Readiness For Independent Practice Research Articles

Transition From Graduate Medical Education to Independent Practice: A Scoping Review.

This study examines the gaps in early career physician readiness for independent practice after graduating from their final graduate medical education (GME) program. The authors conducted a literature search of 4 online databases (PubMed, Scopus, Health Business Elite, and Education Resources Information Center) using the following terms: population terms (GME, fellow, resident, and others), early career terms (onboarding, hiring, early career, ready, and others), readiness terms (readiness, preparedness, knowledge, skills, competence), and independence terms (attending, physician, independent practice). The databases were searched on March 12, 2024, for articles that explored GME graduate gaps in readiness for independent practice; assessment tools, curricula, or curricular need aimed at gaps in early career physician readiness; or an area where GME graduates need more knowledge and skills. They extracted specific gaps in preparedness and categorized them using existing competency frameworks. The search returned 116 articles addressing gaps in preparedness for independent practice among recent GME graduates. Surgery yielded more articles than any other specialty (43 [37%]). Overall, 192 individual gaps were extracted; the greatest number of gaps came from patient care (75 [39%]) followed by personal and professional development (44 [23%]). The most frequently identified gaps were procedural independence (10 occurrences), practice management (9 occurrences), and billing (7 occurrences). Despite advances in GME, learners still struggle when transitioning to independent practice. Personal and professional development is a useful categorization for many gaps and should be considered for inclusion as a GME competency. Systematic assessment of new-to-practice attendings could help stakeholders better understand the true outcomes of GME programs. Concerted investment by specialty societies may drive greater understanding and innovative solutions. Additional study could help address the challenges in the GME-to-practice transition.

Looking Beyond the Numbers: A Comparison of Operative Self-Efficacy, Supervision, and Case Volume in General Surgery Residency.

Background A national survey of general surgery residents revealed significant self-assessed deficits in preparation for independent practice, with only 7.7% of graduating postgraduate year 5 residents (n=1145) reporting self-efficacy for all 10 commonly performed operations surveyed. Objective We sought to understand why this phenomenon occurs. We hypothesized that self-efficacy would be positively correlated with both operative independence and case volume. Methods We compared 3 independent datasets: case information for the same 10 previously surveyed operations for residents graduating in 2020 (dataset 1), operative independence data obtained through the SIMPL OR app, an operative self-assessment tool (dataset 2), and case volume data obtained through the Accreditation Council for Graduate Medical Education National Data Report (dataset 3). Operations were categorized into high, middle (mid), and low self-efficacy tiers; analysis of variance was used to compare operative independence and case volume per tier. Results There were significant differences in self-efficacy between high (87.7%), mid (68.3%), and low (25.4%) tiers (P=.008 [95% CI 6.2, 32.7] for high vs mid, P<.001 for high vs low [49.1, 75.6], and P<.001 for mid vs low [28.7, 57.1]). The percentage of cases completed with operative independence followed similar trends (high 32.7%, mid 13.8%, low 4.9%, P=.006 [6.4, 31.4] for high vs mid, P<.001 [15.3, 40.3] for high vs low, P=.23 [-4.5, 22.3] for mid vs low). The total volume of cases decreased from high to mid to low self-efficacy tiers (average 91.8 to 20.8 to 11.1) but did not reach statistical significance on post-hoc analysis. Conclusions In this analysis of US surgical residents, operative independence was strongly correlated with self-efficacy.

A qualitative study of stakeholder perspectives of the current system of assessing pharmacists’ readiness for independent practice in Ireland

