Incoming Interns Research Articles

Patient Panel Handoffs for New Interns in Internal Medicine Residency Continuity Clinics.

Compared to inpatient care transitions, end-of-year resident continuity clinic panel transitions affect a greater number of patients, yet warm handoffs occur less often. We developed a program-wide curriculum to implement warm handoffs (defined as in-person or virtual via videoconference) for high-risk continuity clinic patients between graduating and incoming residents. The warm handoff intervention was phased in at different clinic sites over the study period and ultimately implemented program-wide across nine affiliated continuity clinics. Graduating residents were instructed to identify high-risk panel patients and optimize documentation of key patient care information for handoff. They then participated in a structured, in-person warm handoff event in June during intern orientation involving a direct transfer of information to incoming interns. We surveyed residents between 2017 and 2021 to assess their satisfaction with the continuity clinic handoff process, as well as their perceptions about safety outcomes, comparing those who received a warm handoff to those who did not. Achieving warm handoffs was feasible, reported by 72% (23/32) of intern respondents by the end of the study period, compared to 43% (13/30) during the first year. Residents who received a warm handoff were more likely to prefer warm handoffs (adjusted odds ratio (aOR) 8.1) and to report satisfaction with the handoff process (aOR 2.7). They were less likely to report having near-misses or adverse events. There were no statistically significant differences in attitudes regarding the importance of outpatient handoffs. Structured warm handoffs of high-risk resident continuity clinic patients from graduating senior residents to incoming interns are feasible and associated with improved resident satisfaction with the continuity clinic panel transfer process and fewer perceived adverse patient care events during this vulnerable time of transition.

Factors Influencing Underrepresented Minority Applicants’ Ranking of General Surgery Residency Programs

Background: Underrepresented minorities (URM) are disproportionately lacking in academic surgery, yet there is wide variation in URM in residency programs. This mixed methods study aims to describe factors that URM interns identified as important in their rank list of general surgery residency programs. These data will aid institutions in increasing URM representation and creating supportive training environments in academic surgery. Methods: We employed a mixed methods approach using an online survey and semi-structured interviews developed through focus group engagement and literature review. Interviews were audio recorded, transcribed, and coded for themes. We conducted narrative thematic analysis. Results: Sixty-four incoming general surgery interns completed the survey with median age 25 to 29. Of respondents, 67% identified as female and 34% as URM. URM general surgery interns were more likely to rate program benefits and finances, revisit opportunities (ie, organized post-interview revisit weekends), and post-graduate job opportunities higher than were non-URM participants (p<0.05). URM participants also ranked factors such as diversity of residents and faculty and diversity and inclusion statements by programs higher than did non-URM participants (p<0.05). Five URM interns completed semi-structured interviews. Qualitative themes influencing URM interns’ rank list decisions included (1) presence of URM in the program, (2) program support of resident-led goals, (3) active inclusivity initiatives, and (4) direct experiences of current URM residents. All interview participants relied heavily on interactions with current URM residents as a source of information. Detractors from programs included interns concerned with being the only person of color at their prospective program and no concrete initiatives or goals in place to support diversity and inclusion, raising concern for performative allyship. Conclusions: When evaluating residency programs, URM weighed current representation and support of URMs, active diversity and inclusion initiatives within a program, and lived experiences of URM residents. Surgery residency programs should take steps to not only intentionally recruit URM applicants but also create a supportive training environment that is diverse, inclusive, and empowering.

