Residency Class Research Articles

Leveraging the Electronic Health Record to Measure Resident Clinical Experiences and Identify Training Gaps: Development and Usability Study.

Competence-based medical education requires robust data to link competence with clinical experiences. The SARS-CoV-2 (COVID-19) pandemic abruptly altered the standard trajectory of clinical exposure in medical training programs. Residency program directors were tasked with identifying and addressing the resultant gaps in each trainee's experiences using existing tools. This study aims to demonstrate a feasible and efficient method to capture electronic health record (EHR) data that measure the volume and variety of pediatric resident clinical experiences from a continuity clinic; generate individual-, class-, and graduate-level benchmark data; and create a visualization for learners to quickly identify gaps in clinical experiences. This pilot was conducted in a large, urban pediatric residency program from 2016 to 2022. Through consensus, 5 pediatric faculty identified diagnostic groups that pediatric residents should see to be competent in outpatient pediatrics. Information technology consultants used International Classification of Diseases, Tenth Revision (ICD-10) codes corresponding with each diagnostic group to extract EHR patient encounter data as an indicator of exposure to the specific diagnosis. The frequency (volume) and diagnosis types (variety) seen by active residents (classes of 2020-2022) were compared with class and graduated resident (classes of 2016-2019) averages. These data were converted to percentages and translated to a radar chart visualization for residents to quickly compare their current clinical experiences with peers and graduates. Residents were surveyed on the use of these data and the visualization to identify training gaps. Patient encounter data about clinical experiences for 102 residents (N=52 graduates) were extracted. Active residents (n=50) received data reports with radar graphs biannually: 3 for the classes of 2020 and 2021 and 2 for the class of 2022. Radar charts distinctly demonstrated gaps in diagnoses exposure compared with classmates and graduates. Residents found the visualization useful in setting clinical and learning goals. This pilot describes an innovative method of capturing and presenting data about resident clinical experiences, compared with peer and graduate benchmarks, to identify learning gaps that may result from disruptions or modifications in medical training. This methodology can be aggregated across specialties and institutions and potentially inform competence-based medical education.

Virtual Interviewing and Diversity Among Psychiatry Residents.

Psychiatry residency program directors were surveyed regarding their impression of the impact virtual interviewing had on the perceived and actual diversity of individuals selected for interviews and residency training. A link to an anonymous survey was sent to 299 psychiatry residencies. Psychiatry program directors provided information about their programs and rated their perception of the impact of virtual interviewing on candidates they interviewed and matched. They also reported the demographic information of incoming residency classes for 2020-2023. This data was assessed for differences in the average number of residents by each diversity category and interview format (i.e., in person or virtual) and between diversity categories and cohorts. A linear trend analysis assessed whether the number of residents in each demographic category had a significant change over time. Sixty-five program directors (21.7%) provided at least partial data. Half of the responding program directors believed that virtual interviewing had increased the diversity of interviewed applicants, but there were no statistically significant differences in the average number of incoming residents who were identified as women or were in an Underrepresented in Medicine category when comparing the in-person interview year (2020) and the virtual interview years (2021-2023). The analyzed data demonstrated that the type of interview (in-person vs virtual) did not appear to affect the diversity of incoming psychiatry residents. Ongoing efforts to increase diversity, equity, inclusion, and belonging should be paired with measurements of their impact.

Cadaveric Simulation in Rib Plating is Beneficial for Helping Surgical Trainees to Assimilate New Technologies.

