Postgraduate Training Programs Research Articles

Learning collaboration at the primary-secondary care interface: a dual-method study to define design principles for interventions in postgraduate training programmes

BackgroundCollaboration between primary and secondary care (PSCC) is important to provide patient-centered care. Postgraduate training programmes should provide training to learn PSCC. With a design based research (DBR) approach design principles can be formulated for designing effective interventions in specific contexts. The aim of this study is to determine design principles for interventions aimed to learn PSCC in postgraduate training programmes.MethodsDBR is characterised by multi-method studies. We started with a literature review on learning collaboration between healthcare professionals from different disciplines within the same profession (intraprofessional) to extract preliminary design principles. These were used to inform and feed group discussions among stakeholders: trainees, supervisors and educationalists in primary and secondary care. Discussions were audiotaped, transcribed and analysed using thematic analysis to formulate design principles.ResultsEight articles were included in the review. We identified four preliminary principles to consider in the design of interventions: participatory design, work process involvement, personalised education and role models. We conducted three group discussions with in total eighteen participants. We formulated three design principles specific for learning PSCC in postgraduate training programmes: (1) The importance of interaction, being able to engage in a learning dialogue. (2) Facilitate that the learning dialogue concerns collaboration. (3) Create a workplace that facilitates engagement in a learning dialogue. In the last design principle we distinguished five subcategories: intervention emphasises the urge for PSCC and is based on daily practice, the presence of role models, the work context creates time for learning PSCC, learning PSCC is formalised in curricula and the presence of a safe learning environment.ConclusionThis article describes design principles for interventions in postgraduate training programmes with the aim to learn PSCC. Interaction is key in learning PSCC. This interaction should concern collaborative issues. Furthermore, it is essential to include the workplace in the intervention and make adjacent changes in the workplace when implementing interventions. The knowledge gathered in this study can be used to design interventions for learning PSCC. Evaluation of these interventions is needed to acquire more knowledge and adjust design principles when necessary.

Establishing Entrustable Professional Activities for Entry-Level Dietitians in Teaching Hospitals in Taiwan

<p>可信賴專業活動(entrustable professional activities, EPAs)是將多種核心能力整合成專業任務，可應用於醫療職場教學訓練，以信賴等級作為能力進展依據，供臨床工作授權參考。此專案針對接受衛福部二年期營養師訓練課程之新進營養師，建置教學醫院新進營養師EPAs。來自全國教學醫院臨床營養及營養學專家，以名義團體法進行共識及投票，建置七項EPA任務及其對應核心能力架構。EPAs任務為「住院病人常見疾病營養照護」、「門診病人常見慢性疾病營養照護」、「重症單位營養照護」、「醫院膳食盤餐督餐作業」、「盤餐膳食設計與食材成本管理」、「疾病飲食營養團體衛教」及「住宿型長照機構個案營養照護」。EPAs建立可將能力進展轉化為臨床營養工作授權，促進營養醫療照護品質提升。</p> <p> </p><p>Entrustable professional activities (EPAs) involve the integration of a variety of core competencies into professional practice tasks, and they can be applied for learning and training in the medical workplace. Supervision levels can help guide the development of competencies and are referenced for clinical work authorization. This paper describes the development of EPAs for entry-level dietitians in a postgraduate clinical training program established by the Ministry of Health and Welfare at teaching hospitals in Taiwan. Clinical instructors in dietetics and nutrition experts from across Taiwan were invited to participate in a consensus development conference, and the nominal group technique was employed to develop profession-specific EPAs. This project established seven EPAs, namely, nutritional care for inpatients with common diseases, nutritional care for outpatients with common chronic diseases, nutritional care in critical care units, hospital plate-meal preparation and supervision, meal design and cost management, group education for disease-specific nutrition, and nutritional care in residential long-term-care institutions. The establishment of EPAs can help transform such competencies into criteria for the authorization of clinical nutrition work in teaching hospitals and may enhance the quality of nutritional medical services.</p> <p> </p>

Evaluation of Three Cohorts of the First Neurology Postgraduate Training Program in Zambia (P4-8.001)

