Medical Residency Programs Research Articles

Medical Residents, the Group and the Formation of Professional Identity During the COVID-19 Pandemic.

Residency is still considered the gold standard for quality medical training, and acquiring a professional identity as a specialist is one of its central elements. Residents obtain this identity through both the educational environment and direct interaction with peers and supervisors. However, modifications in health care and educational routines during the recent coronavirus disease 2019 (COVID-19) pandemic have significantly impaired these channels. This study is part of a qualitative research project to analyze professional identity formation in a medical residency program in obstetrics and gynecology at a public hospital in southern Brazil. The authors conducted 28 semi-structured interviews with medical residents and preceptors, as well as a focus group with the residents, which was recorded, transcribed, and analyzed in an effort to construct major analytical categories. Restricted movement and physical contact have forced the use of alternative means of interpersonal interaction, such as communication through social media or instant messaging applications. This has also affected educational activities, such as morning rounds, lectures, and seminars. These changes represent a significant impact, especially in Brazil, where physical proximity is an important cultural feature, even in the work and school environments. We speculate that this new type of virtual interaction will also affect the formation of professional identity among obstetrician-gynecologists. These findings suggest that medical residency programs should be attentive to changes in resident training to ensure that the specialist profile and the expected skills, which are consolidated over many years, are not lost.

Trends in Matriculation from Neurological Surgery Training Programs into Academic Versus Private Practice

A career in academic neurosurgery is an arduous endeavor. Specific factors influencing physician practice preferences remain unclear. This study analyzes data from the American Association of Neurological Surgeons membership identifying the impact of several demographic and educational characteristics influencing neurosurgical career choices centered on academia, private practice, or a combination in the United States. A list of all current neurosurgeons was obtained from the American Association of Neurological Surgeons membership, and information on physician characteristics was collected via internet searches and institutional databases. The practice type of all neurosurgeons considered in this study were categorized as follows: private practice, academic, or a combination of private practice and academic, termed privademic. These data were subsequently correlated to race, gender, current age, training at a top 40 National Institutes of Health-funded medical school or residency program, and current practice. The median age of private practice and academic neurosurgeons was 58.18 and 53.61 years, respectively (P < 0.001). Age was significantly associated with practicing in an academic setting (odds ratio 0.96), with younger neurosurgeons pursuing careers in academia. Data indicated a positive and statistically significant contribution of female gender (P < 0.001) and training at a top-40 National Institutes of Health-funded institution to practicing in an academic setting (P < 0.01). Neurosurgery as a field has grown significantly over the past century. The authors recommend that future efforts seek to diversify the neurosurgical workforce by considering practice setting, demographic characteristics, and educational background.

Outcomes of nephrectomy for renal cell carcinoma: An ecologic retrospective study in a middle-income country.

The aim of this study was to describe and compare the outcomes and indirect costs of oncological radical (RN) and partial nephrectomies (PN) in hospitals from the São Paulo public health system, Brazil. An ecologic retrospective study was performed from 2008 to 2019, using the TabNet Platform of the Brazilian Unified Health System Department of Informatics.Hospitals were classified according to volume of surgeries (low and high-volume, and also into four quartiles according to volume of surgeries), and with or without medical residency program in urology. The results were compared between groups. In the period analyzed were performed 2.606 RN in 16 hospitals. Data available for PN ranged only from 2013-2019 and included 1.223 surgeries comprising 15 hospitals. Overall mortality rates were 0.41% for PN and 2.87% for RN. The length of hospital stay was significantly higher in low-volume hospitals for both RN and PN (8.97 vs. 5.62 days, p = 0.001, and 7.75 vs. 4.37 days, p = 0.001, respectively), and also for the RN in hospitals without residency program in Urology (9.37 vs. 6.54 days, p = 0.03). When the volume of surgeries was divided into four quartiles, the length of hospital stay and ICU hospitalization days were significantly higher in the first quartile hospitals for RN (p = 0.016) and PN (p = 0.009), respectively. The mortality rates and indirect costs were not different considering PN and RN in the different types of hospitals. The length of hospital stay was significantly lower for both PN and RN in high-volume hospitals, and also for RN in hospitals with residency program in Urology.

