Graduate Medical Education Training Programs Research Articles

The State of Mastery Learning in Pediatric Graduate Medical Education: A Scoping Review.

The aim of this study was to characterize the state of mastery learning interventions, identify gaps in current approaches, and highlight opportunities to improve the rigor of ML in pediatric graduate medical education (GME) training programs. In October 2022, we searched Ovid, PubMed, Scopus, and ERIC. Two reviewers independently screened 165 citations and reviewed the full manuscripts of 20 studies. We developed a modified data abstraction tool based on the Recommendations for Reporting Mastery Education Research in Medicine (ReMERM) guidelines and extracted variables related to mastery learning curricular implementation and design and learner assessment. Eleven studies of ML approaches within pediatric GME were included in the full review, with over half published after 2020. ML interventions were used to teach both simple and complex tasks, often in heterogeneous learner groups. While deliberate practice and feedback were consistently reported features of ML in pediatrics, opportunities for improvement include clearly defining mastery, conducting learning over multiple sessions, presenting sufficient validity evidence for assessment tools, adhering to rigorous standard setting processes, and reporting psychometric data appropriate for ML. In pediatric GME, ML approaches are in their infancy. By addressing common shortcomings in the existing literature, future efforts can improve the rigor of ML in pediatric training programs and its impact on learners and patients.

Assessment of Quality Improvement and Patient Safety Resources, including Event Reporting Systems, in Graduate Medical Education Training Programs - An Institutional National Survey

Background Quality improvement (QI) and patient safety (PS) education were requirements implemented in 2017 by the Accreditation Council for Graduate Medical Education (ACGME) for residents and fellows. Trainees must receive training and experience in QI processes, including an understanding of healthcare disparities, but how training and experience occur remains largely unknown. Our study aimed to determine how institutions have integrated these requirements into medical education. Methods A Google Forms survey was emailed to the Designated Institutional Officials (DIOs) of 650 United States’ institutions with ACGME accredited programs in September 2021. The survey consisted of 34 multiple choice questions related to QI and PS parameters and the event reporting system (ERS); a Likert scale was used. Results More than half (n=392) of the emails were undeliverable, leaving only 258 possible responders; 51 responses were received, and all but one met the inclusion criteria of having at least one training program, which translated to a response rate of 19% (=50/257). The survey found that while 90% of institutions had an institutional QI/PS Committee, only 30% of these institutions also had a Graduate Medical Education-specific QI/PS Committee as well. Most institutions provided QI (88%) or PS training (94%), but only 71% and 83%, respectively, had mandatory training. Most institutions utilized an ERS (96%). While one of the less common methods was education on the ERS, approximately two-thirds of responding DIOs believed that by providing education on the ERS, resident/fellow participation in event reporting would improve, as well as contribute to their total education. Conclusions Further ERS education is warranted to encourage resident/fellow participation to develop various protocols related to QI and PS parameters.

An Ideal System of Assessment to Support Competency-Based Graduate Medical Education: Key Attributes and Proposed Next Steps

Competency-based medical education (CBME) is the future of medical education and relies heavily on high quality assessment. However, the current assessment practices employed by many general surgery graduate medical education training programs are subpar. Assessments often lack reliability and validity evidence, have low faculty engagement, and differ from program to program. Given the importance of assessment in CBME, it is critical that we build a better assessment system for measuring trainee competency. We propose that an ideal system of assessment is standardized, evidence-based, comprehensive, integrated, and continuously improving. In this article, we explore these characteristics and propose next steps to achieve such a system of assessment in general surgery.

Critical Care Ultrasound Competency of Fellows and Faculty in Pulmonary and Critical Care Medicine: A Nationwide Survey

Purpose: Competency assessment standards for Critical Care Ultrasonography (CCUS) for Graduate Medical Education (GME) trainees in pulmonary/critical care medicine (PCCM) fellowship programs are lacking. We sought to answer the following research questions: How are PCCM fellows and teaching faculty assessed for CCUS competency? Which CCUS teaching methods are perceived as most effective by program directors (PDs) and fellows. Methods: Cross-sectional, nationwide, electronic survey of PCCM PDs and fellows in accredited GME training programs. Results: PDs and fellows both reported the highest rates of fellow competence to use CCUS for invasive procedural guidance, but lower rates for assessment of deep vein thrombosis and abdominal organs. 54% and 90% of PDs reported never assessing fellows or teaching faculty for CCUS competency, respectively. PDs and fellows perceived hands-on workshops and directly supervised CCUS exams as more effective learning methods than unsupervised CCUS archival with subsequent review and self-directed learning. Conclusions: There is substantial variation in CCUS competency assessment among PCCM fellows and teaching faculty nationwide. The majority of training programs do not formally assess fellows or teaching faculty for CCUS competence. Guidelines are needed to formulate standardized competency assessment tools for PCCM fellowship programs.

