Internal Medicine Residents Research Articles

Work-Family Conflict Among Resident Physicians: A Comparative Analysis of Surgical and Internal Medicine Specialties

Aims: To investigate whether there is a difference in work-family conflict between surgical and internal medicine residents and to determine the factors associated with work-family conflict Materials and Methods: A cross-sectional, questionnaire-based survey study was conducted with 443 resident physicians working at a university hospital. A form about demographic data and a Turkish version of the Work-Family Conflict Inventory (WFCI) were used to gather data during in-person interviews. Results: Three-hundred-forty-eight residents responded (76.8%). Weekly working time was significantly more in surgical medical sciences (SMS) residents than in internal medicine sciences (IMS) residents (62.3±13.8 vs 53.2±13.6 hours respectively, p

Evaluating the impact of structured POCUS training during internal medicine clerkship and residency training

Background: Point of Care Ultrasound (POCUS) is a vital tool in rheumatology for detecting pathologies like osteophytes and joint effusion. Its integration into rheumatology electives during internal medicine clerkship and residency is limited, despite its emphasis in pre-clinical years. Methods: In this QIRB-approved, single-center, prospective study (2022–2023), third- and fourth-year medical students and internal medicine residents in a two-week rheumatology elective voluntarily completed online surveys. These surveys assessed their confidence using POCUS in rheumatology, using a 5-point Likert scale. Results: A survey of 25 residents and 10 medical students found that 84% of residents and 90% of students rated POCUS training as valuable or very valuable. Both groups felt more confident identifying knee joint effusion (average scores: 3.5 for students, 2.6 for residents) compared to other ultrasound techniques and pathologies. Confidence was lower in hip ultrasounds (2.20 for students, 1.68 for residents) and chondrocalcinosis identification (2.20 for students, 1.76 for residents). Among participants, 28% of residents and 70% of students had prior informal POCUS training. Previous training significantly increased comfort levels, with average scores of 2.86 for students and 2.30 for residents, compared to 2.69 and 1.91 for those without prior training (P-values: <0.001). Conclusion: Prior experience significantly enhances confidence and comfort, reinforcing the need for early, comprehensive, and targeted POCUS training in medical curricula to address proficiency gaps. Keywords: Education, medical, undergraduate, rheumatology, point-of-care systems, ultrasonography

Check, Please! Supervisor-Learner Dyads Using "Checking" for Clinical Support During Indirect Supervision.

Indirect supervision is essential for granting autonomy to learners. Sometimes referred to as leaving the learner "unsupervised," there is growing recognition that learners and supervisors engage in clinical support through ongoing interactions, albeit at a distance. To understand how the complementary activities of asking for and providing clinical support at a distance come together as indirect supervision by identifying the natural language used between learners and supervisors. A collective case study of 15 attending physician-senior medical resident dyads from 2018 to 2023. Each case consisted of 2 full days of ethnographic observation of the resident on an internal medicine clinical teaching unit in one of three metropolitan hospitals; 2 end of day interviews with each dyad member; and a third interview with the attending after the 2-week rotation. Fifteen internal medicine residents (PGY-2 and PGY-3) who were scheduled to work for the first time with 15 attending physicians. Data collection was iterative with deductive and inductive analysis to identify patterns of communication. The language of "checking," such as checkpoints, checking on, and checking in, was central to communications within dyads. Indirect supervision included attendings using scheduled checkpoints and backstage oversight activities to check on the senior resident's patient care while expecting residents to access their support, as needed, by checking-in with them. Residents checked in with their attending to relay patient information updates, ask questions, and hint at needing their plans doublechecked; these communications had similar formats making them difficult to distinguish but functioned to preserve resident independence while accessing clinical support. Indirect supervision creates clinical support through ongoing communication between learners and supervisors at a distance. It is a collaborative process for mutual reassurance that safe patient care is being provided and that support is available when needed.

