Hospital Residency Program Research Articles

Attracting medical school graduates to residency programs in remotely located hospitals: the challenge lies beyond financial incentives

BackgroundRecruitment to residency programs in hospitals located in other than major hubs (“remotely located”) is a challenge in many countries. In 2011, the Israeli Ministry of Health launched a 10-year financial incentive to encourage physicians to enroll in residency programs in such hospitals. Nearly 1 billion New Israeli Shekels (260 million US$) were invested in that program which had only limited success. As a new physician association’s collective agreement is impending, we aimed to measure the effectiveness of selected incentives in attracting medical school graduates to residencies in remotely located hospitals.MethodsThis study included Israeli medical students in their final year of medical school. We used an online questionnaire with multiple-choice demographic questions and a 5-point Likert scale to gauge the effect of various incentives on their preference for residency location.ResultsBetween July and November 2022, 522 students responded (405 studied in Israeli medical schools [out of 705 students] and 117 in foreign medical schools [out of 1936 students]). Forty-two percent had at least one clerkship in a remotely located hospital, and 24% had included at least one remotely located hospital among their top five choices for internship. Only 13% reported that they prefer a residency program in those institutions. The incentive selected by students as most persuasive was government assistance in acceptance to and financial support for a fellowship abroad, followed by a financial grant and fewer on-call hours. Only 7% of the students indicated that no incentive would influence them to choose a remotely located hospital for their residency training. Medical education in a remotely located university and the choice of at least one remotely located hospital among the top five choices for internship were significantly associated with positive incentive receptivity, whereas male sex and older age were associated with negative receptivity.ConclusionThis study on the attitudes of Israeli medical school graduates toward incentives aimed at attracting them to residencies in remotely located institutions revealed that career development opportunities and assistance in obtaining fellowships might influence their choice.

Role of artificial intelligence and machine learning in the diagnosis of cerebrovascular disease.

Cerebrovascular diseases are known to cause significant morbidity and mortality to the general population. In patients with cerebrovascular disease, prompt clinical evaluation and radiographic interpretation are both essential in optimizing clinical management and in triaging patients for critical and potentially life-saving neurosurgical interventions. With recent advancements in the domains of artificial intelligence (AI) and machine learning (ML), many AI and ML algorithms have been developed to further optimize the diagnosis and subsequent management of cerebrovascular disease. Despite such advances, further studies are needed to substantively evaluate both the diagnostic accuracy and feasibility of these techniques for their application in clinical practice. This review aims to analyze the current use of AI and MI algorithms in the diagnosis of, and clinical decision making for cerebrovascular disease, and to discuss both the feasibility and future applications of utilizing such algorithms. We review the use of AI and ML algorithms to assist clinicians in the diagnosis and management of ischemic stroke, hemorrhagic stroke, intracranial aneurysms, and arteriovenous malformations (AVMs). After identifying the most widely used algorithms, we provide a detailed analysis of the accuracy and effectiveness of these algorithms in practice. The incorporation of AI and ML algorithms for cerebrovascular patients has demonstrated improvements in time to detection of intracranial pathologies such as intracerebral hemorrhage (ICH) and infarcts. For ischemic and hemorrhagic strokes, commercial AI software platforms such as RapidAI and Viz.AI have bene implemented into routine clinical practice at many stroke centers to expedite the detection of infarcts and ICH, respectively. Such algorithms and neural networks have also been analyzed for use in prognostication for such cerebrovascular pathologies. These include predicting outcomes for ischemic stroke patients, hematoma expansion, risk of aneurysm rupture, bleeding of AVMs, and in predicting outcomes following interventions such as risk of occlusion for various endovascular devices. Preliminary analyses have yielded promising sensitivities when AI and ML are used in concert with imaging modalities and a multidisciplinary team of health care providers. The implementation of AI and ML algorithms to supplement clinical practice has conferred a high degree of accuracy, efficiency, and expedited detection in the clinical and radiographic evaluation and management of ischemic and hemorrhagic strokes, AVMs, and aneurysms. Such algorithms have been explored for further purposes of prognostication for these conditions, with promising preliminary results. Further studies should evaluate the longitudinal implementation of such techniques into hospital networks and residency programs to supplement clinical practice, and the extent to which these techniques improve patient care and clinical outcomes in the long-term.

