Postgraduate Year Level Research Articles

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.

Resident Performance on the Obstetrics and Gynecology In-Training Examination After Implementation of a New Academic Curriculum.

Background The goals of the annual Council on Resident Education in Obstetrics and Gynecology In-Training Examination (CREOG-ITE) are to provide residents with an assessment of their knowledge and program directors an assessment of their residency programs. Research has shown that a score greater than 200 is correlated with passing the qualifying board examination. We observed a substantial number of our residents were not performing well on the exam, which prompted the implementation of a new academic program aimed at determining the impact of an academic curriculum addition on CREOG-ITE scores in an American College of Graduate Medical Education (ACGME) accredited obstetrics and gynecology (OB/GYN) residency program. Methods We performed a prospective cohort study of residents at a single institution to evaluate the effect of a remediation course for residents identified as "at risk." Residents with CREOG-ITE scores of <180 were placed into the experimental group who underwent a year-long remediation programand were compared to the control group (those with scores >180 who did not undergo remediation).Each resident in the experimental group served as their internal control by comparing their pre-intervention score to their post-remediation score. Results Themean improvement of the experimental group of the remediation programwas 23.2 points. After controlling for post-graduate year (PGY), their score improvement remained significant and was not simply a by-product of the inherent academic knowledge of a resident further along in training. Conclusions This scholastic remediation program was associated with a statistically significant improvement in CREOG-ITE scores, even when accounting for PGY level. This program may serve as a model for improving OB/GYN resident education.

Improving Resident Comfort With Peripartum Cesarean Hysterectomy Through the Use of Low-Fidelity Simulation Models.

Introduction Cesarean hysterectomy is a relatively rarely performed, complex, life-saving procedure considered during post-partum hemorrhage and other obstetric complications. This multi-site study aimed at validating a low-cost, low-fidelity cesarean hysterectomy model to support resident proficiency and increase their confidence in performing this critical procedure. Materials and methods We developed a low-fidelity, anatomically representative model for cesarean hysterectomy simulation purposes. Obstetrics and Gynecology residents at two residency programs were offered a simulation experience using the model, with a performance assessment via two validated assessment tools. The clinical case involved a 38 y/o woman with a delivery complicated by postpartum hemorrhage who failed conservative therapy and required a peripartum hysterectomy. Participants included 26 residents, postgraduate year (PGY)1 through PGY4, at two midwestern university-based obstetrics and gynecology residency programs. Results The median resident scores on the Task Specific Checklist (TSC) and Global Rating Scale (GRS) correlated with increasing PGY levels. The combined TSC+GRS score was a median of 40 out of 49 total for the PGY4 class, while the PGY1 class had a median combined TSC+GRS score of 12 of 49. The PGY2 and -3 classes had TSC+GRS scores of 14 and 28, respectively. The simulation model was well-received with a median 4/5 rating for improving comfort level with cesarean hysterectomy and a median 4/5 rating for model realism. Conclusion This study validated a cost-effective, easily reproducible model that highlights the vital anatomy relevant to a cesarean hysterectomy. The model and simulation offer a way to introduce cesarean hysterectomies to residents while in training, particularly at sites that may not perform a substantial number of these procedures.

Medication Errors as a Marker of Resident Competency.

Introduction Educators continue to evaluate ways to assess resident performance in conjunction with the Accreditation Council for Graduate Medical Education (ACGME) general surgery milestones. We investigated whether the rate of medication errors could reflect general surgery resident competency. We hypothesized that the identification of increased medication errors made by general surgery residents could be a potential screening tool to identify residents who are academically at risk prior to their formal biannual milestone evaluation by the clinical competency committee. Methods This is a retrospective cohort study comparing rates of medication ordering errors against ACGME core competency scoresover four years in a general surgery residency program at an academic, university-affiliated, level 1 trauma center in the Northeastern United States. Results We identified 95 general surgery residents who inputted 1,164,663 medication orders during the four years studied. There were 1,214 (0.1%) errors identified. Of those, 1,146 (94.4%) were level 3 errors, and 68 (5.6%) were level 4 errors. This represents an error rate of 1.04 errors per 1,000 medication orders. There was a statistically significant decrease in the error rate as the post-graduate year (PGY) level increased (p=0.005). However, there was no correlation between the error rate and individual ACGME milestone competency scores by PGY level. Conclusions We explored whether medication errors may be an early measurement of worsening resident performance as demonstrated by a decrease in ACGME core competency scores. However, the rate of errors did not correlate consistently with these measures. This may underscore that medication errors measure an aspect of resident performance that we do not capture with our current assessments.

