PGY-2 Year Research Articles

Year One Outcomes Assessment of a Masters Suturing and Knot-Tying Program for Surgical Interns

We implemented and evaluated the outcomes of a proficiency-based program to enhance basic suturing and knot-tying skills in surgical interns. A suturing and knot-tying "masters program" was implemented for 9 surgical interns. Assessment consisted of timed and videotaped technical performance (TP) of 6 suturing (simple interrupted, subcuticular, and vertical mattress) and tying tasks (1-handed, 2-handed, and tie on pass) preinstruction (baseline) and at 4 months. Feedback and remediation were done after 4 months, and interns were retested until goals were met. TP was scored on a 1-5 scale (1 = novice, 3 = proficient, and 5 = expert). The results were compared with 6 end of PGY2 year residents and rotation evaluations, case numbers, and American Board of Surgery In-Training Examination (ABSITE) scores. The data are mean ± standard deviation (SD); statistical analysis was by 1-way ANOVA, Kruskal-Wallis test, and Pearson correlation. The total combined task times improved significantly from initial (1289 ± 301 seconds) to final assessment (770 ± 139 seconds, p = 0.0003) and between 4-month assessment (1092 ± 253 seconds) and final assessment (p = 0.0237), but not baseline to 4-month assessment (p = 0.213). Final TP scores were improved significantly (baseline, 1.87 ± 0.81; 4-month assessment, 2.63 ± 0.75; and final assessment 3.51 ± 0.39 [p < 0.001]. All interns reached proficiency on 6/6 tasks but not until 10.1 months (range, 4-12 months) and 2.4 assessment sessions (range, 1-3). No significant differences in final total task times or TP scores were found between interns (770 ± 139 seconds and TP, 3.51 ± 0.39) and end of PGY-2 residents (677 ± 109 seconds and TP, 3.6 ± 0.43). The total task time and rotation technical comments were associated significantly, but TP scores, case numbers, and ABSITE scores were not. Training, feedback, and remediation are necessary to reach proficiency in basic suturing and knot tying. This program provides an objective assessment of interns' skills not discernible by conventional measures.

Assessing Residents in Surgical Ethics: We Do It a Lot; We Only Know a Little

PGY-1 year of surgical residency brings together many persons of disparate experiences and educational backgrounds, including their exposure to ethics. We hypothesized that surgical PGY-1s would have a similar exposure to ethical scenarios but lack the confidence in practice and understanding of ethical principles compared with more senior residents. Surgical residents were invited to resident-initiated surgical ethics workshops utilizing a standardized text. Here a survey and multiple choice tests were administered to participants. The survey determined prior exposure to ethics curricula, the frequency of exposure to various ethics topics, and their comfort with these scenarios. A multiple choice test then quantified the knowledge base of participating residents. The results were collected and compared between surgical PGY-1s and more senior residents. Eighteen PGY-1s and 12 senior residents completed this curriculum. Resident exposure to ethical concepts was common. Resident confidence in these topics was ranked moderate or higher for both groups. Despite frequent clinical exposure and strong confidence in their skills of addressing these topics, performance on the test was poor, with an average score of 59% for PGY-1s and 47% for more senior residents (P=0.03). Despite clinical exposure to and confidence in their management of ethical topics, their knowledge base was poor and worse for more senior residents. Given the overall interest in a formal ethics curriculum and the knowledge deficit demonstrated, educational intervention and professional ethics support should be provided for surgical residents even with the current educational time constraints.

Changes in Resident Work and Sleep Hours 1999 to 2009: Results From a Survey of 4 Specialties

Resident work hours have been a recurring source of concern and controversy for many years. From the Spartan origins of the Halsted generic model of the surgical service at Johns Hopkins in 1897 to the present, there have been major tensions between the educational needs of learners and the workload demands of patient care, resulting, at times, in classic labor-management confrontations about work hours and conditions.

