Graduate Medical Education Website Research Articles

Very Few ACGME-accredited Orthopaedic Surgery Residency Programs Have Web-accessible Leave Policies Dedicated to Parental Leave for Residents, Despite ACGME Requirements.

The Accreditation Council for Graduate Medical Education (ACGME) requires that all graduate medical education (GME) programs provide at least 6 paid weeks off for medical, parental, and caregiver leave to residents. However, it is unclear whether all orthopaedic residency programs have adapted to making specific parental leave policies web-accessible since the ACGME's mandate in 2022. This gap in policy knowledge leaves both prospective and current residents in the dark when it comes to choosing residency programs, and knowing what leave benefits they are entitled to when having children during training via birth, surrogacy, adoption, or legal guardianship. (1) What percentage of ACGME-accredited orthopaedic surgery residency programs provide accessible parental leave policies on their program's website, their GME website, and through direct contact with their program's administration? (2) What percentage of programs offer specific parental leave policies, generic leave policies, or defer to the Family and Medical Leave Act (FMLA)? As indicated in the American Medical Association's 2022 Freida Specialty Guide, 207 ACGME-accredited orthopaedic residency programs were listed. After further evaluation using previous literature's exclusion criteria, 37 programs were excluded based on osteopathic graduate rates. In all, 170 ACGME-accredited allopathic orthopaedic surgery residency programs were identified and included in this study. Three independent reviewers assessed each program website for the presence of an accessible parental leave policy. Each reviewer accessed the program's public webpage initially, and if no parental leave policy was available, they searched the institution's GME webpage. If no policy was found online, the program administrator was contacted directly via email and phone. Available leave policies were further classified into five categories by reviewers: parental leave, generic leave, deferred to FMLA, combination of parental and FMLA, and combination of parental and generic leave. Our results demonstrated that 6% (10 of 170) of orthopaedic residency programs had policy information available on their program's main orthopaedic web page. Fifty nine-percent (101 of 170) of orthopaedic residency programs had a clearly stated policy on their institution's GME website. The remaining 35% (59 of 170) had no information on their public website and required direct communication with program administration to obtain policy information. After directly contacting program administration, 12% (21 of 170) of programs responded to researchers request with a PDF explicitly outlining their policy. Twenty-two percent (38 of 170) of programs did not have an accessible policy available. Of the programs that had available policies, a total of 53% (70 of 132) of programs were categorized as offering explicit parental leave policies, 9% (12 of 132) were categorized as offering general leave policies, and 27% (36 of 132) deferred to FMLA. Seven percent (9 of 132) offered combined parental leave policies with FMLA, and 4% (5 of 132) offered combined general leave policies with FMLA. Although most ACGME-accredited allopathic orthopaedic surgery residency programs met the ACGME requirement of written parental leave policies in 2023, a small minority of programs have clear, accessible parental leave policies provided on their webpage. Parental leave policies should be easily accessible to prospective and current trainees and should clearly state compensation and length of leave. Ensuring orthopaedic surgery residency programs provide accessible and transparent parental leave policies is important for maintaining diversity in prospective applicants and supporting the work-life balance of current residents.

Analyzing the Role of Research in the Radiation Oncology Match

PurposeProgram directors consider scholarly output to be integral in matching applicants with radiation oncology residencies. However, applicants’ research productivity can be quantified in several ways, and the results can be misleading for both applicants and program directors. We conducted a bibliometric analysis to quantify the research productivity of applicants who had successfully matched to radiation oncology residencies and to test for associations between research productivity and residency program rankings. Methods and MaterialsWe identified U.S. radiation oncology residency programs from the Accreditation Council for Graduate Medical Education website and sorted the findings into 4 tiers based on the programs’ reputation and research output per Doximity's Residency Navigator. First-year (post-graduate year-2) radiation oncology residents starting in 2020 were identified on residency program websites. Residents’ research productivity was estimated by identifying peer-reviewed research articles (published before the residency applications began) via PubMed, Scopus, and Google Scholar for each resident. Bibliometric variables were analyzed for potential association with matching to higher-tier residencies. ResultsWe identified 187 first-year residents in 83 U.S. residency programs. The mean number of National Resident Matching Program publications (which was self-reported and included presentations and abstracts) was 18.3 per applicant; the mean (± standard deviation) peer-reviewed publications was 2.47 (±2.88) per resident. Multivariate analysis showed that number of first-author publications was associated with matching to a higher-tier program, based on the program's reputation (P = .019) and research output (P = .010); numbers of radiation oncology–specific publications (P = .039) and h-index (P = .024) correlated with matching to a higher-tier residency based on the program's research output. ConclusionsThe number of first-author publications was significantly associated with matriculating into a higher-tier residency ranked by both reputation and research output. Significant correlations were also found for number of radiation oncology–specific publications and h-index. Applicants may find publishing meaningful radiation oncology articles, especially as first author, to be more valuable than meeting National Resident Matching Program numbers.