Results of a National Survey of Program Directors’ Perspectives on a Pass/Fail US Medical Licensing Examination Step 1

This survey study of medical residency program directors assesses differences in the relative importance of the US Medical Licensing Examination (USMLE) Step 1 in resident selection following its transition to pass/fail evaluation.

Diversifying Medical School and Residency Programs: a Practical Guide for Gatekeepers

Diversifying Medical School and Residency Programs: a Practical Guide for Gatekeepers

Gender, racial, and ethnic representation of cardiology fellows in the United States, 2014-2020: An underwhelming pace of diversification worsened by the COVID-19 pandemic

IntroductionCardiologists serve a diverse population of patients, yet the lack of diversity within the cardiology workforce has continued to persist and does not represent the composition of the patient population in the United States. Although medical schools and internal medicine residency programs have witnessed major improvements in diversity, the field of cardiology has not emulated these patterns. MethodsGender, race, and ethnicity data from the graduate medical education supplements published annually in the Journal of the American Medical Association from 2014 through 2020 were analyzed. The effect of the COVID-19 pandemic on the recruitment of female trainees in cardiology was also investigated. Results and discussionWomen represented 24.6% of cardiology trainees in the year 2020, which is a minor increase from 21.2% in 2014. The percentage of Hispanic trainees has slightly decreased from 6.90% in 2014 to 6.26% in 2020, while the percentage of Black trainees has only increased from 5.45% in 2014 to 5.50% in 2020. The data demonstrate a clear disparity and a desperate need for diversification of the cardiology trainee workforce. The COVID-19 pandemic may also exacerbate this lack of diversity in upcoming years due to the reemergence of inequities in social responsibilities between male and female trainees. ImplicationsStrong action must be taken on an institutional level to shift the culture in cardiology to one that is more appealing to women and underrepresented minorities in order to better serve an increasingly diverse population.

A survey of program directors for combined pediatrics and medical genetics and genomics residency programs: Perspectives when evaluating applicants.

While combined pediatrics and medical genetics and genomics residency programs are growing in number and applicants, there are still workforce shortages within the medical genetics field. Medical students would benefit from additional information on the training pathways and insight into the application process itself. Program Directors of combined pediatrics and medical genetics and genomics residency programs were surveyed to characterize factors that influence interview selection and rank list decisions, application logistics, recruitment, and training pathways. When evaluating applicants, representatives from both pediatrics and medical genetics are involved in the screening process. Additionally, both groups value prior research experience, but do not have a clear preference for a particular subcategory or domain of research. Most program directors think that all currently-available training pathways can provide optimal training. Further action is needed to provide medical students with the knowledge to make more informed decisions about their career and medical school advisors with objective data to counsel students. There was support among program directors to initiate consideration of creating a pathway for medical students to match directly into a medical genetics and genomics residency.

Student Perceptions and Use of Social Media as Residency Program Information.

Virtual residency interviews during the 2020 COVID-19 pandemic posed unique challenges to students and residency programs in the United States. We evaluated fourth-year medical students' perceptions of the virtual format and social media use to help select residency programs. We also assessed applicant utilization and perceived usefulness of our social media content. We administered an anonymous, web-based survey study of interviewees at an urban, academic medical center residency program. We analyzed data using descriptive statistics. Seventy-five of 138 applicants completed the survey (response rate 54%). Most applicants reported worry about obtaining enough information about residency programs to apply (64%) and to rank programs (87%). Though more traditional information sources remain most prevalent, social media is now widely used to research residency programs (62%). Most applicants to this family medicine residency program used social media to gather information, but they expressed worry that it was enough. Virtual interviews are likely to remain postpandemic, creating challenges for residency programs and especially for their hopeful applicants. Programs seeking to provide well-rounded information for applicants should maintain a social media presence as part of their recruitment practices.

