Medical Residency Training Research Articles

Defining Key Elements of a Clinical Experience in Hospice and Palliative Medicine for Medical Residents in the United States.

Training in hospice and palliative medicine (HPM) is essential for practicing internists, who routinely care for patients and families facing serious illness. Program directors and medical residents acknowledge the importance of palliative medicine skills, and trainees themselves desire more such training. The ACGME has also recognized the importance of HPM training for medical residents, establishing in its 2022 Common Program Requirements for Internal Medicine a new expectation that all residents have a clinical experience in HPM. However, internal medicine residencies vary significantly in their approach to teaching HPM skills, and what constitutes a useful clinical experience in HPM has not been well-described. In this perspective, we draw from the available literature and our experience as educators to propose 5 core elements for creating an optimal HPM experience for medical residents. These include practice with symptom management and communication in serious illness, exposure to interdisciplinary care, appreciation of the continuum of care settings for HPM delivery, and an understanding of the key principles of hospice care. We then describe the relevance of each element and offer educational strategies regarding how each can be achieved.

Orthopaedic Surgery in the Metaverse: Current Data on Virtual-Reality Based Training

BACKGROUND: Immersive, realistic, and low-risk training has long been ideal for skill-based disciplines such as surgery. Recent advances in virtual reality technology have led to development of surgical training software with the goal to provide experience without risk. The aim of this review is to summarize the current data for virtual reality-based orthopaedic surgery training to evaluate how beneficial the technology may become in educational circumstances. METHODS: A literature review was completed analyzing eight randomized controlled trials completed between 2019 to 2022 to evaluate the effect of virtual reality on orthopaedic surgery education for medical students and residents. Each trial included groups of learners that were trained on a specific procedure with standard methods (“control”) or virtual reality software (“VR group”). Subjects were then evaluated on completion of procedures with real-life models. Procedures included total hip arthroplasty (n=2), tibial intramedullary nail (n=2), slipped capital femoral epiphysis pinning (n=2), and unicompartmental knee arthroplasty (n=2). The primary metrics assessed were time to complete procedure and objective assessment scores. Secondarily survey results were evaluated regarding subjects’ perceived utility of virtual reality in orthopaedic surgery training. RESULTS: 168 subjects (medical students n=68, residents n=100) were included across the 8 different trials. All trials included at least one objective assessment and it was found that overall, the VR group performed 19.9% better than control group on average (19.875 ± 18.324, 95% CI). Seven of the trials reported time to complete procedure, in which it was found that overall VR group completed the procedures 12% faster than control group on average (12 ± 10.988, 95% CI). Subjective measures showed that over 70% of subjects found the VR learning to be at least “helpful” or “useful”. CONCLUSION: Early studies of the emerging field of virtual reality in surgical training are promising. When looking at objective measures and time to complete procedures, VR trained learners perform as well, if not better, than standard method learners. Inclusion of virtual reality-based practice in medical school curricula and residency training may lead to less surgical errors, increased knowledge of procedures, and more efficient learning in real-life scenarios. This potential impact extends beyond well-resourced institutions, as VR technology can provide a cost-effective and accessible alternative for surgical training in low-income and low-resource areas of the world, democratizing access to high-quality medical education. Continued research on translation into clinical practice is warranted, with the potential to bridge educational disparities and improve surgical outcomes on a global scale.

Case-Based Immigrant Health Ethics Curriculum: A Pathway to Improve Care and Advocacy.

Introduction Immigrants comprised a significant portion of the total population in the United States (US), and a considerable number of children in the US live with at least one immigrant parent, which has continued to increase over the past decades. However, healthcare providers (HPs) in the US report lack of comfort in interacting with immigrant and refugee populations. Methods The authors, in partnership with the Midwest Consortium of Global Health Educators, developed an innovative,interactive ethics curriculum within the Immigrant Partnership Advocacy and Curricular Kit (I-PACK). They sought to increase HPs' confidence in navigating complex encounters with immigrant families by teaching a relevant ethical framework, highlighting the importance of cultural humility, and equipping learners with an ethics tool (five-box Method) for use in clinical encounters. They piloted the curriculum during threeworkshop sessions in 2020-2021, and this curriculum continues to be used nationally as a part of I-PACK. Results Pre- and post-session surveys indicated thatall participants (100%, n=22) reported acquisition of new skills/knowledge and 19 (86%) felt confident applying this to their clinical practice. The participants reported appreciation for an ethical framework with which to analyze cases, enjoyment of active participation in small group discussions, and utility of the five-box method tool. Some areas of improvement offered were to have more cases and more time dedicated to small-group discussions. Conclusions Given the success of the I-PACK ethics curriculum pilot, the authors plan to incorporate immigrant health cases in the general ethics training in medical school classes and pediatric residency training. Furthermore, they will advocate for the importance of including immigrant health ethics across graduate medical education, as fluency and competence in navigating the ethics of immigrant health are required to provide patient-centered, culturally informed care to all populations.

