Postgraduate Medical Training Programs Research Articles

Teaching clinical phenomenology in a post-graduate medical training program

IntroductionPatient care suffers when practitioners do not understand the patient’s experience of the illness. This is especially true in psychiatry relative to patients having learned the jargon and studying the diagnostic criteria for various mental disorders using internet search engines, especially Google. Patients more commonly present with a list of symptoms that match the checklist for their self-diagnosis. Their experience may be quite different from the words they use to present their symptoms to medical personnel. More than ever, psychiatric providers need to unpack the words their patients use to discover the actual experience. K. Toombs has written exquisitely about clinical phenomenology in the context of her diagnosis of multiple sclerosis and her negotiation of a medical system that largely ignored her lived experience. This algorithmic, checklist approach to human suffering derives from an understanding of clinical practice in which the practitioner applies scientific knowledge of the bodily processes of diseases, recognizing those diseases by inquiring about the presence of symptoms characterizing those diseases and then rendering treatments based upon statistical studies (preferably randomized, controlled trials) of large groups of individuals. Within this approach, little need exists to encounter the person with the disease as an actual human being, an Other in the sense of Levinas. This approach suffers because even history-taking requires an encounter with an Other in which the internal, private experience of this Other must be heard and made part of the clinical process. This approach can ignore the role of the doctor-patient relationship and the clinical encounter in symptom relief.ObjectivesTo describe an educational program in clinical phenomenology that was well received by trainees who rated that it improved their practice.MethodsIn this presentation, we will describe our efforts at teaching clinical phenomenology and psychiatry within a residency training program, in which we encourage trainees to develop deeper listening skills through conducting life story interviews, motivational interviewing techniques, and narrative approaches in which they search for the metaphors underlying the patients’ illness. We will describe factors influencing trainees’ acceptance or rejection of these approaches and the change in the culture of our training program and clinic that have arisen from their implementation.ResultsOne hundred and twenty residents have taken this course. Eighty-eight percent reported improved clinical skills and ability to relate to patients.ConclusionsThe practice of medicine does not exist independently from the relationships in which medicine is practiced and a thorough understanding of the lived experience and experience of the patient is necessary for accurate diagnosis, psychiatric or medical, and for discovery of a treatment approach with the patient.Disclosure of InterestNone Declared

Exploring how immigrant international medical graduates successfully manage complex sociocultural challenges.

While immigrant international medical graduates (I-IMGs) contribute significantly to the physician workforce in North America, researchers have highlighted the myriad of ways sociocultural challenges can negatively impact their success. Conceptual understanding that unpacks the complex processes of how I-IMGs effectively manage sociocultural challenges is relatively sparse. In addressing this critical knowledge gap, this study explored how I-IMGs successfully manage sociocultural differences as postgraduate residents. We interviewed eleven I-IMGs from diverse backgrounds who are in training or recently trained in a distributed multi-site postgraduate medical training program in Canada. We used the lens of sociocultural learning theory to gain insights into the processes of how I-IMGs describe successful management of sociocultural challenges. The overarching storyline of participants emphasized that their experiences were humbling as they grappled with inner struggles, emotions, and vulnerabilities while embracing the ambiguity of not knowing what was expected of them. The following dominant themes from their narratives encapsulate the salient processes for how I-IMGs conceptualize and successfully manage sociocultural challenges: 1) successfully navigating transitions; 2) resisting or altering elements of prior sociocultural norms while embracing the new; 3) living and being in community and having supportive social networks; 4) risk taking to self-advocate and actively seek help. Understanding the strengths and positive strategies for how I-IMGs interface with complex sociocultural challenges has application for medical training institutions. Our insights suggest the need for practical, effective, and continuous assistance within I-IMG training programs to better support future trainees dealing with sociocultural challenges.

Simulation vs workplace-based assessment in resuscitation: a cross-specialty descriptive analysis and comparison.