Applications of Blueprints on Hospital Residency Program

Residency programs are completely essential for medical school students. This pivotal experience enriches students’ education and yields an opportunity to secure jobs. Training local doctors is a laborious endeavor that faces many challenges during the recruitment cycle. Private medical schools have attempted to meet their goals by reducing waste and improving processes. This study aims to investigate the issues that arise in the service flow process on the hospital residency programs and to investigate the impact of risk on the provided service. Service blueprint techniques are applied to examine and provide a comprehensive understanding of hospital residency programs and the underlying resources and processes that make it possible. Data is collected from a private hospital to develop the initial and future service blueprint, providing strategic benefits for the hospital. The study helps in reducing the service process time by almost 90%.

The role of educators, mentors, and motivation in shaping dental students to become life-long learners: A pan-Canadian survey.

The core values taught in dental school will arguably stay with the student for their whole career. An instructor has the power to influence a student's education through guidance, mentorship, and encouragement. This influence could be the factor that determines whether a student will become a motivated practitioner. The aim of this study was to identify whether dental schools are providing motivation to students to excel in their career and to become life-long learners. A web-based questionnaire was distributed electronically during 2020-2021 to Canadian dental students via email, social media, etc. The questionnaire included questions on demographics, the dental school environment, instructor evaluation, and dental student perspectives on education. Of the 318 participants, 95.7% indicated their school follows a pass/fail system in some to all courses. Note that 61.2% found didactic components were weighted more heavily than clinical components. A greater number of participants found that their clinical instructors were more invested than their didactic instructors, in seeing their students become successful (53.0%) and excellent (44.6%) in their future careers. A total of 84.7% have not found a mentor, and 76% are not interested. Most participants indicated they are "moderately" motivated by their instructors to take continuing education courses (41.3%) and "not at all" motivated to continue their studies in a hospital (42.1%) or speciality residency program (56.3%). Instructors, educators, and mentors play a vital role in shaping dental student motivation in didactic and clinical courses, and beyond the school environment. Teaching institutions should incorporate opportunities for mentorship and student feedback to improve the delivery of dental education. Further studies may include assessing the role of mentorship at dental schools.

Desafios em saúde mental durante a pandemia: relato de experiência

Resumo A readequação do atendimento em saúde mental durante a pandemia de covid-19 foi facilitada por mudanças na legislação médica vigente. O teleatendimento trouxe oportunidades para tratar, acompanhar e identificar os transtornos mentais de modo diferente. Este artigo tem por objetivo relatar a experiência do serviço de saúde mental de um hospital universitário e da residência médica em psiquiatria durante este período. A assistência ambulatorial incluiu teleatendimento e consultas presenciais conforme a gravidade, e foi criado o projeto Acolhimento em Saúde Mental em Tempos de Pandemia para assistir os profissionais do hospital. Espera-se que no futuro o teleatendimento seja usado como ferramenta para o cuidado em saúde mental, sendo ainda necessário treinar os profissionais e avaliar a qualidade desse recurso.

Hospital characteristics preferred by medical students for their residency programs: A nationwide matching data analysis.

BackgroundIn 2004, Japan introduced a mandatory 2‐year postgraduate training program for graduating medical students with a super‐rotation curriculum. A national matching system was established to determine the hospital residency programs best suited for the students. We examined the hospital characteristics preferred by applicants for residencies.MethodsA nationwide cross‐sectional study was conducted. Data on salaries, bonuses, and number of accepted ambulances were compiled from the Residency Electronic Information System. Information on the prefectural population, urban area, and number of senior residents (postgraduate years 3–5) for specialty training was extracted from data published on the web page. The ratio of the number of first‐choice applicants to recruitment capacity (matching ratio) for each program was compared between the characteristics of the hospitals and prefectures.ResultsA strong linear relationship was observed between the number of first‐choice applications and the allocated number of resident positions (correlation coefficient, .72). The matching ratio was greater in community hospitals (2.10 times compared with university hospitals; 95% confidence interval [CI], 1.75–2.53), in hospitals with higher numbers of accepted ambulance cases (1.05 times per 1000 annually; 95% CI, 1.03–1.08), and in hospitals that served a larger prefectural population (1.05 times per million; 95% CI, 1.02–1.08).ConclusionsFinancial incentives do not seem to attract residency applicants. Applicants prefer non‐university hospitals located in populous areas and those that accept larger number of ambulance cases. To recruit junior residents, an emergency department may need to have higher activity with larger numbers and variety of cases.

