Residency Program Directors Research Articles

Comparison of Current Post-Graduate Pain Management and Palliative Care Pharmacy Residency Programs

Post-graduate pharmacy residency training in pain management and palliative care is continuing to increase in availability. It is expected that there will be further expansion in the need for specialty trained pain and palliative care pharmacists as the population continues to age and prevalence of pain increases; however, descriptions of current post-graduate year 2 pain management and palliative care residencies are limited. The purpose of this survey is to collect program information and compare baseline characteristics of the currently available programs. Data collected included funding source, required and elective experiences, residency program director training, jobs held by residents upon completion of the program, and preceptor availability/training. Of the 15 respondents, baseline characteristics were variable. Outpatient chronic pain management was the most commonly selected required experience. Approximately 33% of residency program directors had completed a post-graduate year two residency in pain management and palliative care, and the majority of responding programs were funded by the Department of Veterans Affairs. The characteristics of responding programs illustrates the diversity of current post-graduate pain management and palliative care residency opportunities. The results of this survey help evaluate these opportunities and will provide valuable information as this specialty continues to progress.

Internal Medicine Residency Program Director Support and Burnout During the COVID-19 Pandemic: Results of a National Survey.

Burnout is common among physicians and physician leaders, including residency program directors (PDs). The effects of the COVID-19 pandemic and other stressors in 2020 on PDs is unknown. To measure the prevalence of burnout among internal medicine (IM) residency PDs 6 months into the COVID-19 pandemic. A total of 429 IM PDs, representing 83% of accredited residency programs, were surveyed from August to December 2020. Burnout, using a 2-item screening tool, and self-reported consideration of resigning in 2020, were compared to their annual prevalence since 2012 and tested for possible associations with pandemic stressors and program characteristics. The survey response rate was 61.5% (264 of 429). One-third (33.6%, 87 of 259) of PD respondents met burnout criteria, and 45.1% (110 of 244) reported considering resigning in the past year, which were within the range of preceding years. PDs who reported feeling highly supported by institutional leadership were less likely to meet burnout criteria and to have considered resigning. There were no associations between burnout or consideration of resigning and the amount of clinical time PDs spent in their roles, duration of maximum stress on programs, budget cuts to programs, or geographic region. The prevalence of burnout among PDs in fall 2020 was similar to the prevalence of burnout in pre-pandemic years despite uniquely extreme stressors. PDs' perception of being highly supported by institutional leadership was associated with lower prevalence of burnout and consideration of resigning. Perceived leadership support may be a protective factor against burnout during periods of high stress.

Minimum Case Numbers: The New Pandemic in a Changing Clinical Environment.

Minimum Case Numbers: The New Pandemic in a Changing Clinical Environment.

Critical Care Pharmacy Program Accreditation Standards Framework and Core Competencies in Saudi Arabia

Clinical pharmacy services in Saudi Arabia are expanding steadily, particularly with notable developments in critical care pharmacy services and training programs, including four critical care residency programs localized in Riyadh and one program in Jeddah. The Scientific Council of Pharmacy leads extensive efforts to advance clinical pharmacy practice and training under the Saudi Commission for Health Specialties (SCFHS), the accrediting body for critical care training programs and all other specialties. Despite launching critical care pharmacy programs in 2013, currently available accreditation standards and competency assessments for specialized residency programs in critical care were established in 2020. These accreditation standards and competency assessment modalities have been found to have significant areas of improvement based on the feedback of practicing critical care pharmacy residency program directors and trainees over the past few years. This is an opinion paper based on a consensus of critical care and emergency medicine pharmacy experts which recommends updating the current accreditation standards framework and competency assessment blueprint for specialized critical care pharmacy programs. Additionally, it highlights the need to modify the accreditation standards framework for critical care pharmacy programs. Further evaluation of these modalities can be revised as deemed reasonable by governmental authorities by recruiting practicing critical care clinical pharmacy experts.