Residents, Training Directors Get New Duty-Hour Rules

Residents, Training Directors Get New Duty-Hour Rules

Evidence-based medicine training during residency: a randomized controlled trial of efficacy

BackgroundEvidence-based medicine (EBM) has been widely integrated into residency curricula, although results of randomized controlled trials and long term outcomes of EBM educational interventions are lacking. We sought to determine if an EBM workshop improved internal medicine residents' EBM knowledge and skills and use of secondary evidence resources.MethodsThis randomized controlled trial included 48 internal medicine residents at an academic medical center. Twenty-three residents were randomized to attend a 4-hour interactive workshop in their PGY-2 year. All residents completed a 25-item EBM knowledge and skills test and a self-reported survey of literature searching and resource usage in their PGY-1, PGY-2, and PGY-3 years.ResultsThere was no difference in mean EBM test scores between the workshop and control groups at PGY-2 or PGY-3. However, mean EBM test scores significantly increased over time for both groups in PGY-2 and PGY-3. Literature searches, and resource usage also increased significantly in both groups after the PGY-1 year.ConclusionsWe were unable to detect a difference in EBM knowledge between residents who did and did not participate in our workshop. Significant improvement over time in EBM scores, however, suggests EBM skills were learned during residency. Future rigorous studies should determine the best methods for improving residents' EBM skills as well as their ability to apply evidence during clinical practice.

A National Study of Attrition in General Surgery Training

Implementation of the 80-hour mandate was expected to reduce attrition from general surgery (GS) residency. This is the first quantitative report from a national prospective study of resident/program characteristics associated with attrition. Analysis included all categorical GS residents entered on American Board of Surgery residency rosters in 2007 to 2008. Cases of attrition were identified by program report, individually confirmed, and linked to demographic data from the National Study of Expectations and Attitudes of Residents in Surgery administered January 2008. All surgical categorical GS residents active on the 2007-2008 resident rosters (N = 6,303) were analyzed for attrition. Complete National Study of Expectations and Attitudes of Residents in Surgery demographic information was available for 3959; the total and survey groups were similar with regard to important characteristics. About 3% of US categorical residents resigned in 2007 to 2008, and 0.4% had contracts terminated. Across all years (including research), there was a 19.5% cumulative risk of resignation. Attrition was highest in PGY-1 (5.9%), PGY-2 (4.3%), and research year(s) (3.9%). Women were no more likely to leave programs than men (2.1% vs. 1.9%). Of several program/resident variables examined, postgraduate year-level was the only independent predictor of attrition in multivariate analysis. Residents who left GS whose plans were known most often pursued nonsurgical residencies (62%), particularly anesthesiology (21%) and radiology (11%). Only 13% left for surgical specialties. Attrition rates are high despite mandated work hour reductions; 1 in 5 GS categorical residents resigns, and most pursue nonsurgical careers. Demographic factors, aside from postgraduate year do not appear predictive. Residents are at risk for attrition early in training and during research, and this could afford educators a target for intervention.

25: Investigating Depression Among Emergency Medicine Residents

Minimal data exists investigating clinical depression among emergency medicine (EM) residents, allowing EM programs to effectively address residents struggling with depression during their training. This study quantifies the prevalence of depression among EM residents at four residency programs, and investigates associated variables and coping strategies. This prospective online survey-based study evaluated the prevalence of clinical depression among EM resident physicians at four EM programs. The protocol utilized a well-validated, self-reporting depression scale (the CES-D) as well as questions assessing coping mechanisms. Possible major depression is classified as a CES-D score >21. Assessments of residents were conducted anonymously through an Internet based system every 3 months for one year. All participants received relevant resources in the event of a suggestive CES-D score. Descriptive statistics were analyzed and changes in depression scores evaluated using repeated measure statistics. Ninety-nine residents were enrolled. During the 12-month period, the overall mean depression score was 11.9 (SD: 9.7), with a mean prevalence of 12.3% of residents categorized as having the “possibility of major depression.” Upon repeated measure analysis, change in CES-D score was not associated with age, sex, training level, marital or family status. There was, however, a positive association between self-identified “new stressors” and CES-D scores found on two follow-up periods (P = .009, .017) and an association with non-EM rotation found on one follow-up (P = .029). Of all the different coping strategies, physical activities (P = .012), alcohol use (P = .029), and confiding in family and friends (P = .016) were significantly correlated. This multi-centered study found a mean prevalence of 12.3% possible major depression (CES-D >21) in residents surveyed over the course of a 12-month period when interviewed at 3-month intervals. We concluded that PGY year and sex does not affect CES-D scores, whereas introduction of a new stressor does increase scores and thereby related to feeling “depressed.” Coping mechanisms most commonly utilized to deal with stress included physical activity, confiding with family and friends and even alcohol use. Knowledge of this information can help EM programs identify residents with depression, and implement programs to encourage positive coping mechanisms for these residents.

