Graduate Medical Education Research Articles

Pediatric Palliative Care Simulation Improves Resident Learning Outcomes: an 11-Year Review

Context: Many general pediatrics residents lack sufficient opportunities to conduct difficult conversations with families, particularly about end-of-life care. Simulation learning is an effective means of practicing professional skills. A pediatric palliative care (PPC) physician is uniquely suited to mentor residents and fellows learning to lead difficult conversations through simulation. Co-facilitation of the simulated difficult conversation by a bereaved parent or family member enhances the learning experience. Objectives: To report 11-years’ experience simulating difficult conversations with bereaved parent-actors. Methods: PPC physicians developed two simulations to teach difficult conversations to clinical learners at a midwestern quaternary pediatric medical center. Bereaved parents and hospital chaplains co-facilitated the simulation. The first portrayed the death of an infant following emergency resuscitation, and the second, a goals-of-care conversation with the parent of a child with a degenerative condition. A de-novo evaluation rubric was prepared using the six Accreditation Council for Graduate Medical Education (ACGME) Core Competencies to evaluate the participant's performance in the simulation. Results: For the first simulated scenario (N=194 residents; N=16 fellows), residents improved significantly on 16/21 ACGME-based criteria between encounters; for the second (N=118 residents; N=14 fellows), residents improved significantly on 10/21 criteria. Fellows’ performance did not improve significantly in either scenario, but they presented with high baseline scores. Conclusions: Simulations with bereaved parent actors improved general pediatrics residents’ performance and comfort during difficult conversations and are transportable to diverse settings.

2024 ACLP Recommendations for Training Residents in Consultation-Liaison Psychiatry

Despite rapid shifts in consultation-liaison psychiatry (CLP) training in residency, including increasing general residency training requirements from the Accreditation Council for Graduate Medical Education, greater utilization of advanced practice providers, and effects of the coronavirus-2019 pandemic, the Academy of Consultation-Liaison Psychiatry (ACLP) has not updated recommendations for residency training in CLP since 2014. A national survey of residency program directors in 2021 suggested many changes to the structure of CLP rotations at individual programs over the past decade. We convened a workgroup of 8 ACLP members holding leadership positions in residency and fellowship education on local and national levels. The project was approved by the ACLP Executive Council and conducted via a three-stage iterative process. Consensus was reached on 34 recommendations across four domains, including structural issues, faculty supervsion, formal curriculum and evaluations, and elective experiences. Residents must spend sufficient time on CLP rotations to achieve relevant milestones. Given that consultants are expected to offer unique insight, the ideal placement of core CLP rotations comes at a time in residency where residents are able to provide expert opinion and lead teams. Faculty expertise in CLP and availability to provide direct supervision and oversight to trainees is essential. A separate and formal CLP didactic curriculum should exist, and elective opportunities should be offered to supplement training. These recommendations are intended to guide residency program directors towards optimizing CLP training for all residents, including those who will eventually pursue CLP fellowship. Establishing a strong CLP foundation for all residents is essential for ensuring competency in providing psychiatric care for medically complex patients and collaborating with our colleagues in other specialties, as well as fostering trainee interest in pursuing a career in CLP.

Ophthalmic Surgeries at a Nigerian Teaching Hospital from the Perspectives of Undergraduate Medical Education

BackgroundAn appraisal of the profile of ophthalmic surgeries performed at Ladoke Akintola University of Technology Teaching Hospital (LAUTECHTH), Ogbomosho, Nigeria over a seven-year period with a view to harnessing their potentials for maximising ophthalmic experiences of medical students. MethodsA retrospective review of ophthalmic surgery records over a seven-year period (2013 – 2019) at LAUTECHTH. ResultsThere were 386 eye surgeries, mean ophthalmic surgeries: 4 - 5/month or 55/year. Most (329, 85.2%) surgeries were performed on individuals aged at least 45 (range 10 - 95) years with slight male dominance (1.1:1). The most common indication for surgery was cataract (307, 79.6%). Most surgeries were elective (362, 93.8%) and performed under local anaesthesia (367, 95.1%). Despite the highest number of surgeries being performed in the months of April and September; and lowest during the months of May and October; there was fair distribution across and over the years. Small incision cataract surgery with or without intraocular lens implant (307, 79.6%) was the most common surgery followed by pterygium excision with adjuvant therapy (37, 9.6%). ConclusionThe study showed a broad spectrum of eye surgeries, including cataract and pterygium, performed at the teaching hospital, encompassing common conditions that lead to visual impairment or blindness. This exposure provides valuable training opportunities for undergraduate medical students to become physicians especially those aspiring to become ophthalmologists. However, there is a need to increase the overall volume of eye surgeries to enhance the learning experience and potentially influence career choices.

