PGY-1 Residents Research Articles

Orthopedic Resident Intern Foundations: A Cross-Institutional, Month-Long Skills Training Boot Camp for PGY-1 Residents.

Orthopedic residents are tasked with rapidly acquiring clinical and surgical skills, especially during their PGY-1 year. However, resource constraints and other factors frequently cause skills training to fall short of established guidelines. We aimed to design and evaluate a cross-institutional, month-long curriculum aimed at pooling resources to optimize training. The O.R.I.F. (Orthopaedic Resident Intern Foundations) Boot Camp was created to teach foundational residency skills and knowledge through daily didactic and simulation-based training covering 6 domains: orthopedic knowledge, orthopedic skills, nonorthopedic clinical knowledge (e.g. radiology), day-to-day hospital tasks, academic research, and social aspects of medicine. Content was based on ACGME milestones and core competencies. The program ran 8 hours each weekday throughout November 2022 and 2023. Before and after the curriculum, participants were administered a 65-question orthopedic knowledge assessment and self-reported competency surveys. Additionally, graduates from the O.R.I.F. 2022 class and a cohort of peer residents from nonparticipating institutions were administered a follow-up survey 1 year after Boot Camp. Comparative testing was performed using Wilcoxon signed-rank analysis (α = 0.05). The curriculum was hosted at a Level 1 urban trauma center. Over the study period 40 residents from the Chicagoland institutions participated in Bootcamp: 25 PGY-1 residents from 5 programs in 2022 and15 residents from 3 programs in 2023. Orthopedic assessment scores increased from 45.7 (SD = 8.3) precurriculum to 60.1 (SD = 7.6) postcurriculum (p < 0.001). Additionally, self-rated competence increased in 5/6 domains-all except the social aspects of medicine. One year after O.R.I.F. 2022, a higher proportion of graduates reporting that skills training provided good or very good preparation for intern year and allowed them to network with peers at other institutions compared to non-Boot Camp residents. The O.R.I.F. Boot Camp improves PGY-1 clinical knowledge and skills in a resource-efficient model while also providing an environment that cultivates cross-institutional camaraderie.

Non-cadaveric spine surgery simulator training in neurosurgical residency

BackgroundSpine surgical training faces increasing challenges due to restricted working hours and greater subspecialization. Modern simulators offer a promising approach to teaching both simple and complex spinal procedures. This study evaluated the acceptance and efficacy of spine simulator training using a lumbar herniated disc model tested by 16 neurosurgical residents (PGY-1-6), and compared 3D and 2D teaching methods. MethodsSixteen residents utilized the Realists RealSpine L4/L5 disc simulator with both microscope and exoscope. A mixed-methods analysis assessed the efficacy and acceptance of the training. Six PGY-1 residents participated in a learning curve study, divided into exoscopic and microscopic cohorts. Each group watched a tutorial in either 3D or 2D, followed by three surgical sessions. Endpoints included surgical progress within 30 minutes and complication rates. Microsurgical skills and mental concepts were evaluated on a numeric Likert Scale. ResultsParticipants rated the simulator training favorably, with a median score of 8/10 across six categories. The learning curve study showed a 30% improvement in microsurgical performance. The completion rate of herniated disc removal increased from 50% at T2 to 100% at T3 and T4. Significant improvement in mental concept was observed (p=0.035), with slightly better consolidation in the exoscope group. Self-assessments revealed significantly improved skills across all participants. ConclusionSpine simulator training was well-received and resulted in improvements in both mental concept and microsurgical performance, with enhanced outcomes in the 3D teaching/exoscope group. This study supports the integration of spine simulators into spine surgical residency, particularly for early-stage training, to improve both cognitive and practical surgical skills.

Effects of opening a vertical care area on emergency medicine resident clinical experience.

