Level Of Postgraduate Training Research Articles

Knowledge of epilepsy surgery: A survey among medical doctors in Nigeria

BackgroundEpilepsy surgery has been shown to significantly improve the quality of life of patients with drug resistant epilepsy. Despite this, epilepsy surgery remains remarkably underutilized in Nigeria. There are high misconceptions about epilepsy and its management among physicians and trainees. MethodsThis study aims to identify knowledge gaps in epilepsy surgery among medical doctors in Nigeria and factors associated with their level of knowledge of the procedure. A cross-sectional study was carried out among 566 medical doctors in Nigeria, at different levels of post-graduate training (House officers, Medical officers, Resident doctors and Consultants). An online survey with a 24-item questionnaire adapted from a standardized pro forma was utilized. Binary and multiple logistic regression were used to identify associations between the independent variable and outcome variable (good or poor knowledge) ResultsMajority of the respondents were medical officers (post-intern physicians) comprising 65.7 % of the participants. Significant predictors of poor knowledge included being a medical officer [P=0.006], working in north-central [P=0.017] and north-western Nigeria [P=0.045], seeing less than 20 epilepsy patients per month [1–10 patients, P=0.015; 11–20 patients, P=0.011], and enrolment in online epilepsy course [P=0.004]. ConclusionComprehensive education and awareness about epilepsy surgery are important in overcoming the knowledge gap and improving access to care.

Specific steps in the operation determine resident speed: Experience with a live tissue simulation model of laparoscopic nephrectomy.

It is increasingly important to identify and eliminate inefficiencies in resident education. We hypothesize that slower performance of specific operative steps in laparoscopic nephrectomy accounts for much of the slower operative speed observed in junior residents vs. their senior colleagues. Therefore, we sought to evaluate the by-step time-differential between experienced senior residents and their junior colleagues in a live-tissue simulation. Residents participated in our swine model surgical simulation of laparoscopic radical and partial nephrectomy (LRNx and LPNx). PGY5 and 6 residents were considered senior; junior residents were PGY3 and 4. We defined discrete surgical steps. Residents' post-graduate training levels were tracked and time-to-completion of each operative step was recorded. Seven live-tissue simulations sessions took place, with 12 residents conducting 22 operations (12 LRNx, 10 LPNx). On average, each resident operated in 2 simulation sessions (range 1-4). The average time required by senior residents for LPNx was 152 min; junior residents required 173 min (p = 0.35). When considering the operative steps, juniors required nearly twice as much time to achieve hilar control (42 min vs. 23 min, p = 0.03). Significant differences in performance time were not seen in the other steps. The performance differential between senior and junior residents conducting nephrectomies was most evident during hilar dissection. Our study suggests that specific efforts should be focused on teaching junior residents the skills required for this step early in their training.

Confronting implicit bias toward patients: a scoping review of post-graduate physician curricula

BackgroundPhysicians’ behavior may unknowingly be impacted by prejudice and thereby contribute to healthcare inequities. Despite increasingly robust data demonstrating physician implicit bias (The Office of Minority Health. Minority Population Profiles, 2021; COVID-19 Shines Light on Health Disparities, National Conference of State Legislatures 2021), the evidence behind how to change this with training programs remains unclear. This scoping review therefore reports on the implementation, outcomes, and characteristics of post-graduate physician implicit bias curricula.MethodsThe authors conducted a literature review using scoping review methodology. They searched 7 databases in February and November 2020 for English-language academic and gray literature on implicit bias curricula for physicians at all levels of post-graduate training. Ten reviewers screened studies for eligibility independently, then extracted data from these studies and compiled it into a chart and analytical summary.ResultsOf the 4,599 articles screened, this review identified 90 articles on implicit bias interventions for post-graduate physicians. Inductive data analysis revealed a spectrum of educational approaches, which were categorized int o 4 educational models called Competence, Skills-Based, Social Contact, and Critical Models. The most commonly reported strength was the interactive nature of the curricula (26%), and the most frequently identified challenges were related to time and resources available (53%). Half of the interventions discussed facilitator preparation, and the majority (62%) evaluated outcomes using pre and post self-assessments.ConclusionsThis review provides a comprehensive synthesis of the literature on physician implicit bias curricula. It is our goal that this supports medical educators in applying and improving aspects of these interventions in their own programs.

