Graduate Medical Education Training Programs Research Articles

Virtual Recruitment: Experiences and Perspectives of Internal Medicine Program Directors

Virtual Recruitment: Experiences and Perspectives of Internal Medicine Program Directors

Training Inadequacies Among Accreditation Council for Graduate Medical Education (ACGME) Surgical Specialties

<h3>Study Objective</h3> To compare general trends in residency training operative experience between Obstetrics & Gynecology (OBGYN), Urology, and General Surgery as determined by ACGME, the governing body that sets the standards for US graduate medical education training programs. <h3>Design</h3> All available ACGME residency case log data was collected. OBGYN data was available from 2002-2019, Urology from 2015-2019, and General Surgery from 1999-2019. Operative experience was assessed, with particular attention to retroperitoneal dissection/ureterolysis and small bowel repair. The mean case numbers reported per resident were compared between the 2 groups using unpaired 2-tailed t tests, with P values < .05 considered significant. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> We reviewed data from approximately 865 ACGME-accredited institutions. Case log data was self-reported by residents as cases were performed each year of their training program. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> The mean number of total gynecologic cases logged by OBGYN residents was 315.48 (SD 46.09). The mean number of cases logged by urology residents was as follows: intestinal diversion 5.25 (SD 1.02); ureteral exposure 207.23 (SD 3.44); gynecologic cases 35.9 (SD 1.22). The mean number of cases logged by general surgery residents was as follows: small bowel repair 14.13 (2.78); ureteral exposure 11.08 (2.54); gynecologic cases 4.19 (1.33). <h3>Conclusion</h3> Notably, both urology and general surgery training programs require cross-specialty exposure and familiarity with retroperitoneal dissection, ureterolysis, bladder and bowel repairs, whereas OBGYN training does not. We propose multiple potential solutions for addressing these inadequacies in surgical training among OBGYN residents, including amending the base ACGME requirements for graduation to include some exposure to retroperitoneal dissection and bowel surgery in order to increase comfort level with operating in these spaces frequently encountered by gynecologic surgeons.

The Baby and the Board: A Step Toward Normalizing Childbearing During Surgical Training.

The Baby and the Board: A Step Toward Normalizing Childbearing During Surgical Training.

A Call for LGBTQ Content in Graduate Medical Education Program Requirements.

A well-developed body of literature demonstrates that lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals experience poorer health outcomes and report worse health care experiences than straight/cisgender individuals. Many reforms since 2010 have addressed the LGBTQ-related education of future health care professionals at the undergraduate medical education (UME) level; however, reforms at the graduate medical education (GME) level are lagging, and new literature suggests that didactic education at the UME level is not enough to prepare future physicians to properly and compassionately care for LGBTQ patients. Recently, the Accreditation Council for Graduate Medical Education (ACGME) implemented a major revision of its Common Program Requirements that requires residents to demonstrate, as a competence, respect and responsiveness to diverse populations. Given these revisions and the ongoing failure of many GME training programs to adequately prepare future physicians to care for LGBTQ patients, the authors argue that now is the time for the ACGME to develop and implement LGBTQ health-related residency requirements. In addition, the authors outline a path by which the academic medical community may develop and implement these requirements.

