Years Of Postgraduate Training Research Articles

Evaluation of Resident Confidence Performing Entrustable Professional Activities During the First Year of Residency Training

Background: Entrustable Professional Activities (EPAs) for medical students were designed to help prepare students for the clinical roles of residency training. To date, there have been no published studies examining resident confidence performing the EPAs across the first year of post-graduate training.
 Objective: To examine self-reported confidence levels of first-year residents performing the 13 activities included in the Core Entrustable Professional Activities for Entering Residency.
 Methods: Entering allopathic and osteopathic residents from seven residency programs were contacted at the start, and after 3, 6, and 12 months of training to complete an electronic survey self-assessing confidence performing EPAs.
 Results: All 46 (100%) eligible residents completed surveys at the four study time points for the 13 EPAs, which resulted in 2,392 data points. Residents reported a high level of confidence performing four EPAs (i.e., 1, 5, 6, and 9) at baseline. Conversely, more than two-thirds of residents reported a lack of confidence performing four EPAs (i.e., 4, 8, 12, and 13) at baseline. A significant positive trend in confidence from baseline to 12 months was seen in almost all EPAs. However, more than 10% of residents reported not being confident performing EPAs 12 and 13 at twelve months.
 Conclusions: Results revealed not all residents reported being confident performing EPAs at the beginning and end of the first year of training. Medical schools need to examine preparation of graduating students in the EPA areas. Residency programs need to assess entering resident competency to determine the need for increased initial supervision and remediation.
 
 Funding/Support: None
 Ethical approval: The study received approval from the Human Subjects Committee of UnityPoint Health – Des Moines.
 Conflict of Interest: The authors declare they have no competing interests.

Empathy in Internal Medicine Residents at Community-based Hospitals: A Cross-sectional Study.

Introduction:Many research reports revealed declining empathy in medical schools that continues in postgraduate years of training.Objective:The aim of this study is to examine the self-reported empathy levels of internal medicine (IM) residents in 3 community-based teaching hospitals.Methods:The Jefferson Scale of Physician Empathy, Health Professionals version, is an online, self-administered, questionnaire that was offered to 129 current and incoming residents at 1 osteopathic and 2 allopathic, IM training programs in Flint, Michigan.Results:Forty-five residents responded (35% response rate). Our residents’ cumulative mean empathy score was 112.5 with a SD of 12.72, which is comparable with the cumulative empathy scores for IM residents at university hospitals. There was an increase in empathy score from the beginning level of training, postgraduate year 0 (PGY0), to the PGY1 level, and a noticeable, although statistically non-significant, decrease in empathy score for both PGY2 and PGY3 residents. The graduating residents’ scores were higher compared with incoming residents.Conclusions:The cumulative mean empathy score in community-based IM residents showed an increase in the beginning of residents’ training and decrease in empathy score by the end of training. There were significant differences in empathy scores by level of training at individual hospitals. This might be related to different targeted curricula.

Feasibility of a Design of an Objective Framework for Internal Assessment of Post Graduates in Prosthodontics

Background and Objectives: Post Graduate Assessment in the Indian dental profession occurs only during the time of examination. There is no objective systematic record of evaluation conducted either in a formative or summative manner. Even if these records are present there is no weightage of internal assessment for evaluation of postgraduates. The study is intended to construct an objective framework with an appropriate curricular pattern for internal assessment for post graduates in prosthodontics specialty in dentistry. The model to be analysed for testing the feasibility of the model through an online focus group discussion involving the subject experts. Material and Methods: Situation analysis was carried out with feedback obtained from the trainees, trainers of the post graduate programme in prosthodontics. The proposed design was then subject to an online Focus Group Discussion involving subject experts at a senior level with more than 10 years of post-graduate training in the field all over India. Results: The inputs of the analysis was used to create a design of a curricular framework for post graduate prosthodontics and Crown & Bridge training programme. This had the scope of systematic objective formative and summative evaluation in four modules – Pre-clinical, Basic clinical, Advanced clinical and Master clinical. The curriculum spacing and guidelines for assessment and scoring pattern was outlined. The outcomes of the Focus Group Discussion was analyzed by thematic analysis based on the lead questions and results were interpreted with a narrative description. Conclusion: The proposed tool was found to be feasible and acceptable with the minor modifications suggested from the focus group discussion.

Mixed Messages or Miscommunication? Investigating the Relationship Between Assessors' Workplace-Based Assessment Scores and Written Comments.

