Structure Of Residency Programs Research Articles

A Resident-Preceptor Collaboration to Encourage Wellness and Reduce Burnout Amongst Pharmacy Residents

Pharmacy residents are especially vulnerable to burnout given the professional and personal stressors associated with postgraduate training. Residency programs need to prioritize burnout reduction strategies to support resident health and well-being. This commentary describes a resident-preceptor collaborative approach to encourage wellness and reduce burnout within a large residency program at an academic medical center. Strategies that have been utilized include (1) fostering collaboration among residents and preceptors; (2) assessing resident interests and needs to ensure alignment; (3) leveraging available institutional and community resources; and (4) integrating initiatives within the existing residency program structure. This commentary aims to provide suggestions that can be implemented to address resident burnout for other residency programs, regardless of resource availability.

Dual Degree Training: Balancing Clinical Aptitude and Medical Licensure Requirements

Dual Degree Training: Balancing Clinical Aptitude and Medical Licensure Requirements

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.

Operating bedside cardiac ultrasound program in emergency medicine residency: A retrospective observation study from the perspective of performance improvement.

Point-of-care ultrasound is one of useful diagnostic tools in emergency medicine practice and considerably depends on physician's performance. This study was performed to evaluate performance improvements and favorable attitudes through structured cardiac ultrasound program for emergency medicine residents. Retrospective observational study using the point-of-care ultrasound (PoCUS) database in one tertiary academic-teaching hospital emergency department has been conducted. Cardiac ultrasound education and rotation program has been implemented in emergency medicine residency program. Structured evaluation sheet for cardiac ultrasound and questionnaire toward PoCUS have been developed. An early-phase and a late-phase case were selected randomly for each participant. Two emergency medicine specialists with expertise in PoCUS evaluated saved images independently. We used a paired t-test to compare the performance score of each phase and the results of the questionnaire. Multivariable linear regression analysis was conducted to evaluate the association between the characteristics of participants and performance improvements. During the study period, a total of 1,652 bedside cardiac ultrasounds were administered. Forty-six examinations conducted by 23 emergency medicine residents were randomly selected for analysis. The performance score increased from 39.5 to 56.1 according to expert A and 45.3 to 62.9 according to expert B (p-value <0.01 for both). The average questionnaire score, which was analyzed for 17 participants, showed improvement from 18.9 to 20.7 (p-value <0.01). In multivariable linear regression analysis, younger age, higher early-phase score and higher confidence had a negative association with a greater improvement of performance, while the number of examinations had a positive association. Bedside cardiac ultrasound performance and attitudes toward PoCUS have been improved through structured residency program.

Recommended Musculoskeletal and Sports Medicine Model Curriculum for Emergency Medicine Residency Training.

Musculoskeletal and sports medicine conditions are common in the emergency department (ED). Emergency physicians may not be receiving adequate education to achieve clinical competency in musculoskeletal medicine during residency training. This article aims to provide a standardized musculoskeletal and sports medicine curriculum for emergency medicine training. Broad curriculum goals include proficiency in evaluating and managing patients presenting to the ED with acute and chronic musculoskeletal complaints and other medical conditions related to or affected by physical exertion, sports participation, or environmental exposure. Specific objectives focus on knowledge of these disorders, physical examination skills, procedural skills including musculoskeletal ultrasound, appropriate consultation and referral, and patient education for these conditions. Educational methods will consist of didactics; online self-directed learning modules; simulation; and supervised clinical experiences in the ED, primary care sports medicine clinics, and orthopedic clinics if available. Curriculum implementation is expected to vary across programs due to differences in residency program structure and resources.

