Medical Education Requirements Research Articles

Medical Teachers' Roles from the Students' Perspective: A Moroccan National Survey-based Study.

The present study aimed to explore medical students' expectations from their teachers in Moroccan medical schools, regarding their primary educational roles. An online questionnaire was distributed to medical students from the five main public medical schools in Morocco using a snowball sampling strategy. Two thousand four hundred and eighteen complete answers were collected and analyzed. The respondents gave the highest scores to "information provider" and the lowest scores to "Planner." When asked about their most preferred role they would want to see in their teachers, 40.6% of the respondents chose "Facilitator." These results highlight that Moroccan medical schools should become more invested in training their faculty members to meet the rapidly changing demands and requirements of modern medical education.

Development of a neonatal cardiac curriculum for neonatal-perinatal medicine fellowship training.

The topic of neonatal cardiovascular care in neonatal-perinatal medicine (NPM) fellowship training has continued to transform due to increased complexity of patients, development of specialized units, continued Accreditation Council for Graduate Medical Education requirements, and clinical practice variation across centers that care for neonates with congenital heart disease (CHD). We developed a neonatal cardiac curriculum comprised of eight interactive sessions with novel active learning concepts specific to our NPM fellows. A self-assessment survey in comfort in managing infants with CHD and perceived competency in neonatal cardiology topics was performed by all neonatology fellows at baseline and after completion of the curriculum. The American Board of Pediatrics Subspecialty In-training Exam (SITE) scores for fellows were compared to that of the national average. The average comfort score (0-100) of the first-year fellows increased from 33 to 76, and that of the second and third-year fellows increased from 72 to 86, and 75 to 86, respectively. The first-year fellows improved their competency score by 44 points (3 standard deviations), the second-year fellows improved their score by about 26 points (one standard deviation), and there was an overall 9-point increase in the competency score of all fellows (one standard deviation). The average local SITE score was lower than the national average before the initiation of this curriculum, became nearly equal to the national average score at the end of the first year the curriculum was implemented, and has progressively become higher since then. Due to the variable clinical exposure and differing practice models of managing CHD a neonatal cardiac curriculum may be beneficial to NPM trainees.

Beyond medical knowledge: a didactic curriculum focused on knowledge, wisdom, and application

OBJECTIVE The aim of this study was to determine whether a flipped classroom curriculum coupled with case-based learning would improve residents’ perceptions of the learning environment, improve education outcomes, and increase faculty engagement. Research suggests that active learning yields better educational results compared with passive learning. However, faculty are more comfortable providing lectures that require only passive participation from learners. METHODS A council was created to identify issues with the current format of the resident didactic curriculum and to redesign the neurosurgical curriculum and conference per Accreditation Council for Graduate Medical Education (ACGME) requirements. Trends from the authors’ 2022 and 2023 ACGME Resident Surveys were tracked to assess changes in the organizational learning environment. Surveys of resident participants were conducted to assess learner satisfaction. RESULTS Between July 2022 and June 2023, the authors gathered 127 survey responses from neurosurgical residents. The majority of respondents, comprising 50.4% (n = 64), were postgraduate year (PGY)–4 and PGY-5 residents. Sixty-six percent (n = 84) reported that the new format ranked within the top third of sessions they had experienced. On analysis of trends from these 2022 and 2023 ACGME Resident Surveys, the authors observed a positive trajectory in various key components. Notably, there was an upward trend in achieving an appropriate balance between service and education, in the availability of protected time for structured learning, faculty engagement and interest in education, and amount of clinical and didactic teaching. CONCLUSIONS The results of this study suggest that this innovative educational model can have a positive impact on residents’ perceptions of the learning environment, their educational outcomes, and faculty engagement. As residency education continues to evolve, the flipped classroom model offers an exciting avenue for enhancing the quality of residency education.

Comparing Graduating Plastic Surgery Residents' Case Logs With Accreditation Council for Graduate Medical Education Requirements, Content at National Meetings, and In-Service Examination Test Items.