The shift toward broader, programmatic assessment has revolutionized the approaches that many take in assessing medical competence. To understand the association between quantitative and qualitative evaluations, the authors explored the relationships that exist among assessors' checklist scores, task ratings, global ratings, and written comments. The authors collected and analyzed, using regression analyses, data from the McMaster Modular Assessment Program. The data were from emergency medicine residents in their first or second year of postgraduate training from 2012 through 2014. Additionally, using content analysis, the authors analyzed narrative comments corresponding to the "done" and "done, but needs attention" checklist score options. The regression analyses revealed that the task ratings, provided by faculty assessors, are associated with the use of the "done, but needs attention" checklist score option. Analyses also identified that the "done, but needs attention" option is associated with a narrative comment that is balanced, providing both strengths and areas for improvement. Analysis of qualitative comments revealed differences in the type of comments provided to higher- and lower-performing residents. This study highlights some of the relationships that exist among checklist scores, rating scales, and written comments. The findings highlight that task ratings are associated with checklist options while global ratings are not. Furthermore, analysis of written comments supports the notion of a "hidden code" used to communicate assessors' evaluation of medical competence, especially when communicating areas for improvement or concern. This study has implications for how individuals should interpret information obtained from qualitative assessments.

HEEADSSS up: pediatric residents' confidence and practice in adolescent health care before and after mandatory adolescent medicine rotations in Thailand.

Background The field of adolescent medicine is an emerging area of specialization in Thailand. Adolescent medicine was made a mandatory rotation in general pediatric residency training programs for the class of 2013. Objective This study aims to explore the difference in pediatric residents' confidence and the frequency in providing aspects of care to adolescents. Subjects Participants included two groups of pediatric residents; the former curriculum group (FCG) in 2012 and the mandatory curriculum group (MCG) in 2015. Methods Participants in this cross-sectional study answered a 41-item self-administered questionnaire and results were analyzed by descriptive statistics. Results There were 91 participants, 50.05% were in the MCG. The FCG reported a higher percentage of feeling "more confident" on physical examination (p = 0.031, V = 0.23) and growth assessment (p = 0.040, V = 0.22). The MCG reported a higher percentage of "more frequently" carrying out the psychosocial assessment (p = 0.035, V = 0.22). Conclusion The FCG reported higher levels of confidence than the MCG in most of the items, while the MCG reported higher levels of frequency in providing care. The psychosocial (HEEADSSS) assessment, a key aspect of the adolescent clinical visit, was the item that the MCG reported doing more frequently than the FCG which remained significant when only the postgraduate year of training (PGY) 4s were compared.

Medical students' preparation for the transition to postgraduate training through final year elective rotations.

Objectives: This study adds to the ongoing discussion on how to ease the transition from undergraduate medical training to postgraduate training. In the Netherlands there is no central matching system for admission to residency. Medical school graduates just apply for a position in an open job market. Many choose to acquire general or specialty-specific clinical experiences after the medical degree before residency, to further explore career opportunities and to increase their chances to get into their preferred specialty. To shorten this gap between undergraduate and the start of postgraduate training, the sixth and final year of most Dutch medical schools is designed as a “transitional year”. Students work with more clinical responsibilities than in the earlier clerkships, and this year includes many elective options. Our study focuses on these elective options and explores how medical students use these transitional year electives to prepare for transition to postgraduate training.Methods: In 2012-2013 we asked all 274 graduating students at one Dutch medical school to complete an open-answer questionnaire with the following topics: their preferred specialty at the start of the transitional year, electives they chose during this year and reasons for these choices, and whether the transitional year electives changed their career considerations. Questionnaire results were coded by two researchers and were discussed with all members of the research team. Results: A total of 235 students responded (86%). Answers about motivation for choices revealed that most electives where chosen for career orientation and to optimize chances to get into a residency program. Students also focused on additional experiences in specialties related to their preferred specialty. Many students chose electives logically related to each other, e.g. combinations of surgery and radiology. About two-thirds of the respondents stated that their elective experiences did confirm their specialty preferences or resulted in a more clear insight.Conclusion: We conclude that students use the transitional year electives to focus on their future postgraduate training program, i.e. for orientation and to align their curriculum vitae with their preferred specialty, resulting in spontaneous early specialty streaming. To take advantages of this streaming, and to make sure students can transfer their experiences to other specialties if their career preferences change, individual elective Entrustable Professional Activities (EPAs), next to the core EPAs for all medical students, may serve to prepare a smooth transition to a specialty of choice and should be fully documented.