Factors Influencing Specialty and Training Center Choices Among Saudi Medical Residents.

This cross-sectional study aims to identify and quantify the factors influencing Saudi medical residents in selecting their desired specialty and primary training center, while examining the associations between these factors. The study received approval from an institutional ethical committee at King Abdulaziz University. An electronic questionnaire was designed and validated via content, face validity, and the Content Validity Index. The sample size was calculated based on a 95% CI and a 5% margin of error. The study targeted all current residents in the current Saudi Specialty Certificate Programs. Descriptive statistics summarized demographic characteristics, training-related information, and factors influencing the selection of a specialty and training center. Fisher's exact test and Chi-square tests were employed for data analysis. A total of 387 respondents completed the survey, with a 32.3% response rate. The majority of respondents were male (n = 232, 59.9%), and the majority were also married (n = 67.2%), with internal medicine (n = 92, 23.8%) and family medicine (n = 74, 19.1%) being the most prevalent specialties. Notably, 89.4% (n = 346) reported matching into their first-choice specialty, and 67.2% (n = 260) into their first-choice training center. Furthermore, 90.2% (n = 349) had prior training (elective/internship) in their chosen specialty, and 63% (n = 244) had previous training (elective/internship) at their primary training center. Prior exposure to both specialty and center significantly resulted in them being the resident's top choice (p < 0.01). Multiple factors influencing the choice of either the specialty or the center were found to have statistically significant associations with the gender, specialty, residency level, sector of the training center, and timing of the specialty decision (p < 0.05). This study reveals the substantial influence of early experiences on Saudi medical residents' specialty and training center choices. It also uncovers gender disparities and variations in the influence of specialty-related factors. Future research with larger and more diverse samples is recommended to gain a deeper understanding of the multifactorial decision-making processes, enabling the development of strategies to better meet the evolving needs and preferences of healthcare professionals in Saudi Arabia.

The effectiveness of simulation-based education combined with peer-assisted learning on clinical performance of first-year medical residents: a case-control study

BackgroundSimulation-based education and peer-assisted learning (PAL) are both known as useful educational methods. Previous research has reported that combining these two methods are effective for training medical residents in short-term evaluation. This study was aimed to evaluate the middle- to long-term effects of simulation-based education combined with PAL on the performance of medical residents during emergency department duties.MethodsThis study was designed as a case-control study and conducted over three years at Okayama University Hospital in Japan. Postgraduate-year-one medical residents were assigned to three groups: a simulation group that received simulation-based education, a lecture group that received traditional lecture-based education, and a control group that received no such prior trainings. Prior training in emergency department duties using PAL was performed as an educational intervention for the simulation and lecture groups during the clinical orientation period. The residents’ medical knowledge was assessed by written examinations before and after the orientation. The performance of residents during their emergency department duties was assessed by self-evaluation questionnaires and objective-assessment checklists, following up with the residents for three months after the orientation period and collecting data on their 1st, 2nd, and 3rd emergency department duties. All the datasets collected were statistically analyzed and compared by their mean values among the three groups.ResultsA total of 75 residents were included in the comparative study: 27 in the simulation group, 24 in the lecture group, and 24 in the control group. The simulation and lecture groups obtained significantly higher written examination scores than the control group. From the self-evaluation questionnaires, the simulation group reported significantly higher satisfaction in their prior training than the lecture group. No significant differences were found in the emergency department performance of the residents among the three groups. However, when evaluating the improvement rate of performance over time, all three groups showed improvement in the subjective evaluation, and only the simulation and lecture groups showed improvement in the objective evaluation.ConclusionSimulation-based education combined with PAL is effective in improving the knowledge and satisfaction of medical residents, suggesting the possibility of improving work performance during their emergency department duties.

Evaluation of a Remote Curriculum to Improve Internal Medicine Resident Knowledge and Confidence in Oncologic Emergency Identification and Management

