Off-service Rotations Research Articles

Applicant Perception and Content Exploration of the 2024 podiatric Residency Interview Process

Considerable resources are dedicated on an annual basis to the podiatric medicine and surgery residency interview by both students and programs. Despite this, relatively little is known about student perception of the process, nor the format and content of interview. The objective of this investigation was to study and organize experiences of fourth-year podiatric medical students following the 2024 Centralized Residency Interview Program (CRIP) process. An anonymous and voluntary survey was developed and made available to fourth year podiatric medical students. It was relatively common for there to be academic, social/personal, case work-up, and rapid-fire academic question components to the interview. It was also very common to be provided with the opportunity to ask programs questions. It was relatively uncommon for there to be ethical/moral questions, personality/psychologic assessments, logic assessments, and hands-on demonstrations. The most common hands-on demonstrations were suturing, hand ties and performance of fixation principles. Relatively high yield academic topics included plain film radiography interpretation, rearfoot/ankle osseous trauma, diabetic foot infection, advanced imaging interpretation, and fixation constructs/principles. When evaluating programs, students placed high value on surgical volume, surgical variety, relative resident autonomy, program location, exposure to outpatient clinics, salary, future connections as a program alumnus, unique off-service rotations, exposure to business management/coding/billing, scope of practice, exposure to inpatient management, resident salary, and who the senior co-residents would be. The results of this investigation provide unique information for both medical students and residency programs with respect to the perception, format and content of the podiatric residency interview process.

Psychological safety and perceived organizational support in emergency medicine residencies.

The clinical learning environment (CLE) is a key focus of the Accreditation Council of Graduate Medical Education. It impacts knowledge acquisition and professional development. A previous single-center study evaluated the psychological safety and perceived organizational support of the CLE across different specialties. Building on this work, we explored and evaluated psychological safety and perceived organizational support across multiple heterogeneous emergency medicine (EM) residencies to identify trends and factors affecting perceptions of the CLE. Using the Psychological Safety Scale (PSS) and Survey of Perceived Organizational Support (SPOS), residents from seven U.S. EM residencies were surveyed using REDCap software from September through November 2021, with 300 potential respondents. As an adjunct to these surveys, three open-ended questions were included regarding features of their learning environments. A total of 137 out of 300 residents completed the survey. The overall response rate was 45.7%. There was a variable response rate across programs (26.0%-96.7%). Pooled results demonstrate an overall positive perception of CLEs, based on positive mean responses (i.e., "Members of my department are able to bring up problems and tough issue" had a mean of 4.2 on a 5-point Likert scale). Open responses identified teaching, collegiality, and support from program leadership as supportive features of the CLE. Confrontational interdisciplinary communication, a sense of being devalued, and off-service rotations were identified as threats or areas for improvement to the CLE. PSS and SPOS scores were generally positive in this multi-institution study, consistent with the prior single-institution study indicating that EM is often considered psychologically safe and supportive. EM training programs can consider using the PSS/SPOS to audit their own programs to identify areas for improvement and foster supportive features already in place.

16. Knowledge is Power – Designing a Pilot Plastic Surgery Residency “Curated Wiki” to Improve Efficiency and Spread Institutional Knowledge

