Residency Program Coordinators Research Articles

Cosmetic Gynecology: Is There Enough Exposure in the Obstetrics and Gynecology Residency?

Introduction While cosmetic gynecology has gained popularity, the training experience for obstetrics and gynecology residents in this area is limited and not standardized. The primary objective was to investigate the exposure of obstetrics and gynecology residents to cosmetic gynecologic procedures including hymenoplasty, labia majora reduction, vaginoplasty, G-spot amplification, labiaplasty, clitoral hood reduction, and vaginal laser therapy. The secondary objective was to assess their comfort in performing the procedures after graduation. Methods This is a non-validated cross-sectional survey of obstetrics and gynecology residents and their exposure to cosmetic gynecology procedures. Using the Fellowship and Residency Electronic Interactive Database Access System, the Accreditation Council for Graduate Medical Education-accredited Obstetrics and Gynecology residency programs in the United States were identified, and the residency program coordinators were asked to distribute the survey. Data regarding demographics, program-specific characteristics, and exposure to certain cosmetic gynecology procedures were obtained and reviewed. Participants' reported comfort with the independent practice of certain cosmetic gynecology procedures after graduation was also obtained. Descriptive statistics were completed. Results A total of 96 responses were received. Approximately 50% of participants were exposed to cosmetic gynecology during training. Moreover, 70.9% of residents disagreed that they would feel confident in defining the included procedures. Furthermore, 87.5% disagreed that they would feel comfortable performing the procedures independently. A minority of participants were also unsure of the indication for cosmetic gynecology procedures, with 15.4%, 7.1%, 5.7%, and 4% unaware of the surgical indication for hymenoplasty, vaginoplasty, labiaplasty, and labia majora reduction, respectively. No participant knew the indication of surgery for vaginal laser therapy or clitoral hood reduction. Conclusions In the setting of current cosmetic gynecology training, nearly 90% of residents were not comfortable with these surgeries after graduation. Exposure to cosmetic gynecology for obstetrics and gynecology residents was limited. Without adequate exposure, residents may face difficulty performing procedures and managing complications after graduation. Therefore, standardizing resident training for cosmetic gynecology should be considered.

Validation of entrustable professional activities for use in neonatal care residency programs

ObjectiveDefine and develop a set of entrustable professional activities (EPAs) to link clinical training and assessment of the hospital components of neonatal care in neonatology medical residency programs. MethodsAn exploratory study was conducted in two phases using a modified Delphi approach. In the first phase, a committee of five neonatology residency program coordinators drafted an initial set of EPAs based on the national matrix of competencies and on EPAs defined by international organizations. In the second phase, a group of neonatal care physicians and medical residents rated the indispensability and clarity of the EPAs and provided comments and suggestions. ResultsSeven EPAs were drafted by the coordinators´ committee (n = 5) and used in the content validation process with a group (n = 37) of neonatal care physicians and medical residents. In the first Delphi round, all EPAs reached a content validity index (CVI) above 0.8. The coordinators´ committee analyzed comments and suggestions and revised the EPAs. A second Delphi round with the revised EPAs was conducted to validate and all items maintained a CVI above 0.8 for indispensability and clarity. ConclusionSeven entrustable professional activities were developed to assess residents in the hospital components of neonatal care medicine. These EPAs might contribute to implementing competency-based neonatology medical residency programs grounded in core professional activities.

Factors impacting neurosurgery residents' operative case volume: a nationwide survey.

Neurological surgery residency remains one of the most competitive and longest specialties in terms of training in medicine. The Accreditation Council for Graduate Medical Education uses residents' case volume throughout residency as one of its measures for the quality of surgical training. The objective was to study the variability of residency case volume among US training programs and to analyze the factors that potentially influence that case volume. In line with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines, an online survey regarding department size, case volume, number of residents per year, number of dedicated research years, presence of fellows, and resident case volume by the time of graduation was created using Google Forms and distributed to all neurosurgery residency program directors and coordinators in the US. A total of 97 of the 115 programs (84.3%) responded to the survey. Fifteen programs were excluded due to missing data or incomplete resident cohort at the time of the survey, and a total of 82 programs were included in the analysis. The average number of cases performed by residents as lead or senior surgeons by the time of graduation ranged from 900 to 2250 (median 1600 cases). The resident case volume did not have a significant correlation with the program case volume, number of operating attending neurosurgeons, number of residents, number of research years, or presence of fellows. The only factor that impacted the resident case volume was the number of cases performed per faculty. The number of cases performed by residents throughout residency varied significantly between programs. Although other factors play important roles in the quality of training, including autonomy, variation, and complexity of cases, the resident case volume is one of the only measurable factors. This study sheds some light on the factors that potentially influence neurosurgical resident case volume.