Strategy for teaching radiology in a medical residency programme in infectious diseases construed through qualitative research

IntroductionTo understand the perspectives of infectious disease residents and their preceptors on teaching radiology in medical residency programmes in this speciality. The aim is to support the creation of a strategy to facilitate teaching and promote learning within the competency matrix, given the expanding role of diagnostic imaging methods in medicine. Thus, knowledge of radiology is an increasingly useful tool for professional practice in the area of infectious diseases. Material and methodsThis is a qualitative, exploratory investigation in which semi-structured interviews were conducted with resident physicians and preceptors of a medical residency programme in infectious diseases according to the paradigmatic approach of Foucault’s discourse analysis. ResultsBased on analysis of the interviews, the following central points are considered in developing a strategy to teach radiology in the medical residency programme in infectious diseases: understanding of the vocabulary used in radiology, development of good communication skills with radiologists, optimising the time dedicated to learning radiology, the correlation between aspects of radiology and anatomical pathology, as well as the systematisation of a teaching process. ConclusionThe appreciation for peer education and case discussions, particularly with a radiologist integrated into the medical residency team, indicate that these are the measures with the greatest potential to facilitate teaching and promote learning.

Enhancing Medical Communication and Care Through Professional Medical Interpreters

The quality of care provided to patients with limited English-language proficiency (LEP) is significantly affected by the appropriate use of interpreters.1,2 No formal curriculum on the use of professional medical interpreters (PMIs) exists in medical school or residency programs. Herein, I outline communication through PMIs who assist patients with LEP. These patients have a limited ability at speaking, reading, writing, or understanding the English language. Medical institutions should focus on emphasizing the importance of early education on the use of PMIs and integrating these in various teaching curricula.

Distinguishing among Doctors: Status Stratification Processes of Medical Residency Programs

Distinguishing among Doctors: Status Stratification Processes of Medical Residency Programs

Impact of Medical Student Disciplinary Actions on the United States National Resident Match.

Introduction: Each year, the United States National Resident Matching Program describes the relative importance of a number of factors in the residency match for each speciality. However, the impact of disciplinary actions taken by a school when a student fails to meet certain expectations is not specifically evaluated but may have a major impact on a physician’s future performance.Methods: This study used electronic surveys sent to deans of medical education and residency program directors (PDs) to assess the way disciplinary actions are used at US allopathic medical schools, and the perceived implications of those actions on the residency match.Results: Thirty-three deans and 158 PDs participated (response rates of 26% and 22%, respectively). The median percentage of students put on probation each year as a function of class size was 3.3% (interquartile range [IQR] 2% to 6%). Three institutions reported putting greater than 10% of their students on probation each year and one institution reported putting 22% of their students on probation each year. A student's risk of failing to match was thought to be very or extremely likely (to deans and PDs, respectively) if there was a history of failed coursework (18.8% and 41.2%, p = 0.017), academic probation (34.4% and 67.1%, p = 0.009), or professionalism probation (78.1% and 83.9%, p = 0.016). The differences between each of the above types of disciplinary action’s impact on the likelihood of interviewing (p < 0.001) and risk of failure to match (p < 0.001) were also significant among both groups.Conclusion: Significant variability exists in the use and reporting of disciplinary actions at US medical schools. A history of these adverse actions, even if successfully remediated, was thought to negatively impact a student’s likelihood to interview and match. Greater standardization in the use and reporting of disciplinary actions would be appropriate to ensure equitable treatment of students nationwide.

Psychiatry Residency Directors' Attitudes Toward and Uses of the Medical Student Performance Evaluation and Other Potential Tools for Residency Selection.

