Postgraduate Medical Residents Research Articles

Collaboration cognizance: Development of a self-assessment tool to measure intra-professional collaborative practices (IPCP) in postgraduate medical residents at tertiary care hospitals

BackgroundThe ever-evolving healthcare system of today demands physicians who steer their roles as treatment providers, managers and collaborators. Professionals are highly interdependent due to increased complexity of health problems and risk of errors increases with transitions in care. In hospitals, the main workforce is postgraduate residents; therefore, intraprofessional collaboration amongst residents is essential. Several instruments are available to evaluate interprofessional collaboration amongst physicians, nurses and hospital teams but none specifically assessed intra-professional collaborative practices amongst residents working in tertiary care hospitals in multi-disciplinary teams. This study intends to develop and validate an instrument to self-assess intraprofessional collaborative practices in postgraduate residents undergoing residency in multiple specialties at tertiary care hospitals.ApproachThis study on Instrument Development employed mixed method study design executed in two phases. In phase 1, six domains of intraprofessional collaborative practices were identified from literature and 35 items were developed. Fifteen experts participated in qualitative content validation and provided comments. To establish content validity in phase 2, content validity index (CVI) and content clarity average (CCA) were assessed by seventeen experts. Response process validity was established by cognitive interviewing of 5 postgraduate residents. Pilot testing was done on a sample of 407 residents. Cronbach’s alpha was determined, and confirmatory factor analysis established construct validity.ResultsDuring phase 1, items were modified based on qualitative feedback from 15 experts. In round 2, CVI and CCA were determined based on responses of 17 experts. The items having an I-CVI greater than 0.90 were accepted and six items underwent modifications as their I-CVI fell between 0.78 and 0.90. Similarly, four items with a CCA of less than 2.4 were modified to increase clarity. Cognitive interviews of participants on 30 items resulted in the deletion of 1 item and changes in 5 items. The final instrument had 29 items categorized under six constructs. All items had good factor loadings during CFA, so none was deleted. Cronbach’s Alpha α was 0.937.ConclusionIntraprofessional collaborative practices in residents is a valid and reliable self-assessment tool comprising 29 items measuring six constructs. It may be used by residents to assess their collaborative practices and incorporated in curricula to help develop collaborative practices and their assessment during training of postgraduate residents.

Knowledge and attitude on childhood cancer survivorship among healthcare trainees: a multicentre study from India

BackgroundThe proportion of childhood cancer survivors (CCS) in low/middle-income countries (LMICs) is rising. CCS often develop several physical and psycho-social long-term adverse effects, with unique healthcare needs. Primary healthcare providers...

Development of a Clinical Simulation Video to Evaluate Multiple Domains of Clinical Competence: Cross-Sectional Study.

Medical students in Japan undergo a 2-year postgraduate residency program to acquire clinical knowledge and general medical skills. The General Medicine In-Training Examination (GM-ITE) assesses postgraduate residents' clinical knowledge. A clinical simulation video (CSV) may assess learners' interpersonal abilities. This study aimed to evaluate the relationship between GM-ITE scores and resident physicians' diagnostic skills by having them watch a CSV and to explore resident physicians' perceptions of the CSV's realism, educational value, and impact on their motivation to learn. The participants included 56 postgraduate medical residents who took the GM-ITE between January 21 and January 28, 2021; watched the CSV; and then provided a diagnosis. The CSV and GM-ITE scores were compared, and the validity of the simulations was examined using discrimination indices, wherein ≥0.20 indicated high discriminatory power and >0.40 indicated a very good measure of the subject's qualifications. Additionally, we administered an anonymous questionnaire to ascertain participants' views on the realism and educational value of the CSV and its impact on their motivation to learn. Of the 56 participants, 6 (11%) provided the correct diagnosis, and all were from the second postgraduate year. All domains indicated high discriminatory power. The (anonymous) follow-up responses indicated that the CSV format was more suitable than the conventional GM-ITE for assessing clinical competence. The anonymous survey revealed that 12 (52%) participants found the CSV format more suitable than the GM-ITE for assessing clinical competence, 18 (78%) affirmed the realism of the video simulation, and 17 (74%) indicated that the experience increased their motivation to learn. The findings indicated that CSV modules simulating real-world clinical examinations were successful in assessing examinees' clinical competence across multiple domains. The study demonstrated that the CSV not only augmented the assessment of diagnostic skills but also positively impacted learners' motivation, suggesting a multifaceted role for simulation in medical education.

