Resident Competency Research Articles

An assessment of radiology resident competency in identifying suppurative retropharyngeal lymphadenitis: an examination using the WIDI SIM platform.

Suppurative retropharyngeal lymphadenitis is a retropharyngeal space infection almost exclusively seen in the young (4-8years old) pediatric population. It can be misdiagnosed as a retropharyngeal abscess, leading to unnecessary invasive treatment procedures. This retrospective study aims to assess radiology residents' ability to independently identify CT imaging findings and make a definitive diagnosis of suppurative retropharyngeal lymphadenitis in a simulated call environment. The Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM) is a computer-aided emergency imaging simulation proven to be a reliable method for assessing resident preparedness for independent radiology call. The simulation included 65 cases across various imaging modalities of varying complexity, including normal studies, with one case specifically targeting suppurative retropharyngeal adenitis identification. Residents' free text responses were manually scored by faculty members using a standardized grading rubric, with errors subsequently classified by type. A total of 543 radiology residents were tested in three separate years on the imaging findings of suppurative retropharyngeal lymphadenitis using the Wisdom in Diagnostic Imaging simulation web-based testing platform. Suppurative retropharyngeal lymphadenitis was consistently underdiagnosed by radiology residents being tested for call readiness irrespective of the numbers of years in training. On average, only 3.5% of radiology residents were able to correctly identify suppurative retropharyngeal lymphadenitis on a contrast-enhanced computed tomography (CT). Our findings underscore a potential gap in radiology residency training related to the accurate identification of suppurative retropharyngeal lymphadenitis, highlighting the potential need for enhanced educational efforts in this area.

The Impact of a Paracentesis Clinic on Internal Medicine Resident Procedural Competency.

Competency in paracentesis is an important procedural skill for health care practitioners caring for patients with decompensated cirrhosis. It is estimated that 97,577 paracentesis procedures were performed between 2010 and 2012 across 120 academic medical centers and 290 affiliated hospitals. Due to limitations of resources at the Central Texas Veterans Affairs Hospital, a paracentesis clinic was created to give patients improved access to this procedure which is staffed by a supervising physician and internal medicine residents. We evaluated resident competency via survey and change in the number of paracentesis procedures performed with the utilization of this clinic. Thirty-three residents completed the survey. The total mean number of paracentesis sessions participated in was 4.8. It was found that during training, 79% met conditional independence in performing this procedure with a high level of comfort by rotating through this clinic. It was also found that the number of procedures performed by internal medicine residents significantly increased with the addition of this clinic. A dedicated paracentesis clinic with internal medicine resident involvement can increase resident paracentesis procedural independence, the number of procedures available and performed, and procedural comfort level by the end of training.

Social Determinants of Health in Family Medicine Residency: A National Survey of Program Directors.

Social factors account for most health outcomes, underscoring the need to address social determinants of health (SDH) to eliminate health disparities. Our objectives are (1) to describe the scope of formal SDH curricula in family medicine residency, (2) to identify residency program characteristics associated with integrated core curriculum components to teach SDH, and (3) to identify barriers to addressing SDH in residency. We distributed a cross-sectional survey to all family medicine residency program directors (PDs) accredited by the Accreditation Council for Graduate Medical Education as identified by the Association of Family Medicine Residency Directors. Of 624 eligible program directors, 279 completed the survey (45% response rate). Overall, 41.2% of respondents reported significant formal SDH training in their program. Though a majority (93.9%) agreed that screening for social needs should be a standard of care, most (58.9%) did not use standardized screening tools. The most common barriers to addressing SDH were lack of clinical resources (eg, social workers, legal advocates), lack of community resources (eg, food banks, substance use disorder treatment), and inadequate screening instruments or integration into the electronic medical record system. Availability of referral resources was associated with PDs' increased perception of resident SDH competency. Nearly all respondents agreed that screening for social needs should be a standard part of care; however, this vision is not yet realized. To better train the next generation of physicians to identify and meaningfully address social needs, additional research is needed. This research might include mixed-methods approaches that incorporate qualitative assessments to define best practices and patient-centered outcomes related to identifying and responding to SDH.