Investigating First Year Surgery Residents' Expectations of Demand, Control, and Support During Training

To provide a more granular understanding of the expectations of general surgery interns regarding workplace demand, control, and support prior to starting training. General surgery (GS) interns are at highest risk for burnout and attrition. Maslach frames burnout as resulting from a mismatch between workplace expectations and reality. Occupational science demonstrates workplace demand, control, and support (DCS) as strong influencers of job strain. GS interns' realistic expectations of demands are associated with decreased likelihood of attrition, but their expectations regarding this factor are poorly understood. Semi-structured interviews were conducted with 14 incoming surgical residents at UCSF: University of California, San Francisco (57% women, 71% non-White), exploring expectations regarding workplace DCS. Transcripts were uploaded to analytic software and coded in dyads using an iterative approach to consensus. Transcripts were thematically analyzed using inductive and deductive reasoning, applying job-demand-resource theory frameworks, and following a published 6-step approach. Four main themes emerged: past experiences, expected rewards, anticipated challenges, and the desire to belong. Past experiences describes the expectation to successfully cope with future stressors via self-reliance. Rewards such as professional mastery, personal growth, and sense of meaning were expected outcomes seen as balancing anticipated challenges. Anticipated challenges included low control, toxic cultural elements, and discrimination. Desire to belong (i.e., earned recognition as a peer, inclusion in an elite culture) emerged as a powerful motivator, with survival connotations for women and non-Whites. Our results suggest incoming interns overestimate the efficacy of self-reliance for coping; count on specific rewards; express realistic expectations regarding challenges; and see inclusion among surgeons as an aspiration that off-sets prolonged effort. Further study is warranted to understand expectation-reality mismatch and potential interventions to target dissonance. In this institutional study of general surgery interns, we provide a more granular understanding of the expectations of general surgery interns regarding workplace demand, control, and support prior to starting training, and how we might target "expectations-reality" mismatch and the "desire to belong" as a means of mitigating burnout and minimizing attrition from training.

Using a Virtual Simulation Workshop to Teach Interns Evidence-Based Feedback Techniques.

Background TheAccreditation Council for Graduate Medical Education requires residents to demonstrate competence in integrating feedback into their daily practice. With the shift to virtual medical education during the pandemic, the need for new skills in delivering effective feedback through virtual media has emerged. Methodology This study aimed to assess the feasibility of a virtual bootcamp for interns, utilizing virtual simulation workshops to teach effective feedback skills. The curriculum employed a situated learning-guided participation framework. Virtual standardized students participated, and interns engaged in activities such as providing virtual feedback, completing self-assessments, and receiving instruction on feedback principles, including the one-minute preceptor's five micro-skills. Interns repeated the feedback process, with virtual students providing assessments. Data were collected from 105 incoming interns at Arrowhead Regional Medical Center in June 2021 and June 2022, using Zoom® as the online platform. Results Competency assessments revealed a significant post-training increase in proficiency/expert milestones (88% versus 47%, p = 0.007). Interns' self-assessments also significantly improved (18.02 versus 16.74, p = 0.001), particularly for previously trained interns (18.27 versus 16.7). Non-primary care interns outperformed primary care interns in milestone scores. The majority of interns (80%) reported valuable learning experiences during the workshop, with 70% expressing confidence in using the one-minute preceptor technique during residency. The one-minute preceptor step "reinforce what was right" was deemed the easiest, while "obtain commitment" and "explore emotional reaction" presented significant challenges. Conclusions This study demonstrates the potential of virtual workshops to enhance intern competency in delivering effective feedback through formal processes and the one-minute preceptor. These virtual approaches offer innovative alternatives to in-person teaching, enabling evaluation at higher levels of Miller's pyramid of clinical competence.

Are Incoming Interns Prepared for Patient Safety? New York University Grossman School of Medicine 5-Year Experience.

Are Incoming Interns Prepared for Patient Safety? New York University Grossman School of Medicine 5-Year Experience.

Medical Specialty Interest Survey (MSIS): understanding career interest and specialty training in commencing Australian medical interns

AimTo assess specialisation interests in commencing interns and create a standardised survey to aid medical schools, supervisors and health services in quantifying, understanding and supporting medical career development to improve...

Evaluation of an Individualized Learning Plan Template for the Transition to Residency.

