Resident Confidence Levels Research Articles

The Development of an Innovative Crowdsourced Resident Procedure Team Model to Improve Bedside Procedural Proficiency in the Inpatient Setting.

Background Bedside procedures are a necessary skill for many residents. Practice changes, including the discontinuation of a minimum number of procedures required by the American Board of Internal Medicine, may have resulted in decreased incentive for residents to seek procedural opportunities. Objective To improve residents' procedural output and confidence in abdominal paracentesis, arterial and central venous line placement, nasogastric intubation, and ultrasound-guided peripheral intravenous catheter insertions (USPIV). Methods A novel Resident Procedure Team (RPT) model was created using crowdsourced proficient (having completed ≥5 procedures) near-peers in combination with peer-led USPIV simulation workshops to increase the number of supervising residents available. Procedure logs and the number of residents who became qualified to perform and supervise procedures were tracked from July 2018 to June 2022 and compared before and after the implementation of the RPT in July 2020. Results Implementing the novel RPT model significantly increased the number of procedures performed (1875 procedures post-RPT vs 1292 pre-RPT; P=.02). Abdominal paracentesis increased from 411 to 482 (17.3%), central venous line placement increased from 344 to 401 (16.6%), USPIV increased from 318 to 389 (22.3%), arterial line placement increased from 189 to 360 (90.5%), and nasogastric intubation increased from 30 to 243 (710.0%). Resident confidence levels increased significantly after RPT-led USPIV workshops (P<.05 for all). Conclusions Implementation of a novel, crowdsourced, resident-led procedure team and peer-led USPIV workshops helped increase the number of procedures performed by residents.

An Educational Needs Assessment of Telehealth in Primary Care Among US Internal Medicine Residents.

As a result of the coronavirus disease 2019 pandemic, many Internal Medicine (IM) residency programs converted to telehealth for primary care. Our objectives in this study were to better understand resident past and present telehealth education, their perceived barriers to telehealth practice, and their perceived solutions to improving telehealth use and education. We performed a cross-sectional needs assessment survey between November 2020 and February 2021 among residents at 10 IM residency programs across the United States. Our primary measures were telehealth use in resident continuity clinics before and during the coronavirus disease 2019 pandemic, telehealth training, and confidence and barriers in using telehealth. Of 857 residents contacted, 314 (36.6%) responded. Residents reported low rates of education in telehealth prepandemic with significant improvements after the start of the pandemic across all visit domains (range of 10.7%-19.6% prepandemic compared with 25.6%-55.7% postpandemic, all P < 0.001). Resident confidence levels were significantly lower (P < 0.001) for video visits and telephone visits compared with in-person visiting across domains of communication, history taking, using an interpreter, making a diagnosis, counseling patients, providing psychosocial support, performing medical management, and coordinating after-visit care. Reported barriers included patient resources, clinic resources, lack of preceptor feedback, and lack of observation. Reported resources for improvement included tutorials on physical examination techniques, clinical space for telehealth, and patient resources for telehealth. To effectively address the educational needs for telehealth practice by IM residents, educators must consider not only curricular needs but also clinical, preceptor, and patient barriers to the high-quality use of telehealth for primary care.

PHSOR06 Presentation Time: 12:55 PM: Medical Physics Residents Have Spoken: They Want More Brachytherapy Training Opportunities

