Residency Training Experience Research Articles

Surgical instrument standardization – A pilot cost consciousness curriculum for surgery residents

IntroductionSurgical cost is astronomical in the US and instrument standardization is one potential mechanism for cost savings. This study describes a core competency based, multidisciplinary curriculum and evaluates resident attitudes towards operating room equipment standardization. Materials and methodsAs part of a quality improvement initiative, surgery residents participated in an hour-long mixed curriculum consisting of brief didactics and small group exercises. Participants developed an equipment standardization plan for laparoscopic appendectomy and cholecystectomy. Participants also completed surveys to assess their attitudes towards 11 potential barriers to implementation as “improves, no change, or worsens”. ResultsFifteen general surgery residents participated. In general, participants felt that standardization improves or does not change metrics including surgeon autonomy, resident training experience, and patient safety. ConclusionOur pilot curriculum addresses a gap in resident education about surgical cost. Residents generally regard equipment standardization as either improving or not changing hospital metrics.

Training Residents in Maternal Depression Care to Improve Child Health: A CERA Study.

Untreated maternal depression negatively impacts both the mother and her children's health and development. We sought to assess family medicine program directors' (PDs) knowledge and attitudes regarding maternal depression management as well as resident training and clinical experience with this disorder. Data were gathered through the Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) national survey of family medicine PDs in US and Canadian programs, from January through February, 2018. Surveys were completed by 298 PDs (57.1% response rate) who were majority male (58.9%) and white (83.8%). Nearly all (90.2%) PDs agreed that family physicians should lead efforts to minimize the impact of maternal depression on child well-being. According to PD report, in the family medicine clinics where residents train, most (77.3%) have a clinic process that ensures that routine screening for depression occurs, and 54.4% do some screening of mothers during pediatric visits. Only 18.2% report routinely taking steps to minimize the impact of the mothers' depression on child well-being. Finally, 41.3% of PDs reported being familiar with the literature on the impact of maternal depression on children; self-reported familiarity was significantly associated with more comprehensive resident training on this topic. Family medicine residency program directors are supportive of training in maternal depression, though their current knowledge is variable and there are opportunities to enhance care of mothers and children impacted by this common and serious disorder.

Developing a 3D composite training model for cranial remodeling.

Craniosynostosis correction, including cranial vault remodeling, fronto-orbital advancement (FOA), and endoscopic suturectomy, requires practical experience with complex anatomy and tools. The infrequent exposure to complex neurosurgical procedures such as these during residency limits extraoperative training. Lack of cadaveric teaching tools given the pediatric nature of synostosis compounds this challenge. The authors sought to create lifelike 3D printed models based on actual cases of craniosynostosis in infants and incorporate them into a practical course for endoscopic and open correction. The authors hypothesized that this training tool would increase extraoperative facility and familiarity with cranial vault reconstruction to better prepare surgeons for in vivo procedures. The authors utilized representative craniosynostosis patient scans to create 3D printed models of the calvaria, soft tissues, and cranial contents. Two annual courses implementing these models were held, and surveys were completed by participants (n = 18, 5 attending physicians, 4 fellows, 9 residents) on the day of the course. These participants were surveyed during the course and 1 year later to assess the impact of this training tool. A comparable cohort of trainees who did not participate in the course (n = 11) was also surveyed at the time of the 1-year follow-up to assess their preparation and confidence with performing craniosynostosis surgeries. An iterative process using multiple materials and the various printing parameters was used to create representative models. Participants performed all major surgical steps, and we quantified the fidelity and utility of the model through surveys. All attendees reported that the model was a valuable training tool for open reconstruction (n = 18/18 [100%]) and endoscopic suturectomy (n = 17/18 [94%]). In the first year, 83% of course participants (n = 14/17) agreed or strongly agreed that the skin and bone materials were realistic and appropriately detailed; the second year, 100% (n = 16/16) agreed or strongly agreed that the skin material was realistic and appropriately detailed, and 88% (n = 14/16) agreed or strongly agreed that the bone material was realistic and appropriately detailed. All participants responded that they would use the models for their own personal training and the training of residents and fellows in their programs. The authors have developed realistic 3D printed models of craniosynostosis including soft tissues that allow for surgical practice simulation. The use of these models in surgical simulation provides a level of preparedness that exceeds what currently exists through traditional resident training experience. Employing practical modules using such models as part of a standardized resident curriculum is a logical evolution in neurosurgical education and training.

