directors via e-mail, using SurveyMonkey. ResultsA total of 44 program directors responded (55%), representing programs that train 78 categorical and 94 total resident positions, approximately 70% of those filled in the match. Respondents identified multiple areas where child neurology residents need more training, including genetics and neuromuscular disease. A substantial majority (73%) believed child neurology and neurodevelopmental disability residents need less than 12 adult neurology training months; however, most (75%) also believed adult hospital service and man-power needs (55%) and finances (34%) would pose barriers to reducing adult neurology. Most (70%) believed reductions in adult neurology training should be program flexible. A majority believed the written initial certification examination should be modified with more child neurology and fewer basic neuroscience questions. Nearly all (91%) felt the views of child neurology and neurodevelopmental disability program directors are under-represented within the Accreditation Council for Graduate Medical Education Residency Review Committee. ConclusionsThe requirement for 12 adult neurology months for Child Neurology and Neurodevelopmental Disability certification is not consistent with the views of the majority of program directors, who favor more training in subspecialized fields of child neurology.

The Present Status of Global Mission Trips in Plastic Surgery Residency Programs.

The present status of global mission trips of all of the academic Plastic Surgery programs was surveyed. We aimed to provide information and guidelines for other interested programs on creating a global health elective in compliance with American Board of Plastic Surgery (ABPS) and Accreditation Council for Graduate Medical Education Residency Review Committee (ACGME/RRC) requirements. A free-response survey was sent to all of the Plastic Surgery Residency program directors inquiring about their present policy on international mission trips for residents and faculty. Questions included time spent in mission, cases performed, sponsoring organizations, and whether cases are being counted in their resident Plastic Surgery Operative Logs (PSOL). Thirty-one programs responded, with 23 programs presently sponsoring international mission trips. Thirteen programs support residents going on nonprogram-sponsored trips where the majority of these programs partner with outside organizations. Many programs do not count cases performed on mission trips as part of ACGME index case requirement. Application templates for international rotations to comply with ABPS and ACGME/RRC requirements were created to facilitate the participation of interested programs. Many Plastic Surgery Residency programs are sponsoring international mission trips for their residents; however, there is a lack of uniformity and administrative support in pursuing these humanitarian efforts. The creation of a dynamic centralized database will help interested programs and residents seek out the global health experience they desire and ensure standardization of the educational experience they obtain during these trips.

Competency in neonatal endotracheal intubation: mission impossible?

The Accreditation Council for Graduate Medical Education Program Requirements (PRs) for Pediatrics require that residents be able to competently perform neonatal endotracheal intubation (NET).1 In this issue of Pediatrics, DeMeo et al2 defined competency as a 75% likelihood of intubation success; only a minority of residents (23%) were able to achieve competency during the study period. Four cumulative NET successes were needed to achieve competency; the median number of NET opportunities for their subjects, however, was 3 (range: 1–13). There are 2 lists of procedures in the current version of the PRs. The first list requires residents to “competently perform,” and the second list requires “competent understanding.” During the PR revision process, the Accreditation Council for Graduate Medical Education Residency Review Committee initially recommended that NET be moved to the second list of procedures. However, feedback from the pediatric community overwhelmingly urged the committee to move NET back to the first list. Advocates for preserving NET as a skill noted that some pediatricians will practice in remote areas, where they could be solely responsible for NET. Responding to the pediatric community, NET was moved … Address correspondence to Joseph Gilhooly, MD, 1900 SW River Dr, Unit 701, Portland, OR 97201. E-mail: gilhooly{at}ohsu.edu

Scope of Global Health Training Opportunities During Residency in Obstetrics and Gynecology

INTRODUCTION: Interest in global women's health is reported to be high among incoming obstetrics–gynecology residents. However, data regarding number and characteristics of programs offering formal training have not been collected systematically. METHODS: We administered a web-based survey to all program directors of Accreditation Council for Graduate Medical Education-accredited obstetrics–gynecology residency programs and used frequency statistics, Fisher's exact, and χ2 for data analysis. RESULTS: One hundred five of 243 program directors completed the survey (response rate 43.2%). A total of 78.1% report at least one resident participating in a global women's health rotation during the last 5 years. A total of 34.3% offer formal didactics and 27.6% offer a formal rotation in global women's health. Of those programs offering a formal rotation, 44.8% offer predeparture training and 62.1% have formal competency-based objectives. Of all respondents, 43.8% report having at least one faculty member in their department for whom global women's health is a dedicated part of their practice. We identified a nonsignificant trend between having a dedicated global women's health faculty member and a program offering a formal global women's health rotation (relative risk 1.91, 95% confidence interval [CI] 0.97–3.7, P=.06) and a significant association between programs with dedicated global women's health faculty and offering formal global women's health didactics (relative risk 1.84, 95% CI 1.07–3.14, P=.03). The most commonly identified barriers to global women's health training include cost or lack of funding, time constraints for faculty and residents, and educational constraints by Accreditation Council for Graduate Medical Education Residency Review Committee. CONCLUSION: Many obstetrics–gynecology residency programs have experience with a trainee participating in a global women's health rotation but do not offer either formal didactics or a formal rotation. Specific barriers are identified to developing more comprehensive global women's health programs.