Strategic Steps to Gaining Approval for Increased Nurse Residency Program Coordinator Full-Time Equivalent Resources.

There is increased reliance on newly licensed nurses to fill open healthcare positions. Nurse residency programs (NRPs) provide the training, mentorship, and support newly licensed nurses require to successfully transition to professional practice. Research suggests that NRPs improve nurse retention, clinical outcomes, and organizational outcomes. Sufficient NRP full-time equivalents are needed to ensure adequate support and program management. This article describes how a Colorado hospital system secured additional NRP Coordinator full-time equivalent using a six-step process.

Factors affecting residency selection for underrepresented minorities pursuing orthopaedic surgery

BackgroundThe United States is increasingly diverse and there are many benefits to an equally diverse physician workforce. Despite this, the percentage of under-represented minorities in orthopaedic surgery has remained stagnant. The purpose of this study was to describe the characteristics underrepresented minorities pursuing orthopaedic surgery value most when evaluating residency programs. MethodsThe contact information of current underrepresented minority orthopaedic surgery residents were obtained through professional society databases, residency program coordinators and residency program websites. Individuals were sent a survey through which they evaluated the importance of a variety of program characteristics. ResultsThe most influential program characteristics were resident happiness and camaraderie, program reputation, geographic location, and relationships between residents and attendings. The least influential characteristics were sub-internship scholarship opportunities for minorities, program affiliation with diversity organizations, word of mouth from others, number of fellows, and centralized training sites. ConclusionsThere is a need to diversify the field of orthopaedic surgery, which begins by selecting more diverse trainees. This study demonstrates that underrepresented applicants are most influenced by many of the same characteristics as their well-represented peers. However, diversity-related factors still play an important role in the decision-making process. Many residents highlighted the impact microaggressions and mistreatment played in their residency experience, emphasizing the need for residency programs to focus not only on recruitment, but also on the successes and retention of their residents. Only once this is done will the field of orthopaedic surgery find sustained improvement in its diversification efforts.

Perception and Comfort with Endometriosis Management Among OB/GYN Residents.

The diagnosis of endometriosis often takes several years, delaying appropriate care while patients suffer from pelvic pain, dysmenorrhea, and dyspareunia. Understanding whether residents in obstetrics and gynecology (OB/GYN) are being adequately exposed to and trained in the diagnosis and management of the disease is important for improving care. We conducted an online cross-sectional survey of OB/GYN residents to investigate their comfort level and familiarity with endometriosis diagnosis and management. Residency program directors and coordinators of 20 OB/GYN residency programs in California, USA were emailed to disseminate the 31-question, anonymous survey in January to February 2023. Responses were collected using Redcap and analysis was conducted using STATA. 67 residents answered at least one non-demographic question and were included. A resident response rate was not calculated because we were unable to determine how many programs distributed the survey. 84% of residents felt they could recognise symptoms of endometriosis but over 30% of senior residents were not comfortable with sonographic diagnosis of endometrioma. Approximately one third of residents felt comfortable managing hypoestrogenic symptoms, osteoporotic risks, and add-back progestin for certain hormonal therapies. Academic-hospital based residents had significantly more exposure to attendings prescribing long-acting reversible contraception, GnRH antagonists, and GnRH agonists but there were no significant differences in trainee prescribing practices or comfort. More respondents would feel comfortable medically managing endometriosis (52%) than surgically managing the disease (26%) if they were in practice today, with only 39% of PGY3-4 residents feeling comfortable surgically managing endometriosis. There is considerable room for improvement in the education of residents in the diagnosis and medical and surgical management of endometriosis.

Technology-Assisted Hip and Knee Arthroplasty in Orthopaedic Residency Training: A National Survey.