Burnout in Urological Education: An In-Depth Study of Residents and Fellows in the 2021 AUA Census.

Our goal was to explore the current trends in burnout, career choice regret, and well-being needs among urology residents and fellows, with specific emphasis on identifying key factors associated with burnout. The AUA Workforce Workgroup collaborated with the AUA Data Team to analyze data from the 2021 AUA Census, comprising a total of 243 residents and fellows. Key demographics, benefits and resources, career choice and debt, and burnout levels were analyzed, focusing on variables like gender, PGY (postgraduate year) level, debt burden, and personal health appointments. Overall, 48% of residents and 33% of fellows met criteria for professional burnout, with a higher incidence among PGY-2 residents (70%). Depersonalization was particularly notable, with 74% of residents reporting medium to high levels. Burnout was significantly associated with difficulty attending personal health appointments (52% vs 34%) and lack of access to on-call rooms (54% vs 36%). In contrast, having children during residency was associated with lower burnout levels (30.8% vs 49.1%). Meal plans were ranked as the most desired benefit (32%), followed by ability to attend health appointments during work hours (17%) and paid family leave (16%). Educational debt over $150,000 was carried by 53% of residents and 48% of fellows. Interestingly, burnout rates showed no statistically significant difference in response rates across genders, relationship status, amount of educational debt, presence of paid maternity or paternity leave, and type of childcare arrangements. Burnout remains a significant issue among urology trainees, with a complex interplay of factors like lack of personal time and provision of call rooms. The alarming rates of depersonalization and exhaustion highlight the urgency of implementing targeted interventions. Enhanced support systems, improved access to health care appointments, provision of call rooms, and debt management programs are recommended to alleviate the growing problem of professional burnout in the field of urology.

Quantification of Radiation Exposure in Canadian Orthopaedic Surgery Residents.

Natural radiation exposure in the general population averages 3 milliSieverts (mSv) annually; however, radiation exposure in orthopaedic residents is not well defined. Despite protective measures, evidence of radiation-related diseases in orthopaedic surgeons is increasing. The purpose of this study was to quantify radiation exposure in orthopaedic residents and to determine the variability of exposure among post graduate year (PGY) of residency. Monthly radiation exposure was measured prospectively over a 12-month period in orthopaedic surgery residents from a single program. Participants wore dosimeters above ("exposed") and beneath ("shielded") protective lead. The primary outcome measure was the absolute value of radiation exposure in mSv. Repeated measures analysis was used to assess exposure with age, sex, year of training, operating room (OR) days, and height. Mean annual occupational radiation exposure was 3.30 ± 0.64 mSv over an average of 107 ± 38 OR days. Mean exposure per OR day was 0.033 ± 0.008 mSv. PGY-2 and PGY-3 residents had the highest cumulative exposure, and PGY-5 residents had the highest mean exposure per OR day (0.044 ± 0.009 mSv/d). Number of OR days per month and PGY level were significant predictors of radiation exposure (p < 0.05). Sex, age, and height were not significant in predicting radiation of the exposed dosimeter. Orthopaedic residents' exposure to radiation is nearly twice the general population's exposure. Given that yearly radiation exposure was highest during early residency years, but exposure based on number of OR days was highest in the final year of training, it is essential for resident education regarding radiation safety and safe clinical practices throughout their training.

Emergency medicine resident productivity across consecutive shifts.