The Impact of COVID-19 on Pediatric Telepsychiatry Training in Child and Adolescent Psychiatry Fellowships.

ObjectiveThis report summarizes findings from a 2020 survey of US child and adolescent psychiatry training programs that explored the impact of the COVID-19 pandemic on pediatric telepsychiatry training. The authors hypothesized that telepsychiatry training significantly increased during the pandemic, in part due to legal and regulatory waivers during the COVID-19 public health emergency.MethodsIn August 2020, an anonymous, 28-question online survey was emailed to all (138) accredited child psychiatry fellowships on the Accreditation Council for Graduate Medical Education website. Forty-nine programs responded (36%). This analysis focuses on three of the 28 questions relevant to the hypotheses: characteristics of the program’s training in telepsychiatry; perceived impediments to clinical training; and perceived impediments to didactic training pre-COVID onset vs. post-COVID onset, respectively. Total scores were created to investigate differences in training programs and impediments to including telepsychiatry pre- and post-COVID onset. Paired sample t-tests were used to compare means pre- and post-COVID onset.ResultsResults provided support for significant differences between training components related to telepsychiatry pre- and post-COVID onset, with participants reporting more training components post-COVID onset (M = 5.69) than pre-COVID onset (M = 1.80); t(48) = 9.33, p < .001. Participants also reported significantly fewer barriers to providing clinical experiences in pediatric telepsychiatry post-COVID onset (M = 2.65) than pre-COVID onset (M = 4.90); t(48) = − 4.20, p < .001.ConclusionsDuring the COVID-19 pandemic, pediatric telepsychiatry training in child psychiatry fellowships increased significantly. Perceived barriers to providing clinical, but not didactic, training decreased significantly.

Fertility Preservation and Infertility Treatment in Medical Training: An Assessment of Residency and Fellowship Program Directors' Attitudes.

Background: Given the concurrence of medical residency and fellowship training with typical childbearing years, trainees often must make difficult decisions regarding family planning, requiring the support of their residency and fellowship program directors (PDs) to guide them.Objective: Our hypothesis was that PDs have knowledge gaps and varying levels of support in terms of their trainees' fertility, and the goal of our study was to assess the knowledge and support of residency and fellowship PDs in the United States toward trainees' reproductive needs.Methods: Cross-sectional survey distributed to all residency and fellowship PDs providing contact information through the Accreditation Council for Graduate Medical Education website in August 2019.Results: Of 299 respondents, the most common lengths of leave reported were 6–8 weeks of maternity leave and under 2 weeks of paternity leave. A total of 57.2% did not know their program's insurance for infertility treatment, and 68.6% did not know fertility preservation coverage. A total of 52.2% of PDs were unaware of if their trainees faced infertility. PDs supported residents' needs through moral support (68.2%) and time off for appointments (65.2%). Similarly, most PDs (66.2%) never had a trainee express interest in fertility preservation to them but offered moral support (59.2%) and time off (48.5%). Respondents felt it was important to increase resources for trainees by increasing their awareness of needs (47.5%) and establishing reproduction-related policies (34.1%).Conclusion: The study found variations regarding PDs' knowledge and support levels for trainees' fertility needs. Most were unaware of their trainees' fertility needs, and many PDs felt it would be important to improve resources by increasing personal awareness and creating policies for support to promote reproductive health equity for trainees.

Trends in Female Plastic Surgery Resident Authorship - Signs of Changing Times?

