Nonuniversity Programs Research Articles

Case logging habits among general surgery residents are discordant and inconsistent

BackgroundGeneral surgery residents log operative case experience as “first assist” (FA) or “primary surgeon” (PS). This study will evaluate their quantitative and qualitative case log practices. MethodsModified Delphi technique was used to create a questionnaire and distributed online to institutions via the APDS. Descriptive analyses and example operative scenarios for resident case logging habits were ascertained. ResultsThere were 363 residents from university (60%) and non-university (40%) programs; 94% did not know the definition of primary surgeon. Over 50% stated they had been encouraged to log a case as surgeon that they did not feel was warranted. Only 4% felt the current logging system is “very accurate.” Given an operative scenario, residents varied how they chose to log the case. ConclusionGeneral surgery residents do not know the current definition of PS. Case logging should be an objective measure of resident operative exposure, but may actually be more complex than previously recognized.

A national survey evaluating obstetric providers’ attitudes and regional trends of trial of labor after cesarean

Objective: To evaluate trends amongst residency programs offering trial of labor after cesarean delivery (TOLAC).Methods: An electronic survey was sent to Program Directors of every obstetrics and gynecology residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME) in the USA and Puerto Rico via publicly available e-mail address for 249 of the 249 programs. The Program Directors were asked to forward the e-mail to all of the current residents in their respective program to complete a similar version of the survey.Results: Seventy-nine Program Directors (33%) and 243 residents responded. All programs offered TOLAC to patients with one prior cesarean. University programs were more likely to offer TOLAC to women with two prior cesareans compared to non-university programs (85 versus 65%; p < .01). Overall, Program Directors and residents were comfortable counseling and managing TOLACs (99 and 95%, respectively). This confidence was associated with advancing years in residency. Residents attending university programs report they are more likely to offer TOLAC to women with 1 prior cesarean (98.1 versus 91.2%, p = .02) and willing to induce TOLAC with favorable cervix (95.2 versus 88.2%; p = .03) post-residency when compared to non-university trained residents. There is an association between region and whether TOLAC is offered to women with two or more prior cesareans, without prior vaginal delivery, and women with twins. Specifically, those in the Mid-Atlantic region are less likely to offer TOLAC to women with two prior cesareans (68 versus 86%; p < .01) and those with unknown type of previous uterine incision (51 versus 74%; p < .01).Conclusion: Offering TOLAC to women with one prior cesarean appears universally acceptable amongst residency programs in the USA. Significant differences arise between types of programs and region of the country in regards to offering TOLAC to women with more complicated obstetrical histories.

Education: The Heart of the Matter.

There are inadequate numbers of anesthesia providers in many parts of the world. Good quality educational programs are needed to increase provider numbers, train leaders and teachers, and increase knowledge and skills. In some countries, considerable external support may be required to develop self-sustaining programs. There are some key themes related to educational programs in low- and middle-income countries:(1) Programs must be appropriate for the local environment-there is no "one-size-fits-all" program. In some countries, nonuniversity programs may be appropriate for training providers.(2) It is essential to train local teachers-a number of short courses provide teacher training. Overseas attachments may also play an important role in developing leadership and teaching capacity.(3) Interactive teaching techniques, such as small-group discussions and simulation, have been incorporated into many educational programs. Computer learning and videoconferencing offer additional educational possibilities.(4) Subspecialty education in areas such as obstetric anesthesia, pediatric anesthesia, and pain management are needed to develop leadership and increase capacity in subspecialty areas of practice. Examples include short subspecialty courses and clinical fellowships.(5) Collaboration and coordination are vital. Anesthesiologists need to work with ministries of health and other organizations to develop plans that are matched to need. External organizations can play an important role.(6) Excellent education is required at all levels. Training guidelines could help to standardize and improve training. Resources should be available for research, as well as monitoring and evaluation of educational programs.