Abstract Introduction Pharmacy students in Ireland are supervised by an approved tutor pharmacist (preceptor) during placement in the final year of the MPharm programme. Since 2020, students must pass two assessments of their readiness to practise – a Competency Assessment completed by their preceptor and an Objective Structured Clinical Examination (OSCE) referred to as the Professional Registration Examination (PRE), prior to registration and independent practice. The Schools of Pharmacy in Ireland are collectively responsible for the PRE, including design and delivery of the national registration examination. A recent scoping review of the methods and processes used to determine pharmacists’ readiness for independent practice identified that Ireland is the only country globally where the Schools of Pharmacy are responsible for the national registration examination.[1] Aim This study aimed to explore pharmacy graduates’ and pharmacy preceptors’ perspectives of the current system of assessing pharmacist’s readiness for independent practice in Ireland. Methods Online, semi-structured interviews were undertaken with preceptors and recent pharmacy graduates. Purposive sampling was used to invite potential participants for interview. Preceptor participants were invited to take part via newsletter invitation and graduates were recruited via social media (Twitter advertisement). Interviews were recorded and transcribed verbatim. The topic guides were developed based on findings from a linked scoping review and the research team’s experience of the assessments.[1] The topic guides were piloted and refined. Key topics included participants’ awareness and perceptions of current assessments to determine readiness for independent practice and participants’ views regarding the readiness of newly registered pharmacists for independent pharmacy practice. Recruitment continued until thematic saturation was reached. Data were analysed using thematic analysis. Results Fifteen interviews were conducted with preceptors (n=7, female=5, male=2) and recent graduates (n=8, female=5, male=3). The key themes identified were: The Competency Assessment Process, The Professional Registration Examination, Pharmacy Curriculum, Placement Training, Alternative Assessment Methods and Challenges Post-Registration. The most frequently noted issues relating to pharmacy curriculum and training were lack of training and practise in development of soft skills, people management and conflict resolution. Participants expressed concern regarding the fact that legal constraints were preventing students from developing skills required of pharmacists, especially in relation to decision making and prescription checking, and this is considered an impediment to fully preparing students for independent practice. Readiness to practise of graduates is considered context-specific with concerns expressed in relation to locuming practices of newly registered pharmacists. Conclusion This study has highlighted a number of stakeholder concerns regarding the current system of assessment of readiness to practise of pharmacists in Ireland, in particular in relation to the Competency Assessment process. While the interview technique facilitated collection of detailed information, the sample size would prevent generalisation to the target population. The possibility of interviewer bias and/or social desirability bias in participants should be acknowledged. Further research is required to explore the feasibility of the improvements proposed by participants.

Credentialing and training advanced practice providers for advanced tertiary care pediatric otolaryngology: A curriculum for hospital and ambulatory practice

ObjectivesInclusion of advanced practice providers (APPs) in hospital-based pediatric otolaryngology has been growing rapidly, aligning with a 70% increase in physician assistants in all surgical subspecialties in recent years. A post-graduate training program is developed to reflect these growing and changing responsibilities. MethodsCurriculum development took place at one institution over eight years for 16 APPs following a standard Six Step Approach to medical curriculum: 1) Problem Identification and General Needs Assessment, 2) Targeted Needs Assessment, 3) Goals & Objectives, 4) Education Strategies, 5) Implementation, and 6) Evaluation and Feedback. This was integrated into an onboarding process for new hires and a continuing education plan for established providers. Gaps were identified throughout the process to improve education, skills required for competency, and readiness for independent practice. ResultsThe curriculum incorporated a subset of goals and objectives from the familiar resident curriculum with significant differences in orientation and onboarding. A Clinical Competency Checklist was used initially for feedback and later to support credentialing after completion of the curriculum. A Procedure Rating Form was used for feedback and documentation of the number of performances required for credentialing. Self-Assessment was utilized to further identify readiness for independence and tailor additional education to meet practice needs. ConclusionThe curriculum and onboarding process presented can be used for any advanced practice provider joining an individual or team of pediatric otolaryngology providers. A standardized curriculum is helpful to the supervisors and trainees. Further collaboration between institutions and development of benchmarks will help ensure excellence in education and in care of pediatric otolaryngology patients.

Revision Rates in Cosmetic Plastic Surgery with and without Resident Involvement.

Changes in surgical education have caused concern over residents' preparedness for independent practice. As the field of otolaryngology requires such a wide breadth of expertise, ill preparation becomes especially costly. This study explores how the presence and participation of a postgraduate year 3 (PGY3) otolaryngology resident in surgery impacts revision rates and operating time as gauges for the resident competency and indirect training costs. A retrospective chart analysis of patients who underwent cosmetic plastic surgery at sites for PGY3 otolaryngology residents' facial plastic surgery rotations was conducted. Residents performed one side of bilateral procedures (eg, blepharoplasties) and approximately 50% of midline procedures (eg, rhinoplasties). Chi-squared testing and odds/risk ratios were done to assess the effect of resident involvement on revision rates. Operating time was compared using t tests. When a resident was involved in cosmetic surgery, the revision rate was 22.2% compared with 3.6% without. The likelihood of a future revision surgery was 7.57 times higher when a resident participated in the original operation. Resident involvement was not a statistically significant predictor of exceeding the allotted operating time. The revision rate of cosmetic surgery was much higher when a resident was involved. Otolaryngology residents would benefit from increased facial plastic and reconstructive surgery training. As a response to this analytical study, this clinical rotation was moved to be offered at a later stage of postgraduate surgical training to allow residents to gain more experience and be better set up for success in the rotation.