A survey was conducted to determine US psychiatry residency directors' attitudes regarding current measures of medical student performance and their preferences for the future. A team of psychiatry medical student educators and residency program directors developed a 23-question survey. In July 2021, links to the survey were sent out to all program directors registered with the American Association of Directors of Psychiatric Residency Training. Seventy program directors out of 223 initiated the survey, resulting in a response rate of 31.4%. Forty percent of respondents reported that the most important use of the Medical Student Performance Evaluation (MSPE) is in screening out applicants for interviews, and only 26.1% reported that the MSPE in its current form could be trusted to provide a valid and reliable assessment of a student's medical school performance. Most respondents agreed that in the absence of United States Medical Licensing Examination (USMLE) step 1 numerical scores, the existing MSPE format/content requirements should be modified, use a set of ranking categories that are uniform across all medical schools, and be supplemented with additional measures of the student's character and ability specific to psychiatry. US psychiatry program directors are eager for change when it comes to the MSPE and how it reports rankings, grades, and professionalism. The transition of the USMLE step 1 score reporting to pass/fail presents an opportunity to pursue this change and for stakeholders from all medical specialties to work together toward a shared goal of an improved residency selection process.

Family Medicine Resident and Faculty Perceptions About the Strengths and Limitations of Telemedicine Training

Background and Objectives: Telemedicine has become a highly-utilized form of primary care, requiring medical schools and residency programs to develop standardized telemedicine training to meet learners’ educational needs. This study highlights specific areas of clinical teaching and faculty development regarded as highly valuable in a family medicine (FM) residency program. Methods: We developed a needs assessment survey instrument based on Accreditation Council for Graduate Medical Education (ACGME) milestones and circulated it to faculty and residents at a suburban FM residency program in August 2020. We mapped each survey question to ACGME core competencies to identify common themes. We performed two-sample t tests to compare perceived self-confidence in faculty assessment and resident performance of key telemedicine clinical skills. Results: A total of 29 respondents (15 faculty, 14 residents) completed the survey. Both residents and faculty expressed comfort with obtaining a focused history, ruling out red flag symptoms, formulating a differential diagnosis, and planning follow-up care. Faculty reported confidence in their ability to provide feedback about medical knowledge and clinical decision making, but also identified a need for better feedback tools. Both faculty and residents identified a need for better teaching of physical exam skills during video visits. There were no statistically significant differences for perceived self-confidence in evaluating and performing key telemedicine skills between faculty and residents, respectively. Conclusion: Development of effective telemedicine educational experiences should emphasize teaching virtual communication and physical exam skills, and developing new approaches to learner evaluation.

Hidden Curriculum in Medical Residency Programs: A Scoping Review.

Introduction: Hidden curriculum is important in medical education and has numerous, long-lasting effects on medical residency. The present scoping review seeks to investigate, identify, and plot the main concepts relating to hidden curriculum and its dimensions, domains, impacts and factors in medical residency courses based on the main references and evidence. Methods: Scoping review methodology was used to guide a search of electronic databases for relevant papers. Of the 394 abstracts initially identified, after screening of both abstracts and full-text papers, 43 studies were selected for inclusion in this review. Following abstraction of key information from each study, a content analysis was undertaken.Results: Eleven themes were identified from the content analysis: 1) Organizational Issues (13.77%), 2) Socio-cultural Issues (10.5%), 3) Professional Issues (13.41%), 4) Communicational Factors (8.7%), 5) Educational Issues (22.83%), 6) Resident Personal Characteristics (21.01%), and 7) Resident Educational Characteristics (9.78%). Among the extracted effective hidden curriculum factors, the role modeling had the highest frequency and was emphasized in the studies. Conclusions: Although this study explained and identified the components, elements and also the preparation of the initial format of the hidden curriculum framework of the medical residency program, its results can reduce the negative effects of the hidden curriculum on it. More extensive and in-depth studies with different qualitative methods or mixed methods related to the hidden curriculum in different contexts and disciplines of medical residency are recommended to define characteristics of a constructive hidden curriculum of medical residency programs.