Large language models in internal medicine residency: current use and attitudes among internal medicine residents

BackgroundArtificial intelligence (AI) uses in healthcare changed dramatically with large language models. While work is underway to integrate generative AI safely and effectively into medical practice, little is known about how resident physicians are already using these tools in their work.ObjectivesTo characterize the current usage patterns and attitudes towards large language models among internal medicine residents in North Carolina.MethodsCross-sectional survey-based study of Internal medicine residents in North Carolina.Results152 of 523 total residents completed the survey (29% response rate). Many identified a role for LLMs in both clinical (56%) and non-clinical medicine (72%) today, although only 26% reported current use. More perceived a future role in clinical (71%) and non-clinical (80%) medicine. None had received formal training, but 94% expressed interest in learning more and 87% thought residencies maybe or definitely should have formal curriculum. Top clinical uses include forming a differential diagnosis, researching treatments, and creating educational materials. Top non-clinical uses included self-directed learning, scientific writing, and summarizing literature.ConclusionsMedical educators and administrators should be aware that residents are using generative AI in professional settings. Residents believe in a current and future role for AI in medicine and desire curriculum and learning opportunities during training.

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

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

Process Groups for Supporting Resident Wellbeing: Factors Influencing Resident Wellness amid the COVID-19 Pandemic.

Background: Burnout is a well-recognized problem among resident physicians. The COVID-19 pandemic impacted the dynamics of the patient/resident relationship and introduced new stressors for medical trainees, such as new restrictions in the hospital, increased patient death, and uncertainty around safety. There is limited research on the implementation of group therapy for residents to address issues of wellbeing and burnout during the pandemic. Method: In response to perceived burnout amongst internal medicine residents, a university-based internal medicine residency program in the Northeast United States implemented process groups, a form of group therapy, in the curriculum. These sessions were held hourly once every five weeks for each cohort of twelve residents during the academic year. We sought to measure resident burnout and identify themes that impacted wellbeing to facilitate the intervention of process groups during the pandemic. In 2021 and 2022, internal medicine residents were invited to complete the Maslach Burnout Inventory (MBI) and answer two open-ended questions about the factors that most negatively and positively influenced their wellness. Results: Of the 134 participants, 82% had high emotional exhaustion or depersonalization. The most prevalent themes hindering wellness were negative personal interactions at work, most notably rude behavior by patients, unsupportive attendings, residency program expectations, and work intensity. Findings unique to the pandemic include social isolation from family, distress from poor outcomes, and fear of contracting or spreading the virus. The most prevalent themes for supporting wellness were personal life, camaraderie, professional satisfaction, and program structured support. Conclusions: Our findings suggest that programs can tailor structured support to improve wellness, despite the presence of significant stressors.

Effects of a Gender-Balancing Strategy on Resident Panels in a Primary Care Setting.

Patients oftenprefergender concordance when choosing a primary care practitioner. In a trainee setting, this may lead to unequal training opportunities for male and female resident physicians. Residency leadershipmay be interested in ways to promotebalance in patient empanelment. To assess the efficacy of an intervention to equalize imbalance in patient gender on resident primary care panels. Observational cohort study. Categorial internal medicine residents beginning residency in 2020. The panels of internal medicine residents were manually rebalanced at the beginning of training for a new cohort of residents with the goal of having similar numbers of male and female patients on each resident's panel. Panel data was observed for 2 years following intervention. Number of male patients, number of female patients, and overall panel size were compared between male and female residents at baseline, 6 months, and 24 months. The analysis included 28 female residents and 20 male residents. After rebalancing, baseline panels had similar numbers of male patients (median of 50 on both male and female residents' panels; average panel 54.7% male) and female patients (median of 41.5 on female residents' panels and 41 on male residents' panels; average panel 45.3% female). At the end of the follow-up period, a significant difference was observed in the median number of male patients (59.5 and 43.5; p < 0.001) and female patients (33.5 and 48.5; p < 0.001) between male and female residents, but no difference was observed in overall panel size. A steady drift towards gender concordance was observed over 2 years following a rebalancing intervention. Program leadership overseeing primary care empanelment for resident physicians may consider periodic rebalancing of panels in addition to other interventions to ensure equal training opportunities and best prepare residents for future practice.

Outcomes of Accelerated 3-Year MD Graduates at NYU Grossman School of Medicine During Medical School and Early Residency.