Background Specialty-specific individualized learning plans (ILPs) have been promoted to improve the undergraduate to graduate medical education transition, yet few pilots have been described. Objective To create and report on the feasibility and acceptability of a pilot internal medicine (IM) ILP template. Methods The ILP was created by a group of diverse IM expert stakeholders and contained questions to stimulate self-reflection and collect self-reported readiness data from incoming interns. US IM residency programs were invited to pilot the ILP with interns in spring 2022. Data was used at the programs' discretion. The pilot was evaluated by a post-pilot survey of programs to elicit perceptions of the impact and value of the ILP and analyze anonymous ILP data from 3 institutions. Results Fifty-two IM residency programs agreed to participate with a survey response rate of 87% (45 of 52). Of responding programs, 89% (40 of 45) collected ILPs, thus we report on data from these 40 programs. A total of 995 interns enrolled with 782 completing ILPs (79%). One hundred eleven ILPs were analyzed (14%). Most programs found the ILP valuable to understand incoming interns' competencies (26 of 40, 65%) and areas for improvement (24 of 40, 60%) and thought it should continue (29 of 40, 73%). Programs estimated the ILP took interns 29.2±14.9 minutes and 21.6±10.3 minutes for faculty mentors to complete. The most common barrier was faculty mentor participation. Conclusions An ILP based on interns' self-reported data was feasible and valuable to IM residency programs in understanding interns' competencies and areas for improvement.

The Road to Mastery: An Analysis of Goal Orientation in the Transition from Medical School to Surgical Residency

Goal orientation (GO) is a psychological construct which describes an individual's intrinsic motivation for learning in terms of mastery and performance goals. Mastery goals relate to the intrinsic drive to learn for the sake of learning, while performance goals are oriented toward validating one's own competence by seeking favorable judgments (Performance Approach; PAP) or avoiding negative judgments (Performance Avoid; PAV). Having a mastery GO has been shown to improve overall job satisfaction as well as optimize job performance. We therefore aimed to examine how GO changes during the transition to residency, which is a notoriously challenging period in medical education, and identify interventions that can increase mastery of GO. The validated Goal Orientation in Surgical Trainees (GO-ST) instrument was administered to incoming surgical interns (n = 19) during orientation in a single, university-based program and again at 3 months into the internship. The perceived stress scale (PSS) was also administered at 3 months. Focus groups were used to assess resident perceptions and identify interventions at the end of the 3-month period. Eighteen interns (95%) completed a baseline GO-ST assessment and the 3-month follow-up, including the PSS. Mastery GO decreased from orientation to 3-month follow-up for the entire cohort, but this was not significant (3.89-3.63; p = 0.19). Preliminary interns showed a significant increase in PAV orientation after 3 months (3.28-3.67; p = 0.04) and had significantly lower mastery orientation scores at this time (4.07 vs 3.19; p = 0.02). PSS was significantly higher in preliminary interns at 3 months (18.56 vs 11.89; p = 0.04). Those who were predominantly mastery oriented had significantly lower perceived stress scores (11.64 vs 20.10; p = 0.002) compared with those that had performance goal orientations (PAP and PAV). Five interns (28%) participated in focus groups-identifying pertinent themes: 1) Perceptions of competence, 2) Training security; 3) Feedback approach, 4) Expectations of competence, and 5) Approaches to growth. Mastery GO declines during the transition to surgical residency. Maladaptive PAV orientation increases in preliminary interns due to different short-term priorities and assumptions of competence. Expectations and perceptions of intern competence by senior residents and attendings have a large impact on intern GO. Identifying interventions that optimize mastery goal orientation and minimize performance avoid orientation will potentially minimize intern stress, thereby improving both well-being and clinical performance.

Are COVID-Era General Surgery Interns Starting Residency Behind on Basic Surgical Skills?