Factors Associated with Burnout among Resident Physicians Responding to the COVID-19 Pandemic: A 2-Month Longitudinal Observation Study.

Background: Burnout during residency may be a function of intense professional demands and poor work/life balance. With the onset of the COVID-19 pandemic, NYC hospital systems were quickly overwhelmed, and trainees were required to perform beyond the usual clinical duties with less supervision and limited education. Objective: The present longitudinal study examined the effects of COVID-19 caseload over time on burnout experienced by resident physicians and explored the effects of demographic characteristics and organizational and personal factors as predictors of burnout severity. Methods: This study employed a prospective design with repeated measurements from April 2020 to June 2020. Participants were surveyed about their well-being every 5 days. Predictors included caseload, sociodemographic variables, self-efficacy, hospital support, perceived professional development, meaning in work, and postgraduate training level. Results: In total, 54 resident physicians were recruited, of whom 50% reported burnout on initial assessment. Periods of higher caseload were associated with higher burnout. PGY-3 residents reported more burnout initially but appeared to recover faster compared to PGY-1 residents. Examined individually, higher self-efficacy, professional development, meaningful work, and hospital support were associated with lower burnout. When all four predictors were entered simultaneously, only self-efficacy was associated with burnout. However, professional development, meaningful work, and hospital support were associated with self-efficacy. Conclusion: Burnout among residency is prevalent and may have implications for burnout during later stages of a physician’s career. Self-efficacy is associated with lower burnout and interventions to increase self-efficacy and the interpersonal factors that promote self-efficacy may improve physician physical and emotional well-being.

Činioci motivacije pripadnika Vojske Srbije

Motivation for work is crucial for the success of modern organizations. Factors that influence the motivation for work are numerous, and their importance is changing. The hierarchy of motivational factors was researched in different time frames and different cultures. In addition the influence of individual characteristics of employees has also been researched. The paper presents a survey of attitudes about the influence of the above mentioned factors on motivation for the work of professional members of the Serbian Armed Forces. The data were collected by anonymous survey of a suitable sample of 1929 members of the Serbian Army during 2010, 2018 and 2020. The questionnaire developed for research consists of a scale of 18 and 16 motivational factors. The 18item scale has a high level of internal consistency (a =0.909/N1) as well as the 16-item scale (a=0.877/N2) and (a=0.829/N3). According to the study results, the hierarchy of motivational factors was constructed: 1) Love for work, 2) Interesting work, 3) Good interpersonal relations, 4) Correct attitude of the manager, 5) Self-affirmation, 6) Success in work, 7) Security of employment, 8) Information sharing, 9) Responsible work, 10) Taking part in decision making, 11) Fair distribution of work, 12) Salary level, 13) Receiving praises, 14) Independence, 15) Possibility for postgraduate training, 16) Awards, 17) Delegation of power, and 18) Criticism. The significance of the money that can be empirically experienced, is not fully proven because the amount of salary is at the 12th position. Results from 2018 and 2020 differ slightly from those gathered in 2010, in terms of hierarchy of the motivational factors and their motivational potential. Noticeable was the decrease in importance of the "interesting job" factor (1/7), as well as the increase for the factor "salary amount" (8/4) and "independence"(9/2). The use of single-factor variance analysis (ANOVA), post hoc test and t-test showed statistically significant differences in the influence of motivational factors on the motivation across different subpopulations of respondents. The size of the impact of the motivational factors on motivation for work increases with the level of postgraduate training, and it is higher in those who are more satisfied with the salary, as well as for the officers in comparison to non-commissioned officers and civilian employees.