<h3>Objective:</h3> Identify strengths, areas for improvement and perceptions of a new neurology training program in Zambia. <h3>Background:</h3> The first Zambian neurology training program commenced in 2018. We report its first programmatic evaluation. <h3>Design/Methods:</h3> All current and former neurology trainees, internal medicine (IM) trainees who rotated with neurology in the past year, all IM faculty, and all international visiting providers from the past four years were sent electronic surveys. Neurology trainees and graduates, IM rotators, international faculty who had visited for at least three months, and one hospital administrator were invited to focus groups or semi-structured interviews. Participants were asked what they perceived as the “most significant change” at the hospital since program implementation. <h3>Results:</h3> 62/78 (80%) completed surveys, 17 contributed to focus groups and interviews. Neurology trainees noted protected didactic time, emphasis on bedside teaching, and one-on-one attending exposure were program strengths and requested more exposure to outpatient subspecialties and electrophysiology training. When asked about the “most significant change”, participants noted providers in other specialties across the hospital also seemed to be learning neurologic examination and diagnostic skills, leading to widely improved neurologic care. Additionally, they noted a stronger research emphasis among trainees, even those outside neurology. <h3>Conclusions:</h3> The Zambian neurology training program has created positive department-wide changes in teaching and research. Other training programs in resource-limited settings may benefit from prioritizing one-on-one bedside teaching and protected didactics. Similarly, trainees in resource-limited settings may benefit from the development of regional collaborations to provide better exposure to subspecialty clinical experiences and mentors that may be limited at single institutions. Our study employed a comprehensive, mixed-methods approach to program evaluation in this resource-limited setting that identified strengths and actionable solutions to areas for improvement. This program evaluation method could provide valuable insights in other training settings, regardless of available resources. <b>Disclosure:</b> Dr. DiBiase has nothing to disclose. Edford Sinkala has nothing to disclose. Dr. Jonathan has nothing to disclose. The institution of Sean Tackett has received research support from NIH. The institution of Dr. Saylor has received research support from National Institutes of Health. The institution of Dr. Saylor has received research support from National Multiple Sclerosis Society. The institution of Dr. Saylor has received research support from American Academy of Neurology. The institution of Dr. Saylor has received research support from United States Department of State. Dr. Saylor has a non-compensated relationship as a Member of multiple committees and task forces focused on improving access to MS medications to people across the world with Multiple Sclerosis International Federation that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the Neurology and COVID19 committee with World Health Organization that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the International Outreach Committee, Junior and Early Career Membership Committee, and Educational Innovation Commitees with American Neurological Association that is relevant to AAN interests or activities.

Four- and three-year emergency medicine residency graduates perform similarly in their first year of practice compared to experienced physicians

IntroductionUnited States emergency medicine (EM) post-graduate training programs vary in training length, either 4 or 3 years. However, it is unknown if clinical care by graduates from the two curricula differs in the early post-residency period. MethodsWe performed a retrospective observational study comparing measures of clinical care and practice patterns between new graduates from 4- and 3-year EM programs with experienced new physician hires as a reference group. We included emergency department (ED) encounters from a national EM group (2016–19) between newly hired physicians from 4- and 3- year programs and experienced new hires (>2 years' experience) during their first year of practice with the group. Primary outcomes were at the physician-shift level (patients per hour and relative value units [RVUs] per hour) and encounter-level (72-h return visits with admission/transfer and discharge length of stay [LOS]). Secondary outcomes included discharge opioid prescription rates, test ordering, computer tomography (CT) use, and admission/transfer rate. We compared outcomes using multivariable linear regression models that included patient, shift, and facility-day characteristics, and a facility fixed effect. We hypothesized that experienced new hires would be most efficient, followed by new 4-year graduates and then new 3-year graduates. ResultsWe included 1,084,085 ED encounters by 4-year graduates (n = 39), 3-year graduates (n = 70), and experienced new hires (n = 476). There were no differences in physician-level and encounter-level primary outcomes except discharge LOS was 10.60 min (2.551, 18.554) longer for 4-year graduates compared to experienced new hires. Secondary outcomes were similar among the three groups except 4- and 3-year new graduates were less likely to prescribe opioids to discharged patients, −3.70% (−5.768, −1.624) and − 3.38% (−5.136, −1.617) compared to experienced new hires. ConclusionsIn this sample, measures of clinical care and practice patterns related to efficiency, safety, and flow were largely similar between the physician groups; however, experienced new hires were more likely to prescribe opioids than new graduates. These results do not support recommending a specific length of residency training in EM.

