PGY-1 Residents Research Articles

0914 Perception of Sleep Medicine (SM) Training among Internal Medicine (IM) Trainees in Puerto Rico

Abstract Introduction Awareness of the importance of SM among trainees at our IM Training Program (IMTP) has not been documented, despite the high prevalence of Sleep Disordered Breathing (SDB) within our clinical population. Recently, the Indiana University Sleep Questionnaire (IUSQ) was administered to quantify the perception of SM in IM residents. Methods We administered the IUSQ questionnaire through an anonymous computer survey sample of IM residents at our ACGME accredited IMTP. Results A total of 52/61 (85%) residents from the Veterans Administration Caribbean Health Care System (VACHS) IMTP participated. There were 18 PGY-1, 16 PGY-2, 15 PGY-3 and 3 PGY-4 residents whom the majority strongly agreed or agreed that the burden of SDB was large in the general population (63% & 35%), that it is important for their training (48% & 46%) and for their general practice (54% & 38%). They were mostly neutral or disagreed about getting adequate training in SDB during residency (38% & 40%). The majority strongly agreed or agreed that sleep specialist is needed for managing SDB (27% & 48%) and 9.6% disagreed with this. Many do not have interest in pursuing a sleep medicine fellowship answering neutral, disagree and strongly disagree (23%, 38% &23%). The majority strongly agree and agree that a sleep fellowship is important in treating sleep disorders (48% & 33%). The residents are mostly neutral or disagree when it comes to their confidence in treating sleep apnea (40% & 48%) and treating other sleep disorders (46% & 38%). Conclusion Despite the high prevalence of SDB in the population they manage, residents do not feel they are getting enough training in the management of sleep disorders. They acknowledge the importance of SM education for the latter purpose, but the majority does not want to pursue formal subspecialty training in SM. In addition, they do not feel comfortable managing SDB and other sleep disorders. Interestingly this mismatch between burden of disease and the need for disease management proficiency is similar to one found previously in a different resident population to which the same IUSQ was administered. An educational approach toward residents may furtherly change these perceptions. Support (if any)

Virtual Reality to Assess Resident Recognition of Impending Respiratory Failure During COVID-19.

To assess the performance of pediatric residents in recognizing a decompensating patient with impending respiratory failure and appropriately escalating care using a virtual reality (VR) simulated case of an infant with bronchiolitis after an extended period of decreased clinical volumes during the coronavirus disease 2019 (COVID-19) pandemic. Sixty-two pediatric residents at a single academic pediatric referral center engaged in a 30-minute VR simulation on respiratory failure in a 3-month-old admitted to the pediatric hospital medicine service with bronchiolitis. This occurred in a socially distant manner across the Zoom platform during the COVID-19 pandemic (January-April 2021). Residents were assessed on their ability to (1) recognize altered mental status (AMS), (2) designate clinical status as "(impending) respiratory failure," and (3) escalate care. Statistical differences between and across postgraduate year (PGY) levels were examined using χ2 or Fisher's exact test, followed by pairwise comparison and posthoc multiple testing using the Hochberg test. Among all residents, 53% successfully recognized AMS, 16% identified respiratory failure, and 23% escalated care. No significant differences were seen across PGY levels for recognizing AMS or identifying respiratory failure. PGY3+ residents were more likely to escalate care than PGY2 residents (P = .05). In the setting of an extended period with decreased clinical volumes during the COVID-19 pandemic, pediatric residents across all PGY levels demonstrated challenges with identifying (impending) respiratory failure and appropriately escalating care during VR simulations. Though limited, VR simulation may serve as a safe adjunct for clinical training and assessment during times of decreased clinical exposure.