Education programmes on performance-based assessment for allied health and nursing clinical educators: A scoping review protocol

Background Performance-based assessment (PBA) is a complex process undertaken in the workplace by healthcare practitioners known as clinical educators, who assist universities in determining health professional students’ readiness for independent practice. Preparing healthcare professionals for PBA is considered essential to ensuring the quality of the assessment process in the clinical learning environment. A preliminary search of the literature indicated a paucity of research guiding the development of education programmes that support practice educators to understand and implement PBA. Objective The aim of this scoping review is to investigate and describe education programmes delivered to allied health and nursing clinical educators, to develop PBA knowledge and skills. Methods This review will follow the Joanna Briggs Institute (JBI) methodology for conducting scoping reviews. Electronic databases relevant to this research topic will be searched including, EMBASE, ERIC, MEDLINE (Ovid), Web of Science and CINAHL and other targeted databases for grey literature. Studies that include PBA as the main focus or a component of the education programmes, of any format, delivered to clinical educators in allied health and nursing will be included. Studies may report the design and/or implementation and/or evaluation of PBA education programmes. Relevant English language publications will be sought from January 2000 to October 2022. Two reviewers will screen all titles and abstracts against the inclusion/exclusion criteria, and publications deemed relevant will be eligible for full text screening, confirming appropriateness for inclusion in the scoping review. Data will be charted to create a table of the results, supported a by narrative summary of the findings in line with the review objectives.

Perspectives of gynecologic oncology fellowship training and preparedness for practice

We aimed to examine the preparedness of recent gynecologic oncology fellowship graduates for independent practice.We conducted a web-based survey study using REDCap targeting Society of Gynecologic Oncology (SGO) members who graduated gynecologic oncology fellowship within the last six years. The survey included 52 items assessing fellowship training experiences, level of comfort in performing core gynecologic oncology surgical procedures and administering cancer-directed therapies. Questions also addressed factors driving participants’ selection of fellowship programs, educational experience, research and preparedness for independent practice. A total of 296 participants were invited to complete the survey. Response rate was 42% with n = 124 completed surveys included for analysis. The highest ranked factor for fellowship selection was fit with program 36% (n = 45). Upon completing fellowship, most were uncomfortable performing ureteral conduit formation 84% (n = 103), ureteroneocystostomy 77% (n = 94), exenteration 68% (n = 83), splenectomy 67% (n = 83) and lower anterior resection 41% (n = 51). Most were comfortable managing intraoperative complications 85% (n = 104) and standard cancer staging procedures (range: 61%–99%). Majority were comfortable providing cancer directed therapies with chemotherapy 99% (n = 123), immunotherapy 84% (n = 104), and poly ADP-ribose polymerase (PARP) inhibitors 97% (n = 120). Upon completing fellowship, 77% (n = 95) report having mentorship that met their expectations during fellowship and 94% (n = 116) felt they were ready for independent practice. Majority of fellowship graduates were prepared for independent practice and felt comfortable performing routine surgical procedures and cancer directed treatment. However, most are not comfortable with ultra-radical gynecologic oncology procedures. Maximizing surgical opportunities during fellowship training and acquiring early career mentorship may help.

"Everything new is happening all at once": a qualitative study of early career obstetrician and gynaecologists' preparedness for independent practice.

The transition from residency training into practice is associated with increasing risks of litigation, burnout, and stress. Yet, we know very little about how best to prepare graduates for the full scope of independent practice, beyond ensuring clinical competence. Thus, we explored the transition to independent practice (TTP) experiences of recent Obstetrics and Gynaecology graduates to understand potential gaps in their perceived readiness for practice. Using constructivist grounded theory, we conducted semi-structured interviews with 20 Obstetricians/Gynaecologists who graduated from nine Canadian residency programs within the last five years. Iterative data collection and analysis led to the development of key themes. Five key themes encompassed different practice gaps experienced by participants throughout their transition. These practice gaps fit into five competency domains: providing clinical care, such as managing unfamiliar low-risk ambulatory presentations; navigating logistics, such as triaging referrals; managing administration, such as hiring or firing support staff; reclaiming personhood, such as boundary-setting between work and home; and bearing ultimate responsibility, such as navigating patient complaints. Mitigating factors were found to widen or narrow the extent to which new graduates experienced a practice gap. There was a shared sense among participants that some practice gaps were impossible to resolve during training. Existing practice gaps are multi-dimensional and perhaps not realistically addressed during residency. Instead, TTP mentorship and training opportunities must extend beyond residency to ensure that new graduates are equipped for the full breadth of independent practice.