Flourishing and the Prioritization of Workplace Elements in General Surgery Residents

IntroductionTo explore and begin to operationalize workplace elements that influence general surgery (GS) resident wellbeing. Tailoring workplace wellbeing interventions is critical to their success. Occupational science has revealed that a person-centered approach to identifying positive and negative workplace influences can inform tailoring while accounting for individual differences. To our knowledge, this approach has not been applied to the surgical training environment. MethodsA national sample of GS residents from 16 Accreditation Council for Graduate Medical Education training programs ranked the importance of workplace elements via an anonymous survey. Latent profile analysis was performed to identify shared patterns of workplace element prioritization and their relation to levels of flourishing, a measure of global wellbeing. ResultsGS trainee respondents (n = 300, 34% response rate – average for studies with this sample population) expressed a hierarchy of workplace element importance which differed by gender and race. “Skills to manage stress” and “a team you feel a part of” were prioritized higher by non-males than males. Residents of color and residents underrepresented in medicine, respectively, prioritized “recognition of work/effort” and “skills to manage stress” more than White and overrepresented in medicine residents. Flourishing prevalence varied by 40% with small differences in the specific profile of workplace element prioritization. ConclusionsDifferences in prioritization of workplace elements reveal subtle but important differences that may guide the design of wellbeing interventions for different populations within surgery.

It Takes a Village: Optimal Graduate Medical Education Requires a Deliberately Developmental Organization.

Coaching is proposed as a means of improving the learning culture of medicine. By fostering trusting teacher-learner relationships, learners are encouraged to embrace feedback and make the most of failure. This paper posits that a cultural shift is necessary to fully harness the potential of coaching in graduate medical education. We introduce the deliberately developmental organization framework, a conceptual model focusing on three core dimensions: developmental communities, developmental aspirations, and developmental practices. These dimensions broaden the scope of coaching interactions. Implementing this organizational change within graduate medical education might be challenging, yet we argue that embracing deliberately developmental principles can embed coaching into everyday interactions and foster a culture in which discussing failure to maximize learning becomes acceptable. By applying the dimensions of developmental communities, aspirations, and practices, we present a six-principle roadmap towards transforming graduate medical education training programs into deliberately developmental organizations.

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.

Resident Research Mentoring Teams: A Support Program to Increase Resident Research Productivity.

Scholarly activity is a requirement for most graduate medical education training programs. However, barriers exist for residents to accomplish projects. To evaluate the correlation between a resident research mentoring team (RRMT) program and meeting presentations and publications of resident research projects. We further plan to report feasibility of the RRMT. We performed a before-and-after study of meeting presentations and/or publication of resident research projects before institution of the RRMT (2004-2011) and post-RRMT implementation (2016-2019). The RRMT is a diverse group of faculty, statisticians, and research staff who meet regularly with residents to provide guidance for their research studies. It is part of overall research support from the department, which also includes biostatistics, database and regulatory help, travel funds, and project budget funds. Data on meeting presentations and publications were collected from Google Scholar, PubMed, Scopus, and the IUPUI ScholarWorks institutional repository, using resident and faculty names and titles of projects. Comparisons of pre- and post-RRMT groups were made. Seventy-four residents were in the pre-RRMT group and 40 were in the post-RRMT group. Post-RRMT residents published, presented, and combined published or presented their projects more frequently than those in pre-RRMT group (57.5% vs 28.4%, P=.002; 50% vs 16.2%, P=.001; 67.5% vs 37.8%, P=.002). Controlling for winning a Research Day award and pursuing a fellowship, being in the post-RRMT group was independently associated with presentation or publication of the resident research project (OR 3.62, 95% CI 1.57-8.83). Support of resident scholarly activity, such as thorough implementation of a program like the RRMT, is associated with increased presentations and publications of research projects.