Placement on COVID-19 Units Does Not Increase Seroconversion Rate of Pediatric Graduate Medical Residents.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated disease COVID-19 (coronavirus disease 2019) has presented graduate medical education (GME) training programs with a unique set of challenges. One of the most pressing is how should hospital systems that rely on graduate medical residents provide appropriate care for patients while protecting trainees. This question is of particular concern as healthcare workers are at high risk of SARS-CoV-2 exposure.Objective: This cross-sectional study sought to assess the impact of hospital COVID-19 patient placement on pediatric graduate medical residents by comparing rates of SARS-CoV-2 seroconversion rates of residents who worked on designated COVID-19 teams and those who did not.Methods: Forty-four pediatric and medicine–pediatric residents at Riley Children's Hospital (Indianapolis, IN) were tested for SARS-CoV-2 immunoglobulin M (IgM) and IgG seroconversion in May 2020 using enzyme-linked immunosorbent assays (Abnova catalog no. KA5826), 2 months after the first known COVID-19 case in Indiana. These residents were divided into two groups: those residents who worked on designated COVID-19 teams, and those who did not. Groups were compared using χ2 or Fisher exact test for categorical variables, and continuous variables were compared using Student t testing.Results: Forty-four of 104 eligible residents participated in this study. Despite high rates of seroconversion, there was no difference in the risk of SARS-CoV-2 seroconversion between residents who worked on designated COVID-19 teams (26% or 8/31) and those who did not (31% or 4/13). Eleven of 44 residents (25%) tested positive for SARS-CoV-2 IgG, whereas only 5/44 (11.4%) tested positive for SARS-CoV-2 IgM, without a detectable difference between exposure groups.Conclusion: We did not observe a difference in SARS-CoV-2 seroconversion between different exposure groups. These data are consistent with growing evidence supporting the efficacy of personal protective equipment. Further population-based research on the role of children in transmitting the SARS-CoV-2 virus is needed to allow for a more evidence-based approach toward managing the COVID-19 pandemic.

Teaching the Teachers With Milestones: Using the ACGME Milestones Model for Professional Development.

Teaching the Teachers With Milestones: Using the ACGME Milestones Model for Professional Development.

Dana-Farber Cancer Institute/Mass General Brigham Fellowship Response to the COVID-19 Pandemic.

The coronavirus disease (COVID)-19 pandemic has affected graduate medical education training programs, including hematology-oncology fellowship programs, both across the United States and abroad. Within the Dana-Farber Cancer Institute/Mass General Brigham hematology-oncology fellowship program, fellowship leadership had to quickly reorganize the program's clinical, educational, and research structure to minimize the risk of COVID-19 spread to our patients and staff, allow fellows to assist in the care of patients with COVID-19, maintain formal didactics despite physical distancing, and ensure the mental and physical well-being of fellows. Following the first wave of patients with COVID-19, we anonymously surveyed the Dana-Farber Cancer Institute/Mass General Brigham first-year fellows to explore their perceptions regarding what the program did well and what could have been improved in the COVID-19 response. In this article, we present the feedback from our fellows and the lessons we learned as a program from this feedback. To our knowledge, this represents the first effort in the hematology-oncology literature to directly assess a hematology-oncology program's overall response to COVID-19 through direct feedback from fellows.

A single center evaluation of applicant experiences in virtual interviews across eight internal medicine subspecialty fellowship programs

ABSTRACT Due to the COVID-19 pandemic, most graduate medical education (GME) training programs conducted virtual interviews for prospective trainees during the 2020–2021 application cycle. Many internal medicine (IM) subspecialty fellowship programs hosted virtual interviews for the first time with little published data to guide best practices. To evaluate how IM subspecialty fellowship applicants perceived the virtual interview day experience. We designed a 38-item questionnaire that was sent via email to applicants in eight IM subspecialty programs at a single tertiary academic medical center (University of California, San Francisco) from September–November, 2020. Seventy-five applicants completed the survey (75/244, 30.7%), including applicants from all eight fellowship programs. Most survey respondents agreed that the length of the virtual interview day (mean = 6.4 hours) was long enough to gather the information they needed (n = 65, 86.7%) and short enough to prevent fatigue (n = 55, 73.3%). Almost all survey respondents agreed that they could adequately assess the clinical experience (n = 71, 97.3%), research opportunities (n = 72, 98.6%), and program culture (n = 68, 93.2%). Of the respondents who attended a virtual educational conference, most agreed it helped to provide a sense of the program’s educational culture (n = 20, 66.7%). Areas for improvement were identified, with some survey respondents reporting that the virtual interview day was too long (n = 11) or that they would have preferred to meet more fellows (n = 10). Survey respondents indicated that the virtual interview was an adequate format to learn about fellowship programs. These findings can inform future virtual interviews for GME training programs.

Sleep medicine exposure offered by United States residency training programs.

