Resident Training Level Research Articles

Effectiveness of a virtual reality trainer for retention of tourniquet application skills for hemorrhage control among emergency medicine residents.

With a rise in mass casualty incidents, training in hemorrhage control using tourniquets has been championed as a basic-and lifesaving-procedure for bystanders and medical professionals alike. The current standard for training is in-person (IP) courses, which can be limited based on instructor availability. Virtual reality (VR) has demonstrated the potential to improve the accuracy of certain medical tasks but has not yet been developed for hemorrhage control. The objective of this study was to evaluate the efficacy of a VR hemorrhage trainer in learner retention of tourniquet application when compared to traditional IP instructor teaching among a cohort of emergency medicine residents practicing in a Level I trauma center. This was a prospective, observational study of 53 emergency medicine residents at an inner-city program. Participants were randomly assigned to either the control or the VR group. On Day 0, all residents underwent a training session (IP vs. VR) for the proper, stepwise application of a tourniquet, as defined by the American College of Trauma Surgeons. Each participant was then assessed on the application of a tourniquet by a blinded instructor using the National Registry Hemorrhage Control Skills Lab rubric. After 3 months, each resident was reevaluated on the same rubric, with subsequent data analysis on successful tourniquet placement (measured as under 90 s) and time to completion. Of the 53 participants, the IP training group had an initial pass rate of 97% (28/29) compared to 92% (22/24) in the VR group (p = 0.58). On retention testing, the IP training group had a pass rate of 95% (20/21) compared to 90% (18/20) in the VR group (p = 0.62). Stratifying the success of tourniquet placement by level of resident training did not demonstrate any statistically significant differences. In this pilot study of emergency medicine residents, we found no significant differences in successful hemorrhage control by tourniquet placement between those trained with VR compared to a traditional IP course among emergency medicine residents. While more studies with greater power are needed, the results suggest that VR may be a useful adjunct to traditional IP medical training.

Creation of a Prototype Cochlear Training Model.

Creation of a novel 3D-printed physical cochlear model that demonstrated the feasibility of creating the model, and impact of a Graphical User Interface (GUI) system on training insertion metrics. Feasibility study with a pilot prospective data collection. Tertiary academic center. The study was IRB exempt. Five resident trainees (PGY1-PGY5) practiced electrode insertions in cadaveric temporal bones before using the simulator. Nine students were educated on how to hold the electrodes and position them, and then allowed to use the simulator. All trainees were instructed that slower insertions were favorable. One cochlear implant (CI) surgeon used the simulator. The GUI captured the real video feed, but also provided distance, trajectory, and velocity measurements. The program is designed to plot the real-time depth of insertion and speed of insertion of the electrode; the user is also provided real-time occurrence of any kinks and back-outs. A total of 14 trainees and 1 CI surgeon inserted the electrode at least 5 times without the use of the GUI (before) and then at least 5 times with the use of the GUI (after). Average Speed before and after (100.84 and 53.23 mm/s); Average minimum speed before and after (59.34 and 9.65 mm/s); and Average maximum speed before and after (416 and 285.81 mm/s). Statistically significant improvements were noted in all the measured speeds of insertion (P < .001). The other variables improved but not to a statistical significance. Real-time training using the 3D-printed model and GUI for cochlear implantation can help improve surgical resident training and comfort levels with electrode insertion for surgical trainees. The advantage of this model is that surgeons/trainees can use it as many times as they like, as the whole set-up is easy, economical, and reusable. The real time graphical user interface enhances training and retention of the practiced skills.

The Influence of Saudi Board of Emergency Medicine Residency Educators on Residents' Academic and Clinical Performance in Riyadh, Saudi Arabia.

The Saudi Board of Emergency Medicine (SBEM) is required to assign educators including program directors to supervise their residents. These educators may impact the residents' academic and clinical performances. After thorough review, we noticed that the current literature lacks information about the direct influence of emergency medicine educators on their residents' academic and clinical performances. The main purpose of this study is to assess the residents' confidence level, and to measure the program directors' satisfaction of the residents' performances during their SBEM training yearsin Riyadh hospitals. This concurrent mixed-methods study was conducted in nine training hospitals in Riyadh, Saudi Arabia, during the 2021-2022 academic year. For the quantitative aspect, a cross-sectional survey was used, based on a questionnaire administered to postgraduate year (PGY)-2 to PGY-4 SBEM residents (n=120) using a nonprobability convenient sampling technique. The survey aimed to assess residents' confidence in their academic and clinical performance, influenced by their educators. A Likert scale with a total of 25 items, covering the seven roles of the CANMEDs framework, was employed. This assessment utilized a published tool called the In-Training Evaluation Report. For the qualitative aspect, program directors' perspectives were gathered through one-on-one unstructured interviews (n=9), guided by theoretical saturation. A purposive sampling technique was employed to select program directors. The interview tool collected demographic data, including gender, years of experience, and training hospital, and included 17 open-ended questions to explore program directors' opinions. The result of mixed methods showed that both quantitative and qualitative data sets were divergent with all independent variables (resident's age, gender, and training level) with the exception of the training hospital which was convergent. Thus, the residents' confidence toward their academic and clinical performances induced by their institutional educators was high. However, the program directors indicated changes that related to residents' training level. The residents' confidence toward their academic and clinical performance induced by their institutional educators was high.The educators had a great deal of influence over the academic and clinical performance of the residents. However,the program directors thought there were some issues with the performance of the residents.Most of the program directors also believed that several influential factors that may have affected the residents' overall performance includestress and receiptof constructive feedback.