Evaluation of the Diversity, Equity, and Inclusion Curriculum of a Pediatrics Residency Program.

Diversity, equity, and inclusion (DEI) training is essential to graduate medical education, but it lacks standardization. Although the impact of providers' biases and cultural competency on patient outcomes is well documented, the value of and satisfaction with DEI curricula in Pediatrics residency training programs is not well studied. This study aimed to complete a cross-sectional evaluation of the current DEI curriculum at a large Pediatrics-focused academic institution and identify areas of perceived deficiency among Pediatrics trainees. Residents and residency program directors completed surveys in 2020. Respondents evaluated the DEI curriculum of the program and the competency of residents to complete patient care related to specific DEI-oriented actions. Our analysis used descriptive statistics. In total, 48 of 137 resident trainees (35%) and 7 of 9 program leaders (78%) completed the survey. Respondents were most dissatisfied with current education related to implicit bias, refugee/immigrant health, and lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other health topics. Respondents reported low resident competency in DEI-focused patient care tasks and did not view residents as competent to address the healthcare needs of patients and families experiencing racism. Pediatrics residents and program directors consider DEI topics important and express a need for more robust DEI curricula.

Teaching residents to teach: A pilot study for an innovative online curriculum.

Resident-as-teacher (RAT) curricula have improved teaching behavior, ability, and confidence among resident participants. However, there are limited data on the appropriate format, length, and content. With teaching being a core residency competency and residents delivering one-third of student teaching in the clinical setting, properly training residents in clinical teaching is essential. We created a formal, scalable, asynchronous RAT curriculum. We report the pilot implementation of this curriculum along with feasibility, user acceptability, and preliminary knowledge outcomes. In this pilot pre-post interventional study, senior emergency medicine residents completed a formalized online education curriculum during their "teach month." The curriculum consisted of three online modules completed weekly over a 4-week rotation. Topics included adult learning, assessment and feedback, and group teaching. Several surveys were sent to residents before and after curriculum implementation. The surveys rated satisfaction and asked several education-specific knowledge questions to assess learning. Ratings were analyzed using means and confidence intervals (95%). Knowledge questions were graded and then analyzed by ANOVA and Fisher's LSD test. After the online modules were completed, the intervention group residents' mean score on knowledge questions was significantly higher than that prior to the curriculum and significantly higher than that the control group (previous graduated residents; 6.00 vs. 2.70, p = 0.0001; and 6.00 vs. 3.00, p = 0.0003, respectively). This score was maintained 3 months after completing the online modules. Intervention group residents were more satisfied with the online education resources than the control group (p = 0.048). Residents participating in a formalized online curriculum during their teach month demonstrate a high comprehension of education concepts and increased satisfaction with the provided educational resources and report high satisfaction with the teach month. Our pilot study suggests that a short online education-focused curriculum is an effective method of providing RAT training and may be applicable to clinical teachers across specialties and experience levels.

Development of Ventral Hernia Repair Curriculum Using the AWSSOM-a Synthetic Abdominal Wall Surgical Skills Operational Model.