Exploring the preparedness of newly qualified general practitioners for independent practice in Ireland

ABSTRACT Background Newly qualified general practitioners’ (NQGPs) experiences of transition to independent practice are varied. Most Irish GP graduates see themselves as either assistant GPs, salaried GPs or locum GPs one year post-qualification, yet anticipate partnership ten years post-qualification. Research into GP trainees' transition to independent practice is scarce, yet perceived lack of preparedness can be associated with emotional exhaustion and burnout. Aims To explore NQGPs experience of their transition to independent practice in Ireland. Methods A qualitative approach was taken, using virtual, semi-structured, one-to-one interviews with NQGPs within five years of graduation, practising in Ireland. Descriptive demographics of participants were obtained. Audio recordings of interviews were analysed using thematic analysis. Results NQGPs reported preparedness for their clinical role, but most did not feel prepared for their non-clinical role. While NQGPs regarded independent practice as an intensive step-up from GP training, they drew on the support of GP colleagues during this transition. The decision on job selection centred largely on practice factors including location, ethos, support, and career prospects. Participants continued to develop in their identity as a GP within this transitionary period. Conclusion This research provides a unique insight into the experiences of NQGPs in Ireland. Specialist GP training schemes are influential in how NQGPs perceive their preparedness for independent practice; however, external factors including their place of work and alignment of professional goals play a part in this stage of NQGPs career.

Dental students' clinical and academic experience during placement in a UK tertiary care children's hospital.

There are well-recognized difficulties across UK dental schools in recruiting paediatric patients who are willing to attend, have manageable dental disease, and do not require the behaviour management skills of an experienced dentist. This presents a concern for the skill development of the future workforce. At the School of Dentistry in Liverpool, the challenge to enable students to develop these core skills is supported by attendance at a tertiary care children's hospital. The present study investigates whether attendance of final-year dental students at a children's hospital affects perceptions of their surgical experience, self-reported preparation for working independently as a dentist, and understanding of specialist care. A self-administered online survey was distributed to final-year dental students (2020-2021). Quantitative and qualitative data were gathered using mixed item formats for descriptive analysis. Questions addressed themes including experience of primary tooth exodontia, understanding of general anaesthetic dental care and multidisciplinary patient management. The response rate was 90% (n = 66). Attendance was beneficial to student learning and experience; responders reported increased surgical experience, self-confidence and understanding of multidisciplinary care. Students developed insight into future career pathways. The present study supports the use of external clinic rotations, known as outreach placements, for dental student training. The findings support existing literature demonstrating the value of outreach placements in providing an experience not available in dental school environments. Dental students' perceptions of their surgical experience, knowledge of specialist care, and preparedness for independent practice may be enhanced by attendance to outreach placements.

Early-career general practitioners’ perceptions of the utility of vocational training for subsequent independent practice

ABSTRACT Purpose To evaluate Australian early-career general practitioners’ perceptions of the utility of their prior vocational training in preparing them for independent specialist practice. We hypothesised that in-practice teaching would be perceived as more useful than formal education delivered by Regional Training Organisations (RTOs). Methods and materials A cross-sectional questionnaire-based study of early-career general practitioners (RTO ‘alumni’). The outcomes were Likert scale ratings of alumni’s perceived impact of RTO education versus in-practice training on their preparedness for independent practice. Ratings were compared using Wilcoxon signed-rank tests. Multivariable linear regression was used to establish alumni characteristics associated with perceptions of utility of in-practice versus RTO-delivered education. Results Three hundred and fifty-four alumni responded (response rate 28%). In-practice training was rated statistically significantly higher than RTO education for minor procedural skills, teaching skills, professional responsibilities, tolerating clinical uncertainty, and preparing for managing child and adolescent health, aged care, chronic disease, multi-morbidity and mental health. RTO education rated higher than in-practice training for practising evidence-based medicine and Aboriginal and Torres Strait Islander health. For a number of further areas, there was no statistically significant difference in alumni ratings of utility. Conclusions In-practice or RTO-led teaching was perceived as more useful for some components of independent practice, whilst for others there was no significant difference. The findings support recognition of the individual educational components of a blended education/training structure.