For accelerated 3-year MD (3YMD) pathways to be fully adopted in medical education, a comprehensive analysis of outcome data is needed. This study includes 7 accelerated 3YMD graduating classes at NYU Grossman School of Medicine (NYUGSOM) and reports on outcomes from both medical school and internship compared to their 4-year MD (4YMD) counterparts. Outcomes across the undergraduate-graduate medical education continuum for the first 7 classes of NYUGSOM graduates (matriculated from 2013-2019) from the accelerated 3YMD (n = 136) and 4YMD pathways (n = 681) were compared. For the internship outcomes, 3YMD interns were compared with 4YMD interns who graduated from NYUGSOM and all 4YMD interns (4YMD graduates from NYUGSOM and any other medical school) at NYUGSOM residencies. Accelerated 3YMD students were approximately 5 months older at admission and had higher multiple mini-interview scores than 4YMD students. Overall, accelerated 3YMD students performed similarly to 4YMD students during medical school and internship. Significant differences included higher performance by 3YMD students on preclerkship exams and lower performance on Steps 1 and 2 (average: 5.6 and 8.3 fewer points, respectively) and the physical examination portion of the NYUGSOM Comprehensive Clinical Skills Exam. Internship data indicated comparable team assessments across all residencies, statistically significant higher performance on Step 3 when compared to all 4YMD interns, and, in internal medicine, comparable clinical reasoning between 3YMD and all 4YMD interns. When comparing 3YMD interns to all 4YMD interns in the internal medicine residency program, 3YMD interns had a statistically significantly higher performance on milestones. The outcomes from 7 years of graduating accelerated 3YMD students at NYUGSOM show similar performance in medical school and early residency to 4YMD graduates. Long-term study of accelerated 3YMD students from NYUGSOM and other medical schools is needed to further validate the success of this innovative medical education pathway.

(Mis)Alignment in resident and advisor co-regulated learning in competency-based training.

In implementing competence-based medical education (CBME), some Canadian residency programmes recruit clinicians to function as Academic Advisors (AAs). AAs are expected to help monitor residents' progress, coach them longitudinally, and serve as sources of co-regulated learning (Co-RL) to support their developing self-regulated learning (SRL) abilities. Implementing the AA role is optional, meaning each residency programme must decide whether and how to implement it, which could generate uncertainty and heterogeneity in how effectively AAs will "monitor and advise" residents. We sought to clarify how AA-resident dyads collaboratively interpret assessment data from multiple sources, co-create learning goals and action plans and attempt to enhance residents' SRL skills. Shortly after each of their six meetings during two years of Internal Medicine residency, we conducted individual, brief interviews with AAs (N = 10) and residents (N = 10). We analysed transcripts using an abductive framework with theory-based and evidence-based sensitizing concepts. We collected 49 residents and 36 AA 'meeting debriefs', which produced rich data on how dyads variably engaged in SRL and Co-RL. Residents and AAs adopted "learning stances" that oriented their perceptions and approaches to Co-RL. Their stances did not always align within dyads. We found unique patterns in how stances evolved or devolved over time, and in how these changes impacted dyads' Co-RL processes. While some dyads evolved to engage in proactive co-regulation, most stayed consistent or oscillated reactively in their relationships, with little apparent Co-RL focused on helping residents to develop clinical competencies through SRL. We catalogued multiple influential sources of regulation of learning. The conceptually ideal form of Co-RL was not consistently achieved in this well-intended implementation of AA-resident dyads. To better translate 'coaching over time' from intention to practice, we recommend that residency programmes use Co-RL principles to refine CBME processes, including refining assessment tools, resident orientation sessions and faculty development practices.

Internal Medicine Residents' Confidence and Preferences in Hospital Medicine Competencies: A Multi-Site Study.

Hospital medicine (HM) is an important career option for internal medicine (IM) residency graduates. Limited data exist regarding preferences and educational gaps in HM competencies among IM residents. To assess resident confidence and desire for additional instruction in HM competencies across a broad spectrum of residents. A multi-center survey-based assessment of IM resident confidence and desire for additional instruction in published HM competencies. PGY-1 through PGY-4 residents from eight US IM residency programs, including academic medical center (AMC) and community-based programs (CBPs). Resident confidence and desire for more teaching in HM competency domains including procedures, point-of-care ultrasound (POCUS), system-level competencies, clinical skills, patient-level competencies, palliative care, and care transitions. We received survey responses from 272 of 594 (46%) residents. More than half of respondents envisioned a future HM position. Results demonstrated lower than expected confidence for all HM competencies surveyed. Confidence was lowest (30-36% confident) for procedures, POCUS, and system-level competencies, and highest (65-78%) in care transitions, patient-level competencies, and palliative care. Desire for more instruction was highest in the same competency domains rated with the lowest confidence. Junior residents (PGY-1 and PGY-2) reported significantly lower confidence levels than senior residents (PGY-3 and PGY-4) across all domains except patient-level competencies. Junior residents expressed a significantly higher desire than senior residents for more teaching in all domains. There were no significant differences in confidence or desire for more instruction between trainees who envision a future HM position versus those who do not. Residents from AMCs expressed significantly higher confidence than those from CBPs in POCUS, clinical skill, patient-level, palliative care, and care transitions, while residents from CBPs reported significantly higher confidence in procedures. Our data can inform targeted inpatient competencies and educational curricula for IM residents in the USA.