Faculty Entrustment and Resident Entrustability

As the surgical education paradigm transitions to entrustable professional activities, a better understanding of the factors associated with resident entrustability are needed. Previous work has demonstrated intraoperative faculty entrustment to be associated with resident entrustability. However, larger studies are needed to understand if this association is present across various surgical training programs. To assess intraoperative faculty-resident behaviors and determine if faculty entrustment is associated with resident entrustability across 4 university-based surgical training programs. This cross-sectional study was conducted at 4 university-based surgical training programs from October 2018 to May 2022. OpTrust, a validated tool designed to assess both intraoperative faculty entrustment and resident entrustability behaviors independently, was used to assess faculty-resident interactions. A total of 94 faculty and 129 residents were observed. Purposeful sampling was used to create variation in type of operation performed, case difficulty, faculty-resident pairings, faculty experience, and resident training level. Observed resident entrustability scores (scale 1-4, with 4 indicating full entrustability) were compared with reported measures (faculty level, case difficulty, resident postgraduate year [PGY], resident gender, observation month) and observed faculty entrustment scores (scale 1-4, with 4 indicating full entrustment). Path analysis was used to explore direct and indirect effects of the predictors. Associations between resident entrustability and faculty entrustment scores were assessed by pairwise Pearson correlation coefficients. A total of 338 cases were observed. Cases observed were evenly distributed by faculty experience (1-5 years' experience: 67 [20.9%]; 6-14 years' experience: 186 [58%]; ≥15 years' experience: 67 [20.9%]), resident PGY (PGY 1: 28 [8%]; PGY 2: 74 [22%]; PGY 3: 64 [19%]; PGY 4: 40 [12%]; PGY 5: 97 [29%]; ≥PGY 6: 36 [11%]), and resident gender (female: 183 [54%]; male: 154 [46%]). At the univariate level, PGY (mean [SD] resident entrustability score range, 1.44 [0.46] for PGY 1 to 3.24 [0.65] for PGY 6; F = 38.92; P < .001) and faculty entrustment (2.55 [0.86]; R2 = 0.94; P < .001) were significantly associated with resident entrustablity. Path analysis demonstrated that faculty entrustment was associated with resident entrustability and that the association of PGY with resident entrustability was mediated by faculty entrustment at all 4 institutions. Faculty entrustment remained associated with resident entrustability across various surgical training programs. These findings suggest that efforts to develop faculty entrustment behaviors may enhance intraoperative teaching and resident progression by promoting resident entrustability.

The residency levels' effect on pediatric dental rehabilitation operation time

BackgroundPostgraduate pediatric dental residents' competency, to perform dental rehabilitation procedures under General anesthesia (GA), at different levels of training is challenging for operation time control. An adequate operation time (OT) for children decreases morbidity risk and improves hospital time utilization efficiency. The aim of the study is to assess the effect of pediatric dental resident training level on OT for pediatric dental rehabilitation procedures under GA at King Abdulaziz Medical City (KAMC).MethodsA cross-sectional study included pediatric dental rehabilitation performed under GA by pediatric dental residents at (KAMC) -Jeddah from October/2015 to September/2022. The primary outcome was OT, and the predictive variable was resident training levels. A linear regression analysis was used to compare OT between procedures performed by junior (years 1–2) or senior (years 3–4) trainees, adjusting for patient and operative factors.ResultsOne thousand seven pediatric dental rehabilitation cases were performed under GA by junior (13) and senior (31) residents. The univariant analysis indicated that OT for senior residents was significantly longer (13 min) than for junior residents. However, the linear regression analysis showed that senior residents had a significantly shorter OT when considering the more dental procedures performed per case under GA than junior residents. Senior residents took significantly more radiographs and performed more primary pulp therapies and multi-surface anterior colored restorations under GA than junior residents.ConclusionsThe OT for pediatric dental rehabilitation procedures under GA is associated with resident training level. The total OT was significantly longer based on procedure number, type, and resident level. The study indicated that senior residents could manage more complex cases in a shorter time. The finding emphasizes the importance of assigning GA cases to residents based on their level and the case's complexity. Additionally, it helps standardize the resident privileges under GA and understand the impact of residency training on hospital efficiency.

