Internal Medicine Residency Program Research Articles

Quality and Health Equity Dashboards for Internal Medicine Residents: Interactive Displays to Promote Systems-Based Practice and Practice-Based Learning and Improvement.

Background Quality measures help identify gaps and disparities in care delivery and prioritize opportunities to improve health. Calls to enhance Systems-Based Practice and Practice-Based Learning and Improvement competencies for residency training cite the need for quality measures for trainees as central to this effort. The authors sought to demonstrate the feasibility of creating a residency program data visualization dashboard to examine individual and program quality measures for an internal medicine residency program within Kaiser Permanente Northern California. Methods An interactive display was developed to allow for easy visualization of quality and operational measures through an iterative design process. The dashboard displays data for individual residents, residency classes (PGY1-3), and the entire program, including quality measures, systems measures, and patient diagnoses. An iterative process continues to improve the functionality and usefulness of the dashboard. Results It is feasible to create a dashboard to visualize individual and program quality measures and health equity measures for a residency program using a learner-centered approach and alignment with institutional goals through collaboration between education and operational teams. Future studies will examine the audit and feedback process, resident perceptions, and changes to patient outcomes. Conclusion Use of dashboards in graduate medical education is feasible and can be used to help residents and residency programs identify gaps in quality of care.

Health Justice Standards in Graduate Medical Education: Moving from Performative to Concrete Change.

Inadequate support for underrepresented-in-medicine physicians, lack of physician knowledge about structural drivers of health, and biased patient care and research widen US health disparities. Despite stating the importance of health equity and diversity, national physician education organizations have not yet prioritized these goals. To develop a comprehensive set of Health Justice Standards within our residency program to address structural drivers of inequity. The J. Willis Hurst Internal Medicine Residency Program of Emory University is an academic internal medicine residency program located in Atlanta, Georgia. This initiative was led by the resident-founded Churchwell Diversity and Inclusion Collective, modified by Emory IM leadership, and presented to Emory IM residents. We used an iterative process to develop and implement these Standards and shared our progress with our coresidents to evaluate impact. In the year since their development, we have made demonstrable progress in each domain. Presentation of our work significantly correlated with increased resident interest in advocacy (p<0.001). A visionary, actionable health justice framework can be used to generate changes in residency programs' policies and should be developed on a national level.

What internal medicine attendings talk about at morning report: a multicenter study

BackgroundMorning report is a core educational activity in internal medicine resident education. Attending physicians regularly participate in morning report and influence the learning environment, though no previous study has described the contribution of attending physicians to this conference. This study aims to describe attending comments at internal medicine morning reports.MethodsWe conducted a prospective, observational study of morning reports conducted at 13 internal medicine residency programs between September 1, 2020, and March 30, 2021. Each attending comment was described including its duration, whether the comment was teaching or non-teaching, teaching topic, and field of practice of the commenter. We also recorded morning report-related variables including number of learners, report format, program director participation, and whether report was scripted (facilitator has advance knowledge of the case). A regression model was developed to describe variables associated with the number of attending comments per report.ResultsThere were 2,344 attending comments during 250 conferences. The median number of attendings present was 3 (IQR, 2–5). The number of comments per report ranged across different sites from 3.9 to 16.8 with a mean of 9.4 comments/report (SD, 7.4). 66% of comments were shorter than one minute in duration and 73% were categorized as teaching by observers. The most common subjects of teaching comments were differential diagnosis, management, and testing. Report duration, number of general internists, unscripted reports, and in-person format were associated with significantly increased number of attending comments.ConclusionsAttending comments in morning report were generally brief, focused on clinical teaching, and covered a wide range of topics. There were substantial differences between programs in terms of the number of comments and their duration which likely affects the local learning environment. Morning report stakeholders that are interested in increasing attending involvement in morning report should consider employing in-person and unscripted reports. Additional studies are needed to explore best practice models of attending participation in morning report.

C-L Psychiatrists Bring Expertise to End-of-Life Care

C-L Psychiatrists Bring Expertise to End-of-Life Care

Resident Performance Evaluations May Be Biased Toward Whites

Resident Performance Evaluations May Be Biased Toward Whites

Osteitis Condensans Ilii: An Important Mimic of Sacroiliitis.