Palliative care training: a national study of internal medicine residency program directors in the United Arab Emirates

BackgroundInternal medicine residents are responsible for providing much of the direct care for palliative and terminally ill patients in teaching hospitals in the United Arab Emirates (UAE). To date, little systematic information is available on the prevalence of palliative care (PC) programs or faculty in UAE academic hospitals, or on the nature of PC education in internal medicine residency programs in the country.MethodsSemi-structured interviews were conducted with program directors of all 7 internal medicine residency programs in the UAE. Qualitative content analysis was conducted to identify recurring themes.ResultsAll program directors agreed that PC knowledge and skills are an essential component of training for internal medicine residents, but have had variable success in implementing the components. Three themes emerged, namely lack of structured PC training, perceptions of resident preparedness, and barriers to implementing a PC curriculum.ConclusionInternal medicine residency programs in the UAE currently lack structured, mandatory PC curricula and have limited opportunities for formal teaching and assessment of PC knowledge and skills. The planned development of comprehensive oncology and palliative care centers and ongoing curricular reform in teaching hospitals in the country will provide important opportunities to train a cadre of competent health professionals to provide high quality palliative and end-of-life care to UAE patients and their families.

How to Reassure Program Directors of International Medical Graduates' Preparedness for Residency With the Fall of the USMLE Step 2 CS Exam.

To the Editor: The demise of the Step 2 Clinical Skills (CS) exam of the United States Medical Licensing Examination (USMLE), together with the USMLE Step 1’s transition to a binary reporting format, means that applicants for medical licensure have a single objective opportunity (Step 2 Clinical Knowledge) in proving their candidacy. 1 Programs may be reluctant to hire international medical graduates (IMGs) whom they have not previously observed in a clinical setting. As a potential substitute for the Step 2 CS exam, we propose that direct clinical observation of several new patient interactions during clerkships, or online assessment of communication and interpersonal skills while interacting with standardized patients, be included in respective clerkship evaluations. Structuring away-rotation evaluations for an IMG to include this scored component could reassure program directors of an IMG candidate’s preparedness for residency. To understand why an alternative clinical scoring component is needed for IMGs applying for residency, we need to examine the rise and fall of the Step 2 CS exam. The rise of the Step 2 CS exam has an interesting history. In the 1980s, U.S. residency program directors were concerned that the clinical competence of some IMGs was grossly deficient compared with their medical knowledge. 2 Subsequent events 3 led to the inception of the Clinical Skills Assessment (CSA) in 1981. The CSA’s validation led to its incorporation as a mandatory component for Educational Commission for Foreign Medical Graduates certification of IMGs in 1998 and subsequently for U.S. medical students as well. 4 Concerns voiced about subjecting only IMGs to the CSA were among the reasons for this change 4; this paved the path for the introduction of the Step 2 CS exam in 2004. Step 2 CS was not well received by U.S. medical students, though. The limit of taking the exam at only 5 U.S. centers, necessitating travel, plus an additional $975 examination fee, was unpopular. Despite growing questions regarding the utility of the exam and the high pass rate of nearly 97%, passing this exam was made a prerequisite for taking the USMLE Step 3—the final exam needed for obtaining medical licensure. 4 In the end, the COVID-19 pandemic, which necessitated travel restrictions and social distancing precautions, pushed the Step 2 CS exam to extinction. The Step 2 CS exam may have been flawed, but IMGs applying to U.S. residency programs need a new way to demonstrate their clinical competency. Structuring away-rotation evaluations for IMGs to include direct clinical observation or an online assessment could fill this gap.

The virtual interview format for fellowship recruitment in obstetrics and gynecology: a nationwide survey of program directors

ABSTRACT Due to Covid-19, fellowship programs could not conduct in-person interviews during the 2020–2021 interview cycle and were forced to implement virtual interviews. We conducted two nationwide surveys of residency and fellowship Program Directors (PDs) involved in the Obstetrics and Gynecology (Ob/Gyn) Subspecialty Fellowship match cycle to gain a better understanding of virtual interviews from each of their perspectives. 1) Fellowship PDs’ confidence in using a virtual platform to holistically evaluate applicants during the 2020–2021 match cycle, 2) Residency PD’s perception of virtual interviews and impact on their program’s operations, and 3) to assess the desire of fellowship and residency PDs to continue virtual recruitment during forthcoming interview seasons. Two separate nationwide web-based surveys were administered to 1) Ob/Gyn fellowship PDs and 2) residency PDs through SurveyMonkey from July-September 2020 to assess the impact of virtual interviews form each parties’ perspective. Surveys solicited demographic information, four-point Likert scale questions, and free response questions Of programs meeting inclusion criteria, 75/111 (67.6%) fellowship PDs and 67/117 (57.3%) residency PDs responded to their respective surveys. Most fellowship PDs believed that they could confidently assess applicants’ professionalism (88%) during a virtual interview and (90.7%) felt confident in making a rank-order list. However, only 73.3% were just as confident in preparing a rank list after a virtual interview as they have been with in-person interviews. Most residency PDs (69.9%) believed that virtual interviews made it easier for their program to comply with duty hours, and 76.8% agreed that virtual interviews allowed their residents to accept more interviews than an in-person format. Most fellowship PDs found virtual interviews convenient. However, difficulty in observing social interaction and gauging applicant interest may be the biggest challenge moving forward.