Simulation-based assessment can complement workplace-based assessment of rare or difficult to assess Entrustable Professional Activities (EPAs). We aimed to compare the use of simulation-based assessment for resuscitation-focused EPAs in three postgraduate medical training programs and describe faculty perceptions of simulation-based assessment. EPA assessment scores and setting (simulation or workplace) were extracted from 2017-2020 for internal medicine, emergency medicine, and surgical foundations residents at the transition to discipline and foundations of discipline stages. A questionnaire was distributed to clinical competency committee members. Eleven percent of EPA assessments were simulation-based. The proportion of simulation-based assessment did not differ between programs but differed between transition (38%) and foundations (4%) stages within surgical foundations only. Entrustment scores differed between settings in emergency medicine at the transition level only (simulation: 4.82 ± 0.60 workplace: 3.74 ± 0.93). 70% of committee members (n=20) completed the questionnaire. Of those that use simulation-based assessment, 45% interpret them differently than workplace-based assessments. 73% and 100% trust simulation for high-stakes and low-stakes assessment, respectively. The proportion of simulation-based assessment for resuscitation focused EPAs did not differ between three postgraduate medical training programs. Interpretation of simulation-based assessment data between committee members was inconsistent. All respondents trust simulation-based assessment for low-stakes, and the majority for high-stakes assessment. These findings have practical implications for the integration simulation into programs of assessment.

Performance Prediction of the Family Medicine Applicants of Oman Medical Specialty Board in Multiple Mini-interviews Using the International Foundations of Medicine Exam and Situational Judgment Test

Background: Entry into postgraduate medical training programs should be based on valid selection measures predictive of training performance. A situational judgment test (SJT) is often used during the residency selection process to measure knowledge and behavioral attributes. Objectives: This study aimed to test the validity of the International Foundations of Medicine (IFOM) examination and an SJT for predicting performance during multiple mini-interviews (MMI) of the applicants for a family medicine residency program in Oman. Methods: This retrospective cross-sectional study was conducted at Oman Medical Specialty Board (OMSB) during the application process of residency for the academic year 2021. Data were collected from 80 applicants to the OMSB Family Medicine Residency Program. Before participating in the MMI panels, all applicants underwent pre-interview tests (comprising the IFOM examination and SJT). Multiple regression analysis was performed to determine the predictors of the MMI score. Results: A total of 67 applicants completed the entire selection process cycle and were included in the study. The SJT score was a significant predictor of the MMI score (r = 0.367; P = 0.002), whereas the IFOM score was not a significant predictor (r = 0.105; P = 0.396). Conclusions: This study supports using SJT as an additional selection measure alongside the MMI panel for entry to OMSB residency training.

Evaluation of postgraduate rural medical training programs and implications for rural workforce development: a systematic review.

Providing postgraduate rural training programs has been recognised as central for successful recruitment and retention of medical workforce. While there have been many documented cases of rural training program development, documented program outcome evaluations are few. This review investigated how postgraduate training and educational programs for rural and remote medicine are evaluated worldwide. Through the use of a systematic review, the study explored three questions: 'What are the outcomes of postgraduate rural and remote training programs worldwide?', 'How are the program evaluations conducted?' and 'What evaluation models and approaches are used in evaluating the effectiveness of these training programs?' A qualitative synthesis was undertaken of evaluations of postgraduate rural training programs published in the English language in medical education journals. The study involved pooling quantitative and mixed-methods research data and findings from qualitative studies, which were aggregated, integrated and interpreted. PubMed, PsycINFO, ERIC and Web of Science databases were searched to identify studies that satisfy the search criteria. Of the 1297 articles identified through the database search, 26 studies were included in the analysis. Most of the evidence from the studies consists of descriptive studies with some longitudinal tracking programs and cohort studies. Nine themes were identified: practice location after training completion; training location and decentralised model; educational aspects; incentives, political contexts and regulations; personal, social and cultural issues; professional development; rural orientation and community engagement; support system; and gender and racial issues. Key outcomes were analysed and cross-validated against the 2020 WHO guideline on health workforce development, attraction, recruitment and retention in rural and remote areas. These studies' most frequent evaluation methods were surveys, followed by interviews, questionnaires and secondary data from existing databases. Methodological characteristics, the relationship between rural background and program outcomes, and implications for decentralised training, telehealth and tele-assessment during the COVID-19 pandemic are discussed. Analysis from the key outcomes suggests evaluation as a strategy to uncover outcomes in postgraduate rural and remote training and medical education. Regardless of the similar outcomes, the program evaluations implemented and the robustness of evidence vary across programs and medical schools. The absence of solid evaluation designs and their alignment to the program objectives will lessen the strengths of evidence. Better quality research and evaluation design, objective settings, qualitative inquiry to uncover the contexts, and developing appropriate indicators and benchmarks for monitoring and evaluating strategies must be considered during program development and implementation.

