Postgraduate Medical Training Research Articles

The early experience of doctors training in pediatrics: patient safety culture and the role and influence of the registrar.

Postgraduate medical training incorporates education, both formal and informal, combined with clinical service. This study explored the early training experience of pediatricians in Ireland and its potential impact on patient safety. We sought to identify factors that contribute to the patient safety experience of new entrant pediatric trainees. Trainees, or senior house officers (SHOs), in their first year of postgraduate training, participated in an interview conducted using a critical interview technique (CIT). They described an adverse event where the medical care delivered to the patient was not ideal. Thematic analysis identified themes that influenced the described event. Thirteen trainees participated in the interviews. This study identified influences on the relationship between the SHO and patient safety, including the SHO themselves, teamwork and communication. Colleagues within the workplace, including consultants, registrars, and nurses, also affect this relationship. The registrar is described as a central figure holding an active role in clinical care in 11 of the 13 stories told. In the participants' experience, the registrar was the senior decision-maker, teacher, team builder, and communication intermediary within the teams' hierarchical structure. The registrars' previous clinical experience, communication style, along with their ability to supervise and provide feedback shaped the SHO experience. Through a process designed to focus on exploring patient safety, it emerged that the registrar plays a crucial role in the working experience of their junior colleagues. The influence of the registrar needs to be recognized within clinical teams and by postgraduate training bodies.

Staying SHARP in times of crisis – The impact of COVID-19 on anaesthesiology residency

The COVID-19 pandemic is an unprecedented crisis that has taken the world by storm, and it has taken an especially immense toll on the healthcare sector. Although much effort has been made to make changes in key areas such as clinical practice, national policy and research, we believe that it is just as important to evaluate the impact of the crisis on postgraduate medical training. To this end, we would like to share our experience within an anaesthesiology residency programme in Singapore, the SingHealth Anaesthesiology Residency Programme, which we hope will benefit other training programmes and anyone involved in postgraduate medical education as a whole. Key challenges identified include restrictions on teaching events, difficulties in completing core posting requirements, changes in clinical workload, postponement of examinations, exposure risk (particularly in relation to aerosol-generating procedures) and psychological burden. Strategies that have been implemented to tackle these challenges are also described, including the use of online platforms, modifications to posting and promotion requirements, manpower adjustments, provision of protective equipment and training in infectious disease protocols. Ultimately, we believe that a supportive work environment is essential to ensure the wellbeing of residents in times of crisis.

The Effect of COVID-19 Pandemic on Performance of Postgraduate Medical Trainee Doctors: A Nationwide Epidemiological Study in Pakistan.

To find out various organizational, personal, and systemic factors influencing the performance of the postgraduate trainee doctors in managing COVID-19 pandemic. Analytical cross-sectional study. Conducted in various medical institutions of Pakistan from 15th April to 30th June, 2020. An analytical cross-sectional study was conducted on 11,656 postgraduate doctors. They were contacted through the e-log system of College of Physicians and Surgeons Pakistan. Semi-structured questionnaire was used consisting of demographic details, presenting symptoms, systemic involvements, clinical features, diagnostic tests, management of cases, authenticity of the information used, telemedicine services, practice of preventive measures, training and interactive educational activities, performance-based tasks and details about workplace environment. Mean and standard deviation was reported for continuous variables. Bivariate and multivariate analyses were used to report p values. Among 11,656 postgraduate doctors, 3,193 (27.4%) were directly involved in the management of COVID-19 patients in designated special corona facilities. Multivariate analysis was performed to control confounders. The risk factors, found statistically significant with performance, were presence of comorbidity (OR 1.261; 95% C.I.1.06-1.50), allergic and autoimmune disorders (OR 1.18; 95% C.I.1.03-1.35), confirmed COVID-19 status due to exposure (OR 0.570; 95% C.I.0.41-0.81), and care provision to old parents (OR 1.299; 95% C.I.1.19-1.42). The effect of COVID-19 on performance of postgraduate doctors was multi-factorial.Significant risk factors were presence of a comorbidity, allergic and autoimmune disorders, and confirmed COVID-19 due to exposure. Key Words: COVID 19, Postgraduate trainee, Pandemic, Comorbidity, PCR.

Key elements of effective postgraduate GP educational environments: a mixed methods study

ObjectivesEvidence in the literature suggests that satisfaction with postgraduate general practice (GP) training is associated with the quality of the educational environment. This study aimed to examine GP registrars’ level...