To compare incoming general surgery interns' performance on a basic skills assessment before and after the COVID pandemic. A retrospective cohort study compared surgical skill performances of incoming general surgery interns. Each underwent an evidence-based standardized assessment (pretest) with 12-basic surgical knot tying and suturing tasks. A post-test was administered after a 3-month self-directed skills curriculum. Student's t-tests compared proficiency scores from pre-COVID vs. COVID-era general surgery interns before and after curriculum completion. p < 0.05 was significant. Data was collected from surgical residents in an academic general surgery program in the United States. General surgery interns from 2017 to 2019 (pre-COVID) and 2021 to 2022 (COVID-era) were included. Interns with missing data or extreme outliers were excluded. A total of 100 interns in general surgery were included in the pretest cohort (59 pre-COVID, 41 COVID-era) and 101 interns were in the post-test cohort (66 pre-COVID, 35 COVID-era). COVID-era interns scored significantly lower on the pretest compared to pre-COVID interns (COVID-era 721.9+/-268.8 vs. pre-COVID 935.9+/- 228.0, p < 0.001). After the skills curriculum both cohorts improved their proficiency scores. However COVID-era interns still scored significantly lower (COVID-era 1255.0+/-166.3 vs. pre-COVID 1369.8+/-165.6, p = 0.001). This analysis objectively described deficits in fundamental surgical skills for incoming interns whose medical school education was disrupted by the COVID-19 pandemic. A targeted surgical skills curriculum partially remediated these deficiencies. However, many surgical interns may need additional intervention and potentially more time in order to fully develop their surgical skills and meet the competency requirements required for advancement.

Using a Consensus-Driven Approach to Incorporate Holistic Review Into an Internal Medicine Residency Program.

Despite growing interest in incorporating holistic review within residency admissions, implementation by residency programs remains challenging. To incorporate holistic review into the internal medicine residency program at the University of Wisconsin and to report initial feasibility and acceptability data. During the 2020-2021 application cycle, residency stakeholders performed a consensus-driven process to identify highly valued applicant attributes. We used a holistic review process to identify the presence of these attributes among applicants and updated our rank list algorithm to incorporate these attributes. We modified our interview screening criteria and rank list algorithm to de-emphasize other metrics. We surveyed stakeholders to assess time required for this process and compared our final rank list to what it would have been using our prior system. The final list of 10 prioritized applicant attributes included extraordinary leadership, community service, and grit, among others. Among 25 matched residents, 8 (32%) were recognized to have exceptional achievement within one of these 10 attributes. Four members of the incoming intern class (16%) would have been in a rank position lower than our historical matched resident cutoff had they not received additional points for these attributes. Faculty reported that holistic review of applications took an additional 3.8 minutes on average. It was felt that current application materials limit the ability to implement a fully holistic review. The addition of holistic review to our residency admissions process was achieved using a consensus-driven approach and showed favorable feasibility and acceptability data.

Self-Reported Perceptions of Preparedness among Incoming Ophthalmology Residents.