Beyond Knowledge Ventriloquism and Echo Chambers: Raising the quality of the Debate in Teacher Education

Background/Context For over two decades, there has been a steady call for deregulating U.S. teacher education, closing down allegedly poor quality college and university programs, and creating greater market competition. In response to this call to disrupt the dominance of colleges and universities in teacher education, and because of the policies and funding allocations of the U.S. Education Department and private foundation funding, non-university providers of teacher education have proliferated in certain areas of the country. A critical aspect of the current call for greater deregulation and market competition in teacher education has been the declaration that university teacher education has failed. While there is no dispute about the need for improvements in the dominant college and university system of teacher education, it is also important to critically evaluate the warrants for the value of programs that critics claim should replace college and university programs. Purpose The focus of this paper is to illustrate how research has been misrepresented to support policies and programs that would simultaneously reduce the role of colleges and universities in preparing U.S. teachers and support the expansion of the role of non-university providers. We also examine the print news media's role in uncritically reproducing a narrative of failure about university teacher education and promoting the success of new non-university programs—attention that has served to inflate the public perception of these organizations and programs beyond what is warranted by the available evidence. Research Design Four cases are presented that illustrate the efforts to manufacture a narrative of the failure of colleges and universities in preparing teachers, and to construct a narrative of success for the non-university programs that have been funded to replace them. The authors use the concepts of echo chambers and knowledge ventriloquism to show how this process operates. Conclusions/Recommendations Following the presentation of the cases, specific recommendations are offered for raising the quality of the debates about the future of U.S. teacher education. These include greater transparency in the process of reform, better communication between researchers and stakeholders, using research that has been vetted to inform the debates, and genuinely exploring different policy options for teacher education.

Burnout in Obstetrics and Gynecology Residents

BACKGROUND: Residency training is associated with a significant degree of burnout in single institution studies. OBJECTIVE: To assess the rate of burnout in a national sample of obstetrics and gynecology residents. METHODS: A web link to a 50-item, online, nonobligatory survey was distributed to all Accreditation Council for Graduate Medical Education–accredited obstetrics and gynecology residents through program coordinators and directors. The survey was open for responses from March 11, 2014 to June 5, 2014. RESULTS: Of 892 who responded to the survey, 790 (88.6%) were valid for analysis. Of 790, 26% were noted to have high burnout. Residents with burnout also had higher rates of depression and anxiety (P<.001). There were no statistically significant differences in burnout between men and women, single compared with married, university compared with nonuniversity programs, and size of programs (more than 20 compared with 20 or fewer residents). Burnout rates were not associated with either the number of children or year of training. However, burnout rates were higher for residents who worked more than 70 hours/week. Residents with burnout felt there was a lack of “strong support” by the faculty (P=.001) and fellow residents (P=.006), that faculty were not committed to teaching (P<.001), perceived a greater emphasis on “service over education” (P<.001), and were less satisfied with the hospital's benefits and facilities (P=.023). Furthermore, as frequency of poor clinical outcomes increased, the severity of the depression also increased (P=.021). CONCLUSION: Nationally, about 25% of obstetrics and gynecology residents have high burnout. It is important to recognize factors associated with burnout in residents, so we may institute changes to better accommodate our future physicians and assure patient safety.

La formación de los trabajadores sociales en Chile: ¿un asunto de oferta y demanda?

This article addresses the education of social workers from the perspective of demand and training opportunities generated by the Chilean higher education system today. Researching about: how many social workers are graduated and how is their geographic distribution? Which are the characteristics of the training institutions, regarding accreditation, funding models, tuition, etc.? Which are the characteristics of the students concerning information on gender and on educational establishments of origin? It also explores the process of labour market integration, reviewing employability indicators and salary levels compared with other category of graduated, and analyzing the «profitability» of studying Social Work. The main findings show the increased of academic programs of social work in recent years, in addition to the expansion of non-university programs, which by 2017 could generate greater number of diploma in social work than those from university, therefore with new scenarios for the profession. Another interesting finding is the origin of social work students, in addition to various situations for the professional practice, according to the territory. Finally, we conclude with a series of challenges for Chilean Social Work Schools, highlighting the need to generate a rational planning of social workers education in Chile.