Postgraduate Students’ Individual Educational Paths: Design Principles and Implementation Conditions (on the Example of a Technical University)

The article addresses the importance of introducing individual educational paths (IEP) in training research and pedagogical personnel in postgraduate studies. The idea of an individual approach of learning is enshrined in a number of documents including the Federal Law “On Education in the Russian Federation”. However, in practice, there are obstacles to the implementation of IEP: the presence of regulatory documents governing the organization of the educational process in higher education, the predominance of the group form of organizing classes, the unpreparedness of teachers for the implementation of the personalized learning model. We find it reasonable to start the implementation of IEP at the level of postgraduate training, given the relative small number of students, as well as their cognitive independence and well-developed educational skills. The design of the IEP will make it possible to better take into account the initial competencies of postgraduate students, their cognitive needs and goals in further career advancement (orientation towards teaching, research, production activities), which are largely determined by the nature and level of professional education.The article reveals the specifics of the training of research and pedagogical personnel in the postgraduate study of a technical university, identifies the factors that have an impact on the way postgraduate students build their learning trajectories, substantiates the principles of IEP design, and describes the stages of personalized learning technology. The research data on the readiness of postgraduate students to design IEP on their own are presented. The results of the survey of post graduate students and their supervisors indicate that there are sufficient grounds for the successful implementation of a personalized learning model using IEP. Postgraduate students of a technical university are well versed in information resources, actively use University’s services of the electronic educational environment. They are able to determine the goals of educational and scientific activities, assess their competencies, and analyze achievements and failures. Most of scientific advisors are ready to assist postgraduate students in IEP designing. The article analyzes the difficulties that universities may encounter when introducing a new teaching model, and substantiates the conditions for the successful implementation of IEP in postgraduate studies.

Redeployment of psychiatrist trainees during the COVID-19 pandemic: evaluation of attitude and preparedness.

Background: The coronavirus disease-2019 (COVID-19) pandemic has imposed an unprecedented strain on healthcare systems worldwide. In response, psychiatrist trainees were redeployed from their training sites to help manage patients with COVID-19. This study aimed to examine the attitude of psychiatrist trainees toward redeployment to COVID-19 sites and their perceived preparedness for managing physical health conditions during redeployment. Methods: A cross-sectional researcher-developed online survey was administered among psychiatrist trainees in May 2020 at the Department of Psychiatry, Hamad Medical Corporation, Qatar. Results: Of the 45 psychiatrist trainees, 40 (88.9%) responded to the survey. Most trainees reported being comfortable dealing with chronic medical conditions, but less so with acute life-threatening medical conditions. Half reported feeling anxious about redeployment, and most felt the need for additional training. We found that trainees’ perceived redeployment preparedness was significantly associated with their level of postgraduate training and the time since and duration of their last medical or surgical training. Conclusion: Adequate preparation and training of psychiatrist trainees is important before redeployment to COVID-19 sites to ensure that they can effectively and safely manage patients with COVID-19.

Trainee Utilization of the SCORE Curriculum is Associated With Improved ABSITE Performance: A Multi-institutional Study

The Surgical Council on Resident Education's (SCORE) structured educational curriculum for general surgery residents uses a 2-year repeating cycle of modules and quizzes called "This Week in SCORE" (TWIS) to organize and sequence the curricular content on the SCORE portal. The purpose of this study was to evaluate the impact of using the SCORE content and TWIS curriculum on American Board of Surgery In-Training Examination (ABSITE) performance. To date, no multi-institutional studies have examined this effect. Eight residency programs participated, including university and community-based programs. SCORE usage overall, TWIS usage, and ABSITE percentile scores (adjusted for post-graduate year [PGY]) were analyzed for the academic years 2017 to 2020. SCORE usage was defined as number of SCORE logins annually per resident with "low usage" ≤10 times and "high usage" >10 times. TWIS usage was defined as "low usage" (no TWIS quizzes done) or "high usage" (≥1 TWIS quiz per year). Four hundred and twenty-eight trainees were evaluated. Trainees with high SCORE and TWIS usage consistently achieved a higher ABSITE percentile score. This difference was maintained in subgroup analysis by PGY with the greatest impact in PGY-1 and PGY-2 levels. Utilization of multiple aspects of SCORE content appears to have a significant positive impact on ABSITE performance across all levels of postgraduate training. This multi-institutional study of a large number of users is the first to demonstrate that increased usage of SCORE content appears to be a predictor of ABSITE performance success.