Gender discrepancies exist in academia for leadership positions, advancement opportunities, and research. As of 2019, the ratio of total male-to-female attending plastic and reconstructive surgeons was 4.8:1. However, the ratio of male-to-female residents in integrated plastic surgery programs fell to 1.3:1, indicating rising female representation. With more balanced gender distributions of residents, the authors sought to determine whether this translates to greater equality of opportunities and achievements. Specifically, this study compares the academic productivity of male and female integrated plastic surgery residents. A list of integrated plastic surgery residency programs was obtained from the Accreditation Council for Graduate Medical Education website and ranked by reputation using the Doximity Residency Navigator. Integrated plastic surgery residents from 2019 to 2020 were identified via program websites and social media accounts. Works published during residency were identified through PubMed and Scopus from July 1 of each resident's intern year through August 10, 2020. Demographic variables for residents, including training class and medical school, as well as for programs, including geographic region, Doximity ranking, and medical school affiliation, were collected. Medical schools were ranked according to US News by research. Research productivity was assessed through the number of total research articles with authorship position (first, second, or last), the number of articles published in plastic surgery journals with the highest impact factors (Plastic and Reconstructive Surgery and Aesthetic Surgery Journal), and H-indices. Chi-Squared tests and Mann-Whitney U-tests were used to make comparisons between male and female residents (α = 0.05). In total, 931 residents in 81 integrated plastic surgery programs were identified, including 534 (57.4%) male and 397 (42.6%) female residents. There were no differences between male and female residents in terms of training year or program geography. Female residents were more likely to come from a top-50 medical school than males (54.7% vs. 48.1%, p = 0.049). There were no significant differences in gender distribution of residents from top-20 programs or programs affiliated with a top-20 medical school. The median (IQR) number of publications in total, and for each gender, was 3 (1-6). There was no difference in the number of total publications by training year by gender, besides the second-year resident class where male residents had a median (IQR) of 2 (1-4) compared to 1 (0-3) (p = 0.028). Male and female residents did not differ with regards to authorship position or proportion of times publishing in top journals. The distribution of H-indices for male residents was slightly higher than female residents (p = 0.003), but the median (IQR) was the same at 3 (1-5). Currently, male and female integrated plastic surgery residents have similar levels of academic productivity. This suggests that female representation is slowly increasing along the pipeline in academia, representing a paradigm shift from previous trends of gender inequality in plastic surgery.

S3427 Online Patient Ratings of Gastroenterologists in the United States

Introduction: The purpose of this study was to analyze the various factors affecting the online ratings of gastroenterologists on leading physician websites in the United States Methods: A search for all gastroenterology (GI) fellowship programs was performed on the Accreditation Council for Graduate Medical Education website and programs were identified. Online search was performed to identify all gastroenterologists affiliated at the institutions. Academic rank and subspecialty within GI (general, hepatology, IBD or advanced endoscopy) were recorded from the online curriculum vitae. The three most popular physician rating websites - healthgrades.com, vitals.com and rateMDs.com, were accessed to record the average patient rating of the GI physicians. All three websites provide an aggregate rating out of 5. Age and gender were recorded from healthgrades.com. Results: A total of 2362 gastroenterologists’ profiles were identified, of which 664 (28.1%) were females and 1686 (71.4%) males (data was missing for 12). Average patient ratings were available for 1631 GI physicians on healthgrades.com, 1623 GI physicians on vitals.com and 617 GI physicians on rateMDs.com. The mean (standard deviation and median) patient ratings were 4.0 (1.0, median 4.3), 4.1 (SD 0.9, median 4.3) and 3.8 (SD 1.1, median 4.0), on healthgrades, vitals and rateMDs respectively. There was no significant difference in patient ratings on all websites amongst GI physicians when grouped by gender, subspecialty or academic rank (p >0.05 for all groups). Spearman test showed statistically significant correlation between vitals and healthgrades (r=0.300, p< 0.005), healthgrades and rateMDs (r=0.314, p< 0.005) and vitals and rateMDs (r=0.257, p< 0.005). There was no significant correlation between patient ratings and the number of publications, citations or h-index of the GI physicians. There was a weak but statistically significant inverse correlation between age and patient ratings on healthgrades (r = -0.97, p< 0.005) and vitals (r = -0.92, p< 0.005), and a nonsignificant negative correlation on rateMDs (r = -0.046, P=0.267). Conclusion: Majority of gastroenterologists have been rated on physician online rating websites. The average ratings were found to be inversely correlated with age. Factors including academic rank, academic productivity, gender or subspecialty were not found not to be affecting the average ratings.Table 1.: Comparison of various factors affecting the online ratings of gastroenterologists on leading physician websites in the United States.Figure 1.: Flowchart depicting methods of the study.

The Virtual Interview Experience for MATCH 2021: A Pilot Survey of General Surgery Residency Program Directors.

Virtual interviews (VIs) for the 2020 residency application season were mandated as a result of the COVID-19 pandemic. We aimed to determine the perspectives of general surgery (GS) program directors (PDs) on the benefits and drawbacks of VIs. A 14-item survey was emailed to all GS PDs from programs identified on the American Council for Graduate Medical Education website. Program directors were asked about the cost-time benefit of VIs, its ability to assess candidates, and their thoughts on the future of VIs for evaluating residency applicants. 60 PDs responded corresponding to a response rate of 21%. While 93% agreed/strongly agreed that VIs were less expensive, only 35% found VIs to be less time-consuming. 75% and 67%, respectively, disagreed/strongly disagreed that VIs allowed for an easier assessment of an applicant's fit, and personality and communication skills. Almost one-half of our survey respondents suggested that VIs made the selection committee rely more heavily on objective applicant data. Almost two-thirds of GS PDs suggested that they would adopt both VI and in-person interview formats for future application cycles. The median [interquartile range] cost saved through the implementation of VIs was US$ 4500 [1625 - 10000]. Remarkably, VIs have been swiftly imbibed by all residency programs and many aspects of the VI experience were positive. While MATCH 2021 has definitely proved to be one of its kind, the implementation of VIs has been met with overall broad success and a promising future awaits this novel modality of resident selection to GME programs in the United States.