Purpose The purpose of this study was to assess the self-perceived preparedness of incoming postgraduate year 1 (PGY1) and postgraduate year 2 (PGY2) ophthalmology interns/residents to carry out core competencies in ophthalmology. Methods An online survey was created using the Survey Monkey survey platform and distributed to all ophthalmology resident applicants to the Bascom Palmer Eye Institute from the 2021 to 2022 and 2022 to 2023 application cycles. The survey contained questions pertaining to demographics, prior ophthalmic experience, online resources that were used to prepare for ophthalmology, and self-perceived preparedness to carry out key clinical skills in ophthalmology. Results A total of 170 responses were obtained (16.1% response rate). Of those, 119 (70%) were incoming PGY1 interns and 51 (30%) were incoming PGY2 residents for the 2022 to 2023 academic year. Most respondents (90.6%, n = 154) reported that their ophthalmology residency was affiliated with an integrated ophthalmology intern year. Incoming PGY2s moderately agreed with the statement that they felt as prepared to see patients in ophthalmology as they do in other surgical subspecialties, whereas incoming PGY1s only mildly agreed with that statement ( p = 0.003). Both incoming PGY1s and PGY2s felt most prepared to obtain histories relating to basic ophthalmic complaints and felt least prepared to read and interpret ophthalmic imaging studies. The most popular online resources used by respondents in order of popularity were EyeGuru (35.2%, n = 60), EyeWiki (32.9%, n = 56), Tim Root/OphthoBook (26.5%, n = 45), American Academy of Ophthalmology (13.5%, n = 23), and EyeRounds/University of Iowa (13.5%, n = 23). Conclusion A major challenge in integrating ophthalmic education into the medical school curricula is the gradual shift toward shorter preclinical curricula. However, having a core foundation of ophthalmic knowledge is critical for incoming ophthalmology residents to be able to maximize their specialty-specific training. Integrated ophthalmology intern years likely play a significant role in the increased self-efficacy of incoming PGY2s compared with incoming PGY1s. Adopting nontraditional teaching methods like flipped classroom learning, utilizing online medical education resources, and continuing to increase ophthalmology exposure during PGY1 year may better prepare incoming PGY2s to operate independently in ophthalmology settings.

Adverse Childhood Experiences, Household Income, and Mentorship Among Interns Who Are Underrepresented in Medicine.

Underrepresented in medicine (UIM) interns have unique lived experiences that affect their paths to medicine, and more information is needed for medical residency and fellowship programs to better support them. We describe self-reported differences between UIM and White physician interns in key demographic areas, including household income growing up, physician mentorship, and adverse childhood experiences (ACEs). Between 2019 and 2021, we administered a diversity survey to incoming medical interns at the University of Minnesota-Twin Cities. Response rates across the 3 years were 51.2% (167 of 326), 93.9% (310 of 330), and 98.9% (354 of 358), respectively. We conducted analyses to compare UIM and White groups across demographic variables of interest. A total of 831 of 1014 interns (81.9%) completed the survey. Relative to White interns, UIM interns had lower household incomes growing up, lower rates of mentorship, and higher rates of experiencing 4 or more ACEs. The odds of experiencing the cumulative burden of having a childhood household income of $29,999 or less, no physician mentor, and 4 or more ACEs was approximately 10 times higher among UIM (6.41%) than White (0.66%) interns (OR=10.38, 95% CI 1.97-54.55). Childhood household income, prior mentorship experiences, and number of ACEs differed between UIM and White interns.

Evaluating PubMed-Indexed Publications of Applicants Successfully Matching into the Top 50 Urology Residency Programs in the 2021-2023 Cycles.

Background and objective Urology residency match occurs through the American Urological Association (AUA), and hence information about the success of applicants in finding a match is not readily available. The average number of publications a successful urology applicant has when applying for residency is unknown. In light of this, we conducted this study to examine the number of PubMed-indexed research projects involving US senior medical students who successfully matched into the top 50 urology residency programs in the 2021, 2022, and 2023 match cycles. We also assessed these applicants based on their medical schools and gender. Methods Doximity Residency Navigator was used to generate the top 50 residency programs as sorted by reputation. Newly matched residents were found using program Twitter accounts and residency program websites. PubMed was queried for peer-reviewed publications of incoming interns. Results The average number of publications across all incoming interns in the three years was 3.65. The average number of urology-specific publications was 1.86 and that of first-author urology publications was 1.11. The median number of total publications for matched applicants was 2, and applicants with a total of five publications were in the 75th percentile for research productivity. Conclusion A successful applicant had two PubMed-indexed urology paperson average and also had a urology-specific first-author paper in the cycles we surveyed. There has been an increase in publications per applicant when comparing the results to previous application cycles, which can be attributed to post-pandemic changes.