A Comparison of Surgical Subspecialty Match Rates in 2022 in the United States.

This paper examines the 2022 surgical subspecialty results within the Match hosted yearly by the National Resident Matching Program (NRMP) in the United States. It exists to place medical graduates with post-graduate training programs via an algorithm based on ranked lists provided by both residency programs and individual applicants around the world. This paper compares the match rates between allopathic medical graduates (MDs) and osteopathic medical graduates (DOs). Using published NRMP data and reports from Program Director surveys, we explored possible reasons for match rate differences between the two groups, hypothesizing that lower match rates among DOs could be explained by completion of less volunteerism, research, or curricular activities that may have affected their overall first-choice match rates in competitive surgical specialties. While the data showed that MDs consistently out-matched DOs, the cause was deemed multifactorial as the data did not provide concrete evidence to the contrary. We concluded that more data over time should be collected to understand why osteopathic students do not match as well as allopathic students in surgical specialties.

Abstract 723: Who reconstitutes my chemotherapy? Examining the educational needs of oncology pharmacy practitioners in Nigeria

Abstract BackgroundNigeria has the highest cancer burden in Africa with 124,815 cancer cases and 78,899 cancer deaths in 2020. The limited number of oncology specialists, inaccessibility of essential cancer medicines like chemotherapies, and suboptimal delivery of cancer care lead to poor treatment outcomes. Oncology pharmacy (OP) practitioners are critical oncology professionals in the multidisciplinary team (MDT) for cancer treatment globally. In Nigeria, there is a limited number of OP practitioners providing services like reconstitution of chemotherapy, clinical research, safe use of biosafety cabinets, and monitoring of adverse drug reactions. Although the interest in oncology pharmacy is increasing, the educational needs, available skill sets, and directed training in oncology pharmacy across the nation are unknown. In this study, we examined the educational needs of OP practitioners and worked with the West African College of Pharmacy West African Postgraduate College of Pharmacists (WAPCP), Oncology Pharmacy Practitioners Association of Nigeria (OPPAN), and the International Society of Oncology Pharmacy Practitioners to upgrade the oncology pharmacy practice in Nigeria. MethodA cross-sectional study with a semi-structured questionnaire was done in 2021 with 39 pharmacists working in oncology centers across Nigeria. General descriptive statistics and qualitative analysis was performed. ResultsThere is no board-certified oncology pharmacist in Nigeria. More than 50% of the general pharmacists working in oncology centers are responsible for chemotherapy reconstitution. Understanding chemotherapy reconstitution (automation of chemotherapeutic mixing, use of radiopharmaceuticals, etc), use of biosafety cabinets, knowledge of pharmacology, designing treatment protocols, data management, immunotherapy delivery, and oncology clinical trials were some of the most significant educational needs of the OP practitioners in Nigeria. OP practitioners are lacking in most cancer centers and MDTs. ConclusionThere is an urgent need for a specialty postgraduate training programme in oncology pharmacy in Nigeria. This would help increase oncology clinical trials, improve delivery of cancer medicines, quality of care, and management of toxicities. The West African Postgraduate College of Pharmacists and OPPAN need appropriate training resources to develop an oncology pharmacy curriculum, promote the specialty and collaborate with global institutions for board certifications. Citation Format: Runcie C. Chidebe, Ramatu M. Alabelewe, Darlingtina K. Esiaka, Gloria C. Okwu, Tochukwu C. Orjiakor, Nwamaka Lasebikan, Jacinta Emejulu, Adamu A. Umar, Ndifreke Okwuegbunam, Funsho David, Toyosi Adepoju, Krishna Prasad Sapkota, Candidus C. Nwakasi, Agha A. Agha, Simeon C. Aruah, Katy Graef, Richard Mshelia, Rob Duncombe, Matthew O. Nwaneri, Noel Wannang, Cindy O’Bryant, R. Donald Harvey, Peace C. Babalola, Folakemi T. Odedina. Who reconstitutes my chemotherapy? Examining the educational needs of oncology pharmacy practitioners in Nigeria [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 723.