The Effect of Single Accreditation on Medical Student Match Rates in Surgical Specialties.

IntroductionThe year 2020 marked the first year in which a match under single accreditation took place. Both osteopathic (DO) and allopathic (MD) students would participate in the first match cycle without a dedicated DO match system. Our primary objective was to investigate how single accreditation has impacted the DO applicants attempting to match into surgical specialties. Our secondary objective was to investigate the impact of single accreditation at the program director (PD) level and whether or not this process would see a change in DO PD distribution in previously American Osteopathic Association (AOA)-approved programs.MethodInformation on number of applicants and post-match positions was gathered from AOA and National Residency Match Program (NRMP) websites. Credentials of PDs were obtained from the Accreditation Council on Graduate Medical Education website. Based on the available data, the following surgical specialties were compared for the years 2020, 2018, and 2016: General Surgery, Neurological Surgery (NSGY), Orthopedic Surgery, Otolaryngology/ENT (ENT), Plastic Surgery, and Thoracic Surgery. Data from 2016 were not included in the results as the AOA match results analysis was insufficient and unable to be directly compared to the NRMP data. Results of matched DO and MD applicants were compared using bivariate analysis. A p-value of <0.05 was considered significant.ResultsFrom the year 2018 to 2020, the DO applicants saw a decrease of 3% in the total number of matched postgraduate year 1 spots in surgical specialties. NRMP results from 2020 saw that 51.7% of DO applicants matched and 67.7% (p < 0.001) of MD applicants matched for the specialties examined. Percent of matched:applied for DO applicants was lower than MD applicants in the fields of NSGY (p < 0.001), ENT (p < 0.001), Plastic Surgery (p < 0.001), General Surgery (p < 0.001), and Thoracic Surgery (p = 0.011). After evaluating 60 former AOA General Surgery programs, 56% were found to have MD as PD. Another 26 former AOA surgical programs were investigated, and 58% were found to have MD PD. ConclusionSingle accreditation has impacted the match process now that a large number of both MD and DO applicants are using the NRMP match system for postgraduate placement. Based on the available data, our results indicate that in the examined surgical specialties, there is a statistically significant difference in the number of MD and DO residents.

A National Survey of Robotic Surgery Training Among Otolaryngology-Head and Neck Surgery Residents.

The aim of this study is to describe the current state of robotic surgery training among Otolaryngology-Head and Neck Surgery (OHNS) residency programs in the United States. This is a national survey study among OHNS residents. All OHNS residency programs were identified via the Accreditation Council for Graduate Medical Education website. A total of 64/127 (50.3%) of OHNS programs were selected based on a random number generator. The main outcome measure was the number of OHNS residents with access to robotic surgery training and assessment of operative experience in robotic surgery among those residents. A total of 140 OHNS residents participated in the survey, of which 59.3% (n = 83) were male. Response rate was 40.2%. Respondents came from middle 50.0% (n = 70), southern 17.8% (n = 25), western 17.8% (n = 25), and eastern sections 14.3% (n = 20). Most respondents (94.3%, n = 132) reported that their institution utilized a robot for head and neck surgery. Resident experience at the bedside increased in the junior years of training and console experience increased across the years particularly for more senior residents. However, 63.4% of residents reported no operative experience at the console. Only 11.4% of programs have a structured robotics training program. This survey indicated that nearly all OHNS residencies utilize robotic surgery in their clinical practice with residents receiving little formal education in robotics or experience at the console. OHNS residencies should aim to increase access to training opportunities in order to increase resident competency. IV.

Education Research: Neurology Resident EEG Education: A Survey of US Neurology Residency Program Directors.

