Opinions Of Program Directors Research Articles

Orthopaedic Resident and Program Director Opinions of Resident Duty Hours

The Accreditation Council for Graduate Medical Education (ACGME) established national guidelines for resident duty hours in July 2003. Following an Institute of Medicine report in December 2008, the ACGME recommended further restrictions on resident duty hours that went into effect in July 2011. We conducted a national survey to assess the opinions of orthopaedic residents and of directors of residency and fellowship programs in the U.S. regarding the 2003 and 2011 ACGME resident duty-hour regulations and the effects of these regulations on resident education and patient care. A fifteen-item questionnaire was electronically distributed by the Candidate, Resident, and Fellow Committee of the American Academy of Orthopaedic Surgeons (AAOS) to all U.S. orthopaedic residents (n = 3860) and directors of residency programs (n = 184) and fellowship programs (n = 496) between January and April 2011. Thirty-four percent (1314) of the residents and 27% (185) of the program directors completed the questionnaire. Statistical analyses were performed to detect differences between the responses of residents and program directors and between the responses of junior and senior residents. The responses of orthopaedic residents and program directors differed significantly (p < 0.001) for fourteen of the fifteen survey items. The responses of residents and program directors were divergent for questions regarding the 2003 rules. Overall, 71% of residents thought that the eighty-hour work week was appropriate, whereas only 38% of program directors agreed (p < 0.001). Most program directors (70%) did not think that the 2003 duty-hour rules had improved patient care, whereas only 24% of residents responded in the same way (p < 0.001). The responses of residents and program directors to questions regarding the 2011 duty-hour rules were generally compatible, but the degree to which they perceived the issues was different. Only 18% of residents and 19% of program directors thought that the suggested strategic five-hour evening rest period implemented in July 2011 for on-call residents was appropriate (p > 0.05), and both groups (84% of residents and 74% of program directors) also disagreed with the limitation of intern shifts to sixteen hours (p < 0.001). Seventy percent of residents and 79% of program directors thought that the new duty-hour regulations would result in an increased number of handoffs that would be detrimental to patient care (p < 0.001). The mean responses of junior residents and senior residents differed for eight of the fifteen survey items (p < 0.001), with the responses of senior residents more closely resembling those of program directors on six of these eight questions. The mean responses and percentiles for the survey items did not differ significantly between residency directors and fellowship directors (p > 0.05). This national survey indicated significant differences between the opinions of orthopaedic residents and program (residency and fellowship) directors regarding the 2003 ACGME resident duty-hour regulations and the effects of these regulations on resident education and patient care. However, both residents and program directors agreed that the further reductions in duty hours in the 2011 rules may be detrimental to resident education and patient care.

Should anesthesia residents with a history of substance abuse be allowed to continue training in clinical anesthesia? The results of a survey of anesthesia residency program directors

Study Objective To determine the experience, attitudes, and opinions of program directors regarding the reintroduction of residents in recovery from substance abuse into the clinical practice of anesthesiology. Design Survey instrument. Setting Anesthesia residency training programs in the United States. Measurements After obtaining institutional review board approval, a list of current academic anesthesia residency programs in the United States was compiled. A survey was mailed to 131 program directors along with a self-addressed stamped return envelope to ensure anonymity. Returned surveys were reviewed and data compiled by hand, with categorical variables described as frequency and percentages. Main Results A total of 91 (69%) surveys were returned, representing experience with 11,293 residents over the ten-year period from July of 1997 through June of 2007. Fifty-six (62%) program directors reported experience with at least one resident requiring treatment for substance abuse. For residents allowed to continue with anesthesia residency training after treatment, the relapse rate was 29%. For those residents, death was the initial presentation of relapse in 10% of the reported cases. 43% of the program directors surveyed believe residents in recovery from addiction should be allowed to attempt re-entry while 30% believe that residents in recovery from addiction should not. Conclusions The practice of allowing residents who have undergone treatment for substance abuse to return to their training program in clinical anesthesia remains highly controversial. They are often lost to follow-up, making it difficult, if not impossible to determine if re-training in a different medical specialty decreases their risk for relapse. A comprehensive assessment of the outcomes associated with alternatives to re-entry into clinical anesthesia training programs is needed.

Physician Assistant Program Director Opinions Regarding the Importance of Faculty Research and Publication

Purpose: Over the last decade, rapid growth in the number of physician assistant (PA) programs has strained our profession’s ability to supply sufficient numbers of well-prepared faculty members. As the profession shifts towards an entry-level graduate degree, PA educators—generally recruited out of clinical practice—are feeling more pressure to be involved in traditional scholarship activities. The goal of this portion of a two-part study was to elicit opinions from PA program directors regarding the importance of, and barriers to, successful publication by their faculty members. Methods: A written survey instrument on various issues surrounding research and publication by faculty members was administered to directors of all accredited PA programs in May 2002. Results: PA program directors rated their priorities for faculty duties in the following order: (1) classroom teaching, (2) service and administrative duties, (3) clinical practice, and (4) research and academic scholarship. Program directors felt that faculty should ideally spend about 15% of their time on research activities. The factors felt to have the largest detrimental effect on publication success were: lack of time due to teaching or other responsibilities, lack of training in research design, and lack of previous experience with successful publication. Creation of set-aside time dedicated to research and writing was considered the most important factor for promotion of faculty scholarship. Conclusions: Although program directors consider research and publication to be compatible with institutional priorities and very important to the profession as a whole, these activities are generally given a lower priority than other faculty duties.