Background Oncologic emergencies (OEs) are life-threatening complications of malignancy that can present in multiple clinical settings and necessitate early recognition and intervention. Most medical resident training is experiential, but variability in exposure can yield gaps in medical knowledge that could result in delayed patient care. Remote curricula are commonly used to fill these gaps and reduce classroom burden on trainees. Given their time-sensitive nature, OEs are a prime target to augment clinical experience with a supplementary curriculum to prepare residents for new scenarios. This study evaluates whether an original, remote curriculum improves internal medicine resident knowledge of and confidence in recognition and management of OEs. Methods With expert faculty input, we developed a remote curriculum for first-year internal medicine residents at a tertiary care academic medical center. The curriculum includes 6 OEs: tumor lysis syndrome (TLS), hypercalcemia (hyperCa), neutropenic fever (NF), hyperviscosity syndrome and leukostasis (HVS/LS), superior vena cava (SVC) syndrome, and malignant spinal cord compression (CC). OEs were selected based upon prominence in the literature, morbidity and mortality, need for urgent management, and association with malignancy. We created an online lesson in Qualtrics for each OE. Each lesson was designed to be completed in 15 minutes via computer or smartphone. Lessons were delivered by email every 10 days, with reminders every 5 days. Learning objectives for each OE lesson were to 1) identify concerning signs and symptoms, 2) order appropriate workup, and 3) provide prompt management in the appropriate clinical setting. Lessons included clinical questions and evidence-based information delivery contextualized by case presentations. We evaluated the curriculum's efficacy with a randomized, controlled study. First-year residents were randomly assigned to two groups (“Intern A” and “Intern B”). We built assessments of knowledge and confidence with expert faculty input. Confidence in identifying and managing each OE was assessed by Likert scale (“1 - completely confident,” “5 - not at all confident”). Knowledge was evaluated with 3 multiple choice questions per OE, for a maximum knowledge score of 18. After both groups completed the pre-test, Intern A received the curriculum. After curriculum completion, both groups completed the post-test. All interns were required to complete the curriculum, but research participation was optional. Residents consented to participation prior to each test administration. All lessons and research activities were anonymous. Analysis was completed in GraphPad Prism 9 using the unpaired t-test or one-way ANOVA with post-hoc testing, as appropriate. Results Thirty-nine internal medicine residents completed the curriculum. Twenty were assigned to Intern A and 19 to Intern B. Intern A had 10 pre-test respondents (50.0%) with a mean knowledge score of 9.13 (50.7% correct), and Intern B had 13 pre-test respondents (68.4%) with a mean knowledge score of 9.35 (51.9% correct). There were no differences by OE-specific score. Baseline confidence was similar between groups (Table 1). Comparison of mean knowledge scores is shown in Figure 1. Intern A and B had 9 (45.0%) and 10 (52.6%) post-test respondents, respectively. Both Intern A (mean 14.2; 95% CI, 12.8 to 15.7; 78.9% correct) and Intern B (mean 12.2; 95% CI, 10.5 to 13.9; 67.8% correct) significantly improved their knowledge scores compared to prior, though Intern A had a more marked effect size (Intern A mean difference 5.02; 95% CI, 2.84 to 7.21; P&amp;lt;0.0001; Intern B mean difference 2.66; 95% CI, 0.660 to 4.66; P=0.006). Intern A confidence significantly improved from the pre-test in both the identification and management of HVS/LS and SVC syndrome. Intern A confidence was significantly better than Intern B confidence in management of SVC syndrome at the time of the post-test (Table 1). Conclusions Baseline intern OE knowledge scores were sub-optimal. Intern participation in a remote OE curriculum improved knowledge acquisition to a greater degree than experiential learning alone. Confidence in identification and management of OEs with low pre-existing confidence, such as HVS/LS and SVC syndrome, improved in the remote curriculum. Further study should evaluate knowledge retention over time, resident clinical performance, and patient outcomes.

Postgraduate medical education in Colombia. Proposals to improve it

After 70 years of the formalization of medical specialties in Colombia, very little progress has been made in the educational models for the acquisition of clinical competencies in these postgraduate programs.&#x0D; Furthermore, although there is already a law on human resources in health, the Colombian medical education system lacks specific regulations on the training of health professionals (physicians) in the different medical specialty programs offered in the country.&#x0D; Likewise, at present, factors such as the financial crisis of public hospitals, the limited number of accredited hospitals and the growing number of medical schools and specialization programs, affect the comprehensive and equal development of medical competencies of professionals who are trained as specialists in the different postgraduate medical programs offered in Colombia. &#x0D; In view of the above, the purpose of this article is to present a proposal for postgraduate medical education that prioritizes the adequate acquisition of competencies over compliance with the time required to complete the curricula of the different medical specialties. However, this involves several prerequisites: a regulatory body in charge of overseeing and monitoring the training of medical residents or specialists in the country; strong training in university teaching for professors practicing in medical schools and university hospitals; the standardization of the graduates profile; adequate financing of university hospitals, as well as appropriate support in the process of accreditation as such, and the self-evaluation and continuous improvement of postgraduate medical programs.

Designing a Situational Judgment Test for Use in Medical School Admissions.