Challenging clinical environments faced by emergency departments (EDs) have led to operational changes including implementation of vertical care units and fast-track units. Little is known regarding the impact of such units on resident physician clinical education. A retrospective, observational study was performed at an urban quaternary care ED evaluating the effect of opening a vertical care unit with a triage physician directing lower acuity patients to be seen by physician associates (PAs)/advanced practice registered nurses (APRNs) on the following parameters: (1) percentage of patients seen by residents, (2) Emergency Severity Index (ESI) of patients seen by residents, (3) number of procedures performed by residents, (4) number of patients per shift seen by residents, (5) percentage of critical care patients seen by residents, and (6) percentage of behavioral health patients seen by residents. Comparing the implementation of the vertical care unit to the prior 3 months, postgraduate year (PGY)-1 residents had greater exposure to ESI Levels 1 and 2 (odds ratio [OR] 2.15) and more critical care (OR 2.58). PGY-2 and PGY-3 residents had a lower exposure to ESI 1 and 2 patients (PGY-2 OR 0.63, PGY-3 OR 0.61) and less critical care exposure (OR 0.64 for PGY-2 and OR 0.62 for PGY-3) after implementation. PGY-1 residents saw fewer behavioral health patients (OR 0.65) while the other two classes saw more (PGY-2 OR 1.64, PGY-3 OR 2.74). ESI 4 and 5 exposure decreased for all classes (PGY-1 OR 0.15, PGY-2 OR 0.86, PGY-3 OR 0.72). No significant difference was found in the proportion of patients treated by residents (p = 0.85) or the number of procedures performed by residents (p = 0.25) comparing the implementation of a vertical care unit to the prior 3 months. This study suggests no detrimental effects of vertical care unit implementation on multiple resident education outcomes including the number and acuity level of patients seen as well as procedure numbers of resident trainees. While the outcomes measured did not show significant negative effect for the resident compliment as a whole, we noted changes to the distribution of patient acuity based on PGY level. Similar assessments are recommended to determine the educational impact of comparable operational changes in other EDs.

Simulation-Based Resuscitative Transesophageal Echocardiography Training for Emergency Medicine Residents

BackgroundTransesophageal echocardiography (TEE) is an emerging resuscitation tool in emergency medicine. Simulation-based training is necessary for teaching this skillset. There has been no evaluation of how simulation prepares emergency medicine (EM) residents to perform this skill in live patients. ObjectivesThe objective of this study is to evaluate competency following simulation training and performance of resuscitative TEE on live patients in the operating room (OR). MethodsA prospective study at a single academic site, enrolling volunteer PGY2 and PGY3 EM residents. Residents underwent the following: Pre-test examination to assess general TEE knowledge; 30-minute lecture on a resuscitative protocol: mid-esophageal four chamber (ME4C), mid-esophageal long axis (MELAX), trans-gastric short axis (TGSAX) and ascending aortic short axis (AscAoSAX); Two 1-hour sessions with a HeartWorks TEE simulator led by a physician trained in resuscitative TEE; Post-test examination; TEE examination in the OR with a cardiac anesthesiologist. Data were summarized with descriptive statistics. Test scores were compared with paired t-test or Wilcoxon rank-sum tests. ResultsFifteen residents participated. The pre-test mean score was 11.07, 95% CI: 9.35 – 12.79. The post-test mean score was 19.40, 95% CI: 18.94 – 19.86. A significant difference in scores was noted, t=-11.996, p<0.0001. The OR assessment findings included: number of placement attempts (mean: 1.27; 95% CI: 1.01 – 1.52); clinically acceptable views (ME4C 93.3%, MELAX 93.3%, AscAoSAX 60%, and TGSAX 60%). Of 60 total views, 76.7% were acceptable. ConclusionsSimulation training in resuscitative TEE is an effective method for preparing EM residents to obtain and interpret TEE imaging in a live patient.

59 Enhancing career development in paediatrics residency: A needs assessment

Abstract Background Mentorship is a cornerstone of professional growth within medical training, yet the role of formal mentorship in career advising for medical residents remains understudied. In 2020, our Paediatrics Residency program introduced the role of faculty advisors as part of the Competence by Design framework, with a mission to guide academic growth, professional development, and excellence in patient care. However, it is unclear to what extent career advising is occurring in this advisor-advisee relationship. Objectives The primary aim of this study was to complete a needs assessment for Paediatric residents to inform faculty advisor roles and responsibilities and effectively support paediatric residents in their career development. This included examination of the current state, identification of the ideal state, followed by a gap analysis and recommendations to create a comprehensive advising program. Design/Methods This study utilized a mixed methods approach, using quantitative and qualitative survey methodologies. The survey questions (n=20) were designed from background literature and pilot testing. An anonymous survey was administered through the Qualtrics platform to the Paediatrics residents (n=59). The protocol was submitted for REB review and was granted an exemption as a quality improvement project. Thematic analysis of the qualitative content was completed by two investigators, utilizing the Braun &amp; Clarke six-phase framework. Results The response rate for the survey reached 34% (n=20) with the final sample including 16% PGY1, 42% PGY2, 16% PGY3, and 26% PGY4 residents. Alarmingly, most residents (63%) did not have a well-defined plan for monitoring career goals. No residents claimed to have sufficient career mentorship at present (0%), with majority (84%) expressing their interest in regular career planning sessions. A significant proportion (79%) also underscored the importance of considering life context when setting career goals. Our thematic analysis revealed that career advising currently follows a non-formal, self-initiated process, with time constraints as the primary obstacle. Primary themes elicited emphasized career exploration (n=15), networking (n=7) including discussions around life context (n=6), mentorship (n=6), and advisor role clarity (n=6). Conclusion Our findings affirm a compelling need for enhanced career development within our Paediatrics Residency program. In response, we propose a multi-faceted approach advocating for structured formal career development. This entails scheduled information sessions, resident goal setting, and formal mentorship. We recommend creating opportunities for networking to enable personalized career development considerations. Exploring an adjunctive role to faculty advisors may be necessary to ensure the success of these recommendations in optimizing resident career education.

