Internal Medicine Residency Training Research Articles

Internal Medicine Resident Addiction Training at the Veteran's Health Administration: A Qualitative Evaluation of Site Directors' Response to the 2022 ACGME Requirements.

Substance use disorders (SUDs) are prevalent in the USA yet remain dramatically undertreated. To address this care gap, the Accreditation Council for Graduate Medical Education (ACGME) approved revisions to the Program Requirements for Graduate Medical Education (GME) in Internal Medicine, effective July 1, 2022, requiring addiction medicine training for all internal medicine (IM) residents. The Veterans Health Administration (VHA) is a clinical training site for many academic institutions that sponsor IM residencies. This focus group project evaluated VHA IM residency site directors' perspectives about providing addiction medical education within VHA IM training sites. To better understand the current state, barriers to, and facilitators of IM resident addiction medicine training at VHA sites. This was a qualitative evaluation based on semi-structured video-based focus groups. Participants were VHA IM site directors based at a VHA hospital or clinic throughout the USA. Focus groups were conducted using a semi-structured group interview guide. Two investigators coded each focus group independently, then met to create a final adjudicated coding scheme. Thematic analysis was used to identify key themes. Forty-three participants from 38 VHA sites participated in four focus groups (average size: 11 participants). Six themes were identified within four pre-defined categories. Current state of training: most VHA sites offered no formal training in addiction medicine for IM residents. Barriers: addiction experts are often located outside of IM settings, and ACGME requirements were non-specific. Facilitators: clinical champions help support addiction training. Desired next steps: participants desired incentives to train or hire local champions and a pre-packaged didactic curriculum. Developing competent clinical champions and leveraging VHA addiction specialists from non-IM settings would create more addiction training opportunities for IM trainees at VHA sites. These insights can likely be applied to IM training at non-VHA sites.

Customised knowledge-sharing platform to foster resident quality improvement activities, tracking and scholarship

IntroductionMeeting accreditation requirements to train resident physicians in quality improvement (QI) may require more than education. Barriers to resident QI engagement underscore the need to demonstrate the impact and value...

An internal medicine residency preparatory curriculum for fourth-year medical students.

Intern preparation courses are often broad in scope; there are few published specialty-specific programs outside of General Surgery and Obstetrics. We designed an internal medicine (IM) residency preparatory course at the University of Maryland School of Medicine, which aimed to prepare graduating medical students for the rigours of IM residency training, mapped to Entrustable Professional Activities (EPAs). Fourteen fourth-year medical students who were matriculating into IM residency programs enrolled in a 4-week long residency preparation course. The course was designed to teach skills using case-based learning modules, specialty topic seminars, simulation laboratories, procedure laboratories and clinical practice. Participants were surveyed before and after the course on their perceived knowledge and ability with the skills tested. With the exception of 'giving signout to a colleague', there was a significant difference in the participant's perceived ability for each skill taught within the course (P< 0.03 for each), with mean pre-course scores of 1.4-3.7 (SD=0.5-1.2) and mean post-course scores of 3.2-4.2 (SD=0.5-1.3). A second survey on course evaluation and perceived impact, completed 3months after starting intern year, resulted in all respondents reporting that the information learned during the course had directly affected their care of patients on a daily or weekly basis. The modified Ottawa scale was the primary assessment means for the EPAs, with participants approaching entrustment at the conclusion of the course. Implementation of an IM-specific residency preparation course is a useful adjunct in the fourth year of medical school.

Neurophobia among medical students and resident trainees in a tertiary comprehensive hospital in China

sBackgroundMedical students and residents have been revealed to have extraordinary difficulties in managing patients with neurological complaints. However, specific information on Chinese trainees is scarce. Herein, we aimed to uncover the presence of, contributing factors for, and potential solutions to neurophobia among medical students and resident trainees in China.MethodsQuestionnaires were administered to the medical students of Peking Union Medical College and residents of the Internal Medicine Residency Training Program at Peking Union Medical College Hospital. We asked about perceived difficulty, knowledge, interest, and confidence in neurology in contrast to six other specialties. The reasons why neurology is regarded as difficult and approaches for improving neurological teaching have been appraised.ResultsA total of 351 surveys were completed by 218 medical students and 133 residents. The response rate exceeded 70% in both groups. The prevalence of neurophobia was 66.1% and 58.6% among medical students and residents, respectively. Respondents declared that greater difficulty was observed in neurology than in other specialties, and the management of patients with neurological problems was the least comfortable (p < 0.0001). Neurophobia has various perceived causes, and neuroanatomy is regarded as the most important contributor. Nearly 80% of medical students felt that improvements in neurology teaching could be achieved through further integration of preclinical and clinical neurological teaching.ConclusionsThe findings of the first survey on neurophobia in China are in accordance with those of previous studies. Neurophobia is highly prevalent in Chinese medical students and residents. Strategies to improve teaching, including enhanced integration of teaching and more online resources, are needed to prevent neurophobia.