Impact of Laparoscopy on Training: Are Open Appendectomy and Cholecystectomy on the Brink of Extinction?

The operative experience of present-day surgical residency training has evolved as a result of the contributions of laparoscopic surgery. Some traditional open procedures are now more descriptive and less of a familiarity to many general surgery residents (GSRs). The aim of this study was to investigate how open operative experience compares with laparoscopy for GSRs. A retrospective, multicenter, consecutive cohort study of all patients undergoing surgical intervention involving the appendix and gallbladder identified from the ACS-NSQIP database over a 2.5-year period. All GSR postgraduate year-level operative experience was recorded. Of 777 procedures, 13 laparoscopic appendectomy conversions to open (4.3%) by Rocky-Davis (15%) or lower midline (84.6%) incisions were performed versus 285 that remained laparoscopic (95.6%). Fifty (10.4%) open cholecystectomies (38 open + 10 conversions + 2 common bile duct (CBD) exploration), 27 (5.6%) laparoscopic cholecystectomies with cholangiogram, and 402 (83.9%) laparoscopic cholecystectomies were performed. Twenty-nine different GSRs participated in procedures. Eighty-five (10.9%) operations were performed with multi-postgraduate year levels. Surgical residents have an unequal operative experience for case-specific open procedures. A competency-based system to demonstrate a resident's hands-on surgical skills is fundamental to residency training and should be considered for specific types of low-volume open surgical cases.

Improving the Intraoperative Educational Experience: Understanding the Role of Confidence in the Resident-Attending Relationship

With recent changes to graduate medical education, the balance between resident autonomy and need for supervision impacts the educational and training experience of residents. The objective of this study was to understand the relationship between the confidence of attendings and residents and their different perspectives of perceived educational experience and autonomy in the operating room (OR). We hypothesized that the attending's confidence in the resident would be an important factor in improving the educational experience and resident's autonomy in the OR. Self-reported confidence-rating and operative experience surveys were administered to teams of post-graduate year (PGY 1) through PGY 5 surgical residents and attendings in two temporal sets (Early: Sept-Dec 2015, n = 20; Late: Jan-Apr 2016, n = 22). A second "end-of-year" survey was distributed to residents (n = 9, 37.5% response) and attendings (n = 10, 35% response) asking questions regarding their educational experience and operative experience during the past year. Large rural teaching hospital. Nineteen general surgery residents (PGY 1 - 5) and 14 general surgery attendings. Resident perception of confidence differs from junior to senior residents, and that there was discordance between resident's confidence and skill as perceived by attendings, particularly in senior residents. Results also showed that attending's confidence in residents was positively correlated with attending's perceived educational experience in the OR. Residents and attendings both indicated attending's confidence in residents as an important factor in increasing resident autonomy in the OR, thus the attending's confidence in residents could have a positive impact on resident autonomy and educational experience in the OR. We have demonstrated a relationship between self-confidence for residents and improved confidence from attendings in residents' capabilities. Based on these findings, we would propose identifying methods to expand resident's awareness of surgical situations and develop attending's confidence in residents.

Learning from Our Patients: Training Psychiatry Residents in Refugee Mental Health.

Psychiatric residents are increasingly called upon to work cross-culturally, serving diverse populations including refugees. This study aims to (1) understand the training experience of psychiatry residents working with refugees and (2) assess the level of satisfaction of refugees, most of whom are Iraqi, who seek psychological treatment at the University of Colorado Hospital (UCH)'s Refugee Mental Health Program of Colorado (RMHPC). Using qualitative methodology, over a 1-year period, independent evaluators interviewed a group of nine residents who chose to participate in an RMHPC elective and also interviewed ten Iraqi refugee patients who sought services at the clinic. Recordings of the interviews were transcribed and analyzed using thematic analysis. Emerging themes were identified for both resident and refugee patient interviews. Five major themes emerged summarizing residents' experiences: (1) adapting practices to meet refugee needs, (2) value of supervision, (3) cultural barriers, (4) need for extra resources, and (5) effect on future practice. Four major themes emerged summarizing Iraqi refugees' experiences: (1) reasons for seeking treatment, (2) barriers to treatment, (3) residents' knowledge of culture and needs, and (4) quality of treatment. This study's findings highlight the complexities of effectively treating refugee patients and suggest ideas for training residents. Additionally, they offer important frameworks for developing, implementing, and evaluating culturally responsive practices in the context of training psychiatry residents and other mental health professionals. An essential key to this process was giving voice to refugees who accessed and engaged our services.