Analysis of Racial and Gender Distribution of US MD Graduates Entering Into General Surgery and Surgical Subspecialties Residencies: The Need for Effective & Sustainable Diversity, Equity, and Inclusion Strategies

IntroductionWe aim to investigate disparities & inequities based on race, sex, graduating age, and the number of peer-reviewed publications among allopathic U.S. Doctor of Medicine graduates who reported entering a surgical training program over a span of 5 y. MethodsA retrospective cohort analysis of the Association of American Medical Colleges student records system and Electronic Residency Application Service for graduates entering a surgical specialty residency during graduate medical education training cycles 2015-2020. ResultsAfrican American, Asian, and Hispanic applicants each accounted for less than 1% of graduates who reported entering a surgical training program. Asians (OR = 0.58, P = 0.01) and those identifying as other races (OR = 0.74, P = 0.01) were significantly less likely to enter a surgical subspecialty when compared to Caucasians. Orthopedic surgery contained the lowest proportion of minorities; African Americans 0.5% (n = 18), Asians 0.3% (n = 11), Hispanics 0.1% (n = 4), and others with 2% (n = 68). Females who reported entering Orthopedic surgery training represented the smallest female population in surgical specialties (17%, n = 527). The number of peer-reviewed publications was significantly associated with male sex (β = 0.28, P < 0.01), age between 30 and 32 at graduation (β = 1.76, P < 0.01), and identification as other races (β = 1.53, P < 0.01). ConclusionsRacial minorities represented only 5.1% of graduates who reported entering a surgical specialty graduate medical education training program. Minority races and females were significantly less likely to enter a surgical subspecialty training program compared to Caucasian graduates and males, especially in orthopedic surgery. Implementation of specialty-specific programs and diversity, equity, and inclusion departments that promote mentorship and guidance toward residency programs is needed to combat continued race and sex disparities.

Trainee Physician Milestone Ratings and Patient Complaints in Early Posttraining Practice

Evaluation of trainees in graduate medical education training programs using Milestones has been in place since 2013. It is not known whether trainees who have lower ratings during the last year of training go on to have concerns related to interactions with patients in posttraining practice. To investigate the association between resident Milestone ratings and posttraining patient complaints. This retrospective cohort study included physicians who completed Accreditation Council for Graduate Medical Education (ACGME)-accredited programs between July 1, 2015, and June 30, 2019, and worked at a site that participated in the national Patient Advocacy Reporting System (PARS) program for at least 1 year. Milestone ratings from ACGME training programs and patient complaint data from PARS were collected. Data analysis was conducted from March 2022 to February 2023. Lowest professionalism (P) and interpersonal and communication skills (ICS) Milestones ratings 6 months prior to the end of training. PARS year 1 index scores, based on recency and severity of complaints. The cohort included 9340 physicians with median (IQR) age of 33 (31-35) years; 4516 (48.4%) were women physicians. Overall, 7001 (75.0%) had a PARS year 1 index score of 0, 2023 (21.7%) had a score of 1 to 20 (moderate), and 316 (3.4%) had a score of 21 or greater (high). Among physicians in the lowest Milestones group, 34 of 716 (4.7%) had high PARS year 1 index scores, while 105 of 3617 (2.9%) with Milestone ratings of 4.0 (proficient), had high PARS year 1 index scores. In a multivariable ordinal regression model, physicians in the 2 lowest Milestones rating groups (0-2.5 and 3.0-3.5) were statistically significantly more likely to have higher PARS year 1 index scores than the reference group with Milestones ratings of 4.0 (0-2.5 group: odds ratio, 1.2 [95% CI, 1.0-1.5]; 3.0-3.5 group: odds ratio, 1.2 [95% CI, 1.1-1.3]). In this study, trainees with low Milestone ratings in P and ICS near the end of residency were at increased risk for patient complaints in their early posttraining independent physician practice. Trainees with lower Milestone ratings in P and ICS may need more support during graduate medical education training or in the early part of their posttraining practice career.

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.

The Role of Graduate Medical Education in the Fight Against Health Misinformation.

