Resident Self Research Articles

Problem-based learning for anesthesia resident operating room crisis management training

BackgroundSenior anesthesia residents must acquire competency in crisis management for operating room (OR) emergencies. We conducted problem based learning (PBL) OR emergency scenarios for anesthesia residents, focused on emergencies in ‘Airway’, ‘Circulation’, ‘Central venous catheter’, and ‘Pain management complications’. Non-technical skills are an integral component of team-based OR emergency management.MethodsPrior to integrated OR emergency clinical and non-technical skills PBL training, participating 35 anesthesia residents completed two 5-point scale surveys regarding frequency of emergency experiences in the operating room, and self-confidence for anesthesia-related crisis management. Repeat administration of the self-confidence survey was completed immediately following PBL training.ResultsPost-PBL resident clinical management self- confidence improved (P<0.05) in all scenarios on Circulation, Central venous catheter, and Pain treatment related complication topics. Impossible intubation, impossible oxygenation, and awake intubation did not show significant difference following PBL.ConclusionOur findings suggest that PBL for OR emergency management can improve resident self- confidence in anesthesia residents.

Resident Self Perception of Milestone Level as Compared to the Clinical Competency Committee

PURPOSE: To assess resident perception of Milestone level as compared to the Clinical Competency Committee (CCC). BACKGROUND: The Milestone Project was a joint initiative of ACGME, ABOG and ACOG and implemented in July of 2014. The Milestones serve as a descriptive blueprint to guide curriculum development and assessment practices. They allow programs to more accurately evaluate the outcomes of residency education and allow programs to track resident development over time. METHODS: The 24 residents of the Saint Louis University Ob/Gyn program were asked to rate themselves on each of the 28 Milestones based on their perception of where they felt they were in their training. This was done independent of the CCC. The CCC met for its semi-annual meeting and completed the Milestone report for each resident in standard fashion. The CCC was not aware that the residents were also rating themselves on each Milestone. Resident and CCC ratings were compared, with differences defined as a discrepancy ≥1 point. RESULTS: Overall, there was a close approximation of what the CCC and residents determined to be their Milestone level. Milestone agreement varied slightly by post graduate year, with the greatest agreement observed in PGY-4 (90%) and the least agreement in PGY-3 (79%). When analyzed by Milestone group, the greatest agreement was observed in Interpersonal Communication and Medical Knowledge (90% and 89%, respectively). DISCUSSION: Resident self-perception of Milestone level is comparable to the CCC in our program. There tends to be slightly more variation among the PGY-2 and 3 levels across all Milestones.

Missed Case Feedback and Quality Assurance Conferences in Radiology Resident Education: A Survey of United States Radiology Program Directors

Diagnostic Radiology (DR) residents typically generate preliminary reports for imaging examinations, but few publications discuss feedback regarding missed or misinterpreted findings. Our goal was to determine the practices of United States DR residencies with respect to missed case feedback, including the role of Quality Assurance (QA) conferences. A 23-item survey containing multiple-choice questions and several free text fields was created and hosted on SurveyMonkeyR. An invitation to complete the survey was sent via email to all DR Program Directors (PDs) or representatives. Responses were tabulated and analyzed using SurveyMonkeyR analytic tools and Microsoft Excel. 188 PDs or representatives were emailed, resulting in 45 survey responses. Common types of missed case feedback included resident QA case conferences (81%), resident self review of cases (72%), discussion during readout at the end of shift (70%), and faculty-resident meetings (67%). A minority of programs reported using automated methods of resident feedback, such as PACS integration or automated emails. Most resident QA conferences were held monthly (64%). Typical formats of conferences included informal discussion (43%), formal presentation (30%), or case conferences (30%). The majority (78%) of respondents rated resident missed case feedback mechanisms at their institution as at least "good". DR residencies use a variety of mechanisms to provide feedback to residents regarding missed or misinterpreted cases, including QA conferences. Although several possibilities for improvement in feedback mechanisms were highlighted by survey responses, most respondents had a favorable view of their program's feedback processes.

Which Measuring Stick? Analysis of Park Access Measures and Their Associations with Self-Reported Physical Activity.

