Year Of Residency Research Articles

Facing the challenges of chief resident year: A standardized experiential simulation leadership curriculum (S13.002)

<h3>Objective:</h3> Design, implement and evaluate a case-based, experiential curriculum focused on development of key skills necessary for successful execution of the chief resident role. <h3>Background:</h3> A chief resident’s role incorporates administrative, academic and social responsibilities essential to the conduct of a successful residency program. However, rising chief residents receive little formal exposure to leadership training. <h3>Design/Methods:</h3> We developed a one-day curriculum combining didactics and simulation activities for rising chief residents (n=16) from three training programs at NYU Langone (Neurology, Double Board, and Child Neurology), administered six weeks before the first day of chief year. We discussed key topics in leadership and reviewed a psychometric evaluation tool (<i>Insights Discovery)</i> prior to the curriculum day. The simulation activity consisted of three group objective structured clinical examinations scenarios (G-OSCEs) in our simulation center with a focus on: 1) Providing a struggling junior trainee with feedback; 2) Debriefing a bad clinical outcome as team leader; 3) Navigating a challenging situation with a junior faculty member. Learners completed a pre-intervention questionnaire before the curriculum regarding their levels of familiarity and preparedness for their chief year. Learners were surveyed about their overall experience at the completion of the day. Post-intervention questionnaire data was collected in September 2022 (n=9). <h3>Results:</h3> Comparison of pre and post intervention data suggests improvements in familiarity across the key domains of communication skills, feedback, leadership development, organizational culture, cultural competency, and wellness. All participants demonstrated improved comfort in regards to the simulated scenario situations, most notably with debriefing a bad outcome. Learners reported satisfaction with all elements of the leadership development day, and in particular, noted the experience with the psychometric evaluation debrief as the highlight of the curriculum. <h3>Conclusions:</h3> A one-day leadership development curriculum combining didactics and simulation is an effective means of preparing rising chief residents to succeed in their transition to this leadership role. <b>Disclosure:</b> The institution of Dr. Zakin has received research support from American Board of Psychiatry and Neurology. Dr. Abou Fayssal has nothing to disclose. Dr. Lord has nothing to disclose. Dr. Nelson has nothing to disclose. Dr. Rostanski has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for individual law firms. Dr. Zhang has nothing to disclose. Sondra Zabar has nothing to disclose. Dr. Galetta has nothing to disclose. Dr. Kurzweil has nothing to disclose.

Assessment of the competence in electrocardiographic interpretation among Arabic resident doctors at the emergency medicine and internal medicine departments: A multi-center online cross-sectional study.

This study aims to assess the electrocardiographic interpretation abilities of resident doctors at internal medicine and emergency medicine departments in eight Arabic countries. An online cross-sectional study was conducted between October 7, 2022 and October 21, 2022 in eight Arabic countries. The questionnaire consisted of two main sections: the first section included sociodemographic information, while the second section contained 12 clinical case questions of the most severe cardiac abnormalities with their electrocardiography (ECG) recordings. Out of 2,509 responses, 630 were eligible for the data analysis. More than half of the participants were males (52.4%). Internal medicine residents were (n = 530, 84.1%), whereas emergency medicine residents were (n = 100, 15.9%). Almost participants were in their first or second years of residency (79.8%). Only 36.2% of the inquired resident doctors had attended an ECG course. Most participants, 85.6%, recognized the ECG wave order correctly, and 50.5% of the participants scored above 7.5/10 on the ECG interpretation scale. The proportions of participants who were properly diagnosed with atrial fibrillation, third-degree heart block, and atrial tachycardia were 71.1, 76.7, and 56.6%, respectively. No statistically significant difference was defined between the internal and emergency medicine residents regarding their knowledge of ECG interpretation (p value = 0.42). However, there was a significant correlation between ECG interpretation and medical residency year (p value < 0.001); the fourth-year resident doctors had the highest scores (mean = 9.24, SD = 1.6). As well, participants in the third and second years of postgraduate medical residency have a probability of adequate knowledge of ECG interpretation more than participants in the first year of residency (OR = 2.1, p value = 0.001) and (OR = 1.88, p value = 0.002), respectively. According to our research findings, resident doctors in departments of internal medicine and emergency medicine in Arabic nations have adequate ECG interpretation abilities; nevertheless, additional development is required to avoid misconceptions about critical cardiac conditions.