To better understand the EEG education provided to adult neurology residents by surveying program directors of adult neurology residency programs in the United States. An online survey focused on characteristics of neurology residency programs and their EEG teaching systems was distributed to the 161 adult neurology residency program directors listed in the Accreditation Council for Graduate Medical Education website at the time of the study. Forty-seven (29%) out of the 161 program directors completed the survey. Most of the participating programs (89%) were academic. The mean number of 1-month EEG rotations required to graduate was 1.7 (range 0-4, median 1.75). EEG rotations involved the inpatient and outpatient setting in 91% and 70% of programs, respectively. The average number of EEGs read during a typical EEG rotation varied from more than 40, in about one-third of programs, to 0-10, in about 14% of programs. There was significant variability in the requirements for successful completion of EEG rotations, and most program directors (64%) reported not utilizing objective measures to assess EEG milestones. The most commonly used educational methods were didactics throughout the year (95%) and EEG teaching during EEG rotations (93%). The most commonly reported barriers to EEG education were insufficient EEG exposure (32%) and ineffective didactics (11%); possible solutions are summarized. Our study identified a lack of consistency in teaching and evaluating residents during residency and presented EEG education barriers alongside possible solutions. We encourage program directors across the country to re-evaluate their EEG teaching systems in order to optimize EEG education.

An Analysis of the Residents’ Research, Education, and Wellness Resources in Radiation Oncology Residency Programs in the United States

The purpose of this research was to evaluate the variations in research, education, and wellness resources for residents among radiation oncology (RO) residency programs across the United States. A list of accredited programs for the academic year 2018 to 2019 was collected using the Accreditation Council for Graduate Medical Education website. Individual residency program websites were used as the primary source of the data, and the Fellowship Residency Electronic Interactive Data Access System website complemented any missing data. We collected data on dedicated research time, resident rotations, wellness resources, and salary information. Excel 2013 was used for analysis. Information from the 94 Accreditation Council for Graduate Medical Education accredited RO residency programs during the academic year 2018 to 2019 was collected. Seventy-five (80%) programs reported the duration of dedicated research time on their websites. At least 6 months are allowed in 48 (51%) programs, and 27 (29%) programs report that dedicated research time is negotiable. Outstandingly, 20 (21%) programs allow 1 year of dedicated research time, and the median dedicated research time is 9 months. From our study, only 13 (14%) residency programs allow residents to rotate in other departments of the same institution. Fifty-nine (63%) programs allow away rotations at other institutions (external electives). An international rotation is permitted only in 19 (20%) programs. Wellness resoursces specifically fatigue managment, resident retreat and resident mentoring programs were available in 53%, 26% and 42% of programs, respectively. The salary information is obtainable for 63 institutions, and the yearly compensation ranges between $51,000 and $78,000. Moonlighting is allowed only in 28 (30%) programs. Our study found that major variations exist among RO residency programs in the United States regarding research, education, and wellness resources for residents.

The Current State of Orthopaedic Educational Leadership.

It is important to understand the current characteristics of orthopaedic surgery program leadership, especially in the current climate of modern medicine. The purpose of this report was to describe the demographic, academic, and geographic characteristics of current orthopaedic chairs and program directors (PDs). Orthopaedic surgery residency programs were obtained from the Accreditation Council for Graduate Medical Education website and cross-referenced with the Electronic Residency Application Service, identifying 161 residency programs for the 2018 to 2019 cycle. All data were collected in January 2020 to best control for changes in leadership. Demographic and academic information were collected from public websites. For geographic analysis, the United States was divided into five regions, and training locations were categorized as appropriate. A total of 153 chairs and 161 PDs were identified. 98.0% of chairs were men versus 88.8% of PDs (P = 0.001). Chairs had been in practice and in their current position for longer than PDs (26.4 vs 16.8 years [P < 0.005] and 9.1 vs 7.1 years [P = 0.014], respectively). Chairs had more publications and were more likely to be professors than PDs. PDs were more likely to remain at both the same region and institution that they trained in residency. The most common subspecialty was sports among chairs and trauma among PDs, although when compared with national averages orthopaedic trauma and orthopaedic oncology were the most overrepresented subspecialties. Orthopaedic chairs are more likely to be men, have had longer careers, and have more academic accomplishments than their PD counterparts. Geography appears to have an association with where our leaders end up, especially for PDs. Subspecialization does not notably influence leadership positions, although orthopaedic trauma and orthopaedic oncology surgeons are more commonly represented than expected. This report serves to identify the current state of orthopaedic leadership and may provide guidance for those who seek these leadership positions.

Parental Leave and Neuroradiology Fellowships.