Myers-Briggs Type Indicator Personality Types of Ophthalmology Residents

Abstract Objective This study attempts to use the Myers-Briggs Type Indicator (MBTI) to analyze personality types among current and recent ophthalmology residents. We aimed to evaluate the prevalence rates of each specific personality type in ophthalmology, and whether these changed by level of training, training program, or fellowship selection. The study aimed to evaluate whether certain personality types are more prevalent in ophthalmology as a unique medical specialty. This can help understand specialty choice and potentially predict trends in specialty selection. Study Design After obtaining institutional review board approval from Howard University Hospital, an electronic version of the MBTI questionnaire, form M, was sent to participants. In addition to the questionnaire, participants responded to four questions inquiring about home program, postgraduate training level, subspecialty interest, and work environment (if applicable). The anonymous responses of the surveys were automatically scored on google forms, and the results were analyzed by using StatView statistical analysis. Setting This study was conducted at Howard University, Georgetown University, George Washington University, University of Texas Medical Branch at Galveston, and Kresge Eye Institute. Participants A total of 66 current residents and recent graduates of five residency programs were involved in this study. Main Outcomes and Measures This study evaluated four-letter personality type from each participant. Results Ophthalmology residents were statistically more likely to be identified in the categories of extroversion (E) than introversion (I) (p = 0.049), thinking (T) than feeling (F) (p = 0.027), and judging (J) than perceiving (P) (p = 0.007), with no statistically significant difference between sensing (S) and intuition (N). ENTP, ESTJ, and ISTJ were the most common personality types, each comprising 13.6% of the sample population. The ratio of J:P was found to increase as training level increased, beginning with postgraduate 2nd year until graduate level. Conclusion Certain personality types are more common among ophthalmology residents in our cohort from five different training programs. It is possible that individual types change over the course of residency training and career. Understanding that these findings exist can be used as a baseline for future research in terms of potential predictors for applicants, of resident knowledge base, and personality changes over the course of one's training.

A 20-year review of surgical training case logs: Is general surgery still general?

BackgroundSurgical training has undergone many facets of restructuring over the most recent decades, with critiques of the quality and variability of training as well as the competency of recent graduates. This study examines the changes in surgical training in operative volume and breadth in the past 2 decades. MethodsThe Accreditation Council for Graduate Medical Education Case Log Statistics Reports from 1999 to 2019 were reviewed. Case logs were grouped into defined case categories and group levels of postgraduate training. Descriptive analyses and multiple linear regressions were performed. ResultsGeneral surgery residents are graduating with 10.7% more cases, owing to increases in mostly junior year cases (P < .001). The breadth of specialty cases has decreased, while there was an increase in alimentary and abdominal cases to 58.4% from 47.2% 20 years ago. A decrease in vascular surgery cases from 19.9% to 10.7% of all cases was noted. Analysis of the distribution of defined categories showed right skewness in many categories with mode being much lower than reported mean. ConclusionEvaluation of trends, despite residents graduating with higher case volume than the minimum required, shows that the breadth and variety of cases has narrowed significantly in the past 20 years, providing a case for general surgery training restructuring.

A Trainee’s Approach for Effective Operating Room Learning

Introduction: Surgical training has gone through a paradigm shift in recent years. The trends have shifted from an apprenticeship model to a new era of self-teaching and an attitude-driven learning. In this study, we aim to comprehensively investigate the knowledge and attitude pertaining to the perception of preparation required for the operating room and how the residents prepare themselves for it. Method: A quantitative study was conducted via predefined questionnaire. Surgical residents at a single tertiary care institution were asked to complete the survey via Google forms that was distributed by means of email to residents of the general surgery department. Inclusion and exclusion criteria were defined. Results: Forty surgical residents opted to participate in the survey. The majority of the residents had a similar perception of operating room preparation. The most prominent theme that emerged following the discussion was that the residents learned through trial and error, and advice solicited from co-residents, which in the majority of the cases, were senior level resident. The resources defined by the residents were similar among majority and factors that affected their preparation were variable. An important aspect highlighted through the discussion was that the level of postgraduate training affected the preparation done by residents in order to better perform in operation theatres. Conclusion: Knowledge and attitude regarding operating room preparation was quite similar among the surgical residents. They varied in their practice for preparation.