DOES RESTRUCTURING THE RESEARCH CURRICULUM OF ORTHOPEDIC TRAINING PROGRAM AFFECT THE RESEARCH PERFORMANCE? EVIDENCE FROM QATAR

Background: The participation of trainees and faculties in the research is an integral part of postgraduate medical training and education. The educational curriculum of the training program should be structured to support the learning of the trainees scholarly activities, address research barriers, foster a culture of inquiry, and improve their research performance. The Accreditation Council for Graduate Medical Education International (ACGME-I) standards include participation in scholarly activities by residents and faculties as an essential requirement of the training program.The possible effects of research-based curriculum after accreditation of postgraduate training program on the research performance was examined in a longitudinal study of the orthopedic training program. Methods: Web-based systematic review for all publicationsfrom our orthopedic training program and only pubmed index publications of other institutional programs before (2009-2013) and after (2014-2018) accreditation was conducted. Data for the type of publications, journal name, impact factors, dates published, orthopedic specialty, level of evidence,and the role of residents and faculties in the authorship were collected.The research academic degree of residents, number of residents applied and matched for a fellowship in North America and/or UK were collected from a residents portfolio. Results: The orthopedics training program published a total of 50 articles between 2009 and 2018, which represented 2% of all other institutional programs publications. There was a significant improvement in the number of publications from three (6%) to 47(94%) articles before and after accreditation, respectively. There were 19(38%) original researches, 17(34%) review articles, 13(26%) case reports, and one letter to the editor. International Orthopedics was the most commonly used journal with ten publications (25%). Most of the publications were in orthopedic trauma with 18 articles (36%), 10(20%) pediatric orthopedics, 7 (14%) foot and ankle and 7(14%) spine articles. The residents were the first author in 50% of publications, and at least one-third were published during their training. Conclusion: This study showed that the development of the structured research based educational curriculumof the residency training program after accreditation helped in enhancing the research performance and publications in our postgraduate training program. Restructuring of the research-based curriculum after accreditation of the program appears to increase the trainees and faculties chances of being an author or co-author of a scientific article.

Creating a Healthcare Entrepreneurship Teaching Program for Medical Students

Introduction: The future of healthcare hinges on effective adoption of innovative solutions. Arguably, physicians are ideally positioned to propel clinical innovation given their firsthand experience with healthcare challenges; however, physicians often lack the necessary skills in innovation development and implementation methodology. The gap is partly a result of the paucity of exposure to innovation and entrepreneurship concepts within medical education and postgraduate training. To address this gap, the University of Toronto’s distributed medical education campus in Mississauga created a novel teaching initiative designed to impart themes of healthcare entrepreneurship to early stage medical learners. Methods: To inform the design of the program, the authors conducted a series of semi-structured interviews with key stakeholders, including physician entrepreneurs, innovation leaders, curriculum specialists and medical students. Using thematic analysis, key recommendations were extracted regarding learning objectives, approach to program delivery, and anticipated outcomes. A well-established entrepreneurial teaching model, the MaRS Entrepreneurship Framework, was adapted to frame the curricular content to the needs of medical learners. The resulting educational product consisted of six sessions, taught by subject matter experts, which outlined a methodological approach to the development of a medical start-up as a means of launching an innovation. Results: From November 2019 to May 2020, six sessions were held with a total of 37 unique attendees. The authors found that the series generated interest in entrepreneurship among medical students while fostering an appreciation for the basic principles of entrepreneurship. Conclusion: The next stage involves further program evaluation to guide the next iteration of the program. Potential avenues for growth include delivering the series virtually to support greater student accessibility. Future considerations include incorporating entrepreneurship into core undergraduate medical curricula and creating a dual degree program in medicine and entrepreneurship that cater to students with a deep interested in the field of healthcare entrepreneurship. Disclosure: The authors have no conflict of interest to declare. As all data were completely anonymized and no patients were involved, this was not reviewed by an ethics board.

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.

Post-graduate Medical Training in Intellectual and Developmental Disabilities: a Systematic Review.