Quality Improvement and Patient Safety Education in Postgraduate Training Program-A Survey of Residents in Saudi Arabia.

To review the senior resident health trainee's perceived status and need for quality improvement and patient safety (QIPS) education in the residency training program of Saudi Arabia. Residents of medical, dentistry, and pharmacy education were surveyed in 2023 by using pretested 10 QIPS questions. The median and interquartile range (IQR) of the score was correlated to gender, branch, and level of residency training. We surveyed 202 senior residents. Males were 131 (64.9%). Residents of medical (126, 62.4%), dentistry (39, 19.3%), and pharmacy (37, 18.3%). The median score of responses to the QIPS survey was 7.0 (IQR 4.0, 11.6). The median score of residents of dentistry, medicine, and pharmacy were 10 (IQR 7.0, 12.5), 6.75 (IQR 4.0, 12.0), and 5.0 (IQR 2.5, 8.0) respectively, and was significantly different (Kruskal Wallis (KW) chi-square = 19.8, P = .001). The exposure to the QIPS project was significantly and positively associated with a high QIPS score (MW U P = .02). The variations in the score by gender (Mann Whitney P = .148) and the level of residency (KW P = .86) were not statistically significant. Three-fourths of participants feel the need for formal training about QIPS. Nearly half of the participants were not happy with the current method of QIPS training methodology. More than 40% of participants were not sure about questions about opportunities and mentorship of QIPS projects. One-third were involved in QIPS projects. Although senior residents were interested in QIPS, they were dissatisfied with current methods and opportunities to execute supervised QIPS projects. Residents of dentistry and those having performed QIPS projects had higher QPIS knowledge and satisfaction with training.

The impact of residency training level on early postoperative desaturation: A retrospective multicenter cohort study

ObjectiveWe studied the primary hypothesis that the training level of anesthesiology residents (first clinical anesthesia year, CA1 vs CA2/3 residents) is associated with early postoperative desaturation (oxygen saturation < 90%). We also analyzed the change in the rate (trajectory) of desaturation during the resident's development from CA1 to CA2/3 resident, and its effects on postoperative respiratory complications. DesignRetrospective hospital registry study. SettingTwo university-affiliated hospitals networks (MA and NY, USA). Patients140,818 adults undergoing non-cardiac surgery under general anesthesia and extubation in the operating room by residents (n = 378) between 2005 and 2021. MeasurementsMultivariate logistic and quantile regression were used in the analyses. The secondary outcome was major respiratory complication within 7 days after surgery. Main resultsIn 6.5% and 1.6% of cases, early postoperative desaturation to < 90% and 80% occurred. Compared to CA2/3 residents, CA1 residents had higher odds of experiencing early postoperative desaturation to < 90% and 80% (adjusted odds ratio [ORadj], 1.07; 95%CI 1.03–1.12; p = 0.002, and ORadj 1.10; 95%CI 1.01–1.20; p = 0.037, respectively). The change in postoperative desaturation rate during the transition from CA1 to CA2/3 status varied substantially from ORadj 0.80 (decreased risk) to 1.33 (increased risk). Major respiratory complication did not differ between experience levels (p = 0.52). However, a strong decline in improvement regarding the rate of postoperative desaturation during the transition from CA1 to CA2/3, was paralleled by an increased odds of major respiratory complication for CA2/3 residents (ORadj 1.20; 95%CI 1.02–1.42; p = 0.026, p-for-interaction = 0.056). ConclusionPatients treated by CA1 residents have an increased risk of postoperative desaturation. Some residents show an improvement and others a decline in postoperative desaturation rate. Our secondary analysis suggests that there should be more focus on those residents who had a declining performance in postoperative desaturation despite becoming more experienced.

Is Robotic Console Time a Surrogate for Resident Operative Autonomy?