5613514 PAVING THE WAY FOR GENETIC MEDICINE IN SUB-SAHARAN AFRICA: A REPORT ON THE FIRST GENETIC COUNSELLING PROGRAM IN THE REGION

Genetic disorders, chiefly sickle cell disease (SCD), pose a significant public health and developmental challenge in the sub-Saharan African region and genetic counsellors have a unique role to play in addressing this critical challenge in the region. Paradoxically, as at 2021, there were no postgraduate training programmes in human genetics in West Africa. Thus, whereas there were thousands of registered Genetic Counsellors in North America, there were about 25 in Africa, all in South Africa. In January 2022, the West African Genetic Medicine Centre (WAGMC) of the University of Ghana (UG), West Africa, inaugurated the first genetic counselling program in the sub-region. The two-year full-time accredited program aims to provide cutting edge training in the science of genetics while fostering a strong foundation in counselling. Graduates from the 2-year program further undertake one-year internship to be licensed as genetic counsellors by the Ghana Psychology Council, which is the body responsible for ensuring ethical genetic counselling practice in Ghana. In Ghana, where about 14,000 babies are born with SCD every year and the incidence of other genetic disorders keep rising, it is the goal of current genetic and genomic initiatives in the region to better understand these conditions and help drive preventive and precision medicine. This requires the contributions of genetic counsellors. Therefore, the new MSc. Program in Genetic Counselling holds vast opportunities for the first cohort and all prospective students on the program, despite the anticipated challenges. These include limited genetic testing facilities as well as resources for integrating genetic counsellors into the clinical and public health systems of Ghana and other countries in the sub-region.

Detecting residents at risk of attrition – A Singapore pathology residency's experience

The SingHealth Pathology Residency Program (SHPRP) is a 5-year postgraduate training program in Singapore. We face the problem of resident attrition, which has a significant impact on the individual, program and healthcare providers. Our residents are regularly evaluated, using in-house evaluations as well as assessments required in our partnership with the Accreditation Council for Graduate Medical Education International (ACGME-I). We hence sought to determine if these assessments were able to distinguish residents who would attrite from residents who would graduate successfully. Retrospective analysis of existing residency assessments was performed on all residents who have separated from SHPRP and compared with residents currently in senior residency or graduated from the program. Statistical analysis was performed on quantitative assessment methods of Resident In-Service Examination (RISE), 360-degree feedback, faculty assessment, Milestones and our own annual departmental mock examination. Word frequency analysis of narrative feedback from faculty assessment was used to generate themes.Since 2011, 10 out of 34 residents have separated from the program. RISE, Milestone data and the departmental mock examination showed statistical significance in discriminating residents at risk of attrition for specialty-related reasons from successful residents. Analysis of narrative feedback showed that successful residents performed better in areas of organization, preparation with clinical history, application of knowledge, interpersonal communication and achieving sustained progress. Existing assessment methods used in our pathology residency program are effective in detecting residents at risk of attrition. This also suggests applications in the way that we select, assess and teach residents.

Competencies for Repetitive Transcranial Magnetic Stimulation in Postgraduate Medical Education: Expert Consensus Using a Modified Delphi Process.