Rib fixation procedures are being performed more frequently as they have shown multiple advantages over traditional non-operative management in well-selected patients. We have developed a rib-fixation simulation on cadavers for use by surgical residents in attempt to improve their comfort, knowledge and ability to use this new technology. Residents in years 3 through 5 of training attended a rib-fixation simulation course with cadavers. Trauma faculty and representatives of manufacturers of rib-fixation hardware participated. The simulation consisted of groups of residents reviewing anatomy and creating adequate exposure for the entire procedure. Each group created rib fractures in the cadaver, determined which materials were needed, and then performed the rib-fixation procedure. Following the simulation, we surveyed the residents to determine the impact of the structured cadaveric rib fixation-based course on their comfort level. The survey was performed using a four- and five-level Likert questionnaire. The results were analyzed using paired t-tests. Of the participating residents, 72% of residents had performed five or fewer rib-fixation procedures in their training in the first cohort, while in the cohort for the following year, 65% had performed 5-10 procedures. The simulation had a statistically significant benefit to the residents' comfort level with rib plating (2.5 versus 3.6, p-value: 0.003). The greatest impact on the comfort level was seen in year 3 of training (2 versus 4, p-value 0.02). One hundred percent of residents found that having faculty and representatives present for the simulation was very helpful. The survey demonstrated that most residents gained new knowledge regarding the anatomy and technical dissection. In 20 of 25 encounters, residents strongly agreed that this simulation was beneficial for their surgical education, when used in addition to real operative experience. Every resident reported that they would recommend the simulation to younger resident classes. Rib-fixation simulations on cadavers were beneficial for surgical residents' self-assessed comfort level. The simulation increased residents' knowledge, comfort, and ability to perform rib-fixation procedures. We have seen a significant increase in resident participation in these cases after simulation training. Based on these findings, we will continue to incorporate these simulations into our program's curriculum.

Conceptualising overlapping politics: Cross-class political relationships in urban Pakistan

Citizen-led activism to demand and secure adequate housing rights, infrastructure, and services in Islamabad forms part of a longstanding socio-political movement in Pakistan. This activism brings together different classes of urban residents. Drawing from qualitative research comprising of 129 interviews, this article reveals an emerging ‘overlapping politics’, defined as the political relationship between two (or more) distinct socio-economic classes of citizen(s) in response to any form of injustice or inequality. This (re)conceptualises everyday forms of urban political practice by countering existing assumptions that urban politics is rooted in class homogeneity. Inspired by the Islamabad case, I argue that ‘overlapping politics’ emerges largely as an alternative to, and progression from, clientelistic politics through four modes where ‘overlapping’ occurs across class lines: knowledge and information; networks and membership; support; and ownership and responsibility. The outcomes of ‘overlapping politics’ manifest spatially in the city, for example through increased interaction between urbanites, privately organised service provision, and urban protests. Although the practice of ‘overlapping politics’ has limitations, it provides an important new conceptual tool and language for understanding and analysing forms of politics that are embedded in cross-class relationships between urban citizens.

Residents' willingness to be compensated for power rationing during peak hours based on choice experiment

There is growing interest in demand-side interventions aimed at reducing residential peak-hour electricity consumption in response to energy transition. However, limited knowledge exists regarding residents' willingness to accept compensation (WTC) for power rationing during peak hours. This study empirically evaluates the compensation standards based on residents' willingness to accept power rationing in peak hours based on the Choice Experiment (CE). The results indicate that residents are concerned most with the attributes of power rationing seasons and power rationing periods, requiring higher compensation for power rationing in summer and at night, whether on weekdays or non-weekdays. Further analysis reveals significant regional and group heterogeneity. Specifically, residents in northern regions are not significantly concerned about the power rationing durations compared to those in southern regions, while they are more on power rationing degrees. Analysis based on the Latent Class Analysis (LCA) model shows that two classes of residents are willing to participate in the power rationing agreement for free on both weekdays and non-weekdays, as well as two categories of residents unwilling to participate in the compensated power rationing on non-weekdays. Based on this, we estimate that the adjusted participation rate of residents in compensated power rationing is 96.59% on weekdays, with compensation ranges from 0.67 ￥/kWh to 13.38 ￥/kWh, and a participation rate of 69.69% on non-weekdays, with compensation levels ranging from 3.99 ￥/kWh to 15.34 ￥/kWh. This paper also assesses the costs of power rationing compensation to provide evidence for policymakers when determining the compensation level of the power rationing program.