Robotic-assisted surgery is an increasing part of general surgery training, but resident autonomy on the robotic platform can be hard to quantify. Robotic console time (RCT), the percentage of time the resident controls the console, may be an appropriate measure of resident operative autonomy. This study aims to characterize the correlation between objective resident RCT and subjectively scored operative autonomy. Using a validated resident performance evaluation instrument, we collected resident operative autonomy ratings from residents and attendings performing robotic cholecystectomy (RC) and robotic inguinal hernia repair (IH) at a university-based general surgery program between 9/2020-6/2021. We then extracted RCT data from the Intuitive surgical system. Descriptive statistics, t-tests and ANOVA were performed. A total of 31 robotic operations (13 RC, 18 IH) performed by 4 attending surgeons and 8 residents (4 junior, 4 senior) were matched and included. 83.9% of cases were scored by both attending and resident. The average RCT per case was 35.6%(95% CI 13.0%,58.3%) for junior residents (PGY 2-3) and 59.7%(CI 51.1%,68.3%) for senior residents (PGY 4-5). The mean autonomy evaluated by residents was 3.29(CI 2.85,3.73) out of a maximum score of 5, while the mean autonomy evaluated by attendings was 4.12(CI 3.68,4.55). RCT significantly correlated with subjective evaluations of resident autonomy (r=0.61, p=0.0003). RCT also moderately correlated with resident training level (r=0.5306, p<0.0001). Neither attending robotic experience nor operation type significantly correlated with RCT or autonomy evaluation scores. Our study suggests that resident console time is a valid surrogate for resident operative autonomy in robotic cholecystectomy and inguinal hernia repair. RCT may be a valuable measure in objective assessment of residents' operative autonomy and training efficiency. Future investigation into how RCT correlates with subjective and objective autonomy metrics such as verbal guidance or distinguishing critical operative steps is needed to validate the study findings further.

What factors impact surgical operative time when teaching a resident in the operating room

PurposeResident involvement would likely lead to prolonged operative time of a surgical case performed at academic medical centers. However, little is known about factors beneath this phenomenon. The purpose of this study was to investigate whether factors from case (procedure type, surgical case complexity, and surgical approach), teacher (attending surgeon experience and gender), and learner (resident postgraduate training year and gender) would influence operative time of surgical cases involved teaching a resident (SCT). MethodsA single-institution retrospective analysis of 3 common general surgery procedures, including cholecystectomies, colectomies, and inguinal hernia, with involvement of general surgery residents between 2016 and 2020 was conducted. Surgical operative time was defined as the "cut-to-close” time from incision to completion of wound closure. Analysis of variance for continuous variables and multivariable linear regression were applied. ResultsA total of 4,417 eligible SCT were included. The average operative time was 114.8 ± 78.7 min. SCT with male resident involvement showed a significantly longer operative time than those with female residents (117 vs. 112, p = 0.01). Comparable operative time was observed between male and female attending surgeon cases (115.5 vs. 110.8, p = 0.15). SCT operating time decreased with increased resident training level, except for SCT with involvement of Year2 residents. SCT with Year5 residents demonstrated the lowest time to case completion (110.5 min); SCT with major complications took least time to complete (105.7 min). Univariate and multivariate analysis revealed resident training year level, resident gender, and case complexity as factors associated with significant differences in operative time. Attending surgeon experience, surgeon gender, surgical approach, and procedure type did not impact SCT operative time. ConclusionOur study findings suggest resident training level, resident gender, and case complexity are factors significantly associated with SCT operative time of cholecystectomies, colectomies, and inguinal hernia. Attending surgeons are recommended to factor them into pre-operative planning.

Simulation training in Neuropalliative Care (P8-6.002)

<h3>Objective:</h3> The purpose of our study is to evaluate if a simulation in neuropalliative care is a useful training method for neurology residents. <h3>Background:</h3> Education in palliative care is lacking in neurology training. The majority of neurology residency programs do not have a formal way to train and assess residents in this domain. <h3>Design/Methods:</h3> The simulation targeted adult and pediatric Neurology residents ranging from PGY2-PGY4. The Serious Illness Conversation Guide (SICG) was used as a framework. Residents first received a didactic reviewing the SICG, followed by two simulations with standardized patients (SPs). The first simulation focused on giving bad news in the outpatient setting. The second focused on shared decision making in the inpatient setting. Residents filled out surveys assessing their comfort levels before and after the simulations, as well as 3 months later to determine how it influenced their practice. <h3>Results:</h3> Twenty-one residents participated in the simulation. Survey responses were received from 100% of participants. After the simulation, respondents who felt comfortable giving bad news increased by 11% for the inpatient setting and by 19% for the outpatient setting. There was a trend towards improved comfort in assessing illness understanding, managing uncertainty in prognosis, making a recommendation based on patient goals, and discussing hospice options. Overall, 91% thought the simulation accurately represented real life and 100% felt that the simulation would influence their future practice. At 3 months after the simulation, 85% of trainees reported using the SICG in palliative care conversations. <h3>Conclusions:</h3> Simulation training with SPs is a valuable way to train neurology residents in neuropalliative care discussions. Future simulations can tailor specific scenarios to resident level of training. <b>Disclosure:</b> Dr. Lalla has nothing to disclose. Ms. Dobie has nothing to disclose. The institution of Dr. Bissonnette has received research support from Michael J Fox Foundation. The institution of Dr. Bissonnette has received research support from Cogan Family Foundation. Dr. Lau has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint. The institution of Dr. Lau has received research support from Amyloidosis Foundation. Dr. Tulsky has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for American Board of Internal Medicine. Dr. Kaku has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Fatcliffe Harten Galamaga LLP.