Pearls of wisdom for aspiring physician-scientist residency applicants and program directors.

Postgraduate physician-scientist training programs (PSTPs) enhance the experiences of physician-scientist trainees following medical school graduation. PSTPs usually span residency and fellowship training, but this varies widely by institution. Applicant competitiveness for these programs would be enhanced, and unnecessary trainee anxiety relieved, by a clear understanding of what factors define a successful PSTP matriculant. Such information would also be invaluable to PSTP directors and would allow benchmarking of their admissions processes with peer programs. We conducted a survey of PSTP directors across the US to understand the importance they placed on components of PSTP applications. Of 41 survey respondents, most were from internal medicine and pediatrics residency programs. Of all components in the application, two elements were considered very important by a majority of PSTP directors: (a) having one or more first-author publications and (b) the thesis advisor’s letter. Less weight was consistently placed on factors often considered more relevant for non-physician-scientist postgraduate applicants — such as US Medical Licensing Examination scores, awards, and leadership activities. The data presented here highlight important metrics for PSTP applicants and directors and suggest that indicators of scientific productivity and commitment to research outweigh traditional quantitative measures of medical school performance.

Using nominal group technique among resident physicians to identify key attributes of a burnout prevention program.

PurposeTo identify preferred burnout interventions within a resident physician population, utilizing the Nominal Group Technique. The results will be used to design a discrete choice experiment study to inform the development of resident burnout prevention programs.MethodsThree resident focus groups met (10–14 participants/group) to prioritize a list of 23 factors for burnout prevention programs. The Nominal Group Technique consisted of three steps: an individual, confidential ranking of the 23 factors by importance from 1 to 23, a group discussion of each attribute, including a group review of the rankings, and an opportunity to alter the original ranking across participants.ResultsThe total number of residents (36) were a representative sample of specialty, year of residency, and sex. There was strong agreement about the most highly rated attributes which grouped naturally into themes of autonomy, meaning, competency and relatedness. There was also disagreement on several of the attributes that is likely due to the differences in residency specialty and subsequently rotation requirements.ConclusionThis study identified the need to address multiple organizational factors that may lead to physician burnout. There is a clear need for complex interventions that target systemic and program level factors rather than focus on individual interventions. These results may help residency program directors understand the specific attributes of a burnout prevention program valued by residents. Aligning burnout interventions with resident preferences could improve the efficacy of burnout prevention programs by improving adoption of, and satisfaction with, these programs. Physician burnout is a work-related syndrome characterized by emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment [1]. Burnout is present in epidemic proportions and was estimated to occur in over 50 percent of practicing physicians and in up to 89 percent of resident physicians pre-COVID 19. The burnout epidemic is growing; a recent national survey of US physicians reported an 8.9 percent increase in burnout between 2011 and 2014 [2]. Rates of physician burnout have also increased [3] during the COVID-19 pandemic with a new classification of “pandemic burnout” experienced by over 52 percent of healthcare workers as early as June of 2020 [4]. Physician burnout can lead to depression, suicidal ideation, and relationship problems that may progress to substance abuse, increased interpersonal conflicts, broken relationships, low quality of life, major depression, and suicide [5–7]. The estimated rate of physician suicide is 300–400 annually [8–10].

Otolaryngology Residency Match During the COVID-19 Pandemic.