9376 Successful Implementation Of Continuous Glucose Monitoring In An Internal Medicine Residency Clinic

Abstract Disclosure: A.E. Manov: None. A. Donepudi: None. A.S. Dhaliwal: None. J. Tam: None. Y. Badi: None. M. Sharaf: None. R. Haddadin: None. A. Wang: None. K. Mefferd: None. Abstract In this 3-year retrospective observational cohort study, data from fifty-one patients with type 1 or type 2 Diabetes Mellitus (DM), receiving a minimum of 3-to 4 insulin injections per day, and self-monitoring their blood glucose (SMBG) 4-times a day, were derived from our internal medicine residency primary care clinic. The patients were equipped with a Continuous Glucose Monitoring (CGM) device that shared 24-hour glucose data with the clinic. They were assigned to members of our CGM team which included internal medicine or transitional year medical residents who functioned under the supervision of a board-certified endocrinologist. In consultation with our endocrinologist, the resident assessed the patients' glucose management data and adjusted their treatment regimens bi-weekly by calling the patients, and monthly by seeing them in the clinic. The rationale of the study which was confirmatory was to show that in the Internal Medicine Residency clinic in a project governed by the medicine residents, the CGM will lead to improvement in diabetes mellitus control compared to SMBG and this can be done not only in specialized endocrine clinics. The inclusion criteria for selecting the patients were as follows: Age-18-90, diagnosis of Type 1 or type 2 Diabetes Mellitus using 3-4 Injections of Insulin per day +/- other per oral antidiabetic medications and SMBG 4 times a day, HbA1c above 7% while using SMBG, patients who can use the CGM device and receive their primary medical care in our Internal medicine Residency clinic.To assess for differences in A1C, TIR, average blood glucose, percent of time spent in mild hypoglycemia, and percent of time spent in pronounced hypoglycemia, five paired t-tests were conducted. A Bonferroni correction set the new accepted alpha level at 0.01. Significant results from the study include a reduction of HbA1c from 9.9% to 7.6%, average blood glucose decrement from 242 mg/dL to 169 mg/dl, reduction of the incidence of mild hypoglycemia below 70 mg/dl to 54 mg/dl from 4.68% to 0.76% per day, and more pronounced hypoglycemia with glucose less than 54 mg/dl from 3.1% per day to 0.2% per day. We observed a significant increase in the time in the range of blood glucose from 33% to 67% per day. Furthermore, 9.5% of the patients in this study eventually discontinued daily insulin injections and continued treatment with oral diabetic medications with or without the use of injectable GLP-1 receptors once a week.This study affirms that CGM devices significantly improved glycemic control compared to SMBG, supporting its efficacy in optimizing glycemic control in real-world clinical practice. The results imply this can be accomplished in internal medicine residency clinics and not exclusively in specialized endocrine clinics. As far as we know, this is the first study of this kind in a residency clinic in the USA. Presentation: 6/1/2024

6631 A Week With Diabetes: Using Real-Time Continuous Glucose Monitoring In A Simulation Activity With Residents And Fellows