Effect of Gender on Practice Patterns of Andrology Fellowship Graduates

ABSTRACT Introduction Women in urology are more likely than their male counterparts to treat a majority female patient population, despite training in non-urogynecologic fellowships. Female urology is accordingly one of the most popular fellowship training choices for female urology residents, while less is known about the traditionally male-dominated subspecialties. Objective We sought to evaluate the current landscape of male reproductive and sexual medicine fellowships as well as characteristics of past andrology fellows and post-fellowship career paths. Methods The websites of the American Urological Association (AUA), Society for the Study of Male Reproduction (SSMR), and Sexual Medicine Society of North America (SMSNA) were reviewed for sponsored fellowships. Program coordinators and institutional websites were queried for information including length of training, curriculum, faculty, current and past fellows. A Google search was performed for each institution in combination with the keywords “male reproduction”, “sexual medicine”, “male infertility”, “prosthetics” and “fellowship” to identify former fellows not listed on institutional websites. Medical school, residency program, current employment, and conditions treated as advertised online were noted. Descriptive statistics and t-tests were used to compare outcomes by gender. P values &amp;lt;0.05 were considered statistically significant. Results The SMSNA endorsed 73% of programs (29/40), and SSMR 48% (19/40) while only 45% of all programs (18/40) participated in the 2021 AUA match. Median length of training was 1 year. Median number of fellowship faculty was 2. Only 20% (8/40) programs had any female andrology faculty. The earliest reported fellows dated back to 1982. From 1982-2021, 324 andrology fellows were identified, 53 of whom were female (16.4%). Of the fellows identified, 43.2% (140/324) were currently working in in an academic position, with 54.5% of women pursuing academia versus 45.5% of men (p=0.39). Men and women were equally likely to advertise an exclusive andrology practice, 65.4 and 61.4%, respectively (p=0.78) versus also seeing general urology indications. We assessed for a change in the proportion of female versus male fellows over time by comparing fellows who began training prior to 2010, and those who began training in 2010 or later. The number of andrology fellows increased from 111 to 213 (91.9%), with an increase in the proportion of female fellows from 8.1% to 20.7%, p=0.0038. Conclusions Less than half of andrology fellowships participate in the AUA match and over a quarter are not endorsed by the SMSNA. Only 1 in 5 fellowship programs had a female faculty member. Male andrology fellows were and remained in the majority over time. Despite this, female andrologists were equally likely to pursue academic careers. National urology and andrology societies have taken steps towards standardizing andrology fellowship training however much of the information is not easily available for residents to view. The limited information on fellowship graduates somewhat restricts interpretation of gender-based differences in practice environment. However, we found there was no negative impact in female andrologists’ ability to practice andrology or enter academic careers despite being in a male-dominated subspecialty. While encouraging, further work is needed by andrology societies to make program information accessible to all trainees and standardize the application process. Disclosure No

Virtual Residency Interviews: Applicant Perceptions Regarding Virtual Interview Effectiveness, Advantages, and Barriers.

Studies of the virtual interview format are needed to inform medical residency program leaders as they plan for future virtual interview seasons. In the current study, completed in 2021, we sought to assess applicant perspectives of virtual interview effectiveness, advantages, and barriers, including factors that might impact equity and inclusion. Interviewees applying to 7 residency programs and 2 clinical psychology programs at an academic medical center in the Pacific Northwest completed a post-interview survey. A total of 565 of 1429 interviewees (40%) completed the survey. A vast majority (83%-96%) agreed virtual interviews were effective in each measured domain, except for learning institutional culture (352 of 565, 62%). Many also found information regarding social/living environments inadequate. Participants selected advantages to virtual interviews more frequently than disadvantages. Commonly selected advantages included cost savings, time efficiency, reduced burden of travel, and reduced carbon footprint. Disadvantages included time zone differences, access to an appropriate interview setting, and reliable access to internet. The majority of interviewees (84%, 456 of 542) desired to keep a component of virtual interviews in the future. There were no significant disparities in results based on gender, rural/suburban/urban location, race, or underrepresented minority status. Virtual interviews were perceived as effective, more advantageous than burdensome, and widely acceptable, with no disparities in these findings by included demographic characteristics.