The Choice of Anticoagulation Among Internal Medicine Residents to Treat/Prevent Venous Thromboembolism in Cancer Patients

Introduction: Venous thromboembolism (VTE) is the second most common cause of death in cancer patients next to disease progression. The patients with cancer are not only at increased risk to develop VTE but are also at increased risk of recurrence and bleeding complications from treatment. Hence, anticoagulation is of utmost importance in this population. The International Society of Thrombosis and Hemostasis (ISTH) and American Society of clinical oncology (ASCO) propose guidelines for treatment and prophylaxis of VTE in cancer patients frequently. We aimed to assess the choice and ease among internal medicine residents at different levels of postgraduate training in a teaching community hospital regarding the use of anticoagulation for the prevention and treatment of VTE in medical cancer patients. This study also determines the awareness of the 2019 guidelines of ISTH and ASCO among these residents. Methods: A Cross-sectional study including a web-based survey of five clinical scenarios was designed to determine the anticoagulation of choice as per the 2019 ASCO and ISTH guidelines. The scenarios consisted of non-gastrointestinal cancer patients with a diagnosis of VTE with and without normal kidney function, upper gastrointestinal cancer patents with recent VTE, and VTE prophylaxis in hospitalized and ambulatory cancer patients. Also, four questions were included to determine the ease of residents to start anticoagulation in cancer patients and to assess the difference in choices based on their postgraduate year (PGY) level making a total of nine questions. Results: 58 (77%) of the total residents (75) responded to the questionnaire who included, 18 PGY-1, 18 PGY-2, and 22 PGY-3. The average correct answers were 1.9 (Mean 39%; SD 21%) out of the five questions that were scored i.e the clinical scenario questions based on guidelines. In the scenario of VTE in non-gastrointestinal cancer, the majority of residents chose Lower Molecular Weight Heparin (LMWH) (60.34%), followed by rivaroxaban (24.14%). For a patient with impaired renal function, although a majority of residents preferred warfarin (41.38%), quite a few picked LMWH (29.31%). For upper gastrointestinal cancer, LMWH was the favored option (41.38%) and apixaban was second (31.03%). For VTE prophylaxis, LMWH had 63.16% of preference vs 35.09% of other options. In an ambulatory, fully functional patient with cancer, only 26% of residents believed anticoagulation is not required. 87.72% of the residents said they were unaware of the current guidelines and a total of 65.38% PGY-3 residents did not feel very comfortable starting anticoagulants on their patients without guidance. For the individual answers based on the PGY level see Figure 1. Conclusion: Most of the internal medicine residents preferred LMWH for cancer patients over direct oral anticoagulants. However, they picked the wrong choices in other common scenarios; such as one third preferred to start apixaban in a gastrointestinal cancer patient, or the majority would give prophylactic anticoagulation to ambulatory patients, which is not required per guidelines. These mistakes were supported by the majority of them saying that they were unaware of the treatment recommendations for VTE in cancer patients. Also more than half of the PGY-3 residents are not very comfortable initiating anticoagulants on their own. Based on the above study, we concluded that all residents should be educated on current VTE guidelines on cancer patients, and emphasis should be on including them in the Internal Medicine curriculum. This action will help the residents be more confident and highlight the importance of keeping up with new guidelines. Disclosures No relevant conflicts of interest to declare.

Confidence gap between men and women in medicine: a systematic review

Background:The aim of this study was to examine the existing data on disparities between men and women in the field of medicine in terms of self-confidence, self-efficacy, impostor syndrome, and other self-assessment factors.Methods:A systematic review of the literature was performed using keywords “confidence gap,” “male female residents,” “self-perception,” “self-confidence,” “self-worth,” “self-assessment,” “impostor syndrome,” “medicine self-esteem,” and “gender differences medicine.” Articles meeting the inclusion criteria were sorted and reviewed. Type of study, outcome measures, and results were recorded in Excel. Qualitative analysis was performed on the data collected.Results:Of the 31 studies included in this review, 24 studies demonstrated that men’s self-reported scores in clinical knowledge, skills, procedural confidence, operative experience, and other competencies were higher than women’s self-reported scores. Women at graduate and post-graduate training levels rated themselves lower in perceived clinical skills, performance, confidence in procedures, identification with the role of doctor, interpersonal/communication skills, and preparedness for leadership positions. Furthermore, the rate of identification with impostor syndrome, stress, and burnout are higher in women than men. Evidence did not demonstrate any objective differences in actual performance or skills between men and women at any level of training in medicine.Conclusions:Even though women and men do not differ in their clinical performance, women in healthcare fields may perceive deficiencies in their abilities more often than their male counterparts. However, these results are tempered by the fact that the level of evidence of the studies included in the review is low.Level of Evidence:Level III.