Abstract Disclosure: T. Gallagher: None. C. Donelly: None. R.E. Amori: None. Background: Continuous glucose monitor (CGM) use in managing diabetes mellitus is increasing rapidly. Fellows and residents often prescribe these devices, but most do not themselves have diabetes mellitus and do not use these devices personally. A real-time simulation activity can help physicians in training learn about using the technology in diabetes management and the patient experience living with diabetes mellitus. Objective: Assessing learner’s experiences using a one week real-time CGM simulation. Methods: A real-time simulation using CGM and elements of role playing can enhance knowledge of CGM use and overall diabetes care. Voluntary participants included endocrinology fellows, internal and family medicine residents, and one health professions student. One common structured learning task per day was assigned to all participants over a single seven day period of use in academic year 2022-23. Assessment of each task occurred via personal observations and reflections. Data was collected in an anonymous form and in a group debrief. Results: Eight of 10 participants completed the deidentified post simulation survey and 8/10 participated in the live debrief. Participants reported ease of CGM placement and use. They reported improved insight into the impacts of diabetes on daily activities and increased awareness of diet and exercise impact on glucose levels. Insulin dose calculations were largely correct but errors were seen. All felt the activity was beneficial to their learning. Conclusions: Real-time CGM simulation improves student, resident, and fellow knowledge of the technology and allows the learner to gain insight into a patient’s diabetes self-management. Presentation: 6/3/2024

12242 Enhancing Continuous Glucose Monitor Utilization In Lower Economic Community Hospital Outpatient Clinics: A Quality Improvement Initiative

Abstract Disclosure: V. Mehta: None. S. Deshpande: None. M. Nieman: None. K. Pereira: None. B. Agrawal: None. S.R. Russell: None. Continuous glucose monitors (CGM) measure the blood glucose level (BGL) and have been used for better glucose control, especially in patients requiring insulin. Primary care physicians (PCP) manage diabetic patients on a large scale in the US, especially in rural settings, and data shows that CGMs are prescribed less in PCP settings than in endocrine clinics. Our study aimed to understand internal medicine (IM) residents' knowledge about CGMs and their application in a community hospital outpatient clinic serving lower-economic populations and demonstrates how a clinical pharmacist (PharmD) led educational intervention successfully increased the adoption of CGMs. A survey was done using a form with multiple-choice questions. 50 residents participated and responded anonymously. Data was analyzed by calculating percentages based on answers, providing understanding of their perspectives on CGMs. 78% knew about and correctly identified CGM. When asked to name indications of CGM, answers varied and included uncontrolled diabetes (34%), insulin-dependent diabetes (34%), elderly and non-compliant patients (14%), any diabetic (12%), and others. Only 14% reported to have had formal training in use and interpretation of CGMs, 70% had prescribed, 34% knew how to apply the device, and 42% knew how to interpret the BGL. More than 95% self-reported having either poor/beginner or fair knowledge about the usage, application, and interpretation, whereas more than 80% professed to need more training to be more confident about prescribing the device. After the survey, our PharmD conducted session demonstrating the indications, types, usage, application, and interpretation of CGM. Following this, an impactful increase in patients who were appropriately prescribed and received CGM was observed. Technologies used in medicine have increased, CGM, being one of them. More than 100 million Americans have prediabetes or diabetes, with more than 10 million using insulin. Hence, access to CGM is crucial for patients for better management. Despite the benefits, many factors play a role in limiting their use, including prescription, cost, insurance coverage, social factors, willingness of the patients, discomfort, and decreased knowledge. Non-compliance, difficulty in application and picking the device from pharmacy was also observed in our clinic. A study by Sherrill et al. on use of CGMs (2014-2020) showed that use of CGM increased almost ten times in 2020 (v/s2014); most patients were younger, employed, and had better insurance coverage.With advances in technology, easier and more efficient devices are available to assess patients' glycemic control. Pharmacists play key role in ensuring continued education among practitioners and trainees. Continued efforts to increase awareness is required to ensure that latest advances are adequately incorporated into graduate medical education. Presentation: 6/3/2024

Assessment and improvement of goals of care discussion by internal medicine residents.

