Residency Programs In Specialties Research Articles

Addressing Low Scholarly Output in Residency With a Resident-Led Society for Innovation and Research.

Research activity in residency develops skills essential for the practice of medicine and has many benefits for residents, residency programs, the community of medicine, and patients. However, resident participation in research and innovation remains limited, with several barriers that are difficult to address without significant overhead or changes to curriculum. In September 2021, the Society for Innovation and Research (SIR), a resident-led organization dedicated to promoting and supporting resident achievement in research and innovation, was founded. Using only 1 hour of protected didactic time a month, SIR workshops provide critical mentoring and feedback to make resident research a success as well as education on various topics of interest to residents. In addition, SIR celebrates and publicizes resident research success and lays the groundwork for interested residents to participate in innovation. The authors analyze the success of SIR in increasing resident research productivity by analyzing PubMed-indexed publications for 11 semesters from fall 2018 to fall 2023. After the launch of SIR, the mean (SD) total number of publications increased from 5.3 (2.4) to 13.3 (1.6) (P = .01), the total mean (SD) number of residents publishing increased from 3.7 (1.3) to 10.0 (1.2) (P = .009), and the mean (SD) total number of coauthored articles increased from 0.1 (0.3) to 2.8 (1.3) (P = .007). The skill set acquired from participation in research during residency is more critical than ever in the wake of the COVID-19 pandemic. SIR initiatives are generalizable to most residency programs in most specialties and require little overhead in terms of physical space, digital resources, and staffing. The authors are currently exploring expanding the SIR program to other residencies at U.S. institutions and have set up processes for the mantle of SIR leadership to be passed down among the pathology resident body.

Aceptabilidad de un modelo de formulación diagnóstica de casos clínicos como estrategia educativa en una residencia de psiquiatría del niño y del adolescente

IntroductionThe aim of the study is to analyze the acceptability of an Integrative and Multidimensional Case Formulation Model implemented as an educational strategy in the first year of a child and adolescent psychiatry residency by a clinical supervisor within a one-way mirror room. Materials and methodsA qualitative methodology is used through content analysis of interviews conducted with residents of the program who had participated consecutively in clinical supervision between 2018 and 2021. For the analysis, 5 theoretical constructs derived from the Theory of Planned Behavior and Fazio's MODE Model are used: attitudes, subjective norm, perceived behavioral control, motivation and opportunity. ResultsTwenty-six thematic codes that influence acceptability emerged from the analysis: 8 attitudinal codes (e.g. acceptability is favored by the usefulness of the Model to gain theoretical insight of the cases but with a high amount of time required); 4 normative codes (e.g. the approval or disapproval of the model by scholars outside the clinical supervision); 7 perceived behavioral control codes (e.g. the perceived self-efficacy increases over time); 4 motivational codes (e.g. the desire to learn) and 3 opportunity codes (e.g. joint deliberation with peers). ConclusionThe results show valuable information for the development of educational strategies in the specialty residency program by approaching significant cognitive and affective factors which influence learning during the training periods. Aspects of the strategy that stand out as favoring the educational process are identified, along with other aspects that can be improved for better acceptability of the educational strategy.

Validity of Using Still Images for Written Competency Assessments for Point-of-Care Ultrasound among Non-Radiologists-pilot study.

Background and Objective: Point-of-care ultrasound (POCUS) has become an integral part of the curricula of various spe-cialty residency programs. POCUS education requires learners to be proficient in image acqui-sition, image interpretation, and integration into clinical practice. The assessment of POCUS skills and competency is variable. This study aimed to assess the validity and reliability of us-ing still ultrasound images as examination test items without providing clinical vignettes or anatomical locations. Methods: This is a proof-of-concept survey pilot study, residents from the Middle East who had com-pleted their training in emergency medicine were surveyed during their competency assess-ment examination. They were provided with a single ultrasound image of an abdominal aortic aneurysm in both print and PowerPoint slide format. The task was to identify the diagnosis based on this image, which was taken from a reference emergency medicine textbook. Results: The study showed that only 50% of the residents correctly identified the diagnoses based on the still images. Many of the incorrect answers included diagnoses that were not related to the anatomical structure that was scanned, indicating that the residents were not able to identify the anatomical locations, which highlighted the challenges of interpreting a single still image without clinical context and emphasized the need for valid and reliable test items in point-of-care ultrasound (POCUS) education and assessment. Conclusions: National and international emergency medicine societies should establish standards for writ-ing POCUS examination test items to ensure their validity and reliability.

