Education Of Medical Trainees Research Articles

Proposed Nutrition Competencies for Medical Students and Physician Trainees: A Consensus Statement.

In 2022, the US House of Representatives passed a bipartisan resolution (House of Representatives Resolution 1118 at the 117th Congress [2021-2022]) calling for meaningful nutrition education for medical trainees. This was prompted by increasing health care spending attributed to the growing prevalence of nutrition-related diseases and the substantial federal funding via Medicare that supports graduate medical education. In March 2023, medical education professional organizations agreed to identify nutrition competencies for medical education. To recommend nutrition competencies for inclusion in medical education to improve patient and population health. The research team conducted a rapid literature review to identify existing nutrition-related competencies published between July 2013 and July 2023. Additional competencies were identified from learning objectives in selected nutrition, culinary medicine, and teaching kitchen curricula; dietetic core competencies; and research team-generated de novo competencies. An expert panel of 22 nutrition subject matter experts and 15 residency program directors participated in a modified Delphi process and completed 4 rounds of voting to reach consensus on recommended nutrition competencies, the level of medical education at which they should be included, and recommendations for monitoring implementation and evaluation of these competencies. A total of 15 articles met inclusion criteria for competency extraction and yielded 187 competencies. Through review of gray literature and other sources, researchers identified 167 additional competencies for a total of 354 competencies. These competencies were compiled and refined prior to voting. After 4 rounds of voting, 36 competencies were identified for recommendation: 30 at both undergraduate and graduate levels, 2 at the undergraduate level only, and 4 at the graduate level only. Competencies fell into the following nutrition-related themes: foundational nutrition knowledge, assessment and diagnosis, communication skills, public health, collaborative support and treatment for specific conditions, and indications for referral. A total of 36 panelists (97%) recommended nutrition competencies be assessed as part of licensing and board certification examinations. These competencies represent a US-based effort to use a modified Delphi process to establish consensus on nutrition competencies for medical students and physician trainees. These competencies will require an iterative process of institutional prioritization, refinement, and inclusion in current and future educational curricula as well as licensure and certification examinations.

Medical Trainee Education and Advocacy Regarding Sexual Health and Oncofertility: Gaps and Opportunities.

Medical Trainee Education and Advocacy Regarding Sexual Health and Oncofertility: Gaps and Opportunities.

Application of Computerized Surgical Planning in Craniosynostosis Surgery.

Craniosynostosis, a medical condition characterized by premature fusion of one or multiple cranial sutures, has historically been treated through surgical correction. Computerized Surgical Planning (CSP) and three-dimensional (3D) modeling have gained significant popularity across craniofacial surgery. Through a collaborative effort between surgeons and engineers, it is now possible to virtually execute a surgical plan based on preoperative imaging using computed tomography scans. The CSP workflow involves several elements including virtual 3D modeling, CSP computer-aided surgical guide design, manufacturing of guides and templates, and intraoperative implementation. Through the gradual optimization of this workflow, it has been possible to achieve significant progress in the surgical process including improvements in the preoperative planning of complex craniosynostosis cases and reduction of intraoperative time. Furthermore, CSP and 3D modeling have had a positive impact on surgical simulation and residency training, along with patient education and counseling. This article summarizes the CSP workflow in the treatment of craniosynostosis and the implications of this treatment modality on medical trainee education and patient management.

"Zoom"ing to the Kitchen: A Novel Approach to Virtual Nutrition Education for Medical Trainees.

While nutritional interventions are first-line therapy for many chronic diseases, most medical trainees receive minimal nutrition education, leaving them unprepared to address nutritional issues with patients. An interactive, single-session, virtual nutrition curriculum was taught online to 80 physician assistant (PA) students. Topics included plant-based nutrition, dietary history-taking and counseling, and culinary medicine. Students were surveyed before, immediately after, and four weeks after the curriculum to assess changes to nutrition-related knowledge, attitudes, confidence, and personal dietary behaviors. Seventy-three PA students (91%) completed the pre-survey, 76 (95%) completed the post-survey, and 42 (52.5%) completed the delayed post-survey. Knowledge scores increased immediately post-intervention (48.9% to 78.9%; p < 0.001) and persisted four weeks later (78.9% to 75.8%; p = 0.54). Post-intervention, students felt more confident in dietary history-taking (55% vs. 95%; p = 0.001) and nutrition counseling (53% vs. 84%; p = 0.003) and agreed that dietary changes alone could reverse type 2 diabetes (74% vs. 97%; p = 0.027) and coronary artery disease (66% vs. 92%; p = 0.039). Curricula using virtual teaching kitchens may be a scalable approach to nutrition education for medical trainees.