Background: Parks are potentially valuable settings for physical activity (PA), but previous studies examining associations between park access and PA yielded mixed results. Inconsistent findings could be due to the variety of measures used to characterize park access and PA. Aim: Examine the influence of park access measures on the association between park access and PA. Methods: As part of the Chelsea STAR project, a community/university collaborative research study, we interviewed 354 residents of a densely populated environmental justice area about park use, PA, and other health-related topics. Questions included resident self- report on the park they prefer to use as well as details about types of PA. We analyzed our primary outcome (total-PA) and location-specific sub-outcomes: PA in any outdoor setting, and park-based PA. Park access measures included park density, type, and proximity (defined as distance between participants' home and the park primarily used by residents for PA). We analyzed the associations between PA and park access using logistic regression, controlling for age, race, education, gender, and injury/impairment. Results: Associations between PA and the different park access measures varied substantially. Proximity showed slight positive associations with total-PA, but density or type showed no or inverse associations with the same outcome. Results also varied according to outcome measures; for example, proximity was not associated with outdoor PA, but was significantly and positively associated with park-based PA. Conclusions: Associations between PA and park access vary depending on the way in which PA is characterized and the specific measure used for park access. This emphasizes the importance of obtaining specific information about the types of PA performed as well as self-reported usage of parks. These measures should be considered carefully in future studies of park access and PA.

Psychometric Characteristics of the 360° Feedback Scales in Professionalism and Interpersonal and Communication Skills Assessment of Surgery Residents in China

The aim of the study was to test the psychometric characteristics of the 360° evaluation instrument for assessing residents' competency in professionalism, interpersonal and communication skills, and develop a feasible, valid, and reliable multisource feedback (MSF) program for surgery residents to address this gap. We carried out an MSF assessment of 149 surgery residents at 19 hospitals all over China. MSF assessment includes 6 surveys with 21, 21, 21, 26, 14, and 15 items and these surveys were developed to assess surgery residents by attending doctor, resident self, peer, nurse, patient, and office staff, respectively, using a 5-point agreement scale with an "unable-to-evaluate" category. Reliability was assessed by Cronbach alpha. Exploratory factor analysis was used to assess validity and determine which items grouped together into scales. A total of 2384 questionnaires were analyzed in this study. The internal consistency reliability of the instruments was a Cronbach alpha of 0.932, 0.936, 0.914, 0.916, 0.939, and 0.903 for attending doctor, resident self, nurse, patient, resident peer, and office staff surveys, respectively. On the attending, resident self, resident peer, nurse, office staff, and patient surveys, the factor analysis identified 2 factors of professionalism and interpersonal and communication skills accounting for 75.62%, 74.81%, 72.65%, 73.38%, 76.11%, and 63.89% of the variance, respectively. Some items, such as Demonstrates respect for my "Sexual Orientation," "Religion," and "Disability," in different surveys had high unable-to-evaluate rates (more than 10%). The data suggest that these instruments developed to assess surgery residents are feasible to administer and provide valid and reliable evidence. Some items in survey need to be adjusted keeping in mind the Chinese culture.

Residents as Teachers: Disconnect between Faculty and Self Assessment of Skills (P07.233)

Objective: To study the impact of a new curriculum based on the One Minute Preceptor (OMP) on resident teaching skills through an Objective Structured Teaching Examination (OSTE). Background Residents serve an important role in teaching medical students and peers. Research on residents-as-teachers curricula is limited, especially in neurology. Design/Methods: Residents participated in a pre-OSTE, a curriculum based on the OMP, and post- OSTE. The curriculum consisted of a one hour session on the OMP. The OSTEs, consisted of 3 stations, measuring the five teaching “microskills” on a 4 point (0-3) Likert scale, with behavioral anchors. Residents and faculty (blinded to resident participation in the curriculum) graded performance on the OSTEs. While not randomized, some residents did not participate in all portions of this study. Descriptive statistics and student t test were used. Results: Of 18 residents, 14 participated in the pre-OSTE, 11 in the curriculum, 17 in the post-OSTE, and 9 in all 3 components of this study. Performance as graded by faculty improved from pre-OSTE (mean ± SD, 1.46 ± 1.42) to post-OSTE (2.20 ± 1.09, p Conclusions: An educational curriculum on the OMP improved resident performance on a post- OSTE graded by faculty, but not by resident self assessment. Overall residents more favorably assessed their teaching skills than by faculty assessment. No significant learning occurred as a result of participation in a pre-OSTE. Disclosure: Dr. Schuh has nothing to disclose. Dr. Zaman has nothing to disclose. Dr. Roth has nothing to disclose.

