Resident Experience Research Articles

Developing a Postpandemic Model for Hybrid Clinical Ethics Rotations in Postgraduate Medical Education

Abstract Bioethics education in residency helps trainees achieve many of the Accreditation Council for Graduate Medical Education milestones and gives them resources to respond to bioethical dilemmas. For this purpose, The Providence Center for Health Care Ethics has offered a robust clinical ethics rotation since 2000. The importance of bioethics for residents was highlighted as the COVID-19 pandemic raised significant bioethical concerns and moral distress for residents. This, combined with significant COVID-19-related practical stressors on residents led us to develop a virtual ethics rotation. A virtual rotation allowed residents flexibility as they were called to help respond to the unprecedented demands of a pandemic without compromising high quality education. This virtual rotation prioritized flexibility to support resident wellbeing and ethical analysis of resident experiences. This article describes how this rotation was able to serve residents without overstraining limited bandwidth, and address the loci of resident pandemic distress. As pandemic pressures lessened, The Providence Center for Health Care Ethics transitioned to a hybrid rotation which continues to prioritize resident wellbeing and analysis of ongoing stressors while incorporating in-person elements where they can improve learning. This article provides a description of the rotation in its final form and resident feedback on its effectiveness.

Keeping Clean: A Qualitative Analysis of Water, Sanitation, and Hygiene Among Residents of Recreational Vehicles in Seattle, WA US

The growing number of people living in vehicles in the urban United States in recent years makes their water, sanitation, and hygiene (WASH) an increasingly relevant public health issue. The WASH context of people living in recreational vehicles (RVs) presents unique challenges, especially as it relates to wastewater disposal. This study answers the question: How do RV residents typically manage their wastewater and meet their other WASH needs? We examined the experiences of RV residents in Seattle, Washington participating in Seattle Public Utilities’ mobile pump-out program, which has offered a free, typically monthly, door-to-door RV wastewater disposal service since 2020. We conducted semi-structured interviews with 31 clients and analyzed the data using qualitative content analysis. We found that RV resident water and hygiene experiences were similar to other urban unhoused populations, whereas their sanitation experiences were quite distinct, most notably with regard to open defecation prevalence and the relative risks of shared versus private sanitation. We proposed four WASH service delivery models that consider the possible implications of our findings for cities looking to engage with RV residents. The models included: mobile RV wastewater collection and water delivery, fixed RV dump stations and water resources, public WASH facilities available for all, and safe parking programs.

Quantifying the stability of refugee populations: a case study in Austria

AbstractThe global surge in displacement, with nearly 110 million people uprooted due to violence, underscores the pressing need to comprehend the challenges faced by refugees. Population growth, environmental crises, and political instability contribute to this crisis, projecting an escalating trend in the decades ahead. While hosting countries strive to address concerns related to labour markets, state provisions, and cultural integration, understanding the well-being of refugees upon entry needs to be more adequately explored. This study focuses on refugee stability and integration, employing Austria as a case study. Stability is assessed through residential movement, where more frequent moves indicate instability. Utilising comprehensive administrative data spanning November 2022 to November 2023, we examine residence movements as a proxy for stability. Our findings reveal a stark contrast in the stability of refugees compared to other migrant groups. Analysing movement profiles, we establish that refugees exhibit significantly higher rates of residential mobility than their counterparts, especially among male refugees. This imbalance persists even when comparing refugees to migrants from top refugee-sending countries without official refugee status. This study contributes valuable insights into the intricate dynamics of refugee stability, shedding light on the enduring challenges faced by this population. By examining movement patterns as a key indicator, we provide a nuanced understanding of the residential experiences of refugees, that can inform targeted policies and interventions for enhanced refugee well-being and integration.

In Desperate Need: Public Sanitation in Contemporary London

AbstractThere has been a collapse in the number of public toilets in UK cities. Austerity cuts, a lack of legal requirements, and a failure to prioritise sanitation has led to significant health and equality impacts. Research on public toilets in the Global North focuses on their historical production, contemporary design, or on the experience of particular social groups, with less work bringing governance and social experience together. We argue for a focus on the “ungoverning” of sanitation, on how residents “learn” sanitation in the city, and on the need for radical transformation in sanitation approaches and delivery. Drawing on research in London, we set out the challenges for public toilet provision and make a case for a sanitation revolution in British cities. We focus on the experience of delivery drivers and residents with health concerns in order to illustrate the inequalities in provision and their consequences.