THE STATE OF TRANSCATHETER AORTIC VALVE IMPLANTATION TRAINING IN CANADA: A NATIONAL SURVEY OF CARDIAC SURGERY RESIDENTS AND PROGRAM DIRECTORS

The volume of transcatheter aortic valve implantation (TAVI) has increased globally with a subsequent increase in demand for clinicians trained in performing this procedure. However, the state of TAVI training for Canadian cardiac surgical residents is unknown. The objectives of this study were: 1. To establish a national inventory of TAVI educational resources 2. Understand the role of residents in TAVI programs 3. Understand the attitudes and perspectives of residents and program directors (PD). Two National web-based surveys targeting residents and PDs in Royal College of Physicians and Surgeons (Canada) accredited cardiac surgery programs were developed. The survey examined available TAVI educational resources, the attitudes towards TAVI training, and barriers to becoming competent in performing TAVI. An electronic invitation was sent to 100 residents and 12 PDs across Canada between February and April 2017. Descriptive analyses were used to summarize data in an aggregate and anonymous manner. Chi-square testing was used to compare responses between residents and PDs. Thematic analysis using a realist approach was undertaken to analyze patterned responses to open-ended survey questions. 73 of 100 (73%) residents and 10 of 12 (83%) PDs completed the survey. Broad representation from all 12 residency programs across Canada programs and all post-graduate years of training was obtained. A minority of residents (15.1%) and PDs (40%) reported that TAVI training in the their program was adequate (Chi-square(1)=3.692; p=0.055). Only 30% of PDs report that their residents had access to TAVI simulation training. While 98.6% of residents and 90% of PDs agreed that TAVI was important to the trainee’s future practice (Table), 68.5% of residents and 60% of PDs agreed that TAVI should be a focus of fellowship training (Chi-square(1)=0.289; p=0.591). Furthermore, 27.4% of residents and 40% of PDs agreed that there was not enough time in residency to teach TAVI (Chi-square(1)=0.680; p=0.401). Reoccurring patterns from the thematic analysis of barriers to TAVI training were identified as: a perceived lack of interest from interventional cardiologists to teach surgical residents, competition from TAVI fellows, and lack of time (Figure). Educational resources for TAVI training are limited for residents across Canada. While almost all respondents agreed that TAVI will play a vital role in the trainees’ future clinical practice, there are many perceived barriers to providing adequate training during residency. Finally, there is a lack of consensus as to whether TAVI competency should be acquired primarily in residency or fellowship training.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Resident Workshop Standardizes Patient Handoff and Improves Quality, Confidence, and Knowledge.

Residency programs are required to instruct residents in handoff; however, a handoff curriculum endorsed by the Accreditation Council for Graduate Medical Education does not exist. Although curricula are available, we preferred to use a curriculum that could be taught quickly, was easy to implement, and used a mnemonic that resembled current practices at our institution. We designed and implemented a novel handoff educational workshop intended to improve resident confidence and performance. In this observational study, pediatric residents across postgraduate training years during winter 2014-spring 2015 participated in two study segments: a handoff workshop with questionnaires and handoff observations. Co-investigators developed and led an interactive workshop for residents that emphasized a standardized approach using the SIGNOUT mnemonic (see text for definition). The effect of workshop participation on handoff abilities was evaluated using a validated, handoff evaluation tool administered before and after the workshop. Qualitative feedback was obtained from residents using pre- and postworkshop surveys. Forty-three residents participated in the workshop; 41 residents completed handoff observations. Improvements were noted in clinical judgment (P = 0.02) and organization/communication (P = 0.005). Pre- and postworkshop surveys demonstrated self-perceived increases in confidence, comfort, and knowledge (P < 0.001). Improvements in handoffs, particularly in clinical judgment and organization/communication domains, suggest that a more standardized handoff approach is beneficial, especially for postgraduate year 1 residents. The novel, interactive workshop we developed can be taught quickly, is easy to implement, is appropriate for all resident training levels, and improves resident confidence and skill. This workshop can be implemented by training programs across all disciplines, possibly leading to improved patient safety.

Can fatigue affect acquisition of new surgical skills? A prospective trial of pre- and post-call general surgery residents using the da Vinci surgical skills simulator.