(065) Let’s Talk about Sex: Resident Run Didactic Curriculum

Abstract Introduction The Council on Resident Education in Obstetrics and Gynecology (CREOG) includes sexual health learning objectives as part of the core education for Ob/Gyn training. Residents are expected to gain understanding of normal sexual function as well as common areas of sexual dysfunction. Unfortunately, several studies have demonstrated a lack of knowledge in this area by Ob/Gyn residents and that educational didactic programs are not standardized on this topic. In 2010, over 90% of post graduate year (PGY)3 and PGY4 residents reported attending fewer than 5 didactic activities on sexual function/dysfunction, with only 50% feeling able to perform a targeted physical exam. Over the past decade, there has not been substantial improvement in this subject matter. In a 2021 survey evaluating the sexual health CREOG objectives showed that more than half of Ob/Gyn residents were not able to describe the disorders of sexual function or list common medications that effect sexual function. This is not isolated to the US, with studies in other countries including Singapore and Brazil, showing residents lack formal training and residents want increased didactic time focused on sexual health. Objective Our hypothesis was that at our institution the baseline knowledge of sexual dysfunction among Ob/Gyn residents would be low. The primary objective was formulating a needs assessment through implementation of a pre/post survey with a curriculum component. The secondary objective was to determine what areas of sexual medicine are most commonly areas of confusion or where residents lack comfort in regard to patient care. Methods The resident-designed curriculum was built with collaboration from a pelvic floor physical therapist. The journal club format was based on American College of Obstetricians and Gynecologists (ACOG) Practice Bulletins, the International Society for the Study of Women’s Sexual Health (ISSWSH) clinical pearls, and the North American Menopausal Society (NAMS) position statements. The pelvic floor physical therapy component focused on pelvic pain, perinatal considerations, and incontinence. The WCG IRB deemed this study exempt. After the pre-curriculum assessment was used to identify knowledge gaps, a month of one-hour weekly sexual health sessions were implemented followed by a post-curriculum survey. Results Due to small sample size, (N=14) there was no way to establish significance in our results. In general, areas that residents were weak and the curriculum focused on were: 1) Pelvic floor/vulvar/vestibular disorders. 2) Genitourinary syndrome of menopause and vasomotor symptoms of menopause. 3) Sexual medicine disorders (hypoactive sexual desire disorder, female sexual arousal disorder, persistent genital arousal disorder, female orgasm disorders, genitopelvic pain penetration dysfunction). Conclusions The baseline knowledge of sexual dysfunction and menopausal concerns among Ob/Gyn residents was low. However, implementation of a structured curriculum after a formal needs assessment improved comfort with these topics. Now that the baseline curriculum is designed it is imperative to expand to further residency programs (in Ob/Gyn as well as other specialties) to disseminate the knowledge to providers in training who require competency in sexual health concerns. Disclosure No

Otolaryngology resident familiarity with surgical instruments and preoperative setup: A pilot study

ObjectiveThis study was designed to determine otolaryngology (ORL) residents' ability to prepare the operating room independently for ORL surgical cases and their familiarity with ORL surgical instruments and related equipment. MethodsA 24-question, one-time, anonymous survey was distributed to otolaryngology-head and neck surgery program directors for distribution among their residents in the United States in November 2022. Residents in every post-graduate year were surveyed. Spearman's ranked correlation and Mann-Whitney U test were used. ResultsThe response rate among program directors was 9.5 % (11/116 programs), while the response rate among residents was 51.5 % (88/171 residents). A total of 88 survey responses were completed. 61 % of ORL residents who responded were able to name most instruments used in surgical cases. The most recognized surgical instruments by ORL residents were microdebrider (99 %) and alligator forceps (98 %); the least recognized were bellucci micro scissors (72 %) and pituitary forceps (52 %); and all instruments except the microdebrider showed significantly increased recognition with increasing post graduate training year (PGY), p ≤ 0.05. ORL residents were most able to set up independently the electrocautery (77 %) and laryngoscope suspension (73 %), while they were least able to set up the robot laser (6.8 %) and coblator (26 %) independently. All instruments showed significant positive correlations with increasing PGY; the strongest correlation was found in laryngoscope suspension, r = 0.74. 48 % of ORL residents reported that there were times when surgical techs and nurses were not available. Only 54 % of ORL residents reported being able to set up instruments when alone in the operating room, including 77.8 % of PGY-5 residents. Only 8 % of residents reported receiving education related to surgical instruments from their residency program, while 85 % thought that ORL residencies should have courses or educational materials about surgical instruments. ConclusionORL residents' familiarity with surgical instruments and preoperative setup improved throughout their training. However, specific instruments had much lower recognition than others and a lower ability for independent setup. Nearly half of ORL residents reported being unable to set up surgical instruments in the absence of surgical staff. Implementation of surgical instrument education may improve these deficiencies.

Preparing for and passing the fundamentals of laparoscopic surgery (FLS) exam improves general surgery resident operative performance and autonomy.

The American Board of Surgery made the Fundamentals of Laparoscopic Surgery (FLS) exam a prerequisite for board certification in 2009. Some residency programs have questioned the need for a continued FLS testing mandate given limited evidence that supports the impact of FLS on intraoperative skills. The Society for Improving Medical Professional Learning (SIMPL) app is a tool to evaluate resident intraoperative performance. We hypothesized that general surgery resident operative performance would improve immediately after preparing for the FLS exam. The national public FLS data registry was matched with SIMPL resident evaluations from 2015 to 2021 and de-identified. SIMPL evaluations are scored in three categories: supervision required (Zwisch scale 1-4, 1 = show and tell and 4 = supervision only), performance (scale 1-5, 1 = exceptional and 5 = unprepared), and case complexity (scale 1-3, 1 = easiest and 3 = hardest). Statistical analyses compared pre and post-FLS exam resident average operative evaluation scores. There were a total of 76 general surgery residents, and 573 resident SIMPL evaluations included in this study. Residents required more supervision in laparoscopic cases performed before compared to after the FLS exam (2.84 vs. 3.03, respectively, p = 0.007). Residents performance scores improved from cases before compared to after the FLS exam (2.70 vs. 2.43, respectively, p = 0.001). Case complexity did not differ before versus after the FLS exam (2.13 vs. 2.18, respectively, p = 0.202). PGY level significantly predicted evaluation scores with a moderate correlation. A sub analysis grouped by PGY level revealed a significant improvement after the FLS exam in supervision among PGY-2 residents (2.33 vs. 2.58, respectively, p = 0.04) and performance among PGY-4 residents (2.67 vs 2.04, respectively, p < 0.001). Preparation for, and passing, the FLS exam improves resident intraoperative laparoscopic performance and independence. We recommend taking the exam in the first two years of residency to enhance the laparoscopic experience for the remainder of training.