Ventral hernia repair cost the U.S. healthcare system nearly 3 billion dollars annually. Surgical repair is a critical competency for residents yet hernia recurrence rates following mesh-based repair range from 0.8% to 24%. Improving surgical techniques using cadavers is often cost-prohibited for many education programs and limited research exists using simulation models with a corresponding hernia repair curriculum in the graduate medical education setting. This pilot project aimed to develop a low cost, easily reproducible novel abdominal wall reconstruction model and pilot-test the ventral hernia repair curriculum to inform further refinement prior to formal evaluation. This descriptive study pilot-tested the newly refined Abdominal Wall Surgical Skills Operative Model (AWSSOM) simulator for ventral hernia repair with mesh and its corresponding 2-h training curriculum for use at all levels of general surgery graduate medical education. The AWSSOM is a 3D printed synthetic anatomically realistic abdominal wall model consisting of silicone cured layers of skin, fat, rectus abdominis and a posterior rectus sheath fascia, and silicone tubules to simulate lateral neurovascular bundles. The curriculum incorporated didactic content reflecting surgical practice guidelines, hands-on practice, and faculty guidance promoting interactive critical thinking development during task performance. A pre-/post-assessment included a 10-item knowledge test, a 19-item psychomotor assessment, and 4-items confidence survey to examine changes in performance, knowledge, and confidence in competently completing the ventral hernia repair technique. Descriptive statistics were used to report the limited results of six military surgical resident participants and inform further model and curriculum refinement prior to formal evaluation. The five-layer AWSSOM model was manufactured in 65 h at a material cost of $87 per model frame, is reusable model, and secure base. Six surgical residents were recruited; only four completed both pre- and post-tests due to resident schedule conflicts. The average increase in knowledge was 25%, although variable changes in confidence were observed over the four program year participants. A larger sample size and a control group are needed to demonstrate curriculum effectiveness at improving knowledge, performance, and confidence in ventral hernia repair with mesh and better delineate if high scores translate to better operative skills. A key improvement requested by residents was a more secure model base for dissection and performance of the hernia repair. The novel abdominal wall surgical skills operative model fills an important proof of concept gap in simulation training. It is low cost with the potential to improve cognitive and psychomotor skills, as well as confidence to competently complete ventral hernia repair with mesh in the graduate medical education setting. Prior to formal effectiveness testing, our lessons learned should be addressed in both the model and curriculum. Future studies must include an adequately powered statistical evaluation with a larger sample across all levels of training.

Competence of pediatric residents and nurses in metered-dose inhaler techniques for asthma patients at Tikur Anbessa Specialized Hospital

Introduction: A Metered Dose Inhaler (MDI) is a device containing dissolved or suspended drugs to deliver drugs for pulmonary diseases efficiently. However, studies in Ethiopia show low competency among health professionals. Thus, we assessed the competency of residents and nurses working in a tertiary hospital. 
 Methods: From June to September 2022, 181 pediatrics and child health department residents and nurses participated in a pretested questionnaire and MDI technique practice. The knowledge score for residents and nurses was determined based on correct answers to questions from 0 to 6 for residents and 0 to 5 for nurses. Good knowledge was defined as a score of 80–100%, moderate knowledge from 60–79%, and poor knowledge from <60% of the total score. The good practice was ≥7 from 11 and all essential steps, while the poor practice was <7 of the total score and skipped essential steps. The chi-square or Fisher exact test was employed to compare groups as appropriate. The 95% confidence interval and a p-value of 0.05 were used to determine statistical significance. . 
 Results: Of the 181 study participants, 103 (56.9%) were residents. The participants' mean age was 32. MDI technique knowledge was poor for more than half of the residents (52.4%) and 46.4% of the nurses. Twenty-six (14.4%) of participants practiced the MDI technique steps, scoring 7 out of 11 steps. However, only 3.3% practiced the technique correctly. Whereas only 5.8% of residents and 0% of nurses practiced the essential steps of the MDI technique. When using a new inhaler drug, nearly half of the participants (47%) did not assess the patients' practice. 
 Conclusion: Healthcare professionals' competency in performing the MDI technique is low. Appropriate training programs are needed to enhance their ability to use inhaled devices and ensure successful drug delivery.

Integration of Geriatric Education Within the American Board of Emergency Medicine Model.