Career Decisions and the Structure of Training

To investigate potential impacts of restructuring general surgery training on colorectal (CR) surgery recruitment and expertise. In response to the American Surgical Association Blue Ribbon Committee report on surgical education (2004), the American Board of Colon and Rectal Surgery, working with the Accreditation Council for Graduate Medical Education and American Board of Surgery, established a committee (2006) to review residency training curricula and study new pathways to certification as a CR surgeon. To address concerns related to shortened general surgery residency, the American Board of Colon and Rectal Surgery committee surveyed recent, current, and entering CR residents on the timing and factors associated with their career choice and opinions regarding restructuring. A 10-item, online survey of 189 CR surgeons enrolled in the class years of 2005, 2006, and 2007 was administered and analyzed May to July 2007. One hundred forty-five CR residents responded (77%); results were consistent across class years and types of general surgery training program. Seventy percent of respondents had rotated onto a CR service by the end of their PGY-2 year. Most identified CR as a career interest in their PGY-3 or PGY-4 year. Overall interest in CR surgery, the influence of CR mentors and teachers, and positive exposure to CR as PGY-3, PGY-4, or PGY-5 residents were the top cited factors influencing choice decisions. Respondents were opposed to restructuring by a 2:1 ratio, primarily because of concerns about inadequate training and lack of time to develop technical expertise. Shortening general surgery residency would not necessarily limit exposure to CR rotations and mentors unless such rotations are cut. The details of proposed restructuring are critical.

Four years of accreditation council of graduate medical education duty hour regulations: Have they made a difference?

Measure compliance with the Accreditation Council of Graduate Medical Education (ACGME) residents' work hour regulations and evaluate their impact on patient care and residents' performance on the Otolaryngology Training Examination (OTE). Retrospective review of an otolaryngology residency program's resident duty hours violations and OTE scores, and review of the associated hospital's benchmark patient data. Residents' duty hour violations were compiled and analyzed for individual violation, postgraduate year (PGY), and service in the program. Annual OTE scores and the department's hospital benchmark measures (inpatient mortality, inpatient length of stay, 30-day readmission rate) were compared before and after the institution of the ACGME duty hours mandate. The 10-hour rule was most frequently violated; residents on the oncology service and PGY-2 year were most commonly in violation. There was no difference before and after institution of the ACGME duty hours mandate in 30-day hospital readmission rates (P = .42), hospital mortality index (P = .55), length of stay (P = .55), OTE scores (P = .11, Student's t test), and graduating resident's operative volume. Institution of the ACGME duty hour regulations did not improve patient care as measured by the 30-day readmission rate, inhospital mortality, and patient's length of stay. Residents' performance on the OTE did not change after implementation of the ACGME rules. Further studies are warranted to assess the impact of the ACGME work hour regulations on patient care and resident-physicians' training.

Impact of the 80-hour Workweek on Surgical Exposure and National In-Training Examination Scores in an Orthopedic Residency Program