Relationship Between National Residency Matching Program (NRMP) Rank Order and Otolaryngology Residency Performance.

The process of resident recruitment is costly, and our surgical residency program expends significant time on the resident selection process while balancing general duties and responsibilities. The aim of our study was to explore the relationship between otolaryngology-head and surgery (OHNS) residents' National Residency Matching Program (NRMP) rank-list position at our institution and their subsequent residency performance. Retrospective cohort study. Single site institution. We retrospectively reviewed 7 consecutive resident classes (2011-2017) at a single tertiary OHNS residency program. We reviewed each resident's absolute rank order in the NRMP matches. Measures of residency performance included overall faculty evaluation during postgraduate year 5 (PGY5), annual in-service examination scores (scaled score), and the number of manuscripts published in peer-reviewed journals. Correlations between NRMP rank order and subsequent residency performance were assessed using Spearman's rho correlation coefficients (ρ). Twenty-eight residents entered residency training between 2011 and 2017. The average rank position of the trainees during this study was 9.7 (range: 1-22). We found no significant correlation between rank order and faculty evaluation during PGY5 (ρ = 0.097, P = .625) or number of publications (ρ = -0.256, P = .189). Additionally, when assessing the association between rank order and annual Otolaryngology Training Examination-scaled scores, no statistically significant relationship was found between the 2 (P > .05). Our results showed that there were no significant correlations between OHNS rank order and various measures of success in residency training, which aligns with existing literature. Further investigation of this relationship should be conducted to ensure the applicability of our findings.

Bias Reduction Practices in Underrepresented Groups in Ophthalmology Resident Recruitment

Best recruitment practices for increasing diversity are well established, but the adoption and impact of these practices in ophthalmology residency recruitment are unknown. To describe the adoption of bias reduction practices in groups underrepresented in ophthalmology (URiO) residency recruitment and determine which practices are effective for increasing URiO residents. This cross-sectional survey study used an 18-item questionnaire included in the online survey of the Association of University Professors in Ophthalmology (AUPO) Residency Program Directors. Data collection occurred from July 2022 to December 2022. The data were initially analyzed on January 16, 2023. Participants included residency program directors (PDs) in the AUPO PD listserv database. Descriptive analysis of resident selection committee approaches, evaluation of applicant traits, and use of bias reduction tools. Primary outcome was diversity assessed by presence of at least 1 resident in the last 5 classes who identified as URiO, including those underrepresented in medicine (URiM), lesbian, gay, bisexual, transgender, queer, intersex, and asexual plus, or another disadvantaged background (eg, low socioeconomic status). Multivariate analyses of recruitment practices were conducted to determine which practices were associated with increased URiO and URiM. Among 106 PDs, 65 completed the survey (61.3%). Thirty-nine PDs used an interview rubric (60.0%), 28 used interview standardization (43.0%), 56 provided at least 1 bias reduction tool to their selection committee (86.2%), and 44 used postinterview metrics to assess diversity, equity, and inclusion efforts (67.7%). Application filters, interview standardization, and postinterview metrics were not associated with increased URiO. Multivariate logistic regression analysis showed larger residency class (odds ratio [OR], 1.34; 95% CI, 1.09-1.65; P = .01) and use of multiple selection committee bias reduction tools (OR, 1.47; 95% CI, 1.13-1.92; P = .01) were positively associated with increased URiO, whereas use of interview rubrics (OR, 0.72; 95% CI, 0.59-0.87; P = .001) and placing higher importance of applicant interest in a program (OR, 0.83; 95% CI, 0.75-0.92; P = .02) were negatively associated. URiM analyses showed similar associations. Ophthalmology residency interviews are variably standardized. In this study, providing multiple bias reduction tools to selection committees was associated with increased URiO and URiM residents. Prioritizing applicant interest in a program may reduce resident diversity. Interview rubrics, while intended to reduce bias, may inadvertently increase inequity.

Orthopedic Surgery Matched Applicants Are Publishing More: A Bibliometric Analysis of Research Output.