The adoption of technology-assisted total joint arthroplasty (TA-TJA) is increasing; however, the extent to which TA-TJA is used among orthopaedic trainees is unknown. The purpose of this study was to assess the current use of TA total knee arthroplasty (TKA) and total hip arthroplasty (THA) by orthopaedic residents and to evaluate resident perceptions toward TA-TJA in their surgical training. In this cross-sectional study, an anonymous electronic survey was sent to all Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency program coordinators to distribute to their PGY-2 to PGY-5 residents. The survey consisted of 24 questions, including resident demographics, utilization of TA-TJA in their training, and perceptions regarding TA-TJA. A total of 103 orthopaedic residents completed the survey, of whom 68.0% reported using TA-TJA at their institution. Of the residents using TA-TJA, 28.6% used TA for total TKA only, 71.4% used TA for both TKA and THA, and none used TA solely for THA. One-third of residents (33.3%) use TA for more than half of all TKAs conducted, whereas 57.0% use TA for <10% of all THAs conducted. Approximately half of all residents (49.5%) thought that training in TA-TJA should be required during residency, with no significant differences between junior and senior level residents ( P = 0.24). Most (82.0%) thought that trainees should be required to learn conventional TJA before learning TA-TJA. 63.0% thought that technology had a positive effect on their primary TJA training experience; however, 26.0% reported concern that their training conducting conventional TJA may be inadequate. This study demonstrates that most orthopaedic residents currently conduct TA-TJA and highlights notable differences in TJA training experiences. These results provide a platform for future work aimed at further optimizing TJA training in residency, particularly as technology continues to rapidly evolve and utilization of TA-TJA is projected to grow exponentially. N/A, survey-based study.

Competency-Based Time-Variable Anesthesiology Residency Training: Identification of Problems and Solutions.

Global medical education is gradually moving toward more comprehensive implementations of a competency-based education (CBE) model. Elimination of standard time-based training and adoption of time-variable training (competency-based time-variable training [CB-TVT]) is one of the final stages of implementation of CBE. While CB-TVT has been implemented in some programs outside the United States, residency programs in the United States are still exploring this approach to training. The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) are encouraging member boards and residency review committees to consider innovative ways programs could implement CB-TVT. The goals of this study were to (1) identify potential problems with the implementation of CB-TVT in anesthesiology residency training, (2) rank the importance of the problems and the perceived difficulty of solving them, and (3) develop proposed solutions to the identified problems. Study participants were recruited from key stakeholder groups in anesthesiology education, including current or former program directors, department chairs, residents, fellows, American Board of Anesthesiology (ABA) board members, ACGME residency review committee members or ACGME leaders, designated institutional officials, residency program coordinators, clinical operations directors, and leaders of large anesthesiology community practice groups. This study was conducted in 2 phases. In phase 1, survey questionnaires were iteratively distributed to participants to identify problems with the implementation of CB-TVT. Participants were also asked to rank the perceived importance and difficulty of each problem and to identify relevant stakeholder groups that would be responsible for solving each problem. In phase 2, surveys focused on identifying potential solutions for problems identified in phase 1. A total of 36 stakeholders identified 39 potential problems, grouped into 7 major categories, with the implementation of CB-TVT in anesthesiology residency training. Of the 39 problems, 19 (48.7%) were marked as important or very important on a 5-point scale and 12 of 19 (63.2%) of the important problems were marked as difficult or very difficult to solve on a 5-point scale. Stakeholders proposed 165 total solutions to the identified problems. CB-TVT is a promising educational model for anesthesiology residency, which potentially results in learner flexibility, individualization of curricula, and utilization of competencies to determine learner advancement. Because of the potential problems with the implementation of CB-TVT, it is important for future pilot implementations of CB-TVT to document realized problems, efficacy of solutions, and effects on educational outcomes to justify the burden of implementing CB-TVT.

Impact of COVID-19 Pandemic on Pathology Residents/Trainees in North America: A Survey-Based Study.