Background: While the literature has examined plastic surgery formal curricula, institutional knowledge and the informal curriculum are less explored. The “curated wiki” concept, an end user-driven comprehensive resource for institutional knowledge and informal expectations, is heavily used in industry and scientific fields, and is proven to improve employee efficiency and reduce person-hours per unit production. However, this concept has only recently been adopted by residency programs. Studies from internal medicine, pathology, and radiology residencies show that curated wikis significantly improve education, efficiency, overall experience, and exam scores. We present a framework for program-specific curated wikis, based on 3 current practices. Methods: Plastic surgery residents and academic faculty, who previously expressed interest in curated resources for plastic surgery education, were informally interviewed. Questions targeted plastic surgery-specific resources used to curate and disseminate medical and institutional knowledge, and informal curriculum components. Follow-up questions were asked to explore participant needs/suggestions, to determine specific components a curated wiki should contain, and to develop a formal questionnaire for future research. Results: Thirteen residents and faculty at 8 programs participated. No programs had a comprehensive curated resource. Two programs had limited resources produced by a single attending, and 1 program had a comprehensive guide to surgical cases, maintained by one resident without institutional support. Five programs had no curated plastic surgery resource. Programs sometimes offered a physical “general intern’s guide” produced by general surgery departments. Residents and faculty both believed curated wikis would speed the learning curve for new residents, could streamline “instrument card” issues, and would reduce burnout. Residents cited reduction in personal stress and a smoother return from off-service rotations as benefits, while faculty cited reduction in resident errors and clearer expectations of residents/more explicit resident duties as benefits. Participant recommendations for content are presented. Conclusion: The curated wiki concept has significant, proven value in industry, scientific fields, and other residency specialties. Given this value, implementing a curated wiki in a plastic surgery residency program has high potential value. We present content guidelines for an internal curated wiki, which can easily be adopted by residency programs.

Comparison of a U.S. and Zambian Ob/Gyn Residency Training Programme.

The major objective of the study was to compare and contrast a U.S. and Zambian Ob/Gyn residency programme, using uniform metrics, as the basis for an initial exploration of perceived inequities in post-graduate medical education between low- and high-income countries. Measurements of the following procedures were used to indicate whether minimum standards had been met by trainees in their respective postgraduate programmes: vaginal deliveries; C-sections; abdominal, vaginal and laparoscopic hysterectomies; other laparoscopic surgeries; cancer cases; abortions; obstetrical ultrasounds; cystoscopies; incontinence and pelvic floor surgeries. Evaluations were also made with respect to the presence or absence of an official ultrasound rotation, subspeciality and off-service rotations, protected didactic time and exclusive time on obstetrics and gynaecologic clinical services. Comparisons were made relative to these various categories and the average procedural numbers at each level of training to determine differences in trends and degree of exposure. Minimal procedural requirements were met by both the U.S. and Zambian programmes. For open surgical cases, the minimum standards were higher for the Zambian programme, whereas for procedures associated with the use of high-end technology, such as ultrasound and minimally invasive surgery, minimum standards were higher for the U.S. programme. There were no significant differences in the Zambian and U.S. Ob/Gyn post-graduate training programmes, relative to their respective metrics. A more extensive analysis is required to determine the actual competency levels that are produced by the respective training systems.

Experience of surgical subspecialty residents on general surgery rotations

BackgroundSurgical subspecialty residents complete 5–6 years of training which includes general surgery rotations. A lack of data exists evaluating these rotations. This study aims to identify discrepancies in subspecialty training and improve the quality of surgical education. MethodsCase logs for surgical subspecialty residents and general surgery residents at our institution were analyzed and queried for cases performed on general surgery rotations. A survey was distributed to subspecialty residents regarding their perceptions of these rotations. Results50 residents were included in the study and the majority were male (n = 27, 54%). Subspecialty residents perform fewer cases per month compared to general surgery residents (13 vs 21, p < 0.001). 75% of subspecialty residents were satisfied with their experience on general surgery rotations. ConclusionsSubspecialty residents perform fewer operations on general surgery rotations. Despite this, most are satisfied with off-service rotations and believe they are an important part of their education.

Unprecedented Training: Experience of Residents During the COVID-19 Pandemic

Unprecedented Training: Experience of Residents During the COVID-19 Pandemic

Impact of COVID-19 on Emergency Medicine Residency Programs: A Cross-Sectional Study in New York State.