191 Background: End-of-life goals and quality of life are intrinsically connected, focusing on providing care that maximizes comfort, dignity, and personal satisfaction during the final stages of life. Residents are primarily involved in Goals of care (GOC) discussion in hospitalized patients it is an integral component in Internal Medicine (IM) resident education. Literature has shown improved outcomes in delivering bad news by residents and oncology fellows after workshops, lectures, and courses. We aimed to improve Residents' competency in effective GOC discussion. Methods: We devised a questionnaire with the help of palliative care specialists and distributed it via a Google survey to the IM residents. After the survey, a palliative care specialist lectured about understanding the POLST form and components of Code Status Discussions. The same questionnaire was sent again. Five survey questions were used as post-lecture improvement parameters, and residents were stratified among three different classes: Interns, Year 2, and Year 3. Results: Before the lecture, residents were asked about their comfort level on a scale from 1-10, with 10 being the most comfortable conducting GOC discussions with the patient or the patient's family. As per the combined survey of all three classes, 50% of residents scored seven or above. Post lecture, 69.3% of intern year residents and 100% of 2nd and 3rd-year residents scored seven and above, which showed significant improvement in residents' comfort level while conducting GOC discussions. The parameters analyzed were the ability to explain SPIKES protocol for 'Breaking Bad News. Initially, 58.3% of the residents were comfortable explaining it, while 41.7 % answered negatively. After the survey, 84.6% from the intern year, 92.3% in 2nd year, and 77.8% of 3rd-year residents stated being comfortable with explaining SPIKES protocol. Another evaluated paradigm was the residents' ability to determine the patient's prognosis using any given scale/score (like the UCSF prognosis calculator). 33.3 % of the residents said 'yes' while 30.6% answered 'maybe.' Post-intervention, 100% of 3rd-year residents and 61.5% of 2nd-year residents, while 30.8% of intern-year residents said 'yes.' The cumulative mean of all three combined classes was 64.1%, which showed significant improvement compared to pre-intervention 33.3%. Conclusions: The results show that residents' comfort level of conducting GOC discussions improved with a single lecture on the topic. Further interventions and mentorship are needed. Intern-year residents were found to have a lower level of subjective comfort in conducting these discussions, which can be explained by their being relatively new to the work environment. A more integrated approach at the beginning of the residency training regarding GOC discussion training can improve interns' confidence and comfort for ensuing such discussions.

S346 Enhancing Anal Cancer Screening Proficiency in Internal Medicine Residents: A Targeted Educational Initiative

S346 Enhancing Anal Cancer Screening Proficiency in Internal Medicine Residents: A Targeted Educational Initiative

A Cross-Sectional, Descriptive Web-Based Survey on Knowledge of the Organ Donation Process among Internal Medicine Residents

A Cross-Sectional, Descriptive Web-Based Survey on Knowledge of the Organ Donation Process among Internal Medicine Residents

An Interactive, Case-Based Workshop on the Patient Experience for Internal Medicine Residents.

The technological revolution has narrowed the information gap between physician and patient. This has led to an evolution in medicine from paternalistic to patient-centric, with health care systems now prioritizing patient experience to achieve higher satisfaction scores. Therefore, it is imperative to start early in educating trainees on how to best address the holistic needs of the patient while also delivering high-quality care. We implemented a 1-hour workshop that was repeated weekly over 8 weeks to capture all internal medicine residents in our program. During the workshop, we reviewed the historical evolution of patient care from paternalistic to patient-centered, presented the Hospital Consumer Assessment of Healthcare Providers and Systems survey questions, and discussed evidence-based strategies for physicians to improve their patients' experience utilizing four case-based scenarios. Over the 8-week period, a total of 195 residents participated in the workshop. One hundred thirty-nine residents (71%) completed the pre- and postsession survey. Results demonstrated significant knowledge improvement (p < .001) in all of the topics discussed. Additionally, the majority of residents felt the workshop would be useful in their clinical practice and found the clinical scenarios useful. Given the evolution towards patient-centered care, it is important to take a proactive approach in providing residents with the tools to best address their patients' needs. Early understanding of patient satisfaction surveys and the impacts they have on hospital metrics can help trainees in their careers as practicing physicians.

S495 Mind the Gap: Identifying and Addressing the Knowledge Gap Among Internal Medicine Residents on Colorectal Cancer Screening Options

S495 Mind the Gap: Identifying and Addressing the Knowledge Gap Among Internal Medicine Residents on Colorectal Cancer Screening Options

Asian representation in the United States (US) oncology workforce.