Quality of Life Among Postgraduate Medical Residents in Oman: A Cross-sectional Survey.

To assess the quality of life (QoL) of medical residents enrolled in the various postgraduate programs of the Oman Medical Specialty Board (OMSB). The data for this cross-sectional study was collected from January to June 2022. All postgraduate residents who were enrolled in all 19 OMSB training programs were targeted. An online English version of the validated 36-Item Short Form Health Survey (SF-36) was used to assess the participants' self-reported QoL. The participants were 425 OMSB residents (mean age = 29.6±2.2 years), of whom 289 (68.0%) were female, 259 (60.9%) were married, and 295 (69.4%) were enrolled in medical specialties. Overall, female residents reported significantly poorer QoL than male residents in all subscales of SF-36 (p =0.001). Married residents reported lower bodily pain scores than unmarried residents (p =0.005), although the latter endorsed better physical functioning, general health, and mental health. Residents in laboratory specialties had higher scores than those in medical and surgical specialties in most QoL dimensions including physical health, role functioning, energy/fatigue, emotional well-being, bodily pain, and general health (p ≤ 0.003). Psychiatry residents reported the lowest overall QoL. Postgraduate medical residents in Oman reported significant variations in QoL based on specialization, gender, and marital status. These findings underscore the need for targeted interventions to tackle health inequalities and improve the QoL of this population.

Development and Evaluation of a Peer Mentoring Programme for Postgraduate Medical Residents in Pakistan: A Pilot Study.

To develop, implement, and evaluate the impact of one-year peer mentoring programme for postgraduate medical residents. Mixed methods. Place and Duration of the Study: The Aga Khan University, Karachi, from January 2019 to December 2020. A survey was administered to junior residents in Medicine, Paediatrics, Pathology, and Radiology residency programmes to identify their academic needs from January 2019 to December 2020. Final-year residents, who served as peer mentors were provided a one-day mentoring workshop, including details of the identified needs. This was followed by one-year intervention in which mentors-mentees met as per mutual feasibility. A structured survey and focus group discussions were conducted to inquire the effectiveness of mentoring. A total of 33 out of 52 (63%) Year 1 residents completed needs analysis survey. Four essential identified areas were research (63%), memory (59%), reading (55%), and time management (53%). Residents reported excelling in areas of research, memory and reading, however, time management needed improvement. Focus group discussions emphasised mentoring as mandatory, including the wide range of skills. Senior residents should be trained as mentors of juniors, and semi-structured formal and informal mentoring can be implemented across all residency programmes. Mentoring, Residents, Postgraduate, Medical trainees.

Leadership skills in postgraduate medical residents

Background of the Study: Safe patient care is the fundamental objective of every healthcare facility by the services provided by high performing healthcare providers with effective leadership skills. Leadership competencies are considered now as essential for all medical trainees, not only to face challenges at individual level but it also helps them solving certain institutional and interpersonal challenges. Aim: To assess the current leadership training needs of postgraduate medical resident undergoing training in different hospitals of the Pakistan. Methods: This was a cross-sectional online quantitative survey. A request link of online google survey form was sent to the residents through social media residents’ groups and through email addresses of residents to fill the form. Results: A total of 67 residents of all years completed the survey. Mean age of the residents was 30.63 ±3.87, with about 81% being male and 84% were getting done their residency training in specialty related to medicine and allied. On a Likert scale (1 = strongly disagree, 3 = neutral, 5 = strongly agree), residents rated the importance of leadership skills in the clinical setting as high (4.15 of 5).

Causal attributions of failure among post graduate medical residents in exit fellowship examination in Pakistan: A qualitative study.