From the ∗Internal Medicine Residency Program †Division of Rheumatology, University of Missouri School of Medicine, Columbia, MO. The authors declare no conflict of interest. Correspondence: Chokkalingam Siva, MD, MS, FACP, Division of Rheumatology, University of Missouri School of Medicine, Columbia, MO. E-mail: [email protected].

Implementation and Evaluation of a Longitudinal Flipped-Classroom Point-of-Care Ultrasound Curriculum at an Internal Medicine Residency Program.

Point-of-care ultrasound (POCUS) has extensive clinical utility in internal medicine, but formal and uniform curricula in internal medicine are lacking. To determine the effectiveness of a longitudinal, flipped-classroom, academic half-day curriculum on internal medicine resident confidence, utilization, and changes in clinical management. We implemented an asynchronous, flipped-classroom, academic half-day curriculum from November 2020 to November 2021 and conducted an evaluation with a prospective, before-after cohort study. Curriculum included 4 rotating sessions comprised of 20 to 30 min of image interpretation followed by 1.5 to 2 h of image acquisition. Confidence was rated via Likert scale. Utilization was reported via indicating never, 1 to 2, 3 to 4, 5 to 6, or >6 times per month (recorded as 1-5, respectively). Image interpretation was assessed via a 6-question, multiple-choice video assessment. Nineteen of 99 potential residents (19%) completed a pre- and post-curriculum evaluation. Residents attended a median of 4 sessions. Confidence improved from 2.47 to 3.53 (P = .002). Utilization did not improve overall (2.11-2.42, P = .22), but utilization of left ventricular function assessment (1.53-2.00, P = .046) and pulmonary assessment (1.53-2.00, P = .039) increased. The percentage of residents that had ever changed their clinical management by POCUS increased from 47% to 84% after implementation of the curriculum. Cardiac, pulmonary/pleural, volume assessment, and abdominal free fluid exams were reported as the most clinically useful. Implementation of a longitudinal, academic half-day curriculum for POCUS resulted in improved confidence, increased POCUS utilization for the cardiac and pulmonary examination, and changes in clinical management based on POCUS.

Novel In-Training Evaluation Report in an Internal Medicine Residency Program: Improving the Quality of the Narrative Assessment.

To determine whether incorporating our novel in-training evaluation report (ITER), which prompts each resident to list at least three self-identified learning goals, improved the quality of narrative assessments as measured by the Narrative Evaluation Quality Instrument (NEQI). A total of 1468 narrative assessments from a single institution from 2017 to 2021 were deidentified, compiled, and sorted into the pre-intervention form arm and post-intervention form arm. Due to limitations in our residency management suite, incorporating learning goals required switching from an electronic form to a hand-deliver form. Comments were graded by two research personnel utilizing the NEQI's scale of 0-12, with 12 representing the maximum quality for a comment. The outcome of the study was the mean difference in NEQI score between the electronic pre-intervention period and paper post-intervention period. The mean NEQI score for the pre-intervention period was 2.43 ± 3.34, and the mean NEQI score for the post-intervention period was 3.31 ± 1.71, with a mean difference of 0.88 (p < 0.001). In the pre-intervention period, 46% of evaluations were submitted without a narrative assessment (scored as a zero) while 1% of post-intervention period evaluations had no narrative assessment. Internal consistency reliability, as measured by Ebel's intraclass correlation coefficient (ICC), showed high agreement between the two raters (ICC = 0.92). Our findings suggest that implementing a timely, hand-delivered paper ITER that incorporates resident learning goals can lead to overall higher-quality narrative assessments.

Impact of an Observation Medicine Educational Intervention on Residents' Confidence, Knowledge, and Attitudes: A Quasi-Experimental Study.