Validity of Using Still Images for Written Competency Assessments for Point-of-Care Ultrasound among Non-Radiologists-pilot study.

Background and Objective: Point-of-care ultrasound (POCUS) has become an integral part of the curricula of various spe-cialty residency programs. POCUS education requires learners to be proficient in image acqui-sition, image interpretation, and integration into clinical practice. The assessment of POCUS skills and competency is variable. This study aimed to assess the validity and reliability of us-ing still ultrasound images as examination test items without providing clinical vignettes or anatomical locations. Methods: This is a proof-of-concept survey pilot study, residents from the Middle East who had com-pleted their training in emergency medicine were surveyed during their competency assess-ment examination. They were provided with a single ultrasound image of an abdominal aortic aneurysm in both print and PowerPoint slide format. The task was to identify the diagnosis based on this image, which was taken from a reference emergency medicine textbook. Results: The study showed that only 50% of the residents correctly identified the diagnoses based on the still images. Many of the incorrect answers included diagnoses that were not related to the anatomical structure that was scanned, indicating that the residents were not able to identify the anatomical locations, which highlighted the challenges of interpreting a single still image without clinical context and emphasized the need for valid and reliable test items in point-of-care ultrasound (POCUS) education and assessment. Conclusions: National and international emergency medicine societies should establish standards for writ-ing POCUS examination test items to ensure their validity and reliability.

The Importance of General Surgery Residency Program’s Online Presence Varies Among Applicant Groups

IntroductionThe COVID-19 pandemic necessitated an exclusively virtual 2021 residency application cycle. We hypothesized that residency programs’ online presence would have increased utility and influence for applicants. MethodsSubstantial surgery residency website modifications were undertaken in the summer of 2020. Page views were gathered by our institution’s information technology office for comparison across years and programs. An anonymous, voluntary, online survey was sent to all interviewed applicants for our 2021 general surgery program match. Five-point Likert-scale questions evaluated applicants’ perspective on the online experience. ResultsOur residency website received 10,650 page views in 2019 and 12,688 in 2020 (P = 0.14). Page views increased with a greater margin compared to a different specialty residency program’s (P < 0.01). From 108 interviewees, 75 completed the survey (69.4%). Respondents indicated our website was satisfactory or very satisfactory compared to other programs (83.9%), and none found it unsatisfactory. Applicants overall stated our institution’s online presence impacted their decision to interview (51.6%). Programs’ online presence impacted the decision to interview for nonWhite applicants (68%) but significantly less for white applicants (31%, P < 0.03). We observed a trend that those with fewer than this cohort’s median interviews (17 or less) put more weight on online presence (65%), compared to those with 18 or greater interviews (35%). ConclusionsApplicants utilized program websites more during the 2021 virtual application cycle; our data show most applicants depend on institutions’ websites to supplement their decision-making; however, there are subgroup differences in the influence online presence has on applicant decisions. Efforts to enhance residency webpages and online resources for candidates may positively influence prospective surgical trainees, and especially those underrepresented in medicine, to decide to interview.