Clinical productivity is an important operational and educational metric for emergency medicine (EM) residents. It is unclear whether working consecutive days and circadian disruption impact resident productivity. The objective of this study was to determine whether there is a correlation between consecutive shifts and productivity. This was a single-site retrospective observational study using data from academic year 2021-2022 (July 1, 2021-June 23, 2022). Productivity was defined as primary resident encounters with patients per hour (PPH). Postgraduate year (PGY)-1 and PGY-2 productivity data and schedules were abstracted from the electronic medical record and scheduling software. Descriptive statistics, including arithmetic mean, standard deviation, and confidence interval (CI), were determined for each shift number and stratified by PGY level. Subgroup analysis of night shifts was performed. Analysis of variance and linear regression analysis were performed. A total of 2950 shifts were identified, including 1328 PGY-1 shifts and 1622 PGY-2 shifts, which involved a total of 32,379 patient encounters. PGY-1 residents saw a mean of 0.88-0.96 PPH on sequential shifts 1-7, respectively (y-intercept 0.923, slope 0.001, 95% CI -0.008 to 0.009, p = 0.86). PGY-2 residents saw a mean of 1.61-1.75 PPH on Shifts 1-7, respectively (y-intercept 1.628, slope 0.004, 95% CI -0.007 to 0.015, p = 0.50). A subgroup analysis of 598 overnight shifts (11 p.m.-7 a.m.) was performed, in which residents saw a mean of 1.29-1.56 PPH on Sequential Shifts 1-7 (y-intercept 1.286, slope 0.011, 95% CI -0.011 to 0.033, p = 0.34). EM resident productivity remained relatively constant across consecutive shifts, including night shifts. These findings may have educational and operational implications. Further research is required to understand patient- and provider-oriented consequences of consecutive shift scheduling.

Improving pediatric procedural skills and EPA assessments through an acute care procedural skills curriculum.

Acute procedural skill competence is expected by the end of pediatric residency training; however, the extent to which residents are actually competent is not clear. Therefore, a cross-sectional observational study was performed to examine the competency of pediatric residents in acute care procedures in emergency medicine. Pediatric residents underwent didactic/hands-on "Acute Procedure Day" where they performed procedures with direct supervision and received entrustable professional activity (EPA) assessments (scores from 1-5) for each attempt. Procedures included: bag-valve mask (BVM) ventilation, intubation, intraosseous (IO) line insertion, chest tube insertion, and cardiopulmonary resuscitation (CPR) with defibrillation. Demographic information, perceived comfort level, and EPA data were collected. Descriptive statistics and Pearson correlation for postgraduate year (PGY) versus EPA scores were performed. Thirty-six residents participated (24 PGY 1-2, and 12 PGY 3-4). Self-reported prior clinical exposure was lowest for chest tube placement (n = 3, 8.3%), followed by IOs (n = 19, 52.8%). During the sessions, residents showed the highest levels of first attempt proficiency with IO placement (EPA 4-5 in 28 residents/33 who participated) and BVM (EPA 4-5 in 27/33), and the lowest for chest tube placement (EPA 4-5 in 0/35), defibrillation (EPA 4-5 in 5/31 residents) and intubation (EPA 4-5 in 17/31). There was a strong correlation between PGY level and EPA score for intubation, but not for other skills. Entrustability in acute care skills is not achieved with current pediatrics training. Research is needed to explore learning curves for skill acquisition and their relative importance.

Item analysis of general surgery multi-institutional mock oral exam: opportunities for quality improvement

PurposeMock oral examinations (MOE) prepare general surgery residents for the American Board of Surgery Certifying Exam by assessing their medical knowledge and clinical judgement. There is no standard accepted process for quality analysis among MOE content items. Effective questions should correlate with mastery of MOE content, as well as exam passage. Our aim was to identify opportunities for question improvement via item analysis of a standardized MOE.MethodsRetrospective review of testing data from the 2022 Southern California Virtual MOE, which examined 64 general surgery residents from six training programs. Each resident was assessed with 73 exam questions distributed through 12 standardized cases. Study authors indexed questions by clinical topic (e.g. breast, trauma) and competency category (e.g. professionalism, operative approach). We defined MOE passage as mean percentage correct and mean room score within 1 standard deviation of the mean or higher. Questions were assessed for difficulty, discrimination between PGY level, and correlation with MOE passage.ResultsPassage rate was 77% overall (49/64 residents), with no differences between postgraduate year (PGY) levels. PGY3 residents answered fewer questions correctly vs PGY4 residents (72% vs 78%, p < 0.001) and PGY5 residents (72% vs 82%, p < 0.001). Out of 73 total questions, 17 questions (23.2%) significantly correlated with MOE passage or failure. By competency category, these were predominantly related to patient care (52.9%) and operative approach (23.5%), with fewer related to diagnosis (11.8%), professional behavior (5.9%), and decision to operate (5.9%). By clinical topic these were equally distributed between trauma (17.7%), large intestine (17.7%), endocrine (17.7%), and surgical critical care (17.7%), with fewer in breast (11.8%), stomach (11.8%), and pediatric surgery (5.9%). We identified two types of ineffective questions: 1) questions answered correctly by 100% of test-takers with no discriminatory ability (n = 3); and 2) questions that varied inversely with exam passage (n = 11). In total, 19% (14/73) of exam questions were deemed ineffective.ConclusionsItem analysis of multi-institutional mock oral exam found that 23% of questions correlated with exam passage or failure, effectively discriminating which examinees had mastery of MOE content. We also recognized 19% of questions as ineffective that can be targeted for improvement.