The importance of adaptable and up-to-date plastic surgery graduate medical education (GME) has taken on new meaning amidst accelerating surgical innovation and increasing calls for competency-based training standards. We aimed to examine the extent to which the procedures plastic surgery residents perform, as represented in case log data, align with 2 core standardized components of plastic surgery GME: ACGME (Accreditation Council for Graduate Medical Education) minimum procedure count requirements and the PSITE (Plastic Surgery In-Service Training Examination). We also examined their alignment with procedural representation at 2 major plastic surgery meetings. Nine categories of reconstructive and aesthetic procedures were identified. Three-year averages for the number of procedures completed in each category by residents graduating in 2019-2021 were calculated from ACGME national case log data reports. The ACGME procedure count minimum requirements were also ascertained. The titles and durations of medical programming sessions scheduled for Plastic Surgery The Meeting (PSTM) 2022 and the Plastic Surgery Research Council (PSRC) Annual Meeting 2022 were retrieved from online data. Finally, test items from the 2020 to 2022 administrations of the PSITE were retrieved. Conference sessions and test items were assigned to a single procedure category when possible. Percent differences were calculated for comparison. The distribution of procedures on plastic surgery resident case logs differs from those of the major mechanisms of standardization in plastic surgery GME, in-service examination content more so than ACGME requirements. Meeting content at PSTM and PSRC had the largest percent differences with case log data, with PSTM being skewed toward aesthetics and PSRC toward reconstructive head and neck surgery. The criteria and standards by which plastic surgery residents are evaluated and content at national meetings differ from the procedures they actually complete during their training. Although largely reflecting heterogeneity of the specialty, following these comparisons will likely prove useful in the continual evaluation of plastic surgery residency training, especially in the preparation of residents for the variety of training and practice settings they pursue.

Drug-related physician continuing medical education requirements, 2010–2020

IntroductionThe crisis of drug-related harm in the United States continues to worsen. While prescription-related overdoses have fallen dramatically, they are still far above pre-2010 levels. Physicians can reduce the risk of overdose and other drug-related harms by improving opioid prescribing practices and ensuring that patients are able to easily access medications for substance use disorder treatment. Most physicians received little or no training in those subjects in medical school. It is possible that continuing medical education can improve physician knowledge of appropriate prescribing and substance use disorder treatment and patient outcomes. MethodsDescriptive legal review. Laws in all 50 states and the District of Columbia were searched for provisions that require all or most physicians to receive either one-time or continuing medical education regarding controlled substance prescribing, pain management, or substance use disorder treatment. ResultsThere has been a rapid increase in the number of states with relevant requirements, from three states at the end of 2010 to 42 at the end of 2020. The frequency and duration of required education varied substantially across states. In all states, the number of hours required in relevant topics is a small fraction of overall required continuing education, an average of 1 h per year. Despite recent shifts in the substances driving overdose, most requirements remain focused on opioids. ConclusionWhile most states have now adopted continuing education requirements regarding controlled substance prescribing, pain management, or substance use disorder treatment, these requirements comprise a small component of the required post-training education requirements. Research is needed to determine whether this training translates into reductions in drug-related harm.

Exploring Quality and Requirements in Faculty Development Related to Teaching.

Little is known about medical school requirements for faculty development related to teaching (FDT) in medical education. This study examined the national landscape and local faculty perceptions of their own institution's FDT requirement. An electronic survey was disseminated to Faculty Affairs Offices in US medical schools to assess FDT requirements. A second survey was distributed to faculty within one medical school to gauge faculty perceptions related to existing FDT requirements. Responses were received from approximately 33% of US medical schools and 36% of local faculty. Few responding medical schools had formal FDT requirements. There was a wide range variation of hours and activities necessary to satisfy existing requirements and consequences for noncompliance. For respondents from schools that did not have a requirement, many saw value in considering a future requirement. Many local faculty agreed that the FDT requirement improved their teaching skills. When asked to share other thoughts about the FDT requirement, several qualitative themes emerged. This study helps establish a national benchmark for the status of FDT requirements in medical education and revealed information on how to optimize and/or improve such requirements. The authors offer five recommendations for schools to consider regarding FDT.

Assessment of Ophthalmology Teaching and its Impact on the Choice of Future Specialties Among Medical Students of Jazan University.