Anesthesiology Resident Knowledge of Transfusion Medicine: Results From the Anesthesiology Transfusion Education Study.

Transfusion of blood products is a common practice in anesthesiology. Inadequate transfusion medicine knowledge may lead to inappropriate transfusion practices and patient risk. Using a validated assessment tool modified for anesthesiology, we conducted a survey of anesthesiology residents in the United States to assess transfusion medicine knowledge. A validated transfusion medicine examination and accompanying survey were forwarded by program directors to residents for anonymous completion on May 5 and closed on June 30, 2021. The outcome of interest was the mean examination score. Secondary areas of interest were performance by year of training and previous educational experience in transfusion reported by the trainees. Rasch analysis was performed on the examination quality and individual question performance. Kruskal-Wallis H tests were used to identify differences between mean scores. Post hoc comparisons were used to assess specific pairwise differences between mean test scores by survey variable. Four hundred twenty-three anesthesiology residents in 37 programs completed the examination. The mean score was 45.5% ± 12.6%. There was a significant difference in mean cumulative examination scores between different resident training levels ( P < 0.001). There was a significant difference in scores between clinical anesthesia (CA)-1 and CA-2 residents ( P = 0.011) and CA-1 and CA-3 residents ( P = 0.012). No significant difference in examination scores was observed between CA-2 and CA-3 residents ( P = 0.95). All these subgroups scored below 50% on the examination. Significant differences between the residency training programs and cumulative scores were identified ( P < 0.001). This examination highlights gaps in transfusion medicine knowledge within US anesthesiology residents. Targeted education may improve knowledge in this area and patient care.

STABILITY OF ORTHODONTIC MINI-SCREWS AND DIFFERENT EXPERIENCE LEVELS OF RESIDENCY TRAINING OF STUDENTS

Objectives: To determine the association between the stability of orthodontic mini-screws with different experience levels of residency training of students. Materials and methods: A total of 240 mini-screws with a diameter of 1.3 mm, and a length of 7 mm were inserted by orthodontic residents in the first, second, third, and fourth years. Stability was assessed after one month of application of orthodontic load. Chi-square tests were used to analyze data. P value ?.05 was considered significant. Results: Out of 240 implants, 172 were found to be stable and 68 were unstable after one month among different resident levels. There was a significant association between the stability of mini-screws and different experience levels of postgraduate residents. For first-year residents, stability was 53.8%, for second-year residents 27.3%, for the third year 93.3%, and the fourth year 90.5%. The association between the placement site of mini-screws and different levels of postgraduate residents was also significant and the highest number of stable mini-screws were found in maxilla and posterior mandible placed by fourth-year residents, and the least stable for second-year residents. Conclusion: The experience level of residents is a significant factor in the stability of mini-screws and site-specific stability is higher in the maxilla and posterior mandible for fourth-year residents. Key Words: Anchorage, Insertion site, Maxilla, Mandible, Orthodontists, Stability, Temporary Anchorage Devices (TADs).

Resident assistant training level is not associated with patient spinal fusion outcomes

ObjectiveA hallmark of surgical training is resident involvement in operative procedures. While resident-assisted surgeries have been deemed generally safe, few studies have rigorously isolated the impact of resident post-graduate year (PGY) level on post-operative outcomes in a neurosurgical patient population. The objective of this study is to evaluate the relationship between resident training level and outcomes following single-level, posterior-only lumbar fusion, after matching on key patient demographic/clinical characteristics and attending surgeon. Patients and methodsThis coarsened-exact matching (CEM) study analyzed 2338 consecutive adult patients who underwent single-level lumbar fusion with a resident assistant surgeon at a multi-hospital university health system from 2013 to 2019. Primary outcomes were 30-day and 90-day readmissions, Emergency Department (ED) visits, reoperations, surgical complications, and mortality. First, univariate logistic regression examined the relationship between PGY level and outcomes. Then, CEM was used to control for key patient characteristics – such as race and comorbid status – and supervising attending surgeon, between the most junior (PGY-2)-assisted cases and the most senior (PGY-7)-assisted cases, thereby isolating the relationship between training level and outcomes. ResultsAmong all patients, resident training level was not associated with risk of adverse post-surgical outcomes. Similarly, between exact-matched cohorts of PGY-2- and PGY-7-assisted cases, no significant differences in adverse events or discharge disposition were observed. Patients with the most senior resident assistant surgeons demonstrated longer length of stay (mean 100.5 vs. 93.8 h, p = 0.022) and longer duration of surgery (mean 173.5 vs. 159.8 min, p = 0.036). ConclusionTraining level of the resident assistant surgeon did not impact adverse outcomes provided to patients in the setting of single-level, posterior-only lumbar fusion. These findings suggest that attending surgeons appropriately manage cases with resident surgeons at different levels of training.