Growth of a Simulation Lab: Engaging the Learner Is Key to Success

igh-fidelity simulation (HFS) is an important adjunct to clinical training for eaching health care workers. Currently, the American College of Surgeons as created a multilevel certification for surgical simulation centers. The merican Society of Anesthesiologists Workgroup on Simulation Education as begun to characterize simulation centers for the purposes of “approval” s a site to provide continuing medical education credits. The Accreditation ouncil for Graduate Medical Education Residency Review Committee for mergency Medicine has determined that simulation may serve as an adjunct or the documentation of competencies. The Society for Academic Emerency Medicine’s Simulation Academy has recently made recommendations or accreditation and programmatic benchmarks for emergency medicine imulation. Since 2006, HFS has become increasingly integrated into ndergraduate and graduate medical educational curricula. The primary benefit of using HFS is that learners can practice medical ecision-making and procedures skills on simulated patients in an environent where the risk of error will not harm an actual patient. These echnologies were developed to practice skills without incurring risk: in the ilitary for war games exercises, in the aerospace industry for flight training f pilots and astronauts, and in the nuclear power industry to train personnel. ridging the gap between other industries and medicine, Gaba and DeAnda ioneered the use of simulation in anesthesia to train anesthesiologists. Simulation has also received favorable reviews as an effective model for eaching medicine because of its ability to allow learners of all levels to

A Collaborative Model for Inpatient Training in a Small Pediatric Residency Program

The nationwide decline in pediatric admissions to community hospitals threatens the sustainability of small pediatric residency programs. Little is known about the response of small programs to this challenge. We report on the design and evaluation of an innovative, collaborative model for pediatric inpatient training between an academic community medical center and a children's hospital. We describe the operational, academic, and financial features of the model. Outcome measures include patient volume and subspecialty mix, resident and faculty perceptions as reported in an anonymous survey, and Accreditation Council for Graduate Medical Education Residency Review Committee (RRC) review. In 2003, Albert Einstein Medical Center (Einstein) closed its pediatric inpatient unit and established an independent teaching service at St Christopher's Hospital for Children (St Christopher's) in Philadelphia, Pennsylvania. Under the new model, patient volume and subspecialty mix more than tripled. Einstein residents and faculty identified 5 major strengths: level of responsibility and decision making, caring for medically complex children, quality of teaching, teamwork, and opportunity to participate in academic activities at a children's hospital. St Christopher's leadership reported increased volume, no disruption of their residency program, and no dilution of clinical teaching material. The Einstein program was reaccredited by the RRC in 2006 for 2years and in 2009 for 4years. A collaborative model for inpatient training was successful in maintaining a community hospital-based pediatric residency program. Positive outcomes were documented for the residency program, the parent community hospital, and the collaborating children's hospital.

Impact of Patient Safety Mandates on Medical Education in the United States

Purpose: To determine the impact of the Institute of Medicine recommendations regarding patient safety on medical education resources in the United States. Methods: Medical textbooks representing major disciplines of medicine in the United States were surveyed for patient safety-related keywords, and content presented was quantified. Allopathic medical school curricula in the United States were reviewed for required or elective patient safety coursework using an on-line database, and specific curricula details were described. The Accreditation Council for Graduate Medical Education Residency Review Committee program requirements for accreditation were reviewed, and patient safety content was quantified. Results: Fifteen (54%) of the most recently published textbook editions reviewed contained patient safety information, and 11 of those (73%) specifically cited the Institute of Medicine report. Of the latest edition textbooks with safety keywords present, 67% dedicated entire chapters to patient safety or quality improvement. In 2007 and 2008, 10.4% of the 125 U.S. medical schools reported patient safety content in elective or required courses. All of the Accreditation Council for Graduate Medical Education Residency Review Committee program requirements contained patient safety content confined to systems-based practice and work-hour restrictions. Conclusions: Popular medical textbook content and core medical school and graduate medical education curricula do not adequately reflect the directive to increase patient safety education and reduce medical error.

