Quality Of Residency Training Research Articles

The Impact of Resident Duty Hour Reform on Family Medicine Residency Training: Residents' Points of View

<p>目的：本研究探討家庭醫學科住院醫師自2019年適用勞動基準法規定後，對工時規範之滿意度、健康影響、學習成效、醫療品質與病人安全層面進行調查，並進一步比較不同訓練職級、不同醫院訓練容額、與不同醫院層級住院醫師在工時規定影響看法上的差異。</p> <p>方法：以2017至2019訓練年度進入家庭醫學專科醫師訓練計畫的住院醫師為對象，以問卷調查工時限制所造成的影響。結果：共有286位家庭醫學住院醫師參與研究，其中有近九成滿意目前工時限制規定，且普遍認為工時限制不會降低訓練品質。其中第一年住院醫師超時的比例較高，較資深住院醫師同意工時規定會減少教學指導與學習體驗的比例較高，但多數還是認為並不影響教學品質。超過半數第一年住院醫師認為醫療錯誤發生率會降低，資深住院醫師則多認為不變。雖然所有醫院層級的住院醫師都認為工作時疲勞情況與嗜睡程度有所改善，但地區與區域級醫院仍有少部分住院醫師認為工作時疲勞及嗜睡程度更明顯。</p> <p>結論：實施工時限制後，大部分家庭醫學科住院醫師滿意目前工時限制規定，認為工時限制不會降低訓練品質，也不需要延長受訓年限。學員普遍認為對於工時限制對住院醫師的身心健康有正向影響，對於病人受到的醫療品質與病人安全則不受影響。</p> <p> </p><p>Objective: The study assessed family medicine residents’ overall satisfaction with the resident duty hour restriction implemented in 2019 and explored their perceptions of the impacts of the restriction on their well-being, education, and patient safety. The study further compared the differences in residents’ perceptions based on the level of residency training, size of residency training program, and level of training hospital.</p> <p>Methods: Residents admitted to the family medicine residency training program by the Taiwan Association of Family Medicine from 2017 to 2019 were selected to participate in this study. A prospective anonymous questionnaire survey was administered to family medicine residents nationwide to gather their opinions and suggestions regarding the newly implemented resident duty hour reform.</p> <p>Results: A total of 286 family medicine residents responded to the questionnaire survey. Nearly 90% of the residents were satisfied with the current duty hour regulations and found the restriction unlikely to compromise the quality of residency training. First-year residents reported a greater frequency of working overtime, compared to residents of other levels. The more senior the residents, the stronger the belief that duty hour restriction reduced time for learning and faculty guidance; however, the majority of the responding residents were of the opinion that the restriction did not affect the overall quality of residence training. Over 50% of the first-year residents felt the restriction helped reduced the likelihood of medical error, while more senior residents found the likelihood unchanged. Regardless of the levels of their training hospitals, a great part of the residents found the problems of fatigue and daytime sleepiness alleviated, yet there was still a minority of residents in regional and district hospitals felt the problems aggravated.</p> <p>Conclusion: After the implementation of duty hour restriction, most family medicine residents are satisfied with the current regulations and feel no significant impact of the restriction on the quality of residency training. In their opinion, there is no need to extend the length of residency training. The duty hour reform does exert positive influences on their physical and mental health and bring about no impact on patients’ safety and quality of care.</p> <p> </p>

A Recognition Survey by Psychiatry Residents and Psychiatrists Regarding the Quality of Residency Training and Clinical Competence in Korea

A Recognition Survey by Psychiatry Residents and Psychiatrists Regarding the Quality of Residency Training and Clinical Competence in Korea

The Multifactorial Contribution of Publications in Plastic Surgery Journals in Microsurgery Education.

Microsurgery is one of the most complex operative skills. Recent restrictions on residents' working hours challenge residency program directors to ensure skill acquisition with scant time dedicated to microsurgery practice. We aimed to summarize the contribution of plastic surgery journals in microsurgical education. A comprehensive literature search was performed. We observed an increasing number of publications on microsurgery education over the years. This could be due to the adoption of new technologies developed in the last 2 decades, the concerns about quality of resident training in the context of reduced work hours, the well-described benefit of medical simulations in other specialties, and the pressure on trainees to be proficient before operating on patients. The variety of aspects addressed in plastic surgery publications is broad: simulators, courses, skills assessment, national surveys, and technology trends. There is an upward trend in the number of publications and plastic surgery journals, demonstrating a remarkable contribution to microsurgery training.