Virtual teaching kitchen classes and cardiovascular disease prevention counselling among medical trainees

BackgroundHands-on culinary medicine education for medical trainees has emerged as a promising tool for cardiovascular health promotion.PurposeTo determine whether virtual culinary medicine programming associates with Mediterranean diet (MedDiet) adherence and...

Harnessing the disruption on medical trainee education due to COVID-19 in New South Wales, Australia.

The coronavirus disease (COVID-19) pandemic has caused disruption and uncertainty for junior medical doctor training and education. This has compounded the existing stress experienced by this cohort. However, by choosing appropriate educational models, as well as using novel educational approaches and advancing our online technology capabilities, we may be able to provide acceptable and even, superior solutions for educational training moving forward, as well as promote trainee wellbeing during these uncertain times.

X-ray therapy safety and awareness education for medical trainees and attending physicians.

Medical imaging involving ionizing radiation is common in the clinical setting. Little is known about the level of radiation safety training for medical trainees and attending physicians. We sought to identify the level of radiation safety knowledge and training at the undergraduate, postgraduate, and attending physician level. A 29-question survey was sent by email to two sites in Canada. We pooled the results of medical students, residents, and attending physicians. The primary outcome was to describe the amount of radiation safety training among these groups. The secondary outcomes were to describe the frequency of radiation exposure, level of radiation knowledge, and preferred training method for radiation safety. Of 115 surveys that were properly completed, 31 (26.9%) medical students, 17 (14.7%) residents, and 67 (58.3%) attending physicians responded. A greater number of medical students (41.9%) reported they had zero hours of training time for radiation safety compared to attending physicians (14.9%) (p<0.05). A higher number of attending physicians (47.8%) and residents (64.7%) participated in patient care involving fluoroscopy daily or at least several times per week compared to medical students (3.2%) (p<0.001). Attending physicians had the greatest number of correct responses to radiation safety questions. Online courses and workshops were the preferred training methods. Radiation safety training is an important component of medical education for medical trainees and attending physicians. Current radiation safety training requirements and procedures at various levels of medical training in Canada should be addressed. Implementing radiation safety education may improve adherence to the radiation safety principles.

Standardizing evaluation of patient-specific 3D printed models in surgical planning: development of a cross-disciplinary survey tool for physician and trainee feedback

Background3D printed models are becoming increasingly popular in healthcare as visual and tactile tools to enhance understanding of anatomy and pathology in medical trainee education, provide procedural simulation training, and guide surgical procedures. Patient-specific 3D models are currently being used preoperatively for trainee medical education in planning surgical approaches and intraoperatively to guide decision-making in several specialties. Our study group utilized a modified Delphi process to create a standardized assessment for trainees using patient-specific 3D models as a tool in medical education during pre-surgical planning.MethodsA literature review was conducted to identify survey questions administered to clinicians in published surgical planning studies regarding the use of patient-specific 3D models. A core study team reviewed these questions, removed duplicates, categorized them, mapped them to overarching themes, and, where applicable, modified individual questions into a form generalizable across surgical specialties. The core study panel included a physician, physician-scientist, social scientist, engineer/medical student, and 3D printing lab manager. A modified Delphi process was then used to solicit feedback on the clarity and relevance of the individual questions from an expert panel consisting of 12 physicians from specialties including anesthesiology, emergency medicine, radiology, urology, otolaryngology, and obstetrics/gynecology. When the Radiological Society of North America (RSNA)/American College of Radiology (ACR) 3D Printing Registry Data Dictionary was released, additional survey questions were reviewed. A final cross-disciplinary survey of the utility of 3D printed models in surgical planning medical education was developed.ResultsThe literature review identified 100 questions previously published in surveys assessing patient-specific 3D models for surgical planning. Following the review, generalization, and mapping of survey questions from these studies, a list of 24 questions was generated for review by the expert study team. Five additional questions were identified in the RSNA/ACR 3D Printing Registry Data Dictionary and included for review. A final questionnaire consisting of 20 questions was developed.ConclusionsAs 3D printed models become more common in medical education, the need for standardized assessment is increasingly essential. The standardized questionnaire developed in this study reflects the interests of a variety of stakeholders in patient-specific 3D models across disciplines.