IntroductionThe 2019 novel coronavirus pandemic has caused significant disruptions in the clinical operations of hospitals as well as clinical education, training, and research at academic centers. New York State was among the first and largest epicenters of the pandemic, resulting in significant disruptions across its 29 emergency medicine (EM) residency programs. We conducted a cross-sectional observational study of EM residency programs in New York State to assess the impact of the pandemic on resident education and training programs.MethodsWe surveyed a cross-sectional sample of residency programs throughout New York State in June 2020, in the timeframe immediately after the state’s first “wave” of the pandemic. The survey was distributed to program leadership and elicited information on pandemic-prompted curricular modifications and other educational changes. The survey covered topics related to disruptions in medical education and sought details on solutions to educational issues encountered by programs.ResultsOf the 29 accredited EM residency programs in New York State, leadership from 22 (76%) responded. Of these participating programs, 11 (50%) experienced high pandemic impact on clinical services, 21 (95%) canceled their own trainees’ off-service rotations, 22 (100%) canceled or postponed visiting medical student rotations, 22 (100%) adopted virtual conference formats (most within the first week of the pandemic wave), and 11 (50%) stopped all prospective research (excluding COVID-19 research), while most programs continued retrospective research.ConclusionThis study highlights the profound educational impact of the pandemic on residency programs in one of the hardest- and earliest-hit regions in the United States. Specifically, it highlights the ubiquity of virtual conferencing, the significant impact on research, and the concerns about canceled rotations and missed training opportunities for residents, as well as prehospital and non-physician practitioner trainees. This data should be used to prompt discussion regarding the necessity of alternate educational modalities for pandemic times and the sequelae of implementing these plans.

Barriers to workplace-based learning in the intensive care unit: A qualitative description of internal medicine residents’ and intensivists’ perspectives

Background Residency programs leverage the acquisition of critical care competencies through off-service rotations in the intensive care unit (ICU). However, recent literature questions the effectiveness of increasing the exposition of residents to critical care units to improve their critical care competencies. We aimed to describe the barriers to learning in the ICU from the perspective of internal medicine (IM) residents and intensivists. Methods A qualitative description methodology was applied to data gathered during an ICU quality improvement initiative in a large tertiary academic hospital. Verbatim transcriptions of 12 focus groups including 22 IM residents and 17 intensivists were assessed through thematic data analysis. Results We identified three key themes and 13 subthemes related to barriers to learning. Aspects of the environment such as the slow socialization process of residents to the ICU environment and stakeholders’ perceptions influenced the quality of learning interactions. Dedicated teaching was further influenced by factors related to the IM residency curricula (e.g. competing co-curricular demands) and contributed to tensions in delivering a standardized ICU curriculum. Conclusion This study provides a description of educational barriers that may be present during ICU rotations. Recognizing these barriers may help clinical teachers improve their trainees’ educational experience.

378 Sleep Time Measured Using Fitbit Devices in Emergency Medicine Residents Based on Rotation

Emergency medicine (EM) residents rotate through various other environments during their training which often have variable hours and schedule patterns. These variations likely affect the amount of sleep residents are able to get. This study aims to determine if EM residents at a level one trauma center sleep less during more time- intensive rotations. This was an IRB approved, prospective, observational study that obtained EM residents’ sleep times using a Fitbit Charge 3 device. Each willing participant received a Fitbit device and was asked to wear it at all times for a three month period. Each resident’s corresponding rotation for the month was also recorded and associated with their data. The device automatically records sleep time for each 24-hour period and syncs to a database that records sleep times for each subject number. Data was interpreted using descriptive statistics, calculating median times for each subject throughout each rotation. Medians were used in order to avoid unnecessary skew for single sleep time outliers. The average median sleep time was then calculated for each rotation. Sleep data was collected for 33 EM residents, 10 female and 23 male, with rotators through nine different environments: EM, medical intensive care unit (MICU), surgical intensive care unit (SICU), pediatric intensive care unit (PICU), trauma, elective, anesthesia, orthopedics, and obstetrics. EM rotators had an average median sleep time of 424.7 minutes (N=32), approximately 7.1 hours daily. Residents on SICU slept 391.8 minutes on average (N=7), orthopedics 398.2 minutes (N=3), trauma 399.8 minutes (N=5), MICU 418.4 minutes (N=8), anesthesia 438.3 minutes (N=6), PICU 439.5 minutes (N=3), elective 455.4 minutes (N=7), and obstetrics 482.8 minutes (N=2), with N representing the number of EM residents with sleep data for at least one month of that rotation. EM rotators had the most robust data set, with 32 out of 33 residents having at least one month of sleep data for emergency medicine. The average sleep time for rotators in EM fell between the other eight rotations. SICU rotators slept the least on average, 391.8 minutes or 6.5 hours. Both trauma and MICU rotators slept less on average than emergency medicine rotators. Orthopedics also had a lower average sleep time, however it is important to note that only three subjects had at least one month of sleep data for their orthopedics rotation, as this is classically a less time-consuming off-service rotation. SICU, orthopedics, trauma, and MICU all had average median sleep times less than seven hours daily. Overall, it does seem that EM residents at our institution sleep a varying amount based on their current rotation which likely affects other elements of lifestyle and wellness. Understanding why certain rotations lead to poorer sleep quantity could aid program leadership in making positive scheduling changes for future generations of trainees.