This study examines the impact of the 80-hour workweek on the number of surgical cases performed by PGY-2 through PGY-5 orthopedic residents. We also evaluated orthopedic in-training examination (OITE) scores during the same time period. Data were collected from the Accreditation Council for Graduate Medical Education (ACGME) national database for 3 academic years before and 5 years after July 1, 2003. CPT surgical procedure codes logged by all residents 3 years before and 5 years after implementation of the 80-hour workweek were compared. The average raw OITE scores for each class obtained during the same time period were also evaluated. Data were reported as the mean +/- standard deviation (SD), and group means were compared using independent t-tests. No statistical difference was noted in the number of surgical procedure codes logged before or after the institution of the 80-hour week during any single year of training. However, an increase in the number of CPT codes logged in the PGY-3 years after 2003 did approach significance (457.7 vs 551.9, p = 0.057). Overall, the average number of cases performed per resident increased each year after implementation of the work-hour restriction (464.4 vs 515.5 cases). No statistically significant difference was noted in the raw OITE scores before or after work-hour restrictions for our residents or nationally. We found no statistical difference for each residency class in the average number of cases performed or OITE scores, although the total number of cases performed has increased after implementation of the work-hour restrictions. We also found no statistical difference in the national OITE scores. Our data suggest that the impact of the 80-hour workweek has not had a detrimental effect on these 2 resident training measurements.

Geriatrics for Surgeons: Infusing Life into an Aging Subject

Geriatric patients have specific medical and social needs for which surgeons must become adept at caring. In an effort to improve the care of the elderly, we have committed to developing a geriatric component for our surgical curriculum that is part of our PGY2-protected block curriculum. Competencies covered by this curriculum plan include medical knowledge, systems-based practice, professionalism, patient care, practice-based learning, and communication skills. The geriatrics curriculum is imbedded in our current protected block curriculum and includes 5 separate sessions during the PGY2 year. During the protected block curriculum, the residents (N = 7) are relieved of all clinical activity, including call. A needs assessment survey assessed the residents' perceptions of the residency program's current focus on geriatric principles. The geriatric portion of this curriculum uses small-group instructional methods consistent with adult learning principles that include practice-based learning, case-based learning, patient simulation using Objective Structured Video Examination (OSVE), and didactic sessions. Faculty instruction is a shared responsibility between geriatricians and general surgeons. The longitudinal geriatrics curriculum includes approximately 10 hours of learner activities over a single-year period. The curriculum will be evaluated by assessing participant knowledge through the use of multiple-choice testing. Resident performance on OSVEs will likewise be assessed. This method will allow for assessment of higher decision making and clinical reasoning. Finally, a family meeting OSCE will be used to assess professionalism and communication skills further. Overall, all 6 competencies will be assessed using our specific assessment tools. The curriculum content and instructional delivery will be evaluated using longitudinal and session evaluation forms. RESULTS AND EXPERIENCE TO DATE: The geriatrics curriculum will be implemented fully over 2 years. Three sessions will be introduced during the 1st year, and 2 more will be implemented in the 2nd year. The needs assessment survey results demonstrated a lack of sufficient educational focus on geriatrics topics and a low comfort level in caring for the elderly patient. The 1st session of the curriculum has taken place with positive results. The 1st session was a case-based session that focused on critical care and end-of-life issues in the elderly. Although the medical knowledge data are limited thus far, the average pretest score was 57% compared with the 86% posttest score. The resident evaluations (N = 7) of the session demonstrated an average 4.7 (1-5 Likert scale) for content and a 3.9 (1-4 Likert scale) for instructional delivery. CONCLUSION AND NEXT STEPS: Elderly surgical patients have multiple challenges. Specific geriatric training for surgical trainees is lacking. Over the next 2 years, the curriculum will be developed and evaluated even more for its ability to provide adequate instruction in the specific care of the elderly surgical patient. The ultimate goal is to improve the care of the elderly surgical patient.

Reliability of the Welling Scale (WS1) for Rating Temporal Bone Dissection Performance

To determine the inter- and intrarater reliability of using a new scale (Welling scale) for resident evaluation of temporal bone dissection performance. Prospective, double-blinded, randomized trial. Twelve residents in otolaryngology (postgraduate year [PGY] 2-5) drilled 26 temporal bones (21 cadaveric, 5 plastic) with the objective to perform a complete mastoidectomy with facial recess approach. These bones were then rated using the Welling scale by six independent raters on two separate occasions (4-6 wk apart). Raters were blinded to PGY year. The Kappa statistic was calculated for inter- and intrarater reliability. Intrarater agreement was high for all raters, ranging from kappa = 0.65 to 0.72 (all P < .001), whereas the interrater agreement scores were more moderate (range, kappa = 0.49-0.64; all P < .01). The Welling scale can be used reliably to assess temporal bone dissection performance where performance is measured by assessment of end product (mastoidectomy with facial recess approach).

