Survey Of Program Directors Research Articles

2024 ACLP Recommendations for Training Residents in Consultation-Liaison Psychiatry

Despite rapid shifts in consultation-liaison psychiatry (CLP) training in residency, including increasing general residency training requirements from the Accreditation Council for Graduate Medical Education, greater utilization of advanced practice providers, and effects of the coronavirus-2019 pandemic, the Academy of Consultation-Liaison Psychiatry (ACLP) has not updated recommendations for residency training in CLP since 2014. A national survey of residency program directors in 2021 suggested many changes to the structure of CLP rotations at individual programs over the past decade. We convened a workgroup of 8 ACLP members holding leadership positions in residency and fellowship education on local and national levels. The project was approved by the ACLP Executive Council and conducted via a three-stage iterative process. Consensus was reached on 34 recommendations across four domains, including structural issues, faculty supervsion, formal curriculum and evaluations, and elective experiences. Residents must spend sufficient time on CLP rotations to achieve relevant milestones. Given that consultants are expected to offer unique insight, the ideal placement of core CLP rotations comes at a time in residency where residents are able to provide expert opinion and lead teams. Faculty expertise in CLP and availability to provide direct supervision and oversight to trainees is essential. A separate and formal CLP didactic curriculum should exist, and elective opportunities should be offered to supplement training. These recommendations are intended to guide residency program directors towards optimizing CLP training for all residents, including those who will eventually pursue CLP fellowship. Establishing a strong CLP foundation for all residents is essential for ensuring competency in providing psychiatric care for medically complex patients and collaborating with our colleagues in other specialties, as well as fostering trainee interest in pursuing a career in CLP.

Variations in Trauma Education Practices Across Emergency Medicine Residencies: Insights from a National Survey of Program Directors.

Care of the acutely injured trauma patient is integral to the practice of emergency medicine. It is currently unknown how most emergency medicine residencies structure their residents' trauma experience and little guidance for competency assessment is provided by the Residency Review Committee. Our study aimed to determine current emergency medicine residency practices in trauma resuscitation. We conducted a cross-sectional survey of members of the Council of Residency Directors in Emergency Medicine (CORD) listserv in April 2023. Frequency with percentage of item responses is reported and differences across trauma levels assessed via Fisher's exact test (α = 0.05). Fifty-seven program directors responded to the survey (21.9%), the majority of whom operate at Level I facilities. Significantly more Level II/ III centers send residents to other sites for trauma experience compared to Level I (p = 0.000). Residents participate in all key procedures (eg, airway management, central venous access) when managing traumas except thoracotomy where participation was notably lower and statistically different across levels (p = 0.000). Lastly, program directors were very confident their residents can lead traumas independently and few acknowledged citations for deficiency in trauma training. Trauma training and confirmation of competency is critical among EM residents who may serve as the sole lead in rural emergency departments. This study demonstrates that there is considerable variability in how residency programs structure trauma education, particularly with regards to the exposure to invasive procedures and the opportunity to lead trauma resuscitations. As the American Board of Emergency Medicine has introduced requirements for program directors to attest specifically to the competence of residents to lead trauma resuscitations, standardized and validated tools should be adopted to support this attestation and ensure competence regardless of the program hospital's trauma level.

Patient safety and quality improvement education in dermatology residency programs: a nationwide survey of program directors.

Patient Safety and Quality Improvement (PSQI) are key components of graduate medical training, as detailed by the Accreditation Council for Graduate Medical Education (ACGME), with specific requirements that residents participate in experiential learning in PSQI during residency training. This study aimed to analyze the breadth of available and required PSQI educational experiences across dermatology residency programs in the United States. The objective of this study was to characterize the scope of PSQI educational experiences across dermatology residency programs. We electronically surveyed program directors of all ACGME-accredited dermatology residency programs from September 2023 to March 2024. Responses to the survey were anonymously collected with Research Electronic Data Capture (REDCap). Of the 145 dermatology programs surveyed, 37 program directors responded (25.5%). 89.2% of programs reported requiring residents to participate in PSQI educational experiences, with the most common being participation in a resident-led QI project (70.3%), which was also the most commonly available experience (91.2%). The least common required experience was observed simulated patient safety events and analyses. 83.8% of programs reported formal mechanisms to assess residents' competency in QI. This study highlights variation in PSQI experiences within dermatology residency programs across the United States. More than 10% of surveyed programs reported no required QI experiences during residency training despite ACGME program requirements. Additional gaps include variation in assessment of resident PSQI competencies. This study provides insight on the current landscape of PSQI education across dermatology residency programs and identifies opportunities to strengthen dermatology programs' PSQI educational offerings.