Pilot Study on Integrating 3D-Printed Models into Undergraduate Medical Education for Congenital Heart Disease

BackgroundThis study aimed to assess the feasibility and effectiveness of implementing 3D-printed heart models in the education of medical students in a Canadian Medical School. MethodsThree types of 3D-printed models – normal, unrepaired Tetralogy of Fallot (TOF) and surgically repaired adult TOF – were provided for medical students in their 2nd year of training after a 30-minute lecture. The repaired TOF model depicted a transannular patch, ventricular septal defect closure, and right ventricular outflow tract resection. Knowledge acquisition was measured by comparing pre-and post-session tests consisting of 5 questions. Learner satisfaction ratings were measured with questionnaires completed after the session. A statistical analysis was performed using the t-test. ResultsTwenty-two medical students participated in the study with 20 students submitting complete data for analysis. The students’ score on 5 questions improved after the 3D-printed model session. The average number of correct answers in the test was 2.1 ± 1.0 pre-session and 4.3 ± 0.9 post-session (P < 0.001) out of the possible total of 5. Participants reported a high level of satisfaction (86.4%), understanding (86.4%), and usefulness (90.9%) with the incorporation of 3D-printed models in the educational session. ConclusionsAn educational session which integrated 3D-printed anatomic models to teach congenital heart disease anatomy significantly enhanced knowledge outcomes. Learner assessment of the impact of the use of the 3D models was highly favourable.

Implementing Core Entrustable Professional Activities in Undergraduate Medical Education: A Psychometric Study.

This study examines the feasibility and psychometric results of an assessment of entrustable professional activities (EPAs) as a core component of the clinical program of assessment in undergraduate medical education, assesses the learning curves for each EPA, explores the time to entrustment, and investigates the dependability of the EPA data based on generalizability theory (G theory) analysis. Third-year medical students from the University of Minnesota Medical School in 7 required clerkships from May 2022 through April 2023 were assessed. Students were required to obtain at least 4 EPA assessments per week on average from clinical faculty, residents supervising the students, or assessment and coaching experts. Student ratings were depicted as curves describing their performance over time; regression models were used to fit the curves. The complete class of 240 (138 women [58.0%] and 102 men [42.0%]) third-year medical students at the University of Minnesota Medical School (mean [SD] age at matriculation, 24.2 [2.7] years) participated. There were 32,614 EPA-based assessments (mean [SD], 136 [29.6] assessments per student). Reliability analysis using G theory found that an overall score dependability of 0.75 (range, 0-1) was achieved with 4 assessors on 4 occasions. The desired level of entrustment by academic year end was met by all 240 students (100%) for EPAs 1, 6, and 7, 237 (98.8%), 236 (98.3%), and 218 (90.8%) students for EPAs 2, 5, and 9, respectively, 197 students (82.1%) for EPA 3, 178 students (74.2%) for EPA 4, and 145 students (60.4%) for EPA 12. The most rapid growth was for EPA 2 (β0 = .286), followed by EPA 1 (β0 = .240), EPA 4 (β0 = .236), and EPA 10 (β0 = .230). The study findings suggest that EPA ratings provide reliable and dependable data to make entrustment decisions about students' performance.

Reinforcement of Core Foundational Science Concepts during Clinical Rotations: A Strategy to Enhance Medical Student Learning and Diagnostic Reasoning.