Survey‐based evaluation of national practices for postgraduate year one pharmacy resident emergency response training

AbstractIntroductionMedical emergency response teams optimally involve interdisciplinary expertise, including pharmacists. A pharmacist may make therapy recommendations, prepare medications, and act as a drug information resource, which are important skills for a postgraduate year one pharmacy resident (PGY1) to develop. Limited data exist evaluating current national practices for PGY1 emergency response.ObjectivesThe purpose of this study was to describe national practices for PGY1 emergency response. These data may help PGY1 programs identify potential best practices for self‐improvement.MethodsAn anonymous survey was developed to describe PGY1 emergency response within the United States and electronically distributed to PGY1 residency program directors. The questionnaire included general demographic information along with questions involving pharmacist and pharmacy resident emergency response and training within their institution. A univariate analysis was performed to evaluate potential predictors of survey respondent confidence in PGY1 independent emergency response by the end of the residency year.ResultsA total of 178 completed responses were obtained (response rate: 33.0%). The majority of respondents had both pharmacist and PGY1 response at their institution, with response to cardiopulmonary arrest being the most common. Of the 36 programs that did not have pharmacy resident involvement, the most common reason was due to lack of pharmacy response at their institution (61.1%). The majority of programs (68.3%) were confident in the ability for a PGY1 to independently respond by the end of their residency year. Only the number of emergency response by the end of the residency year was a predictor in their confidence of PGY1 independent response (p = 0.002).ConclusionThe majority of PGY1 programs had both pharmacist and pharmacy resident response to medical emergencies. The results of this survey may help PGY1 programs identify potential areas of improvement and help prospective residency candidates identify program characteristics that may best prepare them for emergency response.

Early findings and strategies for successful implementation of SIMPL workplace-based assessments within vascular surgery residency and fellowship programs

ObjectiveAs medical education systems increasingly move toward competency-based training, it is important to understand the tools available to assess competency and how these tools are utilized. The Society for Improving Medical Professional Learning (SIMPL) offers a smart phone-based assessment system that supports workplace-based assessment of residents’ and fellows’ operative autonomy, performance, and case complexity. The purpose of this study was to characterize implementation of the SIMPL app within vascular surgery integrated residency (0+5) and fellowship (5+2) training programs. MethodsSIMPL operative ratings recorded between 2018 and 2022 were collected from all participating vascular surgery training institutions (n = 9 institutions with 5+2 and 0+5 programs; n = 4 institutions with 5+2 program only). The characteristics of programs, trainees, faculty, and SIMPL operative assessments were evaluated using descriptive statistics. ResultsOperative assessments were completed for 2457 cases by 85 attendings and 86 trainees, totaling 4615 unique operative assessment ratings. Attendings included dictated feedback in 52% of assessments. Senior-level residents received more assessments than junior-level residents (postgraduate year [PGY]1-3, n = 439; PGY4-5, n = 551). Performance ratings demonstrated increases from junior to senior trainees for both resident and fellow cohorts with “performance-ready” or “exceptional performance” ratings increasing by nearly two-fold for PGY1 to PGY5 residents (28.1% vs 40.6%), and from first- to second-year fellows (PGY6, 46.7%; PGY7, 60.3%). Similar gains in autonomy were demonstrated as trainees progressed through training. Senior residents were more frequently granted autonomy with “supervision only” than junior residents (PGY1, 8.7%; PGY5, 21.6%). “Supervision only” autonomy ratings were granted to 21.8% of graduating fellows. Assessment data included a greater proportion of complex cases for senior compared with junior fellows (PGY6, 20.9% vs PGY7, 26.5%). Program Directors felt that faculty and trainee buy-in were the main barriers to implementation of the SIMPL assessment app. ConclusionsThis is the first description of the SIMPL app as an operative assessment tool within vascular surgery that has been successfully implemented in both residency and fellowship programs. The assessment data demonstrates expected progressive gains in trainees’ autonomy and performance, as well as increasing case complexity, across PGY years. Given the selection of SIMPL as the assessment platform for required American Board of Surgery and Vascular Surgery Board Entrustable Professional Activities assessments, understanding facilitators and barriers to implementation of workplace-based assessments using this app is imperative, particularly as we move toward competency-based medical education.