Education programmes on performance-based assessment for allied health and nursing clinical educators: A scoping review protocol

Background: Performance-based assessment (PBA) is a complex process undertaken in the workplace by healthcare practitioners known as clinical educators, who assist universities in determining health professional students’ readiness for independent practice. Preparing healthcare professionals for PBA is considered essential to ensuring the quality of the assessment process in the clinical learning environment. A preliminary search of the literature indicated a paucity of research guiding the development of education programmes that support practice educators to understand and implement PBA. Objective: The aim of this scoping review is to investigate and describe education programmes delivered to allied health and nursing clinical educators, to develop PBA knowledge and skills. Methods: This review will follow the Joanna Briggs Institute (JBI) methodology for conducting scoping reviews. Electronic databases relevant to this research topic will be searched including, EMBASE, ERIC, MEDLINE (Ovid), Web of Science and CINAHL and other targeted databases for grey literature. Studies that include PBA as the main focus or a component of the education programmes, of any format, delivered to clinical educators in allied health and nursing will be included. Studies may report the design and/or implementation and/or evaluation of PBA education programmes. Relevant English language publications will be sought from January 2000 to October 2022. Two reviewers will screen all titles and abstracts against the inclusion/exclusion criteria, and publications deemed relevant will be eligible for full text screening, confirming appropriateness for inclusion in the scoping review. Data will be charted to create a table of the results, supported by narrative summary of findings in line with the review objectives.

Anything but Cookbook Medicine: Exploring the Influence of Supervisor Practice Variability on Resident Learning in Thrombosis Medicine

Introduction Clinical practice variability is characterized by two or more expert clinicians who make different treatment decisions despite encountering a similar case. Thrombosis Medicine is an example of a specialty that has a large evidence base to support decision-making and where practice variability is common. Our objective was to explore how residents experience and interpret inter-supervisor clinical practice variability in Thrombosis Medicine, and how these variations influence learning. Methods Seventeen senior residents in Internal Medicine, Hematology or Thrombosis Medicine (Postgraduate Year [PGY] 3-6) participated in semi-structured interviews. Data collection and analysis occurred iteratively and concurrently in a manner consistent with constructive grounded theory methodology. Variation theory was used as a sensitizing concept. A central tenet of this theory is that learning occurs by experiencing three sequential patterns of variation: contrast, generalization, and fusion. All transcripts were coded in duplicate by paired members of the study team. Participants were recruited purposively with regard to their field of training until thematic saturation was reached. The primary investigator maintained an audit trail and reflexivity journal. Member checking was performed. Dedoose (version 8.0.35) was used for all analyses. The Hamilton Integrated Research Ethics Board reviewed the study. Results Clinical practice variability was common and generally viewed positively. Residents attributed clinical practice variability to supervisor personality differences, inter-institutional differences, availability and interpretation of evidence, differences in patient preferences and characteristics, and their own participation in the decision-making process. Inherent differences between supervisors, including personality traits, risk tolerance, and prior educational and clinical experiences were a major contributor. Clinical practice variability was felt to be most common when the clinical problem had scant or conflicting evidence to guide practice, for example, in the treatment of subsegmental pulmonary embolism or splanchnic vein thrombosis. Supervisors and learners often took patient preferences into account when making a decision, especially when the net clinical benefit of anticoagulation was uncertain. Supervisor-learner discussions were critical to learning from clinical practice variability. Through these interactions, residents asked clarifying questions, and supervisors shared tacit knowledge, elaborated on their prior experiences, compared and contrasted similar cases, and articulated their clinical reasoning. Residents endorsed the view that a certain baseline level of knowledge is required to appreciate the nuances that are uncovered by clinical practice variability. Junior residents (PGY 2-4) were often assessment-focused and made note of practice patterns between their supervisors in order to predict their supervisors' preferences for future cases. More experienced residents (PGY 5-6), especially those pursuing advanced training in Thrombosis Medicine, were more likely to view clinical practice variability as a means to improve their own decision-making skill in preparation for independent practice. Consistent with variation theory, clinical practice variability helped residents to discern critical aspects that influenced decision-making (contrast), group similar cases together so that the appropriate evidence could be applied (generalization), and weigh multiple variables to make a treatment decision (fusion). Observing practice variability was more helpful for senior learners and less so for junior learners as inexperience and knowledge gaps made it difficult to reconcile differences. Conclusion Residents had a generally positive perception of clinical practice variability in the workplace. Practice variability helped residents discern critical aspects, group similar patients together and practice individualized medicine. Reflection, literature review, and case discussions were felt to maximize learning from practice variability. Clinical supervisors and curriculum designers can promote learning from practice variability through first and second order scaffolding, modeling, coaching, and thinking aloud.