The Menopause Management Vacuum.

The burden of untreated menopause symptoms in midlife women is substantial and can result in reduced quality of life as well as lost work productivity, lost opportunities for advancement at work, and increased health care costs. Unfortunately, the health care system is largely unprepared to help women manage these symptoms, which have a mean duration of 7 to 9 years. Hormone therapy usage rates have plummeted following publication of the results of the Women's Health Initiative trials due to safety concerns. In addition, postgraduate medical training programs include minimal to no training on menopause management. These and other factors have contributed to what is essentially a menopause management vacuum. This vacuum created a market opportunity, particularly given the fact that midlife women are potent drivers of the global economy. In this review, we outline the menopause management gaps and discuss a multipronged approach to close these gaps and improve the care of midlife women.

Das Logische Modell als Grundlage für ein strukturiertes Konzept der Evaluation und Qualitätssicherung der Kompetenzzentren Weiterbildung Allgemeinmedizin

BackgroundThe Competence Centers for Postgraduate Medical Education (KW) established throughout Germany represent complex programs to increase the efficiency and quality of postgraduate medical education in general practice. So-called Logic Models serve as the framework for evaluations and quality management processes of complex programs in many areas. The aim of this article is to develop such a model, using the example of the Competence Center in Baden-Württemberg (KWBW) in order to structure its complex program logic and use it as a framework for future evaluations and quality management processes. MethodsThe adaptation of the Logic Model to the KWBW took place in an informal, nominal group process with employees and participants of the program. ResultsWe identified 76 core elements of the KWBW. These core elements were classified in one of the five pillars of the Logic Model (input, activity, output, outcome and impact) and categorized according to fields of action and target groups. DiscussionThe Logic Model, which was developed using the KWBW as an example, identifies and structures important core elements of a complex postgraduate medical training program for the first time. It seems to be well suited for visualizing the internal logic of this complex program and the interaction of the various elements within the KWBW. It can thus be used as the basis for a comprehensive and systematic evaluation concept and for quality assurance. ConclusionThe model is also a prerequisite for comparative research questions of other university programs for postgraduate medical education and thus offers an opportunity for cooperative development efforts. This article therefore contributes to promoting quality in continuing medical training.

Postgraduate ethics training programs: a systematic scoping review

BackgroundMolding competent clinicians capable of applying ethics principles in their practice is a challenging task, compounded by wide variations in the teaching and assessment of ethics in the postgraduate setting. Despite these differences, ethics training programs should recognise that the transition from medical students to healthcare professionals entails a longitudinal process where ethics knowledge, skills and identity continue to build and deepen over time with clinical exposure.A systematic scoping review is proposed to analyse current postgraduate medical ethics training and assessment programs in peer-reviewed literature to guide the development of a local physician training curriculum.MethodsWith a constructivist perspective and relativist lens, this systematic scoping review on postgraduate medical ethics training and assessment will adopt the Systematic Evidence Based Approach (SEBA) to create a transparent and reproducible review.ResultsThe first search involving the teaching of ethics yielded 7669 abstracts with 573 full text articles evaluated and 66 articles included. The second search involving the assessment of ethics identified 9919 abstracts with 333 full text articles reviewed and 29 articles included. The themes identified from the two searches were the goals and objectives, content, pedagogy, enabling and limiting factors of teaching ethics and assessment modalities used. Despite inherent disparities in ethics training programs, they provide a platform for learners to apply knowledge, translating it to skill and eventually becoming part of the identity of the learner. Illustrating the longitudinal nature of ethics training, the spiral curriculum seamlessly integrates and fortifies prevailing ethical knowledge acquired in medical school with the layering of new specialty, clinical and research specific content in professional practice. Various assessment methods are employed with special mention of portfolios as a longitudinal assessment modality that showcase the impact of ethics training on the development of professional identity formation (PIF).ConclusionsOur systematic scoping review has elicited key learning points in the teaching and assessment of ethics in the postgraduate setting. However, more research needs to be done on establishing Entrustable Professional Activities (EPA)s in ethics, with further exploration of the use of portfolios and key factors influencing its design, implementation and assessment of PIF and micro-credentialling in ethics practice.