ObjectiveTo review changes made by otolaryngology residency program directors (PDs) during the 2020-2021 National Resident Matching Program (NRMP) match cycle and describe their attitudes toward the 2021-2022 match cycle.MethodsCross-sectional study using an anonymous 31-item online survey in Research Electronic Data Capture (REDCap) with questions regarding the 2020-2021 NRMP match. This survey was distributed to 125 PDs from Accreditation Council for Graduate Medical Education (ACGME)-accredited otolaryngology residency programs.ResultsThirty-three PDs responded (26.4%). Of the PDs, 78.8% had an online info-session prior to the start of the cycle, and 30.3% reported that an increased number of applicants contacted them compared to the prior cycle. There were no changes made in Step 1 criteria (72.7%), and 81.8% reported no changes in interview selection. Of the PDs, 54.5% reported interviewing more candidates. Respondents reported a decreased cancellation rate (66.7%) and cost of recruiting (87.9%); 87.9% said that they did not change the way they developed their rank order list (ROL), and 84.8% reported matching at their usual level compared to prior years. Of the respondents, 42.4% reported making a change that was an overall improvement for their program. Of the PDs, 34.4% were unsure whether they would sustain virtual interviews in 2021-2022, 25% stated that they would not incorporate virtual interviews, and 40.7% stated that they would incorporate a virtual interview in some part of the cycle.ConclusionOtolaryngology PDs approached virtual interviewing in different ways. Despite the changes made, applicants can find comfort in knowing that match outcomes were perceived as typical by a majority of PDs.

Aligning Medical Student Workplace-Based Assessments with Entrustable Professional Activities and the RIME Model in a Psychiatry Clerkship.

The authors piloted use of workplace-based assessments of students during the psychiatry clerkship utilizing both entrustable professional activities (EPAs) and the reporter, interpreter, manager, and educator (RIME) model. After supervising cliniciansconducted assessments of medical students (N=109) during the psychiatry clerkship using a supervisory scale aligned with both EPA and RIME models, each student received individualized formative feedback. Students were then surveyed on the usefulness of this feedback, and participating faculty/residents were surveyed on the ease of completion of the supervisory scale. Students' mean skill profile suggested they no longer needed direct supervision on EPA1 and EPA6. Mean scores on other studied EPAs suggested students were well on their way toward performing these EPAs without direct supervision. Students had mean RIME scores that exceeded the suggested levels identified for a Reporter to start clerkships, for an Interpreter to start clerkships, and for a Manager to transition to the fourth year. Close to half of the students found the feedback helpful in their development as a clinician but most felt their performance should not be shared with residency program directors, either before or after the Match. Almost all responding preceptors felt the supervisory ratings were easy to complete. This pilot RIME/EPA framework served as a successful step toward a more competency-based medical education in the psychiatry clerkship with relatively little additional faculty time commitment by using workplace-based assessments already in place and a supervisory scale based on EPAs and RIME.

Gender inequality in PGY1 residency leadership positions and conferral of health-system pharmacy professional awards.

To address gender inequality, the American Society of Health-System Pharmacists (ASHP) created a steering committee that recommended the collection of baseline and ongoing metrics of pharmacy leadership. The purpose of this study was to quantify gender inequality in distributions of residency program director (RPD) and director of pharmacy (DOP) positions and to investigate gender distributions among recipients of ASHP professional leadership awards. RPD and DOP information for postgraduate year 1 (PGY1) programs included in the online ASHP residency directory were collected in December of 2020. Publicly available records were used to collect information on recipients of the Harvey A.K. Whitney Award and John W. Webb Award during the periods 1950-2020 and 1985-2020, respectively. Gender information for RPDs, DOPs, and award recipients was collected from listed pronouns available in public records. A χ 2 test was used for analysis of the collected data. A total of 1,176 PGY1 residency programs were included. Of the RPD positions assessed, 66% (n = 775) were filled by women pharmacists (P < 0.0001), while the percentage of DOP leadership positions held by women was 42% (n = 496) (P < 0.0001). Evaluation of data on recipients of the Harvey A.K. Whitney Award and John W. Webb Award revealed the occurrence of female recipients is 19.7% (n = 14) and 16.7% (n = 6), respectively (P < 0.0001). RPD positions have a higher prevalence of being filled by women. DOP positions remain male-dominated and revealed gender inequality among senior-level leadership roles. Pharmacy leadership award analysis identified further gender inequality. The results from the study serve as a baseline of current gender metrics for pharmacy leaderships in hospital systems with PGY1 residency programs.

