Residency Program Leadership Research Articles

Putting the pediatrics milestones into practice: a consensus roadmap and resource analysis.

The Accreditation Council for Graduate Medical Education has partnered with member boards of the American Board of Medical Specialties to initiate the next steps in advancing competency-based assessment in residency programs. This initiative, known as the Milestone Project, is a paradigm shift from traditional assessment efforts and requires all pediatrics residency programs to report individual resident progression along a series of 4 to 5 developmental levels of performance, or milestones, for individual competencies every 6 months beginning in June 2014. The effort required to successfully make this shift is tremendous given the number of training programs, training institutions, and trainees. However, it holds great promise for achieving training outcomes that align with patient needs; developing a valid, reliable, and meaningful way to track residents' development; and providing trainees with a roadmap for learning. Recognizing the resources needed to implement this new system, the authors, all residency program leaders, provide their consensus view of the components necessary for implementing and sustaining this effort, including resource estimates for completing this work. The authors have identified 4 domains: (1) Program Review and Development of Stakeholders and Participants, (2) Assessment Methods and Validation, (3) Data and Assessment System Development, and (4) Summative Assessment and Feedback. This work can serve as a starting point and framework for collaboration with program, department, and institutional leaders to identify and garner necessary resources and plan for local and national efforts that will ensure successful transition to milestones-based assessment.

Social Media Milestones: Entrusting Trainees to Conduct Themselves Responsibly and Professionally

In this issue of the Journal of Graduate Medical Education, Kesselheim and colleagues1 report on a survey of pediatrics residency program leadership. The study found that approximately one-third of this group is very familiar with social networking sites (SNS), and approximately one-fifth of the respondents use it daily or often, which agrees with findings from other studies of educational leaders.1–3 Their survey reveals that three-fourths of program directors think that inappropriate behavior by residents on SNS is somewhat or very prevalent and are concerned that the prevalence may increase. In an effort to address this concern, the study by Kesselheim et al1 found that approximately half of residency programs educate trainees about SNS at intern orientation, some use written guidelines, and a subset of programs address the issue only when remediation becomes necessary.

Applying the Milestones in an Internal Medicine Residency Program Curriculum

In 2010, University of Kansas Medical Center internal medicine residency program leaders concluded that their competency-based curriculum and evaluation system was not sufficient to promote accurate assessment of learners' performance and needed revision to meet the requirements of the Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System (NAS). Evaluations of learners seldom referenced existing curricular goals and objectives and reflected an "everyone is exceptional, no one is satisfactory" view.The authors identified the American Board of Internal Medicine and ACGME's Developmental Milestones for Internal Medicine Residency Training as a published standard for resident development. They incorporated the milestones into templates, a format that could be modified for individual rotations. A milestones-based curriculum for each postgraduate year of training and every rotation was then created, with input from educational leaders within each division in the Department of Internal Medicine and with the support of the graduate medical education office.In this article, the authors share their implementation process, which took approximately one year, and discuss their current work to create a documentation system for direct observation of entrustable professional activities, with the aim of providing guidance to other programs challenged with developing an outcomes-based curriculum and assessment system within the time frame of the NAS.

Nurse Residency Program Leaders

Nurse Residency Program Leaders

Administrative Organization in Diagnostic Radiology Residency Program Leadership

The aim of this study was to document the current state of administrative structure in US diagnostic radiology (DR) residency program leadership. A secondary objective was to assess for correlation(s), if any, with DR residency programs that equipped positions such as assistant, associate, and emeritus program director (PD) with respect to residency size and region of the country. The Fellowship and Residency Electronic Interactive Database, as well as direct communication and programmatic Web site searches, were used to gather data regarding current US DR residency leadership. Data collected included the presence of additional leadership titles, including assistant PD, associate PD, and PD emeritus, and how many faculty members currently held each position. Programs were excluded if results could not be identified. Analysis of variance and t tests were used to estimate the correlations of the size of a residency with having additional or shared PD positions and the types of positions, respectively. Chi-square tests were used to assess for any regional differences. As of the time of this project, the Fellowship and Residency Electronic Interactive Database defined 186 US DR residency programs. A total of 173 programs (93%) were included in the analysis; the remainder were excluded because of unavailability of relevant data. Seventy-two percent (124 of 173) of programs had additional DR leadership positions. Of these, 30 programs (17%) had more than one such position. There were no significant differences in the sizes of the programs that used these additional positions (mean, 25 ± 12; range, 6-72) compared with those that did not (mean, 24 ± 12; range, 7-51). There were no significant differences between programs that had additional positions with respect to region of the country. The majority of US DR residency programs used some form of additional DR leadership position. In the majority of cases, this was in the form of an assistant or associate PD. Nearly one-fifth of programs studied had more than one such position. This is a positive model for the depth and breadth of management of US residency programs, serving both as a template for matrixed leadership and as a source of leadership succession planning.