Impact of Surgery Program Characteristics on Fate of Non-designated Preliminary Surgery Interns

Non-designated preliminary (NDP) general surgery residents face the daunting challenge of obtaining a categorical residency position while undertaking the rigors of a general surgery residency. This additional application cycle represents a stressful time for these trainees and limited data exists to help guide applicants and program directors regarding the factors predictive of application success. While previous studies have focused solely on applicant related factors, no study to date has evaluated the effect of the residency program structure, institutional resources, or administrative support on these outcomes. A multicenter retrospective review of 10 general surgery residency programs over a 5-year period from 2014 to 2019 was performed. Applicant related information was compiled from NDP general surgery residents and the results of their attempted second application into a categorical position. Applicant factors including age, gender, standardized test scores (USMLE/ABSITE), and professional training were examined. Program and administrative structure including residency class size, number of NDP PGY-2 positions, number of assistant program directors and program director (PD) background were also examined. Primary success was defined as a NDP resident successfully obtaining a categorical position within general surgery or a surgical subspecialty. Secondary success was obtaining a categorical residency position in any field of medical practice other than surgery or a surgical subspecialty in the United States. A total of 260 NDP trainees were evaluated with an average age of 29.1. Almost seventy percent of applicants were male, 40% graduated from a non-U.S. medical school and 24.2% required a visa to work in the United States. Thirty 4 percent of NDPs successfully obtained a categorical surgery position and an additional 35% obtained a categorical residency position in a nonsurgical field for an overall match success rate of 68.9%. Factors associated with primary success included ABSITE score (p < 0.001), US medical school graduation (p = 0.02), visa status (p = 0.03), presence of preliminary PGY-2 positions (p = 0.02), and PD professional development time (p = 0.004). Overall success was associated USMLE Step 1 scores (p = 0.02), number of approved chiefs (p = 0.03), presence of dedicated faculty researchers (p = 0.001), and PD professional development time (p < 0.001). Applicant, program-related, and administrative factors all have a significant impact on the success of NDP general surgery residents in obtaining a categorical surgical position. Trainees should consider all of these factors when applying to NDP residencies and in approaching their second application cycle to maximize their likelihood of a successful match.

Stress and training satisfaction among resident doctors in Nigeria: Any justification for a change in training policy?

Background: There are pointers in existing literature to the stressful nature of residency program, thereby placing training physicians at increased risk of psychological distress. Objectives: The study identified perceived stress, its sources, training satisfaction, and the associated sociodemographic characteristics among resident doctors. Materials and Methods: A total of 405 self-administered questionnaires were given to all attendees of the National Postgraduate Medical College Revision Course. The questionnaires sought information on sociodemographic variables, sources of stress, and training satisfaction. Only 20 questionnaires were not returned. Data were collated and analyzed. Results: A majority of the respondents were male (69.1%), mostly between 31 and 35 years of age. Most (80%) of the respondents were married while 51.4% had over 4 dependents. All the respondents reported a significant level of stress, and different sources of stress were identified. Only 12 (3.1%) of the respondents were satisfied with the quality of training being received in their institutions. Conclusion: Our study found residency training to be stressful for doctors and often compounded by identifiable variables as shown in this study. Such stressful experience can, in turn, have negative impacts on their physical along with mental well-being and the patient care. Thus, there is a need for relevant stakeholders to review the structure of residency program with the view of addressing “modifiable risks” of stress among would-be specialists.

Differences in dermatology training abroad: A comparative analysis of dermatology training in the United States and in India.

Dermatology residency training is not standardized internationally, and each country dictates how training is conducted within its own borders. This article highlights the types of variability in training that can occur from country to country by comparing dermatology residency training programs in the United States and India. This article specifically analyzes the differences that pertain to application and selection, residency program structure, and post-residency opportunities.

A model of self-directed learning in internal medicine residency: a qualitative study using grounded theory

BackgroundExisting theories of self-directed learning (SDL) have emphasized the importance of process, personal, and contextual factors. Previous medical education research has largely focused on the process of SDL. We explored the experience with and perception of SDL among internal medicine residents to gain understanding of the personal and contextual factors of SDL in graduate medical education.MethodsUsing a constructivist grounded theory approach, we conducted 7 focus group interviews with 46 internal medicine residents at an academic medical center. We processed the data by using open coding and writing analytic memos. Team members organized open codes to create axial codes, which were applied to all transcripts. Guided by a previous model of SDL, we developed a theoretical model that was revised through constant comparison with new data as they were collected, and we refined the theory until it had adequate explanatory power and was appropriately grounded in the experiences of residents.ResultsWe developed a theoretical model of SDL to explain the process, personal, and contextual factors affecting SDL during residency training. The process of SDL began with a trigger that uncovered a knowledge gap. Residents progressed to formulating learning objectives, using resources, applying knowledge, and evaluating learning. Personal factors included motivations, individual characteristics, and the change in approach to SDL over time. Contextual factors included the need for external guidance, the influence of residency program structure and culture, and the presence of contextual barriers.ConclusionsWe developed a theoretical model of SDL in medical education that can be used to promote and assess resident SDL through understanding the process, person, and context of SDL.