Repetitive transcranial magnetic stimulation (rTMS) is recommended in Canadian guidelines as a first-line treatment for major depressive disorder. With the shift towards competency-based medical education, it remains unclear how to determine when a resident is considered competent in applying knowledge of rTMS to patient care. Given inconsistencies between postgraduate training programmes with regards to training requirements, defining competencies will improve the standard of care in rTMS delivery. The goal of this study was to develop competencies for rTMS that can be implemented into a competency-based training curriculum in postgraduate training programmes. A working group drafted competencies for postgraduate psychiatry trainees. Fourteen rTMS experts from across Canada were invited to participate in the modified Delphi process. Ten experts participated in all three rounds of the modified Delphi process. A total of 20 items reached a consensus. There was improvement in the Cronbach's alpha over the rounds of modified Delphi process (Cronbach's alpha increased from 0.554 to 0.824) suggesting improvement in internal consistency. The intraclass correlation coefficient (ICC) increased from 0.543 to 0.805 suggesting improved interrater agreement. This modified Delphi process resulted in expert consensus on competencies to be acquired during postgraduate medical education programmes where a learner is training to become competent as a consultant and/or practitioner in rTMS treatment. This is a field that still requires development, and it is expected that as more evidence emerges the competencies will be further refined. These results will help the development of other curricula in interventional psychiatry.

Doctors' knowledge and perceptions of perioperative nutrition support; results from a large Australian tertiary referral Centre.

Nutritional optimisation in the perioperative period is essential in the prevention and treatment of malnutrition, a state of poor bodily function caused by a lack of nutritional intake, thereby altering body composition.1 Although identification and treatment of malnutrition is well recognized as a key component of Enhanced Recovery After Surgery (ERAS) guidelines, it is still highly prevalent, and significantly associated with poor outcomes. Studies have shown that up to 50% of patients undergoing abdominal surgery are malnourished.2-5 These patients are further at risk due to reduced recognition, combined with poor clinician understanding of treatment strategies due to their lack of knowledge and experience.6-10 To identify how we can improve on surgical nutrition management within our surgical units, we performed a survey within a large tertiary referral hospital in Melbourne, Australia. The project was approved by the Western Health Office of Research (QA2020.13_61439). A purpose-built, 23-item anonymous online REDCap survey was distributed to all doctors (including interns, residents, registrars, fellows and consultants) working across all general surgical units at Western Health. As our recruitment strategy involved advertising the survey at the weekly surgical morbidity and mortality meeting and via email distribution, response rate calculation was not feasible. The survey, developed by a team of senior academic dietitians and surgeons, included Likert scale ‘agree/disagree’ questions as well as clinical multiple-choice questions to assess doctor's perceptions and knowledge of perioperative nutritional support within general surgery. Of the 50 respondents, the majority were junior doctors (11 [22%] interns and 17 [34%] residents), 11 were registrars (22%) and a further 11 were consultant surgeons (22%). Only 24% (12) of respondents reported any prior training on perioperative nutritional support. While all respondents agreed on the importance of perioperative nutrition training (100%) and 94% (47) agreed on the need for nutritional assessment both before and after abdominal surgery, only 46% (23) felt confident in being able to initiate enteral or parenteral support according to evidence based guidelines. This was reflected when only approximately half of respondents correctly identified the correct timing to commence enteral (62%; 31) and total parenteral nutrition (50%; 25). Early identification of patients with nutritional deficits is important to ensure appropriate and timely interventions, however only a small proportion (20%; 10) of doctors surveyed were confident in identifying malnutrition and only 34% (17) were able to identify the common risks of malnutrition in a surgical patient. Only 38% (19) of doctors understood that the commonly used ‘fast from midnight’ order was unnecessary.11 These findings correspond with the nutritional knowledge gaps that have been observed across the world amongst medical students, junior medical staff and surgeons.6-10 Many hospitalized patients suffer from malnutrition, and those undergoing abdominal surgery, especially emergency cases, are at risk of deterioration owing to prolonged fasting and slow return to adequate nutritional intake. A recent British audit showed that patients undergoing emergency surgery are more likely to fast for longer periods of time (more than 12 h for clear fluids, and 24 h for food) compared with elective patients.11 Whilst we have shown the majority of doctors understand the importance of nutrition optimisation, they may not be equipped with the knowledge of when and how to do so. The implementation of ERAS protocols which include nutrition components can help standardize nutrition supplementation.12 A recent study also showed a lack of nutrition related education in British postgraduate training curriculums, suggesting a potential solution of implementing nutritional based objectives in all postgraduate training programs.7, 13 We recommend that doctors should be encouraged to make use of available hospital resources, in particular involvement of dietitians and the multidisciplinary team to help with early identification of patients at risk of malnutrition. Embedded education in both undergraduate and postgraduate training could help improve on doctors understanding and management of nutritional deficiencies. Open access publishing facilitated by The University of Melbourne, as part of the Wiley - The University of Melbourne agreement via the Council of Australian University Librarians. Howard H. Y. Tang: Formal analysis; writing – original draft; writing – review and editing. Danielle Taylor: Data curation; investigation; methodology; writing – review and editing. Irene Deftereos: Conceptualization; methodology; writing – review and editing. Aurora Ottaway: Methodology; writing – review and editing. Justin M. C. Yeung: Conceptualization; supervision; visualization; writing – review and editing.