How to phase II: Timelines, perceptions, and suggestions from PGY-1 residency program directors

BackgroundPhase II was implemented in 2016 to provide structure for applicants and unmatched residency pharmacy programs to interact. Previous literature has provided some approaches for this process; however, clarification on navigating the phase II process to successfully match for applicants and their mentors is still needed. In addition, with phase II occurring for >6 years, there is a need for continual evaluation. ObjectivesThe objectives were to describe (1) program phase II structure and timelines, (2) program personnel demand, and (3) perceptions of and suggestions for phase II from postgraduate year (PGY)1 residency program directors (RPDs) to provide clarity to applicants, mentors, and residency stakeholders. MethodsA 31-item survey was developed including 9 demographic items, 13 program-specific timeline-based items, 5 skip-logic items on screening interviews, and 4 qualitative questions on the benefits, drawbacks, and suggested changes to phase II. The survey was disseminated to PGY-1 RPDs participating in phase II with available contact information in June 2021 and May 2022, with 3 weekly reminders. ResultsThe survey was completed by 180 of the 484 RPDs participating in phase II (37.2% response rate). Programs participating in the survey had an average of 1.4 positions (± 0.7) open in phase II and 31 applicants (± 31) per open position. The timelines for screening applications, contacting applicants, and conducting interviews were variable. For qualitative data, RPDs appreciated the structured process and noted high-quality and geographic diversity of applicants in phase II. However, challenges reported were the quantity of applications, lack of time to fully review applications, and technical issues. Suggested changes included an extended phase II timeline, universal application deadline, and technical improvements. ConclusionThe structured approach of phase II was an improvement compared with historical approaches; however, variability exists in timelines for programs. Respondents identified further opportunities to refine phase II to benefit residency stakeholders.

Factors Influencing the Decision to Pursue Multiple Fellowships Following Graduation from Orthopaedic Surgery Residency

Among practicing orthopaedic surgeons, the population that self-identify as generalists has been declining for the past three decades, while sub-specialization has become more prevalent. As more residents are pursuing fellowship training, some elect to complete multiple fellowships, but due to a lack of research, there is a lack of insight into the reasons behind these decisions. The purpose of this study was to determine factors influencing the decision of orthopaedic surgery residents to pursue more than one fellowship following graduation from residency. An anonymous survey was distributed via email to all PGY-4 and PGY-5 orthopaedic surgery residents who had matched into one or more fellowships in the spring of 2021 and 2022. Responses were analyzed to determine the prevalence of different specialties, reasons for pursuing fellowship, and among those pursuing more than one fellowship, the reasons they chose to do so. 259 responses were collected from residents entering a fellowship, with 74 (28.6%) entering fellowships in the Midwest, 54 (20.8%) in the Southwest, 51 (19.7%) in the Northeast, 42 (16.2%) in the Southwest, and 32 (12.4%) in the West. 19 (7.3%) respondents reported matching into two or more fellowships. Among the fellowships pursued, sports medicine was most popular with 10 (52.6%) respondents; followed by shoulder/elbow (5; 26.3%). Out of all 259 respondents, 252 (97.3%) indicated their fellowship choices were based on interest, and 192 (74.1%) were also affected by marketability. Mentorship played a role for 173 (66.8%) and training in an area of deficiency was important for 149 (57.5%). Among those pursuing multiple fellowships, many combinations seem to have been made to decrease the time to breaking even on the financial investment involved in pursuing fellowships after residency. Most orthopaedic surgery residents elect to pursue fellowship training due to personal interest in the field, as well as to increase their marketability, and shorten the time to breaking even in comparison to the loss of compensation required for pursuing fellowship. Our results indicate that residents pursuing multiple fellowships are those interested in less marketable specialties, who then pursue a second fellowship with higher returns on investment, such as completing fellowships in pediatrics and sports medicine.

Addressing the Gender Gap in Residency Clinical Awards Using a Structured Blinded Selection Process (P6-2.002)