<h3>Purpose</h3> To evaluate the current status of brachytherapy (BT) training received by medical physics residents (MPR) in North America by surveying residents currently enrolled in, and recently graduated from CAMPEP-accredited residency programs. The documented decline in the use of BT may result in reduced training opportunities. This survey aims to identify the current strengths and areas for improvement in MPR BT training. <h3>Materials and Methods</h3> A survey consisting of 26 questions was developed to collect data in five areas: (1) training program demographics; (2) didactic and practical training methods; (3) caseload and confidence levels of residents for various treatment modalities (including HDR, LDR, IORT, TARE, and Radiopharm), disease sites, and clinical tasks (including treatment planning, plan checks, and treatment delivery); (4) level of interest in performing BT post-residency; and (5) level of interest in receiving additional BT training opportunities. The survey was reviewed by several AAPM committees and was approved by the Executive Committee. The survey was distributed to residents currently enrolled in, and graduates within 5 years of residency training. <h3>Results</h3> The response rate was 23% (186 responses / 796 recipients). 60% of respondents had completed their training and 40% were currently enrolled in a program. Only 53% of currently enrolled residents had completed the BT training required by their program's curriculum. Therefore, to accurately depict the BT training experience of MPR, data is presented only from those having completed training. The majority of residents (94%) received three months or more of dedicated BT training and 96% believed it was important to learn BT during residency. Further, MPR (88%) believed their program director valued their BT education. A very notable finding was that only 49% of residents felt confident enough to perform BT for all sites treated at their training institution upon completion of their training program. HDR gynecological procedures were the only modality and disease site combination out of 14 modality and site combinations with more than 50% of individuals reporting feeling "very confident" at the completion of their training. MPR indicated an increase in caseload (29%) would most improve their confidence level followed closely by increased case involvement (25%). Few (11%) believed additional didactic training would improve their confidence level. The majority (73%) of MPR enjoyed their BT rotation more than other rotations. Most wanted to (72%) and would be (67%) performing BT at their first position post-residency. Additional training opportunities were desired by the majority (64%) of MPR and 10% were unsure. This subset of individuals reported interest in selecting BT as an elective rotation (66%), performing a BT rotation at another institution with a higher caseload (76%), and completing a BT fellowship post-residency (63%, Figure 1). The interest level of MPR in pursuing a fellowship was greater than the 2% reported by Marcrom et al. (IJROBP, 2018) for radiation oncology residents. <h3>Conclusions</h3> MPR believe BT training during residency is important and the majority of MPR did not achieve their desired level of confidence in performing BT procedures at the completion of their residency training. Caseload was identified as the primary factor contributing to low confidence levels. The majority indicated they wanted to (and would be) performing BT post-residency, and desired additional training opportunities. Strong interest was expressed in pursuing (1) an additional rotation, (2) rotations through outside training facilities, and (3) optional fellowships. These opportunities are available to radiation oncology residents through the ABS-sponsored 300-in-10 program. There is a demonstrated need and interest for an equivalent program for medical physicists.

Implementing FLS Training Protocol for Minimally Invasive GYN Surgery Training

Study Objective The number of minimally invasive surgeries required for residents has increased alongside the requirement of passing the Fundamentals of Laparoscopic Surgery (FLS) program for board certification in Obstetrics and Gynecology (OBGYN) programs. Simulation training has been proposed as a method to increase the proficiency of training surgeons; however, no gynecologic simulation models have been validated. We hypothesized that 24-hour access to the FLS trainer would improve the residents’ times to complete the standardized FLS tasks and improve first time pass rates, and that increased training time would increase resident confidence. Design We performed an observational prospective study. Each resident was timed on the FLS tasks and surveyed to assess confidence each quarter. We compared first time pass rates of the FLS exam for residents who took the exam prior to having access to the trainer to the first-time pass rates of the residents who did have access to the trainer. Setting N/A. Patients or Participants 20 residents were enrolled. During the study period, 1 resident left the program. Interventions N/A. Measurements and Main Results There was no statistical significance between first time pass rates for the FLS exam. Paired t-test was used and found no significant differences in timed task completion or survey question. Conclusion Voluntary simulation-based training was not an effective way to improve gynecologic surgical skills during this study. We suspect this to be a result of lack of defined structure, limited free time, and challenges due to the COVID 19 pandemic. There were low compliance rates of the residents using the FLS trainer and no significant improvement in the time required to finish the standardized FLS tasks, first time pass rates on the FLS exam, or resident confidence levels measured by survey results. More research is needed to evaluate barriers to simulation training to improve minimally invasive surgical skills The number of minimally invasive surgeries required for residents has increased alongside the requirement of passing the Fundamentals of Laparoscopic Surgery (FLS) program for board certification in Obstetrics and Gynecology (OBGYN) programs. Simulation training has been proposed as a method to increase the proficiency of training surgeons; however, no gynecologic simulation models have been validated. We hypothesized that 24-hour access to the FLS trainer would improve the residents’ times to complete the standardized FLS tasks and improve first time pass rates, and that increased training time would increase resident confidence. We performed an observational prospective study. Each resident was timed on the FLS tasks and surveyed to assess confidence each quarter. We compared first time pass rates of the FLS exam for residents who took the exam prior to having access to the trainer to the first-time pass rates of the residents who did have access to the trainer. N/A. 20 residents were enrolled. During the study period, 1 resident left the program. N/A. There was no statistical significance between first time pass rates for the FLS exam. Paired t-test was used and found no significant differences in timed task completion or survey question. Voluntary simulation-based training was not an effective way to improve gynecologic surgical skills during this study. We suspect this to be a result of lack of defined structure, limited free time, and challenges due to the COVID 19 pandemic. There were low compliance rates of the residents using the FLS trainer and no significant improvement in the time required to finish the standardized FLS tasks, first time pass rates on the FLS exam, or resident confidence levels measured by survey results. More research is needed to evaluate barriers to simulation training to improve minimally invasive surgical skills