Emergency medicine (EM) resident training is guided by the American Board of Emergency Medicine Model of the Clinical Practice of Emergency Medicine (EM Model) and the EM Milestones as developed based on the knowledge, skills, and abilities (KSA) list. These are consensus documents developed by a collaborative working group of seven national EM organizations. External experts in geriatric EM also developed competency recommendations for EM residency education in geriatrics, but these are not being taught in many residency programs. Our objective was to evaluate how the geriatric EM competencies integrate/overlap with the EM Model and KSAs to help residency programs include them in their educational curricula. Trained emergency physicians independently mapped the geriatric resident competencies onto the 2019 EM Model items and the 2021 KSAs using Excel spreadsheets. Discrepancies were resolved by an independent reviewer with experience with the EM Model development and resident education, and the final mapping was reviewed by all team members. The EM Model included 77% (20/26) of the geriatric competencies. The KSAs included most of the geriatric competencies (81%, 21/26). All but one of the geriatric competencies mapped onto either the EM Model or the KSAs. Within the KSAs, most of the geriatric competencies mapped onto necessary level skills (ranked B, C, D, or E) with only five (8%) also mapping onto advanced skills (ranked A). All but one of the geriatric EM competencies mapped to the current EM Model and KSAs. The geriatric competencies correspond to knowledge at all levels of training within the KSAs, from beginner to expert in EM. Educators in EM can use this mapping to integrate the geriatric competencies within their curriculums.

Medical-Legal Partnership Education Impacts Resident Physician Competencies Relating to Social Drivers of Health.

Medical-legal partnerships (MLPs) support patients and clinicians by streamlining legal and medical care and helping identify and address a subset of social drivers of health (SDOH). Less is known on the effect of MLPs on the competency of residents regarding SDOH. The aim of this study was to identify how integration of an MLP into a pediatric residency training program affected residents' experience understanding and addressing SDOH.

Improving pediatric procedural skills and EPA assessments through an acute care procedural skills curriculum.

Acute procedural skill competence is expected by the end of pediatric residency training; however, the extent to which residents are actually competent is not clear. Therefore, a cross-sectional observational study was performed to examine the competency of pediatric residents in acute care procedures in emergency medicine. Pediatric residents underwent didactic/hands-on "Acute Procedure Day" where they performed procedures with direct supervision and received entrustable professional activity (EPA) assessments (scores from 1-5) for each attempt. Procedures included: bag-valve mask (BVM) ventilation, intubation, intraosseous (IO) line insertion, chest tube insertion, and cardiopulmonary resuscitation (CPR) with defibrillation. Demographic information, perceived comfort level, and EPA data were collected. Descriptive statistics and Pearson correlation for postgraduate year (PGY) versus EPA scores were performed. Thirty-six residents participated (24 PGY 1-2, and 12 PGY 3-4). Self-reported prior clinical exposure was lowest for chest tube placement (n = 3, 8.3%), followed by IOs (n = 19, 52.8%). During the sessions, residents showed the highest levels of first attempt proficiency with IO placement (EPA 4-5 in 28 residents/33 who participated) and BVM (EPA 4-5 in 27/33), and the lowest for chest tube placement (EPA 4-5 in 0/35), defibrillation (EPA 4-5 in 5/31 residents) and intubation (EPA 4-5 in 17/31). There was a strong correlation between PGY level and EPA score for intubation, but not for other skills. Entrustability in acute care skills is not achieved with current pediatrics training. Research is needed to explore learning curves for skill acquisition and their relative importance.

Pathology as a Basic Medical Subject: Its Relevance and Application During Clinical Practice in Jordanian MD Programs, Interns' and Residents' Perspectives.

Medical literature revealed that there is a lack of information about the opinions of medical interns and residents about curricula provided to them during their undergraduate programs, either in a group of detached subjects or an incorporated and efficacious topic (ie, pathology). To assess and compare the interns' and residents' perspectives towards Pathology as a subject. To recognize their opinions toward the relevance and application of Pathology while practicing clinically. This study was a cross-sectional online, self-administered questionnaire targeting interns and residents. The questionnaire consisted of 30 questions, enquiring about the demographic data, subject strength, teaching duration, interest in the subject, and usefulness of Pathology as a subject in clinical practice. Overall, 103 participants completed the survey. The female and male percentage was 59.2% and 40.8% respectively. 86.4% of participants were interns, while 13.6% were residents. 87% of participants agreed that applying pathology during clinical practice is a skill that should be strengthened in the early stages of preclinical education of Medicine. A modest percentage believed that a practitioner could efficiently treat the majority of patients with no need to know the specifics of the pathological mechanisms involved. Most of the participants believed that pathology courses helped them in making a differential diagnosis, analysis of normal and pathological constituents, and dissection and identification of structures. This study highlights the positive perceptions of Jordanian interns and residents toward pathology courses. It also demonstrates that participants prefer an active and dynamic educational model with an emphasis on better integration of pathology courses and clinical experiences that fit their needs in clinical practice. Thus, we recommend future studies to compare the competencies of interns and residents enrolled in the courses with integrated medical curricula, of pathology versus those who studied the conventional medical curricula of pathology, as well as to evaluate their perceptions of medical education.