Ophthalmology is essential for primary and specialty care physicians, as eye complaints are common, accounting for a sizable proportion of general practice consultations and emergency department visits. Fundamental ophthalmology knowledge is also relevant to other specialty fields. Thus, medical schools must provide effective undergraduate curricula to teach students about salient points, visual examination skills, emergency recognition, and referral indications. The International Council of Ophthalmology (ICO) has set guidelines that medical students should imbibe to become proficient in ophthalmology. However, there have been no recent investigationsevaluating undergraduate ophthalmology education at Jazan University's Faculty of Medicine. Therefore, this study aimed to compare the curriculum at Jazan University to the ICO's requirements for undergraduate medical education. An observational cross-sectional study was conducted with both male and female student participantsenrolled in an ophthalmology course at Jazan University's Faculty of Medicine. Following IRB approval, the questionnaire was distributed on social media to assess if Jazan University's undergraduate ophthalmology curriculum complies with ICOstandards. The study included a diverse sample of 322 participants, predominantly consisting of female students (n=178, 55.3%). The participants' ages ranged from 22 to 36 years, with the majority falling within the 24-25 year age range (n=173, 53.7%). Regarding academic performance, (n=117, 36.3%) of participants had a GPA of less than 4, while 66 (20.5%) had a GPA between 4.76 and 5.00. Among the respondents, 31 (9.6%) indicated having no exposure to ophthalmology, while 117 (36.3%) felt they had insufficient exposure. A considerable percentage of participants expressed competence in various areas, such as obtaining ocular history (n=113, 35.1%), testing visual acuity (n=201, 62.4%), and examining extraocular motility (n=201, 62.4%). In total, 98participants (30.4%) expressed an interest in ophthalmology, while the majority (n=224, 69.6%) were not interested. Essential improvements include increasing hands-on clinical experience, small-group learning, exposure across academic years, and early mentorship. Developing competency-based curricula aligned with ICO guidelines could significantly strengthen education. Better training quality and exposure will equip students with the necessary skills, boost confidence, and potentially expand the ophthalmology workforce.

The Need for Simulation-Based Procedural Skills Training to Address Proposed Changes in Accreditation Council for Graduate Medical Education Requirements for Pediatric Residency Programs.

The Need for Simulation-Based Procedural Skills Training to Address Proposed Changes in Accreditation Council for Graduate Medical Education Requirements for Pediatric Residency Programs.

The Practice Accreditation Resident Reviewer Program (PARRP): A National Program to Educate Residents About Radiation Oncology Practice Accreditation Through Mentored Chart Review

Background While instruction in patient safety and quality improvement is a core requirement for radiation oncology graduate medical education, many residents feel their training in this domain is inadequate. To address this discrepancy, we developed a mentorship program that allows residents to serve as junior chart reviewers within the American College of Radiation Oncology (ACRO) practice accreditation program. Practice accreditation is a voluntary process by which a radiation oncology facility's adherence to quality treatment standards is assessed through comprehensive evaluation of their equipment, personal, and treatment records. We hypothesize that hands-on training in practice accreditation will increase resident knowledge of quality care standards. Methods This prospective study will be open to PGY-4 and PGY-5 radiation oncology residents nationally. Residents will initially undergo a self-administered didactic curriculum - consisting of readings and webinars - on the principles of practice accreditation, quality standards, and documentation review. Subsequently, residents will serve as junior reviewers within the ACRO accreditation program. During each chart review cycle, residents will be paired 1:1 with an experienced accreditation faculty mentor. Both resident and faculty will independently review the same set of charts/treatment records and score documentation quality using a pre-specified rubric. After chart evaluation, faculty will meet with residents via videoconference to discuss scoring and provide feedback. To graduate the program, residents must complete 3 chart review cycles and evaluate at least 10 charts. Results Primary endpoint is improvement in resident understanding of quality care standards, practice accreditation, and documentation review, which will be assessed through pre- and post- program surveys. At the end of each chart review cycle, surveys will be used to assess secondary endpoints including residents' time to complete chart review, confidence in chart review, and perceptions of faculty mentorship. Faculty mentors will also evaluate resident competence in chart review at the end of each chart review cycle. Discussion This is the first program to teach radiation oncology residents about practice accreditation. By providing mentorship and hands-on experience, we aim to better equip residents with the knowledge and skills needed to maintain care and documentation standards as an attending physician. In doing so, this program highlights how patient safety and quality improvement can be incorporated into every day practice. While instruction in patient safety and quality improvement is a core requirement for radiation oncology graduate medical education, many residents feel their training in this domain is inadequate. To address this discrepancy, we developed a mentorship program that allows residents to serve as junior chart reviewers within the American College of Radiation Oncology (ACRO) practice accreditation program. Practice accreditation is a voluntary process by which a radiation oncology facility's adherence to quality treatment standards is assessed through comprehensive evaluation of their equipment, personal, and treatment records. We hypothesize that hands-on training in practice accreditation will increase resident knowledge of quality care standards. This prospective study will be open to PGY-4 and PGY-5 radiation oncology residents nationally. Residents will initially undergo a self-administered didactic curriculum - consisting of readings and webinars - on the principles of practice accreditation, quality standards, and documentation review. Subsequently, residents will serve as junior reviewers within the ACRO accreditation program. During each chart review cycle, residents will be paired 1:1 with an experienced accreditation faculty mentor. Both resident and faculty will independently review the same set of charts/treatment records and score documentation quality using a pre-specified rubric. After chart evaluation, faculty will meet with residents via videoconference to discuss scoring and provide feedback. To graduate the program, residents must complete 3 chart review cycles and evaluate at least 10 charts. Primary endpoint is improvement in resident understanding of quality care standards, practice accreditation, and documentation review, which will be assessed through pre- and post- program surveys. At the end of each chart review cycle, surveys will be used to assess secondary endpoints including residents' time to complete chart review, confidence in chart review, and perceptions of faculty mentorship. Faculty mentors will also evaluate resident competence in chart review at the end of each chart review cycle. This is the first program to teach radiation oncology residents about practice accreditation. By providing mentorship and hands-on experience, we aim to better equip residents with the knowledge and skills needed to maintain care and documentation standards as an attending physician. In doing so, this program highlights how patient safety and quality improvement can be incorporated into every day practice.