Assess the Relationship between the Emirates Medical Residency Entry Examination, Grade Point Average, and Multiple Mini Interview Scores and the Resident’s End-of-Year-One Performance in the UAE

Background: Emirates Medical Residency Entry Examination (EMREE), grade point average (GPA), and multiple mini interviews (MMIs) offer a framework for using independent tests to choose medical students for interviewing and employment, finding people who would do well as residents and become good physicians. However, no one indicator can be used to properly predict performance in residency. Purpose: The primary goal of this study was to measure the relationship between the EMREE score, GPA, and MMI and the performance of residents in year 1. Methods: During the months of September 2021 and July 2022, a quantitative, descriptive, and correlational investigation was conducted in the UAE. Convenience sampling of applicants who met the inclusion criteria was used for the purposes of the current study. Results: There were 106 participants in the current study. EMREE and end-of-year-one evaluation had a moderate positive relationship that was significant statistically (r = 0.599**, n = 106, p < 0.05), according to a Pearson correlation. Similar to this, there was a significant relationship (r = 0.665**, p < 0.05) between GPA and the end-of-year-one performance. Likewise, there was a statistically significant (r = 0.996**, p < 0.05) positive association between MMI the end-of-year-one performance. Conclusion: The present study discovered a significant relationship between resident performance and the EMREE at the conclusion of year one. Additionally, the MMI is indeed a helpful tool to help in the selection of medical students and predict future performance. Additionally, the performance of medical students during their first year of residency can be predicted using their GPA, which has a substantial correlation.

Building Resident Quality Improvement Knowledge and Engagement Through a Longitudinal, Mentored, and Experiential Learning-Based Quality Improvement Curriculum.

Quality improvement (QI) training is an essential component of resident medical education and a part of the ACGME core competencies. We present our residency's evidence-based QI curriculum, which outlines key components identified in the literature for successful QI education. Our curriculum included a mandatory five-part longitudinal educational series during ambulatory education sessions for second-year residents. Modeled after the Institute for Healthcare Improvement model for improvement and taught by a chief resident, our curriculum introduced residents to key QI concepts through case-based, just-in-time didactics and applied experiential learning via concurrent resident-led longitudinal QI projects. Residents received structured, multilayer mentorship from a faculty mentor in their field of interest and the chief resident of quality and patient safety. Their work-in-progress projects were presented to faculty QI experts and institutional leadership for additional feedback and mentorship. Since 2016, a total of 234 internal medicine residents have completed our QI curriculum and developed 67 QI projects, which have been presented at various local, regional, and national conferences. In the 2 most recent academic years, Quality Improvement Knowledge Application Tool Revised (QIKAT-R) scores significantly increased from 4.6 precurriculum to 6.3 postcurriculum (p < .001). A longitudinal, experiential, and mentored QI curriculum teaches residents QI skill sets through incorporating mechanisms associated with successful educational initiatives and adult learning theory. Our QIKAT-R results and project output show that our curriculum is associated with improved trainee QI knowledge and systems-level improvements.

Association between Acculturation and Obesity among Female Migrants in the United Arab Emirates: A Population-Based Study

Abstract Introduction Emerging evidence suggests that the “healthy migrant effect” may diminish over time with increasing years of residency in the host country. However, few studies have documented the duration of residence associated with the prevalence of obesity among female migrants. This study examined the hypothesis that acculturation is associated with an increased prevalence of obesity among female migrants in the United Arab Emirates (UAE). Results The mean ± standard deviation (SD) of the age of participants was 34.0 ± 9.9 years. The overall prevalence of overweight, obesity, and central adiposity was 30.0, 16.8, and 43.2%, respectively. The prevalence of overweight, obesity, and central adiposity varied across nationalities, with 28.6, 6.9, and 30.3% among Filipinos; 30.1, 37.5, and 66.9% among Arabs; and 33.1, 17.3, and 72.4% among South Asians, respectively. After controlling for age, female migrants with ≥5 years of residence in the UAE were twice as likely to be overweight or obese (adjusted odds ratio [aOR]: 2.12 [95%confidence interval (CI): 1.05–4.27]) and having a central adiposity (aOR: 2.05 [95%CI: 1.09–3.84]) as compared with those with fewer years of residence. Female migrants who reported walking for ≤30 min/d were less likely to be overweight or obese (aOR: 0.41 [95%CI: 0.17–0.97]) or exhibit central adiposity (aOR: 0.21 [95%CI: 0.08, 0.59]). Conclusion The findings of the study suggest that duration of residence among female migrants in the UAE is an indicator of acculturation and is associated with unfavorable changes in body composition. Public health programs should focus on promoting healthy lifestyle choices and physical activity among females in the UAE.

Primary, allied health, geriatric, pain and palliative healthcare service utilisation by aged care residents, 2012-2017.

