Graduate Medical Education Training Research Articles

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.

Virtual Recruitment: Experiences and Perspectives of Internal Medicine Program Directors

Virtual Recruitment: Experiences and Perspectives of Internal Medicine Program Directors

Is There a Single Solution for the Dual-Degree Dilemma?

Although the oral and maxillofacial surgery (OMS) residency is accredited by the Commission on Dental Accreditation (CODA), dual-degree surgeons often practice under the auspices of both Doctor of Dental Surgery/Doctor of Dental Medicine and doctor of medicine (MD) licensures and therefore face additional requirements to receive and maintain their credentialing. For some time, every state accepted 1 year of recognized postgraduate Accreditation Council for Graduate Medical Education (ACGME) training to meet medical licensure requirements.

Pain and Addiction: The Distribution of Supply and Demand During the Opioid Epidemic.

A considerable portion of the opioid epidemic has been driven by physician-prescribed opioids for pain management. Thus, policies to address the epidemic must consider not only the resources available to manage addiction but those to manage acute and chronic pain as well. For the period 2017 to 2019, the authors sought to describe the distribution, by state, of indicators of the supply of resources to address pain and addiction (graduate medical education subspecialty training in pain and addiction, number of board-certified pain and addiction specialists, number of opioid treatment centers), as well as indicators of the demands for those services (opioid prescriptions, opioid overdose deaths), to identify states that seem to suffer from a mismatch between supply and demand. It was also sought to examine the relationships between these treatment resources and indicators of the magnitude of the opioid epidemic, through an exploratory correlational analysis. The resulting model may inform public policy by suggesting areas in need of greater graduate medical education training and more pain and addiction specialists and by suggesting hypotheses about the impact of these specialists on outcome that are worthy of further study.

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.

While You Don't See Color, I See Bias: Identifying Barriers in Access to Graduate Medical Education Training.

There is a need to acknowledge and address issues of implicit and explicit bias within medical education. These biases can impact standardized test questions and scores, evaluations of clinical performance, and subsequent letters of recommendation, all of which can affect the selection of diverse candidates advancing through medical training. Biased behavior toward trainees can negatively impact their learning environment and career trajectory. This article outlines key definitions related to bias and discusses the ways in which bias potentially impacts selection and entry into Pulmonary and Critical Care Medicine fellowship training. Finally, we will describe some ways to mitigate bias within the fellowship selection process and training programs.

Development of a Cadaver Laboratory Curriculum for Interventional Spine Procedures for Physical Medicine and Rehabilitation Residents.

There is no standardized curriculum for teaching interventional spine procedures during residency. The objective of this protocol was to share a curriculum using a cadaver laboratory for teaching Physical Medicine and Rehabilitation residents interventional spine procedures, which can be an effective and safe medium to train residents. This protocol provides a checklist that can guide the residents while they are in the cadaver laboratory with a focus on some of the most common lumbar procedures. Twelve physical medicine and rehabilitation resident's confidence in their ability to maneuver the x-ray image intensifier (C-arm), identify spine anatomy under fluoroscopy, and drive the needle improved after the training curriculum (P < 0.005). Although the cadaver laboratory curriculum is not a replacement for the required Accreditation Council for Graduate Medical Education training, it may serve as a tool to improve resident preparedness for spine procedures.

Skills-Based Programs Used to Reduce Physician Burnout in Graduate Medical Education: A Systematic Review

Physician burnout is pervasive within graduate medical education (GME), yet programs designed to reduce it have not been systematically evaluated. Effective approaches to burnout, aimed at addressing the impact of prolonged stress, may differ from those needed to improve wellness. We systematically reviewed the literature of existing educational programs aimed to reduce burnout in GME. Following the PRISMA guidelines, we identified peer-reviewed publications on GME burnout reduction programs through October 2019. Titles and abstracts were reviewed for relevance, and full-text studies were acquired for analysis. Article quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). A total of 3534 articles met the search criteria, and 24 studies were included in the final analysis. Article quality varied, with MERSQI assessment scores varying between 8.5 and 14. Evaluation was based on participant scores on burnout reduction scales. Eleven produced significant results pertaining to burnout, 10 of which yielded a decrease in burnout. Curricula to reduce burnout among GME trainees varies. Content taught most frequently included stress management (n = 8), burnout reduction (n = 7), resilience (n = 7), and general wellness (n = 7). The most frequent pedagogical methods were discussion groups (n = 14), didactic sessions (n = 13), and small groups (n = 11). Most programs occurred during residents' protected education time. There is not a consistent pattern of successful or unsuccessful programs. Further randomized controlled trials within GME are necessary to draw conclusions on which components most effectively reduce burnout.