Simulation to improve healthcare pathway and inequities for people with disabilities.

Introduction: The Convention on the Rights of People with Disabilities (1) reported that people with disabilities do not have equitable access to health services. People with intellectual disabilities, especially the ageing, are more susceptible to somatic disease and other lifestyle diseases than the general population (2, 3, 4, 5, 6). 
 General practitioners' (GP) competence in the field of intellectual disability is largely experience-based, not systematic and research-based (7). In municipalities, approximately half of healthcare workers (HCWs) at municipal housing for people with intellectual disabilities are unskilled. These HCWs have experienced not being taken seriously when calling either their patients’ GP or accident and emergency (A&E) department to report that the resident is 'not well', resulting in residents receiving inadequate healthcare. Municipal leaders and educators decided to address the inadequate clinical observation and communication skills among HCWs with a simulation-based training program (SBTP), to improve competence and treatment of residents when escalating levels of care.
 Methods: Based on national recommendations about ""Early detection of deteriorating condition"" and the urgency of the covid-pandemic, the SBTP was quickly rolled out to all HCW. The SBTP consisted of both theoretical teaching and e-learning in ABCDE, training in the tool NEWS2, as well as the communication technique ISBAR. Baseline NEWS2 scores were established for all residents.
 Based on positive experience with SBTP in donning and doffing of personal protection equipment (8) in the municipality early in the pandemic, and uncertainty about safer care for sick corona patients in residential homes, leaders requested continued use SMTP to improve observational skills.
 Results & Discussion: Evidence of improved competency at work and resulting improved escalation of care came fast.
 One example was of a resident with backpain whose relatives’ recommended painkillers. HCWs performed NEWS2 scoring, discovered pathological changes, contacted A&E, received treatment advice, continually followed up on NEWS2 measurements, secured ambulance help & reaction based on baseline NEWS2, and admission where sepsis was discovered. Similarly, another group of HCWs performed NEWS2 scoring on a patient with presenting manic symptoms, discovered clinical signs of somatic illness, which lead to a completely different medication than expected. These cases were seen as post-SBTP improvements in HCWs behavior, and patient safety.
 
 SBTP to improve observational skills in the municipality has led to better differential diagnosis in the early stage, more precise communication with GP and A&E which in turn has led to better healthcare pathways for a vulnerable patient group.
 Keywords: simulation, observational competence, competence, health rights

The association between abortion training and obstetrics and gynecology resident competence and intention to provide abortion care before Dobbs

ObjectiveTo assess the role of abortion training in fourth-year obstetrics and gynecology (OBGYN) residents’ abortion care competence and practice intentions before the Dobbs decision. Study designThis is a planned secondary analysis of survey data of fourth-year U.S. OBGYN residents. Abortion training was defined as ‘routine’ if automatically included in schedules, ‘‘optional’’ if not scheduled but available, and ‘‘not available’’. Self-assessed competence was defined as feeling prepared to independently provide care. Participants were asked about their competence and post-residency intentions to provide specific aspects of pregnancy loss and induced abortion care. ResultsOf 1241 fourth-year residents, 885 (71%) completed the questions of interest. For each skill, more residents with routine training reported competence compared to those with less comprehensive training. More residents with routine training reported intentions to include abortion care in practice (422, 79%) compared to residents with optional (171, 66%) or no training (51, 55%), p < 0.001). Residents with routine training were nearly six times more likely to intend to provide medication abortion post-residency compared to residents without training; more residents in all groups reported intentions to provide care for pregnancy loss compared to abortion. ConclusionsPre-Dobbs, residents with routine abortion training had greater self-assessed competence in abortion care than those with optional or no training and were more likely to intend to provide this after residency. Given the evolving impacts of the 2022 reversal of Roe v Wade, residency training programs must work to ensure routine access to legally permissible abortion training as routine training is associated with intention to provide fundamental, reproductive healthcare. ImplicationsRoutine training in abortion care during OBGYN residency is associated with higher competence and intention to provide post-residency – availability of this training Is severely compromised in restricted states post-Dobbs.