Where does resiliency fit into the residency training experience: a framework for understanding the relationship between wellness, burnout, and resiliency during residency training

Medical literature reports high rates of burnout among medical professionals. The terms wellness and resilience are often used interchangeably in the solution focused discussions. By confusing the terminology, the distinct role of resilience within residency training may be ill-appreciated.The objective of this paper is to define wellness, burnout, and resiliency and detail a proposed framework to explain how these terms manifest within residency training. MEDLINE and EMBASE searches were performed using the key words "resilience," "residency," "wellness," and "burnout." The search was limited to English language articles published between 2003-2017. The authors propose a framework based on the literature review. This work supports the implementation of resilience-based interventions that enable residents to engage with workplace adversity in a healthy way, acquire skills during the process and avoid resource depletion and, ultimately, burnout. This framework can be used by residency programs to promote educators and residents' understanding of the unique role of resilience within residency, and the importance of differentiating between wellness and resilience initiatives. Future research is required to study the utility of this framework.

Regional Anesthesia in the Combat Setting: Are ACGME Requirements Enough?

Updated Joint Trauma System Clinical Practice Guidelines (CPG) indicate regional anesthesia and pain management (RAAPM) are important for combat casualty care. However, it is unclear whether military anesthesiology residents are receiving adequate RAAPM training to meet the CPGs. The goal of this study was to conduct a preliminary evaluation of resident-completed combat-relevant regional anesthesia procedures. It was hypothesized that most residents would perform an adequate number of each procedure to presume proficiency. Resident-performed, combat-relevant regional anesthesia procedure frequency was extracted from a database maintained at a military anesthesiology residency program. Data collection was limited to a 1-year period. Univariate statistics described procedure distributions, frequencies, and proportion of residents achieving pre-defined, empirically-supported experience criteria for each technique. Analyses examined proportional differences in meeting experience criteria by training-year. Residents (N = 41) performed a variety of procedures. Simple procedures, such as saphenous peripheral nerve blocks, were performed at a greater frequency than more complicated procedures such as thoracic epidurals, continuous peripheral nerve blocks, and transverse abdominus plane blocks. The majority of residents met experience criteria for four out of the eight measured combat-relevant blocks. There were no proportional differences in meeting procedural experience criteria across the different training levels. These results suggest a possible gap between the needs of the Military Health System during conflict and current residency training experiences. Reasons for this gap, as well as solutions, are explored.

Educational and Scholarly Opportunities for Medical Students and Residents in Professional Ophthalmology Organizations

This study examines educational and scholarly opportunities offered by professional US ophthalmology organizations that may enrich the training experience of medical students and residents.

The Contributions of Physician-Scientists Within Divisions of Infectious Diseases.

Physician-scientists, no matter their particular disease or research focus, within divisions of infectious diseases serve a number of key roles. Foremost, they promote scholarship and excellence in research endeavors with the potential for impact not only within their division or university but globally. These individuals also make important contributions to the training experiences of infectious diseases fellows and internal medicine residents, helping to foster an understanding of how evidence-based (or not) our patient care delivery actually is. Ongoing discussions between those focused on the clinical aspects of infectious diseases and those predominantly pursuing research questions enrich the scholarly environment for both physician groups and provides the foundation for translating the science to improved care for patients with infectious diseases.

Development of a Commercial Reference Laboratory Elective Rotation for Residents in Clinical Pathology

To develop a curriculum for a commercial reference laboratory clinical pathology training elective. A 4-day elective at Quest Diagnostics was developed. The elective included 32 sessions composed of interactive didactic sessions and laboratory tours/demonstrations. Ten residents who attended the elective completed a written evaluation and scored each component of the curriculum. Written comments were very positive and demonstrated the goals of the elective were achieved. Laboratory tours and one-on-one sessions with the medical directors were especially well received. Most of the residents stated that the rotation gave them exposure to an area of laboratory medicine that they were not familiar with. The elective provided a resident training experience that was highly regarded and exposed residents to an area of laboratory medicine not encountered in most pathology training programs. Our curriculum could serve as a model for establishing a similar elective in other training programs.