Causal attributions are reasons given to certain events in life including failure and success. The objective of this qualitative study was to explore the attributions perceived as the cause of failure by post graduate residents, failing the final clinical exit examination of Fellowship of College of Physicians and Surgeons Pakistan (FCPS). This exploratory study was conducted from July 2021 to July 2022, at Jinnah Hospital, Lahore. Study population was selected by purposeful maximal variation sampling. A total of ten post graduate residents from four specialties, failing in FCPS part two clinical examination were included. After written informed consent, semi structured face to face, in depth interviews were conducted. Data saturation was achieved after eight interviews after which two more interviews were carried out. All interviews were recorded and transcribed verbatim. Thematic analysis of the data was done by synthesizing codes into categories and themes. A total of 17 attributions noted were grouped into five categories namely 'Inadequate exam preparation', 'Personal factors,' 'Exam related factors,' 'Training related factors and 'Luck'. Two main themes of External and Internal factors emerged from these. Common attributions were; lack of effort (8/10), inadequate knowledge (8/10), family commitments (7/10), luck (8/10) and examiner's attitude (5/10). Most of the residents attributed internal, unstable and controllable factors like inadequate knowledge and lack of effort. In addition, external uncontrollable factors of bad luck and harsh attitude of examiners were considered as contributory factors towards failure.

Differences In Debt Among Postgraduate Medical Residents By Self-Designated Race And Ethnicity, 2014-19.

The US physician workforce does not reflect the racial and ethnic makeup of the country's population, despite efforts to promote diversity. Becoming a physician requires significant time and financial investment, and populations that are underrepresented in medicine have also been excluded from building wealth. Understanding the differential burden of debt by race and ethnicity may inform strategies to improve workforce diversity. We used 2014-19 data on postgraduate resident trainees from the Association of American Medical Colleges to examine the association between race and ethnicity and debt independent of other demographics and residency characteristics. Black trainees were significantly more likely to have every type of debt than the overall sample and all other racial and ethnic groups (96percent of Black trainees had any debt versus 83percent overall; 60percent had premedical education loans versus 35percent overall, and 50percent had consumer debt versus 25percent overall). American Indian/Alaska Native, Hispanic, and Native Hawaiian/Pacific Islander trainees were more likely to have debt compared with White and Asian trainees. Overall, debt prevalence decreased over time and varied by specialty; however, for Black trainees, debt decreased minimally over time and was stable across specialties. Scholarships, debt relief, and financial guidance should be explored to improve diversity and inclusion in medicine across specialties.

Assessment of sleep quality among postgraduate residents of a tertiary care hospital in Kashmir

Introduction: The Postgraduate medical training is long and emotionally taxing. These occupations are associated with stress and good workload along with night shifts which effects the sleep quality. Studies have documented that high levels of stress among medical residents have been associated with sleep problems. Our study aims to investigate sleep quality among the postgraduate residents of a tertiary care hospital using Pittsburgh Sleep Quality Index. Material and Methods: It was a cross sectional study that was conducted from 1 November 2021 to 31 December 2021. Study participants included Postgraduate medical residents working at a tertiary care hospital in district Srinagar of Kashmir valley. A total of 400 participants took part in the study. Results: The mean age of the participants was 33.4 years (S.D 4.9). Majority of the participants (54%) were females. The mean global Pittsburgh Sleep Quality Index score (±SD) for sleep quality was 8.46 (±4.5) with a median score of 6 and Inter Quartile Range of 6.5. Conclusion: Poor sleep quality was reported in 75% of the residents. This highlights the need for awareness about this problem. There is a need for early interventions in order to introduce flexible working hours for medical residents and to provide shifts of manageable durations.

Processes of increasing medical residents' intrinsic motivation: a qualitative study.

This study aimed to determine qualitatively how medical residents develop intrinsic motivation to learn and work in clinical training settings. This study was a descriptive qualitative study, which is widely used in healthcare research. We conducted a semi-structured interview aimed to explore key participants' in-depth experiences and perspectives regarding intrinsic motivation. The authors interviewed seven postgraduate Japanese medical residents. The transcripts were analyzed using the sequential and thematic qualitative data analysis technique steps for coding and theorization, which entails coding steps from open to selective, writing a storyline using the final selective codes, and offering theories. External stimulations (a self-handle environment and a near-peer role model) triggered the medical residents' cognitive process (gap recognition, awareness, and internalization) to intrinsic motivation. The residents' awareness of autonomy, responsibility, and independence played a vital role in this process. Furthermore, a psychological feeling of competence also reinforced their intrinsic motivation. Positive feedback and approval from attending physicians and patients' gratitude promoted residents' sense of competence. We illustrated a process for increasing medical residents' intrinsic motivation. The intrinsic motivation was triggered by external stimulations (a self-handle environment and a near-peer role model), which caused the cognitive process: gap recognition, awareness of important attitudes as a doctor (autonomy, responsibility, and independence), and internalization. Since the first step of this process was an external factor, there are potential benefits of designing an appropriate training environment for increasing medical residents' intrinsic motivation.