CRITICAL INCIDENTS AND PERIOPERATIVE EMERGENCIES: ARE FINAL YEAR RESIDENTS AND ANESTHESIOLOGISTS ARE READY?

A critical incident (CI) is any failed event that could have been prevented and carries the risk of undesirable consequences for the patient. The study of critical incidents and physicians' preparedness for their occurrence helps to reduce their consequences, risks of recurrence and improve patient safety. The aim of the study was to investigate how well are graduate residents and anesthesiologists prepare to manage critical incidents (CI) and perioperative emergencies (PE) during anesthesia. Methods and Materials: A prospective observational study was conducted at the Bogomolets National Medical University, the postgraduate department of surgery, anesthesiology and intensive care. The study was conducted from May 2022 to June 2023. Anesthesiologists and final year residents were assessed for the acquired competencies in the management of CI and PE: they conducted a self-assessment of their own competencies; passed 1 simulation scenario with an assessment on the CEХ scale during the scenario. Results. The study included 60 final year residents and 24 anesthesiologists. Many of residents (55 %) and anesthesiologists (63 %) generally assessed their readiness to manage CI and PE as high: 45% and 47% respectively considered their level of readiness to be insufficient, including 27% and 8% who assessed it as low. When stratified by the type of CI and PE, it was found that residents and anesthesiologists were best prepared to provide care in case of CI and PE from the side of breathing and airway patency cardiovascular system. Significantly worse anesthesiologists assessed their readiness for rare emergencies, such as malignant hyperthermia, anaphylaxis, local anesthetic systemic toxicity (LAST) (OR 0.35 [0.17- 0.74], p=0.009 for residents and OR 0.25 [0.07-0.8], p=0, 04 for anesthesiologists) and events related to apparatus malfunction, lack of power supply, and catching fire in the respiratory circuit (OR 0.4 [0.2-0.8], p=0.03 for residents and OR 0.25 [0.07-0.8], p=0.04 for anesthesiologists). Anesthesiologists had a significantly higher level of readiness and competence for all individual parameters and the overall mean score during simulation scenarios (7.69±0.53 vs. 5.94±1.6, p&lt;0.0001). Conclusions. Anesthesiologists generally showed higher results in readiness to manage CI and PE during anesthesia. Difficult competencies for both residents and anesthesiologists were the resource management, organizational competencies, and stress resistance.

Benefits of lower limb angioplasty training using a virtual reality simulator among vascular surgical residents