To understand the sleep medicine educational exposure among parent specialties of sleep medicine fellowships, we conducted an online survey among Accreditation Council of Graduate Medical Education-approved training programs. Target respondents were program directors of family medicine, otolaryngology, psychiatry, neurology, pediatrics, and pulmonary and critical care training programs in the United States. The survey was based on the Sleep Education Survey, a peer-reviewed, published survey created by the American Academy of Neurology Sleep Section. The modified 18-question survey was emailed via Survey Monkey per published methods totaling 3 requests approximately 1 week apart in January 2017. A total of 1228 programs were contacted, and 479 responses were received for an overall response rate of 39%. Some programs in every specialty group offered a sleep medicine elective or a required rotation to trainees. Pulmonary and critical care and neurology reported the highest percentages of sleep medicine rotation as an option for housestaff (85.7% and 90.8%, respectively), and pulmonary and critical care had the highest portion of programs indicating a rotation requirement (75.4%). Teaching format was a mixture of didactic lectures, sleep center/laboratory exposure, and case reports, with lectures being the most common format. Didactics averaged 4.75 h/y. Few programs reported trainees subsequently pursuing sleep medicine fellowship (<10% produced a fellow over 5 years), and even fewer reported having a trainee who pursued grant funding for sleep-related research over 5 years. There is wide variability and overall low exposure to sleep medicine education among United States "parent" Accreditation Council of Graduate Medical Education training programs whose medical boards offer sleep medicine certification.

Virtual Interviews at Graduate Medical Education Training Programs: Determining Evidence-Based Best Practices

The COVID-19 pandemic has had a profound impact on the nation's health care system, including on graduate medical education (GME) training programs. Traditionally, residency and fellowship training program applications involve in-person interviews conducted on-site, with only a minority of programs offering interviews remotely via a virtual platform. However, in light of the COVID-19 pandemic, it is anticipated that most interviews will be conducted virtually for the 2021 application cycle and possibly beyond. Therefore, GME training programs need to prepare for the transition to virtual interviews using evidence-based practices. At the University of California, San Francisco, a multidisciplinary task force was convened to review existing literature about virtual interviews and determine best practices. This article summarizes these findings, first discussing the advantages and disadvantages of the virtual interview format and then providing evidence-based best practices for GME training programs. Specifically, the authors make the following recommendations: develop a detailed plan for the interview process, consider using standardized interview questions, recognize and respond to potential biases that may be amplified with the virtual interview format, prepare your own trainees for virtual interviews, develop electronic materials and virtual social events to approximate the interview day, and collect data about virtual interviews at your own institution. With adequate preparation, the virtual interview experience can be high yield, positive, and equitable for both applicants and GME training programs.

Simulation-based graduate medical education in MR-guided brachytherapy for cervical cancer

PurposeBrachytherapy is critical for the curative treatment of locally advanced cervical cancer. Although brachytherapy use is declining in the United States (U.S.), novel interstitial or intracavitary applicators and advances in image guidance for applicator placement and treatment planning have allowed for tumor dose escalation while reducing normal tissue toxicity. Recent survey data have suggested insufficient brachytherapy training for radiation oncology trainees in the United States. This study aimed to address these gaps by developing and piloting a simulation-based education (SBE) workshop for MR-guided cervical cancer brachytherapy. Methods and MaterialsAn SBE workshop was developed for graduate medical education (GME) trainees focusing on MR-guided brachytherapy for cervical cancer. Four hands-on stations, simulating aspects of the procedure, were led by a team of gynecological brachytherapy experts. The learners were radiation oncology residents and fellows in a U.S. GME training program. The primary outcome was feasibility, assessed by completion of the workshop within the time constraints of the curriculum. Learners completed preworkshop and postworkshop surveys to provide information on efficacy. ResultsThe workshop was successfully completed in a 1-h block of GME didactic time. Ten trainees completed all four stations, and all completed preworkshop and postworkshop surveys, which showed improvements in knowledge and technical proficiency. Feedback was positive, and trainees requested additional learning opportunities. ConclusionsThis study showed that GME-focused SBE in MR-guided cervical cancer brachytherapy was feasible. SBE provided a nonclinical environment in which to practice aspects of MR-guided brachytherapy. Ongoing work includes collaboration with other U.S. institutions. Future studies should focus on international adaptation.

Planning for Virtual Interviews: Residency Recruitment During a Pandemic.