Characterizing Collegiate Recovery Programs in the US and Canada: A Survey of Program Directors.

Collegiate Recovery Programs (CRPs) play a vital and expanding role in supporting students in recovery from substance use disorders and behavioral addictions at higher education institutions. Despite their importance, there is a lack of comprehensive research characterizing CRPs, including their program directors and the nature and influence of their funding streams. A survey was administered to 70 CRP directors across the US and Canada. Directors reported on their CRPs across a variety of site physical features, policy and program offerings, and funding sources, with "sustainable" funding defined as two or more sources. CRP directors were predominantly non-Hispanic, White, and female, with representation from gender and sexual minorities. The highest concentration of directors responding were in the US states of North Carolina, California, and Texas. CRPs with more than one funding source served twice as many students and had significantly more space, drop-in facilities, and relapse management policies. CRP directors had positive perceptions of harm reduction principles. Additionally, results highlighted the robust availability of All Recovery meetings and the wide diversity of mutual-help group meetings offered within CRPs and directors' positive perceptions of these meetings. This research lays a foundation for enhancing CRPs within higher education settings, emphasizing the significance of sustained funding and an inclusive support framework for the program directors that run CRPs. Future studies should further explore the effectiveness of CRPs and their impacts on the schools and students they serve.

Client and program-level factors associated with planned use of medications for opioid use disorder in specialty substance use treatment programs: Evidence from linked administrative data and survey data

BackgroundMost patients in specialty drug treatment programs that are not federally licensed Opioid Treatment Programs (OTPs) programs do not receive medications for opioid use disorder (MOUD). MethodsWe linked results from a survey of non-OTP treatment program directors in New Jersey (n = 81) to statewide administrative records of admissions for opioid use to those programs between July 2021–June 2022. Using multi-level regression, we examined the association of three types of factors with planned MOUD use: program survey responses, client-level factors, and program-level client characteristic mix. ResultsOf 9583 opioid treatment admissions in non-OTP settings, 41 % included treatment plans involving MOUD. Programs where directors reported staff concerns about buprenorphine's efficacy or diversion had a lower proportion of clients with planned MOUD, as did programs reporting too little physical space to prescribe. Being self-referred to treatment, unemployed and not looking for work, aged 30–49, heroin use (vs. prescription opioid use), and stimulant use in addition to opioids, were positively associated with planned MOUD; while non-Medicaid insurance, and Black and Hispanic race/ethnicity, were negatively associated with planned MOUD. Clients were more likely to have planned MOUD if their programs had a higher proportion of clients aged 30 or older, heroin as primary “drug of abuse,” stimulant use, and not working but actively looking for work. ConclusionFindings suggest addressing program staff attitudes toward buprenorphine could help increase planned MOUD. There is also a need to improve access for clients with non-Medicaid insurance, address within-program race and ethnic disparities, and address employment-related barriers to medication.

AAPM BTSC Report 377.B: Physicist brachytherapy training in 2022 - A survey of therapeutic medical physics residents.