Residency Program Diversity Recruitment and Education: Survey of Efforts and Barriers to Implementation

Examine underrepresented minority (URM) recruitment and diversity education initiatives provided by residency programs in ophthalmology and other specialties, and identify means to support programs as they work to enhance diversity efforts. Cross-sectional study. Multi-center survey of residency program leadership of the Association of University Professors of Ophthalmology, Johns Hopkins Medicine, University of Utah, and the University of California, Los Angeles. Residency program leadership (i.e., residency program directors and associate residency program directors) RESULTS: Our survey response rate was 34% (63/188); 56% percent of responses were from ophthalmology and 44% were from other specialties. Across all specialties, programs with a large number of clinical faculty and trainees were associated with having ≥1 URM resident in their program (p = 0.026 and p = 0.028, respectively). There was no significant difference between ophthalmology and other specialties with regard to the number of URM residents. Ninety-two percent of programs utilized strategies to recruit URM applicants. While certain strategies were more common for ophthalmology than other specialties, information sessions for URM students (62%) and a unique review of all URM residency applicants by a separate committee/person (46%) were most commonly used overall. Although 92% of residency program leadership believed it was highly important for health professionals to receive formal diversity training, only 54% of programs had a diversity education curriculum for both trainees and faculty, 11% had a curriculum for faculty only, and 3% had a curriculum for trainees only. Barriers to implementation of curricula included lack of faculty expertise (30%) and curricular time (30%). An overwhelming majority of programs in our study utilized strategies to recruit URM applicants, but 22% had 0 URM residents in their program. To address the reported barriers to diversity education implementation, shared central resources/diversity education toolkits should be created to provide programs with needed support.

P.118 Curriculum mapping can facilitate transition to Competence by Design

Background: Curriculum maps outline the content of an educational program identifying links between targeted outcomes, educational opportunities, and assessments. The transition to Competence by Design (CBD) in Canadian specialty residency programs requires thoughtful reorganization of educational programming. A curriculum map may assist with understanding the existing curriculum and thereby facilitate planning for CBD. Methods: A map of the pediatric neurology residency curriculum at the University of Calgary was constructed by linking objectives with related learning activities and assessments. Qualitative line-by-line analysis was then conducted to identify gaps in the existing curriculum. The map was used as a framework to plot CBD outcomes and curricular structure as these were established. Results: Generating the traditional curriculum map was time-consuming, requiring 48 hours. Careful review identified several objectives that did not link to formal learning activities or assessments. Many such gaps were recognized to link to non-clinical activities. Using the scaffold of the traditional curriculum reduced the time required for mapping the planned CBD curriculum to 4 hours. Conclusions: The creation of a curriculum map prior to transition to CBD improved understanding of the existing curriculum and will facilitate transition to CBD. Ongoing evaluation of the fit of our predicted CBD map will support effective implementation.

Innovating patient care and gynecologic surgery instruction through tele-education.

Effects of the coronavirus disease 2019 pandemic prompted the need for rapid, flexible change in the delivery of care, education, and commitment to the well-being of obstetrics and gynecology (OB/GYN) residents. Published literature shows multiple models for surge scheduling for residency programs in other specialties. We describe our experience creating a surge schedule for OB/GYN residents that allowed for sufficient coverage of inpatient care while minimizing resident exposure and limited hospital resources, respecting work hour requirements, and plans for coverage due to illness or need for home quarantine. We also report innovative approaches to trainee education through the use of remote-learning technology and gynecologic surgery skills training in absence of normal clinical exposure. Our approach serves as a model for adapting to unprecedented challenges and offers suggestions for creative transformations of traditional teaching that can be continued beyond the immediate crisis.

Demographics of Surgical Specialty Residency Program Directors in the United States: A Cross-sectional Analysis.