Recent directives from The Coalition for Physician Accountability, Association of Pediatric Program Directors, Council on Medical Student Education in Pediatrics, and Association of Medical School Pediatric Department Chairs recommend virtual recruitment for graduate medical education (GME) programs this year. Driven by concerns for safety, equity and financial pressures, virtual interviewing will require a thoughtful approach to achieve the desired goals of recruitment. Drawing on the fields of communication and human resources management, we examine the potential effects of web-based interviews on communication through the lens of several communication theories: media richness, media naturalness, and signaling. We then review the literature on virtual interviews in GME training programs. Finally, we will provide best practices compiled from the literature

Expansion of Surgical Graduate Medical Education Training Programs: A Return on Investment Analysis

BackgroundThe productivity of surgical departments is limited by the staffing of attending surgeons as well as surgical residents. Despite ongoing surgeon shortages, many health care organizations have been reluctant to expand training programs because of concerns about cost. We sought to determine the return on investment for the expansion of surgical training programs within our health system. MethodsThis study was completed as a retrospective review comparing two independent surgical departments at separate hospitals within a single integrated health system, including complete fiscal information from 2012 to 2019. Hospital A is a 594-bed hospital with large growth in its graduate surgical training programs over the study's period, whereas Hospital B is a 320-bed hospital where there was no expansion in surgical education initiatives. Case volumes, the number of full-time employees (FTE), and revenue data were obtained from our health systems business office. The number of surgical trainees, including general surgery residents and vascular surgery fellows, was provided by our office of Graduate Medical Education. The average yearly net revenue per surgeon was calculated for each training program and hospital location. ResultsOur results indicate a positive association between the number of surgical trainees and departmental net revenue, as well as the annual revenue generated per physician FTE. Each additional ancillary provider per physician FTE resulted in a positive impact of $112,552-$264,003 (R2 of 0.69 to 0.051). ConclusionsRegardless of hospital location or surgical specialty, our results demonstrate a positive association between the average net revenue generated per surgeon and the number of surgical trainees supporting the department. These findings are novel and provide evidence of a positive return on investment when surgical training programs are expanded.

The Relationship Between Residents' Perceptions of Residency Program Leadership Team Behaviors and Resident Burnout and Satisfaction.

To explore the relationship between residents' perceptions of residency program leadership team behaviors and resident burnout and satisfaction. In February 2019, the authors surveyed all residents across the 77 graduate medical education training programs at Mayo Clinic's multiple sites. Survey items measured residents' perceptions of program director and associate program director behaviors (using a composite residency program leadership team score), resident burnout, and resident satisfaction with the program and organization. Multivariable logistic regression was performed to evaluate relationships between these variables at the individual resident (adjusting for age, sex, postgraduate training year, program location, and specialty) and program (including only programs with at least 5 respondents) levels. Of the 1,146 residents surveyed, 762 (66.5%) responded. At the individual resident level, higher composite leadership team scores were associated with lower emotional exhaustion and depersonalization and higher overall satisfaction with the residency program and organization (all P < .001). In adjusted logistic regression models, each 1-point gain in composite leadership team score was associated with 9% lower odds of burnout, 20% higher odds of program satisfaction, and 19% higher odds of satisfaction with the organization (all P < .001). At the residency program level, higher mean composite leadership team scores were associated with a lower rate of burnout (r = -0.35, P = .03) and higher program and organization satisfaction (r = 0.67 and 0.74, respectively, both P < .001). The behaviors of residency program leadership teams influence residents' burnout and satisfaction. Additional studies are needed to determine if leadership training results in improved resident well-being and satisfaction.

DERMS DO 5: A Proposed Curriculum for Dermatologic Training in 5 Osteopathic Competencies.

Dermatology programs seeking osteopathic recognition under the new single graduate medical education (GME) accreditation system are required to demonstrate osteopathic competencies within their teaching curriculum. Although the Accreditation Council for Graduate Medical Education has put forth guidelines to obtain osteopathic recognition, ambiguity lingers regarding specialty-specific content that would fulfill these requirements. To date, there are no set curriculum guidelines addressing osteopathic principles within the field of dermatology. In this article, we review the existing literature surrounding key competencies and propose a dermatology-focused educational model, "DERMS (Direct, Empathy, Restore, Mobilize, Senses) DO 5," to encourage the teaching of osteopathic competencies within GME training programs. Our proposed curriculum model addresses the 5 osteopathic care models and applications of osteopathic manipulative treatment within the realistic realm of dermatology.