A uniform policy on parental leave in radiology training programs is lacking. Although previous publications have addressed the status of parental leave policy among radiology residency programs, the state of parental leave in radiology fellowships has not been addressed to date. Our aim was to determine the state of parental leave policies in American neuroradiology fellowship programs. An Internet survey was sent to the directors of neuroradiology fellowship programs listed on the Accreditation Council for Graduate Medical Education Web site (n = 87) in January 2020. The questionnaire assessed the policies of the fellowship programs and Program Directors' attitudes toward maternal and paternal leave. Four reminders were sent during the 3 weeks before closing data collection. The response rate was 76% (66/87). Ninety-four percent (62/66) of program directors claimed to have a maternal leave policy, of which 51/62 (82%) were written and 53/62 (85%) were paid. Additionally, 77% (51/66) had a policy for paternal leave, of which 80% (41/51) were written and 76% (39/51) were paid. The average length of paid leave was 6.7 ± 3.25 weeks for new mothers and 2.9 ± 2 weeks for new fathers. Unpaid leave was mostly based on the Family and Medical Leave Act. Fellows were responsible for making up call duties during the parental leave in 47% of the programs. Radiation exposure was restricted in 89% of the programs during pregnancy. Policies addressed breast feeding and untraditional parenthood in just 41% of the responding programs. Most program directors supported the development of a unified national policy on maternal (83%) and paternal (79%) leave. Most neuroradiology fellowship programs have explicit maternal and paternal leave policies that grant paid leave to trainees. Some also offer unpaid leave, mostly through Family and Medical Leave Act guidelines. A uniform policy derived from the Accreditation Council for Graduate Medical Education and/or American Board of Radiology would be useful and overwhelmingly accepted.

What Proportion of Orthopaedic Surgery Residency Programs Have Accessible Parental Leave Policies, and How Generous are They?

Parental leave during graduate medical education is a component of wellness in the workplace. Although every graduate medical education program is required by the Accreditation Council for Graduate Medical Education (ACGME) to have a leave policy, individual programs can create their own policies. The ACGME stipulates that "the sponsoring institution must provide a written policy on resident vacation and other leaves of absence (with or without pay) to include parental and sick leave to all applicants." To our knowledge, a review of parental leave policies of all orthopaedic surgery residency programs has not been performed. QUESTION/PURPOSES: (1) What proportion of orthopaedic surgery residency programs have accessible parental (maternity, paternity, and adoption) leave policies? (2) If a policy exists, what financial support is provided and what allotment of time is allowed? All ACGME-accredited orthopaedic surgery residency programs in 2017 and 2018 were identified. One hundred sixty-six ACGME-accredited allopathic orthopaedic surgery residency programs were identified and reviewed by two observers. Reviewers determined if a program had written parental leave policy, including maternity, paternity, or adoption leave. Ten percent of programs were contacted to verify reviewer findings. The search was sequentially conducted starting with the orthopaedic surgery residency program's website. If the information was not found, the graduate medical education (GME) website was searched. If the information was not found on either website, the program was contacted directly via email and phone. Parental leave policies were classified as to whether they provided dedicated parental leave pay, provided sick leave pay, or deferred to unpaid Family Medical Leave Act (FMLA) policies. The number of weeks of maternity, paternity, and adoption leave allowed was collected. Our results showed that 3% (5 of 166) of orthopaedic surgery residency programs had a clearly stated policy on their program website. Overall, 81% (134 of 166) had policy information on the institution's GME website; 7% (12 of 166) of programs required direct communication with program coordinators to obtain policy information. Further, 9% (15 of 166) of programs were deemed to not have an available written policy as mandated by the ACGME. A total of 21% of programs (35 of 166) offered designated parental leave pay, 29% (48 of 166) compensated through sick leave pay, and 50% (83 of166) deferred to federal law (FMLA) requiring up to 12 weeks of unpaid leave. Although 91% of programs meet the ACGME requirement of written parental leave policies, current parental leave policies in orthopaedic surgery are not easily accessible for prospective residents, and they do not provide clear compensation and length of leave information. Only 3% (5 of 166) of orthopaedic surgery residency programs had a clearly stated leave policy accessible on the program's website. Substantial improvements would be gained if every orthopaedic residency program clearly outlined the parental leave policy on their residency program website, including compensation and length of leave, particularly in light of the 2019 American Board of Orthopaedic Surgery changes allowing time away to be averaged over the 5 years of training. Parental leave policies are increasingly relevant to today's trainees []. Applicants to orthopaedic surgery today value work/life balance including protected parental leave [].

Teaching Medical Students Clinical Anesthesia.