A Prospective Study Measuring Resident and Faculty Contour Concordance: A Potential Tool for Quantitative Assessment of Residents’ Performance in Contouring and Target Delineation in Radiation Oncology Residency

Purpose/Objective(s)Accurate target delineation (ie, contouring) is essential for radiation treatment planning and radiotherapy efficacy. As a result, improving the quality of target delineation is an important goal in the education of radiation oncology residents. The purpose of this study was to track the concordance of radiation oncology residents’ contours with those of faculty physicians over the course of 1 year to assess for patterns. Materials/MethodsResidents in postgraduate year (PGY) levels 2 to 4 were asked to contour target volumes that were then compared to the finalized, faculty physician–approved contours. Concordance between resident and faculty physician contours was determined by calculating the Jaccard concordance index (JCI), ranging from 0, meaning no agreement, to 1, meaning complete agreement. Multivariate mixed-effect models were used to assess the association of JCI to the fixed effect of PGY level and its interactions with cancer type and other baseline characteristics. Post hoc means of JCI were compared between PGY levels after accounting for multiple comparisons using Tukey’s method. ResultsIn total, 958 structures from 314 patients collected during the 2020-2021 academic year were studied. The mean JCI was 0.77, 0.75, and 0.61 for the PGY-4, PGY-3, and PGY-2 levels, respectively. The JCI score for PGY-2 was found to be lower than those for PGY-3 and PGY-4, respectively (all P < .001). No statistically significant difference of JCI score was found between the PGY-3 and PGY-4 levels. The average JCI score was lowest (0.51) for primary head and/or neck cancers, and it was highest (0.80) for gynecologic cancers. ConclusionsTracking and comparing the concordance of resident contours with faculty physician contours is an intriguing method of assessing resident performance in contouring and target delineation and could potentially serve as a quantitative metric, which is lacking currently, in radiation oncology resident evaluation. However, additional study is necessary before this technique can be incorporated into residency assessments.

81 A Snapshot of Entrustability of Acute Care Procedural Skills in Paediatrics Residents

Abstract Background General paediatricians are expected to be competent in the resuscitation of children and important to this competency is the ability to perform certain acute care procedural skills. Paediatric residents are expected to be competent in these procedural skills by the end of their training as specified by the Royal College (RCPSC). However, the extent to which residents are actually competent is not fully assessed or understood. There are currently no evidence-supported guidelines suggesting the best path toward procedural skills competency for residents, and they are less likely to receive formal training and or supervision for completing procedural skills than their nursing counterparts. They also report feeling inadequately prepared. To address this gap, the Paediatrics program at McMaster University aimed to conduct a longitudinal cross-sectional study examining the competency of their trainees in specific acute care procedures. Objectives The purpose of this first study was to present a cross-sectional observation of the entrustability of paediatric residents in 6 procedural skills. Design/Methods The procedures were bag-valve mask (BVM) ventilation, intubation, intraosseous (IO) line insertion, chest tube insertion, and cardiopulmonary resuscitation (CPR), and defibrillation, which are all requirements of the RCPSC. Paediatric residents attended an “Acute Care Procedure Day” where they performed each procedure with direct observation and feedback. Entrustable professional activity (EPA) scores (from 1 to 5) were recorded for each attempt. Prior, a 1-hour interactive lecture was given that included procedural information and a video demonstration of each procedure. Residents received a copy of the milestones per EPA. Demographic information, self-perceived comfort, and EPA data were collected. Descriptive statistics and Pearson correlation for PGY level versus EPA scores were performed. Results Of the 36 residents who participated, 24(67%) were in postgraduate year (PGY) 1-2, and 12 PGY 3-4(33%). Reported levels of past experience were lowest for placement of chest tubes (n=3, 8.3%), followed by IOs (n=19, 52.8%). During the sessions, residents showed the highest levels of initial entrustment with IO placement (EPA 4-5 in 28/33), BVM skills (EPA 4-5 in 27/33), and CPR (EPA 4-5 in 16/25), and lowest for chest tube placement (EPA 4-5 in 0/35), defibrillation (EPA 4-5 in 5/31 residents) and intubation (EPA 4-5 in 17/31). Despite this, self-reported overall confidence after training for these procedures was moderate to high. There was strong correlation between PGY level and EPA score for intubation, and no correlation for the other procedures. Conclusion Our findings show that entrustability of certain acute care skills is not being obtained (i.e., defibrillation, chest tube placement), and that there were large discrepancies between entrustment scores and perceived comfort among the PGY levels. Further research is needed to characterize the learning curves for these skills, and their relative importance in paediatrics training.