Resident attitudes, experiences, and preferences on initiating buprenorphine in the emergency department: A national survey.

The objective was to describe emergency medicine (EM) resident attitudes, preferences, and experiences around the knowledge and skills around the evidence-based treatment of opioid use disorder (OUD) in the emergency department (ED). We created an online survey that was distributed by the Emergency Medicine Residents' Association research committee listserv to approximately 6600 resident physicians at all levels of EM residency training. Data were collected between June 2020 and October 2020. This 12-question voluntary, anonymous survey included questions exploring EM resident preferences and experiences around the education and exposure to the evidence-based management of patients with OUD in the ED setting. Descriptive statistics were used. A total of 288 of 6600 invited EM residents (response rate 4.4%) from 127 different EM residency programs across 38 states in the United States, District of Columbia, and Puerto Rico completed the survey. Most respondents (165/288; 57.3%) reported that it was "very important" for emergency physicians to have training to initiate buprenorphine treatment for patients with OUD. Just under half (140/288; 48.6%) reported they have or will receive X-waiver training during residency and 46.9% (135/288) reported experience prescribing buprenorphine in the ED. The estimated proportions of EM faculty at responding residents' primary teaching hospital with an X-waiver was "most or all" (48/285; 16.8%), "about half" (23/285; 8.1%), "a handful" (79/285; 27.7%), "one or two" (33/285; 11.6%), "none" (19/285; 6.7%), or "not sure" (83/285; 29.1%). Survey results suggest that resident emergency physicians perceive the evidence-based management of OUD to be relevant to EM residency training and are interested in receiving training on initiating medications for OUD treatment in the ED. Opportunities to improve resident education and clinical use of buprenorphine during ED residency training were identified.

The Impact of Resident Duty Hour Reform on Family Medicine Residency Training: Residents' Points of View

&lt;p&gt;目的：本研究探討家庭醫學科住院醫師自2019年適用勞動基準法規定後，對工時規範之滿意度、健康影響、學習成效、醫療品質與病人安全層面進行調查，並進一步比較不同訓練職級、不同醫院訓練容額、與不同醫院層級住院醫師在工時規定影響看法上的差異。&lt;/p&gt; &lt;p&gt;方法：以2017至2019訓練年度進入家庭醫學專科醫師訓練計畫的住院醫師為對象，以問卷調查工時限制所造成的影響。結果：共有286位家庭醫學住院醫師參與研究，其中有近九成滿意目前工時限制規定，且普遍認為工時限制不會降低訓練品質。其中第一年住院醫師超時的比例較高，較資深住院醫師同意工時規定會減少教學指導與學習體驗的比例較高，但多數還是認為並不影響教學品質。超過半數第一年住院醫師認為醫療錯誤發生率會降低，資深住院醫師則多認為不變。雖然所有醫院層級的住院醫師都認為工作時疲勞情況與嗜睡程度有所改善，但地區與區域級醫院仍有少部分住院醫師認為工作時疲勞及嗜睡程度更明顯。&lt;/p&gt; &lt;p&gt;結論：實施工時限制後，大部分家庭醫學科住院醫師滿意目前工時限制規定，認為工時限制不會降低訓練品質，也不需要延長受訓年限。學員普遍認為對於工時限制對住院醫師的身心健康有正向影響，對於病人受到的醫療品質與病人安全則不受影響。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Objective: The study assessed family medicine residents&amp;rsquo; overall satisfaction with the resident duty hour restriction implemented in 2019 and explored their perceptions of the impacts of the restriction on their well-being, education, and patient safety. The study further compared the differences in residents&amp;rsquo; perceptions based on the level of residency training, size of residency training program, and level of training hospital.&lt;/p&gt; &lt;p&gt;Methods: Residents admitted to the family medicine residency training program by the Taiwan Association of Family Medicine from 2017 to 2019 were selected to participate in this study. A prospective anonymous questionnaire survey was administered to family medicine residents nationwide to gather their opinions and suggestions regarding the newly implemented resident duty hour reform.&lt;/p&gt; &lt;p&gt;Results: A total of 286 family medicine residents responded to the questionnaire survey. Nearly 90% of the residents were satisfied with the current duty hour regulations and found the restriction unlikely to compromise the quality of residency training. First-year residents reported a greater frequency of working overtime, compared to residents of other levels. The more senior the residents, the stronger the belief that duty hour restriction reduced time for learning and faculty guidance; however, the majority of the responding residents were of the opinion that the restriction did not affect the overall quality of residence training. Over 50% of the first-year residents felt the restriction helped reduced the likelihood of medical error, while more senior residents found the likelihood unchanged. Regardless of the levels of their training hospitals, a great part of the residents found the problems of fatigue and daytime sleepiness alleviated, yet there was still a minority of residents in regional and district hospitals felt the problems aggravated.&lt;/p&gt; &lt;p&gt;Conclusion: After the implementation of duty hour restriction, most family medicine residents are satisfied with the current regulations and feel no significant impact of the restriction on the quality of residency training. In their opinion, there is no need to extend the length of residency training. The duty hour reform does exert positive influences on their physical and mental health and bring about no impact on patients&amp;rsquo; safety and quality of care.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Feedback Guide for direct observation of family medicine residents in Canada: a francophone tool