Medical Residents’ Practices and Perceptions toward Do-Not-Resuscitate (DNR) Order

The knowledge and implementation skills of the DNR order amongst physicians in training appear to be quite variable. Few studies had assessed residents' views on this complex topic. Our objective was to describe the medical residents’ practices and perceptions toward DNR order. A 26 question survey was distributed to medical residents during the academic day activity. Only 56 residents completed the questionnaire (75% response rate). 61.40% of the residents understood the definition of DNR order. 85.96% thought physicians shouldn’t order diagnostic tests for DNR patients and 92.98% thought physicians shouldn’t give blood products and antibiotics to DNR patients. 45.61% thought DNR order would lead to poor care. 36.84% thought physician alone should decide about the DNR decision. 45.61% answered that DNR order never discussed with patients. 64.91% answered that consultant discussed DNR order with patients. 42.11% of residents were involved in the discussion of DNR order. 66.67% answered that time to decide about the DNR order on day of admission. 42.11% answered there was variation between consultants regarding the care of DNR patient. 43.86% answered there was variation in the clinical care before and after DNR order was placed. 87.72% thought here was a need for formal training in DNR discussion. 68.42% didn’t know if KFSH and RC had clinical guidelines for DNR patients care. Conclusion: (1) Majority of the residents had misunderstanding regarding DNR patient care and comfortable care. There is a need for developing a structured residency program curriculum to address resident skills in end-oflife care. (2) Encouraged discussions DNR issues in the outpatient setting could prevent unwanted resuscitation in the acute setting. (3) Efforts are needed to increase patients and their families’ awareness about the meaning of DNR order. (4) There is a need to unify and improve quality of care provided to DNR patients by developing specific strategies within a framework of goals of care.

Perception of Teaching and Assessing Technical Proficiency in American College of Veterinary Surgeons Small Animal Surgery Residency Programs.

To determine how American College of Veterinary Surgeons (ACVS) small animal surgery residency programs are teaching and assessing technical skills, and ascertain the perceived value of those methods. Internet-based survey. Residents and Diplomate supervisors of ACVS small animal residency programs. Residents and supervisors were surveyed on their experience of surgery instruction, use of different resources for teaching, type and frequency of feedback, and perceived effectiveness of their programs in imparting technical proficiency. A total of 130 residents (62%) and 119 supervisors (44%) participated. Both residents and supervisors estimated the resident was the primary surgeon for a mean of 64% of cases, although this proportion varied widely between participants. The majority of residents and supervisors considered that direct intraoperative guidance was the most effective way for residents to develop technical skills. Verbal interactions between supervisor and resident occurred frequently and were highly valued. Regular wet laboratories and access to simulation models were uncommon. Despite over 90% of all participants reporting that a sufficient level of technical aptitude would be attained, only 58% of residents were satisfied with their technical skills training. Residents relied on direct interaction with supervisors to develop technical skills. The traditional mode of instruction for veterinary residents is the apprenticeship model, which is partly driven by ACVS requirements of supervisory support. Exposure to other teaching and assessment methods was variable. The current structure of residency programs is successful in imparting technical competency as perceived by supervisors and residents. However, consideration of a more formal method of residency training with structured assessment of technical skills as in human medicine should not be dismissed.

Supervisor continuity or co-location: which matters in residency education? Findings from a qualitative study of remote supervisor family physicians in Australia and Canada.