There are many reasons for evaluating our approach and improving our teaching of America's future doctors, whether they become anesthesiologists (recruitment) or participate in patient management in the perioperative period (general patient care). Teaching medical students the seminal aspects of any medical specialty is a continual challenge. Although no definitive curricula or single clinical approach has been defined, certain key features can be ascertained from clinical experience and the literature. A survey was conducted among US anesthesiology teaching programs regarding the teaching content and approaches currently used to teach US medical students clinical anesthesia. Using the Accreditation Council for Graduate Medical Education website that lists 133 accredited anesthesiology programs, residency directors were contacted via e-mail. Based on those responses and follow-up phone calls, teaching representatives from 125 anesthesiology departments were identified and asked via e-mail to complete a survey. The survey was returned by 85 programs, yielding a response rate of 68% of individuals contacted and 63% of all departments. Ninety-one percent of the responding departments teach medical students, most in the final 2 years of medical school. Medical student exposure to clinical anesthesia occurred as elective only at 42% of the institutions, was requirement only at 16% of responding institutions, and the remainder had both elective and required courses. Anesthesiology faculty at 43% of the responding institutions reported teaching in the preclinical years of medical school, primarily in the departments of pharmacology and physiology. Forty-five percent of programs reported interdisciplinary teaching with other departments teaching classes such as gross anatomy. There is little exposure of anesthesiology faculty to medical students in other general courses. Teaching in the operating room is the primary teaching method in the clinical years. Students are allowed full access to patient care, including performing history and physical examinations, participating in the insertion of IVs and airway management. Simulation-based teaching was used by 82% of programs during medical student anesthesia clerkships. Sixty-eight percent of respondents reported that they have no formal training for their anesthesiology faculty teachers, 51% stated that they do not receive nonclinical time to teach, and 38% of respondents stated that they received some form of remuneration for teaching medical students, primarily nonclinical time. This article presents a summary of these survey results, provides a historical review of previous evaluations of teaching medical students clinical anesthesia, and discusses the contributions of anesthesiologists to medical student education.

Residency Training in Robotic General Surgery: A Survey of Program Directors.

Objective Robotic surgery continues to expand in minimally invasive surgery; however, the literature is insufficient to understand the current training process for general surgery residents. Therefore, the objectives of this study were to identify the current approach to and perspectives on robotic surgery training. Methods An electronic survey was distributed to general surgery program directors identified by the Accreditation Council for Graduate Medical Education website. Multiple choice and open-ended questions regarding current practices and opinions on robotic surgery training in general surgery residency programs were used. Results20 program directors were surveyed, a majority being from medium-sized programs (4–7 graduating residents per year). Most respondents (73.68%) had a formal robotic surgery curriculum at their institution, with 63.16% incorporating simulation training. Approximately half of the respondents believe that more time should be dedicated to robotic surgery training (52.63%), with simulation training prior to console use (84.21%). About two-thirds of the respondents (63.16%) believe that a formal robotic surgery curriculum should be established as a part of general surgery residency, with more than half believing that exposure should occur in postgraduate year one (55%). Conclusion A formal robotics curriculum with simulation training and early surgical exposure for general surgery residents should be given consideration in surgical residency training.

Multidisciplinary Alternatives to CPAP Program for CPAP-Intolerant Patients.

Continuous positive airway pressure (CPAP) intolerance remains a persistent problem for many obstructive sleep apnea patients. Clinicians and researchers continue to search for other effective treatment modalities given the well-documented sequelae associated with untreated obstructive sleep apnea. A multidisciplinary "Alternatives to CPAP program" (ALT) can facilitate systematic evaluation of non-CPAP therapies appropriate for an individual patient. We review successful strategies and barriers encountered during implementation of an ALT at our institution. Creation of similar programs in private practice and academic settings can help medical, dental, and surgical sleep medicine specialists coordinate evaluation and treatment of CPAP-intolerant patients.

Resident Performance Assessment: A Crucial Area for Development

Plastic surgery resident assessment has become the next element in resident education that must be developed. Reliable, comprehensive resident evaluation is currently difficult to achieve because of inconsistent assessor participation and an incomplete assessment toolbox. Recent advances in technology may be able to help, but they require judicious application. In particular, attention should be paid to assessing all levels of competence. Miller’s pyramid of assessment can help guide the process.1 The foundation of the pyramid is assessment of what a resident “knows.” Multiple choice or short answer examinations are a familiar tool that evaluates a resident’s medical knowledge. Smart phone applications and the online Plastic Surgery Education Network are an improvement over the older paper exams in which they provide both content and continuous assessment of knowledge and immediate feedback. Residents are able to test themselves at their own pace whereas teachers can monitor their progress and provide tailored education based on demonstrated need. The next level up on the pyramid is assessing what a resident “knows how” to do. Oral examinations do a good job of eliciting a plastic surgery resident’s knowledge of how to deliver good patient care or operate. The cognitive aspects of surgery can also be tested by computer simulators, drawing, and scripting. A resident’s ability to draw a procedure correlates well with the ability to perform the procedure. A resident’s operative script gives insight into the ability to plan and adapt, and the script serves as a permanent technical manual for the resident to revise over the course of a career. Overall, plastic surgery has adequate tools to assess the first 2 levels of the pyramid. The challenge lies in assessing the next 2 levels, particularly in the operating room. The third level of the assessment pyramid has the resident “show how.” In the clinic, standardized patients or simulated scenarios provide a safe way of allowing a resident to demonstrate a required competence before engaging with a real patient. For the operating room, surgical skills labs with cadavers or animal models and both low and high fidelity surgical simulators are excellent assessment tools. Particularly important is the ability of these tools to both teach and provide meaningful feedback in a way that does not put a patient at risk. The top of Miller’s pyramid is “does,” assessing a resident treating a real patient in the clinic or operating room. Portable sport cameras, stationary video cameras, and in-line recording of microsurgery allow direct, valid assessment of a resident’s ability to manage a patient or perform a surgical technique when filtered through the Objective Structured Clinical Examination or Objective Structured Assessment of Technical Skills rubrics available on the American Council for Graduate Medical Education website. Smart phone applications that allow for immediate intake and recording of an operative assessment can increase assessor participation, but in the end, technology cannot eliminate the need for an experienced surgeon to be the ultimate resident assessor.