<h3>Objective:</h3> To determine the effect of changing the criteria from faculty vote to a blinded clinical case report on reducing bias in a neurology resident award. <h3>Background:</h3> Women are under-represented in the field of Neurology, especially at the leadership level. Awards can play an important role in career advancement. In the absence of a well-designed process for identifying award winners, there is a risk that the demographics of awardees will reflect those of voters. We hypothesized that a blinded merit-based approach for a junior neurology resident award could reduce bias and result a more balanced gender-profile for awardees. <h3>Design/Methods:</h3> In our program, an annual named award is given to PGY-2 residents who exemplify clinical excellence. From 2003–2018 this award was determined by votes from clinical faculty. In 2019 the award changed to a submitted case report that was independently reviewed by 5 faculty, using a structured scoring rubric. Committee members were blinded to the identity of the submitting resident. We compiled gender data for clinical faculty, residents, and award recipients from 2003 to 2022 and compared recipient gender profiles before and after the change. <h3>Results:</h3> From 2003–2018, 12/16 (75%) of award winners were male, more closely reflecting the gender distribution of voting faculty (77.9% male) than resident demographics (55.3% male). After the change in selection criteria, 0/8 winners were male (p&lt;0.001). The proportion of male residents was significantly lower in 2019–22 (37.5% vs 55.3%, p=0.02), which could partially account for the decrease in male award winners. <h3>Conclusions:</h3> Despite relatively small changes in the gender balance of faculty and residents there was a significant change in the gender balance of award winners when the process became blinded. Moving forward, utilizing a blinded process and more transparent selection criteria could lead to an increase in diversity of award winners in neurology residency programs. <b>Disclosure:</b> Dr. Lambert has nothing to disclose. Dr. Cooper has nothing to disclose. An immediate family member of Dr. Narula has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for abbot vascular. The institution of an immediate family member of Dr. Narula has received research support from Abbot Vascular Inc.. The institution of an immediate family member of Dr. Narula has received research support from US Food and Drug Administration . The institution of an immediate family member of Dr. Narula has received research support from Women’s Health Research at Yale. Dr. Moeller has received publishing royalties from a publication relating to health care.

Addressing Burnout Among Women Residents: Results from Focus Group Discussions.

Physician burnout has been described as more common among women than men. Even if there are no gender-based differences in prevalence, risk factors, such as work/home integration/conflict and gendered biases, likely differ. Prior administrations of an annual resident wellness survey at a single urban academic institution confirmed that rates of burnout were higher among women, especially during the PGY-2 year. A series of focus groups of PGY-3 women residents across specialties were organized in 2019 at a single urban academic medical center. Given the number of participants, demographics were not collected to maintain participant anonymity. The moderator for all groups used a discussion guide consisting of eight open-ended questions based on a review of the literature. Ten residents agreed to participate in one of four hour-long focus group discussions. While the residents identified some factors that were not gender-specific, they also discussed issues that they faced as women in medicine, including needing to work harder to prove themselves and unconscious gendered biases from faculty and patients. The residents thought that their well-being would be improved if their training programs better understood the experiences and needs of women residents and recommended a series of interventions, including improved mentoring and networking opportunities. Interventions to improve well-being need to consider gender-based differences. While mentoring and networking can help all residents, these may be especially useful for women and should be considered as a component of an overarching plan to improve diversity, equity, inclusion, and belonging.

Virtual fundamentals of laparoscopic surgery (FLS) boot-camp using telesimulation: an educational solution during the COVID-19 pandemic.

The Fundamentals of Laparoscopic Surgery (FLS) is an internationally recognized educational and certification program designed to teach the knowledge and skills required for basic laparoscopic surgery. Previously, our institution has organized an FLS boot-camp to teach PGY1 residents the FLS manual skills. During the COVID-19 pandemic, in-person sessions were not possible. The purpose of this study was to utilize telesimulation as an education solution for teaching FLS technical skills to PGY1 residents during the COVID-19 pandemic. A virtual FLS program was established. A complete, easily portable FLS kit was distributed to participantsand instructors to set up an FLS box and connect remotely using telesimulation. The program was delivered by three senior residents using the Zoom™ platform. Participants were split into groups of 3-4 individuals, each receiving three 1-h sessions. Sessions were structured with initial demonstration of tasks followed by individual coaching of participants in 'break-out' rooms. The official FLS exam was administered in-person on the 4th week. Pre- and post-course surveys were administered to participants gauging self-reported proficiency with FLS tasks and overall course feedback. Anonymized FLS exam results were collected. A total of 14 residents participated, and 11 responded to the survey. Participants reported that their overall FLS skills proficiency significantly improved on a 5-point likert scale from 1.5 ± 0.5 pre-course to 4.0 ± 0.5 post-course (mean ± SD). Participants unanimously stated that having the FLS box at home was valuable and enabled them to practice more. On the FLS exam, 13 of 14 participants passed the manual skills component. We developed a telesimulation hands-on FLS course as an alternative to in-person training. The course was practical and effective and was preferred to traditional methods by participants. With ever-expanding technological solutions, virtual telesimulation education is an attractive and underutilized tool, not only in the setting of COVID-19, but also more broadly across current educational programs.

Does Inclusion of Emergency Medicine (EM) Residents in ECG Screening for STEMI Change the Time to Catheterization Lab Activation?