The future of AI clinicians: assessing the modern standard of chatbots and their approach to diagnostic uncertainty

BackgroundArtificial intelligence (AI) chatbots have demonstrated proficiency in structured knowledge assessments; however, there is limited research on their performance in scenarios involving diagnostic uncertainty, which requires careful interpretation and complex decision-making. This study aims to evaluate the efficacy of AI chatbots, GPT-4o and Claude-3, in addressing medical scenarios characterized by diagnostic uncertainty relative to Family Medicine residents.MethodsQuestions with diagnostic uncertainty were extracted from the Progress Tests administered by the Department of Family and Community Medicine at the University of Toronto between 2022 and 2023. Diagnostic uncertainty questions were defined as those presenting clinical scenarios where symptoms, clinical findings, and patient histories do not converge on a definitive diagnosis, necessitating nuanced diagnostic reasoning and differential diagnosis. These questions were administered to a cohort of 320 Family Medicine residents in their first (PGY-1) and second (PGY-2) postgraduate years and inputted into GPT-4o and Claude-3. Errors were categorized into statistical, information, and logical errors. Statistical analyses were conducted using a binomial generalized estimating equation model, paired t-tests, and chi-squared tests.ResultsCompared to the residents, both chatbots scored lower on diagnostic uncertainty questions (p < 0.01). PGY-1 residents achieved a correctness rate of 61.1% (95% CI: 58.4–63.7), and PGY-2 residents achieved 63.3% (95% CI: 60.7–66.1). In contrast, Claude-3 correctly answered 57.7% (n = 52/90) of questions, and GPT-4o correctly answered 53.3% (n = 48/90). Claude-3 had a longer mean response time (24.0 s, 95% CI: 21.0-32.5 vs. 12.4 s, 95% CI: 9.3–15.3; p < 0.01) and produced longer answers (2001 characters, 95% CI: 1845–2212 vs. 1596 characters, 95% CI: 1395–1705; p < 0.01) compared to GPT-4o. Most errors by GPT-4o were logical errors (62.5%).ConclusionsWhile AI chatbots like GPT-4o and Claude-3 demonstrate potential in handling structured medical knowledge, their performance in scenarios involving diagnostic uncertainty remains suboptimal compared to human residents.

Internal Medicine Residents' Confidence and Preferences in Hospital Medicine Competencies: A Multi-Site Study.

Hospital medicine (HM) is an important career option for internal medicine (IM) residency graduates. Limited data exist regarding preferences and educational gaps in HM competencies among IM residents. To assess resident confidence and desire for additional instruction in HM competencies across a broad spectrum of residents. A multi-center survey-based assessment of IM resident confidence and desire for additional instruction in published HM competencies. PGY-1 through PGY-4 residents from eight US IM residency programs, including academic medical center (AMC) and community-based programs (CBPs). Resident confidence and desire for more teaching in HM competency domains including procedures, point-of-care ultrasound (POCUS), system-level competencies, clinical skills, patient-level competencies, palliative care, and care transitions. We received survey responses from 272 of 594 (46%) residents. More than half of respondents envisioned a future HM position. Results demonstrated lower than expected confidence for all HM competencies surveyed. Confidence was lowest (30-36% confident) for procedures, POCUS, and system-level competencies, and highest (65-78%) in care transitions, patient-level competencies, and palliative care. Desire for more instruction was highest in the same competency domains rated with the lowest confidence. Junior residents (PGY-1 and PGY-2) reported significantly lower confidence levels than senior residents (PGY-3 and PGY-4) across all domains except patient-level competencies. Junior residents expressed a significantly higher desire than senior residents for more teaching in all domains. There were no significant differences in confidence or desire for more instruction between trainees who envision a future HM position versus those who do not. Residents from AMCs expressed significantly higher confidence than those from CBPs in POCUS, clinical skill, patient-level, palliative care, and care transitions, while residents from CBPs reported significantly higher confidence in procedures. Our data can inform targeted inpatient competencies and educational curricula for IM residents in the USA.