BackgroundWe assessed the skill acquisition, operative competency, and confidence of vascular surgery residents during a limb angioplasty workshop and evaluated their surgical volume and retention rate at 1 year. MethodsFor 3 years (2018-2020), all residents and fellows in their final year of vascular residency at a teaching hospital were enrolled. Five residents in 2018 were enrolled in the control group (apprenticeship model). Twelve residents and fellows from 2019 (training group) and 2020 (coronavirus disease 2019 [COVID-19] group) were trained using the ANGIO Mentor (Simbionix Ltd, Airport City, Israel) in two workshops. The residents were evaluated using the Objective Structured Assessment of Technical Skills, simulator metrics, and a confidence questionnaire. A P value of < .05 was considered statistically significant. ResultsThe groups were similar in age, sex, and number of limb angioplasties performed (control group, 25.00 ± 5.52; training group, 23.16 ± 7.44; COVID-19 group, 24.50 ± 8.17; P = .91, Student t test). The residents of the training and COVID-19 groups showed significantly improved Objective Structured Assessment of Technical Skills scores after the first workshop (from 15.5 [interquartile range (IQR), 12.62-19.13] to 29.5 [IQR, 25.25-39.38]; and from 14.50 [IQR, 13.62-15.00] to 23.5 [IQR, 21.87-24]; P < .001]; respectively) and reported confidence improvement (from a median of 3 [IQR, 3-3] to 4 [IQR, 4-5]; P = .01). After 6 months, the retention rate was good. During that semester, each resident performed a median of 10.50 limb angioplasties (IQR, 7.00-13.25 limb angioplasties). The second workshop did not improve either the residents' scores or their confidence. At the end of the year, the control group scored worse than did the training and control groups (control group, 23.50 [IQR, 19.00-24.50]; training group, 37.0 [IQR, 36.50-39.37]; COVID-19 group, 34.75 [IQR, 30.75-38.75]; P = .005, Kruskal-Wallis test). The simulation metrics did not show significant differences among the groups. ConclusionsA 3-week limb angioplasty workshop can improve residents' skills and confidence. Performing 10 angioplasties per semester is sufficient to ensure the retention rate is good after 6 months, and a second workshop is unnecessary.

Resident Perceptions of Competency-Based Korean Medicine Education: A Qualitative, Content Analysis Study Conducted using Focus Group Interviews

Objectives: The new educational system emphasizes acquisition of clinical competency by the time of graduation from Korean medicine colleges that allow Korean medicine doctors to immediately perform clinical tasks. This study investigated awareness of competency-based education in Korean medicine hospital residents who must simultaneously undergo training and assist medical students in clinical practice.Methods: This was a qualitative research that was conducted using focus group interviews (FGIs) to investigate the awareness of demands for improvement in competency-based Korean medicine education in Korean medicine hospital. To apply the principles and procedures of FGIs, a semi-structured questionnaire was developed. Data analysis was conducted using the five steps of framework analysis.Results: According to contents analysis, first competency-based education that reflects actual clinical practice tasks is needed. Second, sufficient basic skill mastery education must be reinforced. Third, an intermediate curriculum that mediates clinical practice and basic education is needed. Fourth, the Objective Structured Clinical Examination and Clinical Performance Examination must be expanded to prepare for the Korean medicine doctor practical test.Conclusions: Korean medicine residents reported the gap between clinical practice and use of knowledge and skills acquired in the curriculum while acting as direct observers and educations of clinical clerkship in hospitals. Based on this exploratory study it is necessary to conduct research on the educational competency of Korean medicine residents who play an important role as educational leaders in Korean medicine clinical practice training.

Variation in Competence of Graduating General Surgery Trainees

To examine the readiness of general surgery residents in their final year of training to perform 5 common surgical procedures based on their documented performance during training. Intraoperative performance ratings were analyzed using a Bayesian mixed effects approach, adjusting for rater, trainee, procedure, case complexity, and postgraduate year (PGY) as random effects as well as month in academic year and cumulative, procedure-specific performance per trainee as fixed effects. This model was then used to estimate each PGY 5 trainee's final probability of being able to independently perform each procedure. The actual, documented competency rates for individual trainees were then identified across each of the 5 most common general surgery procedures: appendectomy, cholecystectomy, ventral hernia repair, groin hernia repair, and partial colectomy. This study was conducted using data from members of the SIMPL collaborative. A total of 17,248 evaluations of 927 PGY5 general surgery residents were analyzed from 2015 to 2021. The percentage of residents who requested a SIMPL rating during their PGY5 year and achieved a ≥90% probability of being rated as independent, or "Practice-Ready," was 97.4% for appendectomy, 82.4% for cholecystectomy, 43.5% for ventral hernia repair, 24% for groin hernia repair, and 5.3% for partial colectomy. There is substantial variation in the demonstrated competency of general surgery residents to perform several common surgical procedures at the end of their training. This variation in readiness calls for careful study of how surgical residents can become more adequately prepared to enter independent practice.