THU006 Exploring Primary Care Resident Perspectives On Diabetes Education In Training

Abstract Disclosure: N. Francis: None. S. Cardillo: None. D.R. Nandiwada: None. Background: The training residents gain in Family Medicine (FM) and Internal Medicine (IM) residency programs provide a critical foundation for their knowledge in diabetes (DM) management. It is one of the most common diagnoses physicians-in-training will encounter in their residency training programs and in clinical settings. However, a 2012 study compared diabetes care in resident clinics versus private physicians and found significant decrease in patient satisfaction (56.5% vs. 71.3%) in resident clinics. A 2020 study surveying primary care (PC) residency program directors showed that most FM and IM residency training programs focus on the core diabetes care and management topics with much less focus on emerging topics, such as 2nd generation insulin analogs and digital health technologies. The purpose of our survey was to better assess current resident perceptions and attitudes towards their DM education and their perceived comfort level in comprehensive DM counseling, evaluation, and management. Methods: A 12 item survey was designed using the Qualtrics program. The survey link was sent via email to IM- PC and FM residents at a major academic medical center. Data was collected from September 13th, 2022 to present. The survey included a combination of multiple choice, Likert scale and ranking questions. Results: 14 residents responded to the survey to date with the majority (71%) belonging to the IM-PC group and the remainder (29%) family medicine. Residents felt most comfortable managing diabetes related complications and counseling on foot and eye care and hypoglycemia. Respondents reported being most uncomfortable in prescribing non-insulin medication (50%) and initiating an insulin regimen (43%) and less comfortable counseling patients on continuous glucose monitoring systems (83%) and insulin administration (66%). While majority of residents (72%) found their DM curriculum clinically relevant, 85% of residents reported there was not enough time allotted. Respondents felt a more longitudinal lecture series, with increased access to treatment frameworks and on-site feedback on their DM counseling and care would best supplement their DM curriculum. Conclusion: This survey data explores specific areas that residents have identified as being least comfortable and also expresses what they identified as the most preferable ways to modify and design an educational intervention. This information allows for tailored curricular intervention highlighting diabetes technologies, insulin and non-insulin prescribing practice in a longitudinal lecture style format that provides access to DM treatment frameworks and incorporates direct on-site feedback to the residents. This provides evidence for the development of a novel clinically integrated DM curriculum. Presentation: Thursday, June 15, 2023

Educational supervision in internal medicine residency training – a scoping review

BackgroundAlthough supervision is an important part of residency training, its scope and how it relates to other types of support, such as mentoring, precepting and feedback, remain unclear. While clinical supervision consists of ongoing instructions and feedback in the workplace setting, educational supervision is a formalized component of postgraduate medical educational and supports the process that facilitates a trainee’s progression throughout their training. Since medical specialties have different supervisory traditions, this study focuses on educational supervision in internal medicine. Our aim was to investigate what is known about educational supervision practices in internal medicine and the role of educational supervision in supporting residents’ learning.MethodsWe conducted a scoping review of the literature on educational supervision in residency training in internal medicine based on Levac et al.’s modification of Arksey and O’Malley’s six-step framework. The literature search was performed in the following databases: Medline, Embase, Web of Science and the Educational Resources Information Center. In addition, we conducted a handsearch in Medical Teacher and Google Scholar. We followed the PRISMA guidelines for systematic research.ResultsEighteen of the 3,284 identified articles were included in the analysis. We found few empirical studies describing how educational supervision is conducted and what effect routine educational supervision has on residents’ learning. Our findings suggest that the terminology can be confusing and that educational supervision practices in internal medicine has a weak theoretical foundation.ConclusionThe distinction between educational supervision and other support structures, such as mentoring and feedback, has not been clearly defined in the research literature. We argue that shared terminology is needed to better understand current educational practices and to facilitate clear communication about how to help residents learn.