Racial and oral health equity in dental school curricula.

ObjectivesThe objective of this study was to assess the current efforts to move dental school curriculum beyond diversity and inclusion toward an anti‐racism approach to racial equity.MethodsIn this cross‐sectional study, an electronic Qualtrics survey was sent to 67 Dental School Associate Deans/Deans of Academic Affairs and 15 Dental Public Health (DPH) Residency Program Directors. Survey topics included oral health equity, Critical Race Theory (CRT), racism and the physiologic impacts of racism on oral health. Descriptive statistics were used to demonstrate frequencies.ResultsOverall response rate was 31.7% (DPH = 6, predoctoral Dental = 20). The majority of respondents that answered the question stated that the educational program offered instruction in oral health equity (96.2%), racism (75%), and the physiologic impacts of racism on oral health (83.3%). Only 17.4% of the respondents stated that the educational program offered instruction in CRT. The main barriers to providing the instruction was limited faculty trained in the topics to offer the instruction or there was limited time to offer additional content in the curriculum.ConclusionsFindings demonstrate that oral health equity, racism and the physiologic impacts of racism are being discussed in dental education to some extent, but there is limited instruction in CRT. More robust efforts are needed to ensure dental students and DPH residents are competent in providing anti‐racist and unbiased health care; there should be an incorporation of anti‐racism standards in the Commission on Dental Accreditation (CODA)'s predoctoral and Advanced Education Program standards.

Selecting the Modern Cardiothoracic Surgery Trainee

In this issue of The Annals of Thoracic Surgery, in their review of the latest National Residency Matching Program’s report coupled with survey data from more than half of the country’s 6-year Integrated Thoracic Surgery (I-6) residency program directors, Obafemi and colleagues1 explore the ever-intensifying process of securing a training position in the field of cardiothoracic surgery. Whereas the metrics speak for themselves (average United States Medical Licensing Examination scores continue to rise, research experiences surpass those of applicants to any other specialty), excellence in these aspects on the part of a candidate can now be viewed only as a prerequisite for consideration.

Diversity among transplant surgery fellowship program directors: a call to action.

The diversity among general surgery residency, HPB and other fellowship program directors has been previously analyzed. However, the diversity in abdominal transplant surgery fellowship program directors remains unknown. Abdominal transplant fellowship programs and the corresponding program directors were identified from the American Society of Transplant Surgeons website. Demographic and training information for the members was compiled through internet searches and analyzed. 72 program directors were included. 83.33% were male. 63.9% were non-Hispanic White, 25% were Asian, along with 5.56% Hispanic and Black each. Male program directors were more likely to be Associate Professor (p=0.041), while females were more likely to be Assistant Professor (p=0.021). 66% of female program directors were non-Hispanic White. Transplant surgery fellowship programs are primarily led by male and non-Hispanic White surgeons. Female representation as leaders is on par with their membership in the transplant surgery workforce. There is a deficiency of both male and female underrepresented minorities in program director positions.

The Attributes and Influence of Individuals Associated With Newly Licensed Registered Nurses in Nurse Residency Programs: A Guide for Program Development.

Nurse residency programs address the preparation-practice gap by improving the confidence and skills of newly licensed registered nurses and increasing retention rates. Little is known about how persons involved in nurse residency programs influence new nurses' transition to practice. A qualitative descriptive study revealed five attributes of residency program directors, educators, preceptors, mentors, unit leaders, colleagues, and peers that either hindered or facilitated new nurses' transition to practice. Implications for residency program development are addressed.

The use of emotional intelligence skills in combating burnout among residency and fellowship program directors