To study the effects of fatigue on general surgery residents' performance on the da Vinci Skills Simulator (dVSS). 15 General Surgery residents from various postgraduate training years (PGY2, PGY3, PGY4, and PGY5) performed 5 simulation tasks on the dVSS as recommended by the Robotic Training Network (RTN). The General Surgery residents had no prior experience with the dVSS. Participants were assigned to either the Pre-call group or Post-call group based on call schedule. As a measure of subjective fatigue, residents were given the Epworth Sleepiness Scale (ESS) prior to their dVSS testing. The dVSS MScore™ software recorded various metrics (Objective Structured Assessment of Technical Skills, OSATS) that were used to evaluate the performance of each resident to compare the robotic simulation proficiency between the Pre-call and Post-call groups. Six general surgery residents were stratified into the Pre-call group and nine into the Post-call group. These residents were also stratified into Fatigued (10) or Nonfatigued (5) groups, as determined by their reported ESS scores. A statistically significant difference was found between the Pre-call and Post-call reported sleep hours (p=0.036). There was no statistically significant difference between the Pre-call and Post-call groups or between the Fatigued and Nonfatigued groups in time to complete exercise, number of attempts, and high MScore™ score. Despite variation in fatigue levels, there was no effect on the acquisition of robotic simulator skills.

A national resident survey about the current state of venous education in vascular surgery training programs.

The objective of this study was to characterize U.S. vascular surgery trainees' perceptions, case numbers, and attitudes toward venous disease education, as well as their intent to incorporate it into future practice. These data will provide us with a current snapshot of postgraduate venous education from a resident's perspective. Institutional Review Board approval was obtained. A 13-question survey was created and distributed to all vascular surgery residents in the United States by SurveyMonkey. Formal electronic distribution remained deidentified as the surveys were e-mailed to residents from the Association of Program Directors in Vascular Surgery. Of 464 vascular surgery trainees queried, 104 (22%) responded to the survey. The majority of responders (80%) were between 25 and 34years of age, 60% were male, and 72% were white; 91% reported that they were in an academic training program, and 57% were enrolled in an integrated vascular surgery residency program. Postgraduate years (PGYs) of training among respondents were well represented: PGY 1, 14%; PGY 2, 8%; PGY 3, 14%; PGY 4, 12%; PGY 5, 9%; PGY 6, 18%; and PGY 7, 25%. Vascular resident training experience with venous disease revealed the following: 63% performed<10 inferior vena cava stents, 64% performed<10 vein stripping/ligation procedures, and 50% performed<10 iliac stents; 92% of responders reported having performed<10 venous bypasses during their training. Experience with endothermal ablations was slightly better, with 74% of responders reporting having performed up to 20 cases. Case volumes for endothermal ablation, vein stripping/ligation, inferior vena cava stenting, and iliac stenting increased progressively by clinical training year among integrated vascular residents (P ≤ .02) but were relatively stable for classic 5+ 2 vascular fellows (P ≥ .67). Integrated residents reported having received more didactic venous education than the 5+ 2 vascular surgery fellows (P= .01). There were no differences in overall reported venous procedure volumes between groups (P ≥ .28). The majority of trainees (82%) acknowledged that treating venous disease is part of a standard vascular surgery practice, and many (75%) indicated a desire to have increased venous training. Despite this, 59% of responders reported plans to dedicate<25% of their future vascular surgery practice to venous disease. In this national survey-based study of vascular surgery trainees, we demonstrate a perceived weakness in venous disease case volumes and didactic education in residency. This training deficit is apparent in both integrated (0+ 5) and traditional (5+ 2) training pathways. Our data suggest that expansion of the venous disease curriculum with clear training standards is warranted and that trainees would welcome such a change.

Working hour preferences of female and male residents : Developments over 4years of postgraduate medical training in Germany

This article addresses developments regarding working hours and working hour preferences of residents undergoing postgraduate training in Germany and analyses if, and for what reasons, full-time or part-time working models are preferred. The source of data is the KarMed study, which is based on yearly postal surveys carried out among graduates of the year 2008/2009 from seven medical faculties in Germany. The interviews took place during the entire postgraduate training period. Response rates were 48% in the first year, with subsequent rates of above 85%. For analysis, descriptive statistics and regression models were applied. There is aconsiderable discrepancy between the actual and the preferred working hours of residents undergoing postgraduate training. Postgraduate training is mostly linked to full-time contracts, usually with additional overtime, even though a considerable proportion of doctors prefer apart-time position. More female residents want to work part-time than male doctors. The same applies for the period after medical specialism: in particular, female doctors with children, female doctors trained in former Western Germany states, and those seeking an occupation in outpatient care request part-time contracts for their professional future. Asimilar trend has been increasingly observed over the years for male doctors. Despite the huge number of residents requesting part-time contracts - during postgraduate training and afterward - the reality is still far behind this model. It is apparent that measures should be taken for both genders. Those measures should facilitate the implementation of the favored working-time model.