Changes in the National Residency Matching Program Policy: Are Internal Medicine Program Directors “All-In”?

Michael Adams, MD, FACP, is Program Director of Medicine at Georgetown University; Thomas B. Morrison, MD, is Fellow in Cardiovascular Medicine at Vanderbilt University; Stephanie Call, MD, is Program Director of Medicine at Virginia Commonwealth University; Andrew J. Halvorsen, MS, is Biostatistician and Project and Data Manager in the Internal Medicine Residency Office of Educational Innovations at Mayo Clinic; Jared Moore, MD, is Chief Medical Resident in Internal Medicine at Ohio State University; Maria Lucarelli, MD, is Associate Program Director in Internal Medicine at Ohio State University; Steven Angus, MD, is Program Director of Medicine at the University of Connecticut Health Center; and Furman S. McDonald, MD, MPH, is Program Director of Internal Medicine Residency Office of Educational Innovations at the Mayo Clinic. Funding: This study was supported in part by the Mayo Clinic Internal Medicine Residency Office of Educational Innovations as part of the ACGME Educational Innovations Project. The Mayo Clinic Survey Research Center provided assistance with the survey design and data collection. We are grateful for the support of the Association of Program Directors of Internal Medicine and the members of the Survey Committee and to the residency program directors who completed the Association of Program Directors in Internal Medicine (APDIM) survey. While we are reporting the results of the APDIM Survey Committee, we are not presuming to speak for the organization and our paper does not constitute an official policy statement of APDIM, the APDIM Council, or any other organzation with which any of the authors may be affiliated.

The Association of Pediatric Program Directors: The First 25 Years

In the early 1970s, the American Board of Pediatrics (ABP) had no mechanism for communicating with directors of the more than 200 residency programs. Communication existed between the ABP and the medical school department chairs through the Association of Medical School Pediatric Department Chairs (AMSPDC), but this mechanism did not extend to the numerous nonuniversity programs. Between 1974 and 1982, the ABP sponsored 4 conferences for program directors. At the meeting in 1978, the feasibility of forming an association of program directors was raised, with particular interest expressed by individuals in nonuniversity programs, and, in 1983, the ABP Program Directors Liaison Committee recommended to the ABP leadership that a program directors' association be formed.

Resident research and scholarly activity in internal medicine residency training programs

1) To describe how internal medicine residency programs fulfill the Accreditation Council for Graduate Medical Education (ACGME) scholarly activity training requirement including the current context of resident scholarly work, and 2) to compare findings between university and nonuniversity programs. Cross-sectional mailed survey. ACGME-accredited internal medicine residency programs. Internal medicine residency program directors. Data were collected on 1) interpretation of the scholarly activity requirement, 2) support for resident scholarship, 3) scholarly activities of residents, 4) attitudes toward resident research, and 5) program characteristics. University and nonuniversity programs were compared. The response rate was 78%. Most residents completed a topic review with presentation (median, 100%) to fulfill the requirement. Residents at nonuniversity programs were more likely to complete case reports (median, 40% vs 25%; P=.04) and present at local or regional meetings (median, 25% vs 20%; P=.01), and were just as likely to conduct hypothesis-driven research (median, 20% vs 20%; P=.75) and present nationally (median, 10% vs 5%; P=.10) as residents at university programs. Nonuniversity programs were more likely to report lack of faculty mentors (61% vs 31%; P<.001) and resident interest (55% vs 40%; P=.01) as major barriers to resident scholarship. Programs support resident scholarship through research curricula (47%), funding (46%), and protected time (32%). Internal medicine residents complete a variety of projects to fulfill the scholarly activity requirement. Nonuniversity programs are doing as much as university programs in meeting the requirement and supporting resident scholarship despite reporting significant barriers.