It has long been acknowledged that professional competencies are required for success in medical school, residency training, and medical practice. Over the last decade, medical schools have begun to introduce standardized assessments of professional competencies, but many still rely on interviews to assess these competencies, which occur after about half of the applicant pool has already been screened out. In this article, the authors discuss the development, evaluation, and launch of the Association of American Medical Colleges (AAMC) situational judgment test (SJT) for use in medical school admissions. The AAMC SJT is designed to assess an examinee's understanding of effective and ineffective behaviors related to the core competencies for entering medical students, including service orientation, social skills, cultural competence, teamwork, ethical responsibility to self and others, reliability and dependability, resilience and adaptability, and capacity for improvement. The authors evaluate the evidence for the need for SJTs in medical school admissions by exploring common derailers in medical school, gaps in the admissions process regarding information about professional competencies, and the challenge of conducting holistic review in a high-volume context. They summarize existing research from the employment, international medical education, and residency selection contexts suggesting that SJT scores are positively associated with subsequent performance and may add value to the admissions process. The authors discuss 5 goals that were the foundation for developing the AAMC SJT: (1) assess the professional competencies needed for success in medical school using a proven method, (2) enable holistic review in a high-volume admissions context, (3) create and share a program of research to support the appropriate use of SJT scores, (4) signal the need for preparation in professionalism to learners, and (5) balance the need for a new assessment with minimizing the burden and risk for applicants.

Intraoperative FoCUS: Training Practices and Views on Feasibility

To investigate whether resident anesthesiologists perceive intraoperative focused cardiac ultrasonography (FoCUS) as feasible, the self-reported confidence of residents performing intraoperative FoCUS, and United States graduate medical education resident ultrasound training practices. A cross-sectional survey. The United States Accreditation Council for Graduate Medical Education-listed anesthesiology programs over a 3-month period between June 2022 to September 2022. United States anesthesiology residents. A survey. Reported training practices were as follows: 87.3% of respondents reported formal FoCUS training, and the most commonly reported training was "lectures+live-model training under 5 hours annually" at 31%. Most respondents (82%) stated that faculty never or rarely performed bedside FoCUS, and most respondents (69%) reported no intraoperative FoCUS education exposure. The proportion of residents who reported a positive view on the perceived feasibility of intraoperative FoCUS was 53.2% for extremity surgery, 19.8% for laparoscopic surgery, 18.6% for exploratory laparotomy surgery, and 7.9% for robotic surgery. Most respondents (78.6%) indicated a lack of confidence in performing intraoperative FoCUS independently. The authors found no statistical difference in views on feasibility or reported confidence independently performing FoCUS across training years. Training that included "lectures+simulation" or "live-model" for more than 5 hours annually, faculty routinely using bedside FoCUS, and frequent exposure to intraoperative FoCUS increased the odds of reporting confidence. The misconception that intraoperative FoCUS is infeasible appears prevalent, and most of the authors' respondents expressed a lack of comfort independently performing intraoperative FoCUS. Alterations of training practices, including increasing faculty usage of bedside ultrasonography, increasing trainee time performing FoCUS, and incorporating specific intraoperative ultrasound into the ultrasound curriculum, may address these deficiencies.

Evaluating the Applicability of Existing Lexicon-Based Sentiment Analysis Techniques on Family Medicine Resident Feedback Field Notes: Retrospective Cohort Study.

Field notes, a form for resident-preceptor clinical encounter feedback, are widely adopted across Canadian medical residency training programs for documenting residents' performance. This process generates a sizeable cumulative collection of feedback text, which is difficult for medical education faculty to navigate. As sentiment analysis is a subfield of text mining that can efficiently synthesize the polarity of a text collection, sentiment analysis may serve as an innovative solution. This study aimed to examine the feasibility and utility of sentiment analysis using 3 popular sentiment lexicons on medical resident field notes. We used a retrospective cohort design, curating text data from University of Toronto medical resident field notes gathered over 2 years (from July 2019 to June 2021). Lexicon-based sentiment analysis was applied using 3 standardized dictionaries, modified by removing ambiguous words as determined by a medical subject matter expert. Our modified lexicons assigned words from the text data a sentiment score, and we aggregated the word-level scores to a document-level polarity score. Agreement between dictionaries was assessed, and the document-level polarity was correlated with the overall preceptor rating of the clinical encounter under assessment. Across the 3 original dictionaries, approximately a third of labeled words in our field note corpus were deemed ambiguous and were removed to create modified dictionaries. Across the 3 modified dictionaries, the mean sentiment for the "Strengths" section of the field notes was mildly positive, while it was slightly less positive in the "Areas of Improvement" section. We observed reasonable agreement between dictionaries for sentiment scores in both field note sections. Overall, the proportion of positively labeled documents increased with the overall preceptor rating, and the proportion of negatively labeled documents decreased with the overall preceptor rating. Applying sentiment analysis to systematically analyze field notes is feasible. However, the applicability of existing lexicons is limited in the medical setting, even after the removal of ambiguous words. Limited applicability warrants the need to generate new dictionaries specific to the medical education context. Additionally, aspect-based sentiment analysis may be applied to navigate the more nuanced structure of texts when identifying sentiments. Ultimately, this will allow for more robust inferences to discover opportunities for improving resident teaching curriculums.