BackgroundCurrent rates of burnout among physicians are alarming when compared to nonphysician U.S. workers, and numerous interventions have been introduced to mitigate the issue. However, no interventions have specifically targeted the 30% burnout rate among physician program directors. The complex and demanding role of program directors necessitates building relationships, solving crises, securing jobs for residents and maintaining well-being of trainees. The aim of this study is to investigate the impact of emotional intelligence (EQ) on burnout levels among program directors.MethodsA cross-sectional survey was administered from May 17 to June 30, 2021 to program directors and assistant/ associate program directors at an academic medical center in south-central Pennsylvania. A self-report questionnaire was used to collect data. The survey included an open-ended question along with the Trait Emotional Intelligence Questionnaire- Short Form (TEIQue-SF), Copenhagen Burnout Inventory (CBI), and demographic questions. All data were analyzed using SAS Version 9.4.ResultsOf the 109 program directors and assistant/associate program directors invited in the survey, 34 (31.20%) responded. The findings indicate that there is a moderate inverse association between EQ and burnout, suggesting EQ as a protective factor against burnout. We also found that program directors who were considering leaving their position demonstrated higher levels of burnout compared to those who did not. Results from the open-ended question suggest that perceived lack of support, micromanagement, criticism, and extra duties with less payment were among the reasons program directors and associates were considering steeping down from their position. The results showed no association between EQ skills and years of practicing.ConclusionsBurnout among program directors and assistant/associate program directors is not as alarming as rates of burnout among physicians-in-training. However, despite high level of EQ skills and low burnout level, nearly 43% of program directors were considering leaving their position. Nurturing EQ skills may be useful in improving retention and reducing turnover among medical leaders.

Perceptions of PGY-2 Oncology Programs on Financial Toxicity Education and Preparedness.

Cancer patients experience a rising monetary burden due to increased direct and in-direct costs associated with cancer treatment. This as a result has an adverse effect on the financial well-being of a cancer patient, also known as financial toxicity. Currently, there is a lack of literature surrounding the implementation of financial toxicity in post-graduate oncology residency training for pharmacists. The objective of this study was to describe the perceptions of PGY-2 oncology pharmacy residents and residency program directors on the incorporation of financial toxicity within their training programs and to assess self-perceptions of their level of abilities and experience managing financial toxicity for patients.A qualitative RedCap electronic survey was emailed in December 2020 to resident and directors of PGY-2 oncology programs in the United States.Out of 40 respondents, 64% of residency program directors were highly comfortable with the concept of financial toxicity, while 73% of pharmacy residents were uncomfortable with the concept of financial toxicity within their program. Furthermore, a majority of residents were either uncomfortable or highly uncomfortable managing financial toxicity for patients. In addition, the most commonly utilized method of incorporating the concept of financial toxicity in all programs was through specialty pharmacy and patient assistance programs (PAPs); residents also preferred these methods along with guest speakers to provide this training.Financial toxicity concepts should be considered as an educational standard and incorporated through unique methods of education. We suggest introducing the concept through guest speakers, followed by practical applications integrated in specialty pharmacies and PAPs.

The Current State of Journal Clubs in Psychiatry Residency Programs: Results from a National Survey of Program Directors.

ObjectiveThis study aimed to investigate journal club prevalence, implementation, and perceived effectiveness among psychiatry residency program directors in order to highlight best practices.MethodsThe authors distributed a 44-item thoughtfully designed and peer-reviewed questionnaire electronically via Qualtrics to 235 accredited U.S. psychiatry residency program directors identified using the American Medical Association database.ResultsEighty-nine programs (38%) responded. Of these, 83 (93%) had a journal club. Journal clubs were mandatory in 80 programs (96%), met biweekly or monthly in 62 programs (75%), and lasted 46–60 min in 66 programs (80%). Twenty-three programs (28%) offered a list of articles to choose from, and 22 programs (27%) provided a critical appraisal tool. Only 7 programs (8%) measured learner outcomes from journal clubs. Respondents believed that promoting lifelong learning and practicing evidence-based psychiatry were the most relevant educational goals of journal club (2.57 and 2.51 on a Likert scale of 0 to 3). Journal club’s effectiveness in achieving those goals was believed to be lower (2.16 and 2.09).ConclusionsJournal clubs are common in U.S. psychiatry residency programs and tend to follow a traditional format. In order to boost journal club’s effectiveness in achieving the desired educational goals, more programs might elect to infuse elements known to augment learning.

Surveying surgical skills: perceptions of ob/gyn residency program directors, chief residents and recent graduates

Prior studies suggest OBGYN residency graduates may be underprepared to perform gynecologic surgery at graduation. OBGYN residents typically receive a 18-24 months of surgical training, but it is unclear how much time is actually spent operating or how this translates to surgical competence. This study aimed to survey chief (PGY4) residents, program directors, and recent graduates on their perceptions of surgical experience.