Impact of Trauma Hospital Ransomware Attack on Surgical Residency Training

BackgroundA recent ransomware attack led to the shutdown of the electronic health information system (HIS) at our trauma center for 2 mo. We investigated its impact on residency training during the downtime. Material and methodsGeneral and orthopedic surgical residents who rotated at the hospital were invited to participate in a survey regarding their patient care and residency training experiences during the downtime. Attending surgeons from both the specialties were invited to participate in a semistructured interview regarding their attitude toward residency training during the downtime. ResultsTwenty-nine residents responded to the survey with a response rate of 78.4%. Residents acknowledged significant increases in face-to-face communication and decreases in use of online educational resources during the downtime (P < 0.01). Residents were significantly stressed by the dearth of online resources (P < 0.0001) and by paper-based orders and outpatient clinic (P < 0.05). A multivariate analysis demonstrated an inverse relationship between postgraduate year and stress from paper orders (P = 0.003). Attending surgeon's interviews revealed that they recognized residents' unpreparedness and strove harder to teach more effectively. ConclusionsOur study demonstrated that an unexpected shutdown of the hospital HIS imposed significant stress upon surgical residents providing trauma patient care and made attending surgeons take greater efforts to be more effective teachers. Residents who are digital natives lack adaptability to handle a paper-based workflow. With cyber security threats increasing in health care, preparedness should be included in the graduate medical education curriculum.

Schwartz Chosen APA’s Next President-Elect

Back to table of contents Previous article Next article Association NewsFull AccessSchwartz Chosen APA’s Next President-ElectCatherine F. BrownCatherine F. BrownSearch for more papers by this authorPublished Online:22 Feb 2018https://doi.org/10.1176/appi.pn.2018.3a23AbstractAPA members have selected the current treasurer as the next person in line to hold the Association’s highest elected leadership position.APA’s voting members have elected Bruce J. Schwartz, M.D., of Bronx, N.Y., to become APA’s next president-elect. He ran against Glenn A. Martin, M.D., of Forest Hills, N.Y., and Stephen M. Strakowski, M.D., of Austin, Texas.Bruce J. Schwartz, M.D. (right), will become president-elect of APA at the end of APA’s Annual Meeting in May, when Altha Stewart, M.D., becomes president.Complete results of the election, including vote tallies, appear on page 37.Schwartz, APA’s current treasurer, has long been active in APA. He served in the Assembly and is a past chair of the Council on Healthcare Systems and Financing and the Committee on Reimbursement. He is also the deputy chair, clinical director, and a professor in the Department of Psychiatry and Behavioral Sciences at Montefiore Medical Center and the Albert Einstein College of Medicine. As the program director of the “Tarrytown” Chief Residents Leadership Conference, he has helped shape it into a premier leadership training experience for incoming chief residents. “I am honored to have been elected by my colleagues and friends in APA to help guide our organization and membership into the future,” Schwartz told Psychiatric News. “My entire professional life has been devoted to the care of underserved populations and to the development of physician-centric solutions to solving the need for high-quality mental health care.”The paradox, he said, is that mental illness is among the leading causes of disability and early death, yet psychiatric care—which can improve the quality of life as well as outcomes for chronic medical conditions—is inaccessible to too many people living in this country. “APA can lead the fight against discriminatory underfunding of mental health care and the stigma that prevents people from accessing care,” he said.Asked what he expects to be his major priorities as APA’s president, Schwartz responded, “I plan to build on the initiatives begun by my predecessors—there is so much we need to continue to work on. Among the top advocacy issues I will address is the continuation of mental health and substance use treatment as an essential health benefit in any alternatives to the Affordable Care Act, enforcement of the mental health parity law and related regulations, enhanced and fair reimbursement for psychiatric treatment, practical and affordable solutions to the current Maintenance of Certification requirements, and pressuring Congress to fund new residency and fellowship training positions to address the shortage of psychiatrists.”In the race for treasurer, Gregory V. Dalack, M.D., of Ann Arbor, Mich., emerged the winner. His opponent was Brian Crowley, M.D., of Washington, D.C.In the race for trustee-at large, Richard F. Summers, M.D., of Philadelphia defeated Robert E. Feder, M.D., of Manchester, N.H. Summers is APA’s current trustee-at-large.In the race for early career psychiatrist trustee-at-large, Ayana Jordan, M.D., Ph.D., of New Haven, Conn., outpolled Hector Colon-Rivera, M.D., of Philadelphia and Mark A. Haygood, D.O., of Mobile, Ala.Three of APA’s seven geographic Areas voted for a trustee in this cycle. Only members within an Area may vote for their respective Area trustee.Winning the Area 1 trustee race was Eric M. Plakun, M.D., of Stockbridge, Mass. His opponent was John M. de Figueiredo, M.D., of Cheshire, Conn. For Area 4 trustee, Cheryl D. Wills, M.D., of Cleveland, Ohio, won over Ronald M. Burd, M.D., of Fargo, N.D. For Area 7 trustee, Annette M. Matthews, M.D., of Portland, Ore., outpolled James A. Polo, M.D., M.B.A., of Gig Harbor, Wash., and Joshua Sonkiss, M.D., of Anchorage, Alaska.In the race for resident-fellow member trustee-elect, the winner was Rana Elmaghraby, M.D., a PGY-2 resident at the University of Minnesota. Her opponents were Anne Clark-Raymond, M.D., a PGY-3 resident at New York Presbyterian Weill Cornell, and Helena Winston, M.D., a PGY-3 resident at the University of Colorado.Election results were approved by the Tellers Committee in February, but the results will not be official until after the Board of Trustees reviews them at its meeting this month. All of the winning candidates will assume their positions on the Board at the close of the Annual Meeting in May. ■ ISSUES NewArchived