Survey of the Faculty Status of Optometrists at Academic Medical Centers in the United States.

This is the first study of the prevalence and faculty status of optometrists practicing at academic medical centers in the United States. This study aimed to quantify the number of optometrists at academic medical centers, along with faculty rank and post-doctoral training programs. The official Web sites of academic medical centers and schools of medicine in the United States were examined during the 2021 to 2022 academic year to identify departments of ophthalmology and collect faculty profiles of employed optometrists. Institutional data were cross-referenced and analyzed by geographic distribution. Data were gathered from the Association of Schools and Colleges of Optometry and Accreditation Council on Optometry Education to identify post-graduate training programs in optometry. A total of 192 academic medical centers were identified, of which 121 (63.02%) had a residency or fellowship program in ophthalmology and/or optometry. One hundred twenty-five (65.10%) of these institutions had at least one staff optometrist. Seven hundred eighteen optometrists were found at these institutions, representing 1.83% of the 39,205 practicing optometrists estimated in the United States. Of the 718 optometrists, 369 (51.39%) held an academic appointment at a medical school. The most common academic rank was assistant professor (184 [25.63%]), followed by instructor (138 [19.22%]), associate professor (34 [4.74%]), and full professor (13 [1.81%]). The distribution of academic rank was similar across all regions but varied between institutions as to whether all, some, or none of the optometric faculty were appointed by a medical school. Of 296 optometry residency programs in the United States, 21 (7.09%) were at an academic medical center. Of 15 optometric fellowship programs in the United States, 3 (20%) were at an academic medical center. Of the 192 institutions in this study, 22 (11.46%) had a post-doctoral optometric training program. This study shows the distribution of academic rank and post-doctoral training programs for optometrists at academic medical centers.

Invited Commentary on Skinner S, et al.: Canadian Pediatric Surgeon Workforce: Characterization of Training, Trends Over Time, and 10-year Model for Pediatric Surgery Need

Canada, the second largest country in the world, consists of 10 provinces and three territories. Government-subsidized health service delivery to Canadians is a provincial or territorial responsibility, with federal subsidies for national health programs or as transfer payments to the provinces. Eight of 10 provinces host children’s hospitals in urban centres which offer tertiary/quaternary child health services. Pediatric heart surgery, ECMO and solid organ (liver and heart) transplantation are regionalized services with eastern and western centres. All Canadian children’s hospitals (n=16) are affiliated with a medical school and postgraduate training programs. The North American pediatric surgery match includes 8 Canadian programs: Vancouver, Calgary, Toronto, Ottawa, Hamilton, Montreal ( 2 Baird R Kisa P Muzira A Wesonga AS Sekabira J Butterworth S MacNeily AE Duffy D Blair G Training low-middle-income (LMIC) pediatric surgeons in a high-income country (HIC) program. Pediatr Surg Int. 2022 Feb; 38: 269-276 Crossref Scopus (2) Google Scholar ), and Halifax.

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.

Developing entrustable professional activities for family medicine training in South Africa.