To evaluate program director (PD) demographics, training background, and academic productivity in 11 surgical specialties. There is currently no comprehensive study comparing educational background, research output, and gender differences between PDs of surgical residencies in the United States. The Accreditation Council for Graduate Medical Education (ACGME) and the Association of American Medical Colleges (AAMC) websites were used to identify residency PDs. Age, information related to service as PD, educational background, and research output were collected utilizing online searches including Doximity, PubMed, and Scopus.. The ACGME Data Resource Book was used to obtain data on the gender makeup of residents in each surgical specialty. Data collection occurred between December 14, 2019, and May 9, 2020. 1571 residency PDs across 11 surgical specialties were included. Significant differences between specialties were found with respect to PD gender, current age, age at appointment, years between residency and assignment, term duration, number of PubMed publications, and Scopus h-index. The current age (mean ± SD) ranged from 46.8 ± 8.5 years among Interventional Radiology (IR) PDs to 53.4 ± 9.1 years among Neurological Surgery (NEUROSURG) PDs. The proportion of female PDs ranged from 5.9% in NEUROSURG to 63.5% in Obstetrics and Gynecology (OB-GYN). Completion of a post-residency fellowship was least common for OB-GYN PDs at 9.1%, and most common for IR PDs at 98.8%. The number (mean ± SD) of PubMed publications and Scopus h-index ranged from 13.1 ± 22.3 publications and h index 4.5 ± 5.7 among OB-GYN PDs to 112.5 ± 103.0 publications and h index 27.4 ± 16.7 among Thoracic Surgery PDs. Age and academic productivity as measured by PubMed publications and Scopus h-index were significantly lower among female PDs in multiple surgical specialties. There were significant variations in the PDs of surgical specialties, particularly with respect to gender and academic productivity. Efforts should be made to support and encourage greater female representation in the role of surgical residency PD.

Effect of COVID-19 on Urology Residency Training: A Nationwide Survey of Program Directors by the Society of Academic Urologists.

Coronavirus disease (COVID-19) has profoundly impacted residency training and education. To date, there has not been any broad assessment of urological surgery residency changes and concerns during the COVID-19 pandemic. The Society of Academic Urologists distributed a questionnaire to urology residency program directors on March 30, 2020 exploring residency program changes related to the COVID-19 pandemic. Descriptive statistics are presented. A qualitative analysis of free response questions was undertaken. A post hoc analysis of differences related to local COVID-19 incidence is described. The survey was distributed to 144 residency programs with 65 responses for a 45% response rate. Reserve staffing had started in 80% of programs. Patient contact time had decreased significantly from 4.7 to 2.1 days per week (p <0.001). Redeployment was reported by 26% of programs. Sixty percent of programs reported concern that residents will not meet case minimums due to COVID-19. Wellness activities centered on increased communication. All programs had begun to use videoconferencing and the majority planned to continue. Programs in states with a higher incidence of COVID-19 were more likely to report resident redeployment (48% vs 11%, p=0.002) and exposure to COVID-19 positive patients (70% vs 40%, p=0.03), and were less likely to report concerns regarding exposure (78% vs 97%, p=0.02) and personal protective equipment availability (62% vs 89%, p=0.02). As of April 1, 2020 the COVID-19 pandemic had resulted in significant changes in urology residency programs. These findings inform a rapidly changing landscape and aid in the development of best practices.

Taxonomy of educational objectives and learning theories in the training of laparoscopic surgical techniques in a simulation environment.

The acquisition of psychomotor skills in surgery is the central component of medical residency programs in General Surgery and Specialties. Making learning more effective is a cornerstone of educational processes. This article portrays aspects of educational taxonomies and learning theories that may be involved in the training of surgery. Among the many taxonomies and educational theories applicable to learning in surgery, the following stand out: 1) Dave's taxonomy- Hierarchy to actions that facilitate the acquisition of psychomotor skills; 2) Miller's theory- Step-by-step definition that facilitates acquisition; 3) Ericsson's theory- Competence after repetition of the practice followed by systematic reinforcement; 4) Vigotsky's theory- Definition of the role of the specialist in learning; and 5) Theory of Boud, Schon and Ende- Importance of feedback for students and teachers. Knowledge of these tools by teachers and preceptors can facilitate learning in surgery, especially in more complex activities.

How Small Differences in Assessed Clinical Performance Amplify to Large Differences in Grades and Awards: A Cascade With Serious Consequences for Students Underrepresented in Medicine.