ContexteIl n’existe aucun outil par jalons reposant sur les CanMEDS-MF pour guider la rétroaction en supervision par observation directe (SPOD). Nous avons développé un guide pour soutenir la documentation de la rétroaction en SPOD en médecine familiale (MF) au Canada.MéthodeLa conception du Guide a été effectuée en trois phases avec la collaboration de cinq programmes de MF canadiens ayant minimalement un site d’enseignement francophone : 1) recension des écrits et étude des besoins; 2) élaboration du Guide de rétroaction SPOD; 3) mise à l’essai du Guide en contexte de simulation vidéo avec analyse de contenu qualitative.RésultatsLa phase 1 a démontré le besoin d’un guide narratif ayant pour but 1) de préciser les attentes mutuelles selon le niveau de formation du résident et le contexte clinique, 2) d’outiller et structurer le superviseur dans ses observations 3) de faciliter la documentation de la rétroaction. La phase 2 a permis d’élaborer le Guide, en formats papier et électronique, répondant aux besoins identifiés. En phase 3, 15 superviseurs ont utilisé le guide pour trois niveaux de résidence. Le Guide a été ajusté à la suite de cette mise à l’essai pour rappeler les phases de la rencontre clinique souvent oubliées durant la rétroaction (avant la consultation, diagnostic et suivi), et y suggérer des types de formulation à favoriser (questions stimulantes, questions de clarification, réflexions).ConclusionIssu de données probantes et d’une démarche de concertation, ce Guide outillera les superviseurs et résidents francophones canadiens dans leurs activités de SPOD en médecine familiale.

Readmission after Orthognathic Surgery

PurposeThe purpose of this study is to evaluate the overall readmission rate and identify the associated risk factors. Although studies have documented complications after orthognathic surgery,1,2 there is very limited information regarding specific reasons for readmission after such procedures. Materials and methodsThe researchers performed a retrospective review of records of all patients who underwent orthognathic surgery between 2015 and 2019, with a single surgeon. Readmission was defined as an unexpected admission to the hospital, with or without return to the operating room within a 1-year postoperative period. Study variables included gender, age, ASA status, type of surgery, concomitant third molar extraction, concomitant genioplasty, duration of surgery, resident PGY level involvement, and duration of hospitalization. Methods of data analysisBivariate associations were calculated between variables and readmission status. Specifically, Chi-square or Fisher's Exact tests were used to compare categorical variables, as appropriate, and a 2-sample T-test was used to compare continuous variables. To adjust for potential confounders, a multivariate logistical regression analysis was performed. The number of operative jaws was chosen a priori as a clinically relevant confounder of the association between duration of initial hospitalization and readmission, as the duration of initial hospitalization was longer with increased number of simultaneous operations. To evaluate the relative importance of statistically significant predictors, the change in the c statistic was evaluated. ResultsA total of 701 patients (418 females and 283 males) with a mean age of 25.86 years (14-66 years) were included in the study. A mix of ASA 1 (58.92%), ASA 2 (38.66%), and ASA 3 (2.43%) patients comprised the study population. The overall readmission rate was 9.7%. Of the 68 readmissions, 12 patients (17.6%) were managed non-surgically and 56 patients (82.4%) required a return to the operating room. The most common reason for readmission was infection (n = 11) and for re-operation was hardware removal (n = 24). Other reasons for reoperation were non-union of osteotomy (n = 2), oronasal fistula (n = 2), subjective esthetic concerns (n = 2), malocclusion (n = 3), trismus (n = 5), bleeding (n = 10). Age, gender, type of surgery, third molar extraction, genioplasty, duration of surgery, and resident training level were not found to be predictors for readmission after orthognathic surgery. Outcomes dataThere was an association between ASA status and readmission (P-value .0042). ASA 2 and 3 patients had 1.77 times (95% Confidence Interval: 1.05, 2.97) and 5.32 times (95% Confidence Interval: 1.75, 16.10) greater chance of being readmitted compared to ASA 1 patients, respectively. After adjusting for the number of operative jaws, duration of hospitalization was also associated with readmission (P-value .0162). Overall, ASA classification was more predictive of readmission than duration of hospitalization. ConclusionOnly ASA classification and duration of initial hospitalization after orthognathic surgery are significant risk factors for readmission of patients within the first postoperative year.