Cognitive science principles can facilitate integrating and retaining basic science concepts during the clinical years of undergraduate medical education. We hypothesized that reinforcing foundational science concepts during the core clerkship experiences fosters the development of clinical reasoning in medical students. A patient simulation session on diabetic ketoacidosis (DKA) in the pediatric clerkship was chosen to pilot the program. We introduced an intervention in which a team of clinical and foundational science faculty facilitates student discussions, helping them connect important physiological and pathophysiological concepts to the disorder's clinical presentation, diagnosis, and management. The student survey reported that 87% strongly agreed that it helped them reinforce their understanding of foundational science concepts related to clinical cases. The NBME subject exam results of the pediatric clerkships from the corresponding years were subjected to a cognitive diagnostic assessment called the DINA model analysis. The student content mastery in acid-base disorders was improved following the intervention (student mastery of skills, 0.73 vs 0.80, P=0.035). Similarly, analysis of the Step 2 Clinical Knowledge (CK) skills from the NBME subject exam item analysis reports showed improvement in the skill "diagnosis" on the topic of diabetes (probability value- before and after the intervention, respectively, 0.73 and 0.85, p=0.04) following implementation. Our study shows the impact of foundational science reinforcement during clinical clerkships in developing undergraduate medical students' clinical reasoning and diagnostic skills.

Emergency Medicine Clerkship Grading Scheme, Grade, and Rank-List Distribution as Reported on Standardized Letters of Evaluation

Background: The Standardized Letter of Evaluation (SLOE) is a crucial component of the emergency medicine (EM) application process. Given the critical role of the SLOE, we attempted to better understand the grading scales used, as well as the distribution of grades and rank-list positions.Objectives: Our primary objective in this study was to determine the distribution of grading formats, grades given, and rank-list positions across EM clerkships using the SLOE. Methods: We performed a cross-sectional study of the grading formats, grades given, and ranking distributions as reported on the SLOE during the 2022–23 application cycle. We obtained data on SLOEs from EM residency programs accredited by the Accreditation Council for Graduate Medical Education by reviewing all applicants who applied to either of two EM residency programs in geographically different regions. Trained abstractors recorded the following data: number of students rotating in the prior year; grading format used; and grade and rank distribution among students. Results: We included 264 programs in our final analysis, after 13 programs met exclusion criteria. The majority of programs (72.2%) use an Honors/High Pass/Pass/Fail grading scheme. We determined the mean percent of each grade: Honors/A 27.6%; High Pass/B 31.1%; Pass/C 40.8%; Low Pass/D 0.2%; and Fail/F 0.3%. Finally, we determined the mean percent for each rank-list position: top 10% was 17.6%; top third 36.5%; mid third 34.1%; and low third 11.8%. Conclusion: We determined the grading schemes and grade and rank-list distributions for EM programs during the 2022–2023 academic year. Most programs used a Honors/High Pass/Pass/Fail grading scheme, with the majority of students receiving Honors or High Pass, while 0.3% failed their rotation. Both grades and rank list demonstrated evidence of a skewed distribution toward higher grades and rank-list position.

Crowd-Sourced Assessment of Laparoscopic Surgical Skills for Ob/Gyn Residents

Importance Feedback is an essential part of graduate medical education. With increasing demands on time and fewer opportunities for formal feedback in residency, there is an increasing need for objective and actionable feedback. Objective To understand how the Crowd-Sourced Assessment of Technical Skills (CSATS) assessment of residents’ laparoscopic skills compares with the current faculty assessment in an obstetrics/gynecology residency program. Design, Setting, and Participants This was a prospective educational intervention study involving residents from a single academic obstetrics/gynecology residency program at a large tertiary teaching hospital. Individual performance videos of hysterectomies, myomectomies, and endometriosis resections were recorded and uploaded to the CSATS database where they were analyzed. Formal written feedback reports from the CSATS system were sent to the residents. Residents then completed a survey addressing satisfaction, timeliness, and utility of the CSATS feedback method overall and in comparison with the residency’s in-person feedback and with the standard written, electronic feedback evaluation. Results A total of 16 residents submitted 65 videos of operations. Overall comparison of CSATS vs faculty evaluation was equivalent. Residents found that CSATS response time was slower than receiving in-person feedback from faculty. When comparing CSATS with the standard feedback form, residents felt strongly that CSATS was superior for both surgical skill feedback and procedure evaluation, with both categories having a mean top score. When comparing low-volume CSATS utilization vs high-volume CSATS utilization, there were no statistical differences. Overall, residents reported high satisfaction with CSATS evaluation. Conclusions Residents were generally satisfied with CSATS as an overall feedback tool. CSATS could be a possible addition to help improve resident education.