Competency-Based Medical Training in Anesthesiology: Has It Delivered on the Promise of Better Education?

Competency-Based Medical Training in Anesthesiology: Has It Delivered on the Promise of Better Education?

Comparison of Outcomes of Abdominal Wall Reconstruction Performed by Surgical Fellows vs Faculty

Concern regarding surgical trainees' operative autonomy has increased in recent years, emphasizing patient safety and preparation for independent practice. Regarding abdominal wall reconstruction (AWR), long-term outcomes of fellow autonomy have yet to be delineated. To evaluate the long-term outcomes of AWRs performed by fellows and compare them with those of AWRs performed by assistant, associate, and senior-level professors. This retrospective cohort study included patients who underwent AWR for ventral hernias or repair of tumor resection defects at a 710-bed tertiary cancer center between March 1, 2005, and June 30, 2019. The analysis was conducted between January 2020 and December 2021. Academic rank of primary surgeon. The primary outcome was hernia recurrence. Secondary outcomes were surgical site occurrence, surgical site infection, length of hospital stay, unplanned return to the operating room, and 30-day readmission. Multivariable hierarchical models were constructed to identify predictive factors. Of 810 consecutive patients, 720 (mean [SD] age, 59.8 [11.5] years; 375 female [52.1%]) met the inclusion criteria. Mean (SD) body mass index was 31.4 (6.7), and mean (SD) follow-up time was 42 (29) months. Assistant professors performed the most AWRs (276 [38.3%]), followed by associate professors (169 [23.5%]), senior-level professors (157 [21.8%]), and microsurgical fellows (118 [16.4%]). Compared with fellows and more junior surgeons, senior-level professors tended to operate on significantly older patients (mean [SD] age, 59.9 [10.9] years; P = .03), more patients with obesity (103 [65.6%]; P = .003), and patients with larger defects (247.9 [216.0] cm; P < .001), parastomal hernias (27 [17.2%]; P = .001), or rectus muscle violation (53 [33.8%]; P = .03). No significant differences were found for hernia recurrence, surgical site occurrence, surgical site infection, 30-day readmission rates, or length of stay among the fellows and assistant, associate, and senior-level professors in adjusted models. Compared with fellows, assistant professors (OR, 0.22; 95% CI, 0.08-0.64) and senior-level professors (OR, 0.20; 95% CI, 0.06-0.69) had lower rates of unplanned return to the operating room. This cohort study provides evidence-based reassurance that providing fellows with autonomy in performing AWRs does not compromise long-term patient outcomes. These findings may incite efforts to increase appropriate surgical trainee autonomy, thereby empowering future generations of competent, independent surgeons.

The impact of COVID-19 on ophthalmology resident surgical experience: a retrospective cross-sectional analysis