Changes to health care systems and working hours have fragmented residents' clinical experiences with potentially negative effects on their development as professionals. Investigation of off-site supervision, which has been implemented in isolated rural practice, could reveal important but less overt components of residency education. Insights from sociocultural learning theory and work-based learning provided a theoretical framework. In 2011-2012, 16 family physicians in Australia and Canada were asked in-depth how they remotely supervised residents' work and learning, and for their reflections on this experience. The verbatim interview transcripts and researchers' memos formed the data set. Template analysis produced a description and interpretation of remote supervision. Thirteen Australian family physicians from five states and one territory, and three Canadians from one province, participated. The main themes were how remoteness changed the dynamics of care and supervision; the importance of ongoing, holistic, nonhierarchical, supportive supervisory relationships; and that residents learned "clinical courage" through responsibility for patients' care over time. Distance required supervisors to articulate and pass on their expertise to residents but made monitoring difficult. Supervisory continuity encouraged residents to build on past experiences and confront deficiencies. Remote supervision enabled residents to develop as clinicians and professionals. This questions the supremacy of co-location as an organizing principle for residency education. Future specialists may benefit from programs that give them ongoing and increasing responsibility for a group of patients and supportive continuity of supervision as residents.

What do General Surgery Residents Operate During the Residency Program? An Analysis of the Applicability of the Specialty Program in General and Digestive Surgery

Residents in our country have achieved a homogenous surgical training by following a structured residency program. This is due to the existence of specific training programs for each specialty. The current program, approved in 2007, has a detailed list of procedures that a surgeon should have performed in order to complete training. The aim of this study is to analyze the applicability of the program with regard to the number of procedures performed during the residency period. Material and methodsA data collection form was designed that included the list of procedures from the program of the specialty; it was sent in April 2014 to all hospitals with accredited residency programs. In September 2014 the forms were analyzed, and a general descriptive study was performed; a subanalysis according to the resident's sex and Autonomous region was also performed. The number of procedures performed according to the number of residents in the different centers was also analyzed. ResultsThe survey was sent to 117 hospitals with accredited programs, which included 190 resident places. A total of 91 hospitals responded (53%). The training offered adapts in general to the specialty program. The total number of procedures performed in the different sub-areas, in laparoscopic and emergency surgery is correct or above the number recommended by the program, with the exception of esophageal-gastric and hepatobiliary surgery. The sub-analysis according to Autonomous region did not show any significant differences in the total number of procedures, however, there were significant differences in endocrine surgery (P=.001) and breast surgery (P=.042). A total of 55% of residents are female, with no significant differences in distribution in Autonomous regions. However, female surgeons operate more than their male counterparts during the residency period (512±226 vs 625±244; P<.01). The number of residents in the hospital correlates with the number of procedures performed; the residents with more procedures trained in hospitals where there were less residents (669±237 vs 527±209; P=.004). ConclusionThe surgical activity performed by Spanish surgeons is adequate to the specialty program, except in hepatobiliary and esophageal-gastric surgery. The distribution is homogeneous in the different autonomous regions, although there are differences that depend on the number and sex of the residents in each hospital. This information is essential to evaluate the quality of the specialty program and to design new training programs.

¿Qué operan los residentes españoles durante la residencia?: análisis de la aplicabilidad del programa de la especialidad de Cirugía General y Digestiva al finalizar el periodo de residencia

Residents in our country have achieved a homogenous surgical training by following a structured residency program. This is due to the existence of specific training programs for each specialty. The current program, approved in 2007, has a detailed list of procedures that a surgeon should have performed in order to complete training. The aim of this study is to analyze the applicability of the program with regard to the number of procedures performed during the residency period. Material and methodsA data collection form was designed that included the list of procedures from the program of the specialty; it was sent in April 2014 to all hospitals with accredited residency programs. In September 2014 the forms were analysed, and a general descriptive study was performed; a subanalysis according to the resident's sex and Autonomous region was also performed. The number of procedures performed according to the number of residents in the different centers was also analyzed. ResultsThe survey was sent to 117 hospitals with accredited programs, which included 190 resident places. A total of 91 hospitals responded (53%). The training offered adapts in general to the specialty program. The total number of procedures performed in the different sub-areas, in laparoscopic and emergency surgery is correct or above the number recommended by the program, with the exception of esophageal-gastric and hepatobiliary surgery. The sub-analysis according to Autonomous region did not show any significant differences in the total number of procedures, however, there were significant differences in endocrine surgery (P=.001) and breast surgery (P=.042). A total of 55% of residents are female, with no significant differences in distribution in Autonomous regions. However, female surgeons operate more than their male counterparts during the residency period (512±226 vs. 625±244; P<.01). The number of residents in the hospital correlates with the number of procedures performed; the residents with more procedures trained in hospitals where there were less residents (669±237 vs. 527±209; P=.004). ConclusionThe surgical activity performed by spanish surgeons is adequate to the specialty program, except in hepatobiliary and esophageal-gastric surgery. The distribution is homogeneous in the different autonomous regions, although there are differences that depend on the number and sex the of residents in each hospital. This information is essential to evaluate the quality of the specialty program and to design new training programs.