152 Background: The American Society of Clinical Oncology (ASCO) started the Diversity in Oncology initiative in 2017. Minority representation in the US oncology physician workforce was the subject of a recent series of ASCO State of the Oncology Workforce in America snapshots (1). However, Asian minority representation was not mentioned in any of these reports. Our objective was to determine the proportion of Asian workforce in various oncology specialties inclusive of physician and non-physician practitioners as well as physician trainees. Methods: We searched the web for publicly available data on Asian representation among US oncology adult (A) and pediatric (P) practitioners and trainees. Major data sources included the 2020 US Census, Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, and professional societies. Practitioners included hematologists/oncologists (H/O), gynecologic oncologists (GYNO), radiation oncologists (RADO), surgical oncologists (SURGO), hematopathologists (HP), oncology nurse practitioners (ONP), oncology physician assistants (OPA), and oncology nurses (ON). Trainees included fellows (F) and residents (R). For reference, we obtained similar data on US population, medical students (MS), adult internal medicine residents (AIMR), gynecology residents (GYNR), pediatric residents (PR), pathology residents (PATHR), surgery residents (SURGR), nurses (RN), nurse practitioners (NP), and physician assistants (PA). For a snapshot of the oncology workforce, data from 2020-2022 were used. Whenever available, we obtained serial data for trainees over the years. Results: A snapshot of the proportions of Asians based on their professions is shown (Table). While Asians comprise only 6.2% of the US population, between 14.7% to 32.1% of physician practitioners in various oncology subspecialties are Asian. Moreover, between 17.9% to 35.3% of oncology physician trainees and 26.7% of medical students are Asian and these proportions have remained stable from 2005 to 2022. Data are unavailable for HP, SURGO, and non-physician practitioners except for OPA (7.0%) and RN (7.2%). Conclusions: Asians comprise a large segment of the US oncology workforce. While only 1 in 20 people in the US are Asians, between 1 in 3 and 1 in 5 oncology physician practitioners and trainees are Asians. Data are limited for non-physician practitioners. Asian minority representation should be highlighted and considered as an example of success in diversity. 1. JCO Oncol Pract 2020-2022. Snapshot of Asian representation among oncology trainees and practitioners in the US. Trainees 2022 A-H/O-F 35.3% AIMR 35.9% 2022 P-H/O-F 20.0% PR 22.0% 2022 RADO-R 26.4% MS 26.7% 2022 GYNO-F 17.9% GYNR 14.9% 2022 HP-F 20.0% PATHR 26.6% 2022 SURGO-F 21.2% SURGR 19.2% Practitioners 2021 A-H/O 32.1% OPA 7.0% 2021 P-H/O 20.4% RN 7.2% 2021 RADO 25.9% HP/SURGO/ONP/ON NA 2020 GYNO 14.7% US Census 6.2%

Providing Delayed, In-Person Collected Feedback From Residents to Teaching Faculty: Lessons Learned.

Background Teaching faculty request timely feedback from residents to improve their skills. Yet even with anonymous processes, this upward feedback can be difficult to obtain as residents raise concerns about identification and repercussions. Objective To examine faculty perception of the quality and content of feedback from residents after increasing anonymity and sacrificing timeliness. Methods Between 2011 and 2017, an associate program director at a large internal medicine residency program met briefly with each resident individually to obtain feedback about their teaching faculty shortly after their rotation. To improve anonymity, residents were promised their feedback would not be released until they graduated. In 2019, all feedback was collated and released at one time to faculty. We administered 3 timed, voluntary, anonymous, 36-item closed-ended surveys to faculty asking about the content and value, and to self-identify whether the feedback was praise, constructive, or criticism. Results Exactly 189 faculty participated with 140 completing all 3 surveys (74.1% response rate). Faculty reported this feedback content to be of higher quality (81.0%, 81 of 100) and quantity (82.4%, 84 of 102) in contrast to prior feedback. More than 85.4% (88 of 103) of faculty agreed this feedback was more specific. Faculty identified less praise (median 35.0% vs median 50.0%, P<.001) and more negative constructive feedback (median 20.0% vs median 5.0%, P<.001) compared to prior feedback. More than 82% (116 of 140) of faculty reported it would change their behavior, but 3 months after receiving the feedback, only 63.6% (89 or 140) felt the same way (P<.001). Faculty were divided on the necessity of a time delay, with 41.4% (58 of 140) believing it reduced the feedback's value. Despite the delay, 32.1% (45 of 140) felt they could identify residents. Conclusions Offering a substantial delay in feedback delivery increased anonymity and enabled residents to furnish more nuanced and constructive comments; however, faculty opinions diverged on whether this postponement was valuable.