チェックシート, e-learning, 自作防護具, 精神的サポート : 大学病院研修医プログラムでの取組み

チェックシート, e-learning, 自作防護具, 精神的サポート : 大学病院研修医プログラムでの取組み

Current status of pain medicine training in anesthesiology and pain medicine residency programs in university hospitals of Korea: a survey of residents’ opinions

BackgroundIn Korea, anesthesiologists are expected to be mainstream pain medicine (PM) practitioners. However, anesthesiology and pain medicine (APM) residency programs mostly emphasize anesthesia learning, leading to insufficient PM learning. Therefore,...

From Policy to Execution:: Residency Programs for New Graduate Nurses

The evidence is substantial, and all new graduate nurses should be offered a residency program as part of their transition into practice. In fact, the state of Maryland adopted legislation to ensure such in May, 2019. The American Academy of Nursing (AAN) recommends a residency program for all new graduate nurses. In the spring of 2019, invited nursing leaders from across the United States met during a and discussed essential steps on how to support, execute, and operationalize the recommendations offered by the AAN. In this article, the authors provide a summary of the think tank attended by key opinion leaders and concrete steps to operationalize the future of residency programs in acute care hospitals.

Using financial incentives to attract medical residents to the periphery: The Israeli experience

BackgroundIn 2011, Israel instituted financial incentives as part of a larger program to attract doctors to residency programs in peripheral hospitals. ObjectiveTo explore the impact of these incentives and related changes on the choices of locations for residency training in Israel. MethodsWe performed (A) an analysis of administrative data on the location of all new medical residencies in 2005–2014 (B) an internet/phone survey of residents who began specialty training in 2013–2014, with a response rate of 71%. Results(A) Of all entrants to residency training programs in Israel, those in peripheral hospitals constituted 16–20% in 2005–2010, 19% in 2011, 23% in 2012, and 23% in 2013; the increase consisted predominantly of physicians who were graduates of non-Israeli medical schools (B) About half of all residents in the periphery reported that the incentives contributed to their choice of residency location. About 40% of that group also reported that they had planned already in medical school to practice in the periphery, while 60% of that group (30% of all residents in the periphery) did not have such plans prior to medical school. About 70% of the residents in peripheral hospitals grew up in the periphery; for the southern periphery this was 40% and for the northern periphery this was 80%. ConclusionsThe changes instituted in 2011 apparently affected residency location preferences for a non-negligible proportion of young physicians, particularly among those who grew up in the periphery. Policymakers should consider combining targeted incentives with measures to increase the supply of physicians who grew up in the periphery.

When Coaching Meets Mentoring: Impact of Incorporating Coaching into an Existing Mentoring Program at a Community Hospital.

IntroductionOne in two physicians experiences professional burnout. Resident coaching is a novel method to provide emotional support and professional development to residents. The feasibility of implementing coaching at a community hospital has not been reported. This curricular innovation examined the feasibility and impact of integrating positive psychology coaching at a community hospital.MethodsThe Massachusetts General Hospital (MGH) Professional Development Coaching Program (PDCP) curriculum was used to train faculty coaches and for the informal pre-coaching session refreshers. Participants were paired and expected to participate in four 1:1 coaching sessions. The impact of the PDCP was assessed through pre- and post-PDCP online surveys.ResultsTwelve interns and nine faculty coaches were included in the program and surveyed. Survey completion was 10/12 (83%) and 6/9 (67%) at baseline and 9/12 (75%) and 7/9 (78%) at end of year (EOY) for interns and coaches, respectively. For interns, Emotional Exhaustion (EE) using the Maslach Burnout Inventory (MBI) was high or medium for 60% of respondents at baseline, and 56% at EOY. Fifty percent of coaches scored medium on EE at baseline, compared to only 14.3% at EOY. Seventy-five percent of respondents rated their PDCP experience as excellent or good. Nearly all interns rated the quality of communication with their coaches highly on a five-point Likert Scale.ConclusionsImplementation of a coaching program in a community hospital residency program is feasible. Burnout using the MBI was stable from beginning to EOY for interns, but improved for coaches. Interns and coaches rated their professional development coaching program experience highly, and would recommend it to others.