To examine the incidence and trends in primary care, allied health, geriatric, pain and palliative care service use by permanent residential aged care (PRAC) residents and the older Australian population. Repeated cross-sectional analyses on PRAC residents (N = 318,484) and the older (≥65 years) Australian population (N ~ 3.5 million). Outcomes were Medicare Benefits Schedule (MBS) subsidised primary care, allied health, geriatric, pain and palliative services between 2012-13 and 2016-17. GEE Poisson models estimated incidence rates and incidence rate ratios (IRR). In 2016-17, PRAC residents had a median of 13 (interquartile range [IQR] 5-19) regular general medical practitioner (GP) attendances, 3 (IQR 1-6) after-hours attendances and 5% saw a geriatrician. Highlights of utilisation changes from 2012-13 to 2016-17 include the following: GP attendances increased by 5%/year (IRR = 1.05, 95% confidence interval [CI] 1.05-1.05) for residents compared to 1%/year (IRR = 1.01, 95%CI 1.01-1.01) for the general population. GP after-hours attendances increased by 15%/year (IRR = 1.15, 95%CI 1.14-1.15) for residents and 9%/year (IRR = 1.08, 95%CI 1.07-1.20) for the general population. GP management plans increased by 12%/year (IRR = 1.12, 95%CI 1.11-1.12) for residents and 10%/year (IRR = 1.10, 95%CI 1.09-1.11) for the general population. Geriatrician consultations increased by 28%/year (IRR = 1.28, 95%CI 1.27-1.29) for residents compared to 14%/year (IRR = 1.14, 95%CI 1.14-1.15) in the general population. The utilisation of most examined services increased in both cohorts over time. Preventive and management care, by primary care and allied health care providers, was low and likely influences the utilisation of other attendances. PRAC residents' access to pain, palliative and geriatric medicine services is low and may not address the residents' needs.

Computer assisted interpretation of Tc-99m mercaptoacetyltriglycine diuretic scintigraphy enhances resident performance.

iRENEX is a software module that incorporates scintigraphic and clinical data to interpret 99m Tc- mercaptoacetyltriglycine (MAG3) diuretic studies and provide reasons for their conclusions. Our objectives were to compare iRENEX interpretations with those of expert physicians, use iRENEX to evaluate resident performance and determine if iRENEX could improve the diagnostic accuracy of experienced residents. Baseline and furosemide 99m Tc-MAG3 acquisitions of 50 patients with suspected obstruction (mean age ± SD, 58.7 ± 15.8 years, 60% female) were randomly selected from an archived database and independently interpreted by iRENEX, three expert readers and four nuclear medicine residents with one full year of residency. All raters had access to scintigraphic data and a text file containing clinical information and scored each kidney on a scale from +1.0 to -1.0. Scores ≥0.20 represented obstruction with higher scores indicating greater confidence. Scores +0.19 to -0.19 were indeterminate; scores ≤-0.20 indicated no obstruction. Several months later, residents reinterpreted the studies with access to iRENEX. Receiver operating characteristic (ROC) analysis and concordance correlation coefficient (CCC) quantified agreement. The CCC among experts was higher than that among residents, 0.84, versus 0.39, respectively, P < 0.001. When residents reinterpreted the studies with iRENEX, their CCC improved from 0.39 to 0.73, P < 0.001. ROC analysis showed significant improvement in the ability of residents to distinguish between obstructed and non-obstructed kidneys using iRENEX ( P = 0.036). iRENEX interpretations were comparable to those of experts. iRENEX reduced interobserver variability among experienced residents and led to better agreement between resident and expert interpretations.

Practicing Confidence: An Autoethnographic Exploration of the First Years as Physicians

Phenomenon : Every year is heralded with a cohort of newly-minted medical school graduates. Through intense residency training and supervision, these learners gradually develop self-assurance in their newfound skills and ways of practice. What remains unknown, however, is how this confidence develops and on what it is founded. This study sought to provide an insider view of this evolution from the frontline experiences of resident doctors. Approach : Using an analytic collaborative autoethnographic approach, two resident physicians (Internal Medicine; Pediatrics) documented 73 real-time stories on their emerging sense of confidence over their first two years of residency. A thematic analysis of narrative reflections was conducted iteratively in partnership with a staff physician and a medical education researcher, allowing for rich, multi-perspective input. Reflections were analyzed and coded thematically and the various perspectives on data interpretation were negotiated by consensus discussion. Findings : In the personal stories and experiences shared, we take you through our own journey and development of confidence, which we have come to appreciate as a layered and often non-linear process. Key moments include fears in the face of the unknown; the shame of failures (real or perceived); the bits of courage gained by everyday and mundane successes; and the emergence of our personal sense of growth and physicianship. Insights : Through this work, we – as two Canadian resident physicians – have ventured to describe a longitudinal trajectory of confidence from the ground up. Although we enter residency with the label of ‘physician,’ our clinical acumen remains in its infancy. We graduate from residency still as physicians, but decidedly different in terms of our knowledge, attitudes, and skills. We sought to capitalize on the vulnerability and authenticity inherent in autoethnography to enrich our collective understanding of confidence acquisition in the resident physician and its implications for the practice of medicine.