Demonstrating Clinician Educator Value.

Clinician educators (CEs) can feel pressured by multiple institutional forces: compliance with frequently changing Accreditation Council for Graduate Medical Education (ACGME) requirements; the dynamic operational and fiscal strains of sponsoring institutions (SIs); and personal pressures for career advancement, in both academic and community settings. The value of demonstrating contributions as a CE for academic promotion via an annotated curriculum vitae and/or portfolio is well documented.1,2 However, CEs must also find ways to continuously demonstrate value to program, clinical, and organizational leadership, regardless of the type of SI.CEs should strive to align their educational priorities with the SI's clinical priorities. Two examples of aligned CE-SI goals are achieving a reputation for being a high reliability organization and providing value-based care.3 High reliability organizations strive to provide care with zero harm, and value-based systems provide high-quality patient care focused on improved outcomes, positive patient experiences, and lower use of resources.4To accomplish these goals, most SIs develop quality improvement (QI) and patient safety (PS) programs that often operate independently from the sponsored educational programs.5 The ACGME's Common Program Requirements mandate trainee skill development to provide reliable, safe, and high-quality care. At the same time, trainee involvement in QI and PS programs often goes underrecognized by SI leadership, despite program directors reporting that resident participation in QI led to institutional-level changes.5How can CEs make their SI's and program's leadership aware of their contributions to aligned priorities? Using a framework such as mattering can help. Mattering is a psychological construct which recognizes that we all want to be valued and to add value. When someone matters, they are more engaged, are less stressed and depressed, and feel like they belong. There are 4 accepted components for CEs to incorporate when creating an environment of mattering: awareness, importance, reliance, and ego extension.6 As a CE, demonstrating how your clinical and educational work adds value to the shared goals of high reliability and value-based patient care is vital.By using the 4-part mattering framework, you can enhance how you and your program matter to your SI and program leadership. When you matter to others, they recognize your value as well as the value of your programs and activities in achieving shared goals.

“To Call or Not to Call” Communication Preferences Among Pediatric Hospital Medicine Team Leaders