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic caused significant disruption to in-office and surgical procedures in the field of ophthalmology. The magnitude of the impact of the pandemic on surgical training among ophthalmology residents is not known. This study aims to quantify changes in average case logs among United States (U.S.) ophthalmology residency graduates prior to and during the COVID-19 pandemic.MethodsRetrospective, cross-sectional analysis of aggregate, national data on case logs of U.S. ophthalmology residency graduates from 2012 to 2020. The yearly percent change in the average number of procedures performed in the Accreditation Council for Graduate Medical Education (ACGME) ophthalmology resident case logs were analyzed using linear regression on log-transformed dependent variables. The average percent change from 2019 to 2020 was compared to the average yearly percent change from 2012 to 2019 for procedures performed as the primary surgeon, and primary surgeon and surgical assistant (S + A), as well as procedures for which there are ACGME minimum graduating numbers.ResultsAcross all procedures and roles, average case logs in 2020 were lower than the averages in 2019. While average total cases logged as primary surgeon increased yearly by 3.2% (95% CI: 2.7, 3.8%, p < 0.001) from 2012 to 2019, total primary surgeon case logs decreased by 11.2% from 2019 to 2020. Cataract (-22.0%) and keratorefractive (-21.1%) surgery experienced the greatest percent decrease in average primary surgeon cases logged from 2019 to 2020. Average total cases logged as S + A experienced an average yearly increase by 1.2% (95% CI: 0.9,1.6%, p < 0.001) prior to 2020, but decreased by 9.6% from 2019 to 2020. For ACGME minimum requirements, similar changes were observed. Specifically, the average case logs in YAG, SLT, filtering (glaucoma), and intravitreal injections had been increasing significantly prior to 2020 (p < 0.05 for all) but decreased in 2020.ConclusionsThese findings demonstrate the vulnerability of ophthalmology residency programs to a significant interruption in surgical volume. There is a critical need for development of competency-based, rather than volume-based, requirements to evaluate readiness for independent practice.

Characteristics of family nurse practitioners and their preparation for practice in rural vs urban employment settings

BackgroundPolicymakers are increasingly interested in using nurse practitioners to provide health care to rural populations, yet little is known about their characteristics and preparation for independent practice. MethodsWe obtained data from the 2018 National Sample Survey of Registered Nurses and compared characteristics of family nurse practitioners (FNPs) employed in rural areas versus those employed in non-rural areas. Regression analysis was used to determine the relationship between the outcome variable of interest, preparation for practice and other covariates. FindingsFNPs practicing in a rural setting felt less prepared for independent practice than their counterparts in non-rural settings except for those prepared with a doctoral degree. DiscussionThe majority of FNPs working in rural areas believed they were not as well prepared for independent practice. Because rural FNPs often practice autonomously and without medical back up, nursing educators need to educate FNPs with the skills and knowledge necessary to practice effectively in rural settings.

Current perspectives of gynecologic oncology fellowship training and preparedness for practice

<h3>Objectives:</h3> The field of gynecologic oncology practice has evolved over decades, yet there is little known on how current fellowships are preparing gynecologic oncologists for practice in the era of these changes. Thus, we sought to investigate gynecologic oncology fellowship graduates' training experience and preparedness for practice following fellowship. <h3>Methods:</h3> This is a cross-sectional web-based survey study using REDCap, an electronic web-based application. We surveyed members of the Society of Gynecologic Oncology (SGO) who graduated from gynecologic oncology fellowship in 2015-2020. Email invitations to participate were sent with de-identified survey links. The survey included 51 questions assessing fellowship training experiences and level of comfort in performing core gynecologic oncology surgical procedures and administering cancer-directed therapies, including chemotherapy, immunotherapy, and PARP inhibitors. Additional questions addressed factors driving participants' selection of fellowship programs, education experience, research and preparedness for independent practice. Descriptive statistics were used for analyses. <h3>Results:</h3> A total of 297 SGO members were invited to participate, one was excluded due to a non-working email. The response rate was 43.9% (n=130) and n=123 completed surveys were included for final analysis. Over half (55.2% n=68) of responders were in their first 3 years of independent practice. The highest ranked factor for fellowship selection was fit with program (36.6% n=45) followed by surgical volume (29.3% n=36). Upon completing fellowship, most were uncomfortable performing radical surgeries in ureteral conduit formation (83.8% n=103), ureteroneocystostomy (76.4% n=94), exenteration (67.5%, n=83), splenectomy (66.7% n=83) and lower anterior bowel resection (41.5%, n=51). Most were comfortable managing intraoperative complications (84.5% n=104) and obstetrical hemorrhages (88.6% n=109), as well as standard open and minimally invasive staging (range: 61%-99.2%). More than half of those who did not have off-service surgical rotations in fellowship indicated they would have wanted rotations in surgical oncology (58% n=58), urology (57% n=59) and colorectal surgery (71.5% n=73) in fellowship training. Majority of respondents (91.1% n=112) used cancer-directed therapies in their current practice and were most uncomfortable managing immunotherapy side effects (30.1% n=37). Over a third (34.1% n=42) were somewhat or not confident that their fellowship thesis project will be suitable for oral boards defense and 22.8% (n=28) were unprepared to continue research in their career. Upon completing fellowship, 77.2% (n=95) report having mentorship that met their expectations during fellowship and 94.4% (n=116) overall were prepared for independent practice as gynecologic oncologists. <h3>Conclusions:</h3> Majority of recent gynecologic oncology fellowship graduates were prepared for independent practice and felt comfortable performing routine surgical procedures. However, most are not comfortable with radical gynecologic oncology surgeries; for this reason mentorship in early gynecologic oncology faculty development remains important. Many graduates also desired incorporating non-gynecologic oncology surgery service experience during fellowship, which could help supplement this discrepancy for less common procedures.