Driven by innovations in healthcare, observation medicine (OM) is expanding as a medical specialty. Despite exponential growth, education on OM remains underemphasized in the internal medicine (IM) residency programs. We assessed the impact of an educational intervention pairing didactic and experiential learning with an interdepartmental approach on IM residents' confidence, knowledge, and attitudes when providing observation care to patients with neuro-cardiovascular diseases in the hospital setting. Our multifaceted intervention incorporated OM's principles and practice in a flipped classroom with the team-, case-, lecture- and evidence-based learning model. Kirkpatrick's evaluation model was used to assess the educational intervention's effectiveness according to the first three levels, ie, reaction, learning, and behavior, using quantitative surveys. The surveys were completed pre-intervention, and immediately upon completion of the educational intervention. Of 55 eligible residents, 55 (100%) participated in this intervention. Fifty (90%) completed the pre-intervention survey, and 21 (38%) completed the immediate post-intervention survey. Kirkpatrick's evaluation framework showed that the intervention had a positive impact on residents' motivational reaction (attention, relevance, confidence, and satisfaction [ARCS], M = 3.8, SD = 0.87), their knowledge of common observation diagnoses (pre = 49%, post = 63%), particularly on cardiac diagnostic workup and approach to patients with transient neurological symptoms (P < .05), and their behavior and self-assessment of core competency domains (pre-mean = 2.69, post-mean = 3.18, P < .001). Our multimodal intervention provides a framework for a structured OM educational experience that can be incorporated into residency training, even without a formal observation unit rotation. The analysis also offers literary data on the current state of OM education in an IM residency program and supports the need to expand OM's educational resources to counteract the growth in hospital observation services. Future research should include an analysis of residents' knowledge and skills from a longitudinal OM experience and advancing the results to residency programs where observation care is as applicable as ours.

Impact of a Resident-Driven Research Club on Scholarly Activity in an Academic Internal Medicine Residency Program During the COVID-19 Pandemic.

Traditional journal clubs have been shown to be insufficient in improving residents' scholarly productivity, often due to the inability to sustain residents' interest and participation. Additionally, the 2019 novel coronavirus (COVID-19) pandemic restrictions caused a decline in academic scholarly productivity across residency programs. We evaluated the impact of a resident-led research club called 'journal café' on residents' scholarly productivity by comparing scholarly output between the journal café members and non-members during the COVID-19 pandemic. The journal café was established in the 2012/2013 academic year by internal medicine residents of a university residency program in Atlanta, Georgia, to foster self-directed collaboration among residents based on shared interests in academic research. The journal café runs independently of the residency program's journal club. We categorized IM residents at our institution into journal café members and non-members and collected data on their research productivity during residency training and the COVID-19 pandemic. The survey was conducted between April and June 2021 and analyzed data presented using frequencies, tables, and appropriate charts. Sixty-eight residents (29 journal café members and 39 non-members) completed the survey (response rate of 85%). A significantly higher number of journal café members reported having five or more research publications (55.1% vs 7.1%, P < .001) and scientific presentations (48.3% vs 2.6%, P < .001) compared with non-members. Additionally, more journal café members published COVID-19-related research in peer-reviewed journals compared with non-members (68% vs 32%, n = 19). Finally, most of the residents cited the opportunity of a platform to share and brainstorm on research ideas as the reason for joining the journal café. We found an association between journal café participation and increased scholarly activity, particularly during the COVID-19 pandemic. Independent resident-led research clubs supported by the residency program may complement the traditional journal clubs and enhance residents' participation in research.

Read to Lead: Developing a Leadership Book Club Curriculum for Graduate Medical Education.

The importance of effective leadership for improving patient care and physician well-being is gaining increased attention in medicine. Despite this, few residency programs have formalized education on leadership in medicine. The most effective ways to train graduate medical education (GME) trainees in leadership are unclear. Our large internal medicine residency program implemented a book club to develop leadership skills in residency. Through independent reading of the selected book and resident-led small group discussions, we facilitated dialogue on the challenges of leading effectively. A survey-based curricular evaluation demonstrated that 61% of respondents felt that the book club influenced their thoughts about leadership and that 66% of participants would recommend the book club to other residency programs. Lack of time was the main barrier to participation while addition of complementary media or alternative book formats were identified as possible solutions to increase engagement. Leadership book clubs are a practical and effective way to teach leadership during residency. More research is needed to identify the best formats for book club discussion and to develop additional tools to foster future physician leaders.