Prospective healthcare students' perspectives and attitudes on pharmacy as a chosen career path

BackgroundWith the national increase in the number of colleges and schools of pharmacy as well as the decreased pharmacy school applicant pool in recent years, pharmacy school enrollment challenges are at the forefront of issues facing pharmacy programs today. Factors that can influence a candidate's likelihood to pursue pharmacy school are important to evaluate. Recent studies assessing factors that motivate potential pre-health candidates to pursue pharmacy school or other healthcare careers are limited. ObjectiveTo describe prospective candidates' perspectives and attitudes toward pharmacy as a career pathway and assess factors that motivate or deter them from pursuing pharmacy as a career and from considering a specific pharmacy school. MethodThe study was cross-sectional and used an online data collection form distributed via the Qualtrics platform from October 4, 2022 through October 12, 2022 using the social media platform Reddit. Reddit has hundreds of subcommunities known as subreddits, that allow for exchange of ideas and discussion regarding various topics. This social media platform is commonly used by pre-health students to discuss career options. The survey consisted of 28 items and two domains, demographics and prospective healthcare students' understanding of responsibilities of pharmacists and their overall perspective on pharmacy as a profession. The survey was targeted toward anyone with an intention of pursuing a health science degree or career. ResultFour hundred participants completed the survey. Participants were mainly Caucasian, male, and with a mean age of 25 years. This study assessed prospective candidates' perspectives and attitudes toward pharmacy as a career pathway, appealing and unappealing characteristics about pursuing a career in the field of pharmacy, and factors that motivate or deter candidates from pursuing pharmacy. While 68 % of the participants had heard that career choices are vast and vary in the field of pharmacy, most still had concerns about the pharmacy field being heavily saturated and lack of job opportunities after graduation. Almost 60 % of responders gained information about pharmacy programs through social media platforms. The North American Pharmacist Licensure Examination pass rate, postgraduate residencies/fellowships, program duration and program reputation were among the top factors in choosing a pharmacy program. ConclusionMany survey participants had heard that there are a variety of job opportunities in the field of pharmacy, but the majority had heard that the pharmacy field is heavily saturated and that there are lack of opportunities after graduation. Most responders gained information through social media platforms. For prospective pharmacy school candidates, NAPLEX pass rate, number of graduates matched with PGY1 residencies and fellowships, and duration and reputation of the program seems to be among the most important factors in choosing a pharmacy program. Factors that prospective candidates consider when selecting a pharmacy program and the means they use to research about programs can be important considerations for pharmacy programs recruitment. Awareness of the preferences and baseline knowledge of candidates about the field of pharmacy can aid in developing targeted recruitment strategies and informing decision-making in pharmacy programs and recruitment efforts.

Video-Based Coaching for Laparoscopic Salpingectomy: A Randomized Controlled Trial.

To evaluate the effect of video-based coaching on the gynecology resident performance of laparoscopic salpingectomy. PGY-1 and PGY-2 residents were randomized before their gynecology rotations to standard gynecology curriculum (control group) or standard curriculum plus two video-coaching sessions by a fellowship-trained minimally invasive gynecologic surgeon (VBC group). Residents were video recorded intraoperatively performing three unilateral laparoscopic salpingectomies. Participants in the VBC group were coached between the procedures. The primary outcome was the improvement in modified GOALS (Global Operative Assessment of Laparoscopic Skills) and OSA-LS (Objective Structured Assessment of Laparoscopic Salpingectomy) scores, compared with baseline, in the VBC and control groups, with videos independently graded by three blinded minimally invasive gynecologic surgeons. A minimum sample size of 18 participants (nine per group) was needed to achieve 90% power to detect a difference of 5.0 points. From October 2021 to December 2022, 28 PGY-1 and PGY-2 residents completed the study with 14 participants per group. Baseline characteristics were similar between groups. In the VBC group, modified GOALS scores significantly improved by 3.0 points from video 1 to video 2 ( P =.04) and by 3.2 points from video 1 to video 3 ( P =.02). Modified OSA-LS scores also increased significantly in the VBC group, by 6.1 points from video 1 to video 3 ( P =.02). In the control group, modified GOALS and OSA-LS scores improved from baseline but were not significant ( P =.2, P =.5). Video-based coaching also enhanced resident comfort and confidence in performing laparoscopic surgery. Video-based coaching improves resident performance of laparoscopic salpingectomy and can be used as an adjunct to resident surgical training. ClinicalTrials.gov , NCT05103449.