The spatial distribution of infectious agents in wild Pacific salmon along the British Columbia coast

Although infectious agents can act as strong population regulators, knowledge of their spatial distributions in wild Pacific salmon is limited, especially in the marine environment. Characterizing pathogen distributions during early marine residence, a period considered a survival bottleneck for Pacific salmon, may reveal where salmon populations are exposed to potentially detrimental pathogens. Using high-throughput qPCR, we determined the prevalence of 56 infectious agents in 5719 Chinook, 2032 Coho and 4062 Sockeye salmon, sampled between 2008 and 2018, in their first year of marine residence along coastal Western Canada. We identified high prevalence clusters, which often shifted geographically with season, for most of the 41 detected agents. A high density of infection clusters was found in the Salish Sea along the east coast of Vancouver Island, an important migration route and residence area for many salmon populations, some experiencing chronically poor marine survival. Maps for each infectious agent taxa showing clusters across all host species are provided. Our novel documentation of salmon pathogen distributions in the marine environment contributes to the ecological knowledge regarding some lesser known pathogens, identifies salmon populations potentially impacted by specific pathogens, and pinpoints priority locations for future research and remediation.

MP25-11 PRACTICE READINESS? TRENDS IN CHIEF RESIDENT YEAR TRAINING EXPERIENCE ACROSS 13 RESIDENCY PROGRAMS

You have accessJournal of UrologyCME1 Apr 2023MP25-11 PRACTICE READINESS? TRENDS IN CHIEF RESIDENT YEAR TRAINING EXPERIENCE ACROSS 13 RESIDENCY PROGRAMS Zachary Corey, Erik Lehman, Gary E. Lemack, Marisa M. Clifton, Adam P. Klausner, Akanksha Mehta, Humphrey Atiemo, Richard Lee, Mathew Sorensen, Ryan Smith, Jill C. Buckley, R. Houston Thompson, Benjamin N. Breyer, Gina M. Badalato, Erik M. Wallen, and Jay D. Raman Zachary CoreyZachary Corey More articles by this author , Erik LehmanErik Lehman More articles by this author , Gary E. LemackGary E. Lemack More articles by this author , Marisa M. CliftonMarisa M. Clifton More articles by this author , Adam P. KlausnerAdam P. Klausner More articles by this author , Akanksha MehtaAkanksha Mehta More articles by this author , Humphrey AtiemoHumphrey Atiemo More articles by this author , Richard LeeRichard Lee More articles by this author , Mathew SorensenMathew Sorensen More articles by this author , Ryan SmithRyan Smith More articles by this author , Jill C. BuckleyJill C. Buckley More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Benjamin N. BreyerBenjamin N. Breyer More articles by this author , Gina M. BadalatoGina M. Badalato More articles by this author , Erik M. WallenErik M. Wallen More articles by this author , and Jay D. RamanJay D. Raman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A critical component of residency education is ensuring that trainees are optimally prepared for independent practice upon graduation. The Accreditation Council for Graduate Medical Education establishes minimum case requirements but does not specify a timeline for case exposure. At present, there is limited research to understand the temporal arc of cases completed during training. Therefore, the objective of this multi-institutional experience was to characterize the case distribution that residents complete during their chief year compared to their entire residency. METHODS: Urology resident case logs from 2010-2022 were obtained and de-identified from 13 different institutions for chief years and total residency. Five categorized index procedures were included for analysis: (1) General Urology; (2) Endourology; (3) Reconstructive Urology; (4) Urologic Oncology; and (5) Pediatric Urology. Interactions were tested between the trends for total case exposure in residency training relative to the chief resident year. RESULTS: From a sample of 479 resident graduates, a total of 1,287,433 total cases were logged, including 375,703 during the chief resident year (29%). Urologic Oncology had the highest median percentage of cases completed during chief year (57%) followed by Reconstructive Urology (32%), General Urology (31%), Endourology (23%), and Pediatric Urology (12%). Across the study period, all categories of cases had a downward trend in median percentage completed during chief year except for Urologic Oncology (Figure 1). However, only trends in General Urology (slope of -0.68, p=0.013) and Endourology (slope of -1.71, p=<0.001) were significant. CONCLUSIONS: Over 50% of cases completed by chief residents are Urologic Oncology procedures. Current declining trends indicate that residents are being exposed to proportionally fewer General Urology and Endourology cases during their chief year. More research is needed to determine if lack of exposure to general urology and endourology during chief year translate into decreased preparedness for independent practice. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e346 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Corey More articles by this author Erik Lehman More articles by this author Gary E. Lemack More articles by this author Marisa M. Clifton More articles by this author Adam P. Klausner More articles by this author Akanksha Mehta More articles by this author Humphrey Atiemo More articles by this author Richard Lee More articles by this author Mathew Sorensen More articles by this author Ryan Smith More articles by this author Jill C. Buckley More articles by this author R. Houston Thompson More articles by this author Benjamin N. Breyer More articles by this author Gina M. Badalato More articles by this author Erik M. Wallen More articles by this author Jay D. Raman More articles by this author Expand All Advertisement PDF downloadLoading ...