A Framework and Curriculum for Training Residents in Population Health.

There is increasing imperative to train residents in population health. The Accreditation Council for Graduate Medical Education (ACGME) enhanced its mission with revised Common Program Requirements (CPRs), which were fully implemented on July 1, 2020. The revised CPRs state ACGME's mission: "The development of physicians in GME focused on excellence in delivery of safe, equitable, affordable, quality care; and the health of the populations they serve." The new CPRs clearly articulate the need for graduate medical education (GME) trainees to develop and understand population health concepts during their GME experience, including social determinants of health and community impact. However, currently there is no standardized and widely available curriculum for GME to implement these revised CPRs. This paper proposes a curriculum in population health management for GME, which was developed in 1 institution, using a blend of didactic and experiential learning.

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.

Factors and Interactions Influencing Direct Observation: A Literature Review Guided by Activity Theory

PhenomenonEnsuring that future physicians are competent to practice medicine is necessary for high quality patient care and safety. The shift toward competency-based education has placed renewed emphasis on direct observation via workplace-based assessments in authentic patient care contexts. Despite this interest and multiple studies focused on improving direct observation, challenges regarding the objectivity of this assessment approach remain underexplored and unresolved. Approach: We conducted a literature review of direct observation in authentic patient contexts by systematically searching databases PubMed, Embase, Web of Science, and ERIC. Included studies comprised original research conducted in the patient care context with authentic patients, either as a live encounter or a video recording of an actual encounter, which focused on factors affecting the direct observation of undergraduate medical education (UME) or graduate medical education (GME) trainees. Because the patient care context adds factors that contribute to the cognitive load of the learner and of the clinician-observer we focused our question on such contexts, which are most useful in judgments about advancement to the next level of training or practice. We excluded articles or published abstracts not conducted in the patient care context (e.g., OSCEs) or those involving simulation, allied health professionals, or non-UME/GME trainees. We also excluded studies focused on end-of-rotation evaluations and in-training evaluation reports. We extracted key data from the studies and used Activity Theory as a lens to identify factors affecting these observations and the interactions between them. Activity Theory provides a framework to understand and analyze complex human activities, the systems in which people work, and the interactions or tensions between multiple associated factors. Findings: Nineteen articles were included in the analysis; 13 involved GME learners and 6 UME learners. Of the 19, six studies were set in the operating room and four in the Emergency department. Using Activity Theory, we discovered that while numerous studies focus on rater and tool influences, very few study the impact of social elements. These are the rules that govern how the activity happens, the environment and members of the community involved in the activity and how completion of the activity is divided up among the members of the community. Insights: Viewing direct observation via workplace-based assessment through the lens of Activity Theory may enable educators to implement curricular changes to improve direct observation of assessment. Activity Theory may allow researchers to design studies to focus on the identified underexplored interactions and influences in relation to direct observation.

Training Future Family Physicians to Become Master Adaptive Learners.

This article examines the use of a concept that teaches learners how to learn in the context of family medicine residency training. We describe the four phases of this master adaptive learning framework and its place in educational theory and adaptive expertise, its implications for graduate medical education training and Accreditation Council for Graduate Medical Education competencies, as well as its role in imprinting family medicine residents for career-long learning. We lay out pragmatic strategies supporting this concept with a proposed curricular format for training in family medicine, including small group teaching methods, didactics, the clinic visit, faculty development and an optimal learning environment.