Workplace-based assessment (WPBA) is becoming part of high-stake assessments in specialist training. Entrustable professional activities (EPAs) are a recent addition to WPBA. This is the first South African publication on developing EPAs for postgraduate family medicine training. An EPA is a unit of practice, observable in the workplace, constituting several tasks with underlying knowledge, skills and professional behaviours. Entrustable professional activities allow for entrustable decisions regarding competence in a described work context. A national workgroup representing all nine postgraduate training programmes in South Africa has developed 19 EPAs. This new concept needs change management to understand the theory and practice of EPAs. Family medicine departments with large clinical workloads are small, necessitating navigating logistical issues to develop EPAs. It has unmasked existing workplace learning and assessment challenges.Contribution:This article contributes new thinking to developing EPAs for family medicine in an effort to understand more authentic WPBA nationally.

IMPACT OF COVID-19 PANDEMIC IN THE TRAINING OF SURGICAL POSTGRADUATES, IN TEACHING MEDICAL COLLEGES AND HOSPITAL ACROSS KARNATAKA, INDIA

Purpose of the study Post Graduate surgical training is a well-structured, surgically oriented program which helps in training and grooming of PG students to excel as surgeons and teachers in the future. COVID-19 pandemic has altered the lives of the whole medical fraternity to say the least, but this impact over the PG Training programs has been enormous, especially on the surgical fraternity. Our aim was to understand the impact of covid-19 pandemic in the training of surgery residents in hospitals across Karnataka and to come up with a suitable solution to mitigate the effect of covid 19 pandemic on the training programme. An online survey of 11 questions with sub-questions ha Design ving multiple choice answers were circulated amongst post-graduate students in surgery department and faculty members to study the impact of the pandemic in post-graduate surgical training. 156 PG trainees and 55 trai Results ners participated showing there was significant impact on elective and emergency surgical training. Majority of the surgical trainees haven't performed elective or emergency surgeries required for their level. 78% responded that there was inadequate exposure to Post-operative and in patient care. 89% said their clinical skills were inadequate and 75% r e s p o n d e d t h a t p o s t g r a d u a t e s a r e m e n t a l l y s t r e s s e d a n d h a v e l o w c o n f i d e n c e . Conclusion Covid 19 pandemic had a significant impact on the surgical post graduate training programme on trainee as well as on the trainers, across Karnataka. As a result of the pandemic, most of the young postgraduates are mentally stressed with low confidence in performing or assisting surgeries and in clinically evaluating patients. The Government and medical council should take serious consideration of the plights of PGs and come up with a suitable solution to control the damage and to be prepared in future to face such a problem with minimal effect on training programmes

Competency Level of Teachers’ Subject Matter Knowledge as a Compulsory for Teaching Secondary School Mathematics: A Case Study on Postgraduate Diploma Trainee

The purpose of this paper is to assess the status of mathematics subject matter knowledge competency of student teachers and show the role of subject matter knowledge in teaching secondary school mathematics. This study involved 70 student teachers attending postgraduate diploma training program of teacher training modality. An achievement test was used to collect the data from the participant. The result has shown that the overall subject matter knowledge competency of the trainee is remarkably low. However, algebra received relatively higher competency with a mean score of 2.2, and mathematics as communication and reasoning competency was considerably lower with a mean score of 0.56. In addition to these, a comparison among subject matter knowledge competency areas identified shows that there is a significant difference between algebra (higher competency) and the remaining 12 selected subject matter knowledge competency areas. This study concluded that student teachers have a deficiency in mathematics subject matter knowledge competency in general and lack uniformity within selected mathematics subject matter knowledge competency areas. Based on the findings, it is recommended that subject matter knowledge is particularly required for secondary school mathematics teaching needed in the teacher training program and the teacher training program needs amendment toward the direct purpose.