A Knowledge Translation Framework for Improving Concussion Education Among Medical Students and Physicians

Objective: The objective of this paper is to outline key principles required for a knowledge translation (KT) strategy on concussion education for medical trainees and physicians to promote knowledge retention and practice change. Design: Qualitative review of the literature on concussion education for medical trainees and physicians utilizing the Canadian Institute of Health Research (CIHR) Knowledge to Action (KTA) Cycle as a framework. Results: Medical education on concussion appears to be increasing, but many knowledge gaps persist. Although many concussion guidelines and standardized assessments have been developed, many physicians are either not aware of them, do not use them, or provide inaccurate or inconsistent discharge instructions. Focused, interactive concussion education sessions, education outreach by trained facilitators, and adoption of a spiral curriculum are preferred modalities. To facilitate concussion education, medical professionals must recognize the importance of concussion in their practice. Interventions should deliver high-yield information and be integrated into existing programs such as academic half days (AHD) and the Maintenance of Certification Program (MOC). Many KT tools and interventions have been developed, such as the Concussion Awareness Training Tool (CATT) for Medical Professionals, but evidence of their utilization and effectiveness is limited. Existing tools should be reviewed, updated, implemented, and evaluated for their effectiveness of improving both conceptual and instrumental knowledge. Conclusion: KT strategies for concussion medical education should utilize the CIHR KTA Cycle principles outlined in this review as a guide to design interventions that improve the concussion knowledge of medical trainees and physicians.

Harnessing the disruption on medical trainee education due to COVID-19 in New South Wales, Australia

The coronavirus disease (COVID-19) pandemic has caused disruption and uncertainty for junior medical doctor training and education. This has compounded the existing stress experienced by this cohort. However, by choosing appropriate educational models, as well as using novel educational approaches and advancing our online technology capabilities, we may be able to provide acceptable and even, superior solutions for educational training moving forward, as well as promote trainee wellbeing during these uncertain times.

“The captain of the ship.” A qualitative investigation of surgeon identity formation

BackgroundProfessional identity formation is essential to medical trainee education. Surgeons are expected to guide trainees through this process but may be unprepared as they may not understand their own professional identity. MethodsWe purposively selected 46 surgeons across Michigan to participate in semi-structured qualitative interviews intended to explore surgical decision-making in 2019. Thematic analysis was used to analyze the transcripts. ResultsSurgeon identity formation is a complex process influenced by factors from four domains: individual factors, interpersonal relationships, external influences, and professional experience. We found surgeon identity formation commences prior to residency training and continues to remodel long into practice. ConclusionsBy understanding surgeon identity, surgeons will be prepared to help form trainees’ professional identities and recognize opportunities for improvement. We believe changes, especially within the environment and community, will encourage medical students to enter surgical fields, decrease resident attrition, and promote surgeon well-being.

Enhancing the Interprofessional Learning Environment: An Orientation of ICU Nurses to Effective Team Building and Their Impact on the Professional Development of the Young Physician