"Good Enough" Psychiatric Residency Training in Borderline Personality Disorder: Challenges, Choice Points, and a Model Generalist Curriculum.

While the public health burden posed by borderline personality disorder (BPD) rivals that associated with other major mental illnesses, the prevailing disposition of psychiatrists toward the disorder remains characterized by misinformation, stigma, aversive attitudes, and insufficient familiarity with effective generalist treatments that can be delivered in nonspecialized health care settings. Residency training programs are well positioned to better equip the next generation of psychiatrists to address these issues, but no consensus or guidelines currently exist for what and how residents should be taught about managing BPD. Instead, disproportionately limited curricular time, teaching of non-evidence-based approaches, and modeling of conceptually confused combinations of techniques drawn from specialty BPD treatments are offered. In this article, we (1) explain why training in a generalist model is sensible and why alternative approaches are not appropriate for residents, (2) propose a plan for giving residents adequate training via a generalist model, highlighting minimal didactic and clinical-training objectives (dubbed "core competencies" and "milestones") and a model curriculum developed at the Massachusetts General Hospital/McLean Hospital residency program, and (3) describe obstacles to implementation of effective generalist training posed by infrastructural, faculty-centered, and resident-centered variables.

Residency Programs and Clinical Leadership Skills Among New Saudi Graduate Nurses.

Nurse residency programs have been adopted by health care organizations to assist new graduate nurses with daily challenges such as intense working environments, increasing patient acuity, and complex technologies. Overall, nurse residency programs are proven beneficial in helping nurses transition from the student role to independent practitioners and bedside leaders. The purpose of this study was to assess the impact of residency programs on leadership skills of new Saudi graduate nurses who completed a residency program compared to new Saudi graduate nurses who did not participate in residency programs. The study design was cross-sectional involving a convenience sample (n = 98) of new graduate nurses from three hospitals in Saudi Arabia. The Clinical Leadership Survey was used to measure the new graduate nurses' clinical leadership skills based on whether they completed a residency program or not. Descriptive statistics, correlation, and multiple linear regression analyses were conducted to examine leadership skills in this sample of new Saudi graduate nurses. A significant difference was found between residents and nonresidents in their leadership skills (t = 10.48, P = .000). Specifically, residents were significantly more likely to show higher levels of leadership skills compared to their counterparts. Attending a residency program was associated with a significant increase in clinical leadership skills. The findings of this study indicate that there is a need to implement more residency programs in hospitals of Saudi Arabia. It is imperative that nurse managers and policy makers in Saudi Arabia consider these findings to improve nurses' leadership skills, which will in turn improve patient care. Further research should examine how residency programs influence new graduate nurses' transition from student to practitioner with regard to clinical leadership skills in Saudi Arabia.

Residency application screening tools: A survey of academic medical centers.

The current use and content of screening tools utilized by ASHP-accredited pharmacy residency programs were assessed. A survey consisting of 19 questions assessing residency programs and the screening of pharmacy residency program applicants was e-mailed to residency directors of 362 pharmacy residency programs at 105 University HealthSystem Consortium (UHC)-member institutions. Questions gathered general program demographic information, data related to applicant growth from residency years 2010-11 to 2011-12, and information about the residency screening processes currently used. Responses were received from 73 residency program sites (69.5%) of the 105 UHC-member institutions to whom the e-mail was sent. Many sites used screening tools to calculate applicants' scores and then determined which candidates to invite for an onsite interview based on applicants' scores and group discussion. Seventy-eight percent (n = 57) of the 73 responding institutions reported the use of a screening tool or rubric to select applicants to invite for onsite interviews. The most common method of evaluation was individual applicant review before meeting as a group to discuss candidate selection. The most important factor for determining which residency candidate to interview was the overall impression based on the candidate's curriculum vitae (CV) and letters of recommendation. Most residency programs in UHC-member hospitals used a screening tool to determine which applicants to invite for an onsite interview. The most important factor for determining which residency candidate to interview was the overall impression based on the candidate's CV and letters of recommendation.