Emergency medicine physicians must rapidly obtain and interpret an electrocardiogram (ECG) to quickly identify life-threatening cardiac emergencies such as ST-elevation myocardial infarction (STEMI). Although ECG interpretation is a critical component of residency education, few high-powered studies exploring the accuracy of resident ECG interpretation exist. This study aims to evaluate whether or not the inclusion of Third Year Emergency Medicine Resident ECG interpretations is noninferior to attending-only ECG interpretations in regard to time to STEMI activation. This was a retrospective noninferiority study of STEMI activation times before and after the inclusion of Third Year Emergency Medicine Resident resident ECG interpretations into the workflow at an academic, urban tertiary care center between November 2020 and April 2022, excluding prehospital activations. The primary outcome was the proportion of successful STEMI activations initiated within 5 minutes of ECG completion. An absolute decrease of 10% between groups was chosen as the noninferiority margin. In the attending-only group, 26 (66.7%) cases resulted in successful STEMI activations compared to 31 cases (77.5%) in the combined group. The proportion of successful STEMI activations did not differ with resident screening, X 2 = 1.15, P = 0.28. The absolute difference between groups' successful activations was an increase of 11%, which lies within the noninferiority margin (+11%, 95% confidence interval, -8.68% to 30.7%). Average times to STEMI activation in the attending-only and combined groups were 7.59 minutes (Standard Deviation [SD], 10.19) and 5.13 minutes (SD, 6.95), respectively. Average door-to-balloon times for those undergoing Percutaneous Coronary Intervention were 72.74 minutes (SD, 20.76) in the attending-only group and 89.90 minutes (SD, 67.74) in the combination group. Two sample t-test showed no statistically significant difference between the 2 groups for average time to STEMI activation (difference = 2.46 minutes, 95% CI, -1.46 to 6.38) and average door-to-balloon time (difference = 17.16, 95% CI, -39.73 to 5.41). The inclusion of emergency medicine PGY-3 residents in the ECG screening workflow is noninferior to attending-only interpretation of ECGs with regard to STEMI activation time.

Resident Visit Productivity and Attitudes About Continuity According to 3 Versus 4 Years of Training in Family Medicine: A Length of Training Study.

Training models in the Length of Training Pilot (LOTP) vary. How innovations in training length affect patient visits and resident perceptions of continuity is unknown. We analyzed resident in-person patient encounters (2013-2014 through 2018-2019) for each postgraduate year (PGY) and total visits at graduation derived from the Accreditation Council for Graduate Medical Education reports for each LOTP program. We collected data on residents' perceptions of continuity from annual surveys (2015-2019). We analyzed continuous variables using independent samples t tests with unequal variance and categorical variables using χ2 tests in comparing 3-year (3YR) versus 4-year (4YR) programs. PGY-1 and PGY-2 residents in 4YR programs saw statistically more patients than their counterparts in 3YR programs. In PGY3, 3YR program residents had statistically higher visit volume compared to 4YR program residents. Visits conducted in PGY4 ranged from 832 to 884. The additional year of training resulted in approximately 1,000 more total patient visits. Most residents in 3YR and 4YR programs rated their continuity clinic experience as somewhat or very adequate (range 86.3% to 93.7%), which did not statistically differ according to length of training. Resident visits were significantly different at each PGY level when comparing 3YR and 4YR programs in the LOTP and the additional year of training resulted in about 1,000 more total visits. Resident perspectives on the adequacy of their continuity clinic experience appeared to not be affected by length of training. Future research should explore how the volume of patient visits performed in residency affects scope of practice and clinical preparedness.

Acute Exacerbation of COPD.