A survey of medical physics residency program directors was conducted in Spring 2021 to examine the current state of brachytherapy (BT) training during residency. In this related work, a subsequent survey of therapeutic medical physics residents in 2022 was conducted to assess the confidence and experience of the trainees. Concerns for access to high-quality and diverse training in BT have escalated in importance due to recent declines in BT utilization. A survey consisting of 26 questions was designed by a working unit of the Brachytherapy Subcommittee of the American Association of Physicists in Medicine (AAPM) and approved for distribution by the Executive Committee of the AAPM. The survey was distributed to current trainees and recent graduates of the Commission on Accreditation of Medical Physics Education Programs accredited therapeutic medical physics residency programs by the AAPM. The participant response was anonymously recorded in an online platform and subsequently analyzed using spreadsheet software. The survey was distributed to 796 current medical physics residents or recent graduates over the course of 6weeks in February and March of 2022. The survey received 736 views and a total of 182 responses were collected, with 165 respondents completing the survey in full. Among those responses, 110 had completed their residency training, with program start dates ranging from calendar years 2015 to 2021. Individual responses from the survey takers (including partial survey submissions) were evaluated and analyzed to compile results. Medical physics residents reported the highest levels of confidence and caseload for gynecological BT procedures when compared with other surveyed treatment techniques. This indicates opportunities to improve training and increase access to clinical caseload are needed in order to improve competency and confidence. Time constraints (clinical and rotation-based) were indicated as impediments to BT proficiency. Medical physics residents reported enthusiasm for additional training opportunities in BT, and it is evident that additional structure and programs are required to ensure adequate access to BT training during residency.

Burnout among Postgraduate Healthcare Trainees at a Tertiary Healthcare Center in Saudi Arabia.

The aim of this study was to investigate the level of burnout among postgraduate healthcare trainees at a tertiary care center in Riyadh, Saudi Arabia, and assess the need to establish a well-being program. This cross-sectional study was conducted between December 2021 and January 2022 and used two validated questionnaires: the Copenhagen Burnout Inventory (CBI) for assessing burnout among postgraduate healthcare trainees, and a questionnaire for assessing program directors' opinion on the need for a well-being program. A total of 386 trainees and 85 program directors completed the questionnaire. In both groups, the majority of the respondents were male (trainees: 53.9%; program directors: 61.2%). A total of 226 trainees (58.5%) scored above the CBI burnout cut-off score, with the median score being highest in the personal domain (62.5,IQR: 45.8-75). In the univariate analysis, the mean burnout score was higher among trainees who were married (P = 0.036), had children (P = <0.001), and were seniors (P = 0.028), whereas in the multivariate analysis, the only significant predictor of burnout was having 1-2 children (P = 0.023) or 3-4 children (P = 0.013). In the program directors survey, 90.6% agreed that improving physicians' well-being would directly rectify patients' overall well-being, but only 28.2% stated that it is currently incorporated in the curriculum. This study found that a large proportion of postgraduate healthcare trainees experience burnout, particularly in the personal domain. Although program directors supported the concept of trainees' well-being, its incorporation into the curriculum was lacking, suggesting the necessity of establishing a well-being program.

Mapping out Remediation: An Actionable Roadmap to Support Trainees Through Remediation

What’s NewThis qualitative analysis offers an actionable, stepwise approach to remediation. IntroductionThe goal of graduate medical education is for trainees to develop the competence needed to practice independently; however, some residents struggle to achieve competency and require remediation. Evidence around how to best facilitate remediation is lacking. The objective of this study was to understand best practices for remediation in pediatrics. MethodA national web-based survey of pediatric residency program directors (PDs) on remediation practices was performed. The survey included 3 open-ended questions about PDs’ experiences with remediation. Self-reported barriers to and strategies for remediation were systematically analyzed using inductive thematic analysis to develop a theory of effective remediation in pediatric residency training. ResultsA total of 99 out of 195 (50.8%) program directors responded. Two main themes emerged: developing a personalized plan that ensures competency attainment and fostering psychological safety. Twelve categories outline actionable steps that PDs can take to make the remediation process successful. DiscussionBuilt from insight from pediatric PDs, we propose a conceptual model for effective remediation that accounts for competency attainment while safeguarding the emotional health of the resident. The conceptual model breaks the remediation process down into four phases: identification of the learner who struggles, planning the remediation process, implementation of the plan, and assessing the outcome of the process.