Introduction This studyanalyzed the number of peer-reviewed publications submitted by matriculants prior to applying for the orthopedic surgery residency. The graduating residency classes of 2023 and 2027 were included in the study to understand the trend of publications, to inform aspiring orthopedic surgeons. Methods The top, middle, and bottom 10 orthopedic surgery residency programs were identified on the Doximity online website. Matriculants were searched on PubMed and Google Scholar for publication contributions. Variables including number of publications, orthopedic publications, first-author authorship, and H-index were analyzed. A logistic regression model was created, and a t-test was conducted to statistically compare the 2027 and 2023 graduating classes. Results Matriculants of the 2023 match had higher numbers of publications, orthopedic surgery-specific publications, first authorships, and h-indices than the matriculants of the 2018 match. Conclusion The average number of publications has been observed to increase over four years, indicating an increase in competition to match into orthopedic surgery residency. Publishing in higher numbers may be a good indicator of an applicant's success in not only matching but also matching into a higher-tier program.

(026) Ten Years of Authorship by Women in Sexual Medicine Journals: Are We Making Progress?

Abstract Introduction Women are historically underrepresented in Urology, but the demographics are slowly changing. As of 2023, only 10.9% of urology attendings are women; however, women represent 37% of the accepted residency class of 2028. With increasing representation of women in urology, we hypothesized this would reflect in women’s authorship patterns in published manuscripts. Objective We sought to identify if the increasing representation of women in urology is reflected in first or last authorship in sexual medicine journals. Methods All manuscripts published in the Journal of Sexual Medicine and Sexual Medicine from 2013 to 2023 were reviewed. Original research manuscripts were included; manuscripts submitted under Psychology subsections, Paraphilia subsections, as well as systematic reviews, meta-analyses, communications, commentaries, replies, and those involving psychometrics were excluded. Single author manuscripts were classified under first author for the analysis. First and last authors were identified and internet search was performed to best determine gender, relying on, in order of preference: listed pronouns, picture, or traditionally masculine versus feminine name. We recognize this method of determining gender identity based on conventional gender presentations is imperfect and may not represent the full spectrum of gender diversity of the included authors. Institutional information was also collected. Chi-square analyses and odds ratio were performed to compare authorship patterns. Results 2156 manuscripts met criteria, 1717 from Journal of Sexual Medicine and 439 from Sexual Medicine. From 2013-2023, women composed 44.1% (951/2156) of first authors and 32.5% (691/2156) of last authors. Overall, first authorship by women increased from 2013 (110/271, 41%) to 2023 (59/104, 57%) (p<0.005) [Figure 1]. In 2022 and 2023, women were the majority of first authors (50.3% and 56.7%, respectively). Manuscripts with women as first authors were more likely to have women as last authors (OR: 1.64, CI: 1.45-1.86, p<0.0001). In the US and Canada, the majority of first (61.1%, 214/350) and last (61.6%, 157/254) authors who are women came from public rather than private institutions, but this was non-significant. First authors who are women predominantly came from North America (38.6%), Europe (36.3%), Asia (17.7%), South America (3.9%), Australia/New Zealand (2.6%), followed by Africa (0.9%); last authors who are women had a similar breakdown by continent. The greatest percentage of authorship by women came from Australia/New Zealand with 50.8% (32/63) of first authors and 45% (27/60) of last authors. The largest disparity was seen in Africa with 22.2% (10/45) of first authors and a mere 16.3% (7/43) of last authors being women. Conclusions Authorship by women in sexual medicine journals is increasing over time, with positive trends observed in both first and last authorship. The effect is more pronounced in first authorship as compared to last, possibly reflecting the increasing numbers of trainees who are women. Manuscripts with women as first authors are correlated with last authors who are women, supporting a positive relationship in gender concordant mentorship. Disclosure No.

Predictors of standardized in-service examination performance and residency outcomes in a graduate periodontics program.