Background The COVID-19 pandemic has had a significant impact on resident training and education in the field of Pathology. This study aims to identify the tangible effects and resultant changes in education for Pathology trainees that have resulted from the pandemic. Design An electronic survey regarding Pathology trainee perceptions and experiences in relation to COVID-19 was created via Google Forms. The questionnaire was distributed to the pathology trainees via Twitter and email. The survey was also shared with all Pathology residency program coordinators across the USA and Canada. Results One hundred forty-five trainees responded to the questionnaire. 37.6% reported a significant decrease in specimen volume, whereas 43.3% reported a slight decrease in specimen volume. 18.3% reported the cancellation of educational lectures before shifting to a virtual platform for didactic purposes. However, 74.6% reported shifting all educational activities to virtual platforms. 35% cited cancellations of grand rounds, whereas 18.2% reported cancellations of grand rounds led by guest speakers.53.5% took COVID-19 tests, and 22.7% were quarantined. 100% reported a change in sign-out culture. Conclusions This pandemic has significantly impacted pathology training in various aspects, including training, education, and well-being. Residents harbored anxiety and stress regarding board exam delays or uncertainties, inadequate exam preparation time, family separation, and compromised safety. The exact quantification of educational loss varied from program to program. A significant decrease in specimen volume and detrimental changes in sign-out culture are indicators of compromised resident education due to the pandemic. This pandemic has extended the use of digital pathology and virtual platforms to a higher extent. Free virtual educational resources provided by various pathology organizations were critically important interventions during this pandemic, contributing to resident education. The pandemic has shown that developing a comprehensive infrastructure to overcome the loss of educational opportunities is of paramount importance to alleviate stress and anxiety among trainees.

The impact of intraoperative adverse events on orthopaedic surgery residents

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The goal of this study was to quantify the impact of intraoperative adverse events on orthopaedics residents to better understand how these occurrences affect resident training. Additionally, the study identified the emotional toll of adverse events on trainees and barriers to reporting.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; An anonymous 26 question web-based survey was adapted from the Boston intraoperative adverse events surgeons’ attitude study (BISA) survey to be applicable to orthopaedic residents. The survey was sent to orthopaedic residency program coordinators listed in the Council of Orthopaedic Residency Directors (CORD) database. The coordinators then distributed the survey to each program’s residents and fellows.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 77 orthopaedic residents and fellows completed the survey. Almost all (84.4%) reported having been involved in an IAE during their training, and the majority (80.6%) experienced emotional distress as a result. 50.7% of respondents have never been involved in discussions with patients or their family regarding a complication during their training.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The majority of residents have experienced emotional distress following an intraoperative adverse event, but residents are not routinely involved in subsequent discussions with patients and families following complications. This represents a significant area for improvement in both supporting and training surgical residents.&lt;/p&gt;

Perceptions of Parental Leave Among Ophthalmologists

Benchmarking attitudes surrounding parental leave among posttraining North American ophthalmologists may reveal possible areas for intervention. To evaluate perceptions of current parental leave policy and culture among posttraining North American ophthalmologists. This nonvalidated survey used a 19-item online questionnaire. A convenience sample of 186 self-identified North American-based ophthalmologists who had completed training was obtained using listservs, residency program coordinators, and social media. Data collection occurred from May to July 2022. Descriptive analysis demonstrated response frequencies. Pearson χ2 comparison of means was performed for categorical variables. Two-tailed t tests were performed for continuous variables. Among the 186 surveys completed, 105 respondents (56.5%) identified as female, 76 (40.9%) worked in academia, 133 (71.5%) were 1 to 20 years out of training, and 156 (83.9%) had children. Attitudes toward stop-the-clock policies, or delays in tenure/promotion/partnership review when taking leave, were mixed. Of 171 respondents, 78 (45.6%) thought that stop-the-clock policies should be optional, 39 (22.8%) thought that they should be required, and 31 (18.1%) thought that they should be removed. Of 76 academicians responding, 56 (73.7%) and 49 (64.5%) were unaware if their institution had a stop-the-clock policy for tenure review or promotion review, respectively. Male and female respondents differed in feeling comfortable with taking leave (36 of 66 [54.5%] vs 67 of 90 [74.4%], respectively; P = .04), as well as in their ratings of stress about peer perception on a scale of 0 to 10 (3.70 vs 4.81, respectively; P = .05). Private practitioners and academicians differed in confirmation of leave options for both parents (52 of 101 [51.5%] vs 49 of 69 [71.0%], respectively; P = .02) and ratings of financial stress (7.10 vs 5.43, respectively; P = .004) and research considerations (1.60 vs 3.85, respectively; P < .001). Results of this survey study support the hypothesis that demographic factors affect attitudes toward parental leave among posttraining ophthalmologists; policies could be better publicized. Feelings regarding policies and leave were mixed. These findings should be viewed as hypothesis generating because the survey was not validated and the associations provided could be due to confounding factors.