Perception of Neurosurgical Residents about Learning in Operation Theatre in Tertiary Care Hospitals

OBJECTIVES To explore Neurosurgical postgraduate residents perceptions of their learning environment in operating rooms.METHODOLOGY From March 2022 to August 2022, this cross-sectional study will be carried out in the Department of Neurosurgery Hayatabad Medical Complex, Peshawar, Lady Reading Hospital Peshawar, and Ayub Teaching Hospital Abbottabad. The STEEM survey examined how surgical theatres were perceived as educational environments. After receiving informed consent, a printed questionnaire was provided to 32 surgical residents. SPSS 24 was used to conduct descriptive and inferential data analyses. RESULTS Thirty-one (31) of the 32 surgical residents that were surveyed (or 98.3%) answered. Residents' average age was 29.27 years (2.37); 27 were male, and 05 were female. Most residents were in their third (34.4%) and fourth (21.3%) years of residency. 147.66 (18.57) was the overall mean score. Participants' age and gender did not affect the mean scores; nevertheless, responses were statistically more favorable for residents in their first or fifth year of residency. Fifty-three locals responded favorably or positively overall. CONCLUSION Overall, residents had positive opinions of their training, their supervisors, the opportunities for learning in the operating room, the environment, and the monitoring they received.

Assessment of the self-confidence of obstetrics & gynecology fellows to perform a postpartum hemostasis hysterectomy.

Hemostasis Hysterectomy (HH) is a last resort surgical procedure performed in situations of uncontrolled post-partum hemorrhage in maternity wards. The chances of being confronted with this situation are scarce during residency, and the situation is not well suited for teaching. Nevertheless, every obstetrician-gynecologist can be confronted with this stressful situation, and should therefore possess the surgical competence required, regardless of his routine practice. The aim of the present study is to evaluate clinical exposure and self-awareness concerning HH amongst obstetrics and gynecology residents and fellows. We performed a survey amongst French obstetrics and gynecology fellows. An anonymous survey was sent by email between December 1, 2020 to July 1, 2021. Half of the interrogated fellows had practiced (as operator) an HH during residency with a senior and only 22,6% in post-residency. During the last year of residency 70% of them had performed less than 10 scheduled hysterectomies as primary operator. The laparoscopic approach was the most frequently practiced. Very few hysterectomies were performed as primary operator. Fellows with a surgical or mixed activity (both gynecological surgery and obstetrical activity in current practice) felt significantly more capable of performing HH compared to those with exclusive obstetrical or reproductive medicine activity; respectively 60% vs 36%, p=0.008; Odds Ratio: 2.629 (95% CI 1.2214; 5.8094). The number of scheduled hysterectomies or HH performed as primary operator is very low during residency or fellowship. It remains largely inferior to the number deemed necessary in previous publications about the learning curve for scheduled hysterectomy, which varies from 18 to 80 interventions. Nowadays, the increasing number of residents, added to the decrease of hemostasis hysterectomies through better management of post-partum hemorrhage, pushes towards the development of specific training, such as "damage control simulation".