Actual Duration of Postgraduate Training of Medical Residents in Germany: Results of the KarMed Study Ten Years After Physician Licensure

Professional qualification as a doctor of medicine includes completion of medical studies and residency. Data on the real duration of residency are currently not assessed systematically in Germany. Our study aimed to analyze data on the real length of residency under consideration of area of expertise (specialization), part-time working, grades after school and medical studies, gender, and parenthood of the physicians in residency. The KarMed Study's database consists of annual postal surveys throughout the entire residency of medical students, beginning with their "Practical Year" in 2008/2009 until 2019. The study analyzed data six and ten years within this residency period. The majority of the residents was capable of finishing their residency within the minimal time. One significant effect on actual duration of residency was the subject choice. One-third of the female residents had not yet finished their residency after ten years. Partenhood had a significant effect on female residents, but not on male residents. A regression analysis showed (R²corr=0.03, p<0.001) that the duration of residency was associated with the grade received after studying (β=0.30). Male residents were more satisfied with the overall residency then female residents. Structural improvement in postgraduate training needs to be adjusted in terms of parental status. Prospective studies should take the selection process of universities into account and examine its association with the time required to complete residency.

Burnout and Stress Among Residents in Four Gulf Cooperation Council Countries Using the Copenhagen Burnout Inventory and Stress Overload Scale-Short Form

Physician burnout and stress can have consequential effects on healthcare services and are a leading cause for medical errors and lower quality of care. This is the first study to assess the prevalence rates and associated variables for burnout and stress levels of medical residents in four Gulf Cooperation Council (GCC) countries by combining the Copenhagen Burnout Inventory (CBI) and Stress Overload Scale-Short Form (SOS-S) as assessment tools. A cross-sectional, quantitative research method design using an online survey. This online survey was distributed to second year and above medical residents training in tertiary healthcare centres in four GCC countries (Saudi Arabia, Kuwait, Bahrain, and Oman). Eligible residents (n = 16,686) were recruited via convenience sampling. Out of 2,886 respondents, 996 responses were excluded due to incomplete information. The data was collected from 13th September 2020 to 15th November 2020. Of 1,890 included medical residents, 961 (50.8%) were females, and the mean (SD) age was 29.5 (3.2) years old. Personal burnout prevalence rates were the highest, followed by work-related and patient-related burnout (98.4%, 97.8%, and 79.3%, respectively). Arab and Kuwait Board residents had the highest rates of burnout across all domains. Stress overload scores were high with 51.6% of residents at high risk for illness, with Saudi Board residents most likely to be at high risk and Oman Medical Specialty Board residents at low risk. Burnout predictors included: no access to a wellness programme (p = 0.000), longer shifts (p = 0.000), high personal vulnerability (p = 0.000), and intention to leave (p = 0.05). Our findings show that burnout and stress rates are high for GCC residents, suggesting a significant problem for residents to provide the highest quality of healthcare possible. Further research is needed to evaluate the efficacy of residency wellness interventions to address this issue.

Anticipated Impact of Dobbs v Jackson Women's Health Organization on Training of Residents in Obstetrics and Gynecology: A Qualitative Analysis.

On June 24, 2022, the Supreme Court of the United States in the case of Dobbs v Jackson Women's Health Organization ended constitutional protection for abortion, thus severely restricting access to reproductive health care for millions of individuals. Concerns have arisen about the potential impact on medical students, residents, and fellows training in restricted areas and the effect on gynecologic training and the future provision of competent comprehensive women's health care in the United States. To qualitatively explore the anticipated impacts of the Dobbs ruling on training in obstetrics and gynecology (OB/GYN). A participatory action research approach employing methods of qualitative analysis was used. Trainees and leaders in national OB/GYN professional and academic organizations with missions related to clinical care and training of medical students, residents, and fellows in OB/GYN participated. Two focus groups were held via Zoom in July 2022. Using an iterative process, transcripts underwent coding by 2 independent researchers to identify categories and common themes. Themes were organized into categories and subcategories. An additional reviewer resolved discrepancies. Twenty-six OB/GYN leaders/stakeholders representing 14 OB/GYN societies along with 4 trainees participated. Eight thematic categories were identified: competency, provision of reproductive health care, residency selection, inequity in training, alternative training, law-based vs evidence-based medicine, morality and ethics, and uncertainty about next steps. This qualitative study of leaders and learners in OB/GYN identified 8 themes of potential impacts of the Dobbs ruling on current and future training in OB/GYN.

Importance of interdisciplinarity in modern oncology: results of a national intergroup survey of the Young Oncologists United (YOU).