Dual Degree Training: Balancing Clinical Aptitude and Medical Licensure Requirements

Dual Degree Training: Balancing Clinical Aptitude and Medical Licensure Requirements

Picking Up the Pieces: Healthcare Quality in a Post-COVID-19 World.

Picking Up the Pieces: Healthcare Quality in a Post-COVID-19 World.

Surgical training in gynecologic oncology: Past, present, future

The purpose of this paper is to review the surgical care related to training in gynecologic oncology, from past, present and future perspectives. A marked decline in the incidence of cervical cancer as well as improvements in radiation therapy have led to a reduction in the numbers of radical hysterectomies and exenterations being performed. Utilization of neoadjuvant chemotherapy is reducing the extent of cytoreductive operations, including intestinal surgery. The incorporation of sentinel lymphatic mapping has reduced the number of pelvic, paraaortic and inguinal lymphadenectomies being performed. Coupled with these changes are other factors limiting time for surgical training including an explosion in targeted anticancer therapies and more individualized options beyond simple cytotoxic therapy. With what is likely to be a sustained impact on training, gynecologic oncologists will still provide a broad range of care for women with gynecologic cancer but may be quite limited in surgical scope and rely on colleagues from other surgical disciplines. Enhancement of surgical training by off-service rotations, simulation, attending advanced surgical training courses and/or a longer duration of training are currently incorporated into some programs. Programs must ensure that fellows take full advantage of the clinical materials available, particularly those related to the potential deficiencies described. Changing required research training to an additional elective year could also be considered. Based on the perspectives noted, we believe it is time for our subspecialty to reevaluate its scope of surgical training and practice.

LO78: Ready for launch? A survey of readiness factors among 2019 Competence By Design launch disciplines

Introduction: A critical component for successful implementation of any innovation is an organization's readiness for change. Competence by Design (CBD) is the Royal College's major change initiative to reform the training of medical specialists in Canada. The purpose of this study was to measure readiness to implement CBD among the 2019 launch disciplines. Methods: An online survey was distributed to program directors of the 2019 CBD launch disciplines one month prior to implementation. Questions were developed based on the R = MC2 framework for organizational readiness. They addressed program motivation to implement CBD, general capacity for change, and innovation-specific capacity. Questions related to motivation and general capacity were scored using a 5-point scale of agreement. Innovation-specific capacity was measured by asking participants whether they had completed 33 key pre-implementation tasks (yes/no) in preparation for CBD. Bivariate correlations were conducted to examine the relationship between motivation, general capacity and innovation specific capacity. Results: Survey response rate was 42% (n = 79). A positive correlation was found between all three domains of readiness (motivation and general capacity, r = 0.73, p &lt; 0.01; motivation and innovation specific capacity, r = 0.52, p &lt; 0.01; general capacity and innovation specific capacity, r = 0.47, p &lt; 0.01). Most respondents agreed that successful launch of CBD was a priority (74%). Fewer felt that CBD was a move in the right direction (58%) and that implementation was a manageable change (53%). While most programs indicated that their leadership (94%) and faculty and residents (87%) were supportive of change, 42% did not have experience implementing large-scale innovation and 43% indicated concerns about adequate support staff. Programs had completed an average of 72% of pre-implementation tasks. No difference was found between disciplines (p = 0.11). Activities related to curriculum mapping, competence committees and programmatic assessment had been completed by &gt;90% of programs, while &lt;50% of programs had engaged off-service rotations. Conclusion: Measuring readiness for change aids in the identification of factors that promote or inhibit successful implementation. These results highlight several areas where programs struggle in preparation for CBD launch. Emergency medicine training programs can use this data to target additional implementation support and ongoing faculty development initiatives.