Preference Changes Regarding Future Work Area and Intended Position Among German Residents after Four Years of Residency

Introduction We investigated the preferences of medical residents in Germany with regard to future working place (hospital or private practice) and position (employment/self-employment in private practice; resp. specialist/senior or chief physician in the hospital). This is analysed in a gender comparative perspective, including the influence of parenthood. Methods Annual postal surveys among graduates of seven medical faculties in Germany from their last year ("Practical Year") until after four years of postgraduate training. The return rate at baseline was 48 % and the four surveys after reached rates from 85 % up. In all samples about two thirds were women, which corresponds to the actual gender differentiation in under- and postgraduate training. Descriptive statistics and regression analyses were performed. Results Compared to private practice the hospital is clearly preferred, although the attraction of hospital jobs decreased over the years. The decision for or against the hospital is connected to the discipline. Working in private practice is seen as possibility for part time work. Men prefer self-employment whereas women prefer to work under an employment contract. In the hospital, male doctors prefer to work in leading positions. Those positions are associated with full-time work. Leadership training especially takes place in university hospitals. Discussion Three trends are recognized: Reluctance against leading positions, growing interest for part time work and rising popularity of work as an employee in private practice. Those trends can be understood as a rejection of traditional professional role models. The realization of these preferences is easily feasible because of the current labour market situation. Therefore, emerging problems have to be faced in another way. A change of gender-typical role models was rarely detected.

Stability and Change of Medical Specialty of Residents over Four Years of Postgraduate Training in Germany

Aim We analyzed medical residents' preferences in Germany with regard to the specialization fields after 4 years of postgraduate training and compared them to their preferences in the years before, e. g. at the end of undergraduate education in a gender comparative perspective, including the influence of parenthood. Methods The study is based on annual postal surveys of students of 7 medical faculties in Germany from their last year of medical school ("Practical Year") until after 4 years of postgraduate training. The return rate at baseline was 48% and in the 4 surveys thereafter the rates were 85% and above. In all samples, about two-thirds of respondents were women, which corresponds to the actual gender distribution in under- and postgraduate training. Descriptive statistics and regression analyses were used. Results Compared to the end of undergraduate education, anaesthesiology and general practice were the disciplines which gained in attraction, whereas surgical disciplines lost significantly in their attraction. These developments were similar in both genders. Specialized internal medicine, paediatrics and gynaecology lost attraction among female physicians only. We found important correlations of disciplinary preferences with parenthood and with the preference for part-time work after graduation. Conclusion The data show that "feminization" is not the reason why both anaesthesiology and general practice gained in attraction, since this happened over the 4 years among both male and female physicians. The loss in attraction in all great clinical disciplines, especially in surgery, orthopaedics and urology, may lead to severe problems in supply of medical manpower in the hospital, especially when combined with preference for part-time work.

Die Berufsverlaufszufriedenheit von Assistenzärzten und -ärztinnen nach vierjähriger Weiterbildung

ObjectiveTo evaluate German residents’ career satisfaction and its dependency on intrinsic and extrinsic factors after four years of postgraduate training. Gender, parental status, training conditions and specialty choice were of particular interest. MethodsPostal questionnaires were sent to medical graduates from seven different German faculties annually, starting in 2009. This paper presents cross-sectional data of domestic, working and training conditions four years after graduation. We used descriptive statistics and t-tests. In order to identify factors with an impact on career satisfaction, multiple regression analyses were calculated. ResultsMale residents who have children tended to be more satisfied with their career than residents without children. For female residents, however, having children was associated with lower career satisfaction. Those who chose training in general surgery or orthopedic surgery were less satisfied with their career progress. Residents with prolonged specialty training showed lower career satisfaction. Junior doctors who rated the quality of their residency training higher were more satisfied with their career. Those who perceived their job as particularly demanding were less satisfied. Concerning intrinsic factors, occupational self-efficacy and overall satisfaction with life were significantly associated with career satisfaction. ConclusionResidents in general are quite satisfied with their career after four years of training. Opportunities to work part-time during residency as well as structured training programs should be implemented in order to overcome parenthood as a career obstacle for female residents. The quality of specialty training is particularly important for career satisfaction and has to be ensured across specialties.