Experiences of Losing and Re‐Establishing a ‘Sense of Place’: Insights From Forced Resettlement in Myanmar

ABSTRACTForced resettlement, the process of intentionally displacing and moving people from one location to another, increases impoverishment risks and creates severe and long‐lasting economic and psycho‐socio‐cultural impacts. While these impacts are well established, there is comparatively much less research about ‘loss of place’ after displacement when people are disconnected from a space or spaces that are meaningful to them. Therefore, this paper seeks to address this gap through empirical research on the experiences of residents who were displaced and relocated to an outer township in Yangon, Myanmar, 25 years after the resettlement event. The study examines what it means to lose a sense of place after forced resettlement, and how despite the disorientating impacts of displacement, individuals actively worked to re‐establish social and physical connections over time. The paper outlines how displaced residents developed and implemented strategies to re‐establish their sense of place and rebuild their community. It finds that multiple levels of strategies were developed—at individual, household, and community scales—to restore social connections and adapt to a new environment. These findings contribute to a deeper understanding of place attachment and community rebuilding, particularly in contexts where displacement is driven by urban development, climate change, or state interventions.

Leveraging the Electronic Health Record to Measure Resident Clinical Experiences and Identify Training Gaps: Development and Usability Study.

Competence-based medical education requires robust data to link competence with clinical experiences. The SARS-CoV-2 (COVID-19) pandemic abruptly altered the standard trajectory of clinical exposure in medical training programs. Residency program directors were tasked with identifying and addressing the resultant gaps in each trainee's experiences using existing tools. This study aims to demonstrate a feasible and efficient method to capture electronic health record (EHR) data that measure the volume and variety of pediatric resident clinical experiences from a continuity clinic; generate individual-, class-, and graduate-level benchmark data; and create a visualization for learners to quickly identify gaps in clinical experiences. This pilot was conducted in a large, urban pediatric residency program from 2016 to 2022. Through consensus, 5 pediatric faculty identified diagnostic groups that pediatric residents should see to be competent in outpatient pediatrics. Information technology consultants used International Classification of Diseases, Tenth Revision (ICD-10) codes corresponding with each diagnostic group to extract EHR patient encounter data as an indicator of exposure to the specific diagnosis. The frequency (volume) and diagnosis types (variety) seen by active residents (classes of 2020-2022) were compared with class and graduated resident (classes of 2016-2019) averages. These data were converted to percentages and translated to a radar chart visualization for residents to quickly compare their current clinical experiences with peers and graduates. Residents were surveyed on the use of these data and the visualization to identify training gaps. Patient encounter data about clinical experiences for 102 residents (N=52 graduates) were extracted. Active residents (n=50) received data reports with radar graphs biannually: 3 for the classes of 2020 and 2021 and 2 for the class of 2022. Radar charts distinctly demonstrated gaps in diagnoses exposure compared with classmates and graduates. Residents found the visualization useful in setting clinical and learning goals. This pilot describes an innovative method of capturing and presenting data about resident clinical experiences, compared with peer and graduate benchmarks, to identify learning gaps that may result from disruptions or modifications in medical training. This methodology can be aggregated across specialties and institutions and potentially inform competence-based medical education.

Effects of the Vitality Acupunch Exercise Program on Older Adults With Probable Sarcopenia: A Mixed Methods Pilot Study.

Purpose: Age-related loss of muscle mass and strength is a highly prevalent condition in older adults in long-term care (LTC) facilities. This pilot study aimed to test the effects of a vitality acupunch (VA) exercise program on muscle mass, muscle strength, muscle endurance, functional fitness, activities of daily living, quality of life, and sleep quality of older adults in LTC facilities with probable sarcopenia in the United States and understand the experiences of residents who participated in the VA program. Design: A mixed-methods experimental design was used for this study. Methods: The quantitative phase included a sample of 27 participants randomly assigned to the control (n = 13) or VA (n = 14) condition. The VA condition consisted of three weekly 40-minute instructor-led seated exercise sessions over 24 weeks. Measures were obtained at baseline, three, and sixmonth intervals. Semi-structured interviews were conducted to explore participant's experiences of the program. Findings: Statistical comparison revealed significantly higher handgrip strength for the VA group (p = .008). Narrative analysis revealed that the program had a positive impact on participant's daily lives. Conclusions: The VA program offers a holistic, evidence-based exercise program for older adults with probable sarcopenia living in LTC facilities.