Nephrology Program Director and Fellow Home Hemodialysis (HHD) Curriculum Survey

Nephrology Program Director and Fellow Home Hemodialysis (HHD) Curriculum Survey

Digital technology implementation in prosthodontics postgraduate programs in Saudi Arabia: a multi-institutional survey of program directors

ObjectiveTo assess the current status of digital technology (DT) implementation in prosthodontics post-graduate (PG) programs in Saudi Arabian dental institutions.MethodologyA 19-item survey was created using Google forms and the link was emailed to the 29 prosthodontics PG program directors (advanced clinical training and joint program) in Saudi Arabia. The questionnaire contained five Sect. 1) didactic training and DT usage in PG preclinical, clinical and laboratory training, 2) incorporation of DT in PG program, 3) utilization of DT and the types of cases treated by PG students during their course, 4) information on the faculties involved in prosthodontics PG education, and 5) potential challenges encountered and program directors’ satisfaction of the PG program. Descriptive statistics was used to present the frequencies and proportions, and Chi square inferential test was used to compare the participants’ response based on the type of PG programs (α = 0.05).ResultsOnly 28 program directors responded to the survey, yielding a 95.5% response rate. Among the program directors, 24 (85.7%) and 4 (14.3%) directors supervised the advanced clinical training and joint programs, respectively. Among the DT, CAD/CAM was the most used technology (50–80%), followed by intra-oral scanning (28–96%). Digital technology implementation was largely limited by lack of resources or equipment (67%), cost (53%) and scarcity of PG teaching staff (46%). A significant difference was observed between the programs regarding the mandatory use of DT for their cases (p = 0.03).ConclusionsThis multi-institutional survey of program directors revealed that DT is continuously implemented in the last few years. Saudi dental institutions must prioritize implementing and utilizing DT in PG training to graduate competent prosthodontists in this fast-paced digital era. While DT is pivotal in dental education, its implementation is limited in many institutions due to resources or equipment, cost, and lack of trained faculty.

Evolving Regional Anesthesiology and Acute Pain Medicine fellowship application process: a program director survey

Background and objectivesMost Regional Anesthesiology and Acute Pain Medicine (RAAPM) fellowship programs transitioned to virtual interviews in 2020 because of the COVID-19 pandemic. Then, the RAAPM fellowship match started in...

Psychedelic medicine in psychiatry residency training: a survey of psychiatric residency program directors

Objective The growth of psychedelic medicine creates new challenges in psychiatric education as physicians may soon be responsible for prescribing a number of psychedelic interventions. Despite this growing need for educated providers, very little is known about the training psychiatry residents receive in psychedelic medicine. We conducted a survey to determine the current educational opportunities as well as the priorities and concerns held by training directors about this emerging field. Methods We emailed an online survey to US psychiatry residency training directors. Respondents answered questions about current offerings in psychedelic medicine, as well as their interest, priorities, and concerns about curricular materials and their delivery. Results Sixty-one programs responded to our survey. The majority of respondents (64%) favored devoting additional time to psychedelic education, but many endorsed concerns about the dearth of educational materials (54%) and limited availability of faculty to deliver content (46%). The majority of programs (94%) expressed some interest in implementing a standardized curriculum in psychedelic medicine. Conclusion Training directors recognized that their current curricular materials are limited, and they appeared interested in additional support to meet the upcoming demand in psychedelic education. Further research can inform curriculum development and implementation of psychedelic education in residency training.

Education Research: The Current Landscape of Clinician Educator Tracks in Adult Neurology Residency Programs: A National Survey of Program Directors.

As the concept of a clinician-educator (CE) evolves and the multiple competencies of the role become better defined, there seems to be a growing need for targeted training for clinicians pursuing a career in medical education. This study aims to describe the current state of CE tracks in adult neurology residency programs and to identify the barriers to implementation, potential solutions, and program goals and outcomes. We characterized CE tracks using 2 methods. First, we reviewed the websites of all US adult neurology residency programs to determine the availability of a CE track and its characteristics. Second, we administered a 20-item survey to program directors (PDs) of all US neurology residency programs, with questions focused on track availability, characteristics, perceived benefits of CE tracks on resident career development, barriers to implementation, and ideas for national initiatives that may facilitate track development or improvement. Fifty-eight of 177 (33%) PDs responded to the survey. Combining the results of the website reviews and surveys, we found that 34 of 179 (19%) programs have CE tracks. Seventy percent of PDs felt that CE tracks are very impactful or impactful for participating residents' careers, a perception more common among PDs of programs with tracks. The greatest perceived benefit was in preparing residents for educational leadership roles. The greatest barriers to implementation were a lack of teaching faculty, a lack of resources, and limited resident time. The highest ranked idea for a national initiative that can facilitate track development was live and recorded lectures on medical education topics. Although most PDs surveyed agreed that CE tracks are impactful for preparing residents as teachers and education leaders, such tracks are available in only 19% of adult neurology residency programs. PDs report that the benefits of CE tracks extend beyond the participants, with implications for the health of the residency program and the neurology department. While some programs have significant barriers to implementation, national initiatives may help reduce the resource burden on individual programs. Future areas of study include assessing the development and outcomes of national initiatives and analyzing the outcomes associated with CE tracks.