Understanding the Quality of Life and Its Related Factors in Orthodontics Postgraduate Students: A Mixed Methods Approach

This study analyzed the academic, sociodemographic, and labor conditions related to the quality of life (QOL) of orthodontics postgraduate students in Colombia. A mixed study (explanatory sequential design) was conducted. An online cross-sectional survey (n = 84; 64.3% females) was carried out with sociodemographic, academic, social support, health, labor, and QOL (WHOQOL-BREF) variables. Descriptive, bivariate analyses, and multivariate linear regression were performed. Focus groups (FGs) delved into aspects of relevance regarding QOL and determinants, through qualitative content analysis and triangulation of information. The median score in the four WHOQOL-BREF dimensions surpasses 50 points, with the highest score being in the psychological dimension (62.5 ± 16.7). According to the multivariate linear regression models, the variables significantly associated with QOL scores were playing sports, being married/living together, normal BMI, low social support, and medium/low socioeconomic status. The qualitative results explained the determinants of QOL in the personal, academic, and social dimensions of the participants. The discourses showed that the postgraduate course represents a resignification of their life, where their QOL is affected by the difficulties of their academic development, by the difficulty of reconciling the personal academic load with their affective, work, and social life, and by the stress they experience in their staff process. In conclusion, the participants' QOL was moderate and affected by different factors. The findings highlighted the importance of mental health promotion and well-being strategies in students of orthodontic postgraduate training programs in Colombia for improving QOL.

The state of acute care postgraduate training: Faculty observations

The benefits to postgraduate training programs (PTPs) for nurse practitioners (NPs) in all populations are being well established in the literature. As health care systems and teams evolve, acute care NPs (neonatal, pediatric, and adult-gerontology) are providing more specialized care to increasingly complex patients. As educators and clinicians, we recognize that acute care PTPs are playing an important role in preparing NPs to work to the top of their scope and training. This article provides our perspectives on the merits of PTPs for adult-gerontology acute care NPs and provides guidance for counseling NPs who are interested in acute care PTPs.

The educational value of situational judgement tests (SJTs) when used during undergraduate medical training: A systematic review and narrative synthesis

Introduction Situational judgement tests (SJTs) are a recognised assessment method for admission into medical school, selection into postgraduate training programs, and postgraduate competency assessment. More recently, however, SJTs have been used during undergraduate medical training (UMT). This systematic review identifies, describes, and appraises the evidence for SJTs in UMT to determine educational associations and outcomes. Methods MEDLINE, EMBASE, ERIC, PsycINFO, SCOPUS, Web of Science, and grey literature were searched for original research studies evaluating SJTs implemented within UMT to 1 November 2022. Studies reporting evaluation outcomes were included. Narrative data syntheses were undertaken. Risk of Bias was appraised using the Quality in Prognosis Studies tool. Results 24 studies were included. National database-derived SJTs (n = 14) assessed against professionalism, postgraduate attainment, construct of medical degree, medical school admissions scores, personality attributes, and declaration of disability. In-house derived SJTs (n = 10) assessed against professionalism, clinical skills, and personality attributes. Most evidence evaluated and reported inverse SJT associations with professionalism and were moderate risk of bias. Conclusion SJTs may have utility for developing professional behaviours in medical students. However, further research testing SJT robustness, standard setting methodologies, and prospectively evaluating SJTs against objective outcome measures within the context of UMT is warranted.

Acquisition Status of Basic Clinical Skills in Japanese Novice Rehabilitation Therapists: A Preliminary Single-Center Study.

The number of post-graduate rehabilitation therapists (novice therapists) is increasing due to the growing demand for rehabilitation services in Japan. This study investigated the acquisition status of Japanese novice therapists' basic clinical skills to clarify their quality and characteristics. Eleven participants' basic clinical skills (eight physical and three occupational therapists) were assessed using an Objective Structured Clinical Examination. Tasks included exercises of joint range of motion, muscle strengthening, getting up, standing up and sitting down, and transferring between wheelchair and bed. Assessment items were subdivided into categories: attitude, preparation, intervention, safety management, and feedback. One-way ANOVA and Friedman test were used for statistical analysis to compare the data between tasks and categories. The scores for each task's achievement rate were not statistically significant. However, the achievement rate of each category including tasks was 92.6% (SD 4.0%) for attitude, 81.4% (SD 11.1%) for preparation, 77.9% (SD 14.7%) for intervention, 87.6% (SD 17.3%) for safety management, and 64.0% (SD 14.2%) for feedback. There were significant differences between attitude and feedback (p &lt; 0.001), and between safety management and feedback (p = 0.012). Post-graduate training programs should focus on improving the quality of clinical skills, especially in skills related to feedback.