Purpose: Effective interprofessional teams are critical to resident physicians’ learning and patient safety. 1 How medical trainees function in the clinical learning environment is impacted by interaction with colleagues who may feel they have no “official” role in education, and as a result, often do not recognize their important role in the professional development of the medical trainee. Through a brief educational intervention for ICU nurses orienting to our institution targeted at effective teamwork and acknowledging the role of nurses as educators, we aim to improve the learning environment in this targeted setting. We chose to focus on the ICU as it has historically been a challenging, high-acuity working and learning environment and one that may not as readily espouse a learning culture for a trainee underperforming relative to peers. We elected to implement this intervention for new nurses with the hypothesis that they are still developing their style as regards interprofessional relationships and teamwork and may not recognize the importance of their role in the learning environment. Approach/Methods: In this pilot study, we enrolled 8 nurses participating in an established nurse residency program at Massachusetts General Hospital designed to prepare them for becoming independent ICU nurses. These nurses were surveyed using a Team Assessment tool, 2 followed by two 45- to 60-minute educational sessions roughly 4 months apart centered on elements of effective teamwork, the important role of nurses in physician trainee education, and the approach to a struggling trainee. One “booster” was sent by email summarizing the content of the first session. They were subsequently surveyed again using the same Team Assessment tool at the start of the second session. Results/Outcomes: These educational interventions were easy to incorporate into a previously established ICU nurse orientation program. The program was well received by both nursing leadership and participants. When surveyed, the nurse trainees reported that their teams were functioning moderately well (7–8/10). There was no significant difference in Team Assessment scores after this intervention, as anticipated. However, the nurses-in-training responded positively to the elements of the intervention that emphasized their role in medical trainee education, particularly with the struggling trainee. Discussion: Support for this educational intervention among nursing leadership and participants demonstrates interprofessional interest in improving teamwork and the learning environment in our ICUs. Many institutions have internship/orientation programs for new nurses; these forums are well suited to this type of educational intervention. We discovered that in this pilot program, orienting ICU nurses at our institution felt that teams function moderately well at baseline. However, nurses involved in our intervention did report benefit from clear discussion regarding their potential impact in their role as educators and techniques for managing a trainee who may be underperforming. Significance: Medical trainee learning environment is shaped by an interdependent system of interprofessional colleagues, who are frequently unaware of their important role in the professional development of such a colleague. Prioritizing effective programs during orientation to educate nurses on their role in trainee education has the potential to significantly improve physician-in-training learning, particularly for the underperforming trainee. This pilot program represents 1 feasible mechanism by which to achieve this goal. To significantly alter the culture surrounding medical education at our institution, long-term investment in these programs will likely be required. Further study is needed to understand best practices for implementation and impact on trainee professional development and well-being over time.

Training in pediatric skin of color: Suggested curricular guidelines of the pediatric dermatology research alliance special interest group in pediatric skin of color.

Deficiencies in the skills necessary to diagnose and manage patients with skin of color may contribute to health disparities. The Pediatric Dermatology Research Alliance Special Interest Group in Pediatric Skin of Color (PSOCG) convened to generate a curriculum of topics required for basic pediatric skin of color (PSOC) education for medical students and residents in dermatology to improve the quality of education in PSOC. A survey was distributed to the PSOCG members to assess expert opinion regarding critical topics for inclusion in a basic PSOC syllabus. Video conference and two rounds of survey were used to rank topics for inclusion and to highlight the underlying need for inclusion. Group members composed of academic pediatric dermatologists with teaching responsibilities including skin of color topics for dermatology residents and medical students. Learning objectives were developed for an educational lecture on basic science, and clinical conditions affecting PSOC were grouped by age-infantile, pediatric, and adolescent skin conditions affecting the PSOC population were identified for inclusion with rank score based on specific parameters including greater frequency in skin of color, nuances in skin of color, and need for medical workup. Increased focus on PSOC education is needed to improve quality of care for children of color through enhanced knowledge. Inflammatory, genetic, and particularly primary pigmentary disorders should be the focus of a broad curriculum in pediatric skin of color education for medical trainees. Objectives should include improved diagnosis, treatment, and ability to educate patients and their families regarding the nature of their conditions.

Leadership Training in Medicine-12 Years of Experience From the Feagin Leadership Program.

Increasingly, physicians find themselves in demanding leadership positions. However, leadership education for medical trainees remains lacking with most physicians reporting that they are ill-equipped to tackle the challenges of leadership. Here, we set out to describe the Feagin Leadership Program (FLP) and assess its reception and impact on trainees over the past 12 years. During the 1-year FLP, selected scholars from Duke University, Wake Forest University, and the University of North Carolina participate in five leadership sessions, individual coaching, a leadership forum, and a multidisciplinary team-based capstone project. A 28-question survey with six optional free-response questions was distributed to the Feagin Alumni Network, and descriptive statistics were assessed. Since its founding, 212 scholars have graduated from the FLP and 117 (55%) alumni have gone on to surgical specialties. A survey was distributed among all Feagin alumni. A total of 56 (26%) surveys were completed. Forty-three percent (n = 24) had held at least one leadership position since completing the FLP. When asked about the impact of their experience, 96% (n = 54) said that the program encouraged them to pursue a position of leadership within their field, 95% (n = 53) stated that it prepared them for such a position, and 93% (n = 52) stated that the program positively influenced their decision to be involved with current or future positions of leadership. Over the last 12 years, the FLP has demonstrated a high perceived impact on personal growth, leadership proficiency, and the decision to pursue leadership positions in medicine. The current dearth of leadership education for surgical trainees can best be addressed with models such as the FLP, with adoption benefiting medical trainees, the medical community, and patients they serve.