Cruel Apprenticeship: National Imaginaries in China’s Operating Rooms

Doctors learn to be doctors through clinical or therapeutic apprenticeships. By following, observing, and being mentored by more experienced physicians, trainees at various stages acquire embodied knowledge, affects, and ethics via both taught and hidden curricula. Previous research has demonstrated how biomedical training reproduces the social authority of scientific knowledge. This research article examines how for Chinese surgeons, apprenticeship not only immerses individuals within the scientific logics and hierarchical norms of biomedicine, but also embeds trainees within scientific imaginaries on a national scale. Drawing on ethnographic fieldwork in a Chinese academic hospital and a surrounding network of community hospitals, I examine how apprenticeship for Chinese surgical trainees extends beyond medical school and residency programmes, both in terms of temporality and geography. I examine how ‘technonational’ narratives, which permeate medical practice in China, impact the affects and ethics embodied by Chinese surgical trainees, and argue that changes in training expectations and the scope of training generates entanglements, dreams, and attachments which are cruel in their optimism. Thus, the therapeutic apprenticeship of Chinese surgical training reveals a ‘cruel apprenticeship’, a framing which encourages further exploration of the political and ethical stakes which permeate medical training and practice.

Impact of the COVID-19 pandemic on medical genetics and genomics training: Perspective from clinical trainees.

We sought to understand how the coronavirus disease 2019 (COVID‐19) pandemic has affected the well‐being, clinical training, and medical education for clinical trainees in medical genetics and genomics residency and fellowship programs. All clinical genetics trainees in the Accreditation Council for Graduate Medical Education (ACGME)‐accredited training programs were invited to complete a survey. 31 out of 174 trainees completed the survey. With regards to well‐being, 18 trainees reported increased anxiety, 10 had increased depression, 3 increased financial strain, 13 worsening work‐life balance, and 13 worsening physical health. There was increased telehealth utilization in both outpatient (3% before the pandemic vs. 67% during the pandemic) and inpatient clinical encounters (0% vs. 29%). The most commonly reported challenges in telehealth use were inadequate physical examination and technical problems during visits. Twenty trainees believed that the pandemic has negatively impacted overall clinical training while none reported a positive impact. We concluded that the COVID‐19 pandemic has negatively impacted most clinical genetics trainees in ACGME‐accredited training programs. Telehealth has been increasingly used with some challenges. Further studies are needed on how to optimally integrate what we have learned into the training of medical genetics and genomics in the post‐pandemic era.

Impact of an Educational Intervention on the Opioid Knowledge and Prescribing Behaviors of Resident Physicians.

Objectives: The opioid epidemic is a multifactorial issue, which includes pain mismanagement. Resident physician education is essential in addressing this issue. We aimed to analyze the effects of an educational intervention on the knowledge and potential prescribing habits of emergency medicine (EM), general surgery (GS), and internal medicine residents (IM).Methods: Resident physicians were provided with educational materials and were given pre-tests and post-tests to complete. Descriptive statistics were used to analyze pre-test and post-test responses. Chi-squared analysis was used to identify changes between the pre-tests and post-tests. A p < 0.05 value was considered statistically significant. Results: Following the educational intervention, we observed improvement in correct prescribing habits for acute migraine management among emergency medicine residents (from 14.8% to 38.5%). Among general surgery residents, there was a significant improvement in adherence to narcotic amounts determined by recent studies for sleeve gastrectomy (p= 0.01) and laparoscopic cholecystectomy (p= 0.002). Additionally, we observed a decrease in the number of residents who would use opioids as a first-line treatment for migraines, arthritic joint pain, and nephrolithiasis.Discussion: Resident physicians have an essential role in combating the opioid epidemic. There was a significant improvement in various aspects of opioid-related pain management among emergency medicine, internal medicine, and general surgery residents following the educational interventions. We recommend that medical school and residency programs consider including opioid-related pain management in their curricula.