The objectives of this study were to assess the influence of learner- and education-related factors on standardized in-service examination performance and determine whether in-service examination scores predict residency outcomes. American Academy of Periodontology (AAP) In-service Examination (AIE) scores from 10 periodontics residency classes at a single center were recorded and compared against a panel of learner- and education-related variables using multiple linear regression models. Defined residency outcome measures were analyzed against AIE scores using binomial logistic regression. No evaluated learner- or education-related variable was a statistically significant predictor of AIE score in this study sample. Likewise, AIE score was not a statistically significant predictor of any assessed residency outcome. The AAP has performed a tremendous service to periodontics residents and programs by marshaling the leadership and expertise necessary to offer a professionally constructed assessment instrument. However, in the current study, no relationship could be identified between AIE score and any outcome, including first-attempt board certification. The AAP In-service Committee appears well situated to provide additional leadership focusing on exam implementation, which may enhance AIE value in competency decision making.

The Effect of Underrepresented Minority Mentorship on Orthopaedic Spine Surgery Recruitment and Diversity: A 20-Year Analysis at a Single Institution.

Despite national efforts to increase diversity and inclusion, underrepresented minority (URM) representation among orthopaedic spine surgery faculty remains low. Research has shown that URM trainees are more likely to pursue surgical careers when they have access to URM mentors. The purpose of this study was to explore the influence of URM representation among spine faculty on the rate of URM orthopaedic residents pursuing spine surgery fellowships. From 2004 to 2023, data were collected from each residency class at our academic institution: residency year, number of residents per class (total and URM), and number of residents applying to spine surgery fellowships. These ethnicities were considered URM: Black or African American, Hispanic or Latino, and Native American. In 2018, two African American spine faculty were hired. Data were compared between Before and After their arrival. A subanalysis was done to include a period of increasing URM recruitment (2012 to 2018). Binary logistic regression analysis evaluated associations between appointment of URM faculty and fellowship choice of URM residents. Two hundred fifty-six residents were included. Thirty-one total URM residents were in the program during the study period (12.1%). Overall, URM representation in the program increased over time [OR: 1.1, 95% CI: 1.1 to 1.2], whereas residents applying to spine surgery fellowships did not change [OR: 1.0, 95% CI: 1.0 to 1.1]. Comparing Before-2012 and 2012 to 2018 groups with the After-2018 group demonstrated a significant difference in the proportion of URM residents applying to spine surgery fellowships after the hiring of URM spine faculty (0.0% versus 23.1% versus 74.1%; P = 0.001). This retrospective study provides empirical evidence of the importance of URM representation among orthopaedic spine surgery faculty and the potential effect on URMs pursuing orthopaedic fellowships. Institutions should consider prioritizing the representation of URM faculty in spine surgery to address the lack of current and future diversity in the field. III.

Deformity, etiology, solution, sequence (DESS): Facial analysis in rhinoplasty

PurposeRhinoplasty is amongst the most challenging surgeries to perfect and can take decades. This process begins during residency; however, residents often have limited exposure to rhinoplasty during their training and lack a standardized method for systematically analyzing and formulating a surgical plan. The DESS (Deformity, Etiology, Solution, Sequence) is a novel educational format for residents that serves to increase their pre-operative comfort with the surgical evaluation and intraoperative planning for a rhinoplasty. Materials and methodsA qualitative study performed at a tertiary academic institution with an otolaryngology residency program evaluating three consecutive residency classes comprised of four residents per class. A 9-item questionnaire was distributed to measure change in resident comfort after utilizing the DESS during their facial plastics rotation. Questionnaire responses highlighted resident comfort with facial nasal analysis, identifying deformities, suggesting surgical maneuvers, and synthesizing a comprehensive surgical plan. ResultsTen of the twelve residents surveyed responded. Of those that responded, comfort in facial nasal analysis, identification of common nasal deformities, surgical planning, and development of an overall surgical plan were significantly improved after completion of the facial plastic rotation. These residents largely attributed their success to the systematic educational format, with an average score of 4.8/5.0 (SD 0.42). ConclusionWhile rhinoplasty is a challenging artform to master, systematic approaches to analysis and operative planning are vital for teaching and guiding residents. Through this novel methodology, residents display significant improvement in their comfort with facial nasal analysis and overall surgical preparation.