Patient safety and quality improvement education in dermatology residency programs: a nationwide survey of program directors.

Patient Safety and Quality Improvement (PSQI) are key components of graduate medical training, as detailed by the Accreditation Council for Graduate Medical Education (ACGME), with specific requirements that residents participate in experiential learning in PSQI during residency training. This study aimed to analyze the breadth of available and required PSQI educational experiences across dermatology residency programs in the United States. The objective of this study was to characterize the scope of PSQI educational experiences across dermatology residency programs. We electronically surveyed program directors of all ACGME-accredited dermatology residency programs from September 2023 to March 2024. Responses to the survey were anonymously collected with Research Electronic Data Capture (REDCap). Of the 145 dermatology programs surveyed, 37 program directors responded (25.5%). 89.2% of programs reported requiring residents to participate in PSQI educational experiences, with the most common being participation in a resident-led QI project (70.3%), which was also the most commonly available experience (91.2%). The least common required experience was observed simulated patient safety events and analyses. 83.8% of programs reported formal mechanisms to assess residents' competency in QI. This study highlights variation in PSQI experiences within dermatology residency programs across the United States. More than 10% of surveyed programs reported no required QI experiences during residency training despite ACGME program requirements. Additional gaps include variation in assessment of resident PSQI competencies. This study provides insight on the current landscape of PSQI education across dermatology residency programs and identifies opportunities to strengthen dermatology programs' PSQI educational offerings.

Video-based lecture engagement in a flipped classroom environment

Purposeto analyze which factors are associated with students’ engagement and participation in video-based lectures in a flipped classroom environment.MethodsA single-center experience with video-based lectures in undergraduate medical education is described. The activity was applied to the subject of Neurosurgery during two consecutive courses (2021/22 and 2022/23). The videos were available prior to face-to-face classes through the online application Edpuzzle. Information was obtained from the own platform at the end of each course. Multivariable linear regression analyses were performed to assess the association between different variables and the percentage of video viewing, the early dropout rate, and the percentage of audience retention.ResultsA total of 109 students registered in Edpuzzle (87.2% of all enrolled students). Fifty-one videos were uploaded each course to cover 11 topics. Mean video viewing rate was 41%. Those videos linked to the earliest classroom lessons showed more percentage of viewing and audience retention than those programmed at the end of the course. With mandatory classroom assistance and homework assignments, the seminar videos were viewed more but retained less audience. Shorter videos were associated with higher viewing and audience adhesion, but the presence of questions embedded throughout the clip did not significantly engage students. No significant difference was observed regarding lesson topics.ConclusionsIt is essential to emphasize the importance of designing strategies to initially engage learners since more than half of our students never connected to the clips. Decreasing engagement was associated with the end of the course and video length. Seminar videos were viewed more but retained less audience. Active learning activities such as quizzes embedded throughout the clips did not significantly engage learners.