Levering adult learning principles into a residency core curriculum.

Levering adult learning principles into a residency core curriculum.

Diagnostic Neuroradiology Subspecialty Training: 1 Versus 2 Years; the Canadian Perspective

Canada began a national reform of its post-graduate medical education training programs to a Competence By Design (CBD) model. Trends from accredited neuroradiology programs from the past 10 years were investigated to inform educators and stakeholders for this process. A 13-question electronic survey was sent to program directors of all 8 accredited neuroradiology training programs in Canada. Data was requested for each year on the 2008-2019 graduating classes. Questions pertained to program enrolment; program completion; post-training employment; and the sufficiency of 1-year training programs. Response rate was 100%. Over the timeframe studied, the 2-year programs increased in size (P = 0.007), while the 1-year programs remained steady (P = 0.27). 12.2% of trainees enrolled in the 2-year program dropped out after 1 year, and were considered 1-year trainees thereafter. A higher proportion of 2-year trainees obtain positions within academic institutions (89.5 vs 67.2%, P = 0.0007), whereas a higher proportion of 1-year trainees obtain positions within non-academic institutions (29.3 vs 8.1%, P = 0.0007). A higher proportion of those with Canadian board certification in diagnostic radiology who completed a 2-year program obtained a position within a Canadian academic institution compared to non-certified 2-year trainees (P < 0.001). 71.4% of program directors agreed that a 1-year program was sufficient for non-academic staff positions. The length of the training program has significant impact on employment in academic vs non-academic institutions. This information can be used to guide the upcoming CBD initiative for neuroradiology programs.

Is Canada's Post-Graduate Medical Education Curricula Producing Physicians who can Provide Culturally Safe Care?

Indigenous peoples living in Canada experience significant health inequities relative to non-Indigenous people, which stem largely from experiences of colonization, past and present. An important contributor to such inequities is the paucity of culturally safe healthcare available to Indigenous people. A lack of relevant educational experiences for healthcare professionals has been implicated in both creating culturally unsafe healthcare environments and in perpetuating these healthcare-related inequities (Guerra &amp; Kurtz, 2017). The Truth and Reconciliation Commission of Canada (TRC, 2015) calls for improved cultural safety training for healthcare professionals treating Indigenous patients. Recently, post-graduate medical education training programs have shifted to a competency-based model (CBME) whereby specific learning objectives must be attained to graduate, compared to the historical time-based model (Iobst et al., 2010). However, it is unknown whether the CBME programs sufficiently fulfill the TRC calls to action pertaining to Indigenous health. The objective of this study is to determine the extent to which Canada’s CBME curricula provide cultural safety training regarding Indigenous health. An environmental scan of the publically available national CBME curricula will assess the content of the core portions of the training programs. A self-report mixed-methods survey will be distributed to medical residents at Queen’s University to determine the extent to which they perceive that such training is provided to them. This research aims to identify gaps in the CBME curricula pertaining to Indigenous health, so as to contribute to improved cultural safety training, and thus health equity, in the future.

Encouraging residents\u2019 professional development and career planning: the role of a development-oriented performance assessment

BackgroundCurrent postgraduate medical training programmes fall short regarding residents’ development of generic competencies (communication, collaboration, leadership, professionalism) and reflective and deliberate practice. Paying attention to these non-technical skills in a structural manner during postgraduate training could result in a workforce better prepared for practice. A development-oriented performance assessment (PA), which assists residents with assessment of performance and deliberately planned learning activities, could potentially contribute to filling this gap. This study aims to explore residents experiences with the PA.MethodsWe conducted a qualitative interview study with 16 residents from four different medical specialties who participated in the PA, scheduled halfway postgraduate training. The PA was conducted by an external facilitator, a psychologist, and focused specifically on professional development and career planning. Residents were interviewed 6 months after the PA. Data were analysed using the framework method for qualitative analysis.ResultsResidents found the PA to be of additional value for their training. The overarching merit was the opportunity to evaluate competencies not usually addressed in workplace-based assessments and progress conversations. In addition, the PA proved a valuable tool for assisting residents with reflecting upon their work and formulating their learning objectives and activities. Residents reported increased awareness of capacity, self-confidence and enhanced feelings of career-ownership. An important factor contributing to these outcomes was the relationship of trust with the facilitator and programme director.ConclusionThe PA is a promising tool in fostering the development of generic competencies and reflective and deliberate practice. The participating residents, facilitator and programme directors were able to contribute to a safe learning environment away from the busy workplace. The facilitator plays an important role by providing credible and informative feedback. Commitment of the programme director is important for the implementation of developmental plans and learning activities.