Escape the Drape Divide by Making Off-Service Rotations a Part of Surgery and Anesthesia Residencies.

Unfortunately, the drape dividing the anesthesiologist from the surgeon is far too often a symbol of a greater divide in both communication and culture between the 2 specialties. When anesthesiologists and surgeons spend time rotating on each other's services, they develop a mutual respect for each other's clinical acumen and foster open communication channels for times of both routine clinical care and crisis. There is no better time than in residency, and no better way than cross-training, for anesthesia and surgical residents to hone these skills.

Escape the drape divide by making off-service rotations a part of surgery and anesthesia residencies

Escape the drape divide by making off-service rotations a part of surgery and anesthesia residencies

P026: Dominating the vent: A flipped classroom approach to enhance emergency medicine resident ventilator management

Innovation Concept: Ventilator management is an essential skill and a training objective for emergency medicine (EM) specialists in Canada. EM trainees obtain the majority of this training during off-service rotations. Previous attempts to strengthen ventilator knowledge include lectures and simulation – both of which are time and resource intensive. Given the unique features of ventilator management in the ED, we developed an ED-specific ventilator curriculum. The purpose of this study is to 1) identify resident needs regarding ventilator curricula and 2) assess resident response to this pilot curriculum. Methods: A needs-assessment survey administered to RCPSC- and CCFP-EM residents at The Ottawa Hospital (TOH) showed the majority of residents (87%, n = 31 respondents) believe there is a need for more ED-focused ventilator management training, and only 13% felt confident in ventilator management. Ten on-line modules were prepared by an EM-Critical Care attending, and distributed on-line to all EM trainees at TOH (n = 52). Mid- and post-implementation surveys are used to assess residents’ confidence in ventilator management, and perceived usefulness of the curriculum. User feedback from focus groups constitutes part of the curriculum evaluation. Curriculum, Tool or Material: Employing a flipped classroom approach, ten on-line modules were distributed to RCPSC- and CCFP-EM trainees at TOH. Each module requires less than ten minutes to complete and focuses on a single aspect of ventilation. The modules are available for residents to complete at their own pace and convenience. At curriculum completion, an EM-Critical Care attending physician facilitates an interactive session. Conclusion: Mid-implementation survey results demonstrate increased confidence in independently managing ventilated patients in the ED (13% pre- vs. 56% mid-implementation), and an increased perception of having sufficient ventilator training (26% pre- vs. 78% mid-implementation). All respondents felt the modules were of appropriate length, content was easy to follow, and that the modules should be part of the residency curriculum. Our ED-specific online ventilator modules area a viable tool to increase residents’ confidence in ventilator management. This novel curriculum could be adopted by other residency programs and continuing professional development initiatives. Future work will include post-implementation data-gathering, and formal curriculum evaluation.

Abstract No. 569 Does height really matter? Evaluating personal radiation exposure based on operator height