On-Call Workload Differences in Neurosurgery: Resident Call "Weather" and a Departure from Colored Cloud Labels.

Labeling residents as "black" or "white" clouds based on perceived or presumed workloads is a timeworn custom across medical training and practice. Previous studies examining whether such perceptions align with objective workload patterns have offered conflicting results. We assessed whether such peer-assigned labels were associated with between-resident differences in objective, on-call workload metrics in three classes of neurosurgery junior residents. In doing so, we introduce more inclusive terminology for perceived differences in workload metrics. Residents were instructed to complete surveys to identify "sunny", "neutral", and "stormy" residents, reflecting least to greatest perceived workloads, of their respective classes. We retrospectively reviewed department and electronic medical records to record volume of on-call work over the first 4 months of each resident's 2nd postgraduate academic year. Inter-rater agreement of survey responses was measured using Fleiss' kappa. All statistical analyses were performed with a significance threshold of P < .05. Across all classes, there was strong inter-rater agreement in the identification of stormy and sunny residents (Kappa = 1.000, P = .003). While differences in on-call workload measures existed within each class, "weather" designations did not consistently reflect these differences. There were significant intraclass differences in per shift consult volume in two classes ( P = .035 and P = .009); however, consult volume corresponded to a resident's weather designations in only one class. Stormy residents generally saw more emergencies and, in 2 classes, performed more bedside procedures than their peers. Significant differences in objective on-call experience exist between junior neurosurgery residents. Self- and peer-assigned weather labels did not consistently align with a pattern of these differences, suggesting that other factors contribute to such labels.

Examining Diversity Recruitment Efforts in US-Based Physical Medicine and Rehabilitation Residencies: A Survey of Program Directors on Gender, Ethnic and Racial Diversity, and Implications for Recruitment Efforts.

As the population of the United States continues to grow and diversify, it is critical that the medical profession follows. This study aimed to evaluate aspects of the current landscape of diversity within physical medicine and rehabilitation by surveying program directors of US-based physical medicine and rehabilitation residencies. The secondary aim was to identify program characteristics that correlate with more diverse residency classes. An online, cross-sectional 17-question survey was distributed to program directors of all US-based physical medicine and rehabilitation residencies with known contact information (95/100), with a completed survey response rate of 53% (50/95). Race and ethnicity categories of the survey were based on those used by the US Census. The percentages of individuals identifying as women or those underrepresented in medicine in this survey were below those of the general US population, a trend also seen within the field of physical medicine and rehabilitation overall. Linear regression revealed no statistically significant association between the percentage of underrepresented in medicine residents and commonly used diversity recruitment initiatives. There was a significant association between the presence of a departmental role for diversity, equity and inclusion and the percentage of women residents (odds ratio, 1.13; P = 0.017). Continued research is required to identify additional strategies with demonstrated efficacy in recruiting diverse residency applicants.

Improved Patient Outcomes and Pediatric Resident Performance With a Parent and Faculty Communication Coaching Curriculum.

Communication skills are an important part of patient care, but an often neglected part of residency training. Longitudinal active coaching of communication has the potential to effectively improve communication curricula. A novel communication coach curriculum was implemented with approximately half of a pediatric residency class. Residents were coached by both a parent and faculty coach on multiple occasions throughout their intern year. Effectiveness was evaluated through self-assessment, direct observation, chart review, and follow-up phone calls with families. This longitudinal communication coach curriculum was well-received and resulted in increased self-awareness of communication skills. Coachable behaviors improved in intervention residents, and their patients spoke more positively of their experiences with communication. Additionally, these patients were less likely to be readmitted than patients cared for by control residents. A longitudinal communication coaching model is a feasible and effective curriculum for pediatric residents.