A survey of essential anatomy from the perspective of anesthesiology, emergency medicine, obstetrics and gynecology, and orthopedics resident physicians

BackgroundRecent changes in anatomy curricula in undergraduate medical education (UME), including pedagogical changes and reduced time, pose challenges for foundational learning. Consequently, it is important to ask clinicians what anatomical content is important for their clinical specialty, which when taken collectively, can inform curricular development.MethodsThis study surveyed 55 non-primary care residents in anesthesiology (AN; N = 6), emergency medicine (EM; N = 15), obstetrics and gynecology (OB; N = 13), and orthopedics (OR; N = 21) to assess the importance of 907 anatomical structures across all anatomical regions. Survey ratings by participants were converted into a post-hoc classification system to provide end-users of this data with an intuitive and useful classification system for categorizing individual anatomical structures (i.e., essential, more important, less important, not important).ResultsSignificant variability was observed in the classifications of essential anatomy: 29.1% of all structures were considered essential by OB residents, 37.6% for AN residents, 41.6% for EM residents, and 72.0% for OR residents. Significant differences (with large effect sizes) were also observed between residency groups: OR residents rated anatomy of the back, limbs, and pelvis and perineum anatomy common to both sexes significantly higher, whereas OB residents rated the pelvis and perineum anatomy common to both sexes and anatomy for individuals assigned female at birth highest. Agreement in classifications of importance among residents was observed for selected anatomical structures in the thorax, abdomen, pelvis and perineum (assigned male at birth-specific anatomy), and head and neck. As with the ratings of anatomical structures, OR residents had the highest classification across all nine tissue types (p < 0.01).ConclusionsThe present study created a database of anatomical structures assessed from a clinical perspective that may be considered when determining foundational anatomy for UME curriculum, as well as for graduate medical education.

A breath of fresh air: a pilot flipped classroom approach to airway management skills training

ObjectivesWhile flipped classroom instruction has repeatedly shown efficacy in undergraduate medical education, evidence for its utility in procedural domains remains sparse. This holds particular significance for surgical subspecialties such as otolaryngology, which have limited time in undergraduate medical curricula. We designed a novel airway management skills simulation course with a flipped classroom approach and evaluated its efficacy in a pilot study.MethodsA simulation course was designed to provide instruction in seven airway management skills: bag valve mask ventilation, laryngoscopy, intubation, cricothyroidotomy, tracheotomy, and tracheostomy care. Publicly available YouTube videos were selected as pre-learning materials. Participating students completed surveys before the pre-learning assignment and after completion of the simulation center workshop.ResultsSixteen students participated in the workshop, and data was collected from 14 participants. Learners reported significant improvements in knowledge regarding all covered skills except tracheotomy; mean self-rated knowledge improved from 2.9 to 5.8 (p < 0.001) on a scale from 0 to 10. Significant increases in self-reported confidence in performing all seven skills were also observed, with an overall increase from 1.1 to 5.7 (p < 0.001). Students also rated all elements of the workshop highly, including a prevailing belief that the pre-learning materials markedly enhanced their learning.ConclusionOur novel framework for skills-based education using a flipped classroom approach demonstrated remarkable efficacy in improving learner knowledge and self-reported confidence regarding airway management skills. This educational design, including the use of high-quality, publicly available pre-learning videos, has significant implications for undergraduate medical education in surgical subspecialties.

Prevalence and Extent of Industry Funding to Program Directors Across Pediatric Surgical Specialties

IntroductionIndustry funding in surgical education offers benefits but presents conflicts of interest. This study defines the prevalence and extent of industry funding to fellowship program directors (FPDs) across pediatric surgical specialties. Materials and methodsThis was a retrospective cross-sectional analysis of FPDs in pediatric surgical specialties. Data were amalgamated from the Centers for Medicare and Medicaid Services and the Accreditation Council for Graduate Medical Education. Characteristics of FPDs were obtained from academic websites and medical licensing boards. Personal industry payments from 2016 to 2022 were analyzed, and temporal trends were elucidated. Comparisons were made by year, surgical specialty, and control groups with nonparametric tests. ResultsA total of 241 FPDs were identified, with 206 (85%) receiving industry payments over the study period. The specialties with the highest prevalence of industry funding to FPDs were pediatric orthopedic surgery (100%), pediatric urology (96%), and pediatric surgery (85%). Total industry payments aggregated to $7.3 million dollars with the majority awarded to pediatric orthopedic surgery (91%). Most industry payments were for royalties or licensing (57%) and consulting fees (31%). Median total industry payments per FPD differed between subspecialties (P < 0.001) and was highest in pediatric orthopedic surgery ($7009, interquartile range [IQR], $1771-$50,239) and lowest in pediatric otolaryngology ($116, IQR, $75-$1626). Male FPDs had higher median total industry payments than female FPDs ($1643, IQR, $172-$8731 versus $193, IQR, $84-$712, P < 0.001). ConclusionsIndustry payments to FPDs in pediatric surgical specialties are highly prevalent, but the magnitude varies by specialty. Future work is needed to establish mechanisms that promote equitable partnerships between academia and industry for pediatric surgery training.