Internal Medicine Recruitment in the Age of Social Media: Strategies to Target Residency Applicants

Applicants in the 2020-2021 residency interview cycle were unable to attend in-person meetings or visit prospective sites of future training. Instead, they relied on printed or digital media for information. Over the past few years, many graduate medical education programs have increased the use of social media to disseminate information to attract and retain faculty, staff, and trainees. Previous studies have quantified the relative presence of social media in residency programs, but there has been limited work on the assessment of social media platforms that applicants use to evaluate internal medicine programs. To more effectively target residency applicants through social media, we sought to understand the use of social media in general and specifically in the residency application process of an incoming intern class recruited during the 2020-2021 interview season. We administered an anonymous survey after matching to a single institution’s 2021 class of 40 internal medicine interns in both categorical and preliminary tracks. The group surveyed came from US medical schools (MD and DO degrees) and international programs. The group surveyed comprised 66% women and 16.7% underrepresented groups as defined by Association of American Medical Colleges guidelines. Our data found that the internal medicine residency applicants mostly used hospital websites and Instagram to evaluate programs. Twitter, which is often assumed to be highly used in academic circles, was rarely used. Our work suggests that a better understanding of the use of digital resources by applicants can allow programs to reach residency applicants in a meaningful way.

Measuring Impact of Simulation-Based Informed Consent Training on Surgical Intern's Long-Term Confidence

Our objective was to evaluate the outcome of a training program on long-term confidence of interns and attending physicians. In this prospective cohort study, general surgery interns underwent a training program on informed consent that involved didactics, standardized patient encounters, and supplemental procedure specific guides at the start of the academic year. At the end of the academic year, we surveyed interns from the classes of 2020 (trained) and 2019 (untrained) about their experience and confidence in obtaining an informed consent. Further, we queried attending physicians on their experience and confidence in the interns at the end of each academic year. Single academic general surgery residency program based at 2 urban tertiary hospitals. General surgery interns including unmatched preliminary residents and categorical interns from general surgery, interventional radiology, and urology. Twenty-four incoming interns participated in the training program. Intern confidence discussing operation benefits improved from a median score of 4 to 5 (p = 0.03), and total confidence improved from a median score of 15 to 17.5 (p = 0.08). There was no difference in median total confidence scores (15 vs. 17.5; p = 0.21) between classes. Attending physicians had similar median total confidence scores following intervention (10 vs. 11; p = 0.87). Intern satisfaction was 80% with the didactic session, and 90% with standardized patient encounters. Twenty percent of learners used the supplemental procedure specific guides. Implementation of an intern targeted program on informed consent that incorporated didactics and standardized patient encounters was viewed as useful and may contribute to long-term improvements in confidence.

2. Fear and Panic: Stories from Displaced Plastic Surgery Residents after Residency Closures

Background: In April 2021, two plastic surgery residency programs lost ACGME-accreditation. This displaced 23 trainees, including students who matched into these programs only a month before. In order to study relocation and provide assistance if future closures occur, the ASPS Resident Council formed the Program Closure Working Group and surveyed displaced residents on their experiences. Methods: A 30-item questionnaire was developed and distributed to displaced trainees. Questions addressed the program closure process, impact of relocation on education, resource availability, and faculty/organizational supportiveness. Questions were also asked regarding effects of relocation on affected trainees’ personal lives. Results: The response rate was 14/23 (61%). Only half of respondents were informed of closure by program leadership (n=7). Five residents were never given formal notice; 3 of them discovered the closure via the ACGME website. No incoming intern was aware of potential program closure prior to submitting rank-lists. Nearly all displaced residents reported lack of support and/or outright antagonism from their faculty, program directors, and chairs. In contrast, ASPS and ACGME were most often considered neither helpful nor hurtful, and ACAPS was most often considered supportive but not proactive. The median relocation cost was $8,000 (IQR $15,125). No residents required additional loans, but 6/10 residents who owned homes were forced to sell. All residents reported moderate (n=6, 43%) or severe (n=8, 57%) mental health burden from displacement. In free-text responses (n=10, 71%), residents reported that programs did not allow them to step out for interviews, and threatened non-promotion if residents attempted to use vacation time to relocate prior to the end of the academic year. Receiving-institution GME offices were unsure how to intake relocating residents, causing delays. Conclusion: Plastic surgery residency closures levied steep financial and mental health costs on displaced residents. While residents did not consider plastic surgery organizations antagonistic, they reported room for improvement regarding program closures. A dedicated committee for guiding residents through these catastrophic events would be beneficial. Ongoing efforts by the ASPS Resident Council include petitioning the ACGME to announce program closures before rank-list submissions, and creating a central resource hub for future reference.