The Role of Graduate Medical Education in the Fight Against Health Misinformation.

Developing Military Doctors: An Institutional Approach to Medical Force Readiness in Graduate Medical Education.

Military physicians are required to not only meet civilian accreditation standards upon completion of their Graduate Medical Education (GME) training programs but also be proficient in the military-unique aspects of their field, including medical care in austere environments and management of combat casualties. They must also be familiar with the administrative and leadership aspects of military medicine, which are often absent from the training curriculum. The San Antonio Uniformed Services Health Education Consortium Military Readiness Committee, by incorporating questions of military relevance into each GME program's mandatory Annual Program Evaluation, identified curricular gaps upon which military readiness training objectives and opportunities were developed. These activities included a lecture series on the sustainment of medical and military readiness, an interactive procedural skills training event, trainee involvement in operational pre-deployment exercises, and the development of an elective operational rotation in Honduras. The Military Readiness Committee provides a model for other military GME institutions to develop training goals and opportunities to strengthen the preparedness of their trainees for military service.

The Have and Have Nots: Characteristics of Hospitals With a Pediatric Palliative Care Program.

Pediatric palliative care (PPC) is a board-certified subspecialty1 that provides expert medical management to patients with serious illness. PPC improves pain and nonpain symptoms,2,3 optimizes communication and goal concordant care,4,5 and improves patients’ quality of life.6 Still, PPC programs are neither ubiquitous nor uniformly staffed throughout the United States.In this issue of Pediatrics, Weaver et al7 highlights characteristics of hospitals with a pediatric palliative care program. Past studies have investigated PPC program prevalence, team composition, and services offered; however, these studies have relied on self-reporting.8,9 This study is novel because it used The Children’s Hospital Association Annual Benchmark Report to examine PPC program prevalence and the characteristics of hospitals supporting these programs. As such, we now understand that an unacceptable 20% of pediatric hospitals lack a PPC program.This finding could be perceived as the study’s primary takeaway. Yet, its real impact is its elucidation of differences between hospitals that do and do not support a PPC program. Weaver et al grouped characteristics into operational, missional, educational, and financial categories to give the results structure. They found that larger hospitals with higher acuity are more likely to have PPC programs. Hospitals with pediatric-friendly home hospices and/or respite care in their community are more likely to have a PPC program. Results also highlight that hospitals with Joint Commission accreditation or Magnet Nursing Designation, Accreditation Council for Graduate Medical Education training programs, or an Accountable Care Organization are statistically more likely to have a PPC program.This constellation of hospital characteristics suggests that they and their communities have the financial health to optimize all aspects of pediatric health care. Hospital size, visit volumes, patient acuity, and possessing an Accountable Care Organization are all drivers of financial health. Additionally, these hospitals can and do support the costly endeavor of staffing, training, and maintaining Magnet Nursing Designation, Joint Commission accreditation, and Accreditation Council for Graduate Medical Education training programs. They also support a PPC program, which typically cannot cover its operational costs, let alone generate revenue because of how reimbursement structures currently exist. PPC program existence and growth require operational and philanthropic financial support.Hospital financial health may also be a substantial factor why 20% of pediatric hospitals do not have a PPC program. PPC has now been a valuable subspecialty for decades. It is not novel nor is it limited only to end-of-life care and thus of limited utility. These traditional reasons for the lack of a PPC program are no longer relevant. Rather, this study provides data supporting the belief that finances now determine the presence and likely growth of a PPC program within a hospital.This study’s true “pearl” is the unveiling of this disparity. Moreover, without national metrics or other incentives, hospitals lack the motivation and likely will not have or grow PPC programs unless new motivations or mandates emerge. This study is a call to action for all pediatricians to join PPC providers who have long advocated for change. We need state and national PPC payment models to ensure all hospitals can afford programming. We also need national requirements on the presence and staffing requirements of PPC within hospitals to give health systems a reason to accept the costs of supporting a PPC program. Only then will the thousands of children in need of PPC have access to it.10

Veterans Affairs Graduate Medical Education Expansion Addresses U.S. Physician Workforce Needs.