Ontario Radiation Oncology Residents Needs in the PGY-1 Year–Residents' Perspective Survey

Ontario Radiation Oncology Residents Needs in the PGY-1 Year–Residents' Perspective Survey

Effect of Work-hour Reforms on Operative Case Volume of Surgical Residents

There has been much concern regarding the impact of work-hour reforms on the operative case volume of surgical residents. Operative case volume by PGY year and clinical rotation were examined to determine if changes in work hours affected residents' operative case volume. A careful but aggressive plan of work-hour reduction was devised for the residency of the authors' institution with the goal to decrease work hours while maintaining optimal patient care and resident education, including operative case volume. Changes made included hiring physician extenders (PEs), decreasing call schedules to every fourth night (with the next day free from clinical activities-Q4) or call from home (HC), and night float rotation coverage for services (NF). Case volume before (academic year 2002) and after (academic year 2003) changes were compared by PGY year, for all residents and for specific rotations-private general surgery, which had changes of PE, HC, and NF for PGY5; PE, Q4 and NF for PGY1 and 10% exemption for work hours; Churchill service (a resident-run ward teaching service), which had changes of PE and Q4 for PGY5 and PGY1 and 10% exemption for work hours; and vascular surgery, which had HC and NF for PGY5. Total case volume on these services was likewise compared. Statistical analysis was by student t test. Operative case volume was measured with data from the resident-entered information on the ACGME Surgical Operative Log (SOL). Case volume for PGY4 residents could not be compared over this time period because of lack of access to archived data by PGY year for graduated residents through the ACGME SOL. Work hours before and after rotation changes were measured with an intranet-based monitoring system. This article is a retrospective review of the affects of these work-hour changes on operative case volume. Total case volume for the general surgical services (both private and Churchill) was unchanged over this period (5905 in 02, 5930 in 03), and likewise for the vascular service (1101 vs 1196). Overall, there was no change in mean operative volume per year for surgical residents in this program (231 cases in 2002, 246 cases in 2003; p = 0.61). For PGY5 residents, the case volume increased; 339 cases 02, 390 in 03, and p = 0.05. Mean case volume for PGY5 residents increased on the private general surgery service (136 in 02, 160 in 03, p = 0.03), but it remained stable on the Churchill service (137 in 02, 158 in 03, p = 0.39) and vascular service (65 in 02, 73 in 03, p = 0.42). For PGY3 residents, case volume remained stable (171 in 02, 187 in 03, p = 0.62), as it did for PGY2 and PGY1 residents (PGY2: 148 in 02, 121 in 03, p = 0.12; PGY1: 265 in 02, 246 in 03, p = 0.23). However, operative case volume for PGY1 residents did decrease on the private general surgery service (mean 52 cases per month 02, 43 cases per month 03, p = 0.07), while remaining stable on the Churchill service (mean 23 cases per month 02, 25 cases per month 03, p = 0.66). Average hours worked per week decreased significantly over the time period. Before work-hour reforms, residents' average work hours were as follows: PGY1 105, PGY2 97, PGY3 78.7, PGY4 111, and PGY5 92. After the changes, average work hours were PGY1 81.5, PGY2 77.7, PGY3 78.7, PGY4 75.5, and PGY5 75.9. Work-hour limitation can be devised to maximize resident education, optimize patient care, and maintain resident operative volume. Although some changes (HC, PE, NF) seemed to increase the operative case volume for PGY5 residents, others had no effect (Q4, HC). There does not seem to be a clear relationship between types of changes and case volume. At the PGY1 level, Q4 and PE changes decreased operative experience on 1 rotation but not on another, although the difference in this decrease seems clinically insignificant. Individualization of changes to meet the needs of specific rotations seems more important than specific changes in coverage pattern. Perhaps the most important finding is that changes can be made to bring work hours into compliance without materially effecting operative case volume.