Learning climate positively influences residents\u2019 work-related well-being

An optimal learning climate is crucial for the quality of residency training and may also improve residents’ well-being and empathy. We investigated the associations of learning climate with residents’ work-related well-being. A multicenter questionnaire study was performed among 271 surgery and gynaecology residents in 21 training programs from September 2012 to February 2013. Residents were asked to complete work-related well-being measurements: work engagement (Utrecht Work Engagement Scale), job and specialty satisfaction (measures from Physician Worklife Study), and physician empathy (Jefferson Scale of Physician Empathy). The Dutch Residency Educational Climate Test was used to evaluate learning climate. Multivariate adjusted linear regression analyses were used to estimate associations of learning climate with work-related well-being measures. Well-being measures were completed by 144 residents (53.1%). Learning climate was evaluated by 193 residents, yielding 9.2 evaluations per training program on average. Overall learning climate score was positively associated with work engagement [regression coefficient b = 0.58; 95% confidence interval (CI) 0.18–0.98; p = 0.004] and job satisfaction (b = 0.80; 95% CI 0.48–1.13; p < 0.001). No associations were found between learning climate and empathy and specialty satisfaction. Residents’ work engagement and job satisfaction are positively related to the learning climate and may be further enhanced by improved learning climates of training programs.

Perceptions of emergency medicine residents on the quality of residency training in the United States and Saudi Arabia.

We compare educational environments (i.e. physical, emotional and intellectual experiences) of emergency medicine (EM) residents training in the United States of America (USA) and Saudi Arabia (SA). A cross-sectional survey study was conducted using an adapted version of the validated Postgraduate Hospital Educational Environment Measure (PHEEM) survey instrument from April 2015 through June 2016 to compare educational environments in all emergency medicine residency programs in SA and three selected programs in the USA with a history of training Saudi physicians. Overall scores were compared across programs, and for subscales (autonomy, teaching, and social Support), using chi-squared, t-tests, and analysis of variance. A total of 219 surveys were returned for 260 residents across six programs (3 SA, 3 USA), with a response rate of 84%. Program-specific response rates varied from 79%-100%. All six residencies were qualitatively rated as "more positive than negative but room for improvement". Quantitative PHEEM scores for the USA programs were significantly higher: 118.7 compared to 109.9 for SA, P=0.001. In subscales, perceptions of social support were not different between the two countries (P=0.243); however, role autonomy (P<0.001) and teaching (P=0.005) were better in USA programs. There were no significant differences by post-graduate training year. EM residents in all three emergency medicine residency programs in SA and the three USA programs studied perceive their training as high quality in general, but with room for improvements. USA residency programs scored higher in overall quality. This was driven by more favorable perceptions of role autonomy and teaching. Understanding how residents perceive their programs may help drive targeted quality improvement efforts.

Postgraduate medical education: residents rating the quality of their training.

To determine the residents' rating of the quality of their residency training by measuring their level of satisfaction with the various educational attributes of their training. Cross-sectional survey. Department of Medical Education (DME), Pakistan Institute of Medical Sciences (PIMS), Islamabad, from September to November 2008. Residents who had been pursuing residency training for over a period of one year were included. A comprehensive questionnaire consisting of 14 questions was employed which covered fundamental attributes of the quality of postgraduate training. A five point response scale was used to rate responses to questions. Results for each of the measures of all the included residents were added up, and then an average was calculated and scaled to a score out of 100 to form the Index Score. In this way the residents' level of agreement or disagreement with the questioned statement was measured from 'Strongly disagree' (0%) to 'Strongly agree' (100%). Out of a total of 150 residents contacted, 109 answered the questionnaire. The response rate was thus 73%. Residents variably rated the various educational attributes of their residency training. Relatively favourably rated areas included regular conduct of case/ topic discussions (75.96%), consultant's supervision during interventional procedures (70.27%) and regularly holding journal clubs (69.54%). The less favourably rated areas included constructive feedback by supervisor (54.49%), consultant as role model (54.49%) and faculty as the source of learning (50.82%). Overall, the Index Score was 60.55%. Significant room exists for improvement in the quality of residency training as indicated by the less than desirable ratings of the various educational attributes of the residency programme. Faculty members who constitute the cornerstone of educational process are pivotal to effect the desired improvements.

Clinical teachers’ views on how teaching teams deliver and manage residency training

Background: Residents learn by working in a multidisciplinary context, in different locations, with many clinical teachers. Although clinical teachers are collectively responsible for residency training, little is known about the way teaching teams function.Aim: We conducted a qualitative study to explore clinical teachers’ views on how teaching teams deliver residency training.Method: Data were collected during six focus group interviews in 2010.Results: The analysis revealed seven teamwork themes: (1) clinical teachers were more passionate about clinical expertise than about knowledge of teaching and teamwork; (2) residents needed to be informed about clinical teachers’ shared expectations; (3) the role of the programme director in the teaching team needed further clarification; (4) the main topics of discussion in teaching teams were resident performance and the division of teaching tasks; (5) the structural elements of the organisation of residency training were clear; (6) clinical teachers had difficulty giving and receiving feedback and (7) clinical teachers felt under pressure to be accountable for team performance to external parties.Conclusion: The clinical teachers did not consider teamwork to be of any great significance to residency training. Teachers’ views of professionalism and their own experiences as residents may explain their non-teamwork directed attitude. Efforts to strengthen teamwork within teaching teams may impact positively on the quality of residency training.