Response to "Promoting Diversity, Equity, and Inclusion: Building Community for Underrepresented in Medicine Graduate Medical Education Trainees".

Response to "Promoting Diversity, Equity, and Inclusion: Building Community for Underrepresented in Medicine Graduate Medical Education Trainees".

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 Telemedicine: The Next Frontier for Medical Educators.

The COVID-19 pandemic has pushed telemedicine to the forefront of health care delivery, and for many clinicians, virtual visits are the new normal. Although telemedicine has allowed clinicians to safely care for patients from a distance during the current pandemic, its rapid adoption has outpaced clinician training and development of best practices. Additionally, telemedicine has pulled trainees into a new virtual education environment that finds them oftentimes physically separated from their preceptors. Medical educators are challenged with figuring out how to integrate learners into virtual workflows while teaching and providing patient-centered virtual care. In this viewpoint, we review principles of patient-centered care in the in-person setting, explore the concept of patient-centered virtual care, and advocate for the development and implementation of patient-centered telemedicine competencies. We also recommend strategies for teaching patient-centered virtual care, integrating trainees into virtual workflows, and developing telemedicine curricula for graduate medical education trainees by using our TELEMEDS framework as a model.

An Examination of the Intersection of Climate Change, the Physician Specialty Workforce, and Graduate Medical Education in the U.S.

Issue As U.S. healthcare systems plan for future physician workforce needs, the systemic impacts of climate change, a worldwide environmental and health crisis, have not been factored in. The current focus on increasing the number of trained physicians and optimizing efficiencies in healthcare delivery may be insufficient. Graduate medical education (GME) priorities and training should be considered in order to prepare a climate-educated physician workforce. Evidence: We used a holistic lens to explore the available literature regarding the intersection of future physician workforce needs, GME program priorities, and resident education within the larger context of climate change. Our interinstitutional, transdisciplinary team brought perspectives from their own fields, including climate science, climate and health research, and medical education to provide recommendations for building a climate-educated physician workforce. Implications: Acknowledging and preparing for the effects of climate change on the physician workforce will require identification of workforce gaps, changes to GME program priorities, and education of trainees on the health and societal impacts of climate change. Alignment of GME training with workforce considerations and climate action and adaptation initiatives will be critical in ensuring the U.S. has a climate-educated physician workforce capable of addressing health and healthcare system challenges. This article offers a number of recommendations for physician workforce priorities, resident education, and system-level changes to better prepare for the health and health system impacts of climate change.

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.

The RCA ReCAst: A Root Cause Analysis Simulation for the Interprofessional Clinical Learning Environment.

The Accreditation Council for Graduate Medical Education calls for resident participation in real or simulated interprofessional analysis of a patient safety event. There are far more residents who must participate in these investigations than available institutional root cause analyses (RCAs) to accommodate them. To correct this imbalance, the authors developed an institutionally sponsored, interprofessional RCA simulation program and implemented it across all graduate medical education (GME) residency programs at the Hospital of the University of Pennsylvania. The authors developed RCA simulations based upon authentic adverse events experienced at their institution. To provide relevance to all GME programs, RCA simulation cases varied widely and included examples of errors involving high-risk medications, communication, invasive procedures, and specimen labeling. Each simulation included residents and other health care professionals such as nurses or pharmacists whose disciplines were involved in the actual event. Participants adopted the role of RCA investigation team, and in small groups systematically progressed through the RCA process. A total of 289 individuals from 18 residency programs participated in an RCA simulation in 2019-2020. This included 84 interns (29%), 123 residents (43%), 20 attending physicians (7%), and 62 (21%) other health care professionals. There was an increase in ability of GME trainees to correctly identify factors required for an RCA investigation (62% pre vs 80% post, P = .02) and an increase in intent to "always report" for each adverse event category (3% pre vs 37% post, P < .001) following the simulation. The authors plan to expand the RCA simulation program to other GME clinical sites while striving to involve all GME learners in this educational experience at least once during training. Additionally, by collaborating with health system patient safety leaders, they will annually review all new RCAs to identify cases suitable for simulation adaptation.