This case is targeted to emergency medicine residents of all levels. Shortness of breath (SOB) is one of the top ten most common chief complaints seen in the Emergency Department, accounting for close to 10% of presenting complaints.1 An acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a frequent culprit, accounting for roughly 15.4 million visits and 730,000 hospitalizations per year.2 The diagnosis of treatment of mild to moderate AECOPD can be relatively uncomplicated; however, multiple factors can increase the complexity of management and pose additional challenges that the emergency physician (EP) must be prepared for. Severe AECOPD can necessitate the need for both Non-invasive positive pressure ventilator (NIPPV) such as bi-level positive airway pressure (BiPAP) as well as emergent intubation. Furthermore, managing the ventilator settings in patients with an AECOPD is far from routine, requiring an intricate understanding of pulmonary physiology.3. By the end of this simulation, learners will be able to (1) assess for causes of severe shortness of breath, (2) manage severe COPD exacerbation by administering appropriate medications, (3) identify worsening clinical status and initiate NIPPV, (4) assess the causes of hypoxia after establishing endotracheal intubation and, (5) identify indication for needle decompression and perform chest tube thoracostomy. This simulation was conducted with a high-fidelity mannequin with a separate low fidelity chest tube mannequin that allowed for hands-on practice placing a chest tube. A total of 16 PGY-1 residents participated in the simulated patient encounter. Following the simulation and debrief session, all residents were sent a Likert scale survey via surveymonkey.com to assess the educational quality of the simulation. The survey contained the following questions; 1) Overall, this simulation was realistic and could represent a patient presentation in the Emergency Department, 2) Overall, the case contained complexity that challenged me as a learner, 3) This case helped to expand my medical knowledge, 4) I feel more confident in diagnosing and treating AECOPD, 5) I feel more confident in recognizing the indications for NIPPV and intubation, 6) This simulation offered an opportunity to improve my procedural skills, 7) I feel more confident in setting up the ventilator, 8) I feel more confident in addressing ventilator alarms. Following the simulation and debrief session, all the participants (n=16), were provided a survey to assess the educational quality of the simulation. There were a total of 12 respondents and a hundred percent of them agreed or strongly agreed that the case contained complexity that challenged them. All of the respondents agreed that the simulation case was realistic and that the case helped expand their medical knowledge. Furthermore, all the learners agreed or strongly agreed that the case helped them in improving their procedural skills. This case combines a mixture of high fidelity and medium fidelity components to encompass both clinical knowledge and procedural skills. This case is effective in expanding beyond the basic approach to managing an AECOPD patient and forces learners to address clinical deterioration, escalate airway interventions, manage ventilator settings, and address ventilator alarms, including placement of a chest tube. Residents commented that this case was very realistic and particularly challenging because it highlighted gaps in their clinical knowledge and procedural skills. Residents were most challenged by identifying when to escalate care as well as how to manage ventilator settings in AECOPD patients. Acute exacerbation COPD, intubation, positive pressure ventilation, ventilator alarms, chest tube thoracostomy.

Predicting Resident Competence for Otolaryngology Key Indicator Procedures.

Competency-based surgical education requires practical assessments and meaningful benchmarks. In otolaryngology, key indicator procedure (KIP) minima are indicators of surgical exposure during training, yet it remains unknown how many times trainees must be evaluated on KIPs to ensure operative competence. Herein, we used Bayesian mixed effects models to compute predicted performance expectations for KIPs. From November 2017 to September 2021, a smartphone application (SIMPL OR) was used by attendings at five otolaryngology training programs to rate resident operative performance after each case on a five-level scale. Bayesian mixed effects models were used to estimate the probability that postgraduate year (PGY) 3, 4, or 5 trainees would earn a "practice-ready" (PR) rating on a subsequent evaluation based on their previously earned PR ratings for each KIP. Probabilities of earning a subsequent PR rating were examined for interpretability, and cross-validation was used to assess predictive validity. A total of 842 assessments of KIPs were submitted by 72 attendings for 92 residents PGY 2-5. The predictive model had an average Area Under the Receiver Operating Curve of 0.77. The number of prior PR ratings that senior residents needed to attain a 95% probability of earning a PR rating on a subsequent evaluation was estimated for each KIP. For example, for mastoidectomies, PGY4 residents needed to earn 10 PR ratings whereas PGY5 residents needed 4 PR ratings on average to have a 95% probability of attaining a PR rating on a subsequent evaluation. Predictive modeling can inform assessment benchmarks for competency-based surgical education. NA Laryngoscope, 133:3341-3345, 2023.

A Video Teaching Tool Is Effective for Training Residents in Hip Arthroplasty Templating.

Work hour restrictions imposed on orthopedic surgery residents since the early 2000s have reduced educational opportunities at the workplace and encouraged alternative strategies for teaching outside the clinical setting. Preoperative templating is essential for safe and effective total hip arthroplasty (THA) and is accurate in predicting final implants. We sought to determine the effectiveness of a video tool for teaching orthopedic residents basic THA templating skills. We developed a video-based teaching tool with instructions on proper THA templating techniques. Ten cases were selected for testing, after excluding patients with severe hip deformities and poor-quality radiographsand only retaining those with concordance betweentemplating by the senior authors and implanted components. The study subjects included three postgraduate year 1 (PGY-1), three PGY-2, and three PGY-5 residents, and three adult reconstruction fellows (PGY-6). Templating skills were assessed before and after watching the instructional video. The evaluation included the size and positioning of femoral and acetabular components, as well as the restoration of leg length. Each templating session was repeated twice. Variance was measured to evaluate consistency in measurements. A linear mixed model and F-test were used for statisticalanalyses. The number of years in training significantly affected performance prior to exposure to the instructional video. Post-exposure, there was a significant improvement in the accuracy of sizing and positioning of acetabular and femoral components for PGY-1, PGY-2, and PGY-5 residents. The results achieved were comparable to PGY-6 examiners, who did not gain substantial performance benefits from the instructional video. Limb length restoration was less affected byexperience or exposure to the video. Component positioning and sizing, as well as leg lengthdiscrepancy (LLD), showed a significant decrease in variance after the intervention in all study groups. Video learning is reliable in teaching invaluable skills to orthopedic surgery residentswithout encroaching on work hours. We conceived a concise video to train orthopedic residentsto perform THA templating with proper technique and demonstrated its efficiency andreproducibility.