Perception of postgraduate medical residents regarding educational environment at French Medical Institute for Mothers and children, Kabul Afghanistan

Objective: To assess the perceptions of postgraduate medical education residents regarding educational environment at a medical institution in Afghanistan. Methods: The descriptive cross-sectional study was conducted from 2017 to 2018 at the French Medical Institute for Mothers and Children, Kabul, Afghanistan, FMIC, and comprised postgraduate medical residents. Dundee Ready Educational Environment Measure was administered to determine the perception of learning environment by the residents’ perceptions related to learning, teachers, academic self-perception, atmosphere and social self-perceptions sub scales. Data was analysed using SPSS 22. Results: Of the 63 subjects, 55(87.30%) were males and 42(66.66%) were married. The overall mean age was 30±4.38 years. There was no significant difference in mean subscales scores and overall scores in relation to participants’ age, gender, type of specialty, province and year of training (p>0.05). There was a significant difference in students’ perception of teachers in relation with the type of specialty (p<0.05). Conclusions: The educational environment at the medical institution in Afghanistan was perceived by the students of residency programme as conducive. Key Words: Dundee ready educational environmental measure, DREEM, Educational environment, Residency programme, Afghanistan.

Awareness of personal protective equipment among frontline postgraduate medical residents who provide care to patients with coronavirus disease-2019

Background: To combat the coronavirus disease-2019 (COVID-19) pandemic, which affected the entire world, health-care workers (HCWs) were required to wear personal protective equipment (PPE). PPE offers protection by preventing microorganisms from contaminating hands, eyes, clothing, hair, and shoes. It is mandatory to know about the proper usage of PPE. Objective: The objective of this study was to evaluate the awareness of PPE and its effects on frontline health-care professionals who provide care to patients with COVID-19. Subjects and Methods: This noninterventional cross-sectional questionnaire-based study was conducted in 108 postgraduate (PG) medical residents who have been treated and provided care for COVID-19 in a tertiary care hospital. The Google questionnaire consisted of 25 questions prevalidated through the literature, senior faculty in the department, and ethics. Results: About 87.03% of the 108 PGs were trained in the donning and doffing protocols, whereas 92.59% were aware of the steps. About 62.96% did not follow the two-person protocol for doffing. About 83.33% were aware of the decontamination protocol of PPE. About 64.81% had difficulty intubating and 62.96% had headaches after using PPE. Conclusions: HCWs in a tertiary care center are aware of PPE use and protocols therein. Even though they were adequately trained about protocols, reluctance, and technical difficulties in following them still exist, which can be solved by adequate and repeated training. The problems faced with the use of PPE have appropriate solutions.

Shaken and stirred: emotional state, cognitive load, and performance of junior residents in simulated resuscitation.

BackgroundPatient resuscitation can be overwhelming for junior postgraduate medical residents due to its inherent complexity and high-stakes environment. Emotional states of unpleasant hyperarousal burden cognitive resources, contributing to cognitive overload and performance decline. Our objective is to characterize the associations between pre-scenario emotional state and junior residents’ cognitive load and performance in a simulated-resuscitation, to provide evidence for informed curricular development.Methods:PGY-1 residents self-rated their emotional state before four simulated-resuscitation scenarios, and their cognitive load after. Faculty assessed performance with entrustment scores. Factor analysis identified the principal components of emotional state data. Linear regression models examined the relationship between pre-scenario emotional components, cognitive load, and performance scores.Results:47/47 medical and surgical residents (100%) participated and completed Emotional State (99.5%) and Cognitive Load (98.9%) surveys. Positive invigoration and negative tranquility were the principal components. Pre-scenario tranquility was negatively associated with cognitive load (b= -0.23, p < 0.0001), and cognitive load was negatively associated with performance scores (b= -0.27, p < 0.0001). Pre-scenario invigoration was negatively associated with cognitive load (b=-0.18, p = 0.0001), and positively associated with performance scores (b= 0.08, p = 0.0193).Conclusion:Amongst junior residents participating in simulated resuscitation scenarios, pre-scenario agitation (negative tranquility) is associated with increased cognitive load, which itself is associated with lower performance scores. These findings suggest residency programs should consider developing curriculum aimed at modulating residents’ emotional agitation and reducing residents’ cognitive burden to improve resuscitation performance.