Intercultural practices in experiential rural tourism, case of an Andean community on the shores of Lake Titicaca in Puno, Perú

The practice of experiential rural tourism involves the active participation of the local population, promoting cultural exchange between visitors and residents generating intercultural relationships. The objective of the research was to analyze the intercultural relationships that are established between local inhabitants and tourists in the practice of experiential rural tourism. The factors that were analyzed are communication, mutual respect, socioeconomic development, cultural authenticity, shared cultural practices, reciprocity, valuation of cultural identity and the environment in the perceptions and experiences of tourists and local residents. The qualitative approach and method was used, the techniques applied were the in-depth interview with the local population and tourists, direct observation of the practice of this activity and content analysis. The results revealed that there are intercultural relations due to the direct and meaningful interaction between tourists and the local population, facilitating the exchange of knowledge, mutual understanding, representation, authenticity and cultural integration, promoting intercultural dialogue as a basis for a more inclusive and responsible tourism, as well as the importance of cultural authenticity in attracting tourists and preserving local identity..

Contingent Attachment: Long-term Lived Experience in the Redevelopment of a Third Front Neighbourhood

Abstract Employing the concept of “contingent attachment” as its key point, this paper investigates the transformation of residents’ neighbourhood attachment during the redevelopment of a neighbourhood originally established during the Third Front construction period. By framing neighbourhood attachment as contingent, this paper seeks to highlight that the different directions of neighbourhood attachment hinge upon several factors: the entities mobilizing the narrative, the varying treatment of residents across different phases of the relocation, and residents’ perceptions regarding the changes brought about by the relocation process. Special attention within this paper is paid towards the long-term lived experiences of residents since the onset of the Third Front construction to show how these experiences are woven into diverse narratives associated with residents’ neighbourhood attachments.

Long term care-acute system integration and transformation: Innovations in models of care.

The article discusses innovations in integrating Long-Term Care (LTC) and acute systems, focusing on Humber River Health's (HRH) model. Older adults in LTC homes are vulnerable to avoidable Emergency Department (ED) visits due to frailty and medical complexity. HRH developed an integrated care model centred on LTC Remote Monitoring (RM) with LTC partners, leveraging nurse-led care models, digital tools, and virtual care hub to reduce avoidable ED transfers. Key components include the PREVIEW-ED© tool for early detection of clinical deterioration, LTC+ Hub and LTC++ Diagnostic Imaging and Transportation, supporting improved access to healthcare services. The program aligns with the Quintuple Aim, emphasizing patient and provider experiences, population health, cost reduction, and health equity. Results show significant reductions in ED visits, hospital lengths of stay, and associated costs, while enhancing resident and provider experiences. The LTC RM model is positioned as a scalable solution for system transformation in integrated care.

Exploring Trauma Simulation: Insights from the Simulation in Trauma Across Resident Training (START) Study and Trainee Experiences

Exploring Trauma Simulation: Insights from the Simulation in Trauma Across Resident Training (START) Study and Trainee Experiences

The Impact of Virtual Immersive Public Art on the Restorative Experience of Urban Residents

This study explores the role of virtual immersive public art in improving the psychological well-being of urban residents. The research is set in the context of urban environments, where virtual immersive public art has the potential to foster innovation, integrate technology, and organically blend into public spaces. The study evaluates the impact of such art on psychological restoration by focusing on three key dimensions: interactive themes, interactive mechanisms, and artistic characteristics. A questionnaire survey was conducted to collect participants’ real-life experiences and reactions to these art installations. The results show that virtual immersive public art significantly contributes to the restorative experience of urban residents, offering valuable insights into how these installations can promote mental health. Based on the findings, the study provides practical design recommendations for incorporating virtual immersive public art into future urban planning and design projects to enhance urban living conditions and support psychological recovery.