Fine needle aspiration biopsy: An entrustable professional activity in cytopathology postgraduate training.

Context:In the context of competency-based medical education being advocated worldwide, fine needle aspiration biopsy (FNAB) is considered as an entrustable professional activity (EPA). There is no information regarding how much time and training are required to achieve a “competent level” for performing and documenting FNAB in the Indian context.Aim:To determine the time taken by an average postgraduate pathology trainee to become competent in performing FNAB with respect to history taking, clinical examination, and fine needle aspirate adequacy.Settings and Design:A descriptive, retrospective, chart-based audit was conducted in the Department of Pathology.Materials and Methods:FNAB chart records documented during 3 years of postgraduate training by a cohort of 13 postgraduate (PG) resident trainees admitted in 2010 were included in the study. Adequacy rates and criteria for adequacy were defined for the purpose of the study.Statistical Analysis:Data was entered in MS Excel and analyzed using the Statistical Package for the Social Sciences version 20.0. The adequacy rates are presented as percentages and time taken to achieve adequacy rates as median values.Results:A total of 3272 charts were audited. Median time taken to achieve 85% adequacy rate for history taking, for clinical examination by the first and the second criteria, and for FNAB were 1 month, 1 month and 3.5 months, and 1 month, respectively.Conclusions:Although the mean time taken to achieve 85% adequacy rates for FNAB was 1 month, there was wide variation in the time durations between the residents to achieve this level.

Near peer-assisted learning to improve confidence for medical students' situational judgment tests.

The situational judgment test (SJT) was introduced for all graduating United Kingdom medical students in 2013. Students have anxiety over time pressures and heavy weighting of a single examination. This study aimed to examine formal SJT preparation available, perceptions of a near peer-delivered course, and to measure improvement in students' confidence. Foundation doctors ( first 2 years of postgraduate training) produced a "Situational Judgment Test Preparation Course" in November 2015. Feedback was collected via Likert scores rating teaching, a mock examination, and pre- and post-course confidence along with free-text responses. Delayed feedback was collected via an online survey. Forty-four students completed the feedback. Seventy percent reported <2 h of university SJT preparation. There were significant post-course improvements in familiarity with structure, scoring system, knowledge and content, and overall SJT confidence (P < 0.05). Delayed feedback showed sustained improvement in familiarity with knowledge and content (P < 0.05). Qualitative analysis revealed themes of improved confidence, approachable tutors, and identifying question strategies. Students perceived a lack of formal SJT preparation which was reflected in low pre-course confidence. Improvements in confidence may reflect a unique insight into how to approach the examination from those having recently undertaken it.

An Investigation of the Outcomes of PGY Students' Cognition of and Persistent Behavior in Learning through the Intervention of the Flipped Classroom in Taiwan.

The Postgraduate Year (PGY) Program allows doctors-in-training to learn about the diagnosis, treatment and nursing of various common, general diseases. These items form the core curriculum and are mostly learned through caring for patients and clinical teaching. Doctors-in-training are evaluated for their knowledge through written tests or assignments, based on which the effectiveness of their training is also assessed; however, this generally produces a negative learning attitude among them. So we introduced the flipped classroom into PGY training program to change PGY students’ learning behavior. Although the flipped classroom is highly valued and has been practiced by teachers in schools of various levels, very few attempts have been made until now to report the learning outcomes achieved through the flipped classroom by means of rigorous research methods. Therefore we tried to employed Ajzen and Fishbein’s (1980) theory of reasoned action and Bandura’s self-efficacy to predict and explain the participants’ behavioral intention when participating in the core curriculum learning of the flipped classroom and to assess the change in students’ learning behavior and learning effectiveness. From August 2013 to July 2014, 39 PGY students from the General Surgery of the Tri-Service General Hospital were selected as the participants of this study. The control group included 43 students of the previous year, that is, the year before the intervention of the flipped classroom. A comparative analysis was performed. The questionnaire’s related matrices indicated highest correlation between self-efficacy and behavioral intention (r = 0.491, P < 0.01), followed by attitude (r = 0.365, P < 0.01) and subjective norms (r = 0.360, P < 0.01.) All three showed positive correlations with behavioral intention; among attitude, subjective norms, and self-efficacy, the pairwise correlations also reached significance level. The flipped classroom can indeed change PGY students’ the learning behavior from “passive learning” to “active learning.”