Point-of-Care Ultrasound Overview and Curriculum Implementation in Internal Medicine Residency Training Programs in the United States.

Point-of-care ultrasonography (POCUS) augments physical examination and expedites diagnostic care and clinical decision-making. The use of POCUS in internal medicine (IM) appears inconsistent despite its commendable benefits. It is not fully incorporated into the IM residency core competency skills or academic curriculum. This narrative literature review explores the benefits of POCUS and evaluates the need for an IM-focused POCUS curriculum. The obstacles and a proposed curriculum are also described.

Internal medicine intern performance on the gastrointestinal physical exam.

The gastrointestinal (GI) physical exam provides critical information about underlying disease states. However, since assessment of physical examination skills is rarely conducted as part of internal medicine residency training, little is known about resident performance on the GI physical exam. During a clinical skills assessment that took place between November 2019 and February 2020, internal medicine interns examined the same patient with chronic liver disease while being observed by faculty preceptors. We compared the exam maneuvers performed with those expected by the faculty evaluators. We noted which maneuvers were performed incorrectly, whether physical exam technique correlated with identification of physical exam findings, and if performance on the physical exam was associated with building an appropriate differential diagnosis. This four-hour assessment was required for internal medicine interns within two different residency programs in the Baltimore area. More than half of the 29 participating interns (n=17, 58.6 %) received a "needs improvement" score on their physical exam technique. Technique was highly correlated with identifying the correct physical signs (r=0.88, p<0.0001). The most commonly excluded maneuvers were assessing for splenomegaly and hepatomegaly. The most commonly missed findings were splenomegaly and hepatomegaly. Most interns included chronic liver disease as part of their differential diagnosis even if they received "needs improvement" scores on physical exam technique or identifying physical signs. Internal medicine interns would benefit from learning an organized approach to the gastrointestinal exam. This would likely lead to increased identification of important gastrointestinal findings.

Editorial introductions.

Editorial introductions.

The Morning Report Practice and Its Contribution to Education of Internal Medicine Residents: A Multicenter Cross-Sectional Survey in the Eastern Province, Saudi Arabia.

Morning Report (MR) is a ubiquitous traditional educational activity in internal medicine residency training. It is under-researched; hence, this study was conducted. It aimed to examine the practice of MR by internal medicine residents, their motivation to engage with it, and their perception of its contribution to education. This was a multi-center cross-sectional study. The data was collected using an online self-administered 12-item questionnaire that covered MR practice, respondents' motivation for participation, MR contribution to education, and its impact on the practice of evidence-based medicine and quality improvement and patient safety. One hundred seventy residents returned the online questionnaire (54.7%). The respondents' gender and year of training were balanced (P > 0.05). The most common MR frequency and duration were five days per week (85.4%) and 45-60 minutes (47.1%), respectively. The most common format was handover combined with an emergency long case presentation (55.8%), and consultants were the most common facilitators (79.7%). The respondents' motivation to engage with MR was predominantly intermediate. The top reasons for attending and not attending MR were mandatory attendance and embarrassing questions, respectively. The perceived MR contribution to residents' different roles development was predominantly intermediate; however, it was predominantly very low/low (42%) for overall education. The perceived MR impact on the practice of EBM and QIPS were both predominantly intermediate. MR was found to be a commonly practiced educational activity in internal medicine residency training programs in the eastern province of Saudi Arabia. The case discussion was the core format for education. The respondents' motivation to participate in MR and their perception of its contribution to education was predominantly intermediate. To our best knowledge, this is the first study in Saudi Arabia that examined MR. We hope its findings will be taken for further MR studies and actions for improvement.

Meet the First Authors.

Meet the First Authors.