Validation of a Scoring System to Evaluate Performance of a Hemi-Thyroidectomy

Objective.—To determine how pediatric residents' perceptions of continuity clinic experiences vary by level of training, after controlling for the effect of continuity setting.Method.—Cross-sectional survey of pediatric and combined pediatric trainees in US residency programs.Results.—Survey responses were received from 1355 residents in 36 training programs. Residents' continuity experiences were in hospital-based and community settings. Numbers of patients seen increased between PGY-1 and PGY-3 years, but not in the PGY-4 and PGY-5 years. Compared to PGY-1 residents, PGY-2 and PGY-3 residents were more likely to report more encounters with established patients, but were not more likely to feel like the primary care provider. There were no significant differences by training level in terms of involvement in panel patients' laboratory results, hospitalizations, or telephone calls, although nursery involvement decreased with increasing training level. Autonomy was directly related to training level. The perception of having the appropriate amount of exposure to practice management issues was low for all respondents.Conclusions.—Residents perceived that they had greater autonomy and continuity with patients as they become more senior, yet they were not more likely to feel like the primary care provider. Lack of increased involvement in key patient care and office responsibilities across training years may reflect a need for changes in resident education. These data may be helpful in formulating recommendations to program directors with regard to determining which Accreditation Council for Graduate Medical Education competencies should be emphasized and evaluated in the continuity experience.

Changes in Pediatric Residents' Perceptions of Their Continuity Experience During Their Training: A National Study

To determine how pediatric residents' perceptions of continuity clinic experiences vary by level of training, after controlling for the effect of continuity setting. Cross-sectional survey of pediatric and combined pediatric trainees in US residency programs. Survey responses were received from 1355 residents in 36 training programs. Residents' continuity experiences were in hospital-based and community settings. Numbers of patients seen increased between PGY-1 and PGY-3 years, but not in the PGY-4 and PGY-5 years. Compared to PGY-1 residents, PGY-2 and PGY-3 residents were more likely to report more encounters with established patients, but were not more likely to feel like the primary care provider. There were no significant differences by training level in terms of involvement in panel patients' laboratory results, hospitalizations, or telephone calls, although nursery involvement decreased with increasing training level. Autonomy was directly related to training level. The perception of having the appropriate amount of exposure to practice management issues was low for all respondents. Residents perceived that they had greater autonomy and continuity with patients as they become more senior, yet they were not more likely to feel like the primary care provider. Lack of increased involvement in key patient care and office responsibilities across training years may reflect a need for changes in resident education. These data may be helpful in formulating recommendations to program directors with regard to determining which Accreditation Council for Graduate Medical Education competencies should be emphasized and evaluated in the continuity experience.

Should Sleep-Starved Residents Be Setting Off Alarms?

Should Sleep-Starved Residents Be Setting Off Alarms?

Foot and ankle experience in orthopaedic residency.

Dedicated orthopaedic residency training in the musculoskeletal discipline of foot and ankle is an important contribution to the development of a well-rounded orthopaedic surgeon. Current residency training guidelines are vague and do not require specific experience or proficiency in this discipline. A one-page questionnaire on commitment to foot and ankle education in American Orthopaedic Surgery residency training programs was completed by all 148 program directors. Eighty of the programs (54.1%) had a single faculty member dedicated to foot and ankle orthopaedics, while 21 (14.2%) did not have a faculty member with a specific interest or commitment to problems related to the foot and ankle. Fifteen programs (10.1%) did not have a committed faculty member, nor did their residents have a clinical rotation dedicated to foot and ankle. Ninety-six programs (64.9%) had at least one clinical rotation dedicated to foot and ankle. Fifty-two (35.1%) did not. Thirty-three (34.7%) of those programs with a dedicated foot and ankle experience assigned residents during at least two periods of their training. Of those programs with a single foot-specific rotation, the most common year for training was in the PGY3 year (27 of 63, 42.9%). Of the 60 months' duration of most orthopaedic residency programs, 39 of 96 (40.6%) programs with a dedicated clinical foot and ankle rotation allocated an average of 12 weeks to foot and ankle. Twenty-six (27.1%) allocated less than 3 total months, and 31 (32.3%) allocated 16 to 24 weeks of dedicated foot and ankle experience. Current residency training in the United States does not universally require a commitment to foot and ankle education. A large number of residency programs do not have a faculty member committed to foot and ankle education, and almost one-third have no time specifically allocated to foot and ankle education.