7945 Time to Separate OB from Gyn? Resident Perspectives on Gynecologic Surgical Training and Subspecialty Tracking in Residency Programs

<h3>Study Objective</h3> This study seeks to assess resident satisfaction with their gynecologic surgical training and their opinions on subspecialty tracking in obstetrics and gynecology training programs. <h3>Design</h3> Cross sectional survey of current obstetrics and gynecology residents. <h3>Setting</h3> The survey was distributed to 258 ACGME accredited obstetrics and gynecology residency program coordinators who were asked to distribute the survey to their current residents. <h3>Patients or Participants</h3> PGY1 - PGY4 residents at ACGME accredited obstetrics and gynecology residency programs. <h3>Interventions</h3> An internet-based survey was distributed via the Qualtrics platform. All responses were anonymous. The survey was distributed on two occasions in March 2022. The data presented in this abstract is preliminary. <h3>Measurements and Main Results</h3> Of the 157 Ob/Gyn residents who responded to the survey, 45% plan to pursue a generalist career, 42% fellowship, and 13% undecided. While 75% are satisfied with their laparoscopic training, only 47% are satisfied with robotic training. When asked if they felt confident in their ability to perform specific surgical procedures independently after graduation, 47% felt confident with robotic-assisted procedures, 39% with laparoscopic myomectomy, and only 32% with complex laparoscopic dissection. The majority of residents (52%) felt that tracking would have a positive impact on training, 18% thought it would have a negative impact, and 30% were unsure or thought it would have no impact. Eighty percent felt that tracking would better prepare residents for fellowship training and 53% felt it would increase minimally invasive skills among residents. Over half of respondents (54%) said they would be interested in participating in a residency program that offered subspecialty tracking. <h3>Conclusion</h3> This study highlights the need for change in gynecologic surgical training. The majority of residents surveyed feel subspecialty tracking would have a positive impact on residency training and would be interested in participating in such a program.

LGBTQ+ Training in United States Radiation Oncology Residency Programs

<h3>Purpose/Objective(s)</h3> The LGBTQ community is an understudied and medically underserved population who experience increased cancer risk and worse cancer outcomes. Negative provider interactions, including discrimination and lack of knowledge regarding LGBTQ-specific health issues are cited by patients as barriers to care, including in radiation oncology (RO). Notably, little is known regarding LGBTQ knowledge and attitudes among RO residents (ROR) or LGBTQ-specific training in RO residency training programs. Thus, we sought to assess the extent of current LGBTQ-specific training in U.S. RO residency programs. <h3>Materials/Methods</h3> Two published surveys of LGBTQ-education in residency were adapted to RO. The first assessed LGBTQ education from the perspective of program directors (PD) and associate PDs (APD), while the second survey was to RORs. The surveys were sent to all ACGME-accredited U.S. RO residency PD, APD, and program coordinators (PC), with the ROR survey being disseminated by the respective PCs. Each survey consisted of subsections of attitudes and knowledge in the care of LGBTQ patients, RO program characteristics, program inclusion of LGBTQ-specific education, and individual demographics. <h3>Results</h3> There were 69 responses (29 PD, APD and 40 ROR). The majority of respondents (PD, APD/ROR) identified as white (79%/58%), non-Hispanic (76%/72%), male (55%/55%), and heterosexual (86%/78%). The majority of PD, APDs did not receive LGBTQ education in medical school (60%) or residency training (96%), while the majority of residents (68%) did receive LGBTQ training in medical school; yet, both groups felt this training was insufficient to care for LGBTQ patients during residency (76%/68%). Overall, respondents felt comfortable treating LGB (90%/85%) and T (79%/62.5%) patients. However, the majority did not feel confident in their knowledge for LGB (52%/62.5%) or T (79%/85%) health needs. The majority of respondents' programs have never had a didactic session on LGBTQ health (78%/80%) resulting in 61%/61% of respondents feeling their program inadequately prepares residents to work confidently with LGBTQ patients. However, the majority felt their program is receptive to incorporating LGBTQ health content into their curriculum (75%/75%) and expressed a personal interest in such education (97%/80%). Additional data will be available by time of conference. <h3>Conclusion</h3> We found an increase of LGTBQ education in medical schools between PD, APD and ROR, suggestive of a recent improvement in LGBTQ content; yet most residency programs still lacked any LGBTQ-specific education. While the majority felt comfortable treating LGBTQ patients, they simultaneously lacked confidence in knowledge regarding LGBTQ health needs; yet, possessed desire for additional education and belief that such trainings should require. Conclusion is that residencies need to do a better job incorporating LGBTQ health content into their curricula, which is supported by interest from ROR and program leadership.