A Palliative Care Curriculum May Promote Resident Self-Reflection and Address Moral Injury

IntroductionThere is a lack of formal palliative care education for surgical trainees, and the demanding nature of surgical training and exposure to challenging clinical scenarios can contribute to moral injury. We developed a palliative care curriculum to promote self-reflection, aiming to address moral injury in residents. MethodsFive 1-h palliative care sessions were delivered over the academic year to all post-graduate year (PGY) levels covering the following topics: personal awareness, delivering bad news, surgical palliation for cancer pathology, surgical palliation for noncancer pathology, and urgent palliative care. The curriculum focused on reflection and small group discussions. The Moral Injury Symptom Scale-Health Professional was administered to assess feelings of moral injury. Descriptive statistics, chi-squared analysis, and Mann–Whitney U-test were used to compare the demographics and survey responses. Results23 participants completed the preintervention survey, and 9 participants completed it postintervention. Over 50% of participants were PGY1 or PGY2 residents. Preintervention, 52% of participants reported feeling guilt over failing to save someone from being seriously injured or dying. 30% of participants reported that the feelings of guilt, shame, or distrust impaired their ability to function in relationships, at work, or other areas of life to at least a moderate degree. ConclusionsThe described palliative care curriculum accomplishes several goals as follows: it educates residents on palliative care topics, teaches communication tools, encourages self-reflection, and provides space for building peer relationships. The ease of implementation makes this curriculum applicable across various types of institutions, offering the potential to positively impact surgical training on a national scale.

Cross Sectional Survey of Ob/Gyn Residents’ Graduated Experience with Robotic Surgery

Study ObjectiveOb/Gyn resident experience with robotic gynecologic surgery has been evaluated at time of graduation, but no specific surgical procedures were identified to differentiate the experiences of residents at each level. This study proposes to determine which factors are correlated with more hands-on robotic surgery experience and resident satisfaction. DesignAn IRB-approved, 15-question survey was distributed electronically. 98 responses were received for a rate of 44%. Linear regression and ANOVA statistical analysis were performed. SettingCurrent residents at eight Ob/gyn residency programs in the US were surveyed. PatientsN/A InterventionsSurvey administration Measurement and Main ResultsThe majority of respondents were satisfied (48%) or had neutral feelings (20%) with regard to their robotic surgery experience. All respondents reported experience with uterine manipulation or bedside assisting by PGY2. Earliest experience performing hysterectomy was most common in PGY2 or PGY3.Seventy-six percent of PGY3 or PGY4 residents report operating on the console for some or all major robotic surgeries, with 69% having participated in greater than 20 robotic surgery cases during residency. Only exposure to MIGS faculty is significantly associated with high robotic surgery experience (p=.022).Overall satisfaction with robotic surgery experience increased significantly with higher level of participation (p<.0001), particularly operating at the console during some or most of the surgery; longitudinal experiences with hysterectomy, myomectomy, and salpingectomy/oophorectomy (p<.05); but not with solely bedside assisting or vaginal cuff closure. Factors limiting robotic console experience included case time constraints, lack of first assists, case complexity, and attending comfort. ConclusionsOb/Gyn resident satisfaction with training is significantly related to level and duration of robotic surgery participation. MIGS faculty contribute to more resident experience, and limiting factors include time constraints, case complexity and lack of first assists. These results can provide a framework for structuring resident training in robotic surgery.

The Impact of Fellowship Affiliation on Urogynecology Training in Obstetrics and Gynecology Residency

ObjectiveTo compare characteristics of Urogynecology training and number of “Incontinence and Pelvic Floor” cases logged between OB/GYN residencies affiliated and those not affiliated with Urogynecology fellowships. DesignA retrospective descriptive analysis was performed of OB/GYN residency programs, their Urogynecology training, and association with Urogynecology fellowship programs during the 2023-2024 academic year. Program websites for ACGME-accredited OB/GYN residency programs were reviewed to determine availability, timing, and length of Urogynecology training. ACGME data for “Incontinence and Pelvic Floor” cases were analyzed by training year and association with Urogynecology fellowship programs from the 2012-2013 to 2022-2023 academic year. Data was analyzed using SPSS. SettingThis research was conducted at Harbor-UCLA Medical Center. ParticipantsNone. InterventionsNone ResultsInformation was obtained for 85.9% of programs. Nearly all (97.0%) had dedicated Urogynecology rotations, and 64.4% had rotations in > 1 year of training. Association with Urogynecology fellowship did not affect the availability of Urogynecology training overall nor the overall number of rotations. Urogynecology rotations occurred most often in the third (PGY3) year of residency, though 43.6% of programs had training for junior (PGY1, PGY2) residents. Residencies with associated Urogynecology fellowships were more likely to have a rotation for PGY2 residents and for junior residents overall. From 2012-2023, the number of “Incontinence and Pelvic Floor” cases declined by 36.3%, with trainees at residencies not affiliated with Urogynecology fellowships logging more cases than those at a fellowship-affiliated residency. ConclusionWhile the majority of OB/GYN residencies have dedicated Urogynecology training, most rotations are for senior residents. Training programs associated with Urogynecology fellowships are more likely to expose junior residents to the field, but their trainees log fewer “Incontinence and Pelvic Floor” cases overall. Earlier exposure may enrich surgical training and help residents prepare for their career, whether in Urogynecology or as a generalist.