Comparison of internal medicine applicant and resident characteristics with performance on ACGME milestones

ABSTRACT Internal medicine (IM) residency programs select applicants based on several metrics. Factors predicting success during residency are unclear across studies. To identify whether specific applicant or resident factors are associated with IM resident performance using ACGME milestones. We tested for associations between applicant factors available prior to the start of IM residency and resident factors measured during IM residency training, and resident performance on ACGME milestones across three consecutive years of IM training between 2015-2020. Univariable and multivariable linear regression modeling was used to test associations. Eighty-nine categorical IM residents that completed 3 consecutive years of training were included. Median age was 28 years (IQR 27-29) and 59.6% were male. Mean ACGME milestone scores increased with each post-graduate year (PGY) from 3.36 (SD 0.19) for PGY-1, to 3.80 (SD 0.15) for PGY-2, to 4.14 (SD 0.15) for PGY-3. Univariable modeling suggested referral to the clinical competency committee (CCC) for professionalism concerns was negatively associated with resident performance during each PGY. No applicant or resident factors included in the final multivariable regression models (age at starting residency, USMLE Step scores, interview score, rank list position, ITE scores) were associated with ACGME milestone scores for PGY-1 and PGY-2. Referral to the CCC for professionalism was negatively associated with resident performance during PGY-3. Residency selection factors did not predict resident milestone evaluation scores. Referral to the CCC was associated with significantly worse resident evaluation scores, suggesting professionalism may correlate with clinical performance.

Application and evaluation of Flipped Teaching based on Video Conference in standardized training for internal medicine residents.

In view of the importance of infectious diseases in public health, Shanghai Municipal Health Commission designated a hospital ("Designated Hospital") to carry out infectious diseases training for internal medicine residents in those hospitals ("Dispatching Hospitals") that didn't have an infectious disease ward or could not meet the training standards of infectious diseases. I aimed to explore Flipped Teaching with Video Conference as the carrier in infectious diseases training for internal medicine residents, to make up for the lack of actual training time of the Department of Infectious Diseases for those residents caused by subjective or objective reasons, and to ensure the smooth implementation and quality assurance of infectious diseases training for those residents. Vertical management mode was adopted, management and lecture teams were established, and training program and teaching implementation were formulated. Flipped Teaching based on Video Conference was carried out for internal medicine residents of Dispatching Hospitals who planned to participate in infectious diseases training of the Designated Hospital in April. The quantitative analysis was applied to this teaching evaluation, and the evaluation indexes were included into statistical analysis to evaluate the effect of the teaching model. All 19-member internal medicine residents participated in the Flipped Teaching based on Video Conference from April 1 to 4, of which 12 residents were scheduled to participate in infectious diseases training from March 1 to April 30, and 7 residents were scheduled to participate in infectious diseases training from April 1 to May 31 in the Designated Hospital. A management team of 6 internal medicine residents was built, and a lecture team was composed of 12 internal medicine residents who were scheduled to receive infectious diseases training in the Designated Hospital from March 1 to April 30. According to the training requirements in the Department of Infectious Diseases, 12 contents were selected to be taught, and implementation rate of the teaching plan was over 90%. A total of 197 feedback questionnaires were collected. The feedback that the teaching quality was "good" and "very good" accounted for more than 96%, and the attendance rate of the whole teaching process reached more than 94%. Six internal medicine residents put forward 18 "Improvement suggestions", accounting for 9.1%; and 11 internal medicine residents gave 110 suggestions of "Praise highlights", accounting for 55.8%. The overall evaluation feedback of Flipped Teaching was good, P<0.001. Flipped Teaching based on Video Conference was generally effective in delivering lectures and learning for internal medicine residents participating in the infectious diseases training, and it could be used as a supplementary training method for standardized training of internal medicine residents to make up for the shortage of actual training period in a certain stage.

Implementing case-based collaborative learning curriculum via webinar in internal medicine residency training: A single-center experience.