While students entering medical schools are becoming more diverse, trainees in residency programs in competitive specialties and academic medicine faculty have not increased in diversity. As part of an educational continuous quality improvement process at the University of California, San Francisco, School of Medicine, the authors examined data for the classes of 2013-2016 to determine whether differences existed between underrepresented in medicine (UIM) and not-UIM students' clinical performance (clerkship director ratings and number of clerkship honors grades awarded) and honor society membership-all of which influence residency selection and academic career choices.This analysis demonstrated differences that consistently favored not-UIM students. Whereas the size and magnitude of differences in clerkship director ratings were small, UIM students received approximately half as many honors grades as not-UIM students and were three times less likely to be selected for honor society membership.The authors use these findings to illustrate the amplification cascade, a phenomenon in which small differences in assessed performance lead to larger differences in grades and selection for awards. The amplification cascade raises concerns about opportunities for UIM students to compete successfully for competitive residency programs and potentially enter academic careers. Using a fishbone diagram, a continuous quality improvement root cause analysis tool, the authors contextualize their institutional results. They describe potential causes of group differences, drawing from the education disparities literature, and propose interventions and future research. They also share countermeasures adopted at their institution and encourage other medical schools to consider similar exploration of their institutional data.

Developing Educational Competencies Required for the Infectious Diseases Specialty Residency Program in Iran: A Competency-based Curriculum

Background: Curriculum design and development are among the key components of medical education. Today, the dominant approach to curriculum planning is the competency-based approach. However, despite the emphasis posed by the medical education scientific community on this approach, medical education in both undergraduate and graduate levels in Iran continues to be delivered traditionally. As it is highly important for infectious diseases specialists to acquire the necessary competencies for the treatment of patients with infectious diseases, this study aimed to identify and present such competencies through localizing the competencies laid down by the Accreditation Council for Graduate Medical Education (ACGME) of the United States. Methods: This study built on ACGME competencies as its point of departure. The Delphi method was used to extract the required items (i.e., competencies) into a questionnaire. When the content and face validity as well as the reliability of the questionnaire was confirmed, copies of the questionnaire were distributed among faculty members, specialists and residents. The items were prioritized according to the scores given by the participants. Results: According to the results of this study, one general rotation and ten specialized rotations were defined for infectious diseases residents. In each rotation, the expected competencies are enlisted. These competencies are categorized differently in competency-based curricula for the infectious diseases specialty residency programs. Conclusion: According to characteristics of a competency-based curriculum, accountable physicians can be assuredly expected to be trained according to the requirements of the community in case they are trained within such a program.

Operating room nurse residency and specialty educators: Paramount in the success of novice nurse retention

Perioperative service is one of the specialties of nursing in which a team approach is vital for optimal patient care. The registered nurse is responsible for coordinating and delivering safe patient care. Operating room (OR) nurses are responsible for applying fundamental applications of the nursing process while formulating plans of care unique to surgical patients. The growing shortage of nurses worldwide especially impacts highly complex areas such as the OR, where skills specialized are needed to care for patients. One of the largest challenges of a graduate nurse (GN) is becoming enculturated to new environments. Traditionally, OR nursing is a paradigm foreign in nursing curricula; this creates challenges in the GN population in applying their practical nursing skills to surgical patients. In an effort to combat ongoing knowledge deficits unique to OR nursing, Houston Methodist Hospital (HMH) created an OR nurse residency program. The literature suggests that specialty-specific nursing residency programs offer GNs essential tools for becoming successful in their transition. Additionally, research suggests reductions in nurse burnout and turnover rate among GNs with adequate training and preparation. The purpose of this article was to provide insight on the importance of introduction to the OR prior to graduating from nursing school and the importance of OR nursing specialty residency programs and specialty educators as they pertain to the ideal nursing transition, sustainability, retention, and favorable patient outcomes. A questionnaire was created to capture successful applicable practices; the questionnaire also provided an opportunity for GNs to suggest opportunities for program improvements. The questionnaire was used to explore feedback from the summer 2014 Operating Room (OR) residency program graduate nurses in an effort to capture improvements needed for future program success.