Creation of a Didactic Clinical Pharmacology Lecture Series for Internal Medicine Residents.

One of the noted areas of weakness for internal medicine residents is pharmacology. However, there is little data documenting the creation and effect of a comprehensive pharmacology didactic program.Our goal was to create a two-year clinical pharmacology didactic program focused on areas of stated weakness and to evaluate this program for an increase in knowledge and prescribing confidence of the participants. From August 2020 to June 2022, a two-year pharmacology program was developed, which included 20 didactic lectures on a variety of topics. Pre- and post-tests were given for 15 of the lectures, and four surveys were given, two during each year of the program. Four questions on each survey were the same and asked about confidence in choosing an appropriate medication based on current guidelines, patient-specific factors, primary literature, and pharmacokinetics. Over the two years, participation in the pharmacology sessions ranged from 17 to 29 residents (65-74% of the residency class). The average pre- and post-test scores increased by an average of 25.1%, which was a statistically significant increase (p<0.001, 95% CI [17.5, 32.8]). A Kruskal-Wallis H test showed a statistically significant difference in resident-reported confidence adjusting medications based on primary literature between the different survey groups, χ2 = 9.871, p = 0.02. A two-year, didactic pharmacology program improved the knowledge of resident participants and confidence in their ability to choose an appropriate medication based on primary literature.

A novel 6-day cycle surgical pathology rotation improves resident satisfaction and maintains Accreditation Council for Graduate Medical Education (ACGME) milestone performance

Surgical pathology residency training in the United States lags behind other specialties in quality control and graduated responsibility to train independent pathologists capable of seamlessly entering practice after training. We observed that our traditional 3-day-cycle surgical pathology cycle (day 1–grossing; day 2 –biopsies/frozens/preview; day 3 – sign-out) consistently and negatively impacted resident education by reducing preview time, case follow-up, immunohistochemical stain (IHC) interpretation, and molecular study integration. We aimed to create a modern surgical pathology rotation that improved performance and outcomes. We innovated our rotation to enhance resident education and ensure graduated responsibility. A novel 6-day cycle was created composed of 2 grossing days, 1 frozens/biopsies/preview days, 2 dedicated sign-out days, and 1 frozens/biopsies/case completion day. Residents completed surveys before implementing the new rotation and 6 months after implementation to track self-assessment of Accreditation Council for Graduate Medical Education (ACGME) milestone performance and internal quality control metrics. Clinical Competency Committee (CCC) annual evaluations were assessed in paired PGY levels pre- and post-intervention. After implementation, there was a statistically significant improvement in self-assessment of levels 4 and 5 of ACGME milestones and improved satisfaction of quality metrics, including time for previewing, reviewing IHC, graduated responsibility, and perceived readiness for independent practice. CCC evaluations showed overall maintained performance levels, with trends towards improvements in junior resident classes. Our 6-day cycle adequately fulfills the current demands of our sizeable academic center's surgical pathology training and can be a model for pathology residencies looking to modernize their surgical pathology rotations and resident education.

Implementation of Debriefing Services for Pharmacy Residents in a 24-Hour, In-House Clinical Pharmacy On-Call Program: A Pilot Study

Background: This clinical pharmacy on-call program (CPOP) is a 24-hour, in-house service provided by pharmacy residents. During shifts, challenging situations may arise, which may correlate with depression, anxiety, and stress. Objective: This pilot study aims to describe the implementation of a debriefing program and characterize mental health patterns of residents in the CPOP. Methods: A structured debriefing process was developed to provide support to residents in the CPOP. Over a 1-year period, twelve outgoing pharmacy residents and ten incoming pharmacy residents completed a modified Depression Anxiety Stress Scale (mDASS-21) questionnaire and received a stress perception score (SPS) during debriefing. Data from first and final on-call shifts were compared via a paired Wilcoxon signed-rank test. Residents were referred to an Employee Assistance Program (EAP) based on mDASS-21 and SPS results. Scores from final on-call shifts were compared between residency classes via a Wilcoxon rank sum test. Results: Following successful implementation, 106 debriefing sessions were completed. Pharmacy residents responded to a median number of 38 events per shift. Significant reductions in anxiety and stress scores were observed from the first and final on-call shifts. Six residents were referred to EAP. A lower incidence of depression, anxiety, and stress was observed in pharmacy residents who received debriefing compared to previous residents. Conclusion: The debriefing program provided emotional support to pharmacy residents participating in the CPOP. Implementation of debriefing demonstrated a reduction of anxiety and stress from the beginning to the end of the academic year and in comparison to the previous year.