Private facilities must make educational contribution

The scope and quality of residency training in Canada may ultimately be compromised unless privately operated medical facilities become integral players in the education of future physicians, says the Royal College of Physicians and Surgeons of Canada. With ongoing devolution of care, particularly

Community psychiatrists who see geriatric patients: what's training got to do with it?

This study examines the issues influencing psychiatrists' decisions to provide care to the under-served geriatric population. Community-based psychiatrists who see geriatric patients participated in focus group discussions exploring factors that influence the characteristics of their current practices. Personal themes, environmental issues and quality of residency training emerged as important factors interacting in eventual practice choice. Major influences within training programs included teachers, diverse patient exposure and high-quality essential skills teaching. Residency program curricula might capitalize on these to better prepare residents and enhance the likelihood of graduates eventually choosing to incorporate geriatric patients into their practices.

Implementing Resident Work Hour Limitations: Lessons From the New York State Experience

New York State has had residency work hour regulations for 15 years, and, since 1998, a strong effort to enforce these rules has been made. This study examines the impact of implementation of these rules on residency training, the quality of residents' lives, and patient care. Data were gathered with a carefully constructed questionnaire sent to all surgical residents in the state, including senior residents in their final year (n = 1037). Three hundred nineteen questionnaires were returned. Respondents felt their residency programs generally complied with the regulations and that support and enforcement were growing. Twenty-five percent reported stricter enforcement following an inspection that resulted in a fine for violation of regulations. Also, 19% noticed stricter enforcement after an adverse patient outcome, a site visit, or other event. Both residents and their residency programs reported a mean of 88 hours worked per week (range, 11-140 hr). The schedules reported by junior and senior house staff and by community and academic hospitals were in general agreement. Most residents said they took in-house calls no more frequently than every third night. Calls were taken from home more often by senior residents (16.7% vs. 4.7% for juniors; P <.05) and by those in academic programs compared with community hospitals (14.3 vs. 4.7%; P <.05). Respondents reported that hospitals used various strategies to cover night call, including night floats, increased cross-coverage, and increased use of nurse practitioners and physician assistants. Nearly 3/4 of the residents thought that, in general, the regulations were a good thing. Sixty-four percent and 66%, respectively, of participants said that with the implementation of the regulations they felt more 'well rested and that their quality of life outside the hospital was improved. Less than half, 42%, felt the quality of their work life inside the hospital was improved. A total of 33.4% senior residents and 28.2% academic residents reported a negative impact of regulations on their work life compared with 19.3% of junior residents and 20% of community hospital residents (P <.01 for both). Senior house staff were more likely to feel that the reduction in work hours left them with the burden of much of the scut work that once was the juniors' respponsibility (79.2% of seniors vs. 34.9% of juniors, P <.01). Overall, 71% of the residents from community hospitals more frequently reported a reduction in work hours (81%) than those in academic centers (66.4%, P <.05). Twenty-two percent of respondents said that the overall quality of resident training had improved whereas 35% felt the regulations had resulted in a decrease in the overall quality of their training. More time for reading and studying was noted by 47% of residents. However, 50% reported participating in fewer operations, and 51% said that they hail missed too many learning opportunities under the new regulations. These sentiments were more likely to be expressed by senior residents and residents in academic medical centers than by junior house staff or those in community residencies.

Using the world-wide-web to obtain feedback on the quality of surgical residency training

Background: Resident feedback can lead to an improvement in teaching performance. Compliance with our previous rotation evaluation system has been poor.Methods: Rotation evaluation forms were integrated to the departmental World-Wide-Web site. Anonymously completed evaluations are automatically sent to an appointed surgery professor via electronic mail (e-mail). They are then collated and transmitted to program directors.Results: Ninety-two percent (24 of 26) of our surgical residents have an e-mailaccount. During the 2-month trial, 18 residents completed 48 evaluations. This represents a 75% (18 of 24) compliance rate among residents with e-mail capabilities. The response rate was 82% (9 of 11) for core residents, 64% (7 of 11) for third- and fourth-year residents, and 50% (2 of 4) for chiefs. A second 2-month trial yielded a 75% (18 of 24) response rate and 43 evaluations.Conclusions: The World-Wide-Web is a user-friendly medium suitable to obtain valuable feedback on the quality of residency training. Compliance was improved using this new system.