Scholarly Tracks in Emergency Medicine

Over the past decade, some residency programs in emergency medicine (EM) have implemented scholarly tracks into their curricula. The goal of the scholarly track is to identify a niche in which each trainee focuses his or her scholarly work during residency. The object of this paper is to discuss the current use, structure, and success of resident scholarly tracks. A working group of residency program leaders who had implemented scholarly tracks into their residency programs collated their approaches, implementation, and early outcomes through a survey disseminated through the Council of Emergency Medicine Residency Directors (CORD) list-serve. At the 2009 CORD Academic Assembly, a session was held and attended by approximately 80 CORD members where the results were disseminated and discussed. The group examined the literature, discussed the successes and challenges faced during implementation and maintenance of the tracks, and developed a list of recommendations for successful incorporation of the scholarly track structure into a residency program. Our information comes from the experience at eight training programs (five 3-year and three 4-year programs), ranging from 8 to 14 residents per year. Two programs have been working with academic tracks for 8 years. Recommendations included creating clear goals and objectives for each track, matching track topics with faculty expertise, protecting time for both faculty and residents, and providing adequate mentorship for the residents. In summary, scholarly tracks encourage the trainee to develop an academic or clinical niche within EM during residency training. The benefits include increased overall resident satisfaction, increased success at obtaining faculty and fellowship positions after residency, and increased production of scholarly work. We believe that this model will also encourage increased numbers of trainees to choose careers in academic medicine.

Education First: Reforming the First-Year Curriculum of the Internal Medicine Residency

Many opinion leaders of the academic internal medicine community have expressed concern about the adequacy of internal medicine (IM) residency training to prepare residents for their careers and to attract medical students to IM residency programs. In response to those concerns, several core organizations have prepared reports and issued significant recommendations suggesting comprehensive reform and restructuring of IM training programs.The authors discuss their approach, strategy, and efforts to restructure the first year in the IM residency training program at the University of California, Irvine. They point out that educators have often viewed the internship as a rite of passage, heavy with inpatient service commitment. However, in the authors' view, the current trend to residents' early subspecialty commitment has made it imperative that the first year of IM residency be more focused, standardized, meaningful, and effective in order to achieve core educational goals before each resident's career focus has become too narrowed and while the big picture is more apparent. The authors describe in detail their review of their first-year curriculum based on consensus goals and objectives. This process led to a restructuring of the first year that places emphasis on a defined educational model and a central core curriculum. The authors conclude that residency program leaders can restructure the first year to provide a model of education that includes appropriate educational experiences as well as meaningful time for reflection and professional growth.

OPHTHALMOLOGY RESIDENCY PROGRAM LEADERSHIP EXPECTATIONS OF RESIDENT COMPETENCY IN RETINAL PROCEDURES AND RESIDENT EXPERIENCE WITH RETINAL PROCEDURES

To investigate ophthalmology residency program leadership expectations regarding resident competency in retinal procedures by graduation and to investigate resident experience performing retinal procedures. A survey was emailed to the program director at each accredited US ophthalmology training program. Completed surveys were received from 37/117 (32%) programs. Most respondents identified panretinal photocoagulation (100%), laser for retinal tear (100%), laser for diabetic macular edema (94%), laser for macular edema associated with branch retinal vein occlusion (92%), intravitreal injection (83%), and vitreous tap/intravitreal injection (78%) as procedures residency graduates should be competent to perform; 89%, 3%, 64%, 17%, 14%, and 3% reported residents perform >20 such cases, respectively, as primary surgeon, and 0%, 56%, 6%, 37%, 46%, and 63% reported residents perform one to five such cases, respectively. Competency in scleral buckling and pars plana vitrectomy was expected by 17% and 19%, respectively. Most respondents expect residency graduates to be competent in retinal laser and injection procedures. Competency in incisional retinal procedures is generally not expected. For some laser and injection procedures, a substantial proportion of residents perform one to five cases as primary surgeon.

Responsibly Managing Ethical Challenges of Residency Training: A Guide for Surgery Residents, Educators, and Residency Program Leaders

Responsibly Managing Ethical Challenges of Residency Training: A Guide for Surgery Residents, Educators, and Residency Program Leaders