To determine the correlation between operator height and occupational dose equivalent of Interventional Radiologists. Dosimeter data was obtained for fellow (n=29) and attending (n=8) interventional radiologists at a large volume, academic practice from 2012 to 2017. Average monthly deep dose equivalent (DDE) was compared to self-reported heights for each operator using bivariate, Pearson correlation. A separate analysis was performed with outlier months excluded (<100 mrem for fellows, <50 mrem for attendings) assuming dosimeter badge non-compliance or off-service rotation. Negative correlation exists between height versus average monthly DDE (mrem) for fellows and attendings combined (-0.49 [-0.70, -0.19], p=0.001), fellows (-0.48 [-0.71, -0.12], p=0.007), and attendings (-0.67[-0.93, 0.09], p=0.067). With outlier data excluded, there is a stronger negative correlation between height versus average monthly dose equivalent for fellows and attendings combined (-0.65 [-0.81, -0.41], p<0.001), fellows (-0.72 [-0.87, -0.47], p<0.001), and attendings (-0.63 [-0.93, 0.16], p=0.095). There is no significant difference in correlation between fellows versus attendings including (p=0.576) or excluding (p=0.719) outlier data. A significant negative correlation exists between operator height and average monthly dose equivalent with shorter operators receiving more radiation. Marginal statistical significance for the attending data set is attributed to the low number of total operators. Equipment geometry may be responsible for this disparity, favoring taller operators whose dosimeter badges are typically positioned farther from the patient and zone of maximum scattered photons. While all Interventional Radiologists are responsible for adherence to ALARA principles, shorter individuals should practice extra caution to reduce occupational exposure.

An Evaluation of Off-Service Rotations in Podiatric Medicine and Surgery Residency Training

Residency training in podiatric medicine and surgery includes 3years of comprehensive training. Complementing their podiatric medicine and surgery training, residents complete a series of required nonpodiatric, or off-service, rotations in a range of specialties. However, there has been a lack of formal investigation of these off-service rotation experiences. An online survey was developed and distributed to both program directors and residents nationwide. The survey instrument covered various aspects of off-service rotations, including rotation value, length, goals and objectives, activities, feedback, and resident satisfaction. In total, 122 of 222 directors responded and 151 of 243 residents responded. Resident responses reflected the impact of podiatric responsibilities during off-service rotations and the importance of hands-on, interactive, and dedicated learning opportunities during these rotations. Both similarities and differences were appreciated with regard to perceived rotation value between resident and director perspectives. Perceived satisfaction of certain rotations was correlated with rotation length, feedback, specific rotation activities, and whether residents received goals and objectives. Though perhaps neglected, the off-service rotation experience is an important part of the podiatric medical and surgical residency experience. Considering the perspectives of both directors and residents can be helpful in directing these experiences and in considering future changes.

Hurricane Sandy: How Did We Do? Assessing a Manhattan Hospital's Response.

Hurricane Sandy: How Did We Do? Assessing a Manhattan Hospital's Response.

Evaluation of off-service rotations at National Guard Health Affairs: Results from a perception survey of off-service residents

Context:“Off-service” clinical rotations are part of the necessary requirements for many residency training programs. Because these rotations are off-service, little attention is given to their structure and quality of training. This often leads to suboptimal educational experience for the residents on these rotations.Aims:The aim of this study was to assess medical residents’ perceptions, opinions, and levels of satisfaction with their “off-service” rotations at a major residency training site in Saudi Arabia. It was also to evaluate the reliability and validity of a questionnaire used for quality assurance in these rotations. Improved reliability and validity of this questionnaire may help to improve the educational experience of residents in their “off-service” rotations.Materials and Methods:A close-ended questionnaire was developed, Pilot tested and distributed to 110 off-service residents in training programs of different specializations at King Fahad Naitonal Guard Hospital and King Abdulziz Medical City, Riyadh, Saudi Arabia, between September 2011 and December 2011.Results:A total of 80 out of 110 residents completed and returned the questionnaire. Only 33% of these residents had a clear set of goals and educational learning objectives before the beginning of their off-service rotations to direct their training. Surgical specializations had low satisfaction mean scores of 57.2 (11.9) compared to emergency medicine, which had 70.7 (16.2), P value (0.03). The reliability of the questionnaire was Cronbach's alpha 0.57. The factor analysis yielded a 4-factor solution (educational environment, educational balance, educational goals and objectives, and learning ability); thus, accounting for 51% variance in the data.Conclusion:Our data suggest that there were significant weaknesses in the curriculum for off-service clinical rotations in KAMC and that residents were not completely satisfied with their training.