Shaping Graduate Medical Education: Status of the Colon and Rectal Surgery Training Program Requirements.

Shaping Graduate Medical Education: Status of the Colon and Rectal Surgery Training Program Requirements.

Medical student use of practice questions in their studies: a qualitative study

Practice questions are highly sought out for use as a study tool among medical students in undergraduate medical education. At the same time, it remains unknown how medical students use and incorporate practice questions and their rationales into their studies. To explore this heavily relied upon study strategy, semi-structured interviews were conducted with second-year medical students to assess how they approach using practice questions. Qualitative thematic analysis revealed several recurrent themes: (1) Medical students use practice questions for primary learning, (2) Medical students place more importance on the rationale of a practice question versus selecting the right answer, and (3) Medical students view practice questions as being designed to be used once or having a single-use. Together, these themes provide insight into how medical students use practice questions to study, which may guide medical educators in their creation of practice questions with appropriate rationales and provide foundational data for future mixed methods analyses seeking to generalize these findings.

Bridging the Gap: A Pilot Study of a Health Care Transition Podcast Curriculum and Standardized Patient Case for Graduate Medical Education Trainees

Bridging the Gap: A Pilot Study of a Health Care Transition Podcast Curriculum and Standardized Patient Case for Graduate Medical Education Trainees

Assessing Neurosurgery Training: Accreditation Council for Graduate Medical Education Case Minimums Versus Surgical Autonomy.

The Accreditation Council for Graduate Medical Education (ACGME) requires neurosurgery residents to reach a set number of cases in specified procedure types (case minimums) before graduation and mandates completion of Milestones. We used the Surgical Autonomy Program, a validated method of autonomy-based resident evaluation, to determine the number of cases it took for residents to become competent and compared these with the ACGME case minimums. We collected data from neurosurgery residents at Duke University on 7 procedures (tumor craniotomy, trauma craniotomy, ventriculoperitoneal shunt, anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), discectomy/laminectomy, and posterior thoracolumbar spinal fusion [PSF]). We defined competency as being graded at the highest autonomy level in the Surgical Autonomy Program by attending neurosurgeons for the first and second time and determined the case volume on the ACGME case log when these were achieved. These results were analyzed with summary statistics. The median case volume among residents (N = 4-8) for the first and second competency rating (and ACGME minimum) for each procedure type was found to be: tumor: 44.5 and 64.5 (min. 60), trauma: 21 and 30 (min. 60), ventriculoperitoneal shunt: 11.3 and 13 (min. 20), ACDF: 30 and 32.5 (min. 20), PCF: 24 and 40 (min. 30), discectomy/laminectomy: 28 and 36 (min. 30), and PSF: 51 and 54 (min. 30). We found variation in the case numbers to reach competency and that for some procedures (tumor, ACDF, PCF, discectomy/laminectomy, and PSF), most residents required more cases than the ACGME case minimums to achieve competency. The ACGME case minimums may not accurately reflect the number of cases required for neurosurgical residents to reach competency. To promote trainee-centered education, individualized, competency-based evaluation systems may be better determining readiness for graduation, including a system that builds off the established ACGME Milestones.

Surgical training trends in the Americas: A cross-continental assessment of minimally invasive surgery and open surgery among surgical trainees.