29. A Suturing Evolution: From MS1 to Intern Skill Level after 2-week Intervention

Background: Suture training is a critical component of the medical school curriculum, serving as the first opportunity to learn proper technique. Commonly students are taught in one-time suturing workshops. However, these workshops are minimally effective, because skill acquisition requires repetitive and deliberate practice over an extended time period. The purpose of this project was to create an at-home, self-directed suture training package consisting of a 3D printed suture pad, instructional videos, and materials. By providing this at-home training package to first year medical students, we hypothesized that their suturing skills would dramatically improve and become equal to the skills of incoming surgical interns. Methods: Our plastic surgery department’s 3D printing lab developed a 10cm x 5cm x 2cm mold. Different textures of silicone were poured into the mold and dyed with pigment to simulate the layers of skin, fat, and muscle. We then created a 20-minute instructional video that covers simple interrupted, horizontal mattress and vertical mattress suturing. Seventeen MS1 students were recruited to participate. On day zero, they completed 3 drills, where they had 10 minutes to complete either simple interrupted, horizontal mattress or vertical mattress sutures. Photos were taken of the final product providing a baseline skill assessment. Students then received our training package (suturing trainer, video, tools and sutures) for 2 weeks. After two weeks they repeated the 3 drills. To serve as a control, 16 general surgery interns completed the same drills. For grading, two surgeons looked at blinded photos and assessed how many “acceptable” sutures were placed for each given drill. This number determined participants’ scores. Results: For all three drills, the students’ baseline scores were worse than the interns. After 2 weeks the students demonstrated statistically significant improvement from their baseline. Additionally, after 2 weeks, the post-intervention students were as good as the interns. Conclusion: We created an at-home suturing training package. By giving MS1 students access to this curriculum for 2 weeks, they improved to the skill level of general surgery interns. This strengthens the argument that suturing skill acquisition requires deliberate practice over an extended period of time.

OrthoACCESS: Implementing a Sub-Internship Curriculum for MS4s Applying to Orthopaedic Surgery

Medical students pursuing orthopedic surgery residency build foundational knowledge during clinical rotations. Most clinical rotations, home and away, were paused during the COVID-19 pandemic. Given the lack of structured fourth-year medical student (MS4) education for basic orthopedics, educators developed the Ortho Acting-Intern Coordinated Clinical Education and Surgical Skills (OrthoACCESS) curriculum in 2019. This study demonstrates the accessibility and usability of a MS4 virtual orthopedic curriculum and examines the curriculum's role in increasing learner familiarity with basic orthopedic topics in 2020. OrthoACCESS faculty presented weekly lectures from July to October 2020 using Zoom Webinar. Website content included recorded webinars, external resources, and skills videos. Registrants were anonymously surveyed after each webinar characterizing the knowledge and utility of individual lectures. After the webinar series, registrants were emailed an anonymous post-curriculum survey characterizing their experience using the OrthoACCESS curriculum. OrthoACCESS had 1062 registrants, with 59% (624/1,062) MS4s. 4528 users accessed the OrthoACCESS website from 66 countries. The 15 lectures were viewed 3743 times, 1553 live views and 2190 asynchronous views. 444 postwebinar surveys were completed. Weekly response rates ranged from 18% to 45%. Respondents felt more knowledgeable and more able to apply their knowledge after viewing each lecture (p < 0.001), and found the webinars to be well-organized, well-paced, enthusiastically taught, and level-appropriate. 122/976 (13%) students and 45/291 (15%) faculty completed the postcurriculum survey. Faculty reported that OrthoACCESS was "quite useful" (4 [3-5]) for providing knowledge for an incoming orthopaedic intern. Faculty and students would recommend OrthoACCESS to future learners (5 [4-5]). OrthoACCESS delivered foundational musculoskeletal instruction during a period of increased need. In its initial iteration, this virtual curriculum demonstrated high utilization in the United States and internationally and improved participants' self-reported topical knowledge and ability to apply it clinically.