Cardiac POCUS: Another Tool in the Armory.

This study assessed the educational impact of hybrid cardiac Point of Care Ultrasonography (POCUS) training in a community-based academic setting. Internal Medicine and Medicine/Pediatrics residents across all post-graduate years (PGY) at a midwestern medical school under-took a structured hybrid (online and hands-on teaching) model of POCUS training. Anonymous surveys with Likert-type scale responses were administered before and after the curriculum. Questions were categorized into domains to assess the residents' interest in learning POCUS, their understanding of fundamental cardiac ultrasound (US) concepts, and their confidence in its application. The authors used Fisher's Exact and t-test, and estimated odds ratios to gauge the impact of the training to achieve net scores above 0 on each domain. A total of 27 and 26 residents completed the pre-and post-training surveys, respectively. Experience with previous cardiac US use showed a positive skew. The training resulted in a significant increase in both, the understanding of the principles, and the residents' confidence in its application. These findings were most significant amongst PGY 2 and 3 residents. Post-training mean scores were similar across all domains for subgroups of PGY level and previous ultrasound experience. Residents displayed greater understanding of the fundamental cardiac ultrasound concepts with improved confidence levels after implementing a structured hybrid teaching model for POCUS. Future studies with objective assessment tools are needed to gauge the clinical impact of POCUS and its adoption rate in clinical practice to guide a recommendation for its incorporation into the residency curriculum.

Formation and Assessment of a Laryngology Pathology Video Atlas for Resident Education

Conventional reference images of laryngeal pathologies may provide educational value for Otolaryngology-Head & Neck Surgery (OHNS) residents, but observing dynamic vocal fold function is critical for diagnosis. Our aim was to develop and validate a video atlas of laryngeal pathologies for resident education in OHNS. A multi-institution, prospective case-control study. Ten videos showing 10 representative laryngeal pathologies were verified by two laryngologists. Six videos per category with kappa>0.8 were included in the video database. A collection of the videos was shown to a group of OHNS residents in a quiz fashion to determine if senior trainees would score higher than junior trainees. Another group of residents in OHNS was recruited and randomized to control or intervention. The control group was shown a quiz of 10 laryngeal videos at baseline and 24 weeks later. The intervention group was shown quizzes at baseline and every 6 weeks, ending at 24 weeks. Free-text diagnoses were scored for accuracy. Descriptive statistics, two-tailed tests, and analysis of covariance were performed. Twenty-nine residents participated, with 14 (48.3%) randomized to control, and 15 (51.7%) to the intervention. The postgraduateyear (PGY) level had a significant impact on diagnostic performance. PGY1 and 2 had a significantly lower score than PGY5 (P=0.017 and P=0.035, respectively). PGY3 and PGY4 scores were not statistically different from PGY5 scores. The mean score difference between groups decreases as the PGY level increases (mean difference between groups=0.87, P=0.153), but this was not significant. The current study has created a validated collection of videos that are representative of common laryngeal pathologies and can be easily incorporated into resident video-based learning. Future directions include larger multi-site studies to further elucidate whether repeated viewing of this video atlas can improve OHNS resident laryngology knowledge.

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.

Perceptions of the Shared Learning Environment by Vascular and General Surgery Residents

Perceptions of the Shared Learning Environment by Vascular and General Surgery Residents

The Impact of Post-graduate Year and Program Accreditation Status on In-Training Examination Performance in Orthopaedic Surgery.