Disparities in Radiation Therapy: Practice Patterns Analysis of Deep Inspiratory Breath Hold Use in Non-English Speakers

Our purpose was to examine current practice patterns in non-English-speaking patients with breast cancer undergoing deep inspiratory breath hold (DIBH). An anonymous, voluntary REDCap survey was distributed to 60 residency program coordinators of US radiation oncology departments to survey their faculty and recent graduates. Eligibility was limited to board-certified radiation oncologists who had treated breast cancer within the prior 6 months. There were 69 respondents, 53 of whom were eligible. Forty-two percent (n=22) of eligible respondents were from the main site at an academic center, with 28% (n=15) representing a satellite site and 30% (n=16) from private practice. Fifty-three percent reported at least 10% of their patients were non-English speaking. Ninety percent offered DIBH at their institution; of those, 74% used DIBH for at least one-fourth of their patients with breast cancer. Ninety-eight percent of those who use DIBH performed coaching at simulation, with 32% answering they would be "less likely" to use DIBH for non-English speakers. When used, 94% take into consideration potential language barriers for proper execution of DIBH. However, 51% had an interpreter present 76% to 100% of the time at computed tomography simulation, which decreased to 31% at first fraction and 11% at subsequent treatments. For non-English-speaking patients undergoing DIBH coaching without a certified interpreter, 55% of respondents indicated that they provided verbal coaching in English, 32% indicated "not applicable" because they always use a certified interpreter, 11% used visual aids, and 32% indicated "other." Of those who answered "other," the most commonly cited response was using therapists or staff who spoke the patient's native language. Disparities in the application of DIBH exist despite its established utility in reducing cardiac dose. This study provides evidence that language barriers may affect physician treatment practices from initial consideration of DIBH to subsequent delivery. These data suggest that breast cancer treatment considerations and subsequent execution are negatively affected in non-English-speaking patients.

The Future is Female: The Influence of Female Faculty and Resident Representation on Female Applicant Match Rate Amongst Urology Residency Programs Over 3 Years

ObjectiveTo investigate whether there is a correlation between the proportion of female faculty and residents at urology residency programs and the proportion of females matched to those programs. Materials and MethodsWe utilized official results from 3 consecutive AUA match cycles from 2018 – 2020 to obtain the number of females matched to each program. The number of female residents and faculty members in each program was acquired through querying program websites and contact with residency program coordinators. The correlation between the proportion of females in the newly matched class of residents and the proportion of current female faculty members and residents in that program was calculated for each match cycle. ResultsThere was a positive correlation between the proportion of matched female applicants and the proportion of female residents in each program for the 2018, 2019, and 2020 match cycles (R = 0.23, P = .01; R = 0.21, P = .02, R = 0.11, p <.001, respectively). There was a positive correlation between the proportion of matched female applicants and the proportion of female faculty at their matched program in the 2018 and 2020 match cycles (R = 0.22, P = .02; R = 0.06, P < .01, respectively). There was no significant predilection of females matching to programs with a female program director or chairperson, and geographic location of program (based on AUA section) did not appear to influence female applicant match rates. ConclusionThere has been a consistent trend in the proportion of matched female applicants to urology programs correlating positively with the proportion of female residents at those programs over the past three years. This is indicative of the increased potential for female mentorship and leadership opportunities. Further research is needed to investigate the factors that draw female applicants to urology programs with increased female representation.