Association of Surgical Practice Patterns and Clinical Outcomes With Surgeon Training in University- or Nonuniversity-Based Residency Program

Important metrics of residency program success include the clinical outcomes achieved by trainees after transitioning to practice. Previous studies have shown significant differences in reported training experiences of general surgery residents at nonuniversity-based residency (NUBR) and university-based residency (UBR) programs. To examine the differences in practice patterns and clinical outcomes between surgeons trained in NUBR and those trained in UBR programs. This observational cohort study linked the claims data of patients who underwent general surgery procedures in New York, Florida, and Pennsylvania between January 1, 2012, and December 31, 2013, to demographic and training information of surgeons in the American Medical Association Physician Masterfile. Patients who underwent a qualifying procedure were grouped by surgeon. Practice pattern analysis was performed on 3638 surgeons and 1 237 621 patients, representing 214 residency programs. Clinical outcomes analysis was performed on 2301 surgeons and 312 584 patients. Data analysis was conducted from February 1, 2017, to July 31, 2017. NUBR or UBR training status. Inpatient mortality, complications, and prolonged length of stay. No significant differences were observed between the NUBR-trained surgeons and UBR-trained surgeons in age (mean, 53.3 years vs 53.7 years), sex (female, 18.2% vs 16.9%), or years of clinical experience (mean, 16.5 years vs 16.5 years). Overall, NUBR-trained surgeons compared with UBR-trained surgeons performed more procedures (median interquartile range [IQR], 328 [93-661] vs 164 [49-444]; P < .001) and performed a greater proportion of procedures in the outpatient setting (risk difference, 6.5; 95% CI, 6.4 to 6.7; P < .001). Before matching, the mean proportion of patients with documented inpatient mortality was lower for NUBR-trained surgeons than for UBR-trained surgeons (risk difference, -1.01; 95% CI, -1.41 to -0.61; P < .001). The mean proportion of patients with complications (risk difference, -3.17%; 95% CI, -4.21 to -2.13; P < .001) and prolonged length of stay (risk difference, -1.89%; 95% CI, -2.79 to -0.98; P < .001) was also lower for NUBR-trained surgeons. After matching, no significant differences in patient mortality, complications, and prolonged length of stay were found between NUBR- and UBR-trained surgeons. Surgeons trained in NUBR and UBR programs have distinct practice patterns. After controlling for patient, procedure, and hospital factors, no differences were observed in the inpatient outcomes between the 2 groups.