430 Etiology of Hepatocellular Carcinoma in the 27-County Rochester Epidemiology Project Catchment Area, 2010-2021

OBJECTIVES/GOALS: The goal of this study is to examine the incidence, etiology, and outcomes of hepatocellular carcinoma (HCC) in a 27-county region in SE Minnesota and W Wisconsin between 2010 and 2021. A comparison of the first to second half of the period will be made to look for possible trends. METHODS/STUDY POPULATION: The Rochester Epidemiology Project (REP) is a database of patient records across SE Minnesota and W Wisconsin. Starting in 2010, the REP opened to a 27-county catchment area, which includes over 1.3 million patients with a population coverage of approximately 64%. This study will use the expanded REP data to collect data on patients 20 years of age and older with a new diagnosis of HCC between Jan 1, 2010 and Dec 31, 2021—an estimated 1000 cases. Patients with a record of less than one year of residence in the catchment area will be excluded. Data on etiology, comorbidities, and outcomes of HCC will be extracted from medical records and analyzed for risk factors and changes over time. RESULTS/ANTICIPATED RESULTS: We anticipate that the overall incidence of HCC in the REP geographic area has increased over the period of 2010 to 2021. We anticipate that the prevalence of hepatitis C virus infection in patients with HCC has between 2010 and 2021, due to the widespread use and accessibility of hepatitis C-specific antiviral treatment over the past decade. We anticipate that the prevalence of NAFLD in patients with HCC has increased between 2010 and 2021. We do not anticipate significant changes in treatment modality or survival outcomes over this period. DISCUSSION/SIGNIFICANCE: This study will provide a comprehensive update on the state, etiology, and outcomes of HCC in the area surrounding Rochester, MN. We will be able to track changes in risk factors over time and work to enhance screening protocols to target the most vulnerable populations.

MP25-14 MAKING PROGRESS OR STANDING STILL? COMPARATIVE ANALYSIS OF PROFESSIONAL BURNOUT AND CAREER CHOICE REGRET AMONG UROLOGY RESIDENTS

You have accessJournal of UrologyCME1 Apr 2023MP25-14 MAKING PROGRESS OR STANDING STILL? COMPARATIVE ANALYSIS OF PROFESSIONAL BURNOUT AND CAREER CHOICE REGRET AMONG UROLOGY RESIDENTS Kevin Koo, Bridget Findlay, Kevin Hanna, and Candace Granberg Kevin KooKevin Koo More articles by this author , Bridget FindlayBridget Findlay More articles by this author , Kevin HannaKevin Hanna More articles by this author , and Candace GranbergCandace Granberg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urology residents have reported greater levels of professional burnout compared to other specialties. Recently, increased awareness of risk factors for burnout and interventions to enhance trainee well-being may have contributed to changes in the prevalence of resident burnout. We aimed to measure burnout and career choice regret in a national sample of urology residents. METHODS: We analyzed residents’ responses to the AUA Census in 2019, 2020, and 2021. We compared urology residents’ responses to the 22-item Maslach Burnout Inventory in 2019 vs 2021, including overall professional burnout and the emotional exhaustion and depersonalization subscales. We also assessed responses to questions about career and specialty choice regret in 2019 vs 2020-2021. RESULTS: Among 415 respondents in 2019 and 166 respondents in 2021, the prevalence of professional burnout was 47% and 48%, respectively. 7% and 10% of residents met criteria for emotional exhaustion, while 47% and 48% of residents met criteria for depersonalization. Burnout symptoms were highest among second-year residents in both cohorts (65% and 69%). In 2019, among the 53% of residents who had ever reconsidered career or specialty choice, a majority (54%) experienced this most frequently during the second year of residency. Similarly, in 2020-2021, among the 51% who had reconsidered career or specialty choice, 57% said it was most frequent during the second year. There was no significant difference between the cohorts in terms of the prevalence of burnout, emotional exhaustion, or depersonalization, or in terms of the frequency of career and specialty choice regret (all p>0.05). Finally, there was no significant gender disparity in either cohort regarding the prevalence of career and specialty choice regret: 58% women vs 50% men in 2019, and 56% women vs 49% men in 2020-2021 (all p>0.05). CONCLUSIONS: In a national sample of urology residents, the prevalence of professional burnout has remained unchanged between 2019 and 2021. Second-year residents appear to be at greatest risk for career and specialty choice regret. Interventions targeting early-career residents may reduce the psychosocial burden of residency on trainees. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e348 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Koo More articles by this author Bridget Findlay More articles by this author Kevin Hanna More articles by this author Candace Granberg More articles by this author Expand All Advertisement PDF downloadLoading ...