A Novel Ambulatory Curriculum for Pulmonary and Critical Care Fellowship Training.

Background: Dedicated ambulatory training during pulmonary and critical care medicine (PCCM) fellowships is often limited. A novel 2-year longitudinal outpatient pulmonary fellowship curriculum was previously developed, piloted, and studied. The exportability and potential impact of this ambulatory curriculum on PCCM fellowship training nationally is not known.Objective: We aim to understand the current state of ambulatory training in PCCM fellowships and the impact of a standardized outpatient curriculum on fellows’ ambulatory knowledge and competency.Methods: Nineteen programs participated in the study from 2017 to 2019. Six programs received the first year of content, seven programs received the entire 2-year curriculum, and seven programs served as a control. Fellows, faculty, and program directors (PDs) completed a series of surveys assessing satisfaction with ambulatory education and the curriculum. Fellows completed a series of medical knowledge inventories, and programs submitted in-training exam scores.Results: A total of 221 fellows (39%) and 17 PDs (89%) completed the precurriculum surveys, and 38 (12%) fellows and 10 (53%) PDs completed postcurriculum surveys. Before curriculum implementation, only 34.4% of fellows rated the quality of their ambulatory education as good or outstanding compared with 57.9% at the end of the study. Eighty-five percent of faculty and 89% of PDs rated the curriculum as good or excellent. Faculty believed that the teaching scripts were easy to use (78.4%), were factually accurate (86.3%), and provided high-yield information (82.1%). The majority of PDs indicated that the curriculum positively impacted patient care (78%) and fulfilled an unmet educational need (100%), and most planned to continue the curriculum after the study (78%). Feedback surrounded the need for updated content based on recently published guidelines and studies.Conclusion: The curriculum is a standardized and feasible way to address a previously unmet need in PCCM fellowship education. PDs rated the curriculum highly and most plan to continue it in the future. Our limited data set suggests that the curriculum was well received by fellows and faculty and positively impacted perceptions of ambulatory education and preparedness for independent practice. Future study with a larger sample of fellows is needed to better understand the generalizability of these findings.

The evolution of medical students\u2019 preparedness for clinical practice during the transition of graduation: a longitudinal study from the undergraduate to postgraduate periods

BackgroundGraduating from medical school and beginning independent practice appears to be a major transition for medical students across the world. It is often reported that medical graduates are underprepared for independent practice. Most previous studies on undergraduates’ preparedness are cross-sectional. This study aimed to characterize the development and trend of medical students’ preparedness and its association with other objective and subjective indicators from the undergraduate to postgraduate periods.MethodsThis was a prospective cohort study. The participants were recruited and followed from two years before graduation to the postgraduate period. The preparedness for independent practice, professional identity, and teamwork experience were biannually measured using previously validated questionnaires. The participants’ basic demographic information, clinical learning marks from the last two years, and national board exam scores were also collected.ResultsA total of 85 participants completed 403 measurements in the 5 sequential surveys. The mean age at recruitment was 23.6, and 58 % of participants were male. The overall total preparedness score gradually increased from 157.3 (SD=21.2) at the first measurement to 175.5 (SD=25.6) at the fifth measurement. The serial individual preparedness scores revealed both temporal differences within the same learner and individual differences across learners. Despite the variations, a clear, steady increase in the overall average score was observed. Participants were least prepared in the domain of patient management at first, but the score increased in the subsequent measurements. The participants with better final preparedness had better professional identity (p<0.01), better teamwork experience (p < 0.01), and higher average clinical rotation marks (p<0.05).ConclusionsThe preparedness for practice of medical students from the undergraduate to postgraduate periods is associated with their professional identity, teamwork experience, and objective clinical rotation endpoint. Although preparedness generally increases over time, educators must understand that there are temporal fluctuations and individual differences in learners’ preparedness.