Intraoperative Near-Infrared Fluorescence Imaging With Second-Window Indocyanine-Green Offers Accurate and Real-Time Correction for Brain Shift and Anatomic Inconsistencies in Framless Neuronavigation

Abstract INTRODUCTION Neuronavigation allows neurosurgeons to localize intracranial structures in 3D space and has been shown to have positive impacts on patient survival in neuro-oncology surgery. However, its major limitation is the intraoperative brain-shift phenomenon, in which the brain moves during surgery due to physical, surgical, and/or biological factors, invalidating the preoperative registration and leading to inaccuracies in the cranium. One reliable way to account for brain-shift intraoperatively may be to use tumor-targeting near-infrared fluorophores, such as ICG accumulating in neoplastic tissue (ie, Second-Window ICG), which offers real-time visualization of tumors through normal cortex and dura. METHODS Patients undergoing craniotomy for primary resection of intracranial tumors were enrolled under an ongoing clinical trial investigating the efficacy of SWIG. For this analysis, retrospective data were collected on patients in whom neuronavigation was used to plan the craniotomy in such a way as to place the tumor in the center of the craniotomy (ie, parasagittal tumors, skull-base tumors, and large/asymmetrical tumors were excluded). During surgery, near-infrared imaging was performed before and after durotomy to localize the gross tumor. Image analysis was performed to measure the deviation between the craniotomy center and the center of the tumor as seen with near-infrared fluorescence. RESULTS A total of 63 patients (24 high-grade-gliomas, 12 meningiomas, 25 metastases, 2 others) were included in this preliminary analysis. Neuronavigation demonstrated a median deviation of 22.4% (range 7.7%-44.4%) relative to craniotomy size. Patient position was a significant predictor of neuronavigation inaccuracy, with the prone position having significantly higher inaccuracy (28.5 ± 8.8%) compared to the supine (19.3 ± 9.2%, P-value = .015) or the lateral (17.9 ± 6.6%, P-value = .012) positions. Additionally, the neuronavigation device used and postgraduate training level of the residents performing the registration trended towards significance on multivariate analysis. In contrast, near-infrared fluorescence perfectly delineated the tumor in all cases. CONCLUSION We demonstrate that near-infrared fluorescence imaging offers more accurate localization of intracranial tumors compared to frameless neuronavigation. Near-infrared imaging could potentially be used to adjust neuronavigation registrations intraoperatively to enhance accuracy. Further prospective studies with distance measurements could better explore this potential benefit of intraoperative near-infrared imaging.

Modern possibilities of application of the project method while organizing the educational process at the postgraduate level

The purpose of the work is to optimize the principles and methods of organizing independent work on the basis of interactive learning technologies (design method) in the context of planning the educational process of interns in the specialty “Surgery”, clinical residents, postgraduates and students (optional) in the cycles of thematic improvement within the program Cycles of the Chair of Surgery and Vascular Surgery of Shupyk National Medical Academy of Postgraduate Education. The use of traditional educational and pedagogical means, technologies and methods does not ensure the intensive development of all areas of activity at the postgraduate level. Overcoming these contradictions is possible provided that new modern and innovative approaches to the formation of knowledge and skills are taken into account, taking into account the existing possibilities of information and communication technologies. Solving the problem is possible through the use of interactive learning methods — the method of projects. The introduction of interactive methods in the educational process at all levels of postgraduate training is aimed at the systematic formation of knowledge of specialists who can solve problems in various areas of practical professional activities.