Despite the increasing number of people with autism-spectrum disorder (ASD), intellectual disabilities (ID), and developmental disabilities (DDs), individuals with these conditions continue to have high levels of unmet physical and mental health needs. Robust training of health professionals can help bridge this gap. A systematic review was conducted to describe the features and educational outcomes of existing postgraduate medical education curricula to inform the development of future training to address the growing unmet care needs of people with intellectual and developmental disabilities (IDD) such as ASD and ID. Four major databases were searched for peer-reviewed, English-language research focusing on post-graduate training in IDD education. Educational curricula and outcomes were summarized including Best Evidence in Medical Education (BEME) Quality of Evidence and Kirkpatrick training evaluation model. Sixteen studies were identified with a majority published after 2000 (69%). Pediatric departments were involved in 69%, Psychiatry 19%, Medicine-Pediatrics 19%, and Family Medicine 6.3%. Analysis of Kirkpatrick outcomes showed 31% were level 1 (satisfaction or comfort); 38% level 2 (change in objective knowledge or skills); 13% level 3 (change in behavior); and none at level 4. BEME analysis showed 19% of studies were grade 1 (no clear conclusions), 31% grade 2 (ambiguous results), and half (50%) grade 3 (conclusions can probably be based on findings), with none scoring four or higher. There is a paucity of objectively evaluated research in the area. Studies reviewed show clear promise for specialized, interdisciplinary, competency-based education which may be foundational for future curriculum development.

Perception and Usage of Point of Care Devices: A Cross-sectional Study Targeting Residents and Trainers in Oman.

ObjectivesThe use of mobile technologies and handheld computers by physicians has increased worldwide. However, there are limited studies globally regarding training physicians on the use of such devices in clinical practice. In addition, no studies have been conducted previously in Oman addressing this issue among postgraduate medical trainees and trainers. The present study explores the practice and perception of resident doctors and trainers towards the use of mobile technologies and handheld devices in healthcare settings in Oman.MethodsThis cross-sectional study was conducted using a validated questionnaire disseminated via email to all residents and trainers in five major training programs of the Oman Medical Specialty Board (OMSB). The questionnaire explored three main areas; perception, usage, and perceived barriers of handheld devices.ResultsOverall, 61.4% of the residents and 28.3% of the trainers responded to the questionnaire. Both types of participants agreed that the use of such devices positively affects clinical decision-making. In total, 98.8% of the participating residents and 86.7% of the trainers frequently used handheld devices. Both OMSB residents and trainers agreed that lack of time, training, and applications were the most common factors limiting the use of these devices. Participants emphasized the need for constructive training regarding the use of handheld devices as healthcare resources.ConclusionsPoint-of-care devices are positively perceived and frequently used by OMSB trainees and trainers. However, constructive training on the effective usage of these devices in clinical decision-making is needed. Further future studies to evaluate the impact of using such devices in patient care should be conducted.

Global prevalence of burnout among postgraduate medical trainees: a systematic review and meta-regression.

Background:Burnout among postgraduate medical trainees (PMTs) is increasingly being recognized as a crisis in the medical profession. We aimed to establish the prevalence of burnout among PMTs, identify risk and protective factors, and assess whether burnout varied by country of training, year of study and specialty of practice.Methods:We systematically searched MEDLINE, Embase, PsycINFO, the Cochrane Database of Systematic Reviews, Web of Science and Education Resources Information Center from their inception to Aug. 21, 2018, for studies of burnout among PMTs. The primary objective was to identify the global prevalence of burnout among PMTs. Our secondary objective was to evaluate the association between burnout and country of training, year of study, specialty of training and other sociodemographic factors commonly thought to be related to burnout. We employed random-effects meta-analysis and meta-regression techniques to estimate a pooled prevalence and conduct secondary analyses.Results:In total, 8505 published studies were screened, 196 met eligibility and 114 were included in the meta-analysis. The pooled prevalence of burnout was 47.3% (95% confidence interval 43.1% to 51.5%), based on studies published over 20 years involving 31 210 PMTs from 47 countries. The prevalence of burnout remained unchanged over the past 2 decades. Burnout varied by region, with PMTs of European countries experiencing the lowest level. Burnout rates among medical and surgical PMTs were similar.Interpretation:Current wellness efforts and policies have not changed the prevalence of burnout worldwide. Future research should focus on understanding systemic factors and leveraging these findings to design interventions to combat burnout. Study registration:PROSPERO no. CRD42018108774

The Effect of the Educational Environment on the rate of Burnout among Postgraduate Medical Trainees - A Narrative Literature Review.

Background:Burnout among postgraduate medical trainees is common. It is a syndrome characterised by emotional exhaustion, depersonalisation and reduced personal accomplishment. Burnout is seen as an organisational problem rather than the result of an individual’s ability to cope with the stress at work. The educational environment can play a pivotal role in the prevention of burnout among postgraduate medical trainees. This narrative literature review is aimed at assessing the effect of the educational environment on burnout in postgraduate doctors-in-training.Methods:A search of the databases Medline and PscyInfo for articles published between 2015 and 2020 was performed with the key words ‘burnout’ and ‘educational environment’ or ‘clinical learning environment’ or ‘postgraduate medical education’ or ‘learning environment’.Results:A total of 27 studies were identified and reviewed by the author. The prevalence of burnout reported varied widely between studies, ranging from 10% to 62%. Many of the factors that contribute to burnout form part of the educational environment, for example, hours worked, mistreatment, harassment and perceptions of injustice. Residency itself is a stressful period wherein trainees have to balance their responsibilities towards their patients with their responsibilities at home, all while furthering their studies and taking on new responsibilities. Interventions to prevent burnout and tackle existing burnout are multiple but very little solid evidence exists to attest to their efficacy. More research is needed to identify the most effective ways to deal with burnout in postgraduate medical trainees.