Severe Acute Respiratory Syndrome Coronavirus-2-Associated Perceived Stress and Anxiety among Indian Medical Students

Introduction: The spread of coronavirus disease (COVID-19) is a new public health concern that has shaken the whole world and possesses a challenge to the mental health of the public. This study aimed to investigate the impact of COVID-19 pandemic on the perceived stress, anxiety level, and mental health of medical students as well as to explore the knowledge of COVID-19 among Indian medical students. Methods: A web-based cross-sectional survey was conducted among the undergraduate medical interns and postgraduate medical residents using the online data collection form. The form consisted of five domains (sociodemographic details, knowledge assessment, perceived stress assessment, generalized anxiety disorder-7 assessment, and assessment of the perceived level of change in social habits and personal hygiene related to COVID-19 outbreak). The statistical analysis of the responses was carried out by the Mann–Whitney U-test and Kruskal–Wallis tests. Results: Two hundred participants filled the distributed survey, 61% (n = 122) were males. The mean knowledge score of 200 participants was 4.27 ± 1.45. The participant had a mean perceived stress score of 18.35 ± 6.28, and the females had a significantly higher perceived stress level than the male (P = 0.037). About 10% (n = 20) of the participants reported high perceived stress level (27–40), and moderate stress (score 14–26) was reported in 69% (n = 138) of the participants. However, only 21% (n = 42) of the participants reported low stress (0–13). While only moderate anxiety (score 10–14) was reported in 16% (n = 32) of the participant and 4% (n = 8) of the participants reported severe anxiety (score &gt;14). Conclusion: There is an increased stress and anxiety in Indian medical students due to overburdened responsibilities and lack of adequate resources.

Association Between Resident Duty Hours and Self-study Time Among Postgraduate Medical Residents in Japan

This cross-sectional study uses information from the General Medicine In-Training Examination survey in Japan to assess the association between resident duty hours and self-study time.

BURNOUT AMONG RESIDENTS OF GENERAL SURGERY: WORK-LIFE BALANCE, SOCIAL SUPPORT, AND BURNOUT AMONG RESIDENTS OF GENERAL SURGERY

Purpose: Postgraduate medical students or residents are candidates who gain rigorous specialized training in any field of medical science. The study attempted to explain how work-life fit and perceived social support minimize burnout in public hospital general surgery units.&#x0D; Method: Explanatory, cross-sectional, and quantitative research methods were employed. A questionnaire was administered to 120 respondents using purposive sampling. Besides reliability and validity testing, inferential statistics were used to evaluate data and test hypotheses.&#x0D; Principal Findings: Work-life fit and perceived social supports affect emotional tiredness in responders. However, perceived social support and emotional weariness outweigh work-family balance and emotional exhaustion. Burnout is predicted by the number of children, gender, work-life balance, work-life interference, and personal life interference.&#x0D; Implications: The current study helps us understand the process that affects the professional efficacy of medical professionals. Despite their high cognitive capacity, they were victims of depersonalization, emotional tiredness, and burnout. Therefore, it is crucial to successfully address surgeon burnout to enhance patient care.&#x0D; Novelty: The study has novel findings for exploring the link between work-life balance, social support, and burnout in the cultural settings of Pakistan. It was not comprehensively investigated in our traditional healthcare system which is lacking in internal and external rewards therefore a complete investigation of the matter is required. Thus, these findings will enrich scientific understanding to further study these topics.