This study aimed to investigate the effects of the Case-based collaborative learning (CBCL) curriculum in webinar format on internal medicine residents' knowledge covering cardiologic topics and their attitudes toward the CBCL teaching module. CBCL is a novel small-group approach, that incorporates elements of problem-based learning and case-based learning, and it has shown to improve medical students' knowledge mastery. However, few studies have explored its applicability for internal medicine residents, especially in the webinar format. This prospective cohort study included internal medicine residents in a residency program in Beijing, China. Eight CBCL sessions in webinar format covering cardiologic topics were delivered to them from February to April 2020. Pre-session reading materials included textbook and guidelines published by the academic societies. Multiple-choice questions were delivered to assess participants' knowledge before and after the sessions. Changes in participants' knowledge were determined using the paired t test to compare mean values. In addition, surveys based on 5-point Likert scale scores assessed satisfaction at the end of the second and eighth sessions. The Wilcoxon signed-rank test was used to identify any potential satisfaction improvement. In total, 9 internal medicine residents participated in the study, of whom 33.3% were male, and the overall rate of participation in CBCL sessions in webinar format was 94.4%. The mean scores of 50 multiple-choice questions were 68.0 ± 12.3 and 75.1 ± 9.9 in the pre- and post-curriculum assessments (P = .029). In the first survey performed at the second week, 5 (55.6%) residents chose "like" or "extremely like" in overall satisfaction, "neutral" by 3 (33.3%) residents and "dislike" by 1 (11.1%) resident. In the second survey, only 1 (11.1%) resident selected a neutral reply in satisfactory assessment, and the other 8 (88.9%) residents selected either "like" or "extremely like" choices. Compared with the results of the first survey, the overall satisfaction rate significantly improved (P = .031). Implementing the CBCL sessions in webinar format for cardiology residents was resulted in the improved knowledge mastery and a high acceptance rate.

Embracing our responsibility to ensure trainee competency.

Embracing our responsibility to ensure trainee competency.

Gender Disparities in Critical Care Procedure Training of Internal Medicine Residents.

Procedural training is a required competency in internal medicine (IM) residency, yet limited data exist on residents' experience of procedural training. We sought to understand how gender impacts access to procedural training among IM residents. A mixed-methods, explanatory sequential study was performed. Procedure volume for IM residents between 2016 and 2020 was assessed at two large academic residencies (Program A and Program B: 399 residents and 4,020 procedures). Procedural rates and actual versus expected procedure volume by gender were compared, with separate analyses by clinical environment (intensive care unit [ICU] or structured procedural service). Semistructured gender-congruent focus groups were conducted. Topics included identity formation as a proceduralist and the resident procedural learning experience, including perceived gender bias in procedure allocation. Compared with men, women residents performed disproportionately fewer ICU procedures per month at Program A (1.4 vs. 2.7; P < 0.05) but not at Program B (0.36 vs. 0.54; P = 0.23). At Program A, women performed only 47% of ICU procedures, significantly fewer than the 54% they were expected to perform on the basis of their time on ICU rotations (P < 0.001). For equal gender distribution of procedural volume at Program A, 11% of the procedures performed by men would have needed to have been performed by women instead. Gender was not associated with differences in the Program A structured procedural service (53% observed vs. 52% expected; P = 0.935), Program B structured procedural service (40% observed vs. 43% expected; P = 0.174), or in Program B ICUs (33% observed vs. 34% expected; P = 0.656). Focus group analysis identified that women from both residencies perceived that assertiveness was required for procedural training in unstructured learning environments. Residents felt that gender influenced access to procedural opportunities, ability to self-advocate for procedural experience, identity formation as a proceduralist, and confidence in acquiring procedural skills. Gender disparities in access to procedural training during ICU rotations were seen at one institution but not another. There were ubiquitous perceptions that assertiveness was important to access procedural opportunities. We hypothesize that structured allocation of procedures would mitigate disparities by allowing all residents to access procedural training regardless of self-advocacy. Residency programs should adopt structured procedural training programs to counteract inequities.

Editorial introductions.