Defining Successful Performance Among Pediatric Residents

The pediatric literature has documented a growing attention to defining the nature and quality of residency training. The critical incident technique, a method widely accepted in industrial settings, was used in this study to determine attitudes and behaviors deemed critical for successful performance of residents in a pediatric training program. Structured interviews with 17 senior teaching faculty produced descriptions of resident behavior that were classified into the following mutually exclusive categories: commitment to learning, clinical judgment, communicating medical information, recognition of limits, professional behavior, interpersonal skills with patients, and dealing with emergency situations. Only 30% of the critical incidents obtained from the faculty were related to criteria traditionally used to select and evaluate residents, such as knowledge and technical skills, while the remaining incidents were noncognitive in nature. The results of this study have implications for the evaluation and selection of residents and suggest that pediatric program directors and faculty must give attention to the means by which noncognitive skills are fostered in residents.

A criterion-referenced examination in cardiovascular disease

This study described criterion-referenced tests of electrocardiograph reading skill and basic knowledge in cardiology, assessed their dependability and validity, and explored their impact on overall certification rates. Data indicated that the standard-setting processes and the two criterion-referenced tests produced dependable results both separately and together. Scores of each had the expected relationships with quality of residency training and experience with the examination. Moreover, these sections of the examination identified a small subset of examinees who failed the criterion-referenced sections but passed the norm-referenced examinations. Taken as a whole these results replicate the findings of an earlier study in terms of a criterion-referenced test of electrocardiograph reading skill and extended them to a criterion-referenced test of basic knowledge in cardiology.

Practice patterns and attitudes toward education among Canadian obstetricians and gynecologists

A group of 1370 specialists in obstetrics and gynecology were surveyed for information about practice patterns, continuing medical education preferences, and their perception of the adequacy of their own residency training. The overall response rate was 65.7%. More than half were in solo practice, practiced in communities of over 250,000, had been in practice for more than 10 years, or had a full or part-time appointment with a Canadian medical school. A wide range of continuing medical education methods were used. Journals were ranked highest by 41%. It is disturbing that very few physicians (15%) indicated any involvement in practice audit. The quality of residency training was ranked low in a number of areas including genetic counseling, ultrasound, neonatology, intensive care, colposcopy, sexual dysfunction, marital counseling, and hysteroscopy. The survey highlights a number of areas that merit the attention of Canadian programs in postgraduate and continuing medical education in obstetrics and gynecology.

IV. SUMMARY REPORTS OF ROUND TABLES WITH PERTINENT DISCUSSIONS

1. The value of research to a pediatric residency training program rests more in the environment it creates than in relation to any direct participation of the resident in individual projects. Active, high-quality research programs, regardless of their subject matter, create ferment, a spirit of inquiry, rigor of criticism, and an emphasis on selfreliance in seeking answers and evaluating data. This atmosphere engenders a scholarly approach to clinical problem-solving and fosters continuing self-education. The developing pediatrician in such an environment also has the opportunity to examine realistically research methods, to assay the kind of people involved in research, and to learn the limitations inherent in clinical as well as laboratory investigation. Through these experiences he builds a frame of reference for evaluating research results independently later in his career, in whatever direction he differentiates. 2. The emphasis on research in pediatric training centers during recent years has not increased the proportion of residents entering full-time research. Available data indicate a slight drop in the per cent entering academic careers although the absolute number is increasing. 3. A major discrepancy exists between approved pediatric programs in university centers in their capacity to provide a research background to the resident training environment. For example, 43% of university-associated pediatric resident programs have less than ten research projects of any kind; 25% have less than four and a number have none at all. Although comparable data are not available, affiliated programs are undoubtedly less able to marshal these resources. This Round Table interprets these findings, together with other evidence, as indicative of a profound need to augment the quality of existing residency programs, both affiliated and non-affiliated, as a first order of business of American pediatrics. 4. Among the possible factors which appear to affect adversely the quality of residency training identified by the group are: a) Absence of a formal mechanism for feedback from the certifying group—The American Board of Pediatrics—to the training programs themselves—with respect to the performance of their own trainees. In addition, no data are available on the fate or progress of those who finish residency training and are never certified, and on other pertinent aspects of pediatric training. b) Inadequate communication and ineffective coordination between the certifying group—The American Board of Pediatrics—and the accrediting group—The Joint Council on Residency Training of the A.M.A.—has resulted from their independent goals and leadership, despite joint stewardship. c) The criteria for accreditation have appeared to be more centered upon service elements of residency programs such as number of outpatients visits, number of operations, and variety of diagnoses, than upon the educational elements. d) Criteria for accreditation include no specific emphasis on the importance of ongoing research as an element of the optimal training environment.