The loss of rural vital places: A case study using the social determinants of health framework

Healthy food sources, recreational facilities, and social spaces serve as vital places for supporting health. Less is known about what happens when vital places are lost, especially in rural contexts that have experienced disinvestment and population decline. In this paper we use a case study of a small rural community in Pennsylvania that lost a substantial share of its vital places over a short period of time to explore the experiences of local residents. Using qualitative interviews with 26 local residents we show that the loss of vital places, which are part of the neighborhood and built environment, intersected with other social determinants of health with potential consequences for health and well-being. This was often because vital places were essential (i.e., few or no alternatives existed) and multifunctional (i.e., supporting health through multiple behavioral and social mechanisms). Examining experiences of local residents following the loss of vital places through a social determinants of health lens helps to identify consequences and inform adaptation strategies. We also use the findings to refine the vital places framework for rural contexts.

57 Resident education in the NICU: A curriculum innovation project

Abstract Background For paediatrics residents, much of newborn care is learned during Neonatal Intensive Care Unit (NICU) rotations. However, the NICU is a high-stress and specialized learning environment. Today’s residents often have less NICU exposure during their training than in the past, leading to concerns from trainees that they are inadequately prepared for neonatal care and resuscitation upon graduation. Objectives We aimed to develop, implement and evaluate a paediatric residency NICU curriculum aimed to augment and improve learning on rotation. Design/Methods We utilized Kern’s Six Step Approach for Curriculum Development. Step 1: We identified that our paediatric residents consistently expressed dissatisfaction with the quality and quantity of learning opportunities on their NICU rotations. Step 2: A collaborative working group of residents, paediatricians, and neonatologists identified learning needs. Step 3: Needs were mapped to specific general paediatrics educational objectives within the Royal College Competency Based Medical Education (CBME) curriculum. Step 4: Suitable learning strategies were selected including simulation, procedural skill training, embedded time with the neonatal resuscitation team, and lunch and learn seminars. Steps 5 and 6: The curriculum was piloted during the 2021-2022 academic year and resident reactions evaluated. Results The detailed curriculum is shown in Table 1. At the start of each NICU rotation, all paediatrics residents on rotation attended a half-day simulation based “boot-camp” consisting of a didactic Neonatal Resuscitation Program (NRP) refresher course, relevant procedural skills stations (intubation, UVC placement, needle thoracocentesis), and simulated neonatal resuscitation scenarios. Junior residents were scheduled for protected time to attend deliveries with a dedicated multidisciplinary resuscitation team to ensure familiarity and begin to solidify skills. Learning was further augmented by weekly, resident-led lunch and learn sessions on topics mapped to level of training. To evaluate this curriculum, resident satisfaction was assessed using surveys post bootcamp and at the end of their rotation. Overall, the curriculum was well received. Bootcamp was the highest rated element; 96% of residents agreed or strongly agreed that the session was useful for their education (Figure 1). Post curriculum implementation, there was significant improvement in resident NICU rotation feedback; residents expressed that the NICU learning environment and resident experience has improved. Conclusion We successfully implemented a NICU curriculum for paediatrics residents, with high satisfaction ratings and improved overall rotation feedback. This program shows promise in addressing a long standing educational gap. More research is needed to investigate whether it leads to improved competency in practice.

Surgical Tracheostomies: A Retrospective Chart Analysis Comparing ENT Specialists and Residents.