Relationship between sociodemographic factors and selection into UK postgraduate medical training programmes: a national cohort study

IntroductionKnowledge about allocation of doctors into postgraduate training programmes is essential in terms of workforce planning, transparency and equity issues. However, this is a rarely examined topic. To address this...

Medical Training Experience and Expectations Regarding Future Medical Practice of Medical Students at the University of Cape Verde.

Cape Verde is a small insular developing state. Its first experience of undergraduate medical education began in October2015. The purpose of this paper is to describe and analyze the professional expectations and profile of the first class of medicalstudents at the University of Cape Verde. A piloted, standardized questionnaire, with closed and open-ended questions, was distributed to registeredmedical students attending classes on the day of the survey. All data were analyzed using SPSS. Students decided to study medicine in their mid-teens with relatives and friends having had significant influence over theirdecisions. Other major reasons for choosing medical training include "to take care of other people", "fascination for the subject mattersof medicine" and "I have always wanted to". The degree of feminization of the student population is extremely high (20/25; 80.0%).Medical students are in general satisfied with the training program, and have expectations that the training received will allow them to begood professionals. Nevertheless, they consider the course too theoretical. Medical students know that this represents an opportunityfor them to contribute to public welfare. Nonetheless, their expectations are to combine public sector practice with private work. Medicalstudents come mostly from Santiago Island where the Capital of the Country is located. They still do not know about their future area ofspecialization. But all of those who want to specialize want to do so abroad. They mostly expect to follow hospital careers rather thanhealth administration or family and community medicine. This study contributes to the growing body of knowledge about medical students' difficulties and expectations regardingmedical schools or curriculums in lusophone countries. The decision to invest in the training of local physicians is justified by the needto be less dependent on foreigners. Local postgraduate medical training programs are already considered a priority for the immediatefuture. Cape Verde is pursuing a bold strategy to deal with a shortage of medical doctors. The problems experienced by medicalstudents provide an important insight to help the new medical school to provide a better learning environment for students. The fact thatstudents are not sure about their future area of specialization is an opportunity to guide them towards the areas of the health systemwith pressing needs. The current feminization of the medical workforce will be sustained with the profile of the present intake, hence theneed to take this into account in workforce planning.

Stakeholder perspectives on workplace-based performance assessment: towards a better understanding of assessor behaviour

Workplace-Based Assessment (WBA) plays a pivotal role in present-day competency-based medical curricula. Validity in WBA mainly depends on how stakeholders (e.g. clinical supervisors and learners) use the assessments—rather than on the intrinsic qualities of instruments and methods. Current research on assessment in clinical contexts seems to imply that variable behaviours during performance assessment of both assessors and learners may well reflect their respective beliefs and perspectives towards WBA. We therefore performed a Q methodological study to explore perspectives underlying stakeholders’ behaviours in WBA in a postgraduate medical training program. Five different perspectives on performance assessment were extracted: Agency, Mutuality, Objectivity, Adaptivity and Accountability. These perspectives reflect both differences and similarities in stakeholder perceptions and preferences regarding the utility of WBA. In comparing and contrasting the various perspectives, we identified two key areas of disagreement, specifically ‘the locus of regulation of learning’ (i.e., self-regulated versus externally regulated learning) and ‘the extent to which assessment should be standardised’ (i.e., tailored versus standardised assessment). Differing perspectives may variously affect stakeholders’ acceptance, use—and, consequently, the effectiveness—of assessment programmes. Continuous interaction between all stakeholders is essential to monitor, adapt and improve assessment practices and to stimulate the development of a shared mental model. Better understanding of underlying stakeholder perspectives could be an important step in bridging the gap between psychometric and socio-constructivist approaches in WBA.