Urban Negotiations And Art Tactics

Urban Negotiations and Art Tactics are art strategies that find possibilities for art to engage in real life issues. Nomadic Kitchen is an interstitial transversal artwork that occupies a place between art and urban space. This work engages with issues of self-organization, in the process negotiating the urban environment with the residents of Vila Nova, a favela community in Sao Miguel Brazil. Vila Nova is in a process of regeneration but this does not sanitize the conflict of local conditions, it is within the contradictions of conflict that new ideas emerge for models for urbanity. Nomadic Kitchen is one urban practice among many in a collaborative and participatory action in the production of public and private space. The artwork operates as bricolage within and across the transversal field of operation that includes institution and post-institutional art practice. The emergent strategies for this artwork evolved through a series of workshops with residents of Vila Nova. The field of production creates a place of selforganisation between participants. The project embraces ‘informality’ as another kind of intelligence whose tactics bring a collective visibility to the project and other kinds of urban negotiations. The structure functions as a locus where residents self govern and develop flexible and creative ways of building a context for living. The transversal field of Nomadic Kitchen invests in a desiring production that is flexible, fluid, nomadic and adaptable to different occasions and contexts of informal urban practices. Urban decisions around producing public and social space are made while cooking eating and meeting in the Nomadic Kitchen. This interstitial sculptural structure becomes a place of dialogue while defining the circumstances that determine its situated conditions and public space. The consequences of Nomadic Kitchen explore the potential limits of art production as an urgent action in creating an aesthetic-ethical-spatialpolitics. URBAN NEGOTIATIONS AND ART TACTICS

Resident self-assessment versus faculty assessment of laparoscopic technical skills using a global rating scale

Accurate self assessment of laparoscopic technical skill development can accelerate a trainee's learning growth and guide lifelong development for surgeons. The aim of this study was to measure the accuracy of obstetrical and gynecology resident self assessments as compared to faculty assessments of laparoscopic technical skill performance using a technical skill global rating scale evaluation.

Confidence, Competence and Leadership: The Role of High Fidelity Simulation Workshops to Improve Emergency Medicine Residents Self Confidence, Technical Competence and Leadership Skills

Confidence, Competence and Leadership: The Role of High Fidelity Simulation Workshops to Improve Emergency Medicine Residents Self Confidence, Technical Competence and Leadership Skills

The Impact of Duty Hours on Resident Self Reports of Errors

BackgroundResident duty hour limitations aim, in part, to reduce medical errors. Residents’ perceptions of the impact of duty hours on errors are unknown.ObjectiveTo determine residents’ self-reported contributing factors, frequency, and impact of hours worked on suboptimal care practices and medical errors.DesignCross-sectional survey.Subjects164 Internal Medicine Residents at the University of California, San Francisco.Measurements and ResultsResidents were asked to report the frequency and contributing factors of suboptimal care practices and medical errors, and how duty hours impacted these practices and aspects of resident work-life. One hundred twenty-five residents (76%) responded. The most common suboptimal care practices were working while impaired by fatigue and forgetting to transmit information during sign-out. In multivariable models, residents who felt overwhelmed with work (p = 0.02) and who reported spending >50% of their time in nonphysician tasks (p = 0.002) were more likely to report suboptimal care practices. Residents reported work-stress (a composite of fatigue, excessive workload, distractions, stress, and inadequate time) as the most frequent contributing factor to medical errors. In multivariable models, only engaging in suboptimal practices was associated with self-report of higher risk for medical errors (p < 0.001); working more than 80 hours per week was not associated with suboptimal care or errors.ConclusionOur findings suggest that administrative load and work stressors are more closely associated with resident reports of medical errors than the number of hours work. Efforts to reduce resident duty hours may also need to address the nature of residents’ work to reduce errors.