Integração ensino-serviço-gestão na saúde bucal em Santa Maria e região: relato de experiência em estágio curricular acadêmico e Residência Multiprofissional

Os autores descrevem as experiências de integração ensino-serviço-gestão entre a Universidade Federal de Santa Maria, a Prefeitura Municipal de Santa Maria e a 4ª Coordenadoria Regional de Saúde do Rio Grande do Sul. O objetivo é apontar as principais ações planejadas e executadas por docentes, gestores, residentes e estudantes de graduação destas três instâncias. O envolvimento dos estudantes de graduação nas atividades de estágio obrigatório é avaliado por meio da análise dos relatórios e as experiências de formação em serviço dos residentes da Residência Multiprofissional por meio de registro das atividades realizados nos serviços públicos de saúde do município. Aborda-se os avanços alcançados na implementação das ações, as dificuldades e as potencialidades encontradas na sua articulação, além da importância dos espaços de integração destas instâncias como ambientes privilegiados na formação dos cirurgiões-dentistas e dos estagiários da Odontologia. O estreitamento das relações entre a Residência Multiprofissional em Saúde e a gestão municipal e regional permitiu a concretização de espaços de interlocução entre profissionais em formação, docentes, gestores e usuários do serviço, proporcionando a reflexão sobre o processo de produção do cuidado, bem como a corresponsabilização pela formação profissional e pela qualidade do serviço de saúde.

Getting it RITE: Impact of a Dedicated Hospital Medicine Curriculum for Residents.

The goal of this study was to improve resident confidence in inpatient care and knowledge in hospital medicine topics with a newly developed rotation and curriculum called the Resident Inpatient Training Experience. This study was a prospective observational study completed by postgraduate year-2 (PGY-2) internal medicine residents in two affiliated hospitals. Forty-six PGY-2 residents each rotated on the Resident Inpatient Training Experience service for 1 month and completed a pre- and postrotation confidential online survey. Primary outcomes included confidence in managing hospitalized patients, knowledge regarding hospital medicine topics, and interest in pursuing hospital medicine as a career. Thirty-three PGY-2 residents completed both the pre- and postrotation survey (72% response rate). After completing the rotation, the residents' confidence level (measured on a 5-point Likert scale, with 1 = strongly disagree and 5 = strongly agree) rose significantly in managing hospitalized patients, from 3.82 to 4.33 (P = 0.003) and in leading a ward team, from 3.76 to 4.21 (P = 0.020). Knowledge level (measured on a 5-point Likert scale with 1 = very poor and 5 = excellent) improved significantly in transitions of care, from 3.45 to 3.79 (P = 0.023); cost-conscious care, from 3.00 to 3.42 (P = 0.016); physician billing/coding, from 2.55 to 3.03 (P = 0.007); hospital metrics, from 2.39 to 2.94 (P = 0.002); and hospital reimbursement, from 2.48 to 3.09 (P = 0.001). Interest in pursuing hospital medicine as a career also increased. Resident independence in managing patients and training in hospital medicine topics has not kept up with evolving need. Dedicated hospital medicine rotation and curriculum are effective ways to alleviate the deficiencies in resident education.

A Survey of Program Directors’ Experience With Patient Safety Training Programs for Medical and Physics Radiation Oncology Residents