Snippets: an innovative method for efficient, effective faculty development.

Faculty development is believed to change participants' teaching behaviors and effectiveness, thus influencing learners—students and residents—in their learning and their delivery of patient care.1–,3 Traditionally, faculty development sessions are delivered in the form of workshops (46%); seminar series (19%); short courses (11%); longitudinal programs, such as fellowships (10%); or in some other format such as e-learning (9%).1,2,4–,6 Participation in these types of training requires time. This has been identified as the primary barrier for faculty attendance at faculty development sessions.5–,11 Other barriers to participating in faculty development include resources; competing priorities, such as patient care, research, and administrative tasks; and the lack of financial rewards or social recognition for the teaching role.5–,11 Perhaps, the most significant psychologic barrier to participation in faculty development is the real or perceived lack of institutional support for teaching, with institutions frequently appearing to place a higher value on clinical and research-related activities than they do on teaching.2,5,6,10,11 When surveyed, faculty have acknowledged several skill sets that are important as they pursue their role in academic medicine and the education of residents.2,12–,14 Those skills include assessing learners and their learning needs, giving feedback, establishing a good learning environment, and keeping up to date as a teacher.15,16 Further, faculty members at various levels need different types of training. Junior faculty may need development in more introductory topics, such as teaching at the bedside and giving feedback, whereas faculty with more seniority may need development that focuses on keeping their teaching up to date or training in educational leadership.5,16 An increased awareness of faculty development has been stimulated by the Accreditation Council for Graduate Medical Education (ACGME) accreditation requirements. In the most recent iteration of the Common Program Requirements,17 faculty development has been identified as a core component. To overcome the barriers identified for attending formal faculty development sessions, and to meet accreditation requirements, as well as to address faculty needs, we are introducing a new methodology for faculty development. This innovative method, the “snippet,” provides a brief faculty development session in the context of a required faculty activity, such as a departmental meeting, thereby engaging those who might otherwise be unable or unwilling to participate in such sessions. Snippets are highly structured to teach skills, but they do not replace traditional faculty development. The snippet can also be useful as a “trailer,” or preview, for longer stand-alone faculty development sessions. This article describes the snippet and how it has been incorporated nationwide into faculty-development processes in a variety of institutions with graduate medical education programs.

State of the Field Survey: Spinal Cord Stimulator Use by Academic Pain Medicine Practices

The concept of neuromodulation via the use of spinal cord stimulators (SCS) was first established over forty years ago. Since then, its popularity has grown as numerous studies have demonstrated its utility to reduce chronic pain, improve patient function, and reduce long-term health care costs. The aim of this study was to update the pain medicine community on the evolution of SCS practice trends in academic centers. Ninety-three pain medicine fellowship programs in the United States were identified from the Accreditation Council for Graduate Medical Education Website and were contacted to participate in an internet survey. A 37-item questionnaire was inspired by a previous study performed by Fanciullo et al. Questions focused on three main themes regarding SCS clinical application, namely demographics, education, and technical matters. Completed surveys were received from 50 institutions, all of which reported performing SCS interventions. Annual implants ranged from 0 to 150. Fellowship training was cited as the most valuable modality for learning implantation. Nearly all programs reported manufacturer representative participation during SCS procedures, with a minority of program directors discouraging their involvement in fellow education. SCS trials were performed exclusively on an outpatient basis. The average length for trials was 4-7 days. The most common indication for SCS implantation was failed back surgery syndrome, which also had the highest 2-year success rate. Post procedure, patients generally were followed up every 2-4 weeks for device reprogramming, which was performed by company representatives 92% of the time. Standardized SCS training is imperative as the implementation of neuromodulation therapy continues to increase.