The United States has a well-trained, highly specialized physician workforce yet continues to have care gaps across the nation. Deficiencies in primary care and mental health specialties are most frequently cited, though critical shortages in multiple disciplines exist, particularly in rural areas. Sponsoring institutions of physician graduate medical education (GME) have created rural residency tracks with modest federal funding and minimal incentives, though efforts targeting shortages in these specialties and geographic locations have been limited. In response to access problems in the Veterans Health Administration, Department of Veterans Affairs (VA), the second largest federal funder of GME with the most expansive clinical education platform, Congress passed the Veterans Access, Choice, and Accountability Act of 2014. This act directed the VA and provided funding to establish 1,500 new positions, a 15% expansion of VA-funded positions at the time. Priority for position selection was given to primary care, mental health, and any other specialties the secretary of VA determined appropriate. Importantly, priority was also given to VA facilities with documented physician shortages, those that did not have GME training programs, those in communities with high concentrations of veterans, and those in health profession shortage areas. Many rural facilities match this profile and were targeted for this initiative. At the conclusion of fiscal year 2021, 1,490 positions had been authorized, and 21 of the 22 VA medical centers previously without GME activity had added residents or were planning to soon. Of the authorized positions, 42% are in primary care, 24% in mental health, and 34% in critically needed additional specialties. Targeted GME expansion in the VA, the largest integrated health care system in the nation, has been successful in addressing physician GME training that aligns with physician shortages and may serve as a model to address national physician specialty and geographic workforce needs.

The Best Laid Plans? A Qualitative Investigation of How Resident Physicians Plan Their Learning.

Adaptive expertise (AE) has been identified as a critical trait to cultivate in future physicians. The 4-phase master adaptive learner (MAL) conceptual model describes the learning skills and behaviors necessary to develop AE. Though prior work has elucidated skills and behaviors used by MALs in the initial planning phase of learning, most resident learners are not thought to be MALs. In this study, the authors investigated how these majority "typical" learners develop AE by exploring the strategies they used in the planning phase of learning. Participants were resident physicians at graduate medical education (GME) training programs located at 4 academic medical centers in the United States. Participants participated in semistructured individual interviews in 2021, and interview transcripts were analyzed using constant comparative analysis of grounded theory. Fourteen subjects representing 8 specialties were interviewed, generating 152 pages of transcripts for analysis. Three themes were identified: "Typical" learners were challenged by the transition from structured undergraduate medical education learning to less-structured GME learning, lacked necessary skills to easily navigate this transition, and relied on trial and error to develop their learning skills. Participants used trial and error to find learning strategies to help them manage the systemic challenges encountered when transitioning from medical school to residency. The success (or failure) of these efforts was tied to learners' efficacy with the self-regulated learning concepts of agency, metacognitive goal setting, and motivation. A conceptual model is provided to describe the impact of these factors on residents' ability to be adaptive learners, and actionable recommendations are provided to help educators' efforts to foster adaptive learning skills and behaviors. These findings also provided valuable evidence of validity of the MAL model that has thus far been lacking.

Cultural Competency Curricula in US Graduate Medical Education: A Scoping Review.

Cultural competency training provides participants with knowledge and skills to improve cross-cultural communication and is required for all graduate medical education (GME) training programs. The authors sought to determine what cultural competency curricula exist specifically in GME. In April 2020, the authors performed a scoping review of the literature using a multidatabase (PubMed, Ovid, MedEdPORTAL) search strategy that included keywords relevant to GME and cultural competency. The authors extracted descriptive data about the structure, implementation, and analysis of cultural competency curricula and analyzed these data for trends. Sixty-seven articles met criteria for inclusion, of which 61 (91%) were focused exclusively on residents. The most commonly included specialties were psychiatry (n=19, 28.4%), internal medicine (n=16, 23.9%), and pediatrics (n=15, 22.4%). The shortest intervention was a 30-minute online module, while the longest contained didactics, electives, and mentoring programs that spanned the entirety of residency training (4 years). The sample sizes of included studies ranged from 6 to 833 participants. Eight (11.9%) studies utilized OSCEs as assessment tools, while 17 (25.4%) conducted semi-structured interviews or focus groups. Four common themes were unique interventions, retention of learning, trainee evaluation of curricula, and resources required for implementation. Wide variation exists in the design, implementation, and evaluation of cultural competency curricula for residents and fellows.