Disparities in Radiotherapy: Practice Patterns Analysis of DIBH Use in Non-English Speakers

<h3>Purpose/Objective(s)</h3> To examine current practice patterns in non-English speaking breast cancer patients undergoing Deep Inspiratory Breath Hold (DIBH). We hypothesize that disparities in DIBH utilization exist between English and non-English speaking patients. <h3>Materials/Methods</h3> An anonymous, voluntary online survey was distributed to residency program coordinators of U.S. radiation oncology departments to survey their faculty and recent graduates. Eligibility was limited to board-certified radiation oncologists who have treated breast cancer within the prior 6 months. <h3>Results</h3> There were 66 respondents, 50 of whom were eligible. 70% (n = 35) of eligible respondents were from academic sites. Slightly over half (52%) of respondents reported that at least 10% of their patients were non-English speaking. Most offered DIBH at their institution (92%) and of those, 82% of responding radiation oncologists used DIBH for at least a quarter or more of their breast cancer patients. Nearly all of those who use DIBH (98%) used coaching at the time of simulation, with about a third (37%) answering they would be "less likely" to utilize DIBH for non-English speaking patients. If DIBH is used for non-English speaking patients, 86% would take into consideration potential language barriers for proper execution of DIBH. However, slightly over one-half of respondents had an interpreter present 76-100% of the time at CT simulation. At the first DIBH treatment, 31% used an interpreter 76-100% of the time. And at each subsequent treatment, 11% used an interpreter 76-100% of the time. <h3>Conclusion</h3> Disparities in the application of DIBH exist despite its established utility in reducing cardiac dose. This study provides evidence that language barriers may impact physician treatment practices from initial consideration of DIBH to subsequent delivery. Even within a limited sampling of self-reported responses, this data suggests that breast cancer treatment considerations and subsequent execution are negatively affected in non-English speaking patients.

352 Virtual Etiquette: A Closer Look at Emergency Medicine Didactics in the Age of COVID

Covid derailed multiple facets of emergency medicine (EM) residency training, including the need to move from in-person to online weekly didactics. While online education has been used within 90% of medical schools, it has not traditionally been used for residency education. Recent studies evaluating post-graduate residents' perception of online education found a receptive audience eager to incorporate the modality. To date, no study has analyzed how EM programs are approaching online education, including content, efficacy, and attendance etiquette. As part of a process improvement project, an online Survey Monkey questionnaire was sent out to 180 EM residency program directors and coordinators. The survey was open from November 2020 to March 2021. We received 52 responses from program directors and coordinators from all regions of the United States with a majority from academic or university-affiliated programs. Due to COVID-19, over 90% of programs shifted to an online didactic platform with only 10% maintaining in-person didactics. Zoom has been the preferred modality utilized at 89% of programs we surveyed with minimal security and techinical issues. Program consensus was that residents should be on time or no more than 5-minutes late for credit (42% of programs), have video cameras on (52% of programs), and appear attentive (44% of programs). Virtual etiquette was also examined, including screen presence: upright posture (less than 18% of programs reported accountable), background (less than 10%), and lighting (less than 6%). A majority of programs had not set expectations for screen presence. If not presenting, the dress code is generally at the resident’s discretion and was noted to be casual (52%). Sixty percent of programs reported increased faculty attendance since moving to a virtal conference. Programs also reported maintiaing consistency in content (62% of programs), increased utilization of guest speakers (50% of programs), use of national platforms (21% of programs), and maintaing small group sessions (77% of programs). Many residency programs do not record didactics, and only 15% offer credit if lectures are watched at a later date. When safely able, over 65% of programs plan to return to in-person didactics. The online learning platform provides opportunities and proves challenges. Many programs have shifted to online learning and diversified their curriculum. EM residency training requires a strong foundation in core content, which may not entirely be suited for an online platform. This coupled with the loss of face-to-face learning may reflected in the desire for programs to return to in-person learning. The benefits of online learning, which include accessibility, flexibility, and broader reach of topics should not be neglected. Further exploration of the efficacy of knowledge acquisition within online didactics would aid in decisions regarding next steps for return to a potential hybrid teaching model.