Bridging the gap: Development of an experiential learning-based health disparities curriculum.

The increasing number of vulnerable populations served by the emergency department (ED) calls for developing and implementing curricula aimed at training residents to deliver quality care for the most marginalized groups. We aimed to address this by developing and piloting a curriculum to introduce the unique challenges and disparities encountered by our diverse ED patient population using an experiential learning approach. We engaged community partners in designing and implementing a curriculum for incoming interns. This curriculum addresses specific populations encountered within the ED including patients with psychiatric illness, patients with cognitive disabilities, intoxicated patients, violent patients, patients of various cultural backgrounds, non-English-speaking patients, and LGBTQ patients. Experiential and active learning sessions with content experts and site visits to area organizations were arranged. Pre-, post-, and time-delayed surveys were deployed to evaluate the pilot of this curriculum. Thirteen incoming interns participated in the orientation curriculum. Residents' comfort with each of these various patient populations as well as familiarity with community and ED resources was assessed before, after, and 1 year delayed from each session (response 13/13, 100%). Their scores increased significantly from baseline in the postsurvey and were maintained 1 year later (p < 0.05). Residents additionally provided narrative responses regarding what they learned and what was most helpful after completing their intern year. This pilot curriculum demonstrates that implementing an experiential learning curriculum and engaging community leaders and resources is key to training residents to address health disparities within their unique ED patient population. As such, it is imperative that we seek to immersively introduce trainees to the unique needs of the patient population they will serve early in training.

Core Entrustable Professional Activities for Entering Residency: A National Survey of Graduating Medical Students' Self-Assessed Skills by Specialty.

The Association of American Medical Colleges described 13 Core Entrustable Professional Activities (EPAs) that graduating students should be prepared to perform under indirect supervision on day one of residency. Surgery program directors recently recommended entrustability in these Core EPAs for incoming surgery interns. We sought to determine if graduating students intending to enter surgery agreed they had the skills to perform these Core EPAs. Using de-identified, individual-level data collected from and about 2019 Association of American Medical Colleges Graduation Questionnaire respondents, latent profile analysis was used to group respondents based on their self-assessed Core EPAs skills' response patterns. Associations between intended specialty, among other variables, and latent profile analysis group were assessed using independent sample t -tests and chi-square tests and multivariable logistic regression methods. Among 12,308 Graduation Questionnaire respondents, latent profile analysis identified 2 respondent groups: 7,863 (63.9%) in a high skill acquisition agreement (SAA) group and 4,445 (36.1%) in a moderate SAA group. Specialty was associated with SAA group membership (p < 0.001), with general surgery, orthopaedic surgery, and emergency medicine respondents (among others) overrepresented in the high SAA group. In the multivariable logistic regression models, each of anesthesiology, ophthalmology, pediatrics, psychiatry, and radiology (vs general surgery) specialty intention was associated with a lower odds of high SAA group membership. Graduating students' self-assessed Core EPAs skills were higher for those intending general surgery than for those intending some other specialties. Our findings can inform collaborative efforts to ensure graduates' acquisition of the skills expected of them at the start of residency.