The primary aim of our retrospective chart review is to compare open surgical (OS) tracheostomies performed by specialist and supervised resident surgeons, focusing on surgical time and post-surgical complications. The secondary objective was to compare these data based on the years of surgical experience for both specialists and residents. All patients undergoing surgical tracheostomy at the Unit of Otorhinolaryngology, Head & Neck Department, University of Verona between 1 January 2017, and 31 December 2022, were subjected to a retrospective analysis. A total of 385 OS tracheostomies were included in the study. Procedures conducted by supervised residents across various training years were compared with those performed by junior and senior specialists, focusing on surgical duration and postoperative complications. Subsequently, these data were stratified based on the surgical experience of subgroups: residents were categorized into 4 years of training, and specialists were categorized into junior (with less than 5 years of experience) and senior (with at least 5 years). Statistical analysis concerning patients' anatomy revealed a significant increase in operative times among those with no palpable neck landmarks (p = 0.006) and those with previous neck surgery (p = 0.039). Among patients' comorbidities, only anticoagulant or antiaggregant therapy was found to prolong operative time (p = 0.018), while the ASA score did not correlate with the duration of surgery. Finally, no statistically significant differences in surgical time were observed (p = 0.287), and no significant differences in complication frequency were reported between supervised residents and specialists (p = 0.908), regardless of years of experience. Under appropriate supervision, OS tracheostomy has demonstrated safety for residents as early as their first year of residency. Residents can perform tracheostomies without significantly prolonging the duration of the operation or increasing the risk of peri- and post-operative complications.

Experiences of residents in a therapeutic community model of substance use disorder treatment in a mental hospital in Ghana

BackgroundIn Ghana, the use of illegal drugs and alcohol has been classified as endemic. To manage this menace, the Therapeutic Community model for Substance Use Disorders (SUD) was introduced in Ghana about a decade ago as an alternative to other existing strategies. However, the effectiveness of this treatment modality for substance use disorders in Pantang Mental Hospital and Accra Psychiatric Hospital has not been scientifically studied.ObjectiveThis study, therefore, sought to explore the experiences of substance users or residents enrolled in the Therapeutic Community programme toward recovery from substance use disorders.MethodThis research employed an explorative-descriptive design. Participants (N = 20) were enrolled purposively sampled and recruited into the study. Face-to-face interviews were conducted using a semi-structured guide and data were analyzed using Colaizzi’s descriptive phenomenology data analysis process.ResultsTwo main themes emerged from the data: “Why I stayed” (Motivation), and “All things are new” (Life transformation). The study pointed out that residents or participants mainly expressed positive experiences in the programme, including experiencing a sense of belongingness, enhanced self-esteem/self-worth, and most importantly, developing hope of a life free of addiction.ConclusionIn conclusion, the study found that participants in the Therapeutic Community (TC) program generally had positive experiences and believed in its effectiveness for recovery. Factors such as a relaxed environment, supportive staff, and interactions with other residents contributed to their positive experience. The study discovered that motivation, a conducive environment for care, structured program activities, and relationships among residents were key factors that motivated participants to stay and actively participate in the therapeutic community program. These factors fostered hope and a sense of belonging, ultimately contributing to their recovery journey. However, participants expressed the need for self-actualization, which they hoped to achieve after completing the program and reintegrating into the community.

Urban Color Perception and Sentiment Analysis Based on Deep Learning and Street View Big Data

The acceleration of urbanization has resulted in a heightened awareness of the impacts of urban environments on residents’ emotional states. This present study focuses on the Lixia District of Jinan City. By using urban street view big data and deep learning methods, we undertook a detailed analysis of the impacts of urban color features on residents’ emotional perceptions. In particular, a substantial corpus of street scene image data was extracted and processed. This was performed using a deep convolutional neural network (DCNN) and semantic segmentation technology (PSPNet), which enabled the simulation and prediction of the subjective perception of the urban environment by humans. Furthermore, the color complexity and coordination in the street scene were quantified and combined with residents’ emotional feedback to carry out a multi-dimensional analysis. The findings revealed that color complexity and coordination were significant elements influencing residents’ emotional perceptions. A high color complexity is visually appealing, but can lead to fatigue, discomfort, and boredom; a moderate complexity stimulates vitality and pleasure; high levels of regional harmony and aesthetics can increase perceptions of beauty and security; and low levels of coordination can increase feelings of depression. The environmental characteristics of different areas and differences in the daily activities of residents resulted in regional differences regarding the impacts of color features on emotional perception. This study corroborates the assertion that environmental color coordination has the capacity to enhance residents’ emotions, thereby providing an important reference point for urban planning. Planning should be based on the functional characteristics of the region, and color complexity and coordination should be reasonably regulated to optimize the emotional experiences of residents. Differentiated color management enhances urban aesthetics, livability, and residents’ happiness and promotes sustainable development. In the future, the influences of color and environmental factors on emotions can be explored in depth, with a view to assist in the formulation of fine urban design.