Team-Based Learning as a Feasible, Acceptable, and Effective Educational Method for Internal Medicine Trainees - A Multi-phase Intervention and Cohort Comparison.

Team-based learning (TBL) is an active learning strategy gaining traction in medical education. However, studies demonstrating successful incorporation into Graduate Medical Education (GME) curricula are limited. To assess the feasibility, acceptability and efficacy of Infectious Disease (ID) TBL sessions within an Internal Medicine (IM) residency curriculum as part of a traditional 60-minute conference. We conducted a prospective cohort study of TBL implementation assessing acceptability and feasibility (Phase 1), and efficacy (Phase 2). Phase 1 included 101 IM residents and eight TBL naïve faculty. Phase 2 included aggregate cohort IM In-Training Exam (ITE) data before (2008-2013) and after (2014-2019) TBL implementation. Eight TBL sessions were delivered once or twice weekly during 60-minute noon conferences. We assessed feasibility by measuring individual Readiness Assurance Test (iRAT) completion rates and inclusion of TBL elements in each session; acceptability through attendance, perceived effectiveness rating and attitudes about TBL; efficacy by comparing ITE data for the overall ID content and specific TBL associated learning objectives. Seventy-five of 93 (80%) residents attended at least one session. All TBL elements were successfully incorporated each session. Of those surveyed, 86% rated the TBL sessions as facilitating their learning "very (4)" or "extremely (5)" well on a 5-point Likert scale (p<0.001). ITE mean percent correct scores of total ID content as well as TBL associated learning objective performance were both significantly higher for the post-TBL cohort among PGY-2 (76.2 vs 62.3; 76.2 vs 62.6) and PGY-3 (73 vs 64.5; 76.2 vs 64.5) IM residents (p<0.05; p<0.001 respectively). Implementing a complete TBL pedagogy within the traditional noontime conference hour in GME is feasible, acceptable to residents and faculty, and associated with improved learning efficacy demonstrated through improved ITE scores.

Recent Trends and Challenges in Employment for Emergency Medicine Trainees: A Survey of Graduating Residents' Perspectives.

The landscape of the emergency medicine (EM) workforce has undergone significant changes recently, posing challenges for residents who are about to graduate from EM training programs. The objective of this study was to survey graduating residents' perceptions of the recent EM job market. We conducted a cross-sectional survey study involving EM residents from programs in New York and New Jersey between August 2021 and November 2021. The survey consisted of 12 multiple-choice questions that focused on graduating EM residents' perceptions of the EM job market, its impact on their job search, and their interest in pursuing fellowship training. During the study period, 436 survey results were collected from 26 EM residency programs. Of the 418 respondents, 233 (56%) expressed their intention to start their job search earlier than their counterparts in previous years, as highlighted by the survey. Among respondents, 141 (76%) postgraduate year (PGY)-2, 139 (79%) PGY-3, and 47 (85%) PGY-4 residents anticipated a challenging job search. Nearly 90% of respondents believed that the coronavirus disease 2019 pandemic would affect both academic and nonacademic medical centers in terms of job openings. A total of 248 (59%) were interested in pursuing a fellowship after residency. Most residents preferred job opportunities on the East and West Coasts of the United States. The findings highlight the increasing competitiveness and challenges residents face in securing their first job, the declining interest in pursuing fellowships as residents progress in their training, and the geographic preferences for job opportunities.

Do Interns Learn On-The-Job How to Obtain Proper Informed Consent for Surgical Procedures?