Confidence in Neurology: how Educators can help Junior Doctors fight Neurophobia

Aim: To study factors influencing junior doctors’ confidence when managing neurological conditions.Methods: Using a previously-validated questionnaire, residents of a Singaporean Internal Medicine residency programme were retrospectively-surveyed on their confidence when managing neurological conditions against a 6-point Likert scale. Those who considered themselves confident were compared against those who did not, studying factors contributing to differences in their confidence.Results: 54% (94) of eligible residents completed the survey, of which only 58% felt confident when surveyed, and tended to report adequate interaction with neurologists (69% vs 31%, p = 0.004) and patients (75% vs 24%, p = 0.0001), and that the training material (75% vs 44%, p = 0.023) and bedside teaching were adequate (69% vs 38%, p = 0.026). Of note, graduates from the United Kingdom, Republic of Ireland, and Australia reported feeling less-than-confident immediately upon graduation (31% vs 6%, p = 0.043). However, during graduate medical training, those who experienced improvement in their confidence tended to be males (46% vs 23%, p = 0.024), and were likelier to have received adequate training material (41% vs 20%, p = 0.032) and bedside teaching (67% vs 46%, p = 0.035).Conclusion: Low confidence prevails amongst junior doctors when managing neurological conditions. Female trainees, and graduates of medical schools in culturally-different countries are likelier to require increased organizational support. Equity within the medical training framework is also vital for building their confidence.

Racial and Ethnic Differences in Internal Medicine Residency Assessments

Previous studies have demonstrated racial and ethnic inequities in medical student assessments, awards, and faculty promotions at academic medical centers. Few data exist about similar racial and ethnic disparities at the level of graduate medical education. To examine the association between race and ethnicity and performance assessments among a national cohort of internal medicine residents. This retrospective cohort study evaluated assessments of performance for 9026 internal medicine residents from the graduating classes of 2016 and 2017 at Accreditation Council of Graduate Medical Education (ACGME)-accredited internal medicine residency programs in the US. Analyses were conducted between July 1, 2020, and June 31, 2022. The primary outcome was midyear and year-end total ACGME Milestone scores for underrepresented in medicine (URiM [Hispanic only; non-Hispanic American Indian, Alaska Native, or Native Hawaiian/Pacific Islander only; or non-Hispanic Black/African American]) and Asian residents compared with White residents as determined by their Clinical Competency Committees and residency program directors. Differences in scores between Asian and URiM residents compared with White residents were also compared for each of the 6 competency domains as supportive outcomes. The study cohort included 9026 residents from 305 internal medicine residency programs. Of these residents, 3994 (44.2%) were female, 3258 (36.1%) were Asian, 1216 (13.5%) were URiM, and 4552 (50.4%) were White. In the fully adjusted model, no difference was found in the initial midyear total Milestone scores between URiM and White residents, but there was a difference between Asian and White residents, which favored White residents (mean [SD] difference in scores for Asian residents: -1.27 [0.38]; P < .001). In the second year of training, White residents received increasingly higher scores relative to URiM and Asian residents. These racial disparities peaked in postgraduate year (PGY) 2 (mean [SD] difference in scores for URiM residents, -2.54 [0.38]; P < .001; mean [SD] difference in scores for Asian residents, -1.9 [0.27]; P < .001). By the final year 3 assessment, the gap between White and Asian and URiM residents' scores narrowed, and no racial or ethnic differences were found. Trends in racial and ethnic differences among the 6 competency domains mirrored total Milestone scores, with differences peaking in PGY2 and then decreasing in PGY3 such that parity in assessment was reached in all competency domains by the end of training. In this cohort study, URiM and Asian internal medicine residents received lower ratings on performance assessments than their White peers during the first and second years of training, which may reflect racial bias in assessment. This disparity in assessment may limit opportunities for physicians from minoritized racial and ethnic groups and hinder physician workforce diversity.

Directory of Internal Medicine Residency and Fellowship Programs in Women's Health, 2022.

Journal of Women's HealthVol. 32, No. 2 Original ArticlesDirectory of Internal Medicine Residency and Fellowship Programs in Women's Health, 2022Amy H. Farkas, Katherine Bopp, Rosemarie L. Conigliaro, Deborah DiNardo, and Rachel S. CasasAmy H. FarkasAddress correspondence to: Amy H. Farkas, MD, MS, Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 5000 W. National Avenue, Milwaukee, WI 53295, USA E-mail Address: ahfarkas@mcw.eduhttps://orcid.org/0000-0002-5199-3028Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.Milwaukee VA Medical Center, Milwaukee, Wisconsin, USA.Search for more papers by this author, Katherine BoppDepartment of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.Search for more papers by this author, Rosemarie L. ConigliaroDepartment of Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.Search for more papers by this author, Deborah DiNardoDepartment of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.Search for more papers by this author, and Rachel S. CasasDepartment of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.Search for more papers by this authorPublished Online:8 Feb 2023https://doi.org/10.1089/jwh.2022.0448AboutSectionsView articleView Full TextSupplemental MaterialPDF/EPUBView Supplemental Data Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 32Issue 2Feb 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Amy H. Farkas, Katherine Bopp, Rosemarie L. Conigliaro, Deborah DiNardo, and Rachel S. Casas.Directory of Internal Medicine Residency and Fellowship Programs in Women's Health, 2022.Journal of Women's Health.Feb 2023.248-251.http://doi.org/10.1089/jwh.2022.0448Published in Volume: 32 Issue 2: February 8, 2023Online Ahead of Print:December 26, 2022Keywordswomen's healthgraduate medical educationinternship and residencyPDF download