Preparing junior radiology residents for overnight call via peer-led, hands-on simulation.

The aim of this study was to assess the perceived value and impact of a hands-on mock call simulation program on resident confidence with interpretation of emergency department overnight call cases. A five-session course was implemented in June of 2018 for rising PGY-3/R2 residents to mimic the experience of overnight call with indirect supervision. Sessions were led by senior residents in the program and consisted of timed, independent interpretation of 15-20 high-yield cases per day which highlighted "do-not miss" critical findings and simulated workflow interruptions including phone calls, consultations, and questions from technologists. IRB-approved, and anonymous pre- and post-course surveys were administered to participants which assessed residents' degree of confidence in interpretation of on-call cases and comparison of the mock call experience with existing preparatory strategies. Survey responses were analyzed using McNemar's test and Mann-Whitney U test. Our survey response rate was 91% (29/32). After completing the mock call simulation, there was a significant increase in the mean Likert score of resident confidence levels and feelings of preparedness from 4.59 to 7.38 (p < 0.01). The majority of respondents (72.4% [21/29]) felt that the mock call simulation was "extremely useful." One hundred percent of respondents indicated that the mock call simulation should be implemented for the following year. Implementation of a hands-on mock call simulation significantly improves the confidence levels of radiology residents before assuming on-call responsibilities and may serve as an adjunct to existing preparatory strategies.

Developing a Telemedicine Curriculum for a Family Medicine Residency.

Telemedicine has rapidly become an essential part of primary care due to the COVID-19 pandemic. However, formal training in telemedicine during residency is lacking. We developed and implemented a telemedicine curriculum for a family medicine residency program and investigated its effect on resident confidence levels in practicing telemedicine. We designed a process map of the telemedicine visit workflow at the residency clinic to identify key topics to cover in the curriculum. We created a live 50-minute didactic lecture on best practices in telemedicine, along with a quick-reference handout. We distributed pre- and postintervention surveys to current residents (N=24) to assess the effect of the educational intervention on their confidence in practicing telemedicine. Fourteen residents (58% response rate) completed all aspects of the study including both surveys and participation in the educational intervention. Confidence levels in conducting telemedicine visits increased in three of five domains: (1) virtual physical exam ( P=.04), (2) visit documentation (P=.03), and (3) virtually staffing with an attending ( P=.04). Resident interest in using telemedicine after residency also increased following the educational intervention. Telemedicine requires a unique skill set. Formal education on best practices improves resident confidence levels and interest in practicing telemedicine. Primary care residency programs should incorporate telemedicine training to adequately prepare their graduates for clinical practice.

Assessing Resident Confidence and Enhancing Advanced Care Planning in an Outpatient Resident Clinic (GP722)