Pediatric Hospital Medicine fellowship programs need to abide by Accreditation Council for Graduate Medical Education requirements regarding communication and supervision. Effective communication is critical for safe patient care, yet no prior research has explored optimal communication practices between residents, fellows, and attending hospitalists. Our objective is to explore communication preferences among pediatric senior residents (SRs), Pediatric Hospital Medicine fellows, and hospitalists on an inpatient team during clinical decision-making. We conducted a cross-sectional survey study at 6 institutions nationwide. We developed 3 complementary surveys adapted from prior research, 1 for each population: 200 hospitalists, 20 fellows, and 380 SRs. The instruments included questions about communication preferences between the SR, fellow, and hospitalist during clinical scenarios. We calculated univariate descriptive statistics and examined paired differences in percent agreement using χ2 tests, accounting for clustering by institution. Response rates were: 53% hospitalists; 100% fellows; 39% SRs. Communication preferences varied based on role, scenario, and time of day. For most situations, hospitalists preferred more communication with the fellow overnight and when a patient or family is upset than expressed by fellows (P < .01). Hospitalists also desired more communication between the SR and fellow for an upset patient or family than SRs (P < .01), but all respondents agreed the SR should call the fellow for adverse events. More fellows and hospitalists felt that the SR should contact the fellow before placing a consult compared with SRs (95%, 86% vs 64%). Hospitalists, fellows, and SRs may have differing preferences regarding communication, impacting supervision, autonomy, and patient safety. Training programs should consider such perspectives when creating expectations and communication guidelines.

Soaring to New Heights: Strengthening Outcomes and Assessment in Residency.

Preparing family medicine physicians to meet the needs of their patients is a fundamental goal of residency training. These needs shift, and so training must also adapt. The revised Accreditation Council for Graduate Medical Education (ACGME) requirements for GME in family medicine call on residency

Tips and Tricks: Starting Your Own Continuing Medical Education Course

Tips and Tricks: Starting Your Own Continuing Medical Education Course

Knowledge and attitude of adverse drug reaction reporting process among Indian medical undergraduates in a tertiary care teaching hospital - a questionnaire based study

Introduction: The primary objective of this study is to assess the knowledge, attitude and awareness of adverse drug reaction reporting process among Indian medical undergraduates in a tertiary care teaching hospital. Material and Methods: This is a cross sectional questionnaire based study on 250 Indian medical graduates. Phase III – Part 1 and Part 2 Medical Undergraduates at Trichy SRM Medical College Hospital & Research Centre for next 3 months were included. The students were informed in person with participant information sheet during PHASE 3 clinical posting. Those students who did not gave informed consent for participation in the study were excluded. Results: The mean age of the study participants was 20.12±1.3 years. There was male preponderance with 52% male medical graduates and 48% female medical graduates. Majority of the included subjects were in Phase III Part 1. Table 1 describe the distribution of knowledge related questions. Around 70% correctly answered the definition of pharmacovigilance, 40% answered about important purpose of pharmacovigilance, 48% on healthcare professionals are responsible for reporting ADRs, 61% on organization conducting National Pharmacovigilance Program in India, 40% on regulatory body responsible for monitoring pharmaceuticals and medical devices, 42% answered correctly on location of international centre for adverse drug reaction monitoring.Conclusion: There is requirement for continuous medical education in these students on regulations of Pharmacovigilance. This study provides baseline data of the knowledge and attitude for providing educational intervention.

Scholarly impact of the dissertation requirement for postgraduate medical education and factors affecting transformation into publication: A bibliometric analysis of 2434 dissertations in the field of emergency medicine.

In Turkey, conducting research for a dissertation is necessary to obtain a specialist degree, but publication of this research is not mandatory. Previous studies have shown a low rate of publication for dissertation-derived research. The aim of this study was to determine publication rates, factors affecting the transformation of the dissertations into high-quality publications, and bibliometric analysis of published articles in the field of emergency medicine (EM). This was a retrospective bibliometric study of EM dissertations submitted between 1998 and 2021 to the National Thesis Center. Research characteristics, publication status, journal characteristics, indexing, citation analysis, and institution characteristics were recorded. Journals indexed in the web of science (WOS) were defined as high-quality journals. A logistic regression was performed to identify factors affecting publication in high-quality journals. A total of 2434 dissertations were included. Of these, 864 (35.5%) were published and 474 (54%) were published in WOS-indexed journals. The most common area of research was trauma (n = 150, 17%), and the most common journal was the American Journal of EM (n = 74, 8%). Prospective data collection (odds ratio [OR] = 2.5, 95% confidence interval [CI] = 1.8-2.5), experimental design (OR = 2, 95%, CI = 1.3-3), university-type residency program (OR = 1.4, 95% CI = 1.02-2.1), and duration between year of graduation and publication (OR = 0.9, 95% CI = 0.84-0.95) were associated with publishing in WOS-indexed journals. EM is a relatively successful specialty for publishing dissertation-derived studies. Prospective and experimental research design, graduation from a university-type residency program, and shorter duration between the graduation and publication may increase the chance of publishing in high-quality journals.