Assessing Retroperitoneal Lymphadenectomy Experience in United States Urological Residency Programs

Surgical experience is important for the mastery of operative procedures. We evaluated the current United States urological surgical resident training in performing retroperitoneal lymph node dissection. The Accreditation Council for Graduate Medical Education Residency Review Committee for Urology operative log reports from 2000 through 2004 were reviewed. We analyzed resident retroperitoneal lymph node dissection experience as surgeon and first assistant by examining CPT codes for retroperitoneal lymph node dissection (CPT codes 38780, 38570 and 38572). The overall number of retroperitoneal lymph node dissections performed at urological residency training programs has increased from 2000 to 2004 (781 to 924). The average number of retroperitoneal lymph node dissections performed by graduating residents in 2001 and 2004 did not change significantly (3.5 vs 4.0). Half of all graduating urology residents in 2004 had performed 2 or fewer retroperitoneal lymph node dissections as the primary surgeon and 1 or none as the first assistant during their training program. However, a small percentage (10%) of graduating residents completed their respective programs with 9 or more retroperitoneal lymph node dissections as primary surgeon and 4 as first assistant. There were no laparoscopic retroperitoneal lymph node dissections logged by graduating residents from 2001 through 2004. Accreditation Council for Graduate Medical Education data suggest that many urology residents have minimal surgical exposure and training in retroperitoneal lymphadenectomy. These results indicate that alternative strategies should be explored not only to improve the residency training experience but also to determine minimum training criteria.

Teaching Community Pediatrics to Pediatric Residents: Strategic Approaches and Successful Models for Education in Community Health and Child Advocacy

To improve child health at a community level, pediatricians require knowledge and skills that have not been traditionally included in residency training. Recent policy statements from the American Academy of Pediatrics and requirements from Accreditation Council for Graduate Medical Education Residency Review committees emphasizing the importance of community pediatrics training have provided additional incentive for pediatric residency programs to actively explore methods of teaching the principles and promoting the practice of community pediatrics to resident trainees. With a growing number of diverse educational models in various stages of practice or development, common themes and approaches to promote successful teaching of community health and child advocacy can be described. This article defines strategies for 2 critical elements of community pediatrics training, engaging residents and building strong community partnerships, then highlights a number of educational models that illustrate key curricular components and methods. Published results from evaluations of some programs suggest that community pediatrics training of this caliber will cultivate a cadre of pediatricians (academic and community based, generalists and subspecialists, researchers and practitioners) who understand child health in the context of community and have the leadership and collaborative skills to improve the health of children in their communities.

In the footsteps of Abraham Jacobi, an early international medical graduate: contributions of a single South African medical school to US pediatrics.

Abraham Jacobi is generally recognized as the father of pediatrics in the United States. He was born in Germany and graduated from the University of Bonn in 1851 at a time of political turmoil. He was jailed for 2 years for high treason as a result of his activities as a member of a democratic revolutionary group. He was advised to leave the country to escape additional prosecution. After a brief, unsuccessful attempt to set up a practice in England, he made his way to the United States in 1853 during a period when immigrants from Europe were being welcomed with open arms. He established a practice in the Bowery in New York City, which, at the time, housed a quarter of a million German immigrants and hundreds of thousands of others seeking opportunities in the land of the free. His practice grew by leaps and bounds, and he began translating abstracts of articles from Germany dealing with diseases of children as well as publishing in US journals. In 1859, he co-authored the textbook Midwifery and Diseases of Women and Children. His 1860 appointment as Professor in Infantile Pathology and Therapeutics at New York Medical College was one of the first, if not the first, such academic appointment in pediatrics in the United States. In recognition of his clinical skills, his dynamic bedside teaching, and his contributions to the scientific literature, he was offered and accepted a professorial appointment at Columbia in 1870. However, he had to wait 18 years before he was granted faculty voting privileges. Jacobi’s Therapeutics of Infancy and Children was first published in 1895. He remained at Columbia until his death in 1919, having served as president of both the American Pediatric Society (APS) and the American Medical Association.1–3 As the first international … Reprint requests to (G.S.G.) Emeritus Staff Office, Plummer 10, Mayo Clinic, Rochester, MN 55905. E-mail: gilchrist-gerald{at}msn.com

Certificate of added qualification in transplant hepatology

Certificate of added qualification in transplant hepatology