Society for Maternal-Fetal Medicine Special Statement: Commitment to excellence in obstetrical care, research, and education for people with diverse sexual and gender identities

The Society for Maternal-Fetal Medicine seeks to ensure excellence in obstetrical outcomes for all people who desire or experience pregnancy, including people with diverse sexual and gender identities. The Society commits to the use of practices in clinical and research settings that affirm the sexual and gender identities of all people, encourages the development of undergraduate and graduate medical education curricula and training programs that address diverse pathways to pregnancy and support clinicians with diverse sexual and gender identities, and promotes the use of inclusive language that is accurate and, when possible, specific.

Con: Interviews for Adult Cardiothoracic Anesthesiology Fellowship Program: In Favor of the In-Person Interview

SINCE ITS accreditation in 2006, the Adult Cardiothoracic Anesthesiology fellowship has become extremely competitive, as revealed by the increased number of applicants. 1 Capdeville M Hargrave J Patel PA et al. Contemporary challenges for fellowship training in adult cardiothoracic anesthesiology: Perspectives from program directors around the United States. J Cardiothorac Vasc Anesth. 2020; 34: 2047-2059 Google Scholar Candidates submit applications online through the SF (San Francisco) Match to programs of interest. 2 Feinman JW Roberts ML Al-Ghofaily L et al. the fellowship experience in adult cardiothoracic anesthesiology—strategies for applicants and fellows to navigate the coronavirus crisis. J Cardiothorac Vasc Anesth. 2020; 34: 2561-2565 Google Scholar Fellowship programs invest substantial time, labor, and resources to select a subset of applicants for interview, 3 Haas MRC He S Sternberg K et al. Reimagining residency selection: Part 1-a practical guide to recruitment in the post-COVID-19 era. J Grad Med Educ. 2020; 12: 539-544 Google Scholar ,4 Sternberg K Jordan J Haas MRC et al. Reimagining residency selection: Part 2—a practical guide to interviewing in the post-COVID-19 era. J Grad Med Educ. 2020; 12: 545-549 Google Scholar which plays a paramount role in the final selection process. 5 Huppert LA Hsiao EC Cho KC et al. Virtual interviews at graduate medical education training programs: Determining evidence-based best practices. Acad Med. 2021; 96: 1137-1145 Google Scholar It also provides a platform for sharing information between candidates and fellowship programs, showcasing their own strengths while evaluating each other. 6 Joshi A Bloom DA Spencer A et al. Video interviewing: A review and recommendations for implementation in the era of COVID-19 and beyond. Acad Radiol. 2020; 27: 1316-1322 Google Scholar This information helps guide their decision-making. 4 Sternberg K Jordan J Haas MRC et al. Reimagining residency selection: Part 2—a practical guide to interviewing in the post-COVID-19 era. J Grad Med Educ. 2020; 12: 545-549 Google Scholar

Determinants of research productivity during postgraduate medical education: a structured review

BackgroundAlthough formal participation in research is an integral and often mandatory component of clinical training programs, resulting productivity is highly variable. The objective of this review was to identify determinants of successful research performance among graduate medical education trainees.MethodsA structured review of the published literature was performed by searching PubMed, CINAHL, and EMBASE from inception through to 7 April, 2021. Articles examining graduate medical education trainee research productivity evidenced by publications in peer-reviewed journals were included.ResultsEighty-five articles were included of which most (66; 78%) were reported from the USA or Canada (10; 12%). A wide range of disciplines were represented with the most common being general surgery, internal medicine, orthopedic surgery, and pediatrics. Themes (number of reports) included trainee characteristics (n = 24), project characteristics (n = 8), mentoring/supervision (n = 11), and programmatic aspects (n = 57). Although variable results were observed, research productivity tended to be higher with prior research experience, later years of training, male gender, and pursuit of a postgraduate degree. Few project related aspects of success were identified. Trainee publication was associated with mentors with higher rank, publication productivity, and supportive academic environments. Training programs with organised programs/curricula including protection of time for research were associated with increased productivity as were provision of incentives or rewards but not mandatory requirements.ConclusionThis review identifies several trainee characteristics, project and mentor aspects, and programmatic aspects associated with increased productivity that may serve as a useful resource for trainees and graduate medical education training programs.