Obtaining surgical informed consent (SIC) is a critical skill most residents are expected to learn "on-the-job." This study sought to quantify the effect of 1 year of clinical experience on performance obtaining SIC in the absence of formal informed consent education. In this case-control cohort study, PGY1 and PGY2 surgical residents in an academic program were surveyed regarding their experiences and confidence in obtaining SIC; then assessed obtaining informed consent for a right hemicolectomy from a standardized patient. Single academic general surgery residency program in Buffalo, NY. Ten PGY1 and eight PGY2 general surgery residents were included in the study, after excluding residents with additional years of training. PGY2 residents had significantly more experience obtaining SIC compared to PGY1 residents (median response: ">50" vs "between 6 and 15," p = 0.001), however there was no difference in self-reported confidence in ability obtaining SIC (mean 3.2/5 in PGY1 vs 3.4/5 in PGY2, p = 0.61), self-reported knowledge of SIC (mean 3.1/5 in PGY1 vs 3.6/5 in PGY2, p = 0.15), performance on a test regarding SIC (mean score 9.0/20, SD 3.9 for PGY1 vs mean score 9.6/20, SD 3.5, t = 0.387, p = 0.739) or performance during a standardized patient interview (mean 11.2/20, SD 2.78 for PGY1 vs mean 11.4/20, SD 1.51 for PGY2, p = 0.87). In the interviews all residents addressed general risks (bleeding/infection), however both groups performed worse in addressing procedure-specific risks including anastomotic leak as risk for hemicolectomy. A year of clinical training between PGY1 to PGY2 did not improve performance in obtaining surgical informed consent when lacking formal education, despite self-confidence in their ability. A curriculum covering the content, delivery and assessment of informed consent should be initiated for residents upon arrival to surgical training.

Emergency medicine resident productivity during the SARS-CoV-2 disease 2019 (COVID-19) pandemic

BackgroundThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) pandemic disrupted medical education in many care settings, including the Emergency Department (ED). It is unclear what effects these changes have had on resident training and clinical productivity. ObjectiveThe purpose of this study is to determine Emergency Medicine (EM) resident productivity in the ED during the COVID-19 pandemic. MethodsThis was a retrospective observational study at an academic medical center with an EM residency program. Data were collected from the electronic medical record from 7/1/2017–10/31/2021. The primary outcome was patients per hour (PPH). Postgraduate year (PGY) 1 and 2 shifts were included. Analysis included descriptive statistics (mean ​± ​standard deviation), correlation testing, and multivariate linear regression. ResultsOverall, PGY1 residents saw fewer PPH than PGY2 residents (1.00 ​± ​0.12 vs 1.40 ​± ​0.13 ​PPH, p ​< ​0.001). During academic year (AY) 2019–2020, there was a trend towards lower resident productivity compared to pre-COVID (2017–2019) that was statistically significant at the PYG2 level (PGY1 0.96 ​± ​0.13, p ​= ​0.06; PGY2 1.31 ​± ​0.10 ​PPH, p ​= ​0.004). This difference resolved over the course of AY 2020–2021. Multivariate linear regression showed association of resident productivity with patient volume, month of residency, and year of residency. ConclusionThe period surrounding the COVID-19 pandemic showed a trend towards decreased resident productivity during AY 2019–2020, which proved transient and resolved during AY 2020–2021. Resident productivity was associated with both month of training and ED volume. Additional research is needed to describe the long-term effects on the training environment during COVID-19 on physician productivity.

Evaluating the Impact of Coaching Through the Transition to Residency.

Coaching has been proposed to support the transition to residency. Clarifying its impact will help define its value and best use. To explore the experiences of residents working with coaches through the residency transition. A cohort comparison survey compared experiences of a coached resident cohort with coaches to the prior, uncoached cohort. Post-graduate year (PGY)-2 residents in internal medicine, obstetrics and gynecology, emergency medicine, and pathology at a single academic center. Faculty trained as coaches had semi-structured meetings with graduating medical students and residents throughout the PGY-1year. An online anonymous survey assessed effects of coaching on measures of self-directed learning, professional development, program support and impact of coaching using existing scales (2-item Maslach Burnout Inventory, Brief Resilient Coping Scale, 2-item Connor-Davidson Resilience Scale, Stanford Professional Fulfillment Inventory), and novel measures adapted for this survey. Bivariate analyses (t-tests and chi-square tests) compared cohort responses. MANOVA assessed the effects of coaching, burnout and their interactions on the survey domains. Of 156 PGY2 residents, 86 (55%) completed the survey. More residents in the "un-coached" cohort reported burnout (69%) than the "coached" cohort (51%). Burnout was significantly and negatively associated (F = 3.97 (df 7, 75); p < .001) with the learning and professional development outcomes, while being coached was significantly and positively associated with those outcomes (F = 5.54 (df 9, 75); p < .001). Significant interaction effects were found for goal-setting attitudes, professional fulfillment, and perceived program career support such that the positive differences in these outcomes between coached and un-coached residents were greater among burned out residents. Coached residents reported a positive impact of coaching across many domains. Residents experiencing coaching reported better professional fulfillment and development outcomes, with more pronounced differences in trainees experiencing burnout. Coaching is a promising tool to support a fraught professional transition.