The perceived contributions of non-physician team members to residents’ interprofessional education during a critical care rotation

During rotations, post-graduate medical residents must learn about interprofessional teamwork and collaboration. Our study examined the role of non-physician healthcare team members in such education, from the perspectives of both residents and team members themselves.MethodsThis qualitative study took place in the intensive care unit (ICU) of a teaching hospital in a Canadian city. We conducted semi-structured individual and focus group interviews with both residents (n = 6) and the team members with whom they collaborated: pharmacists, nurses, respiratory therapists, and a social worker (n = 19).ResultsWe developed a number of themes about interprofessional education (IPE) in this context from the data, including the presence of planned, unplanned, and tacit teaching; the influence of contextual factors like ICU culture, work demands, resident motivation, power hierarchies, and perceptions of ‘good’ and ‘bad’ residents; the gap between team member perceptions of their contribution to residents’ IP education and residents’ own perceptions; and concerns about the transferability of IPE to other contexts.ConclusionsThe influence of non-physician team members on residents’ IPE in the clinical environment is an understudied topic. While our study was limited to one ICU, the themes that emerged may be of interest to others in similar contexts

Impact of COVID-19 on the analytical diagnosing ability of family medicine residents.

This article described the difficulties of family medicine residents regarding diagnostic skill training during the pandemic of COVID-19. Social impact may strongly affect clinical reasoning skills.

Vaccination and immunization status among healthcare students: results from the SAVES survey

Abstract Background Adequate vaccination coverage among healthcare workers, including students in healthcare professions (SHPs), is crucial in order to prevent spreading of infections within healthcare facilities. However, vaccination coverage among SHPs is often inadequate. We aimed to describe the vaccination/immunization status of SHPs of the University of Milan. Methods We spread an e-survey to the academic e-mail addresses of postgraduate medical residents and to first- and last-year undergraduate SHPs. The questionnaire covered sociodemographic data (age, sex, education, municipality of residence, internship in high-risk wards) and the reported vaccination/immunization status for Influenza (previous flu season), Varicella, MPR and DTaP vaccines. Results Among 5743 invited SHPs, 884 participated in the survey. The study sample comprised 462 medical residents and 422 undergraduate SHPs (medicine 176, nursery 186, midwifery 4, healthcare assistance 32, prevention techniques 24). Median age was 27 years (IQR 7); 68.4% participants were female; 91.3% had attended high school in a lyceum, while others in a professional (2.9%) or technical (5.8%) institute; 36.7% lived in municipalities of &amp;lt; 20.000 inhabitants, while 26.1% of &amp;gt; 250.000. Traineeships took place in high-risk wards for 46% of participants. Reported vaccination coverage for Influenza was 33,7% (with higher coverage for pediatric nursing and midwifery students, medicine students and medical residents). Participants reported immunity (either vaccine or natural immunity) to Varicella in 93,3% cases. Declared vaccination coverage for Hepatitis B was 94,1%; 91,7% participants reportedly completed the MPR schedule, 76,2% the recommended DTaP booster. Conclusions Influenza vaccination coverage was suboptimal in our sample of SHPs, suggesting the need of specific educational programs and targeted vaccination campaigns, which may help shaping a positive vaccination attitude for future healthcare professionals. Key messages Immunization status for VPDs is suboptimal among Italian students in healthcare professions. The monitoring of the immunization status should include healthcare students actively involved in healthcare activities.

Identifying research obstacles; a cross sectional comparative study of perceptions of postgraduate medical and dental residents in three public sector medical colleges.

To explore the attitude of postgraduate medical and dental residents about research work and to identify barriers in the way of research activities. The cross-sectional study was conducted from May to July, 2018, at three public-sector medical and dental institutions in Quetta, the capital of Pakistan province of Balochistan, and comprised postgraduate residents. Data was collected using a pre-validated 16 item Likert scale questionnaire. Data was analysed using SPSS 23. Of the 72 subjects, 44(61.1%) were males. The overall mean age was 23.3±4.6 years (range: 28-30 years. The residents demonstrated willingness to conduct clinical research with a mean score of 4.36±0.65. There was no association of attitudes and barriers with socio-demographic and personal characteristics (p>0.05). Deficient lab facilities (p-<0.001), and inaccessibility to electronic and hospital data (p=0.003) were the major factors identified as research barriers. Barriers to research need to be addressed in designing research curricula to encourage and facilitate meaningful research.