•Evaluate the effectiveness of educational intervention and practice initiative for Healthcare Power of Attorney Discussions in Outpatient Clinic.•Measure the scope of healthcare power of attorney discussions in an internal medicine resident clinic by requesting nursing staff to initiate the conversation with patients. Prior studies centering on physician initiatives demonstrated increased communication surrounding advanced directives (ADs). Structured curricula in training programs led to increased confidence in leading ADs discussions. The sampled community hospital clinic lacked a palliative care curriculum and resultant low levels of confidence regarding such discussions. The aim of this study was to assess the effect of a short presentation and practical experience on resident confidence levels. Secondary aim was to assess if an interdisciplinary approach involving nurses and residents increased conversations regarding healthcare powers of attorney (HCPOA). This is a retrospective chart review of patients in an Internal Medicine Resident Clinic to assess rate of HCPOA conversations. The residents either attended or reviewed a 10-minute narrated PowerPoint on HCPOA. A convenience sample of internal medicine residents were anonymously surveyed at three points throughout the study, at initiation, after the lecture, and conclusion, 38, 32, and 34 respondents respectively. Confidence was assessed on a Likert scale. Over a six-month period, nurses were asked to discuss HCPOA during their initial intake interview, and residents answered questions and consolidated the importance of assigning HCPOA. Kruskal-Wallis Test was utilized to assess residents' confidence levels. They increased between the first and second surveys, p=0.0023 (p<0.05) and first and third surveys, p=0.00063 (p <0.05). Initially, only 5 of 426 patients screened had completed a HCPOA. At completion, 42 of 240 patients who presented during the study period had conversations about HCPOA. An educational component increased confidence levels but education and practice changing initiatives were more impactful. An interdisciplinary approach to initiating conversations also leads to increased completion rates, as a number of residents noted a key limiting factor was time.

Interactive Learning Modules With Visual Feedback Improve Resident Learning in Colposcopy.

The Accreditation Council for Graduate Medical Education and the Council on Resident Education in Obstetrics and Gynecology have milestones and/or competencies relating to colposcopy; however, the optimal way to reach these objectives is not proscribed and left to individual programs. Here, we aim to assess resident skill, confidence levels, perceived level of knowledge, and satisfaction with colposcopic training before and after implementation of a new interactive learning module with visual feedback. A new online educational intervention was developed by the author (E.L.N.) based on adult learning theory and introduced into our obstetrics and gynecology resident colposcopy curriculum in July 2014. We assessed performance on an objective competency examination administered at baseline and repeated after 6 months of our 24 residents.In addition, we assessed resident confidence levels, perceived level of knowledge, and satisfaction with training before and 6 months after intervention. Scores on a national online examination improved after the intervention (p = .014). Significant improvements on the examination were seen in the sections of medical knowledge (p = .031) and management (p = .011). Residents' perceived knowledge increased significantly after the intervention (p = .030). Learning outcomes improved after introduction of a novel teaching intervention.

Multi-Institutional Regional Otolaryngology Bootcamp.

In order to increase junior resident physician proficiency and improve patient safety, simulation-based procedural training courses, or bootcamps, have been become an emerging educational tool. To compare pre- and post-course confidence levels and to assess station efficacy after completion of our single day bootcamp. We developed the University of California (UC) Davis otolaryngology bootcamp, a single day course including six cadaveric task trainer stations and four simulations. The six task trainer stations included (1) Epistaxis, (2) Cricothyrotomy/tracheostomy, (3) Peritonsillar abscess/auricular hematoma, (4) Nasal bone reduction/zygoma reduction/lateral canthotomy/canalicular trauma and probing, (5) Local nerve blocks, and (6) Soft tissue reconstruction. The simulations comprised of airway fire during tracheostomy, pediatric respiratory code during airway evaluation, dislodged pediatric tracheostomy tube in the ICU, and angioedema in the emergency department with inability to intubate or ventilate. Junior residents from multiple locoregional institutions were recruited to participate. Pre- and post-course Likert surveys assessing participant confidence and station efficacy were collected and analyzed. There was a statistically significant increase in resident confidence levels for all task trainer stations. All stations had a station efficacy Likert score average of 4 "very effective" or 5 "most effective." A multi-institutional, locoregional, simulation-based bootcamp can be a valuable adjunct to junior resident training. It can promote camaraderie, pool limited resources, and may be cost-effective.