Chief Residency

Chief Residency

The teaching of cellular and molecular biology: A survey of program directors in internal medicine

Although there has been an explosion in our knowledge of cellular and molecular biology, it is unclear if medical students entering internal medicine residency programs have been adequately trained in these basic sciences. To ascertain the perceived importance of these subjects to the practice of medicine and to determine if medical schools are properly training their students, a survey was sent to internal medicine program directors. A survey was sent to 401 internal medicine program directors. Repeat questionnaires were sent if no response was received within 6 months. Questionnaires were returned by 309 program directors (77%). Only 41% of the program directors felt that their residents had received adequate training in cellular and molecular biology. Directors of university programs were significantly more likely to think that knowledge of these sciences was essential to the practice of medicine and that their residents were inadequately trained than directors from nonuniversity programs. Only 30% of programs offered any formal training in these sciences. Medical schools need to reevaluate their curricula in order to integrate the basic sciences into all 4 years. Training in these sciences, however, should not stop with graduation. The importance of a knowledge of these sciences should be emphasized at all training programs.

Evaluation of pediatric residents and their training programs

Theoretic objectives in the evaluation of the training of pediatricians are presented, with an assessment of the extent to which the current procedures of the American Board of Pediatrics are able to measure the success of such training. An introspective analysis of the Board's written examination is detailed. The relative inability of Board procedures to measure a candidate's physical skills and professional attitudes is recognized. In order to aid in the evaluation of the quality of individual educational programs, the performances of candidates from university-affiliated programs and those from nonuniversity ones in the written examination from 1968 through 1970 have been analyzed. Although the number of programs in each category is about equal, about 75 per cent of the Board candidates are trained in university programs. The mean scores of these candidates are higher than those from nonuniversity programs. Reasons for these differences are discussed.

TRAINING IN NUCLEAR MEDICINE FOR RADIOLOGY RESIDENTS.

Since 1936, when radioisotopes were introduced in clinical medicine with the therapeutic use of P32, many radiologists have been involved in the overall development of nuclear medicine. In this development internists, surgeons, general practitioners, and physicists have also participated, but from the beginning individual interest rather than any particular medical specialty has determined the use of the radioisotopes. The American Boards of Internal Medicine and of Pathology expect candidates to possess some knowledge of radioisotope procedures and of their interpretation. Furthermore, the Board of Pathology gives credit for up to six months of training in nuclear medicine as part of the clinical pathology program. The Board of Radiology is the only Board that requires specific training and gives separate examination and certification in nuclear medicine. At present the American Board of Radiology requires three months of training in nuclear medicine. The Board, however, does not appear to consider this training program in the same category as those for diagnostic roentgenology or the other portions of therapeutic radiology (1). The training in nuclear medicine need not be the responsibility of a radiologist, nor need it be given in an institution approved for residency in radiology. No quantitative figures have been established by the Board regarding the clinical experience expected in the diagnostic or therapeutic uses of radioisotopes. Radiology residents at the University of California Hospitals in San Francisco complete a laboratory course in basic principles, participate in an active clinical radioisotope section in the Department of Radiology, and receive instruction in radiation physics and radiobiology. Concern about deficiencies in this program and the desire to learn how other institutions are handling the problem prompted a recent survey of hospitals accredited for residency training in radiology. Questionnaires were mailed to all radio1ogy departments listed in the 1962 Directory of Approved Internships and Residencies published by the American Medical Association. The requested information concerned (a) basic training in instrumentation, physics, radiation safety, and related aspects; (b) clinical training in diagnostic uses of radioisotopes; (c) clinical training in their therapeutic uses. In all three sections, information was requested concerning the total number of hours of training as well as the portion of time given to “lecture” and “laboratory.” The informant was also asked if the training was given in the radiology department and what other departments participated. Additional comments were invited. Answers to part or all of the three major sections of the questionnaire were received from 92 per cent of the university departments and 71 per cent of the nonuniversity departments. The data relating to university programs have been compared with those of nonuniversity programs.