415 Gender Differences in Operative Autonomy Using the Surgical Autonomy Program

INTRODUCTION: While efforts to recruit females into surgical fields have increased, gender differences in surgical training exist. METHODS: The SAP divides a surgical case into four parts, or zones of proximal development (ZPD). For each ZPD, residents are evaluated on a 4-tier autonomy scale (TAGS scale). Using logistic regression analysis, we evaluated neurosurgery residents at Duke University Hospital from July 2017-July 2021 to compare differences in male and female trainee autonomy as rated by both attendings and residents. RESULTS: There were a total of 4,441 cases logged by 26 different residents and 30 attendings. 69% of residents were male (n = 18) and 31% (n = 8) were female. An ordinal regression analysis showed that female residents were given less autonomy than males by attendings (OR 0.59, 0.51-0.69 95% CI, p &lt; 0.001). Females were also less likely to focus on a more complex ZPD (OR 0.53, 95% CI 0.46-0.61, p &lt; 0.001). Based on self-evaluation, female residents rated their autonomy lower than males (OR 0.71, 0.61-0.82 95% CI, p &lt; 0.001). Faculty provided greater intraoperative feedback in cases with female residents (84%, n = 539) compared to male residents (79%, n = 1,875) (X2 = 7.52, df = 1, p &lt; 0.01). Female and male residents were fully autonomous on a similar proportion of cases in post-graduate year seven (73% and 72%, respectively). CONCLUSIONS: Female residents were given less autonomy compared to their male counterparts for index neurosurgical cases and were less likely to focus on a more complex portion of a case. Female residents were more self-critical, though received greater significant intraoperative feedback. Nonetheless, females and males were fully autonomous on a similar number of cases in their final residency year. Increased efforts are needed to address the gender gap within surgical education.

Gender Difference in Teaching Evaluation Scores of Pediatric Faculty.

To evaluate associations between faculty gender and milestone-based teaching assessment scores assigned by residents. We performed a retrospective cohort study of milestone-based clinical teaching assessments of pediatric faculty completed by pediatric residents at a mid-sized residency program from July 2016 to June 2019. Assessments included 3 domains (Clinical Interactions, Teaching Skills, Role Modeling/Professionalism) comprised of a total of 11 sub-competency items. We used multilevel logistic regression accounting for repeat measures and clustering to evaluate associations between faculty gender and assessment scores in the 1) top quartile, 2) bottom quartile, or 3) top-box (highest score). Findings were adjusted for faculty rank and academic track, and resident year and gender. Over 3 years, 2889 assessments of 104 faculty were performed by 91 residents. Between assessments of women and men faculty, there were no significant differences in the odds of receiving a score in the top quartile for the 3 domains (Clinical aOR 0.99, P = .86; Teaching aOR 0.99, P = .93; Role Modeling aOR 0.87, P = .089). However, assessments of women were more likely to receive a score in the bottom quartile in both Teaching (aOR 1.23, P = .019) and Role Modeling (aOR 1.26, P = .008). Assessments of women also had lower odds of receiving the highest score in 6 of 11 sub-competencies. Results suggest that gender bias may play a role in resident assessments of pediatric faculty. Future studies are needed to determine if findings are replicated in other settings and to identify opportunities to reduce the gender gap in pediatric academic medicine.

Milestones Next Steps: Results of a Feedback Questionnaire

Milestones Next Steps: Results of a Feedback Questionnaire

Electronic platform-based education for radiology residents: results of a two-year survey

BackgroundElectronic platform based-learning for residents is increasing. The aim of this study was to identify the most reliable predictor variables related to the usage of electronic platform-based educational material for radiology residents which can predict a successful multiple-choice test during the academic year.MethodsA two year survey was conducted based on the records of electronic platform-based educational material for radiology residents. Radiology resident education was based on the educational content of two educational electronic platform databases named RADPrimer and STATdx (Elsevier, Amsterdam) consisting in evidence-based and expert-vetted summary information to support learning and diagnosing in radiology. A pool of multiple-choice questions was addressed in RADPrimer by each resident after 6 months from the beginning of each academic year, and at the end of the respective residency year as part of end of the year assessment. A per-resident analysis was performed to analyze the correlation between the amount of electronic platform content accessed by residents (measured by total login times, login frequency per month, and the number of per-topic addressed questions) in preparation for the electronic test during the academic year (predictor variables) and per-resident average percentage of correct answers on electronic test (outcome variable). Statistical significance (p < 0.05) was determined using logistic regression and correlation analysis.ResultsTotal login times (OR, 3; 95% CI, 2.2 -4), login frequency per month (OR, 4; 95% CI, 3.1–5.3), the number of per-topic addressed questions (OR, 3; 95% CI, 2.2 -4), and the number of topic-verified correct answers to multiple choice test (OR, 30.5; 95% CI, 12.8–80.9) all showed a statistically significant correlation with final percentage of correct answers on final year electronic test.ConclusionThe number of correct answers to multiple choice test was related to the number and frequency of login access, the number of per-topic addressed questions and the number of topic-verified correct answers to multiple choice test. The electronic-based educational material contributes significantly to a successful radiology residency program.