51108 Skin of Color Education in Primary Care Residency Programs: A Nationwide Survey of Program Directors

51108 Skin of Color Education in Primary Care Residency Programs: A Nationwide Survey of Program Directors

Pleural Procedure Education in Fellowship: A National Survey of Program Directors

Pleural Procedure Education in Fellowship: A National Survey of Program Directors

Perspectives Regarding Virtual Interviewing for Dermatology Residency in the United States: A Survey of Applicants, Residents, Faculty, and Program Directors in the 2022-2023 Application Cycle

Background: Despite the widespread adoption of virtual interviewing for dermatology residency in the United States (US), there are limited data on the perspectives of those affected. Objectives: Characterize the viewpoints regarding virtual interviewing of applicants, residents, and faculty who participated in the 2022-2023 US dermatology residency application cycle. Methods: Two anonymized surveys were created: one for applicants and the other for programs (residents, program directors, and other faculty). The program survey was distributed through the US Dermatology Program Director listserv in January 2023. The applicant survey was distributed through email in April 2023. Results: There were 336 respondents: 135 applicants, 63 program directors, 77 other faculty, and 61 residents. Overall, the largest proportion favored virtual-only interviewing (39%), followed by some combination of in-person and virtual interviews (28%) and in-person–only interviewing (20%). There was no significant difference between preferences of applicants and program directors (P=0.13). The respondents’ most supported changes for future application cycles were limiting the number of programs to which an applicant can apply (34%), limiting the number of interviews an applicant can accept (30%), and providing funding for applicants with demonstrated need (13%). Limitations: Our study may be limited by the response rates, estimated to be 21% for applicants and 45% for program directors. Conclusion: Given the range of preferences, we would not advocate for requiring virtual-only interviewing at this time for our specialty. Instead, reforms should prioritize the respondents’ most supported changes for future application cycles.

Administrative Time Expectations for Residency Core Faculty: A CERA Study.

Academic family medicine (FM) physicians aim to balance competing needs of providing clinical care with nonclinical duties of program administration, formal education, and scholarly activity. FM residency is unique in its scope of practice, clinical settings, and training priorities, which may differ between university-based and community-based programs. In both types of programs, these competing needs are a source of faculty dissatisfaction and burnout. We performed this study to explore the allocation of nonclinical administrative full-time equivalents (FTE) for FM residency core faculty members. Reported nonclinical administrative FTE time allocation is equivalent between university/medical school-based and community-based programs. The ideal proportion of FTE distribution identified by DCs had greater amounts of direct clinical care compared to greater emphasis on precepting time identified by PDs. DCs and PDs agreed that administrative time should be used for advising residents, curriculum development and delivery, and evaluation of resident performance. Barriers to allocating additional administrative time for DCs included loss of revenue and pressure by hospital-level leadership. PDs responded that the need for clinical supervision of residents was most significant. We performed our research through a cross-sectional survey of FM department chairs (DC) and residency program directors (PD) conducted by the Council of Academic Family Medicine Educational Research Alliance. We used descriptive statistics to characterize the data and Pearson's χ2 tests to evaluate bivariate relationships. DCs and PDs offer a similar ideal picture of core responsibilities, though subtle differences remain. These differences should be considered for the next revision of the Accreditation Council for Graduate Medical Education minimum program standards to best meet the needs of all FM programs.