To Assess the Attitude and COVID-19 Preparedness Among Postgraduate Medical Trainees in a Tertiary Care Hospital in Central India

To Assess the Attitude and COVID-19 Preparedness Among Postgraduate Medical Trainees in a Tertiary Care Hospital in Central India

An Evaluation of Burnout among Foundation Doctors in Malta—A Cross-Sectional Observational Study

Background: Postgraduate medical trainees are at an increased risk of burnout. Burnout has been defined as “a psychological condition of emotional exhaustion, depersonalization and reduced personal accomplishment occurring in people persistently exposed to emotional and interpersonal stressors at work”. It can arise either from within the individual, from the medical profession itself or from healthcare organisations. Burnout is associated with mental health issues in trainees, impaired work performance and suboptimal patient outcomes. Objective: To evaluate the level of burnout among trainees of the Malta Foundation Programme. Methods: A cross-sectional observational study of three cohorts of the Malta Foundation Programme was conducted using the Copenhagen Burnout Inventory (CBI) to evaluate incidence of personal-, work-related and client related burnout. The cohorts were at 3 months, 1 year and 2 years of training respectively. The CBI was administered via Google Forms after ethical clearance. Descriptive statistics and non-parametric comparative statistics were used to analyse the results through SPSS v25.0. Results: A global response rate of 26.5% was achieved. CBI and its subscales showed good internal validity. High scores for burnout in all three scales were identified except for client-related burnout in First Year doctors. Burnout peaked midway through the 2-year period. High numbers reported “feeling “tired” and “physically exhausted”. Males reported more burnout than females. Conclusion: The high level of burnout so early in the career of Maltese postgraduate medical trainees is of concern. More studies are needed on the causality of this burnout and what factors are associated with burnout in this population.

The use of Virtual Media in Postgraduate Medical Training During the COVID-19 Pandemic

Context: The novel coronavirus disease 2019 (COVID-19) pandemic brought about public health safety measures of social distancing and avoidance of crowded gatherings. These led to widespread disruptions in activities of daily living, as well as routine health-care services and learning activities. There has been a noticeable move to the online domain as the platform for teaching and learning. Aims: The present study aimed to describe the online learning and teaching experiences of postgraduate medical doctors in Nigerian hospitals. Subjects and Methods: The study was a cross-sectional online survey sent to medical doctors across social media platforms, and it sought to find out the current number of hours utilized and modalities of their online educational media use. Results: A total of 116 doctors responded and completed the survey, with 74 (63.8%) and 104 (89.6%) of them having some webinar experience before and during the pandemic, respectively. At least 82 (70.4%) had 1–5 h of online learning activities each week, and an overwhelming 114 (98.2%) used a personal Internet data subscription to access online educational material. In addition, 56 (48.3%) felt that online learning was less rewarding than in-person interactions even though 93 (80.2%) found the online learning activities to be quite convenient. Poor Internet connectivity was cited as a major challenge to a successful online learning experience in 80 (68.9%). Conclusion: Although the COVID-19 pandemic restricted face-to-face human contact including learning activities, postgraduate medical education has filled the void by increasing online learning activities, resulting in an admixture of experiences and reactions.

Augmenting postgraduate ophthalmology residency training during the COVID-19 pandemic