956. Improving Understanding and Utilization of the Antibiogram among Medical Residents

Abstract Background The antibiogram is a powerful tool for providers when selecting empiric antibiotic coverage. Its use is recommended by the Infectious Disease Society of America, Center for Disease Control, and clinical decision support resources to aid in antibiotic stewardship and patient care. Antibiograms are a key component of antimicrobial stewardship programs. A quality improvement project was implemented for the family medicine, internal medicine, and surgery residency programs at Creighton University to assess and improve early trainees' comfort with, utilization of, and understanding regarding antibiograms. Methods Forty-two first year residents making up 100% of the post graduate year one classes of the family medicine, internal medicine, and surgery residency programs at a Midwest Academic institution were interviewed in April 2021. Questions collected data regarding the function of, knowledge regarding, comfort and personal experience with antibiograms, as well as past exposure to infectious disease training. Antibiogram training lectures, informational posters, and new methods of accessing the antibiogram were implemented in July 2021. Post implementation of these interventions thirty-seven second year residents and forty first year residents, consisting of 100% of the respective classes of the three residency programs, were interviewed in January 2022. Survey Questionnaire Nine-question survey to gather data regarding residents knowledge and use of antibiograms. Educational Poster Information about how to use an antibiogram and quick response codes to access institutions antibiogram. Posters were displayed in all residency team rooms. Results Our efforts resulted in statistically significant increase in resident reported understanding, utilization, and comfort with the antibiogram. A total of 24/42 of the 2021 residents and 69/77 of the 2022 residents surveyed reported correct understanding of the antibiogram (p &amp;lt; 0.001). Residents who reported knowing how to access the antibiogram increased from 24% to 78% (p &amp;lt; 0.01) and use of the antibiogram in patient care increased by 19% (p = 0.027). The average reported comfort level increased from 2.3 to 4.2 out of 5 (p &amp;lt; 0.01). Conclusion Previous literature documents that many residents are not comfortable with using antibiogram data. This quality improvement project demonstrates that simple inexpensive measures can improve physician's comfort, access, and utilization of the antibiogram. Disclosures Renuga Vivekanandan, MD, MDstewardship: Ownership Interest Christopher Destache, Pharm D, Shionogi Inc: Honoraria.

The Resident Voice: Identifying Qualities of Resident Leadership with a Focus Group of Second Year Internal Medicine Residents

Background The Accreditation Council for Graduate Medical Education (ACGME) Internal Medicine Residency Program Guidelines identifies leadership as a core competency. The definition of strong resident leadership is not clearly defined. Prior studies have identified characteristics of resident leadership from the perspective of residency program leaders with little emphasis on the resident point of view. Objective This study aims to identify qualities of effective resident leadership from the perspective of Internal Medicine (IM) residents. Methods Participants were recruited through email invitations. An online focus group with five IM residents was conducted in September 2020. The transcribed discussion was inductively analyzed using thematic data analysis. Results Analysis resulted in four main themes of strong resident leadership: mentorship, team ownership, communication, and emotional intelligence. All four themes were further characterized by subthemes. Being a mentor as a resident leader was described as having the ability to guide, motivate, and empower team members. Team ownership was defined as caring about team image, adaptability, and accountability for team performance. Communication skills included setting expectations, giving feedback, and utilizing closed-loop communication. Emotional intelligence was characterized as practicing empathy, psychological safety, and appreciation. Conclusions Strong resident leadership is crucial to providing effective residency training and the highest level of patient care. This study identifies from the perspective of residents, the principal characteristics of strong resident leadership: mentorship, communication, team ownership, and emotional intelligence. The identification of these characteristics provides an opportunity to create leadership curricula for residents that focus on developing these specific skills.