Digital supervision in the clinical learning environment: Characterizing teamwork in the electronic health record.

Attending physicians in academic hospitals work in supervisory team structures with medical residents to provide patient care. How attendings utilize the electronic health record (EHR) to support learning through supervision is not well understood. To compare EHR behavior on teaching versus direct care, including evidence of supervisory calibration to learners. Cross-sectional study analysis of EHR metadata from 1721 shifts of hospital medicine faculty at a large, urban academic medical center, January to June 2022. Measures included total EHR time per shift, EHR time outside shift, and time spent on: note-writing, note review/attestation, order entry, and other clinical review. We assessed within physician differences across these service types and used multilevel modeling to determine whether these behaviors varied with resident physicians' experience, accounting for physician-specific signature behavior patterns. Attendings spent substantially less time in the EHR while on teaching service than on direct service (129 vs. 240 min; p < .001) and apportioned their work differently throughout the day. Physicians were less behaviorally consistent and varied more than their peers when on teaching service. Attendings calibrated their supervision to learners. Attendings logged 12.7% less EHR time when paired with more senior residents than postgraduate year 2 (PGY2) residents (137 vs. 120 min, p = .002). PGY1 presence was also associated with reduced EHR time, suggesting some delegation of supervision to senior trainees. EHR behaviors on teaching service are highly variable and differ substantially from direct care; a lack of consistency suggests important opportunities to establish best practices for EHR-based supervision and create an effective clinical learning environment.

Policy engagement as ‘empowered representation’: democratic mediation through a participatory research project on climate resilience

Background: The article analyses the policy engagement component of a research project on climate resilience in vulnerable communities that took place in Cape Town, South Africa. Conducted in 2022, the engagement included community and stakeholder events in three research sites, and a cross-cutting policy event with municipal officials, held at the end of the project. Importantly, this policy engagement process occurred in a context of political marginalisation, that is, one characterised by low trust, and little meaningful representation or even communication between these vulnerable communities and the city. Aims and objectives: This article examines the impact of policy engagement on political relations between local government and vulnerable communities. Methods: The overall methodology of the article is qualitative, using an illustrative case-study research design to unpack the subjective experiences of both government officials and residents of vulnerable communities. Primary data included many primary documents, direct observation of the engagements and post-event interviews. Findings: First, the engagement process created new ‘invented’ spaces for the representation of community perspectives to the city, and the city’s perspective to the community. Second, the engagement facilitated community self-representation through educating community members to advocate for their ideas in these new invented spaces. Third, this engagement tended to be more constructive and deliberative than polarising and confrontational. Discussion and conclusions: Drawing on the theoretical framework of ‘political mediation’, the policy engagement process is characterised as a positive instance of democratic mediation through ‘empowered representation’, with some specified limitations.

Enhancing social interaction in nursing homes through public tabletop displays: A field study of R2S

The prevalence of social isolation among nursing home residents highlights the need for innovative solutions to enhance their social interactions and wellbeing. Despite extensive efforts over recent decades to develop in-room systems or public applications under caregivers’ supervision, there remains a gap in designing public social technologies that can be integrated into residents’ daily lives. Furthermore, the challenges associated with low adoption and the complexities of evaluating such technologies in public care settings have limited our understanding of their impact on residents' social activities and experiences. To address this, our study introduces R2S, a tabletop display system designed to encourage older adults to view, share, and discuss news articles collaboratively in public care environments. A 6-week field trial was conducted in a Dutch care home to investigate the influence on residents’ daily social activities, R2S's utilization, and residents’ perceived user experiences and social emotions. The results reveal that R2S can generally promote daily social interactions among residents, even altering their long-established social habits. Five usage patterns of social technologies within public care environments were identified to provide insights into designing systems in comparable contexts. The participants reported a highly positive user experience with the system. Although their affective social benefits were not significant, they substantially outweighed the affective costs. These findings not only deepen the understanding of how technology can enhance social interaction in public care settings but also provide insights to inform the design and implementation of related technologies in the future.