Current ACGME and CAMPEP guidelines expect physicians and physicists to teach quality improvement (QI) as a core element of residency curriculum in radiation oncology (RO). However, a recent national study found that most residents did not feel they had adequate safety and QI training during their residency, and the type of training most desired by the residents were practical workshops. We surveyed program directors (PDs) in RO and therapy medical physics to understand current conditions and potential ways to address this educational gap. PDs of accredited US RO and medical physics therapy programs were surveyed via email. Questions inquired about demographics, curricular elements, perceived barriers to development/improvement of safety training, and attitudes regarding training using a 5-point Likert scale. Differences in proportions of responses between medical and physics PDs were tested using chi-square. Responses were collected from 56 of 175 PDs (32%); 45% identified as medical faculty and 55% as physics faculty. Most medical (88%) and physics PDs (94%) felt that safety and QI training are an important part of resident education. More physics than medical PDs felt residents were enthusiastic about safety training (77% physics, 48% medical, P < 0.05). Likewise, more physics than medical PDs agreed that residents were well exposed (83% physics, 64% medical, P = 0.18) to safety and QI concepts and adequately prepared to meet the safety expectations of clinical practice (90% physics, 60% medical, P = 0.07), but these did not reach significance. Likewise, more physics PDs (90%) agreed that residents were adequately prepared to meet the patient safety expectations of clinical practice than medical PDs (60%) (P = 0.07). PDs most often used safety/QI publications (53%), curriculum templates (38%), and online modules/guides (36%) to create the safety training experience for residents. Common curricular elements included web-based modules (66%), patient safety rotations (61%), and clinical projects (37%, e.g., root cause analysis). The most common reported barriers to improving resident safety education were lack of resident time (38%), faculty time (27%), and faculty expertise (27%). Only a small minority (3%) felt that institutional safety culture was a barrier to improving resident safety education. The most common modes of assessing the effectiveness of a safety curriculum were resident feedback (56%), faculty feedback (37%), and assessments of resident knowledge and/or attitudes (27%). The results show that the majority of PDs feel their residents are adequately prepared for the patient safety and QI expectations of clinical practice, which is different than the results of a prior survey of residents in training. While residents most desire practical workshops, none of the programs appeared to offer this opportunity. National guidelines and resources would help PDs efficiently improve patient safety curricula in their programs.

A novel resident-as-teacher curriculum: the role of experiential learning and coaching.

This article was migrated. The article was marked as recommended. Background: Canadian family medicine residency programs have the challenge of training in a wide breadth of topics and competencies within a two-year program, including training residents to be effective teachers. There has been a gap in knowledge with regards to the most effective method to train residents to teach. We developed, implemented, and evaluated a novel multi-level resident-as-teacher (RAT) coaching curriculum to provide training and authentic experiences for family medicine residents in teaching medical students. Methods: A curriculum centred around multi-level coaching was designed where family medicine faculty members directly observed and provided feedback to family medicine residents teaching small group clinical skills to first and second year medical students. Family medicine residents received didactic training on how to provide effective feedback to students and manage small group dynamics, after reviewing the learning objectives that students were to achieve. This was followed by the authentic small group teaching experiences. A survey was sent out by email to all residents and faculty members who had participated in the RAT curriculum at the end of the 2013-2014 and 2014-2015 academic years. Quantitative survey data were analyzed using descriptive statistics (frequencies, percentages, correlation coefficients (Spearman's rho)). Qualitative analysis was completed through thematic analysis of respondents' written comments to open-ended survey questions. Results: 80% of 127 residents strongly agreed (26%) or agreed (54%) that the RAT program effectively developed their teaching skills. 57% either strongly agreed (17%) or agreed (40%) that the direct observation and feedback from faculty coaches helped to improve their teaching skills. There was a significant positive correlation between residents' perceptions of the usefulness of the feedback from faculty coaches and residents' perceptions of the overall RAT program's effectiveness in developing their teaching skills (r=0.42; p=0.001). Qualitative analysis revealed that residents perceived the RAT program to have solidified their own knowledge base for the content covered in the sessions. Residents also perceived a benefit of near-peer teaching for the medical students and an elevated family physicians' profile as teachers. They found the active learning experience increased their self-awareness of their teaching skills. Time away from clinical rotations and preparation time were derived as a potential drawback of the program. All faculty coaches agreed or strongly agreed that the RAT curriculum improved the teaching skills of family medicine residents. Thematic analysis of the faculty coaches' comments revealed that participating as coaches allowed for their own professional development in that their feedback and coaching skills improved. Conclusions: Our experiences and program evaluation of a novel multi-level resident-as-teacher coaching curriculum show that direct observation with feedback of authentic teaching activities is highly valued, and appears to be effective in developing resident teaching skills while fostering interest in future teaching.