Knowledge and confidence in managing obstructive sleep apnea patients in Canadian otolaryngology - head and neck surgery residents: a cross sectional survey

BackgroundObstructive sleep apnea is an expected competency for Otolaryngology - Head and Neck surgery residents and tested on the Royal College of Physicians and Surgeons examination. Our objective was to evaluate the knowledge, attitudes and confidence of Canadian Otolaryngology - Head and Neck surgery residents in managing Obstructive Sleep Apnea (OSA) patients.MethodsAn anonymous, online, cross-sectional survey was distributed to all current Canadian Otolaryngology-Head and Neck surgery residents according to the Dillman Tailored Design Method in English and French. The previously validated OSA Knowledge and Attitudes (OSAKA) questionnaire was administered, along with questions exploring resident confidence levels with performing OSA surgeries. Descriptive statistics, Wilcoxon Rank Sum and unpaired Student’s t tests were calculated in Excel.ResultsSixty-six (38.4%) out of 172 residents responded (60.6% male; 80.3% English-speaking). Median OSAKA knowledge score was 16/18 (88.9%; Interquartile range: 14–16). Although all respondents believed that OSA was an important clinical disorder, only 45.5% of residents felt confident in managing OSA patients, while only 15.2% were confident in managing continuous positive airway pressure therapy (CPAP). Senior residents were more confident than junior residents in identifying OSA patients (96.7% vs 69.4%; p < 0.005) and managing the disease (60.0% vs. 33.3%; p = 0.03), including CPAP (26.7% vs. 5.6%; p = 0.01).Residents had lowest confidence levels in performing tongue base suspension (1.5%), transpalatal advancement pharyngoplasty (3.0%), and laser assisted uvulopalatoplasty (6.1%). Highest confidence levels were described in performing septoplasty (56.1%), adult tonsillectomy (75.8%), and tracheotomy (77.3%).ConclusionsOtolaryngology - Head and Neck surgery residents’ knowledge of OSA was very good; however, confidence levels for managing OSA and performing OSA surgeries were varied. Several areas of perceived strengths and weaknesses in OSA training were identified by Canadian Otolaryngology - Head and Neck surgery residents.

Two-Year Experience Implementing a Curriculum to Improve Residents’ Patient-Centered Communication Skills

Surgery milestones from The Accreditation Council for Graduate Medical Education have encouraged a focus on training and assessment of residents' nontechnical skills, including communication. We describe our 2-year experience implementing a simulation-based curriculum, results of annual communication performance assessments, and resident evaluations. Eight quarterly modules were conducted on various communication topics. Former patient volunteers served as simulation participants (SP) who completed annual assessments using the Communication Assessment Tool (CAT). During these 2 modules, communication skills were assessed in the following standardized scenarios: (1) delivering bad news to a caregiver of a patient with postoperative intracerebral hemorrhage and (2) primary care gallstone referral with contraindications for cholecystectomy. SP-CAT ratings were evaluated for correlations by individual and associations with trainee and SP characteristics. Surgical patient experience surveys are evaluated during the curriculum. Independent academic medical center surgical simulation center. Twenty-five surgery residents per year in 2015 to 2017. Residents have practiced skills in a variety of scenarios including bad news delivery, medical error disclosure, empathic communication, and end-of-life conversations. Residents report positive learning experiences from the curriculum (90% graded all modules A/A+). Confidence ratings rose following each module (p < 0.001) and in the second year (p < 0.001). Annual assessments yielded insights into skills level, and relationships to resident confidence levels and traits. Communication scores were not associated with resident gender or postgraduate year. Over the course of the curriculum implementation, surgical patients have reported that doctors provided explanations with improved clarity (p = 0.042). The simulation-based SP-CAT has shown initial evidence of usability, content validity, relationships to observed communication behaviors and residents' skills confidence. Evaluations of different scenarios may not be correlated for individuals over time. The communication curriculum paralleled improvements in patient experience concerning surgeons' clear explanations. An ongoing surgery resident communication curriculum has numerous educational, assessment, and institutional benefits.

Emergency airway management: Training and experience of chief residents in otolaryngology and anesthesiology

Resident training in emergency airway management is not well described. We quantified training and exposure to airway emergencies among graduating Otolaryngology-Head and Neck Surgery and Anesthesiology residents. The methods used for this study were a national web-based survey of chief residents. The response rate was 52% (otolaryngology) and 60% (anesthesiology). More otolaryngology residents rotated on anesthesiology than anesthesia residents on otolaryngology (33% vs 8%). More anesthesiology chiefs never performed an emergency surgical airway than otolaryngology (92% vs 18%). The most common self-rating of competency was "9," with 82% overall self-rating "8" or higher (10 = "totally competent"). Otolaryngology and anesthesiology emergency airway management experience/training is heterogeneous and nonstandardized. Many chief residents graduate with little exposure to airway emergencies, especially surgical airways. Resident confidence levels are high despite minimal experience. This high confidence-low experience dichotomy may reflect novice overconfidence and suggests the need for improved training methods.