Reported Visa Acceptance or Sponsorship for Non-US Citizen Applicants to US Internal Medicine Residency Programs.

Non-US citizen international medical graduates (IMGs) make up a significant proportion of the physician workforce, especially in physician shortage areas and specialties. IMGs face barriers matriculating in US residency programs. Whether a program reports accepting J-1 visas and sponsoring H-1B visas influences their decision to apply, it remains unclear which institutional factors shape programs' likelihood to consider visa-seeking applicants. We investigated factors associated with programs reporting accepting J-1 visas or sponsoring H-1B visas for non-citizen applicants in internal medicine, the specialty most sought after by IMGs. We performed multivariable regression analyses using publicly available data to identify characteristics associated with reported visa acceptance (J-1 and or H-1B). Covariates included university affiliation, program size, program type (academic, university-affiliated community, or community), and Doximity reputation ranking. We identified 419 programs: 267 (63.7%) reported accepting J-1 visas. Among programs that accepted J-1 visas, 65.6% (n=175) accepted only J-1 visas while 34.5% (n=92) sponsored H-1B and accepted J-1 visas. Ranking in the third quartile (vs first quartile) was associated with lower odds of accepting J-1 (aOR 0.12; 95% CI 0.02-0.87; P=.04) and sponsoring H-1B visas (aOR 0.19; 95% CI 0.05-0.76; P=.02). Community status (vs academic) was associated with lower odds of accepting J-1 visas (aOR 0.2; 95% CI 0.06-0.64; P=.007), as was county hospital affiliation vs non-county hospitals (aOR 0.22; 95% CI 0.11-0.42; P<.001). While prior evidence shows that most internal medicine programs that substantially enroll IMGs are low ranking, high-ranking internal medicine programs are paradoxically more likely to report that they consider and sponsor visa-seeking applicants.

Resident factors associated with American board of internal medicine certification exam failure

ABSTRACT Introduction Performance on the certifying examinations such as the American Board of Internal Medicine Certification Exam (ABIM-CE) is of great interest to residents and their residency programs. Identification of factors associated with certification exam result may allow residency programs to recognize and intervene for residents at risk of failing. Despite this, residency programs have few evidence-based predictors of certification exam outcome. The change to pass-or-fail score reporting of the USA Medical Licensing Exam (USMLE) Step 1 removes one such predictor. Materials and Methods We performed a retrospective study of residents from a medium-sized internal medicine residency program who graduated from 1998 through 2017. We used univariate tests of associations between ABIM-CE result and various demographic and scholastic factors. Results Of 166 graduates, 14 (8.4%) failed the ABIM-CE on the first attempt. Failing the first attempt of the ABIM-CE was associated with older median age on entering residency (29 vs 27 years; P = 0.01); lower percentile rank on the Internal Medicine In-Training Examination (IM-ITE) in each of the first, second, and third years of training (P < 0.001 for all); and lower scores on the USMLE Steps 1, 2 Clinical Knowledge, and 3 (P < 0.05 for all). No association was seen between a variety of other scholastic or demographic factors and first-attempt ABIM-CE result. Discussion Although USMLE step 1 has changed to a pass-or-fail reporting structure, there are still other characteristics that allow residency programs to identify residents at risk of ABIM-CE first time failure and who may benefit from intervention.

Does the Implementation of Competency-Based Medical Education Impact the Quality of Narrative Feedback? A Retrospective Analysis of Assessment Data in a Canadian Internal Medicine Residency Program