Predictors of Radiation Oncology Resident Research Productivity

Academic research is an essential part of residency training, yet resident productivity in research seems to be highly variable. The aim of this study was to determine the factors, both individual and institutional, that contribute to research output among radiation oncology residents. Newly practicing radiation oncologists and current senior residents were identified and invited via e-mail to complete a web-based survey. The survey addressed demographic factors, previous academic accomplishments, and residency program structure. The end point, research productivity, was defined as the number of first-author papers produced or research grants awarded on the basis of work initiated during residency. Ninety-seven of the 232 senior residents and recently graduated radiation oncologists surveyed responded (a 42% response rate). The median number of publications produced on the basis of work during residency was 3 (range, 0-7). Twenty-one respondents indicated that they had received 1 or more grants. Forty-four respondents completed <6 months of research, while 53 completed ≥6 months of research. Univariate analysis revealed that a scientific college major and the amount of designated research time were positively correlated (P < .05) with first-author publications. Entering with a PhD, presenting research at an international meeting before residency, participation in the Holman Research Pathway, female gender, publications before residency, and the amount of designated research time were positively correlated (P < .05) with receiving a research grant. On multivariate regression analysis, the amount of designated research time was the sole determinant of first-author papers (P < .007), while participation in the Holman Pathway was the only surveyed factor that was correlated with research grants awarded (P < .001). The amount of designated research time during residency training is the sole independent predictor of research productivity as measured by publications. Participation in the Holman Pathway is the sole detected item shown to be an independent predictor of achieving a peer-reviewed grant. Residency program structure has a major impact on the productivity of residents.

Residency Factors That Influence Pediatric In-Training Examination Score Improvement

The goal of this study was to determine which measurable factors of resident training experience contribute to improvement of in-training examination (ITE) and certifying examination (CE) scores. This is a descriptive retrospective study analyzing data from July 2003 through June 2006 at a large academic pediatric training program. Pediatric categorical residents beginning residency in July 2003 were included. Regression analyses were used to determine if the number of admissions performed, core lectures attended, acute care topics heard, grand rounds attended, continuity clinic patients encountered, or procedures performed correlated with improvement of ITE scores. These factors were then analyzed in relation to CE scores. Seventeen residents were included in this study. The number of general pediatric admissions was the only factor found to correlate with an increase in ITE score (P = .04). Scores for the ITE at pediatric levels 1 and 3 were predictive of CE scores. No other factors measured were found to influence CE scores. Although all experiences of pediatric residents likely contribute to professional competence, some experiences may have more effect on ITE and CE scores. In this study, only general pediatric admissions correlated significantly with an improvement in ITE scores from year 1 to year 3. Further study is needed to identify which elements of the residency experience contribute most to CE success. This would be helpful in optimizing residency program structure and curriculum within the limitations of duty hour regulations.

Specialist Training in Obstetrics and Gynecology in Singapore: Transition to Structured Residency Program

The article describes the experience of planning and implementing the transition of the residency program in obstetrics and gynecology at Singhealth, Singapore, from a model largely based on British training principles to a new model in accordance with the ACGME-International (ACGME-I) standards. Initial steps in transitioning to the new model entailed (1) identifying faculty with an interest in education to lead the various initiatives and programs and to ensure appropriate educational role models, (2) securing adequate funding, (3) holding focus groups with physicians to identify opportunities for improvement in the new system, and (4) developing a schedule for the phased implementation of key features of the structured system. The program started in July 2011, with 14 residents for a 4-year course of training. The curriculum consisted of 5 modules: (1) general obstetrics and gynecology and ambulatory care, (2) maternal fetal medicine, (3) urogynecology and minimally invasive surgery, (4) reproductive medicine, and (5) gynecology oncology. Faculty was assigned responsibility for teaching and assessing the 6 competencies, and appropriate training was provided through specially designed, professional-development programs. Challenges in the implementation of the new training program included the need to replace clinical service previously provided by trainees, a lack of fit between the traditional qualifying exam and the new model for training, and the need to adapt teaching strategies to new competencies not explicitly taught in the prior program, particularly practice-based learning and improvement and systems-based practice. The strength of the new obstetrics and gynecology residency lies in having a structured, competency-based, closely supervised approach to training with standardized evaluations, timely feedback, and a committed faculty.