Teaching internal medicine residents quality improvement techniques using the ABIM's practice improvement modules.

Standard curricula to teach Internal Medicine residents about quality assessment and improvement, important components of the Accreditation Council for Graduate Medical Education core competencies practiced-based learning and improvement (PBLI) and systems-based practice (SBP), have not been easily accessible. Using the American Board of Internal Medicine's (ABIM) Clinical Preventative Services Practice Improvement Module (CPS PIM), we have incorporated a longitudinal quality assessment and improvement curriculum (QAIC) into the 2 required 1-month ambulatory rotations during the postgraduate year 2. During the first block, residents complete the PIM chart reviews, patient, and system surveys. The second block includes resident reflection using PIM data and the group performing a small test of change using the Plan-Do-Study-Act (PDSA) cycle in the resident continuity clinic. To date, 3 resident quality improvement (QI) projects have been undertaken as a result of QAIC, each making significant improvements in the residents' continuity clinic. Resident confidence levels in QI skills (e.g., writing an aim statement [71% to 96%, P < .01] and using a PDSA cycle [9% to 89%, P < .001]) improved significantly. The ABIM CPS PIM can be used by Internal Medicine residency programs to introduce QI concepts into their residents' outpatient practice through encouraging practice-based learning and improvement and systems-based practice.

Improvement of residents' clinical competency after the introduction of new postgraduate medical education program in Japan

Background: In 2004, the Japanese government reformed the monospecialty-oriented postgraduate medical education (PGME) program and introduced a new PGME program to develop the primary care skills of physicians by mandatory rotation through different clinical departments.Aims: (1) to evaluate whether residents’ clinical competency improved after the introduction of the new PGME program and (2) to compare the change in competency between university and non-university residents.Method: Surveys were conducted before and after the introduction of the new PGME, i.e. in 2004 (response rate 88%) and 2006 (88%). One in every five residents was sampled, and the study subjects were 2474 second-year residents (1762 university residents and 712 non-university residents) in 2004 who were about to complete the previous PGME program and 1166 second-year residents (487 and 679) in 2006 who were the first generation to complete the new PGME program. The clinical competency ratings were measured by the proportion of respondents reporting ‘experience’ in 24 clinical specialties and three items regarding the use of medical records and ‘confidence’ in 35 clinical skills and knowledge items in four areas (i.e basic medicine, allied areas, behavioural science and social medicine, and clinical research).Results: Compared to the residents in 2004, the clinical experience and confidence level of the residents increased dramatically for almost all of the surveyed items in 2006, regardless of the type of teaching hospital (chi-square or Fisher's exact tests, P < 0.0001). The marked improvement in the clinical competency of university residents was noticeable, resulting in the disappearance of the historical trend for non-university residents to obtain significantly more clinical experience than university residents.Conclusions: The new PGME program appears to have been successful at improving both the clinical experience and confidence levels of medical residents, especially at university hospitals.

Practical training for postgraduate year 1 surgery residents

Background: Surgical interns accept significant patient care responsibilities with minimal orientation. We have developed a multifaceted training program for incoming surgical interns in which learning in a simulated environment plays a key role. The purpose of this study was to evaluate resident perceptions of simulated clinical calls as an educational modality and to measure the effect on self-ratings of confidence. Methods: A multidisciplinary team compiled 15 clinical scenarios. Simulated nurse-to-resident clinical call sessions were held on 3 separate days. Daily course evaluation surveys and identical precourse and postcourse confidence surveys were completed. Results: The resident confidence measure increased significantly postcourse (6.73 versus 8.35, P <0.03). The evaluation survey score averaged 4.35 out of 5. Conclusions: Simulated clinical call sessions were well received and resulted in a significant increase in resident confidence levels. Based on this modality’s apparent efficacy and ease of implementation, we offer it as a useful educational tool for incoming postgraduate year-1 surgical residents.