Dear Editor, The coronavirus pandemic resulted in an unsurmountable loss to human life worldwide and created unprecedented challenges for healthcare systems including ophthalmology. The postgraduate medical and surgical training was not far from this negative influence.[1] We read an interesting article by Sarkar et al.[2] regarding surgical simulator-assisted postgraduate training and we must congratulate the authors highlighting the impact of virtual reality simulators (Eyesi, VRmagic, Mannheim, Germany). Although surgical training forms the core of ophthalmology postgraduate training but as a trainee resident, other skills also deserve equal attention for a holistic training program.[3] Here, we want to add a few important points for maximizing resident training output when the patient flow is less and surgical training is at a halt. The residents can practice anterior segment slit-lamp examination and retinoscopy on dummy eyeballs. They can use a slit-lamp and dummy eyeball holders for practicing oblique illumination, retro, and diffuse illumination. In addition, they can also master how to identify the myopic and hypermetropic reflex using a retinoscope on dummy eyeballs. The 3D printed or dummy eyeballs can be used for practicing indirect ophthalmology with the retinal image printed within.[4] They can even practice scleral depression using an earbud or a scleral depressor. The dummy eyeballs can be employed for practicing manual keratometry by identifying mires on the eyeball. In addition, they can have surgical video discussions where they can exchange scientific ideas. The wet lab can be utilized for practicing and tying sutures on a thermocol or a lemon. This initial technique can be taught by a senior, and later, scoring can be done based on the performance of the trainee. The goat’s eyeballs or leftover cadaveric eyeballs can be used to practice scleral tunnel incision, side port incision, tunnel sutures, rhexis in goat’s eyeball, trench, and quadrant emulsification in goat’s eye, and anterior vitrectomy. One innovative technique we follow is that the goat’s eyeballs can be hardened by baking them in the microwave so that the nucleus becomes hard and gives a real-time feel of trenching and emulsification. In addition, the goat’s nucleus can be replaced with a human nucleus and soap pellet to give a real-time feel of phacoemulsification. We believe that this training module can be implemented across different centers for maximizing medical and surgical output when the pandemic is at its peak.[5] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Exploration of Academic Postgraduate Medical Training System in the Context of "Internet plus"

Higher education in China has entered a new era of global quality improvement and innovation. The cultivation of innovative talents is crucial for the development of our higher education. Within the framework of "Internet plus", the culture of university medical graduates must deeply integrate information technology. In the present study, an "Internet plus" academic medical postgraduate training system was discussed. This system includes the establishment of the curriculum system, innovation capability training system and quality evaluation system. By making full use of modern informatics technology, the “Internet plus” system improved the the innovation capability and quality of postgraduates significantly.

Work Based Assessments (WBAs) amongst UK medical trainees during the COVID-19 pandemic: How have we adapted?

Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2) was recently identified as the RNA virus resulting in the Coronavirus disease (COVID-19). This was following cases of pneumonia identified in Hubei Province in China. The World Health Organisation (WHO) recently declared COVID-19 as a pandemic in March The COVID-19 pandemic has resulted in medical, financial and social disruption on an international scale. Such disruption has additionally impacted postgraduate medical training. This has been reflected in the attainment of Work Based Assessments amongst medical trainees in the United Kingdom.

ПІСЛЯДИПЛОМНА МЕДИЧНА ОСВІТА В УКРАЇНІ

Discussion of observations and interviews as to the state of postgraduate medical education in Ukraine during an informal discussion of author’s time as a U.S. Fulbright Scholar for the 2018-2019 academic years for the project titled Postgraduate Medical Education In Ukraine. The interviews with interns (85); attendings, program directors, hospital administrators (75), several medical students and others were recorded during numerous author’s visits and observations (50) to various Ukrainian hospitals. The conclusions made herein are my own and serve to report my observations on the state and quality of postgraduate medical training in Ukraine, reference to that in the United States and the author’s over 45-year practice as a surgeon in Illinois. This mainly concerns internships in the surgical specialties and subspecialties. Some suggestions as to how to change the system are presented.

Breaking Bad News, a Pertinent Yet Still an Overlooked Skill: An International Survey Study.

Delivering bad news to patients is a challenging yet impactful everyday task in clinical practice. Ideally, healthcare practitioners should receive formal training in implementing these protocols, practice in simulation environments, and real-time supervision with feedback. We aimed to investigate whether healthcare providers involved in delivering bad news have indeed received formal training to do so. We conducted a cross-sectional survey study that targeted all healthcare providers in the intensive care units of 174 institutions in 40 different countries. Participants included physicians, nurses, medical students, nursing students, pharmacists, respiratory technicians, and others. The survey tool was created, validated, and translated to the primary languages of these countries to overcome language barriers. A total of 10,106 surveys were collected. Only one third of participants indicated that they had received a formal training. Providers who had received formal training were more likely to deliver bad news than those who had not. Younger and less experienced providers tend to deliver bad news more than older, more experienced providers. The percentage of medical students who claimed they deliver bad news was comparable to that of physicians. Medical schools and post-graduate training programs are strongly encouraged to tackle this gap in medical education.

How We Did It: Creating Virtual Interviews for Postgraduate Medical Trainee Recruitment and Keeping it Personal.

How We Did It: Creating Virtual Interviews for Postgraduate Medical Trainee Recruitment and Keeping it Personal.