Foreign medical practitioners: requirements for medical practice and postgraduate training in Thailand under ASEAN Economic Community liberalization in 2015

Background: The ten member states that currently comprise the Association of Southeast Asian Nations (ASEAN) agreed to cooperate to become the ASEAN Economic Community (AEC). The first targets of the AEC are free flow of goods, services, investment, capital, and skilled labor. The eventual goal is “a single market and production base”. The ASEAN Mutual Recognition Arrangement (MRA) for medical practitioners has been formulated to facilitate cooperation and the mobility of medical practitioners within the AEC. Method: We reviewed the requirements of the Medical Council of Thailand (TMC) and the Thai Ministry of Public Health for medical practice and postgraduate training of foreign medical practitioners. Result: In Thailand a foreign medical practitioner (FMP), holding a valid medical license from their country of graduation, will be recognized as a legal medical practitioner only after obtaining either a temporary or permanent medical licensure from TMC. To acquire a permanent Thai medical license, the FMP needs to register as a member of the TMC, have graduated from a TMC recognized medical school, but also having passed all 3 parts of the National Licensing Examination of Thailand. A Thai medical license is also required for clinical postgraduate medical training. Thai language proficiency is mandatory for registration. There is now only one formal international postgraduate medical training program in Thailand. Participants as observers may be exempted from some or all of these regulations. Conclusion: The current status of medical licensure in the Kingdom of Thailand presents hurdles that may have to be surmounted. Keywords: ASEAN, foreign medical practitioners, medical licensing and reciprocity, medical practice, medical training

A landscape analysis of leadership training in postgraduate medical education training programs at the University of Ottawa

There is growing recognition of the importance of physician leadership in healthcare. At the same time, becoming an effective leader requires significant training. While educational opportunities for practicing physicians exist to develop their leadership skills, there is a paucity of leadership opportunities for post graduate trainees. In response to this gap, both the Royal College of Physicians and Surgeons of Canada and the Association of Faculties of Medicine of Canada have recommended that leadership training be considered a focus in Post Graduate Medical Education (PGME). However, post-graduate leadership curricula and opportunities in PGME training programs in Canada are not well described. The goal of this study was to determine the motivation for PGME leadership training, the opportunities available, and educational barriers experienced by PGME programs at the University of Ottawa. An electronic survey was distributed to all 70 PGME Program Directors (PDs) at the University of Ottawa. Two PDs were selected, based on strong leadership programs, for individual interviews. The survey response rate was 55.7%. Seventy-seven percent of responding PDs reported resident participation in leadership training as being "important," while only 37.8% of programs incorporated assessment of resident leadership knowledge and/or skills into their PGME program. Similarly, only 29.7% of responding residency programs offered chief resident leadership training. While there is strong recognition of the importance of training future physician leaders, the nature and design of PGME leadership training is highly variable. These data can be used to potentially inform future PGME leadership training curricula.

Mapping global health training in Canadian post-graduate medical training programs

Mapping global health training in Canadian post-graduate medical training programs

Analysis of the postgraduate medical training programs in Europe and America and its enlightenment to China

The main form of the postgraduate medical training in China is residency standardized training, while the residency training system in some European and American developed countries is relatively mature. A review is presented on the programs of residency standardized training in Europe and America, concentrating on their strength and defects and reaching the conclusion that standardization, high-efficiency, personalization, socialization and internationalization can be the new trends in the development of residency standardized training in China. Key words: China; Europe and America; Residency standardized training; Trends

Pediatric faculty and residents’ perspectives on In-Training Evaluation Reports (ITERs)

In-training evaluation reports (ITERs) are used by over 90% of postgraduate medical training programs in Canada for resident assessment. Our study examined the perspectives of faculty and residents in one pediatric program as a means to improve the ITER as an evaluation tool. Two separate focus groups were conducted, one with eight pediatric residents and one with nine clinical faculty within the pediatrics program of Memorial University's Faculty of Medicine to discuss their perceptions of, and suggestions for improving, the use of ITERs. Residents and faculty shared many similar suggestions for improving the ITER as an evaluation tool. Both the faculty and residents emphasized the importance of written feedback, contextualizing the evaluation and timely follow-up. The biggest challenge appears to be the discrepancy in the quality of feedback sought by the residents and the faculty members' ability to do so in a time effective manner. Others concerns related to the need for better engagement in setting rotation objectives and more direct observation by the faculty member completing the ITER. The ITER is a useful tool in resident evaluations, but a number of issues relating to its actual use could improve the quality of feedback which residents receive.