Integrated cardio-thoracic imaging curriculum for residents: Design, implementation, and analysis of test and evaluation results

As the field of cardiac imaging has demonstrated exceptional growth over the past several decades, radiology departments and residency programs have struggled to integrate cardiac imaging instruction into training curricula. PurposeTo create an integrated cardio-thoracic teaching and lecture curriculum and resident rotation in accordance with AGGME and Society of Thoracic Radiology (STR) guidelines. Materials and methodsConsecutive PGY-2 to PGY-4 residents (n = 14) rotating through our Cardiothoracic Imaging (CTI) section from 1/1/2021 to 04/18/2022 were give pre- and post- rotation tests of knowledge and feedback evaluations. Attending feedback of the curriculum was obtained at 3-months and 9-months post curriculum implementation. A Wilcxon test was used to evaluate differences in improvement between pre- and post- rotation resident feedback scores, test scores for thoracic and cardiac test questions in addition to attending feedback scores at 3 and 9-months post curriculum implementation. ResultsThe overall post-rotation scores in addition to thoracic only and cardiac only scores improved, with the difference between improved versus stable or decreased scores being statistically significant overall (P = 0.039) and for cardiac scores (P = 0.003), but not for thoracic scores (P = 0.22). The overall (P = 0.002), thoracic (P = 0.027), and cardiac (P = 0.026) resident feedback scores were significantly improved post-rotation. Similarly, the overall attending feedback scores significantly improved over time (P = 0.021). ConclusionAn integrated Cardio-thoracic Imaging teaching curriculum was well received by both residents and attendings with significant improvement in post rotation feedback scores by both groups. Moreover, residents demonstrated improved scores on knowledge tests post rotation.

Virtual Nephron: Evaluation of a Novel Virtual Reality Educational Tool

Recent technological advancements allowed the development of engaging technological tools. Using ASN funding from the ASN, we developed a 3D Virtual Reality (VR) physiology course entitledDiAL-Neph (Diuretic Action and eLectrolyte transport in the Nephron). We hereby present its evaluation. The study consisted of 2 parts: evaluation of knowledge gain, and qualitative evaluation of platform reception. Internal medicine PGY1 residents were randomly assigned into 2 groups: a VR group and a conventional group. Knowledge acquisition was assessed with a post-test administered at the end of the course and repeated within 6 to 12 weeks. Independent t-tests were used to compare the number of correct answers between the groups. A survey and focus groups composed of medicine residents evaluated the platform. Sessions were recorded and transcribed verbatim. Data was analyzed through the content analysis approach by two independent reviewers. Of 117 PGY1 resident participants, 64 were randomized to the VR group and 53 were randomized to the traditional group. Initial test results showed higher scores among VR compared to the traditional group (76.5% correct vs. 68.8%). Seventy-eight PGY1s participated in the follow up testing (46 VR group vs. 32 traditional group) and results showed no significant difference in test results. Greater than 90% of the residents rated the platform positively and 77% preferred it as a teaching method. The DiAL-Neph VR platform appeared to improve short-term learning but not long-term retention. Further studies are needed to investigate the impact of such teaching platforms on overall interest in nephrology.

Resident-as-Teacher: Can It Be Done With an E-Learning Module?

Background Resident-as-teacher initiatives are traditionally specialty-specific and performed in-person, limiting ability to disseminate essential teaching skills to all residents. Objective The aim of this study was to develop, implement, and evaluate a resident-as-teacher interactive e-learning module on growth mindset and coaching. Methods The module was designed and implemented between August 2022 and March 2023. It was distributed to postgraduate year (PGY) 1 residents in all specialties at a large academic institution. Completion rates, Likert ratings, and answers to 2 open-ended questions were used for assessment. Descriptive statistics and 1-way analysis of variance with Sîdák correction for multiple comparisons were performed on Likert ratings. Responses to open-ended questions were evaluated using content analysis. Results The module was completed by all 277 PGY-1 residents (100%), with the evaluation completed by 276 of 277 (99.6%) residents. Mean rating of the module's relevance to the role of resident teacher was 4.06±0.90 (5-point Likert scale), with general surgery residents rating the module less favorably compared to all specialties (3.28±1.06; P<.01; 95% CI 0.26-1.30). Open-ended comments revealed that residents most liked the delivery of relevant teaching strategies and the interactive design of the module. The most common area for suggested improvement was the addition of content such as teaching in challenging situations. Time needed for design, implementation, and evaluation was 80 hours total. Conclusions An e-learning module offers an interactive platform for teaching skills and was found to be an acceptable method of instruction for residents.