The Phenomenon of Harassment Among University Students (Applied study on the University of Mutah)

Objectives: The study aimed to investigate the phenomenon of sexual harassment, its causes, and the locations where female students at Mu'tah University experience it. Additionally, it aimed to determine the variations in the occurrence of harassment among female students of Mu'tah University based on factors such as year of study, age, college residency and monthly income&#x0D; Methods: The study employed a descriptive analytical approach, and the study population consisted of 432 students. A sexual harassment questionnaire was developed, comprising a total of 35 paragraphs.&#x0D; Results: The study's findings revealed patterns in the occurrence of harassment, significant differences related to various factors, and insights into the phenomenon of harassment among Mu'tah University students. These factors included the year of study, place of residence, and monthly income.&#x0D; Conclusions: This research lays the foundation for future studies on harassment. It also suggests that the university should establish dedicated centers in collaboration with other institutions to explore these phenomena. Such efforts would contribute to fostering a supportive environment characterized by order and stability.

A case for lifelong learning in emergency medicine: The perspective from a rural state.

The expansive practice of emergency medicine cannot be fully taught or learned in 3 or 4 years. Lifelong learning, self-assessment,1 and ongoing skill acquisition and retention are necessary. How do we teach and acknowledge this during residency training and how do we support our isolated, rural colleagues? Importantly, there is a growing shortage of rural emergency physicians and many of our trainees may work in these environments.2 As educators, we must study potential solutions and bridge these gaps for our trainees entering independent practice and for our colleagues far removed from formal training. Recent cases, and many like them, illustrate this point. A rural emergency physician expertly places a small-bore chest tube for an atraumatic pneumothorax, the pneumothorax resolved, they requested transfer to a larger center for ongoing management. The tertiary care center is at full capacity. A phone consultation with a specialist recommends removal of the chest tube in the emergency department (ED) and discharge home if a follow up chest x-ray shows sustained resolution. The emergency physician has never removed a chest tube before and the patient is transferred to a larger regional ED for uncomplicated removal. In a second case, a patient is transferred from an hour away, during a snowstorm, for a peritonsillar abscess. The procedure is within an emergency physician's scope of practice. The referring physician had never performed this procedure in their decades of practice. The patient is transferred to the tertiary care center where it is drained by the attending emergency physician and emergency medicine resident. On a winter night, an emergency physician intubates a patient with a head injury in their critical-access emergency department. They request lifesaving medications and the respiratory therapist to set the ventilator. It is nighttime; there is no respiratory therapist or pharmacist. The physician must assist in mixing the medications and setting up the ventilator. The skills required for an emergency physician are ever expanding, particularly as access to tertiary care becomes more difficult. Lifelong learning and practice development to best serve our patients is a necessity in our specialty. Solutions may include regional conferences, collaborative case reviews, real-time peer-based decision support with telemedicine, maintenance of board certification, asynchronous, self-directed learning through free open-access medical education (FOAM), podcasts, textbooks or journal articles, and academic–rural partnerships that create shared faculty positions between rural and tertiary sites and rural rotations for trainees. Each of these has its limitations and time represents a major barrier.3-5 The American Board of Emergency Medicine requires continuous learning for maintenance of certification; this is beneficial but is not tailored to the physician's practice environment.6, 7 Our own work in the rural state of Vermont and upstate New York has led us to offer high-acuity, low occurrence (HALO) courses at the regional academic center twice a year for both residents and practicing emergency physicians within our region and create a rural-specific simulation lab at one of our critical-access sites. Additionally, we established a tele-emergency medicine program to offer a virtual resource from the tertiary care center in times of high-acuity, high-complexity care, or volume surge. The skill of delivering and accepting tele-emergency medicine assistance must also be learned and taught. Our education must continue to adapt to meet the needs of our unique and evolving practice environments. We must also acknowledge that many scenarios cannot be predicted. Instilling the motivation for lifelong learning, self-assessment1 and exposure to resource limited settings during training may help prepare trainees for these challenges. Although these issues are not unique to emergency medicine, we are a specialty that prides itself on adaptability. We must confront this challenge with creative solutions. Skyler Lentz, Ashley Weisman, Jordan Ship, and Matthew S. Siket conceived the idea for this manuscript and contributed substantially to the content, design, writing and editing of the commentary. The authors declare no conflicts of interest.