Training Matters:

Currently, the majority of medical boards require only one year of post-graduate training (PGT) for full and unrestricted licensure. This study analyzes the association between years of PGT, board certification and the risk of being disciplined by the Louisiana State Board of Medical Examiners (LSBME) to assess whether training requirements for physician licensure in Louisiana should be revised. 624 physicians who were sanctioned between 1990 and 2010 were compared to a random sample of 6,552 physicians who were not disciplined during the study period. Statistical methods included chi-squared tests of independence and logistic regression analysis. After controlling for demographics, specialty, years of training, board certification status and changing training requirements over time, physicians who had completed more than one year but less than three years of PGT were more than twice as likely to be disciplined (O.R. 2.24, p&amp;lt;.005), while non board-certified physicians were more than four times as likely to be disciplined (O.R. 4.64, p&amp;lt;.0001). Of all physicians sanctioned for findings of substandard practices/medical incompetency, 21% had fewer than three years PGT, and 46% of physicians with less than three years training were sanctioned for this reason. Our study indicates that physicians who do not complete a minimum of three years post-graduate training are more likely to be the subject of a disciplinary action, and that these physicians are more likely to be sanctioned for competency/standards-related issues. Because medical knowledge and training expectations have increased over time, licensing authorities may want to delay full licensure status until applicants have had a minimum of three years PGT in an ACGME or AOA-accredited training program.

The Russian Child Health Care System

We present a historical and analytical overview of the Russian child health care system describing strengths and challenges of the system. Main indicators of social environment and children's health, general demographics, and socioeconomic factors of Russia are described. The Russian health care system has preserved positive elements of the former Soviet model of pediatric care. However, beginning in 1991, it has been altered greatly in its funding and management. The child health care system is composed of a special network of outpatient and inpatient facilities. The key element of pediatric community care is the pediatric polyclinic, staffed by district pediatricians and nurses. Undergraduate pediatric training is separate from adult medical training. From day one onward, future pediatricians are trained at separate pediatric faculties of universities. Thus, they qualify as general pediatricians after only 2years of postgraduate training. It should be emphasized that the gap between the health status of children in developed countries and the Russian Federation is largely due to the influence of socioeconomic determinants, such as traffic accidents, poverty, pollution, and hazardous life styles, including binge drinking. Further improvements of children's health require protective measures by the state to address the underlying socioeconomic determinants.

Finding Value in Surgical Didactics: Longitudinal Resident Feedback From Case-Based and Traditional Lectures in an Orthopaedic Residency

To evaluate orthopedic resident perceptions of a didactic curriculum presented in traditional and case-based formats. Prospective cohort study using anonymous web-based survey after each conference evaluating resident perceptions of faculty participation, didactic delivery, content, and overall conference value. Conferences were structured as primarily case-based or traditional lecture. Logistic analysis was performed to determine factors predictive of rating a conference as valuable time spent. Orthopedic residency training program at single institution over an academic year. Orthopedic residents in postgraduate training year 1 to 5 attending mandatory didactic conference. Cased-based conferences received higher Likert ratings on residents' perception of faculty participation, instructor delivery, and improvement in topic understanding when compared to traditional lecture-based conferences (p < 0.0001 for each factor). Residents also were more likely to rate case-based conferences as valuable time spent (p < 0.0001). In our logistic model, factors associated with a negative likelihood of rating a conference as valuable were lecture format (odds ratio [OR] = 0.155, 95% CI: 0.115-0.208), PGY-2 level presenter (OR = 0.288, 95% CI: 0.169-0.490), and PGY-3 level presenter (OR = 0.433, 95% CI: 0.269-0.696). Timing in the year, surgical subspeciality, and conference identity were not significant predictors of conference value rating. Longitudinal resident feedback demonstrates highly favorable resident perceptions toward case-based formats in didactic sessions. Junior levels residents are not perceived as effective as senior residents and faculty in presenting material in either format. These methods allow for a dynamic approach to identifying strengths and weaknesses in a resident curriculum as a well as a means for more focused and real-time improvements.