Meta-analysis and machine learning-augmented mixed effects cohort analysis of improved diets among 5847 medical trainees, providers and patients.

We sought to produce the first meta-analysis (of medical trainee competency improvement in nutrition counseling) informing the first cohort study of patient diet improvement through medical trainees and providers counseling patients on nutrition. (Part A) A systematic review and meta-analysis informing (Part B) the intervention analysed in the world's largest prospective multi-centre cohort study on hands-on cooking and nutrition education for medical trainees, providers and patients. (A) Medical educational institutions. (B) Teaching kitchens. (A) Medical trainees. (B) Trainees, providers and patients. (A) Of the 212 citations identified (n 1698 trainees), eleven studies met inclusion criteria. The overall effect size was 9·80 (95 % CI (7·15, 12·45) and 95 % CI (6·87, 13·85); P < 0·001), comparable with the machine learning (ML)-augmented results. The number needed to treat for the top performing high-quality study was 12. (B) The hands-on cooking and nutrition education curriculum from the top performing study were applied for medical trainees and providers who subsequently taught patients in the same curriculum (n 5847). The intervention compared with standard medical care and education alone significantly increased the odds of superior diets (high/medium v. low Mediterranean diet adherence) for residents/fellows most (OR 10·79, 95 % CI (4·94, 23·58); P < 0·001) followed by students (OR 9·62, 95 % CI (5·92, 15·63); P < 0·001), providers (OR 5·19, 95 % CI (3·23, 8·32), P < 0·001) and patients (OR 2·48, 95 % CI (1·38, 4·45); P = 0·002), results consistent with those from ML. The current study suggests that medical trainees and providers can improve patients' diets with nutrition counseling in a manner that is clinically and cost effective and may simultaneously advance societal equity.

Revue compréhensive de l’apport de l’impression 3D en médecine : mise en perspective des différentes applications en urologie

Over the past few years, 3D printing has evolved rapidly. This has resulted in an increasing number of scientific publications reporting on the medical use of 3D printing. These applications can range from patient information, preoperative planning, education, or 3D printing of patient-specific surgical implants. The objective of this review was to give an overview of the different applications in urology and other disciplines based on a selection of publications. In the current narrative review the Medline database was searched to identify all the related reports discussing the use of 3D printing in the medical field and more specifically in Urology. 3D printing applications were categorized so they could be searched more thoroughly within the Medline database. Three-dimensional printing can help improve pre-operative patient information, anatomy and medical trainee education. The 3D printed models may assist the surgeon in preoperative planning or become patient-specific surgical simulation models. In urology, kidney cancer surgery is the most concerned by 3D printing-related publications, for preoperative planning, but also for surgical simulation and surgical training. 3D printing has already proven useful in many medical applications, including urology, for patient information, education, pre-operative planning and surgical simulation. All areas of urology are involved and represented in the literature. Larger randomized controlled studies will certainly allow 3D printing to benefit patients in routine clinical practice.

Role of 3D Printing and Modeling to Aid in Neuroradiology Education for Medical Trainees.