Association Between In-Training Exam Scores and Clinical Exposure During the COVID-19 Pandemic

BackgroundWe sought to evaluate changes in In-Training Examination (ITE) scores and associations with clinical work during the COVID-19 pandemic. We hypothesized that residents saw a decrease in clinical encounters during the pandemic and that this would be associated with smaller gains in ITE scores. MethodsWe compared ITE score changes with data on patient notes for three classes of pediatric residents at four residency programs: one not exposed to the pandemic during their intern year who entered residency in 2018, one partially exposed to COVID-19 in March of their intern year (2019–2020), and one that was fully exposed to the pandemic, starting residency in June of 2020. ResultsITE scores on average improved from the PGY1 to PGY2 year in the “no covid” and “partial COVID” cohorts. The “full COVID” cohort had little to no improvement, on average. The total number of patient encounters was not associated with a change in ITE scores from PGY1 to PGY2. There was a small but statistically significant association between change in ITE score and number of inpatient H+P notes. ConclusionsA drop in ITE scores occurred in pediatric residents who entered residency during the COVID-19 pandemic. This change was largely unrelated to clinical encounter number changes.

Use of Simulation to Develop Telestroke Skills in Trainees (S10.009)

<h3>Objective:</h3> To create an educational intervention to prepare neurology residents for telestroke encounters. <h3>Background:</h3> Telemedicine has become increasingly common in the post-COVID era and is now a part of most clinical practices. There is a need for residency training programs to incorporate telemedicine teaching into their curriculum. Telestroke is a well-established practice and way to bring neurovascular clinical expertise into settings where an in-person stroke specialist may not be available. Skills and professionalism important in a remote telestroke consult apply to all types of telemedicine encounters. <h3>Design/Methods:</h3> Our telestroke OSCE (objective structured clinical examination) case was developed by our neurology faculty in conjunction with a simulation specialist. Two standardized actors were trained to impersonate an acute stroke patient and a bedside provider in an emergency room setting. The neurology resident learner was in a separate room and acted as a stroke specialist, communicating with the standardized actors and conducting an NIHSS using a live video interface. Following the encounter, immediate feedback was given by a faculty observer and the standardized actor rated resident performance using a checklist. After OSCEs were completed, the residents were debriefed in a group setting and a learner feedback survey was collected (1–5, least-most). <h3>Results:</h3> Out of 15 resident participants, 8 completed the learner survey (53%). They reported feeling fairly well-prepared for the OSCE (4±0.5) and rated their performance overall well (4.3±0.5). Many learners identified instructing the standardized remote provider in the NIHSS virtually as the most challenging aspect in the encounter. All learners indicated that this OSCE should be repeated for future residency classes. <h3>Conclusions:</h3> We demonstrated that a telestroke simulation is a useful tool to directly observe residents, offer immediate feedback and review telemedicine best-practices. It is a feasible, valued and important part of our dynamic neurology residency curriculum. <b>Disclosure:</b> Dr. Lillemoe has nothing to disclose. Dr. Kurzweil has nothing to disclose. Dr. Sabadia has nothing to disclose. Dr. Pleninger has nothing to disclose. Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Seminars in Neurology. Dr. Lewis has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neuroscience. Dr. Giglio has nothing to disclose. Sondra Zabar has nothing to disclose.