A Brief Intervention to Improve Food Allergy Knowledge Among US Pediatricians: Lessons Learned

EE Springston, CH Lau, P Patel. Pediatr Allergy Immunol . 2012;23(7):642–647 To determine if a brief educational tool developed for pediatricians would be effective in addressing gaps in food allergy knowledge. US pediatricians ( N = 61), including practicing pediatricians recruited from 4 Chicago-area practices, graduates from the Children’s Memorial Hospital residency program, and current members of the Illinois chapter of the American Academy of Pediatrics. A Food Allergy Comprehension Tool (FACT) was developed …

A survey of access to trial of labor in California hospitals in 2012.

BackgroundIn 2010, the NIH and ACOG recommended increasing women’s access to trial of labor after cesarean (TOLAC). This study explored access to TOLAC in California, change in access since 2007 and 2010, and characteristics of TOLAC and non-TOLAC hospitals.MethodsBetween November 2011 and June 2012, charge nurses at all civilian California birth hospitals were surveyed about hospitals’ TOLAC availability and requirements for providers. VBAC rates were obtained from the California Office of Statewide Health Planning and Development (OSHPD). Distance between hospitals was calculated using OSHPD geocoding.ResultsAll 243 birth hospitals that were contacted participated. In 2010, among the 56% TOLAC hospitals, the median VBAC rate among TOLAC hospitals was 10.8% (range 0-37.3%). The most cited reason for low VBAC rates was physician unwillingness to perform them, especially due to the requirement to be continually present during labor. TOLAC hospitals were more likely to be larger hospitals in urban communities with obstetrical residency training. However, there were six (11.3%) residency programs in non-TOLAC hospitals and 5 (13.5%) rural hospitals offering TOLAC. The majority of TOLAC hospitals had 24/7 anesthesia coverage and required the obstetrician to be continually present if a TOLAC patient was admitted; 17 (12.2%) allowed personnel to be 15-30 minutes away. TOLAC eligibility criteria included one prior cesarean (32.4%), spontaneous labor (52.5%), continuous fetal monitoring and intravenous access (99.3%), and epidural analgesia (19.4%). The mean distance from a non-TOLAC to a TOLAC hospital was 37 mi. with 25% of non-TOLAC hospitals more than 51 mi. from the closest TOLAC hospital.In 2012, 139 hospitals (57.2%) offered TOLAC, 16.6% fewer than in 2007. Since 2010, five hospitals started and four stopped offering TOLAC, a net gain of one hospital offering TOLAC with three more considering it. Only two hospitals cited change in ACOG guidelines as a reason for the change.ConclusionsDespite the 2010 NIH and ACOG recommendations encouraging greater access to TOLAC, 44% of California hospitals do not allow TOLAC. Of the 56% allowing TOLAC, 10.8% report fewer than 3% VBAC births. Thus, national recommendations encouraging greater access to TOLAC had a minor effect in California.

Desarrollo de la medicina familiar en Paraguay

Family Medicine is present in Paraguay since 1981, when officially starts the Family Medicine Residency Programs, at Baptist Hospital in Asuncion (called today Baptist Medical Center). Until 1998, only this hospital was the former of family medicine specialists. After that, several residency programs in others public and private hospitals were opened. In the 1990 the Paraguayan Society of Family Medicine was founded. In the last 10 years, the specialty had grown in an interesting way, because the public and private universities started the family medicine as undergraduate field, they had increased the residence programs and the available spots in there, and the Ministry of Health initiated the opening of Units of Family Health. Also, in the last couple of years, the Paraguayan Society of Family Medicine has begun the regularization of the certification and recertification of the Specialty. Desarrollo de la medicina familiar en Paraguay La medicina familiar en Paraguay tiene alrededor de 25 anos, ya que con el inicio de la residencia medica en 1981 y posteriormente, la fundacion de la Sociedad Paraguaya de Medicina Familiar en 1990, se dan los dos hitos principales para que la especialidad emerja entre las otras especialidades tradicionales en el pais.