Perceptions of the 2011 ACGME duty hour requirements among residents in all core programs at a large academic medical center

BackgroundThe Accreditation Council for Graduate Medical Education (ACGME) implemented revisions to resident duty hour requirements (DHRs) in 2011 to improve patient safety and resident well-being. Perceptions of DHRs have been reported to vary by training stage and specialty among internal medicine and general surgery residents. The authors explored perceptions of DHRs among all residents at a large academic medical center.MethodsThe authors administered an anonymous cross-sectional survey about DHRs to residents enrolled in all ACGME-accredited core residency programs at their institution. Residents were categorized as medical and pediatric, surgery, or other.ResultsIn total, 736 residents representing 24 core specialty residency programs were surveyed. The authors received responses from 495 residents (67%). A majority reported satisfaction (78%) with DHRs and believed DHRs positively affect their training (73%). Residents in surgical specialties and in advanced stages of training were significantly less likely to view DHRs favorably. Most respondents believed fatigue contributes to errors (89%) and DHRs reduce both fatigue (80%) and performance of clinical duties while fatigued (74%). A minority of respondents (37%) believed that DHRs decrease medical errors. This finding may reflect beliefs that handovers contribute more to errors than fatigue (41%). Negative perceived effects included diminished patient familiarity and continuity of care (62%) and diminished clinical educational experiences for residents (41%).ConclusionsA majority of residents reported satisfaction with the 2011 DHRs, although satisfaction was significantly less among residents in surgical specialties and those in advanced stages of training.

Impact of a Nurse Residency Program on Transition to Specialty Practice.

A nurse residency program can support transition for new-to-specialty nurses but requires commitment of time and resources. This implementation project used a specialty residency program shown to be effective in a Burn Center, and translated it into the Emergency Department and Maternal Child Health area located within the same medical treatment facility. Preceptor survey responses and leadership assessment of program suitability provided data related to intervention impact. The evidence pertaining to developing specialty knowledge, skills, competency, and clinical reasoning validated program efficacy. Project outcomes justify investment in building a standardized transitional support system.

Attitudes and factors contributing to attrition in Canadian surgical specialty residency programs.

We recently studied attrition in Canadian general surgical programs; however, there are no data on whether residents enrolled in other surgical residencies harbour the same intents as their general surgical peers. We sought to determine how many residents in surgical disciplines in Canada consider leaving their programs and why. An anonymous survey was administered to all residents in 9 surgical disciplines in Canada. Significance of association was determined using the Pearson χ2 test. The Canadian Post-MD Education Registry (CAPER) website was used to calculate the response rate. We received 523 responses (27.6% response rate). Of these respondents, 140 (26.8%) were either "somewhat" or "seriously" considering leaving their program. Residents wanting to pursue additional fellowship training and those aspiring to an academic career were significantly less likely to be considering changing specialties (p = 0.003 and p = 0.005, respectively). Poor work-life balance and fear of unemployment/underemployment were the top reasons why residents would change specialty (55.5% and 40.8%, respectively), although the reasons cited were not significantly different between those considering changing and those who were not (p = 0.64). Residents who were considering changing programs were significantly less likely to enjoy their work and more likely to cite having already invested too much time to change as a reason for continuing (p < 0.001). More than one-quarter of residents in surgical training programs in Canada harbour desires to abandon their surgical careers, primarily because of unsatisfactory work-life balance and limited employment prospects. Efforts to educate prospective residents about the reality of the surgical lifestyle and to optimize employment prospects may improve completion rates.

Factors Influencing Dental Students' Interest in Advanced Periodontal Education: Perspectives of Department Chairs.