Negociação urbana, arte e a produção do espaço público

Urban Negotiations são estratégias artísticas que encontram possibilidades para a arte se engajar no meio urbano. São ações colaborativas e participativas na produção do espaço público e do privado. "An Artwork for an Imperfect World" é um trabalho colaborativo entre a Galeria Temple Bar, a ONG Merchants Quay Ireland e pessoas sem-teto. Por um tempo a galeria se tornou anfitriã, um lugar de hospitalidade, onde cada jantar foi servido a partir de uma van redesenhada. A obra agora funciona como uma unidade móvel de intercâmbio de necessidades nas ruas de Dublin. "Nomadic Kitchen" é uma iniciativa de arte intersticial que se engaja em processos de negociação do meio urbano com residentes de Vila Nova, São Miguel Paulista (São Paulo, Brasil). A estrutura funciona como um lócus onde residentes se autogovernam e desenvolvem meios criativos e flexíveis de construir um contexto para viver. A estrutura de "Nomadic Kitchen" é flexível, fluida e adaptável a diferentes ocasiões e contextos. Decisões urbanas sobre a produção do espaço público e social são realizadas durante o preparo da comida, o comer e o encontrar na Nomadic Kitchen. Essa estrutura intersticial se torna um lugar de diálogo enquanto são definidas as condições que determinam o espaço público e o privado.

Primary care residents self assessment skills in dementia.

The ability to accurately self-assess is a critical component of professionalism and is included in the newly required Accreditation Council of Graduate Medical Education (ACGME) core competencies. To assess residents' ability to accurately self-assess their competencies related to a commonly presenting problem in geriatrics, a Standardized Patient, portraying an individual with early signs of dementia, was inserted into family medicine residents' clinic schedules. Immediately post the encounter, each resident self-assessed his/her performance using a four category (Communication, History of Present Illness, Social History, Functional Assessment), 17-item behavioral checklist. The items in each category highlighted items specific to a dementia-screening interview (e.g., HPI: Used a standardized exam which includes orientation, memory, recall and registration). Resident ratings were compared to ratings from two faculty assessors who independently viewed the videotape of each resident's SP interview. While statistically significant differences between the self-assessment and expert assessors appeared in only one of the four major checklist categories (functional assessment), item specific analysis revealed significant differences on discrete items within the dementia screening interview. Implications for teaching and assessment consistent with the ACGME required competency assessment category of professionalism are discussed.

Effect of a resident self-study and presentation program on performance on the thoracic surgery in-training examination

Background: In this study we examine whether conversion from a didactic lecture format to a resident self-study and presentation program can improve performance on the Thoracic Surgery In-Training Examination (TSITE). Methods: During the first 5 years, educational conferences were didactic lectures delivered by the attending thoracic surgery staff (group 1, n = 9 residents). During the second 5 years, residents prepared and delivered reviews from major textbook sources (group 2, n = 9 residents). Scores on the American Board of Surgery In-Training Examination (ABSITE) as a chief resident in general surgery were analyzed using one-way analysis of variance to assess fund of knowledge and test-taking skills prior to thoracic surgery training for the two groups. Scores on the TSITE during the first and second years of thoracic surgery training were recorded for each resident and analyzed using a paired t test. The data are expressed as the mean ± standard deviation. Results: Eighteen thoracic surgery residents over a 10-year period were involved in the study. ABSITE scores as a chief resident in general surgery did not differ between the two groups. Residents in group 1 improved their percentile rank from the first to the second year by a mean of 11% ± 12%, whereas those in group 2 improved their scores by a mean of 31% ± 21% ( P < 0.05). Conclusions: When compared with a didactic lecture format, a resident self study and presentation program improves performance on the Thoracic Surgery In-Training Examination. This improvement in performance typically manifests during the second year of thoracic surgery training.