Current Opinion in Endocrinology and Diabetes was launched in 1994, with Obesity added to the title in 2007. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of endocrinology and diabetes are divided into 9 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Editor and Section Editors for this issue. EDITOR IN CHIEF David M. HarlanDavid M. HarlanDr David M. Harlan is a graduate of the University of Michigan (Bachelor of Science) and the Duke University School of Medicine, USA. He completed his internal medicine internship and residency at the Duke University Medical Center. This was before serving for 4 years as a staff internist at the Navy Hospital, San Diego, CA, USA. He then returned to Duke for his fellowship training in diabetes, endocrinology, and metabolism. In 1991 he established his laboratory at the Navy Medical Research Institute, USA, where he rose to become the Director of Combat Casualty Care. He was then appointed to the faculty of the Uniformed Services University of the Health Sciences. In 1999, he moved his laboratory to the National Institutes of Health, where he became the Diabetes Branch Chief within the National Institute of Diabetes, Digestive, and Kidney Diseases. In 2010, he moved to the University of Massachusetts School of Medicine, USA, where he is the William and Doris Krupp Professor of Medicine and Diabetes Division Chief. Dr Harlan also co-directs the UMass Diabetes Center of Excellence. His research interests all relate to diabetes and include the immunopathogenesis underlying type 1 diabetes and improved care delivery models for the disease. SECTION EDITORS Matthew FreebyMatthew FreebyMatthew Freeby, MD, is Health Sciences Associate Clinical Professor of Medicine in the Division of Endocrinology, Diabetes, and Hypertension, David Geffen School of Medicine at the University of California Los Angeles, USA. Dr Freeby received his MD from Virginia Commonwealth University, USA and completed his internal medicine internship and residency training at the University of California San Diego. He subsequently completed training in an endocrinology fellowship at Columbia University Medical Center in New York, USA. Dr Freeby is involved in community leadership for the American Diabetes Association and serves on planning committees for the Endocrine Society's annual meetings. His research has focused on a number of diabetes related topics including non-invasive in vivo measurement of beta cell mass as well as the evaluation of general care and complications. He has also collaborated with researchers evaluating iPS as a method for beta cell replacement in type 1 and other rare forms of diabetes. Lynne L. LevitskyLynne L. LevitskyDr Lynne L. Levitsky is a graduate of Bryn Mawr College and Yale Medical School, USA. She received her pediatric training at the Albert Einstein College of Medicine in New York, USA, and at the Children's Hospital of Philadelphia, USA. She was trained in pediatric endocrinology at the University of Maryland in Baltimore, USA. She was a Pediatric Endocrinologist and Professor of Pediatrics at the Pritzker School of Medicine, University of Chicago, USA, until 1990. She then came to Massachusetts General Hospital, USA, as Chief of the Pediatric Endocrine Unit and Associate Professor of Pediatrics at Harvard Medical School. She is now Emeritus Chief and co-director of the Turner Syndrome Wellness Center, USA. Her research interests in carbohydrate metabolism span laboratory studies of transcriptional control of beta cell function, and a role as an investigator in the NIH-sponsored TODAY treatment study of type 2 diabetes in the young. She is a past President of the Pediatric Endocrine Society and was the first head of the Education Council for that organization.

Quantification of Internal Medicine Resident Inpatient Care Using the Diagnosis Procedure Combination Database.

Objective Quantification of patient encounters during internal medicine residency training is challenging. At present, there are no established strategies for evaluating the whole inpatient experience in Japan. We hypothesized that the Diagnosis Procedure Combination (DPC) database, which is widely used in Japan, might be a useful tool for such an evaluation. Methods We analyzed DPC-based patient encounters of five senior residents with different types of training. One of the diseases on receipt computation data, including the four main diseases and at most eight comorbidities, was matched with each category in the Online system for Standardized Log of Evaluation and Registration of specialty training system (J-OSLER), and the match ratios were assessed. The accumulation of each disease classified into J-OSLER categories was also assessed. Monthly extra working hours and total patient-days per resident were evaluated using a Pearson correlation analysis. Results Two residents with two-year rotations in the general internal medicine department showed high numbers of patient encounters and the highest matching ratio with J-OSLER (approximately 60% with 4 major diseases, 91% with all diseases). There was a moderately positive correlation between the total patient-days and extra working hours in these residents, but no such correlation was noted in the rate of monthly patient encounters and extra working hours among residents as a whole. Conclusion The DPC-based quantification of patient encounters during residency training appears effective in evaluating the coverage of the current J-OSLER list. Owing to its wide availability and generalization, this matching method may be useful as a universal tool for assessing internal medicine programs.

"It's Kind of a Hidden Code": An Exploratory Study of Residents’ Experiences Caring for People with Sickle Cell Disease on the Internal Medicine Wards