Modern, personalized treatment concepts in oncology require an interdisciplinary and multiprofessional collaboration. In addition to its relevance in patient care, interdisciplinary collaboration is also becoming increasingly important in clinical research as well as medical education and resident training in oncology. Between November 2021 and March 2022, an online survey was conducted among German early career research groups, represented by Young Oncologists United (YOU). The aim was to identify the status and need for interdisciplinarity at clinic, educational, and research levels. A total of 294 participants completed the questionnaire in full. 90.7% of the respondents fully or predominantly agreed with the statement that interdisciplinary work plays a major role in their daily clinical work. 78.9% wished for more interdisciplinary collaboration. Of the 49.7% of participants who have never participated in an interdisciplinary research project, 80.1% said they would like to participate in such a study project in the future. Lack of time resources, too much organizational effort, and possible political conflicts between institutions were identified as factors that make practical implementation difficult. 74.1% declared their willingness to become active in an oncology early career research group. Interdisciplinary collaboration has become increasingly important in oncology. Networks that span different disciplines could help to promote interdisciplinary research projects among young scientists and improve exchange in professional practice and education with the implication of improved patient care.

Reconstructing feedback in graduate medical education: development of the REFLECT scale to measure feedback delivery in medical residency training

BackgroundFeedback plays a pivotal role in graduate medical education, where medical residents are expected to acquire a wide range of practical and professional competencies. Assessing the feedback delivery status is a preliminary step for educators to enhance the quality of feedback provided. This study aims to develop an instrument to assess the various aspects of feedback delivery in medical residency training.MethodsThe fifteen-item REFLECT (Residency Education Feedback Level Evaluation in Clinical Training) questionnaire was developed. The content validity was evaluated according to a panel member consisting of fourteen clinical professors and medical education instructors. After evaluating the test-retest reliability, the questionnaire was distributed to a sample of 154 medical residents and was further assessed in terms of internal consistency and factor analysis.ResultsContent validity analysis resulted in an appropriate content validity ratio and content validity index for the final 15 items. The test-retest reliability resulted in an ICC of 0.949 (95% C.I. 0.870–0.980), indicating excellent reliability. The Cronbach’s alpha for the 15-item questionnaire was α = 0.85, demonstrating good internal consistency. The factor analysis resulted in a four-factor structure: “attitude towards feedback”, “quality of feedback”, “perceived importance of feedback”, and “reaction to feedback”.ConclusionsREFLECT proved to a reliable tool that could be utilized as a quick assessment method of feedback delivery, making it a suitable aid for educational managers and faculties to design necessary interventions aiming to enhance the quantity and quality of feedback provided.

Relationship Between Residency Match Distance From Medical School and Virtual Application, School Characteristics, and Specialty Competitiveness.

The COVID-19 pandemic has disrupted the residency match process by eliminating away rotations and changing from in-person to virtual interviews. In this study, we explore the impact of the COVID-19 pandemic on the geographic match distance of United States (US) senior medical students across all specialties. We collected publicly available student match data between 2018 and 2021 from US allopathic medical schools and calculated match distance between medical school and residency training using a novel metric - the "match space." Match space was codified by whether the student matched at their home institution, home state, adjacent state, same or adjacent US census division (non-adjacent state) or skipped at least one US census division. Adjusting for covariates, ordinal logistic regression correlated school and specialty characteristics with match distance pre- and post-pandemic for all specialties. We defined and ranked specialty competitiveness using predictive values from factor analysis. A total of 34,672 students representing 66 medical schools from 28 states matched into 26 specialties in 50 states and Canada. Fifty-nine percentof students were from public institutions, and 27% of schools ranked in the top 40 for research. The mean percentage of in-state students by school was 60.3% (range 3-100%). Match space was lower after the pandemic (adjusted odds ratio (OR) 0.94, 95% CI 0.90-0.98; p=0.006), from schools with higher in-state percentages (OR 0.74, 95% CI 0.72-0.76), from top National Institutes of Health-funded institutions (OR 0.88, 95% CI 0.85-0.92), from the Northeast (OR 0.71, 95% CI 0.67-0.75; Midwest reference), and the West (OR 0.67, 95% 0.60-0.74). Match space was higher for students graduating from private schools (OR 1.11, 95% CI 1.05-1.19), from the South (OR 1.62, 95% CI 1.2-1.33), and matching into more competitive specialties (OR 1.08, 95% CI 1.02-1.14). The top five most competitive specialties were Plastic Surgery, Neurosurgery, Dermatology, Orthopedic Surgery, and Otolaryngology. Internal Medicine ranked eighth. After the COVID-19 pandemic, students graduating from US allopathic schools matched closer to their home institution. Students attending public schools, schools with more in-state matriculants, and schools with higher research rankings also matched closer to their home institutions. Specialty competitiveness and US census region also impacted match distance. Our study adds insight into how geographic match patterns were influenced by school, specialty choice, and the pandemic.