The number of graduates of U.S. dental schools enrolled in U.S. postdoctoral programs in periodontics has been decreasing. The aims of this study were to determine the perspectives of periodontics department chairs regarding 1) features of a school's predoctoral curriculum that promote student interest in advanced periodontal education and 2) characteristics of a periodontal residency program that make it more attractive to dental students over other specialty programs. In 2015, a 14-question survey was designed and sent to chairs of periodontics departments at all 65 U.S. dental schools at the time. Questions addressed number of instructional hours; specialty clinic rotations; elective courses; number of applicants to periodontal residency; existence of a residency program; length of the residency program; and externships, fellowships, and financial stipends offered. The survey response rate was 73.8%. The results showed that departments offering more than seven clinical credit hours in periodontics to predoctoral students had the greatest number of residency applicants. Most of the applicants were from institutions that offered specialty clinic rotations, elective courses, and residency programs in periodontics. The number of applicants did not change significantly if a stipend or fellowship was offered. However, the availability of an externship was significantly associated with a greater number of applicants (p=0.042). These results suggest that offering periodontal clinical rotations, elective courses, and especially externships in periodontics during predoctoral education may encourage more graduating students to pursue postdoctoral periodontal education.

The risk of unintentional out-of-network encounters with hospital-based physicians at in-network hospitals

ObjectiveWhen hospital-based specialists including emergency physicians, anesthesiologists, pathologists and radiologists are not included in the same insurance networks as their parent hospitals, it creates confusion and leads to unexpected costs for patients. This study explored the frequency with which hospital-based physicians at academic medical centers are not included in the network directories for the same insurance networks as their parent teaching hospitals. MethodsWe studied teaching hospitals with residency programs in all four hospital-based specialties. Using insurance plan provider directories, we determined whether each teaching hospital was in-network for randomly selected locally available insurance plans offered through the federal and state marketplace exchanges. For each established hospital-network relationship, we then determined whether hospital-based specialists were included in the provider network directory by searching for the name of each specialty's residency program director and the name of the physician practice group. ResultsWe identified 79 teaching hospitals participating in 144 locally available insurance plan networks. Hospital-based specialist inclusion in these hospital-network relationships was: emergency physicians: 50.0% (CI: 40%–59%); anesthesiologists: 50.0% (CI: 42%–58%); pathologists: 45.4% (CI: 37%–54%); and radiologists: 55.1% (46%–64%). Inclusion of all four hospital-based specialties occurred in only 45.0% (CI: 36%–54%) of the hospital-network relationships. ConclusionFor insurance plans offered through the federal and state marketplace exchanges, hospital-based specialists frequently are not included in the directories for the insurance networks in which their parent teaching hospitals participate. Further research is needed to explore this issue at non-academic hospitals and for off-exchange insurance products, and to determine effective policy solutions.

Increasing Resident Diversity in an Emergency Medicine Residency Program: A Pilot Intervention With Three Principal Strategies.

Much work remains to be done to align the diversity of the health care workforce with the changing racial and ethnic backgrounds of patients, especially in the field of emergency medicine. In academic year (AY) 2012-2013, to increase the number of underrepresented minority (URM) candidates who were interviewed and matched, the Denver Health Residency in Emergency Medicine program (DHREM) initiated a focused pilot intervention with three principal strategies: (1) a scholarship-based externship program, (2) a funded second-look event, and (3) increased involvement and visibility of URM faculty in the interview and recruitment process. One year after implementation of the pilot intervention, the percentage of URMs among all applicants invited to interview at the DHREM doubled (7.1% [20/282] in AY 2011-2012, 7.0% [24/344] in AY 2012-2013, and 14.8% [58/393] in AY 2013-2014) (95% confidence interval [CI] = 5-10, 4-11, and 11-19, respectively). Of all DHREM interviewees in AY 2013-2014, 17.6% (49/279) (95% CI = 12-23) were URMs, nearly a threefold increase from AY 2012-2013 (6.2% [14/226], 95% CI = 3-10). In AY 2013-2014, 23.5% (4/17) (95% CI = 7-50) of all new DHREM residents were URMs, compared with 5.9% (1/17) in AY 2011-2012 and 5.6% (1/18) in AY 2012-2013 (95% CI = 0-29 and 0-27, respectively). Additional studies are needed to determine whether these results are sustainable and generalizable to other residency programs in emergency medicine and other specialties.