introduction: Sickle cell disease (SCD) hospitalizations are rising in Canada. Painful vaso-occlusive episodes (VOEs) are responsible for 90% of acute health care visits for patients with SCD and are often recurrent with more than 50% of patients being re-admitted in the first month after discharge. Yet, there is little medical education literature on SCD and pain management. Also, while it is known that anti-black racism leads to poorer healthcare outcomes for SCD patients, there is no literature on how this impacts medical education, particularly when it comes to internal medicine residents. Objectives: To determine the training experiences and gaps in knowledge, skills, and attitudes of internal medicine residents who care for patients with SCD suffering from VOEs. Methods: We conducted a qualitative study using in-depth, one-on-one interviews with internal medicine residents at the University of Toronto. A semi-structured interview guide was iteratively developed by the study team to explore topics around experiences caring for patients with SCD, the perception of bias in in-patient care for SCD, and training and education around SCD and VOEs. Participant demographics were also collected (post-graduate year, gender, race, and number of patients with SCD cared for). Both purposive and snowball sampling were used for recruitment. All interviews were recorded and professionally transcribed. Qualitative content analysis guided the analysis phase. Codes were developed inductively and discussed between three coders (FK, WY, JZ) until consensus was reached. Interview memo notes were also incorporated in the analysis to capture body language and context that may be missed in the transcription. After four interviews, coders began reading transcribed interviews to conduct analysis. Concurrent analysis allowed the research team to look for thematic saturation. Research ethics approval was obtained. Results: Twelve interviews were completed. Five participants identified as female, and seven as male. Most participants (5/12) were in their post-graduate year 2, and 10/12 participants described having significant exposure to patients with SCD (>3 patients per year). Participants self-reported race included 3/12 South Asian, 3/12 Arab, 2/12 Caucasian, 1 Asian, 1 Black, amongst others. Preliminary findings after analyzing 5 transcriptions are summarized in Table 1. Patients with SCD are treated differently than other in-patients for their care, whether this is operationalized through an unspoken hidden code within healthcare providers or through racial biases. For many internal medicine residents, trust between them and their patient with SCD is paramount: patients with SCD have historically distrusted physicians and the healthcare system. Some patients, however, are still willing to listen to their counselling physicians and allow residents to change their care plan. There is little SCD and pain education taught during residency and much of pain management is learned from cancer or palliative pain. Residents remain feeling uncomfortable managing the pain of patients with VOEs. Conclusion: While these are preliminary findings, they support a wider literature that demonstrates inadequate SCD education during medical training. This study was completed in the largest SCD centre in Canada and yet, educational deficiencies were still noted amongst rotating internal medicine residents suggesting that they are widespread. We hope to use these findings to develop curricular recommendations for training in the management of VOEs, implicit bias training of internal medicine residents, as well as develop teaching moments around health care disparities and societal inequities regarding delivery of care to individuals with SCD. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Current medical education improves OSA-related knowledge but not confidence in residents: An underappreciated public health risk.

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and induces a growing health care burden. However, a large proportion of patients with OSA do not receive appropriate treatment and are underdiagnosed or misdiagnosed in primary care. A contributing factor to the phenomenon is the lack of education, which reflects the current inadequacies in medical education. Therefore, assessing the level of knowledge and attitudes toward OSA and associated factors among resident physicians is highly warranted. A validated questionnaire, the OSA Knowledge and Attitudes (OSAKA) questionnaire was distributed to residents who had already completed undergraduate education and were attending an internal medicine residency training program. The questionnaire consists of 2 parts: including an assessment of (1) OSA-related knowledge involving epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment; (2) the importance of OSA and confidence in diagnosing and treating OSA patients. Other information including demographics, training experience, and questions exploring the future form of the sleep breathing disorder course was collected together. Of the 160 residents who participated in the survey, 153 (95.6%) completed the survey and the mean total knowledge score was 12.6/18 (70% correct). Although all respondents believed that OSA was an important clinical disorder, only a minority of the residents felt confident in identifying patients at risk for OSA (38%), managing OSA patients (27.5%), or continuous positive airway pressure therapy (CPAP) (26.2%). We found that OSA training experience significantly increased knowledge scores (p = 0.002) but not confidence scores (p = 0.248). As for the specific form of medical education, "Small classes during residency training" was the most popular form of sleep-breathing disorder educational training in the future of the resident training program. Despite adequate knowledge of OSA, there was still a generalized lack of confidence in the management of OSA patients among residents. Current medical education can not build enough confidence for physicians, which may in turn affect patients' trust and reduce long-term compliance. Untreated OSA places a significant health threat and economic burden on not only the patients but also their families and society, causing an underappreciated public health risk. In the future, merely increasing OSA courses is not sufficient, a more specific focus on the course format and training effect is required.