SU‐E‐E‐04: The Doctor of Medical Physics, a New Professional Degree

Purpose: In the last 2 to 3 decades, rapid changes have occurred in the fields of radiology oncology prompting a need to rethink training required for medical physicists. It is clear that traditional approaches of obtaining an academic M.S. or Ph.D. degree, coupled with minimal on‐the‐job training, have not produced an acceptable success rate for credentialing by the American Board or Radiology (ABR). As a result, the ABR has taken steps to define required training criteria prior to examination in an attempt to resolve this matter. Methods: In 2006, initial steps began at Texas Tech University to design a new doctoral degree to prepare students to successfully enter and compete in the field of medical physics. This 5‐year degree, the Doctor of Medical Physics, is a clinical degree patterned after the MD degree. This is a new degree program that is complimentary to and not competitive with traditional M.S. and Ph.D. degrees designed to prepare students for academic careers. The Doctor of Medical Physics is appropriate for those physicists who wish to focus their careers in clinical medical physics in an interactive role with their physician colleagues. The first year is indeed the first year of medical school, with the second and third years focused on an interdisciplinary didactic program including physics, biology, mathematics, and related topics. Years 4 and 5 include a structured residency program with graduation contingent on successful completion of the written ABR Examinations. The opportunity exists for a final fellowship year as the student prepares for the oral boards. Results: In 2010, this degree was approved by the Southern Association of Colleges and Schools, Commission on Colleges (SACS‐COC) and by Texas Higher Education Coordinating Board. Conclusions: Other schools in Texas are in various stages of implementing similar degree programs.

Residents’ Practices and Perceptions About Do Not Resuscitate Orders and Pronouncing Death: An Opportunity for Clinical Training

Although ''Do not resuscitate'' (DNR) orders are among the most commonly discussed patient preference treatment measures, few studies have assessed internal medicine residents' views on this complex topic. Our objective was to assess resident practices in establishing code status. We also examined resident training and experiences in pronouncing death. An 18-question survey addressing DNR discussions and pronouncing death was emailed to internal medicine residents in the state of Illinois. Each question had multiple-choice options. A total of 175 residents completed the questionnaire (22% response rate). Seventy-eight percent of the residents had discussed DNR status with patients or their families at least 9 times. However, only one third of the residents felt very comfortable in such discussions. Only 26% of the residents had been observed by a faculty member during a code status discussion and fewer (16%) while pronouncing death. Do not resuscitate discussions rarely occurred in an outpatient clinic (27%). Most residents (90%) thought they would benefit from formal training in DNR discussion. Although most residents discuss DNR status with patients and families, only a quarter are observed in such discussions by attending physicians and only a third feel comfortable with this aspect of clinical care. Developing a structured residency program curriculum to address resident skills in end-of-life care would benefit residency training.

An Assigned Teaching Resident Rotation

The authors' adult psychiatry residency training program identified several educational needs for residents at their institution. Junior residents needed enhanced learning of clinical interviewing skills and learning connected to the inpatient psychiatry ward rotations, and senior residents needed opportunities to prepare for the specialty board exam and to develop teaching skills in preparation for attending positions. Changing the residency program structure and implementing a Teaching Resident rotation addressed these needs simultaneously. The authors describe the responsibilities of the teaching resident, the role of the teaching resident in the program, and instruction in educational methods. Residents shared their perceptions of the new teaching resident rotation in an anonymous survey. PGY-1, PGY-2, and the PGY-4 residents found the teaching resident rotation helpful in many areas of their learning. Service requirements were not compromised and highly valuable educational objectives were achieved for both the PGY-4 teaching residents and the PGY-1 and PGY-2 residents whom they taught. An intensive teaching rotation for senior residents who teach junior residents and medical students is an effective way to deal with systemic changes in psychiatric education.