Providing Transthoracic Echocardiography Training for Intensive Care Unit Trainees: An Educational Improvement Initiative

ObjectiveTransthoracic echocardiography (TTE) is important in the management of critically ill patients, yet it has not been incorporated into many residency programs’ curricula. Our objective is to determine if trainees undergoing a 60-minute training session on TTE have improved knowledge, ultrasound skills, and increases the utilization of TTE during their rotation in the intensive care unit (ICU). We will also compare the results of participants with prior TTE exposure to TTE-naïve trainees. Our hypothesis is that after the training, participants’ will have improved knowledge and ultrasound skills compared to before training. Our secondary hypotheses are that TTE-naïve trainees will have greater improvements in knowledge scores compared to those who have had prior TTE experience and trainees will increase their use of TTE in the ICU. DesignSingle-center, prospective trial. SettingBrigham and Women’s Hospital (academic hospital). ParticipantsResidents and fellows rotating through the ICU, at any level of postgraduate training. ResultsForty-two trainees participated in the study. Statistically significant improvement after training was observed for all multiple choice questions (MCQ) and practical assessments (p < 0.001). When assessing the differences in score improvement between TTE-experienced versus TTE-naïve users, mean score improvements were notably higher for TTE-naïve participants (MCQ: 28.2 ± 11.6; echo clinical: 48.6 ± 23.4) compared to TTE-experienced users (MCQ: 18.6 ± 13.5, p = 0.01; echo clinical: 38.3 ± 30.2, p = 0.04). ConclusionsA short didactic presentation on TTE use may be useful in teaching ICU trainees basic TTE skills and encouraging the use of bedside TTE in the ICU.

POSTGRADUATE TRAINING AND ACADEMIC DEGREE CERTIFICATION FOR FOREIGNERS

The purpose of the article is to analyze training foreigners in Russian universities and conferring academic degrees to them during the latest five years. There has been used extensive statistical material on the system of higher education, including the level of postgraduate training and data on the network of dissertation councils. The subjects of the article include all levels of higher education, i. e. the system of certifying highly qualified scientific personnel, geographical distribution of students and postgraduates, Russian universities providing foreigners’ training and certification. The result of this research is the identification of top 10 countries using the Russian system of conferring academic candidate and doctor degrees. The study showed that 41 % of foreigners completed postgraduate studies with the defense of PhD thesis, which is twice as high as the average level of defenses in Russia (21 %). This fact can prove the necessity to increase in the medium term the number of PhD students and candidates of science in Russian universities. The study can also be a basis for developing managerial decisions at the federal level to work out the target indicators of the program «Development of the Export Potential of the Russian Education System». The article is approvingly supposed to introduce into the scientific circulation certain new factual data about the system of training and certifying higher scientific qualification staff, as provided for the foreigners.

CANADIAN PAEDIATRIC RESIDENT KNOWLEDGE AND PERCEPTION OF THEIR NATIONAL PAEDIATRIC PROFESSIONAL ORGANIZATION

BACKGROUND: The Canadian Paediatric Society (CPS) is the national paediatric professional organization representing over 3000 child and youth health care providers. There are currently 847 resident members of the CPS (including subspecialty fellows) in 2016. Residents are valued members of the CPS, and their engagement in the organization is a priority of the CPS. OBJECTIVES: The primary objectives of this study were to identify: 1. Resident knowledge of the CPS 2. Resident needs from the CPS 3. Further opportunities for engagement of residents within the CPS DESIGN/METHODS: A survey was developed by the principal authors (AR-L,RG-P,RS). The survey consisted of 23 questions with either closed-ended or free text responses. The survey was distributed, in English and French, via email link to 793 Canadian paediatric residents at every postgraduate training site in June 2016. All residents with an email address in the CPS membership database were included. Survey information was obtained through the use of an online electronic tool (Survey Monkey). All responses remained confidential, and were collated by the three authors (AR-L,RG-P,RS). Descriptive statistics were used to analyze the data. RESULTS: The survey response rate was 132/793 (17%). The majority of respondents (80.3%) were female. There was good representation across the provinces and from all levels of postgraduate training. Nearly all (96.2%) self-identified as CPS members. A minority (18/116; 15.5%) were current or past CPS representatives. Three quarters of respondents (73/101) felt that the role of the CPS for residents was educational, followed by roles in providing networking (29.7%) and advocacy (27.7%) opportunities. CPS resources are frequently used by residents; all respondents used its statements and practice points. Half of residents (58/115) have attended the CPS Annual Conference during their residency. Many respondents (33/116; 28.4%) have submitted an abstract to the CPS Annual Conference, while a smaller number have applied for a CPS advocacy grant (8.6%) or a CPS elective grant (5.2%). Most respondents were aware of National Residents’ Advocacy Week (71.6%) and the Residents’ Section Facebook group (44%), but less were aware of the resources on starting a community practice (13.8%) and the national locum listings (32%). Residents want the CPS to provide more educational resources (49.1%), specifically in the area of preparation for the paediatrics licensing exam (22.0%), as well as to provide career counselling (22.0%) through provision of job postings, specialty projections, and mentorship. Half of responding residents would like to be more involved in the CPS. CONCLUSION: Residents see the role of the CPS for residents as primarily educational, and CPS educational resources are well used by residents. Residents see the CPS assisting with their career decision-making by providing career counselling, job opportunities and a community for networking. A significant number of residents would like to be more involved in the CPS.