Curriculum Kardiovaskuläre Schlafmedizin

Sleep-related breathing disorders are very common in cardiovascular disease patients with, for example, difficult-to-control arterial hypertension, coronary artery disease, valvular heart disease, cardiac arrhythmias, or heart failure, and are associated with a worse prognosis. The therapy of sleep-related breathing disorders can usefully complement the treatment of cardiovascular diseases because of its effects on arterial blood pressure and quality of life in selected patients. This makes integrative cardiology and sleep medicine care for these patients all the more important. Therefore, the purpose of the curriculum is to describe a qualification process, the goal of which is to obtain the additional qualification Cardiovascular Sleep Medicine. This is intended to improve the qualification in this specialized field so that it exceeds the level of general residency training in cardiology. The curriculum has a three-tiered structure. Level 1 systematically imparts basic knowledge and skills according to the qualification contents of the curriculum cardiology, level 2 imparts knowledge and skills, among others, for the independent performance of polygraphy and level 3, among others, for the independent performance of polysomnography.

Level of Supervision and Radiation Exposure of Senior Orthopedic Residents During Surgical Treatment of Proximal Femur Fracture.

The sustained use of intraoperative fluoroscopy has led to increased use of minimally invasive surgical techniques, enhanced surgeon proficiency, improved anatomic corrections, reduced patient morbidity, earlier functional recovery, and decreased length of hospital stay. As a result, orthopedic attending surgeons and residents are exposed to more radiation, increasing the risk of cancer and radiation-induced cataracts compared with the general population and those who work in other surgical specialties. The magnitude of radiation exposure depends on the susceptibility of the tissues affected, medical specialty, the position of the C-arm, distance from the radiation beam, level of difficulty of the surgical procedure, surgeon experience, level of resident training, and level of supervision by the attending surgeon. However, little information is available on the effect of supervision level on radiation exposure for orthopedic senior residents. The goal of this study was to investigate whether level of supervision by the attending surgeon affects the radiation exposure of orthopedic senior residents during surgical treatment of proximal femur fracture with cephalomedullary nail fixation. This retrospective cohort study was performed from January 2019 to March 2019. No significant relationship between supervision level and radiation exposure of senior residents was observed. Supervision level does not significantly affect radiation exposure for senior residents; therefore, the implementation of standardized training in radiation safety may be a more essential measure to decrease radiation exposure. [Orthopedics. 2021;44(3):e402-e406.].

Type A Behavior Patterns Among Neurosurgeons and Neurosurgical Trainees

The busy and demanding work schedule of neurosurgeons suggests that they might have type A behavior patterns (TABPs). TABPs are also associated with multiple diseases; hence, their early identification could lead to behavioral changes and disease prevention. We aimed to determine the presence of TABPs among neurosurgeons and trainees in the Philippines and the association between demographic and clinical factors and TABPs. An online survey was sent to neurosurgeons and neurosurgical trainees in the Philippines. Data on age, sex, comorbid conditions, smoking, alcohol use, training institution, level of residency training, and place of practice were obtained. The modified Bortner scale was used to determine TABPs. Univariate and multiple regression analyses were used for analysis. A total of 102 individuals (41 neurosurgeons and 61 trainees) completed the survey. Most of the respondents were men (74%), with a mean age of 36 years. The Bortner scores were normally distributed. TABPs were significantly associated with female sex (P= 0.0006) in the entire cohort. However, the trainee cohort also exhibited a significant association between TABPs and training in a public institution (P= 0.0027). The presence of TABPs followed a normal distribution among neurosurgeons and neurosurgical trainees in the Philippines. A significant association was found between TABPs and female sex for both neurosurgeons and trainees, and training in a public institution was significantly associated with TABPs only among the trainees.