Introduction The progression of medical knowledge competency during surgical residency training is poorly understood. This study measures the acquisition of medical knowledge as orthopedic surgery residents advance during training and the impact of accreditation status on orthopedic in-training examination (OITE) performance. Methods Orthopedic surgery residents taking the OITE during 2020 and 2021 were included. Residents were grouped into cohorts by post-graduate year (PGY) and Accreditation Council for Graduate Medical Education (ACGME) accreditation status. Comparisons were made with parametric tests. Results Eight thousand eight hundred and seventy-one ACGME-accredited residents (89%) and 1,057 non-ACGME-accredited residents (11%) were evenly distributed by the PGY level (range, 19-21%). Residents in both ACGME- and non-ACGME-accredited residency programs had a significant increase in OITE performance at each PGY level (P<0.001). At ACGME-accredited programs, OITE performance increased from PGY1 (51%), PGY2 (59%), PGY3 (65%), PGY4 (68%), and PGY5 (70%) (P<0.001). There were progressively smaller percentage increases in OITE performance during accredited residency training (range, 2-8%), but this increase was linear in non-accredited residency training (range, 4%). At each PGY level, residents at accredited programs outperformed their counterparts at non-accredited programs (P<0.001). Conclusion OITE performance increases during residency training. Among ACGME-accredited residents, performance on the OITE progresses rapidly during junior years and plateaus during senior years. Residents in ACGME-accredited residency programs outperform their counterparts in non-accredited residency programs. More research is needed to understand optimal training environments that promote medical knowledge acquisition during orthopedic surgery residency.

Declining Surgical Resident Operative Autonomy—All Trainees Are Not Created Equal

IntroductionWe have previously shown that resident autonomy has decreased over time overall for all surgery residents. The purpose of this study is to examine changes in operative autonomy in general surgery residency within each postgraduate year (PGY) level. Materials and methodsThis is a retrospective analysis of the Veterans Association Surgical Quality Improvement Program database from July 1, 2004 to September 30, 2019. All general surgery, vascular surgery, and thoracic surgery procedures were analyzed and categorized by level of resident supervision as attending primary, attending operating with resident, or resident primary without attending scrubbed. Procedure work portion of relative value unit was used to capture procedure complexity. Changes in resident autonomy over time, procedure complexity, and outcomes were compared among PGY levels 1 to 5. ResultsA total of 385,482 cases were analyzed. At each PGY level from 2014 to 2018, the relative decrease in resident primary cases ranged from −37.3% (PGY 4) to −75.5% (PGY 3). Mean work portion of relative value unit saw steady increase with PGY level (8.4 ± 3.5 in PGY 1 to 10.8 ± 5.7 in PGY 5, P < 0.001) and did not show a trend over time. ConclusionsSurgical resident operative autonomy has markedly decreased over time across all PGY levels. This effect is most profound at the PGY 3 level, while more senior residents are affected to a lesser degree. Case complexity show PGY level-appropriate increase in resident autonomous cases. Decrease in resident autonomy over time is not associated with changes in case complexity.

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.

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.

Gender Differences in Surgical Case Volume Among Neurosurgery Residents.

Gender differences in surgical training opportunities, measured by case volume, have been demonstrated in the fields of otolaryngology and ophthalmology. We hypothesize that this gender disparity is not present among neurosurgery residents. This study compares median female and male case volumes stratified by postgraduate year (PGY) level for U.S. neurosurgery residents. This retrospective analysis included case log data from two southern California neurosurgery residency training programs, Riverside University Health System (RUHS) and Desert Regional Medical Center (DRMC), from 2015 to 2021. For each PGY level, gender differences in case volumes were summarized using median, SD, and two-sided t-tests. Among 47 (19.1% female) neurosurgery residents, there were no significant gender differences in case volumes across any PGY levels. Female residents had greater median surgical cases during PGY-1 (median (SD), female 107.0 (13.1) vs male 102.0 (24.3); p=0.841) and PGY-7 (female 282.5 (17.7) vs male 246 (60.9); P=0.424), while male residents had greater median case volumes for all other PGY levels. Although previous studies have found significant gender differences in case volumes among surgical residents in otolaryngology and ophthalmology, case log data from two neurosurgery residency programs in southern California, RUHS and DRMC, does not reflect this gender disparity at any PGY level.