A Snapshot on Oral and Maxillofacial Surgery Resident Scholarly Activity: Can We Do Better?

The Commission on Dental Accreditation (CODA) requires oral and maxillofacial surgery (OMS) residents to engage in scholarly activity. Currently, it is unknown how this mandate translates into research output. The purpose of this study was to quantify the research output of OMS residents. In addition, we sought to identify characteristics associated with resident productivity. This was a cross-sectional study of all OMS residents during the 2021-2022 academic year. Attempts were made to obtain resident rosters from every CODA-accredited OMS program. Resident names were searched in PubMed (https://pubmed.ncbi.nlm.nih.gov/) to identify peer-reviewed publications. Postgraduate year (PGY), program name, and total publication count during residency were recorded for each resident. Academic status and fellowship affiliation of the residency program were also included. The primary predictor was PGY level of each resident. The main outcome variable was the publication count of each OMS resident during the 2021-2022 academic year. The covariates were the academic status and the fellowship affiliation of the residency program. A program was determined academic if they were associated with a dental or medical school. Aprogram was determined fellowship associated if they had any CODA approved fellowship. Simple bivariate comparisons were performed using Wilcoxon signed-rank tests. Complete resident rosters were identified for 87 residency programs. One thousand one hundred thirty two residents were queried and a total of 548 peer-reviewed publications were identified. There was a mean of 6.30 publications per program and 0.43 publications per resident. More than half of all residents had no identifiable publication. PGY5 residents averaged the most publications per resident (1.45) followed by PGY6 (1.04) and PGY4 (0.63). Academic programs had significantly more publications per resident than nonacademic programs (median of 3.00 vs 0.00, P=.02). Programs with a fellowship association also had more publications per resident (median of 5.00 vs 2.00, P<.01). Current CODA research requirements do not translate into resident publications. Publication counts appeared to slightly increase with PGY level; however, OMS resident productivity still lags far behind that of other surgical subspecialties.

The Impact of the Virtual Interview on Candidate Experience and Outcomes: Society of Academic Urologists National Survey of Interns Who Participated in the 2020-2021 Urology Match

To examine retrospective experiences with the virtual interview (VI) process among postgraduate year 1 (PGY1) urology residents who participated in the 2020-2021 American Urologic Association (AUA) Match cycle. A 27-question survey created by a Society of Academic Urologists Taskforce on VI was distributed to PGY1 residents from 105 institutions between February 1, 2022 and March 7, 2022. The survey asked respondents to reflect on the VI process, cost concerns, and how experiences at their current program aligned with prior VI representation. A total of 116 PGY-1 residents completed the survey. The majority felt the VI represented the following domains well: (1) institution/program culture and strengths (74%), (2) representation of all faculty/disciplines (74%), (3) resident quality of life (62%), (4) personal fit (66%), (5) quality of surgical training and volume (63%), and (6) opportunities to meet residents (60%). Approximately 71% of respondents did not match at their home program or a program they visited in-person. Within this cohort, 13% agreed important aspects of their current program were not translated virtually, and they would not have prioritized the program had they been able to visit in-person. In total, 61% ranked programs they ordinarily might not have listed during an in-person interview season. Overall, 25% deemed financial costs a "very important" consideration during the VI process. The majority of PGY1 urology residents reported key components of their current program translated well from the VI process. This platform offers a method of overcoming conventional geographic and financial barriers associated with the in-person interview process.

Integrating Surgical Palliative Care Into the Full Spectrum of Medical Education.

We describe our institutional approach to incorporating surgical palliative care education into the Undergraduate Medical Education, Graduate Medical Education and Continuing Medical Education spaces as a model to help guide similarly interested educators. We had a well-established Ethics and Professionalism Curriculum, but an educational needs assessment revealed that both the residents and faculty felt that additional training in palliative care principles was crucial. We describe our full spectrum palliative care curriculum, which begins with the medical students on their surgical clerkship and continues with a 4week surgical palliative care rotation for categorical general surgery PGY-1 residents, as well as a Mastering Tough Conversations course over several months at the end of the first year. Surgical Critical Care rotations, Intensive Care Unit debriefs after major complications, deaths, and other high-stress events are described, as is the CME domain, which includes routine Department of Surgery Death Rounds and a focus on palliative care concepts in Departmental Morbidity and Mortality conference. The Peer Support program and Surgical Palliative Care Journal Club round out our current educational endeavor. We describe our plans to create a full spectrum surgical palliative care curriculum that is fully integrated with the 5 clinical years of surgical residency, and include our proposed educational goals and year-specific objectives. The development of a Surgical Palliative Care Service is also described.