Minimally invasive surgery (MIS) has become standard of care in many high-income countries, but its adoption in low- and middle-income countries (LICs/MICs) has been impeded by resource- and training-related barriers. We hypothesized that trainees in MICs perform MIS procedures less often, and that as procedure complexity increases, the rate of MIS decreases. A 22-question survey, distributed to representative leaders across Latin America, collected country-specific graduating trainee case requirements and volumes for four index procedures (cholecystectomy, appendectomy, inguinal hernia repair, colectomy) using MIS or open surgery (OS). USA data was obtained from the Accreditation Council for Graduate Medical Education. Kruskal-Wallis and Mann-Whitney U tests were performed to determine whether the rate of MIS differed across all countries, procedure complexity classes, and high income countries (HICs)/MICs. Seven experts (70% response rate) completed the survey, representing: Brazil, Chile, Ecuador, Guatemala, Mexico, Panama, and Paraguay. The percentage of MIS completed by trainees varied with mean and interquartile ranges as follows: cholecystectomy (60%±54%), appendectomy (41%±69%), inguinal hernia repair (19%±23%), colectomy (16%±29%). There was a significant difference in mean MIS experience across the eight countries (H=17.6, p=0.014) and between most complex and least complex procedures (p=0.039). No difference was found between MICs and HICs (p=0.786). We found a significant difference of general surgery trainee exposure to MIS versus OS across the Americas, but the difference was not significantly associated with World Bank Income Groups. Different trainee experiences with MIS and OS may highlight an opportunity for international and bidirectional collaboration.

Unionization of Graduate Medical Education Trainees: Perspectives from Designated Institutional Officials.

Labor unions represent an increasing number of graduate medical education (GME) trainees in the United States. Most GME and other leaders at academic medical centers lack familiarity with resident/fellow unions, including what to expect, what decisions need to be made, and the processes involved in a unionization effort. It is important for designated institutional officials (DIOs), GME program directors, teaching faculty, and other institutional leaders to understand the drivers of resident/fellow unionization, the union organizing campaign and election process, and what follows a vote to unionize, including collective bargaining. Careful consideration of the role of educational and other institutional leaders during the unionization process is important to prevent any loss of trust between residents/fellows and those they view as their advocates. In this Commentary, the authors describe these considerations from their perspective as DIOs and GME leaders.

Special Issue on Informatics Education: Vanderbilt Clinical Informatics Center Education Strategy: To Infinity and Beyond!

The Vanderbilt Clinical Informatics Center (VCLIC) is based in the Department of Biomedical Informatics (DBMI) and operates across Vanderbilt University Medical Center (VUMC) and Vanderbilt University (VU) with a goal of enabling and supporting clinical informatics research and practice. VCLIC supports several types of applied clinical informatics teaching, including teaching of students in courses, professional education for staff and faculty throughout VUMC, and workshops and conferences that are open to the public. In this paper, we provide a detailed accounting of our center and institution's methods of educating and training faculty, staff, students, and trainees from across the academic institution and health system on clinical informatics topics, including formal training programs and informal applied learning sessions. Through a host of informal learning events, such as workshops, seminars, conference-style events, bite-size instructive videos, and hackathons, as well as several formal education programs, such as the Clinical Informatics Graduate Course, Master's in Applied Clinical Informatics, Medical Student Integrated Science Course, Graduate Medical Education Elective, and Fellowship in Clinical Informatics, VCLIC and VUMC provide opportunities for faculty, students, trainees, and even staff to engage with Clinical Informatics topics and learn related skills. The described programs have trained hundreds of participants from across the academic and clinical enterprises. Of the VCLIC-held events, the majority of attendees indicated through surveys that they were satisfied, with the average satisfaction score being 4.63/5, and all events averaging a satisfaction score of greater than 4. Across the 20 events VCLIC has held, our largest audiences are DBMI, HealthIT operational staff, and students from the medical and nursing schools. VCLIC has created and delivered a successful suite of formal and informal educational events and programs to disseminate clinical informatics knowledge and skills to learners across the academic institution and healthcare system.