LO13: GridlockED: an emergency medicine game and teaching tool

Introduction/Innovation Concept: In the controlled chaos of the emergency department (ED) it can be difficult for medical trainees similarly recognize that there is definite order to the chaos, and many may never truly appreciate its complexity. How should medical learners develop this skill? Didactic teaching cannot effectively portray the complexities of managing the ED. Much like education in cardiac arrest, trauma, and multi-casualty incident management, it is our belief that the management of patient flow through the ED is best learned through simulation. Thus, we developed GridlockED, a board game that requires players to work cooperatively to manage a simulated ED to win the game. Methods: GridlockED development took place over a six-month period during which iterative cycles of gameplay and redevelopment were used to optimize game mechanics and improve player engagement. The patient cases were created by medical students (PS, DT, JR) and subsequently reviewed for content validity by two attending emergency physicians (TC, AP). Input from attending emergency physicians, residents, medical students, and laypeople was integrated into the game through a Plan-Do-Study-Act (PDSA) model. Curriculum, Tool, or Material: Our game includes: 1) The game board; 2) Patient cards, which describe a patient, their level of acuity, and the tasks that must be completed in order to disposition the patient; 3) Event cards, which cause random positive or negative events to occur-much like random events occur in real life that change the dynamics of the ED; 4) Game Characters, which move around the board to denote where tasks are being completed; 5) A tracking sheet to follow how many tasks each character has performed in each turn; 6) A shift-time clock, which is used to track the ‘hours’ of your shift; 7) A ‘Gridlock counter’, which tracks how many ED backups or adverse patient outcomes occur (‘Gridlocks’). The goal of the game is to work cooperatively with your teammates to complete patient tasks and move patients through the ED to an ultimate disposition (e.g. admission, discharge). The game is won if you finish your shift before reaching the maximum number of ‘Gridlocks’ allowed. Conclusion: Initial responses to GridlockED have been very positive, supporting it as both an engaging board game and potential teaching tool. We are excited to see it validated through research trials and possibly incorporated into emergency medicine training at both student and postgraduate training levels.

POSTGRADUATE STUDIES IN A NEW REALITY

The purpose of the article is the analysis of the dynamics of graduate school admission quotas for educational and scientific organizations over the last 10 years. The analysis shows that in the last 5 years a significant number of regional universities subordinated to the Ministry of education and science experienced a sharp reduction of graduate school admission quotas. The goal is achieved by the use of extensive statistical material on the higher education system, including the level of post-graduate training; the network of dissertation councils; regulatory documents in the field of education. Subject area includes all levels of higher education, the system of highly qualified scientific personnel certification, regions of the Russian Federation, Federal ministries and departments. The result of this study is the development of postgraduate training levels in various ministries/departments, branches of science for the Ph.D. defense as well as efficacy criteria for postgraduate study according to various criteria. The study revealed that in the field of natural sciences 75 % candidates defended after post-graduate training; for organizations subordinated to the Ministry of Agriculture of Russia and the Russian Government the figure is 85 %. As a consequence, this fact may serve as justification for abandoning part-time postgraduate courses for a candidate degree in several branches of science in the medium term. The study will serve as a basis for creating the forecast needs of the Russian economy in the transition to the 6th technological system, and as a consequence, the adjustment of management decisions on the volume of postgraduate study admission quotas and their reallocation among ministries and agencies. The originality and value of the article lies in the introduction of new factual information on the activities of the system of training and certification of highly qualified scientific personnel and analyses of these data into scientific circulation.