A qualitative analysis of characteristics and problems of residency programs in community hospitals in Japan

A qualitative analysis of characteristics and problems of residency programs in community hospitals in Japan

A Survey of Access to Trial of Labor in California Hospitals in 2012

In 2010, the NIH and ACOG recommended increasing women’s access to trial of labor after cesarean (TOLAC). This study explored access to TOLAC in California, change in access since 2007 and 2010, and characteristics of TOLAC and non-TOLAC hospitals. Between November 2011 and June 2012, charge nurses at all civilian California birth hospitals were surveyed about hospitals’ TOLAC availability and requirements for providers. VBAC rates were obtained from the California Office of Statewide Health Planning and Development (OSHPD). Distance between hospitals was calculated using OSHPD geocoding. All 243 birth hospitals that were contacted participated. In 2010, among the 56% TOLAC hospitals, the median VBAC rate among TOLAC hospitals was 10.8% (range 0-37.3%). The most cited reason for low VBAC rates was physician unwillingness to perform them, especially due to the requirement to be continually present during labor. TOLAC hospitals were more likely to be larger hospitals in urban communities with obstetrical residency training. However, there were six (11.3%) residency programs in non-TOLAC hospitals and 5 (13.5%) rural hospitals offering TOLAC. The majority of TOLAC hospitals had 24/7 anesthesia coverage and required the obstetrician to be continually present if a TOLAC patient was admitted; 17 (12.2%) allowed personnel to be 15-30 minutes away. TOLAC eligibility criteria included one prior cesarean (32.4%), spontaneous labor (52.5%), continuous fetal monitoring and intravenous access (99.3%), and epidural analgesia (19.4%). The mean distance from a non-TOLAC to a TOLAC hospital was 37 mi. with 25% of non-TOLAC hospitals more than 51 mi. from the closest TOLAC hospital. In 2012, 139 hospitals (57.2%) offered TOLAC, 16.6% fewer than in 2007. Since 2010, five hospitals started and four stopped offering TOLAC, a net gain of one hospital offering TOLAC with three more considering it. Only two hospitals cited change in ACOG guidelines as a reason for the change. Despite the 2010 NIH and ACOG recommendations encouraging greater access to TOLAC, 44% of California hospitals do not allow TOLAC. Of the 56% allowing TOLAC, 10.8% report fewer than 3% VBAC births. Thus, national recommendations encouraging greater access to TOLAC had a minor effect in California.

Do Early Career Indicators of Clinical Skill Predict Subsequent Career Outcomes and Practice Characteristics for General Internists?

To study relationships between clinical skill measures assessed at the beginning of general internists' careers and their career outcomes and practice characteristics. General Internist Community Tracking Study Physician Survey respondents (2000-2001, 2004-2005) linked with residency program evaluations and American Board of Internal Medicine board certification examination score records; n = 2,331. Cross-sectional regressions of career outcome and practice characteristic measures on board examination scores/success, residency evaluations interacted with residency type, and potential confounding variables. Failure to achieve board certification was associated with $27,206 (18 percent, p < .05) less income and 14.9 percent more minority patients relative to physicians scoring in the bottom quartile on their initial examination who eventually became certified (p < .01). Other skill measures were not associated with income. Scoring in the top rather than bottom quartile on the board certification examination was associated with 9 percent increased likelihood of reporting high career satisfaction (p < .05). Among physicians trained in community hospital residency programs, lower evaluations were associated with 14.5 percent higher share of minority patients (p < .05). Both skill measures were associated with practice type. There are associations between early career skill measures and career outcomes. In addition, minority patients are more likely to be treated by physicians with lower early career clinical skills measures than nonminority patients.