Development of a Tool to Assess Surgical Resident Competence On-Call: The Western University Call Assessment Tool (WUCAT)

A central tenet of competency-based medical education is the formative assessment of trainees. There are currently no assessments designed to examine resident competence on-call, despite the on-call period being a significant component of residency, characterized by less direct supervision compared to daytime. The purpose of this study was to design a formative on-call assessment tool and collect valid evidence on its application. Nominal group technique was used to identify critical elements of surgical resident competence on-call to inform tool development. The tool was piloted over six months in the Division of Plastic & Reconstructive Surgery at our institution. Quantitative and qualitative evidence was collected to examine tool validity. A ten-item tool was developed based on the consensus group results. Sixty-three assessments were completed by seven staff members on ten residents during the pilot. The tool had a reliability coefficient of 0.67 based on a generalizability study and internal item consistency was 0.92. Scores were significantly associated with years of training. We found the tool improved the quantity and structure of feedback given and that the tool was considered feasible and acceptable by both residents and staff members. The Western University Call Assessment Tool (WUCAT) has multiple sources of evidence supporting its use in assessing resident competence on-call.

Radiology resident competency in detecting basilar artery occlusion: a simulation-based assessment.

Basilar artery strokes are rare but can have characteristic imaging findings that can often be overlooked. This retrospective study aims to assess radiology residents' ability to identify CT imaging findings of basilar artery occlusion in a simulated call environment. The Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM)-a tested and reliable computer-aided emergency imaging simulation-was employed to assess resident readiness for independent radiology call. The simulations include 65 cases of varying complexity, including normal studies, with one case specifically assessing basilar artery stroke. Residents were presented with a single, unique case of basilar artery occlusion in two separate years of testing and were only provided with non-contrast CT images. Residents' free text responses were manually scored by faculty members using a standardized grading rubric, with errors subsequently classified by type. A total of 454 radiology residents were tested in two separate years on the imaging findings of basilar artery occlusion using the Wisdom in Diagnostic Imaging simulation web-based testing platform. Basilar artery occlusion was consistently underdiagnosed by radiology residents being tested for call readiness irrespective of the numbers of years in training. On average, only 14% of radiology residents were able to correctly identify basilar artery occlusion on non-contrast CT. Our findings underscore a potential gap in radiology residency training related to the detection of basilar artery occlusion, highlighting the potential need for increased educational efforts in this area.

An investigation into emergency medicine resident cricothyrotomy competency: Is three the magic number?

Cricothyrotomy is a high-stakes emergency procedure. Because the procedure is rare, simulation is often used to train residents. The Accreditation Council for Graduate Medical Education (ACGME) requires performance of three cricothyrotomies during residency, but the optimal number of training repetitions is unknown. Additional repetitions beyond three could increase proficiency, though it is unknown whether there is a threshold beyond which there is no benefit to additional repetition. The objective of this study was to establish a minimum number of simulated cricothyrotomy attempts beyond which additional attempts did not increase proficiency. This was a prospective, observational study conducted over 3 years at the simulation center of an academic emergency medicine residency program. Participants were residents participating in a cricothyrotomy training as part of a longitudinal airway curriculum course. The primary outcome was time to successful completion of the procedure as first-year residents. Secondary outcomes included time to completion as second- and third-year residents. Procedure times were plotted as a function of attempt number. Data were analyzed using descriptive statistics, repeated-measures analysis of variance, and correlation analysis. Preprocedure surveys collected further data regarding procedure experience, confidence, and comfort. Sixty-nine first-year residents participated in the study. Steady improvement in time to completion was seen through the first six attempts (from a mean of 75 to 41 sec), after which no further significant improvement was found. Second- and third-year residents initially demonstrated slower performance than first-year residents but rapidly improved to surpass their first-year performance. Resident mean times at five attempts were faster with each year of residency (first-year 48 sec, second-year 30 sec, third-year 24 sec). There was no statistically significant correlation between confidence and time to complete the procedure. Additional repetition beyond the ACGME-endorsed three cricothyrotomy attempts may help increase proficiency. Periodic retraining may be important to maintain skills.