Editorial introductions.

Current Opinion in Cardiology was launched in 1985. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of cardiology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Editor and Section Editors for this issue. SECTION EDITORS Ali J MarianAli J MarianDr Marian received his training in clinical cardiology and human molecular genetics at Baylor College of Medicine, Houston, USA. He was appointed as a faculty at the Section of Cardiology at Baylor College of Medicine, Houston, USA in 1992. He joined the Institute of Molecular Medicine in 2006 to lead the Center for Cardiovascular Genetics. Dr Marian is recognized for his research achievements in molecular genetics and clinical aspects of cardiomyopathies. He has published over 200 articles in peer-reviewed journals, which collectively have garnered over 12,000 citations and an H index of 60. He received the Young Investigator Award from the American College of Cardiology, the Established Investigator Award from the American Heart Association, the Clinician-Scientist Award in Translational Research from Burroughs Wellcome Fund, Distinguished Scientist Award from Baylor St Luke's Medical Center, and the Best Editor Award from the American Heart Association Circulation Research. Dr Marian is currently a Deputy Editor for Cardiovascular Research, Section Editor on Genetics for Current Opinion in Cardiology, and the Editor-in-Chief of The Journal of Cardiovascular Aging. He is a former Deputy Editor for Circulation Research, Associate Editor for Circulation and European Journal of Clinical Investigation. Dr Marian's research is supported by R01 grants from the NHLBI-NIH, Leducq Foundation Trans-Atlantic Network of Excellence, and local foundations. Gene KimGene KimDr Kim is a cardiologist with the Advanced heart failure, Cardiac transplant, and Mechanical Circulatory Support Program at the University of Chicago Medicine, USA. He is an Associate Professor of Medicine and the Advanced Heart Failure Fellowship Program Director. His medical school, residency, and fellowship training were completed at the University of Chicago, USA. Dr Kim also directs the Genetic Cardiomyopathy and Hypertrophic Cardiomyopathy Clinics at University of Chicago, USA. Dr Kim's research interests include the genetic and epigenetic regulation of heart failure and arrhythmogenesis with publications on the role of microRNAs in cardiomyopathy. His interests also include myocardial recovery, extracellular matrix in failing myocardium. He has published over 100 articles and book chapters and is an investigator in numerous clinical trials. Bhavadharini RamuBhavadharini RamuDr Bhavadharini (Dharini) Ramu is an Advanced Heart Failure & Transplant Cardiologist, Director of the Cardio-Obstetrics Program and an Associate Professor of Medicine at the University of Minnesota, USA. She completed her internal medicine residency and cardiology fellowship at the University of Connecticut, USA followed by Advanced Heart Failure Fellowship at the University of Minnesota, USA in 2016. She previously served on the faculty at the Medical University of South Carolina, USA from 2016 to 2023. Dr Ramu has been an invited faculty lecturer at scientific meetings of the American College of Cardiology (ACC), Heart Failure Society of America, American Society of Transplantation, and International Society of Heart & Lung Transplantation. She is a member of the ACC's Heart Failure & Transplant Section Leadership Council, the program planning committee for the ACC's Scientific Sessions, and serves on the leadership council of the Women in Heart Transplantation & MCS Network. Dr Ramu's research interests include increasing the understanding of and reducing the impact of health-related disparities in patients with advanced heart failure, with a goal of reducing health inequities and improving the health of disadvantaged and vulnerable populations. She has served as a peer reviewer for many journals and is an investigator in heart failure clinical trials.

Effectiveness of the Eyesi Surgical Simulator for ophthalmology trainees: systematic review and meta-analysis