Background: As training programs implement competency-based models of training oriented around entrustable professional activities (EPAs), the role of traditional assessment tools remains unclear. While rating scales remain emphasized, few empirical studies have explored the utility of narrative comments between methods and models of training. Objective: Compare the quality of narrative comments between in-training evaluation reports (ITERs) and workplace-based assessments (WBAs) of EPAs before and after the formal implementation of a competencybased model of training. Methods: Retrospective analysis of assessment data from 77 residents in the core Internal Medicine (IM) residency program at the University of Calgary between 2015 and 2020, including data collected during a 2-year pilot of WBAs before the official launch of Competency by Design on July 1, 2019. The quality of narrative comments from 2,928 EPAs and 3,608 ITERs was analyzed using the standardized Completed Clinical Evaluation Report Rating (CCERR). Results: CCERR scores were higher on EPAs than ITERs [F (26,213) = 210, MSE = 4,541, p &lt; 0.001, η2 = 0.064]. CCERR scores for EPAs decreased slightly upon formal implementation of Competence by Design but remained higher than the CCERR scores for ITERs completed at that period of time. Conclusions: The quality of narrative comments may be higher on EPAs than traditional ITER evaluations. While programmatic assessment requires the use of multiple tools and methods, programs must consider whether such methods lead to complementarity or redundancy. Résumé Contexte: Alors que les programmes de formation mettent en œuvre des modèles de formation axés sur les compétences et orientés en fonction des activités professionnelles confiables (APC), le rôle des outils d’évaluation traditionnels reste flou. Si les échelles de notation restent privilégiées, peu d’études empiriques explorent l’utilité des commentaires narratifs entre les méthodes et les modèles de formation. Objectif: Comparer la qualité des commentaires narratifs entre les fiches d’évaluation en cours de formation (FECF) et les évaluations des APC sur le lieu de travail avant et après la mise en œuvre officielle d’un modèle de formation axé sur les compétences. Méthodologie: Analyse rétrospective des données d’évaluation de 77 résidents du programme de résidence en médecine interne tronc commun de l’Université de Calgary entre 2015 et 2020, comprenant les données recueillies au cours d’un projet pilote de deux ans d’évaluations en milieu de travail avant le lancement officiel de l’initiative La compétence par conception, le 1er juillet 2019. La qualité des commentaires narratifs de 2,928 APC et de 3,608 FECF a été analysée à l’aide du Completed Clinical Evaluation Report Rating (CCERR) normalisé. Résultats: Les scores du CCERR sont plus élevés pour les APC que pour les FECF [F (26,213) = 210, rétroac-tion multisources = 4,541, p &lt; 0.001, η2 = 0.064]. Les scores du CCERR pour les APC diminuent légèrement au moment de la mise en œuvre officielle de l’initiative La compétence par conception, mais demeurent plus élevés que ceux pour les FECF effectuées à cette période. Conclusions: La qualité des commentaires narratifs serait meilleure pour les APC que pour les FECF traditionnelles. Bien que l’évaluation des programmes nécessite l’utilisation de multiples outils et méthodes, les programmes doivent se demander si l’utilisation de telles méthodes se veut complémentaire ou redondante.

Abstract 11964: Implementation of a Near Peer ECG Didactic Curriculum in an Internal Medicine Residency Program

Introduction: Electrocardiogram (ECG) interpretation is a fundamental skill. Near-peer teaching improves knowledge acquisition and learner satisfaction. We previously demonstrated an improvement in resident comfort level in interpreting ECGs following structured didactics. Here, we aim to establish whether a longitudinal didactic curriculum objectively increases resident performance in ECG interpretation. Methods: This prospective cohort study surveyed Internal Medicine residents at University at Buffalo who participated in monthly ECG didactics over a 7-month period. Pre- and post-curriculum surveys were administered. Responses were anonymous and participation voluntary. Data collected included demographics, attendance, exposure to clinical cardiology, interest in cardiology, and number of sessions attended. Residents were asked to interpret sixteen unique ECGs, divided evenly among eight common rhythms into both surveys. Fall 2021 and Spring 2022 cohorts were compared using t-tests and chi-square analyses. Associations between attendance, comfort level in interpretation, and number of correct interpretations were analyzed using Pearson correlations. Multivariate linear regression determined the strongest predictor of the number of correct ECG interpretations. Results: Spring cohort correctly interpreted a significantly greater percentage of ECGs than Fall cohort (74.5% vs. 60.9% , p &lt; 0.001). Didactic attendance was significantly associated with comfort level in interpreting ECGs (r = .328, p = .018) and a showed trend towards increased number of correct interpretations (r = .248, p = .077). Attending three or more sessions resulted in a greater percentage of correct ECG interpretations compared to those who attended two or fewer sessions (80.0% vs. 71.1%, p = 0.48). Number of clinical cardiology blocks taken was significantly associated with correct interpretations (r = .310, p &lt; .001) and was the strongest predictor of accurately interpreting ECGs (β = 0.29, p = .037). Conclusions: Dedicated ECG didactics improve residents’ ability to interpret ECGs. A longitudinal curriculum which contains both didactic sessions and clinical exposure appears to offer the greatest benefit in improving ECG interpretation skills.