Radiological Imaging Transmission via Smartphones by Neurosurgery Residents in the United States

Neurosurgery requires the communication of radiological imaging. Smartphones are increasingly used for this purpose because of the efficiency and convenience of integrated cameras and native Multimedia Messaging Service (MMS) functionality. There is inconsistency among hospitals regarding policies addressing this use as it relates to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Some hospitals offer a HIPAA-compliant secure messaging application (SMA) as a substitute. The authors hypothesized that the use of smartphones for sharing radiological imaging would be commonplace among residents. We sought to characterize usage patterns, resident awareness of policies and HIPPA, and the effectiveness of SMAs as a means of avoiding HIPAA violations. An electronic dynamic questionnaire was sent to all 116 Accreditation Council for Graduate Medical Education-accredited US neurosurgery residency program directors and coordinators to be forwarded to their residents. A total of 100 responses were received, representing 49 residency programs. Ninety-two (92%) residents reported using MMS to transmit radiological imaging. Twenty-six (26%) reported doing so with patient identifiers. Roughly half (48%) of residents were unaware of policies regarding imaging transmission via MMS at their institutions. Among the 17 (35%) programs providing SMAs, only 3 of 27 (11%) residents in these programs did not use MMS for image transmission. The data suggest that there is widespread resident use of MMS for image transmission, regardless of policy and the availability of alternative HIPAA-compliant applications. Knowledge of local institutional policies and HIPAA privacy rules is poor. Alternative strategies are needed to prevent HIPAA-noncompliant transmission of imaging by residents.

Mapping the residency program landscape

When properly structured, library residencies introduce recently graduated Master of Library and/or Information Science (MLIS) professionals to librarianship, allow recent graduates to apply the knowledge and skills learned during their MLIS studies, and infuse host institutions with new, innovative ideas, including the latest technology and theory being taught in library and information science (LIS) programs. Unfortunately, rather than realizing their potential, residencies are often hampered by miscommunication and a lack of organization that cause real harm to the new resident and the current employees by creating a tense, sometimes even hostile, work environment. This can negate the potential benefits of a residency program, leaving the resident unhappy and disillusioned by the library profession. Understanding the current landscape of residency programs is a necessary first step toward evaluating the efficacy of this form of early career employment in retaining an innovative and engaged next generation of library professionals. Using survey research, this study answered the questions: What are the characteristics of residency programs? How is success measured in residency programs? What are some specific best practices that residency programs are currently implementing? The findings from this survey indicate that there is no one-size-fits-all residency program structure, from the mission and goals of the programs to how a program measures its ultimate success, responses were varied. While there are positive trends, like residencies lasting for at least two years, there is still much work to be done. Notably, most programs still only have one resident per cohort and residency cohorts do not overlap leading residents to feel isolated. While we concede there are likely many concerns (including budgetary) that may make two or more residents per cohort or overlapping cohorts unfeasible, it is an issue that should be addressed because many residents themselves have asked for this change. We also detail several suggestions for building and maintaining buy-in among stakeholders in the residency program, a necessary step toward ensuring each resident feels welcome in an institution and is ultimately successful. It is our hope that this research provides residency program coordinators with a roadmap to follow when planning or re-evaluating their residencies.

Caffeine Consumption Among Orthopedic Residents Is Higher Than the General Population

Background: Orthopaedic surgery residency can be quite demanding at times and leads many residents to consume stimulants, caffeine, to perform their work duties. Question/Purpose: The purpose of this study was to evaluate caffeine consumption among orthopedic surgery residents. We hypothesized that compared to the general population, residents will consume more caffeine. Patients/Methods: An electronic survey consisting of 13 multiple-choice questions was created to query residents on their caffeine consumption. The survey link was e-mailed to all residency program coordinators in the United States who then forwarded the survey to their residents. A subgroup analysis was performed based on respondents’ post-graduate year (PGY), to identify variations in caffeine use. Results: We received 209 surveys which represents 5.4% of orthopedic residents in the country. Of those 209 residents, 189 (90.4%) indicated regular caffeine usage. Of those who consume caffeine 59.8% indicated that they need caffeine to perform their work while 64.6% indicated that they are dependent on caffeine. Nearly one-fourth (24.3%) of respondents indicated that they consume more than 400 mg of caffeine/day. There were no significant relationships across resident PGY groups. Conclusion: We have demonstrated a large proportion of orthopedic surgery residents consume caffeine. When used in moderation, caffeine can be beneficial by improving efficiency, alertness and memory however, in high doses it may have undesirable side effects. Level of Evidence: Level IV evidence