ObjectifLe simulateur chirurgical Eyesi (VRmagic, Mannheim, Allemagne) est le simulateur de réalité virtuelle le plus souvent utilisé en chirurgie ophtalmologique. Si des études ont révélé que des outils de formation fondés sur la simulation améliorent l'acquisition des compétences, aucune revue de synthèse systématique avec méta-analyse n'a encore été réalisée à l’égard du simulateur chirurgical Eyesi. Notre étude visait donc à effectuer une méta-analyse des études qui comparaient le simulateur chirurgical Eyesi à d'autres méthodes d'enseignement des compétences techniques auprès d’étudiants. MéthodesNotre recherche a porté sur 3 bases de données (MEDLINE, Embase et CENTRAL). Les articles inclus comparaient le simulateur chirurgical Eyesi à d'autres formes d'enseignement des compétences techniques auprès d’étudiants et de résidents dans des facultés de médecine. On a réalisé une méta-analyse par paire qui reposait sur l'inverse de la variance à effets aléatoires. Les différences moyennes standardisées (DMS) ont servi de principal paramètre de mesure afin de tenir compte des différences entre les outils d’évaluation des compétences chirurgicales. RésultatsDes 207 citations évaluées, on a retenu 8 études, totalisant 108 étudiants qui ont eu recours au simulateur chirurgical Eyesi et de 123 étudiants qui ont utilisé une autre forme d'apprentissage. L'amélioration des scores de compétences techniques était significativement supérieure dans le groupe Eyesi (3 études; DMS = 2,02; intervalle de confiance [IC] à 95 % : 1,47–2,57; p < 0,001; I2 = 0 %). On a noté une baisse significative du nombre d’étudiants du groupe Eyesi qui ont fait des erreurs techniques après leur formation (5 études : rapport de cotes = 0,43; IC à 95 % : 0,20–0,90; p = 0,03; I2 = 30 %). Aucune différence significative n'a été enregistrée entre les groupes en ce qui a trait au temps consacré pour exécuter une tâche après la formation (3 études; DMS = 1,96; IC à 95 % : –1,96–5,88; p = 0,33; I2 = 97 %). ConclusionsLe simulateur chirurgical Eyesi pourrait améliorer l'acquisition des compétences techniques (faible degré de certitude des données probantes) et réduire le nombre d'erreurs techniques (très faible degré de certitude des données probantes) lors de l'apprentissage de la chirurgie de la cataracte chez des étudiants. Il y a donc lieu de réaliser d'autres études prospectives sur le module Eyesi qui comporteraient un système de notation standardisée.

Child-focused climate change and health content in medical schools and pediatric residencies

Anthropogenic climate change-driven primarily by the combustion of fossil fuels that form greenhouse gases-has numerous consequences that impact health, including extreme weather events of accelerating frequency and intensity (e.g., wildfires, thunderstorms, droughts, and heat waves), mental health sequelae of displacement from these events, and the increase in aeroallergens and other pollutants. Children are especially vulnerable to climate-related exposures given that they are still developing, encounter higher exposures compared to adults, and are at risk of losing many healthy future years of life. In order to better meet the needs of generations of children born into a world affected by climate change, medical trainees must develop their knowledge of the relationships between climate change and children's health-with a focus on applying that information in clinical practice. This review provides an overview of salient climate change and children's health topics that medical school and pediatric residency training curricula should cover. In addition, it highlights the strengths and limitations of existing medical school and residency climate change and pediatric health curricula. IMPACT: Provides insight into the current climate change and pediatric health curricular opportunities for medical trainees in North America at both the medical school and residency levels. Condenses climate change and pediatric health material relevant to trainees to help readers optimize curricula at their institutions.

Surprising pandemic experiences: A confrontation between principle-based and virtue ethics, and a plea for virtue ethics training for medical students and residents. A rudimentary outline of a four-step model.

In past years, physicians have, with a certain continuity, reported increasing numbers of burnout, depression and compassion fatigue in their daily practice. These problems were attributed, not only but also, to a loss of public trust and an increase in violent behaviour of patients and family members towards medical professionals in all walks of life. Recently, however, during the breakout of the coronavirus disease 2019 (COVID-19) pandemic in 2020, there were public expressions of appreciation and respect for health care workers that almost universally have been assessed as indications of a re-establishment of public trust in physicians and appreciation for the medical professions' commitments. In other words, shared experiences of what society was in need of: the experience of a 'common good'. Those responses during the COVID-19 pandemic increased positive feelings among practicing physicians, such as commitment, solidarity, competency, and experiences concerning obligations for the common good and a sense of belonging to one and the same community for all. Essentially, these responses of raised self-awareness of commitment and solidarity between (potential) patients and medical personal point towards the social importance and power of these values and virtues. This shared domain in ethical sources of behaviour seems to hold a promise of overcoming gaps between the different spheres of doctors and patients. That promise justifies stressing the relevance of this shared domain of Virtue Ethics in the training of physicians. In this article, therefore, we shall make a plea for the relevance of Virtue Ethics before proposing an outline of an educational programme for Virtue Ethics training for medical students and residents. Let us start by very briefly presenting on Aristotelian virtues and its relevance to modern medicine in general, and during the current pandemic in particular. We shall follow up this short presentation by a Virtue Ethics Training Model and the respective settings in which it takes place. This model has four steps as follows: (a) include moral character literacy in the formal curriculum; (b) provide ethics role modelling and informal training in moral character in the healthcare setting by senior staff; (c) create and apply regulatory guidelines regarding virtues and rules; and (d) assess success of training by evaluation of moral character of physicians. Applying the four-step model may contribute to strengthening the development of moral character in medical students and residents, and decrease the negative consequences of moral distress, burnout and compassion fatigue in health care personnel. In the future, this model should be empirically studied.