Identification and Accommodation of ADHD in Family Medicine Residencies: A CERA Study.

An increasing number of medical students applying to residency programs request accommodations for attention deficit hyperactivity disorder (ADHD). Early implementation of accommodations for individuals with ADHD during family medicine (FM) residency could help learners and programs, but the number of programs prepared to invite learners to disclose ADHD and to implement accommodations is unclear. The purpose of this study was to describe practices employed by FM residency programs to identify residents who need accommodations for ADHD. We also chose to examine the frequency with which basic categories of ADHD accommodations are used and whether review of technical standards (ie, resident job description) is associated with timing of accommodations. We analyzed responses from the 2022 Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of FM residency program directors, which was distributed via email invitation to all US programs accredited by the Accreditation Council for Graduate Medical Education. A total of 298 program directors (44.3%) responded. Approximately one in six FM residency programs are proactive in their identification of learners with ADHD, typically recognizing the need for accommodations during the interview process or orientation. Once the need is identified, most programs implement accommodations within 1 month, and many employ multiple types of accommodations. While a small subset of programs has developed processes to identify and accommodate ADHD proactively, results suggested that the majority of programs approach accommodation processes on an ad hoc basis. In turn, ad hoc identification precludes a proactive approach, given use of poor performance to identify the need for supports.

Subspecialty Choices Among Medicine-Pediatrics Graduates: Results From a Four-Year National Program Director Survey.

Background and objectives Dual-trained medicine-pediatrics physicians (med-peds) play an important role in the healthcare ecosystem.Little is known about the subspecialty choices of med-peds residency graduates.This study aims to characterize the subspecialty choices of med-peds residency graduates. Methods The Medicine-Pediatrics Program Directors Association (MPPDA) administers an annual survey to the program directors of all med-peds residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).This project represents aggregate survey data from 2020-2023. Results The number of program directors responding to the surveyranged from 80.8% (63/78) to 85.7% (66/77; mean response rate: 82.8%). About 465 of 1,245 (37%) graduates over the four years chose fellowship training, across 51 unique subspecialties. The top five selected pathways were: adult pulmonary and critical care 54 (11.6%), allergy and immunology 37 (7.9%), adult infectious diseases 30 (6.5%), adult cardiology 30 (6.5%), and pediatric cardiology 30 (6.5%). Conclusions Med-Peds residents pursue a diversity of subspecialty training and represent an important contribution to the subspecialty workforce.Improving combined subspecialty opportunities may increase participation by med-peds graduates and, in particular, may support the increasing need for pediatric subspecialists.

Outpatient Training During Hospice and Palliative Medicine Fellowship: A National Survey

ContextOutpatient palliative care (PC) has strong evidence demonstrating impact across serious illnesses, resulting in growing demand for skilled outpatient PC clinicians. However, there is limited literature examining the existing state and quality of outpatient PC education during postgraduate training. ObjectivesCharacterize the current state of outpatient training in United States (US) Hospice and Palliative Medicine (HPM) physician fellowships and elicit perceptions regarding quality of outpatient PC education. MethodsA cross-sectional survey of US adult HPM fellowship program directors (PDs) or their designee conducted between March and July, 2023. ResultsOf 161 programs, 85 participated (53% response rate) with representation across all US regions. HPM fellows spend a median of 4.8 weeks in outpatient PC compared to 24 weeks inpatient PC and 10.5 weeks in hospice settings. Over half (51%) of fellows saw outpatients from primarily one disease type with limited exposure to patients with other serious illnesses. Across programs, fellows’ clinic structure, interdisciplinary team composition, and didactic experiences varied. On a 5-point rating scale, PDs reported significantly lower quality outpatient versus inpatient training (mean rating: 3.58 vs. 4.62, P<0.001) and perceived fellows as less prepared for independent outpatient practice upon graduation (mean: 4.06 vs. 4.73, P<0.001). ConclusionOur survey of US HPM fellowships identified multiple gaps between outpatient and inpatient PC education and training during fellowship and raises concern about the adequacy of outpatient PC training. To prepare the HPM workforce to meet the diverse needs of seriously ill populations and ensure adequate access, outpatient PC training requires reform.