Effect of Training and Other Influences on the Development of Career Interest in Geriatric Psychiatry

Objective The authors examined the relationship between the timing and nature of educational exposure to geriatric psychiatry and other potential influences and subsequent development of career interest in geriatric psychiatry. Methods A 46-item survey was distributed to residents and fellows who attended one of the two sponsored programs for residents at the three American Association of Geriatric Psychiatry (AAGP) annual meetings held between 2000 and 2002, inclusive. Results Ninety-three percent of attendees responded (N=184). Sixty-five percent first developed interest in geriatric psychiatry during their residency years (the majority during their PGY1 or PGY2 year). The timing of individualized teaching exposure, as well as lectures in geriatric psychiatry, was associated with the development of first interest in the field. The most important influences on the development of interest in the field included specific teacher attributes, training experiences, personal experiences with seniors, and characteristics cited as unique to geriatric psychiatry, such as the medical, neuropsychiatric, and multifactorial nature of the field. Patient personal histories and outcomes, as well as non-educational experiences with seniors and cultural attitudes, also contributed to interest. Conclusion It behooves geriatric psychiatry programs to create exemplary educators and commit them to teaching in the early years of general psychiatry programs as well as in medical school. These educators should be identifying potential recruits by enquiring about trainees' previous experiences with older persons as well as emphasizing the unique aspects of geriatric psychiatry that are attractive to trainees. The authors examined the relationship between the timing and nature of educational exposure to geriatric psychiatry and other potential influences and subsequent development of career interest in geriatric psychiatry. A 46-item survey was distributed to residents and fellows who attended one of the two sponsored programs for residents at the three American Association of Geriatric Psychiatry (AAGP) annual meetings held between 2000 and 2002, inclusive. Ninety-three percent of attendees responded (N=184). Sixty-five percent first developed interest in geriatric psychiatry during their residency years (the majority during their PGY1 or PGY2 year). The timing of individualized teaching exposure, as well as lectures in geriatric psychiatry, was associated with the development of first interest in the field. The most important influences on the development of interest in the field included specific teacher attributes, training experiences, personal experiences with seniors, and characteristics cited as unique to geriatric psychiatry, such as the medical, neuropsychiatric, and multifactorial nature of the field. Patient personal histories and outcomes, as well as non-educational experiences with seniors and cultural attitudes, also contributed to interest. It behooves geriatric psychiatry programs to create exemplary educators and commit them to teaching in the early years of general psychiatry programs as well as in medical school. These educators should be identifying potential recruits by enquiring about trainees' previous experiences with older persons as well as emphasizing the unique aspects of geriatric psychiatry that are attractive to trainees.

Effect of Training and Other Influences on the Development of Career Interest in Geriatric Psychiatry

The authors examined the relationship between the timing and nature of educational exposure to geriatric psychiatry and other potential influences and subsequent development of career interest in geriatric psychiatry. A 46-item survey was distributed to residents and fellows who attended one of the two sponsored programs for residents at the three American Association of Geriatric Psychiatry (AAGP) annual meetings held between 2000 and 2002, inclusive. Ninety-three percent of attendees responded (N=184). Sixty-five percent first developed interest in geriatric psychiatry during their residency years (the majority during their PGY1 or PGY2 year). The timing of individualized teaching exposure, as well as lectures in geriatric psychiatry, was associated with the development of first interest in the field. The most important influences on the development of interest in the field included specific teacher attributes, training experiences, personal experiences with seniors, and characteristics cited as unique to geriatric psychiatry, such as the medical, neuropsychiatric, and multifactorial nature of the field. Patient personal histories and outcomes, as well as non-educational experiences with seniors and cultural attitudes, also contributed to interest. It behooves geriatric psychiatry programs to create exemplary educators and commit them to teaching in the early years of general psychiatry programs as well as in medical school. These educators should be identifying potential recruits by enquiring about trainees' previous experiences with older persons as well as emphasizing the unique aspects of geriatric psychiatry that are attractive to trainees.