Improving Graduate Medical Education Through Faculty Empowerment Instead of Detailed Guidelines.

Calls for improvement and reform in graduate medical education (GME) have led to more detail in educational and curricular guidelines. The current level of detail in curriculum guidelines for GME training programs is high, encompassing, for example, competency frameworks, entrustable professional activities, and milestones. In addition, faculty must employ an increasing number of assessment tools and elaborate portfolio systems for their residents. It is questionable whether any further increase in curriculum detail and assessment formats leads to better GME programs. Focusing on this type of system development may even lead to less engaged faculty if faculty are not encouraged to use their own professional judgment and creativity for teaching residents. Therefore, faculty members must be empowered to engage in curricular innovation, since system development alone will not result in better training programs. Raising faculty members' awareness of their virtues and value as teachers and involving them in the debate about how GME can be enhanced might increase their engagement in resident training.

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.

Program Administrator Burnout in Graduate Medical Education: a Longitudinal Study.

Little is known about the level of burnout among program administrators (PAs) in medical education and its impact on the trainee environment. To investigate variations in burnout levels over a 1-year period among a national cohort of PAs and examine any associations between perceived support and isolation. A 1-year longitudinal study conducted to assess burnout levels among PAs across the USA. The Copenhagen Burnout Inventory (score range, 0-100) was used to measure burnout over one academic year (July 2017-June 2018). The generalized estimating equations model was used to measure changes in burnout levels from the start of the academic year. To explore the differences in burnout scores across question response levels, a one-way ANOVA test was utilized and reported as least squares means ± SD. Individuals who self-identified as PAs in a graduate medical education training program. Among the 1084 persons nationwide who expressed interest, 904 (83%) completed the baseline survey; 29 of the 42 (69%) local administrators completed the survey. "Clients" defined as interns, residents/fellows, and medical students. Change in burnout score using the validated tool. Hypothesis formulated prior to data collection. Among the 931 participants, the 3rd quarter (March 2018) marked the lowest average personal burnout score (change from the start of academic year, - 3.67; p < 0.001, 95% CI - 5.77 to - 1.58) and work-related burnout score (change, - 3.03; p < 0.001, 95% CI - 5.01 to - 1.06). Client-related burnout was the lowest in September 2017 (change, - 1.46; p = 0.491; 95% CI - 3.54 to 0.62). June 2018: those who strongly agreed to feeling isolated in their current position had an increased personal (69.1 ± 18.4 SD), work-related (72.5 ± 20.8 SD), and client-related (42.3 ± 23.7 SD) burnout score. PA burnout levels fluctuate over the academic year and are shown to increase as feelings of isolation grow.

A Framework for Inclusive Graduate Medical Education Recruitment Strategies: Meeting the ACGME Standard for a Diverse and Inclusive Workforce.

To help address health care disparities and promote higher-quality, culturally sensitive care in the United States, the Accreditation Council for Graduate Medical Education and other governing bodies propose cultivating a more diverse physician workforce. In addition, improved training and patient outcomes have been demonstrated for diverse care teams. However, prioritizing graduate medical education (GME) diversity and inclusion efforts can be challenging and unidimensional diversity initiatives typically result in failure.Little literature exists regarding actionable steps to promote diversity in GME. Building on existing literature and the authors' experiences at different institutions, the authors propose a 5-point inclusive recruitment framework for diversifying GME training programs. This article details each of the 5 steps of the framework, which begins with strong institutional support by setting diversity as a priority. Forming a cycle, the other 4 steps are seeking out candidates, implementing inclusive recruitment practices, investing in trainee success, and building the pipeline. Practical strategies for each step and recommendations for measurable outcomes for continued support for this work are provided. The proposed framework may better equip colleagues and leaders in academic medicine to prioritize and effectively promote diversity and inclusion in GME at their respective institutions.

Developing Graduate Medical Education Partnerships in American Indian/Alaska Native Communities.

Developing Graduate Medical Education Partnerships in American Indian/Alaska Native Communities.