Impact of COVID‐19 on emergency medicine resident procedure performance

As a result of the COVID-19 pandemic, patterns of patient presentations and medical education have changed, potentially resulting in fewer and different types of patient encounters. Procedural proficiency is a cornerstone of emergency medicine (EM) training, and residents must meet Accreditation Council for Graduate Medical Education (ACGME) requirements to graduate. It is feared there may have been a pandemic-induced decrease in opportunities for residents to perform procedures. This study investigates the change in procedures performed by EM residents during the initial year of the pandemic. This study utilized a multicenter retrospective design. Across three EM residency programs, logs of 14 ACGME-required procedures performed by residents were reviewed. For each procedure, counts were compared prepandemic year (March 2019 to February 2020) to during pandemic year (March 2020 to February 2021). Procedures were further grouped into 4-month periods: March to June, July to October, and November to February. A total of 113 EM resident physicians were included in this study. Procedures performed by EM residents tended to decrease during the COVID-19 pandemic. There were statistically significant decreases in number of annual cricothyrotomies (2.4 vs. 0.9, p < 0.001) and pediatric trauma resuscitations (5.7 vs. 3.9, p=0.024). Comparing the first 4-month periods of each year, there were significant decreases in cardiac pacing (6.3 vs. 5.4, p=0.038), chest tubes (2.2 vs. 1.0, p < 0.001), cricothyrotomies (0.6 vs. 0.1, p=0.001), intubations (8.2 vs. 4.4, p=0.002), and pericardiocenteses (1.7 vs. 0.2, p < 0.001). The COVID-19 pandemic has led to a decrease in the number of procedures performed per EM resident in many of the domains required by the ACGME. Although only some procedures had statically significant decreases, it remains to be seen if this will lead to decreased resident procedural competency. Further research may be required in this area to determine any such effect.

DETERMINING THE ROLE OF THE TEACHER IN MEDICAL EDUCATION INSTITUTIONS AS A MANAGER OF THE EDUCATIONAL PROCESS

The article outlines the problems of applying educational, pedagogical, and professional types of management as a theory and practice of effective management, which is demanded by the medical education institutions (MEI) to find ways to solve the problems they face in modern conditions of life in society, globalization of the labor market and requirements for medical education. It was determined that educational management goes together with pedagogical management, which in turn includes educational management as a system of management of educational activities. The main elements in the "educational management" subsystem, where the teacher acts as a manager of the educational process, implements their own art of managing the education of medical education students, who are both objects of his managerial influence and active subjects of educational activity, are considered. It is necessary to consider the fact that each teacher actually creates an educational process, as if "breathing" life into it, using the available environment, conditions and own competences both as a teacher-specialist in teaching a specific discipline, and as a manager who implements the functions and methods of management, aiming on clearly defined results of joint educational activities with the student of medical education. It is substantiated that the quality of training in a certain academic group or a specific student of education depends not only on pedagogical and professional competencies, but also on the style of management and pedagogical communication used by the training manager; the degree of openness to medical education (student must demonstrate readiness and ability for effective interaction) and the role they play at one or another moment of education and upbringing (it should be oriented towards cooperation and contribute to the development of the personality of the medical education student – mentor, tutor, moderator, coach, facilitator, etc.). Attention is focused on individual pedagogical communication as a creative process that depends on the personal qualities of the teacher and the communicative situation in a specific social environment. It is the manager of the educational process who models, organizes, manages the process, monitors, and analyzes the results of communication during the solution of pedagogical tasks in the process of pedagogical interaction. Applying an approach to education as a management process is exactly what medical education institutions need today to achieve their goals. The study confirmed in practice the demand for the acquisition of managerial competencies by teachers of medical education institutions based on a pedagogical experiment.

Is the volume of Burch urethropexy sufficient for urogynecology fellows to meet the ACGME requirement?