Residency reform: Anticipated effects of ACGME guidelines on general surgery and internal medicine residency programs

The Accreditation Council for Graduate Medical Education (ACGME) has recently amended guidelines for resident work environment. This study was conducted to evaluate opinions of program directors regarding the impact of the changes on residents and residency programs. General surgery and internal medicine program directors were sent a 19-question survey. Questions were asked regarding anticipated effects on patient safety, resident well-being, education, medical errors, implementation costs, and methods needed for compliance. Data were analyzed using the chi-square test, the Mann-Whitney method, and the independent samples t-test where appropriate. Responses were received from 153 surgery program directors and 126 medicine program directors. Differences noted were hours worked (surgery 84.2 hours vs medicine 68.7 hours, p < 0.0005), current compliance (49% vs 73%, p < 0.0005), and allowance of internal (13% vs 54%, p < 0.0005) and external (24% vs 58%, p < 0.0005) moonlighting. Program directors anticipate improved resident safety and well-being. However, education, continuity of care, and board certification success are not expected to improve. Increased cost to institutions is anticipated. Surgery program directors feel medical errors will not decrease; medicine program directors are neutral. To facilitate compliance, surgery program directors anticipate employing physicians' assistants and technology, whereas medicine program directors may implement night float. Neither surgery nor medicine program directors expects increased quantity or quality of applicants. Program directors agree resident work hour reform is essential; however, varied methodology and outcomes are expected.

Impact of the ACGME Work Hour Requirements

The Accreditation Council for Graduate Medical Education (ACGME) approved new residency program duty hour standards for all medical specialties in June 2002. The rationales for the guidelines were threefold: increased acuity of hospitalized patients resulting in greater demands of residents, growing public opinion that long resident duty hours compromise patient safety, and growing evidence of the negative effects of sleep deprivation on performance.1–3 The ACGME resident work hour requirements were implemented in July 2003, and can be summarized by the following standards: 1) an 80-hour weekly work limit, averaged over 4 weeks; 2) a 24-hour limit of continuous duty with up to 6 additional hours for transfer of care and education; 3) one day off per week, averaged over 4 weeks; 4) in-house call limited to no more than once every three nights, averaged over 4 weeks; 5) a 10-hour rest period between duties. The ACGME resident work hour requirements forced major system changes for some neurology programs in the way that patient care is delivered and residents are educated. Although potential issues such as continuity of care, patient safety, resident education, and shifting responsibilities onto academic staff were identified and justified prior to implementation,2 the impact remains to be seen. This survey was undertaken to identify neurology resident and program director opinions as to the early impact of the standards, as well as to identify strategies used to institute and monitor the guidelines in neurology and to promote discussion of these issues. A total of 24 adult neurology residency programs were selected based on publicly available program director contact information. These programs were evenly distributed in terms of geographic region (East, West, South, Midwest) and program size within each region. All correspondence was via e-mail. The initial contact was through the program director. It included the following …

Effect of an Internet-based curriculum on postgraduate education. A multicenter intervention.

We hypothesized that the Internet could be used to disseminate and evaluate a curriculum in ambulatory care, and that internal medicine residency program directors would value features made possible by online dissemination. An Internet-based ambulatory care curriculum was developed and marketed to internal medicine residency program directors. Utilization and knowledge outcomes were tracked by the website; opinions of program directors were measured by paper surveys. Twenty-four programs enrolled with the online curriculum. The curriculum was rated favorably by all programs, test scores on curricular content improved significantly, and program directors rated highly features made possible by an Internet-based curriculum.

A comparison of resident and program director views on the effects of subspecialty fellowships on residency training in obstetrics and gynecology

In separate nationwide surveys, chief administrative residents and residency program directors reported their views on the impact of subspecialty fellowships on residency training. The residents expressed a less positive view of the fellowships, but like the directors, considered them beneficial to their training. The directors underestimated the degree residents regret the loss of operative experiences to the fellows, particularly in laser surgery, infertility surgery, and radical pelvic surgery. Within a given residency program, resident and program director opinions of the fellowships appear unrelated or contradictory. The implications of these findings for a discussion between residents and program directors are presented.

Research training for residents.

I have been given the almost impossible task of assessing the status of research in otolaryngology residency programs across the country. How best to do this is elusive to me. However, three methods seem appropriate for the task. The first is to sample the philosophical opinions of program directors representing widely varied sized and geographically situated programs. The second is to review the pertinent results of the Society of University Ophthalmologists (SUO) survey, performed in 1981, regarding research and residency programs. The third is the presentation of an example of a program with a mandatory research rotation, specifically, that of the University of Washington, Seattle. Prior to composing this article, I thought it best to sample the opinions of directors of representative otolaryngology training programs. What follows are excerpts from letters composed by seven program directors in response to the question, What roles do researchers play in their training programs