Using GoPro to Give Video-Assisted Operative Feedback for Surgery Residents: A Feasibility and Utility Assessment

As an adjunct to simulation-based teaching, laparoscopic video-based surgical coaching has been an effective tool to augment surgical education. However, the wide use of video review in open surgery has been limited primarily due to technological and logistical challenges. The aims of our study were to (1) evaluate perceptions of general surgery (GS) residents on video-assisted operative instruction and (2) conduct a pilot study using a head-mounted GoPro in conjunction with the operative performance rating system to assess feasibility of providing video review to enhance operative feedback during open procedures. GS residents were anonymously surveyed to evaluate their perceptions of oral and written operative feedback and use of video-based operative resources. We then conducted a pilot study of 10 GS residents to assess the utility and feasibility of using a GoPro to record resident performance of an arteriovenous fistula creation with an attending surgeon. Categorical variables were analyzed using the chi-square test. Academic, tertiary medical center. GS residents and faculty. A total of 59 GS residents were anonymously surveyed (response rate = 65.5%). A total of 40% (n = 24) of residents reported that structured evaluations rarely or never provided meaningful feedback. When feedback was received, 55% (n = 32) residents reported that it was only rarely or sometimes in regard to their operative skills. There was no significant difference in surveyed responses among junior postgraduate year (PGY 1-2), senior (PGY 3-4), or chief residents (PGY-5). A total of 80% (n = 8) of residents found the use of GoPro video review very or extremely useful for education; they also deemed video review more useful for operative feedback than written or communicative feedback. An overwhelming majority (90%, n = 9) felt that video review would lead to improved technical skills, wanted to review the video with the attending surgeon for further feedback, and desired expansion of this tool to include additional procedures. Although there has been progress toward improving operative feedback, room for further improvement remains. The use of a head-mounted GoPro is a dynamic tool that provides high-quality video for operative review and has the potential to augment the training experience of GS residents. Future studies exploring a wide array of open procedures involving a greater number of trainees will be needed to further define the use of this resource.

A national resident survey about the current state of venous education in vascular surgery training programs.

The objective of this study was to characterize U.S. vascular surgery trainees' perceptions, case numbers, and attitudes toward venous disease education, as well as their intent to incorporate it into future practice. These data will provide us with a current snapshot of postgraduate venous education from a resident's perspective. Institutional Review Board approval was obtained. A 13-question survey was created and distributed to all vascular surgery residents in the United States by SurveyMonkey. Formal electronic distribution remained deidentified as the surveys were e-mailed to residents from the Association of Program Directors in Vascular Surgery. Of 464 vascular surgery trainees queried, 104 (22%) responded to the survey. The majority of responders (80%) were between 25 and 34years of age, 60% were male, and 72% were white; 91% reported that they were in an academic training program, and 57% were enrolled in an integrated vascular surgery residency program. Postgraduate years (PGYs) of training among respondents were well represented: PGY 1, 14%; PGY 2, 8%; PGY 3, 14%; PGY 4, 12%; PGY 5, 9%; PGY 6, 18%; and PGY 7, 25%. Vascular resident training experience with venous disease revealed the following: 63% performed<10 inferior vena cava stents, 64% performed<10 vein stripping/ligation procedures, and 50% performed<10 iliac stents; 92% of responders reported having performed<10 venous bypasses during their training. Experience with endothermal ablations was slightly better, with 74% of responders reporting having performed up to 20 cases. Case volumes for endothermal ablation, vein stripping/ligation, inferior vena cava stenting, and iliac stenting increased progressively by clinical training year among integrated vascular residents (P ≤ .02) but were relatively stable for classic 5+ 2 vascular fellows (P ≥ .67). Integrated residents reported having received more didactic venous education than the 5+ 2 vascular surgery fellows (P= .01). There were no differences in overall reported venous procedure volumes between groups (P ≥ .28). The majority of trainees (82%) acknowledged that treating venous disease is part of a standard vascular surgery practice, and many (75%) indicated a desire to have increased venous training. Despite this, 59% of responders reported plans to dedicate<25% of their future vascular surgery practice to venous disease. In this national survey-based study of vascular surgery trainees, we demonstrate a perceived weakness in venous disease case volumes and didactic education in residency. This training deficit is apparent in both integrated (0+ 5) and traditional (5+ 2) training pathways. Our data suggest that expansion of the venous disease curriculum with clear training standards is warranted and that trainees would welcome such a change.