Urogynecology fellows report low exposure to nonsling retropubic anti-incontinence procedures such as Burch urethropexy and thus may have difficulty meeting the required minimum case numbers, but there has been an even more objective exploration of this observation. Thus, our objective was to assess the feasibility of meeting the Accreditation Council for Graduate Medical Education (ACGME) requirement for each urogynecology fellow to perform five nonsling retropubic anti-incontinence procedures during fellowship. Cross-sectional study using the National Surgical Quality Improvement Program (NSQIP) and National Resident Matching Program (NRMP) databases from 2009 to 2019. From NSQIP, the number of nonsling retropubic anti-incontinence procedures (open and laparoscopic Burch urethropexy and bladder neck needle suspension) and midurethral sling procedures was extracted using CPT codes. The number of fellows was extracted from the NRMP database. Trends in the number of anti-incontinence procedures were compared with the trend in the number of fellows using linear regression. From 2009 to 2019 the number of fellows doubled from 81 to 176. An average of 97 nonsling retropubic anti-incontinence and 6,372 sling procedures were performed annually. Linear regression showed an increase of 10.7 fellows per year (95% CI 9.3-12.1) versus an increase of 5.8 nonsling retropubic anti-incontinence procedures per year (95% CI -0.4 to 12.1). This contrasts with an increase of 690.9 slings per year (95% CI 509.9-872.0). The increase in the number of nonsling retropubic anti-incontinence procedures does not appear to match the increase in the number of urogynecology fellows. Supplementary educational approaches such as simulation may be prudent.

Wilderness Medicine Curricula in United States EMS Fellowship, Emergency Medicine Residency, and Wilderness Medicine Programs.

Wilderness Medicine (WM) focuses on care delivered in austere or resource-scarce environments. The Accreditation Council for Graduate Medical Education (ACGME) requirements and core content for Emergency Medicine (EM) residency and Emergency Medical Services (EMS) fellowship in the United States (US) include some WM topics that are covered to varying degrees in these programs. Furthermore, there are no ACGME-approved WM fellowships or specific curricula. Different training programs may develop WM content and curricula that differ significantly, leading to variations in WM competencies and training. In 2009, the American College of Emergency Physicians (ACEP) Wilderness Medicine Section created a Fellowship Subcommittee and Taskforce to develop a standardized curriculum and core content for EM-based WM fellowships. However, to date, EMS fellowship and EM residency WM curricula in the US content have not been analyzed for consistency with the ACEP WM fellowship curriculum. In this study, the WM curricula components of EM residency and EMS fellowship were evaluated using the ACEP WM fellowship curriculum as a control. Potential curriculum gaps for each program type were identified. Of the 19 WM competencies developed by the ACEP Wilderness Medicine Section Fellowship Subcommittee and Taskforce, EMS fellowship covers more WM topics (16 topics, or 84%) than EM residency (12 topics, or 63%), and combined, they cover 89% of these topics. By expanding to cover two additional WM topics, all WM curricula topics recommended by the ACEP WM fellowship curriculum could potentially be covered in EM residency + EMS fellowship; however, the depth of education in each topic may vary. It may be beneficial for Graduate Medical Education (GME)-level learners for programs to implement hands-on educational experiences in WM topics.

Design and implementation of a health systems science curriculum at a large teaching hospital

BackgroundPhysicians must increasingly lead change for improvement in the value of health care for individuals and populations. Leadership, stewardship, and population health competencies are not explicitly part of the Accreditation Council for Graduate Medical Education (ACGME) requirements and are best appreciated in the context of Health Systems Science (HSS).HSS education is best approached at the institutional level, yet almost all graduate medical education (GME) curriculum is at the program level. We describe the process of designing and implementing an institutional HSS GME curriculum in a hospital-based sponsoring institution.MethodsA group of diverse stakeholders drafted a curriculum to build competencies in leadership, stewardship, and population health, which was further refined by our Graduate Medical Education Committee (GMEC) and Resident Forum in the academic years 2015–2017. The refined curriculum was implemented at the institutional level of a large urban teaching hospital with over 80 ACGME accredited programs in the 2017–2018 academic year, participation was tracked and impact surveys were conducted.ResultsAll programs participate in at least parts of the curriculum with sustained use. Annual surveys show a progression in assessment of our target competencies and/or opportunities to reflect and provide feedback. The annual program review meeting and GMEC meetings are used to troubleshoot and identify new curricular opportunities.ConclusionThis innovative institutional curriculum has been sustained for over four years and we believe that other training institutions with similar goals will find our experience implementing an institutional curriculum translatable to their clinical learning environment.