Applications of 3-dimensional (3D) printing in medical imaging and health care are expanding. Currently, primary uses involve presurgical planning and patient and medical trainee education. Neuroradiology is a complex subdiscipline of radiology that requires further training beyond radiology residency. This review seeks to explore the clinical value of 3D printing and modeling specifically in enhancing neuroradiology education for radiology physician residents and medical trainees. A brief review summarizing the key steps from radiologic image to 3D printed model is provided, including storage of computed tomography and magnetic resonance imaging data as digital imaging and communications in medicine files; conversion to standard tessellation language (STL) format; manipulation of STL files in interactive medical image control system software (Materialise) to create 3D models; and 3D printing using various resins via a Formlabs 2 printer. For the purposes of demonstration and proof of concept, neuroanatomy models deemed crucial in early radiology education were created via open-source hardware designs under free or open licenses. 3D-printed objects included a sphenoid bone, cerebellum, skull base, middle ear labyrinth and ossicles, mandible, circle of Willis, carotid aneurysm, and lumbar spine using a combination of clear, white, and elastic resins. Based on this single-institution experience, 3D-printed complex neuroanatomical structures seem feasible and may enhance resident education and patient safety. These same steps and principles may be applied to other subspecialties of radiology. Artificial intelligence also has the potential to advance the 3D process.

The Evolving Importance of Artificial Intelligence and Radiology in Medical Trainee Education

Radiology education is understood to be an important component of medical school and resident training, yet lacks a standardization of instruction. The lack of uniformity in both how radiology is taught and learned has afforded opportunities for new technologies to intervene. Now with the integration of artificial intelligence within medicine, it is likely that the current medical trainee curricula will experience the impact it has to offer both for education and medical practice. In this paper, we seek to investigate the landscape of radiologic education within the current medical trainee curricula, and also to understand how artificial intelligence may potentially impact the current and future radiologic education model.

COVID-19 Impact on Interventional Pulmonology Training.

Background: The impact of the coronavirus disease (COVID-19) pandemic extends beyond the realms of patient care and healthcare resource use to include medical education; however, the repercussions of COVID-19 on the quality of training and trainee perceptions have yet to be explored.Objective: The purpose of this study was to determine the degree of interventional pulmonology (IP) fellows’ involvement in the care of COVID-19 and its impact on fellows’ clinical education, procedure skills, and postgraduation employment search.Methods: An internet-based survey was validated and distributed among IP fellows in North American fellowship training programs.Results: Of 40 eligible fellows, 38 (95%) completed the survey. A majority of fellows (76%) reported involvement in the care of patients with COVID-19. Fellows training in the Northeast United States reported involvement in the care of a higher number of patients with COVID-19 than in other regions (median, 30 [interquartile range, 20–50] vs. 10 [5–13], respectively; P < 0.01). Fifty-two percent of fellows reported redeployment outside IP during COVID-19, mostly into intensive care units. IP procedure volume decreased by 21% during COVID-19 compared with pre–COVID-19 volume. This decrease was mainly accounted for by a reduction in bronchoscopies. A majority of fellows (82%) reported retainment of outpatient clinics during COVID-19 with the transition from face-to-face to telehealth-predominant format. Continuation of academic and research activities during COVID-19 was reported by 86% and 82% of fellows, respectively. After graduation, all fellows reported having secured employment positions.Conclusion: Although IP fellows were extensively involved in the care of patients with COVID-19, most IP programs retained educational activities through the COVID-19 outbreak. The impact of the decrease in procedure volume on trainee competency would be best addressed individually within each training program. These data may assist in focusing efforts regarding the education of medical trainees during the current and future healthcare crises.

Patients’ perspectives on the extent of resident participation in the operating room for total hip or knee arthroplasty

Introduction:Previous work suggests that patients do not understand the extent of resident involvement in their care and are also uncomfortable with resident involvement.Methods:We recruited 202 English speaking patients with previous or planned total joint arthroplasty of the lower limb for a prospective survey trial. We assessed participant’s knowledge of resident level of education and confidence of resident involvement in their surgery as a function of supervision.Results :Participants’ mean level of confidence in the consultant surgeon was 4.30 (SD±1.13) on a 5-point Likert scale. Confidence in residents was significantly less, regardless of experience (p < 0.05). 11.1% of participants did not want residents involved in their treatment. 60.6% would like to know more about the education level of the trainee. Less than half of participants correctly identified the education level of residents and fellows.Conclusion :Patient confidence in residents performing part or all of their surgery increases with resident experience and supervision. Compared with attending surgeons, patients have significantly less confidence in residents performing their surgery, including while supervised. Most patients do not understand the educational progression of medical trainees and would like to know more about the education level of the resident involved in their care. Further work should explore how we can help patients better understand resident involvement in their surgical care.