Survey Of Residency Program Directors Research Articles

E-learning in graduate medical education: survey of residency program directors

BackgroundE-learning—the use of Internet technologies to enhance knowledge and performance—has become a widely accepted instructional approach. Little is known about the current use of e-learning in postgraduate medical education. To determine utilization of e-learning by United States internal medicine residency programs, program director (PD) perceptions of e-learning, and associations between e-learning use and residency program characteristics.MethodsWe conducted a national survey in collaboration with the Association of Program Directors in Internal Medicine of all United States internal medicine residency programs.ResultsOf the 368 PDs, 214 (58.2%) completed the e-learning survey. Use of synchronous e-learning at least sometimes, somewhat often, or very often was reported by 85 (39.7%); 153 programs (71.5%) use asynchronous e-learning at least sometimes, somewhat often, or very often. Most programs (168; 79%) do not have a budget to integrate e-learning. Mean (SD) scores for the PD perceptions of e-learning ranged from 3.01 (0.94) to 3.86 (0.72) on a 5-point scale. The odds of synchronous e-learning use were higher in programs with a budget for its implementation (odds ratio, 3.0 [95% CI, 1.04–8.7]; P = .04).ConclusionsResidency programs could be better resourced to integrate e-learning technologies. Asynchronous e-learning was used more than synchronous, which may be to accommodate busy resident schedules and duty-hour restrictions. PD perceptions of e-learning are relatively moderate and future research should determine whether PD reluctance to adopt e-learning is based on unawareness of the evidence, perceptions that e-learning is expensive, or judgments about value versus effectiveness.

A survey of residency program directors in anesthesiology regarding mentorship of residents

IntroductionMentorship of residents has been extensively studied within many academic specialties, but not anesthesia. The purpose of this study is to determine the prevalence of formal mentorship programs among anesthesia residency programs accredited by the Accreditation Council for Graduate Medical Education in the United States by surveying residency directors. The secondary goals of the study are to describe the programs that exist and identify areas that residency directors think should be the focus of mentoring. MethodsOur survey was designed based on previous surveys administered to residency program directors from other specialties. After determination of exempt status by our institutional review board, the survey was administered via e-mail to program directors of Accreditation Council for Graduate Medical Education–accredited anesthesiology residencies. ResultsResponse rate was 34% (45/131). The sample consisted of mainly university-based programs (93%). Most (88%) had a mentorship program in place. There was little consistency between methods of forming faculty-resident mentor pairs. Most mentors (84%) and mentees (79%) did not evaluate their programs. Nearly all program directors agree that mentorship is an important tool for resident development (90.6%) and that it is important to have a mentor during training (90.6%). Program directors identified the areas of career planning, professionalism, and achieving a balance between personal, career, and family demands to be the most valuable subjects to address in a mentoring relationship. ConclusionAnesthesiology is currently underrepresented in the trainee mentoring literature. There is significant support for mentorship during resident training; however, the low rates of training for faculty and minimal evaluation by residents and faculty raise the question as to the efficacy of the existing programs. There is a need for more investigation of anesthesia residents' goals and perceptions of mentorship, and a more detailed evaluation of existing mentorship programs to determine the ideal structure of a mentoring program.

Palliative Care Education in Emergency Medicine Residency Training: A Survey of Program Directors, Associate Program Directors, and Assistant Program Directors

ContextEmergency medicine (EM) residents perceive palliative care (PC) skills as important and want training, yet there is a general lack of formal PC training in EM residency programs. A clearer definition of the PC educational needs of EM trainees is a research priority. ObjectivesTo assess PC competency education in EM residency programs. MethodsThis was a mixed-mode survey of residency program directors, associate program directors, and assistant program directors at accredited EM residency programs, evaluating four educational domains: 1) importance of specific competencies for senior EM residents, 2) senior resident skills in PC competencies, 3) effectiveness of educational methods, and 4) barriers to training. ResultsResponse rate was 50% from more than 100 residency programs. Most respondents (64%) identified PC competencies as important for residents to learn, and 59% reported that they teach7 PC skills in their residency program. In Domains 1 and 2, crucial conversations, management of pain, and management of the imminently dying had the highest scores for importance and residents' skill. In Domain 3, bedside teaching, mentoring from hospice and palliative medicine faculty, and case-based simulation were the most effective educational methods. In Domain 4, lack of PC expertise among faculty and lack of interest by faculty and residents were the greatest barriers. There were differences between competency importance and senior resident skill level for management of the dying child, withdrawal/withholding of nonbeneficial interventions, and ethical/legal issues. ConclusionThere are specific barriers and opportunities for PC competency training and gaps in resident skill level. Specifically, there are discrepancies in competency importance and residency skill in the management of the dying child, nonbeneficial interventions, and ethical and legal issues that could be a focus for educational interventions in PC competency training in EM residencies.

Trends in Urology Residents' Exposure to Operative Urotrauma: A Survey of Residency Program Directors

To determine longitudinal trends in resident exposure to urotrauma and to assess whether presence of Genitourinary Reconstructive Surgeon (GURS) faculty has impacted exposure and career choice. An identical, 31-question multiple-choice survey was sent to program directors of Accreditation Council for Graduate Medical Education (ACGME)-accredited urology residency programs in 2006 and 2013. The areas of focus included program demographics, extent of urotrauma exposure, program director perceptions regarding educational value of urotrauma, and impact of GURS fellowship trained faculty. Responses were de-identified, compiled, and compared for differences. Response rates were 57% (64/112) and 43% (53/123) for the 2006 and 2013 survey, respectively (P = .03). Trauma Level 1 designation (56/64 [89%] vs 44/53 [88%], P = .84) and presence of GURS faculty (22/64 [34%] vs 22/53 [43%], P = .43) were similar between survey periods. Although survey respondents felt urotrauma volume had remained constant (34/64 [53%] vs 30/53 [56%], P = .71), more recent respondents reported that conservative management strategies negatively impacted resident exposure (14/64 [22%] vs 23/53 [43%], P = .01). Residencies with GURS faculty in 2013 (22/53, 42%) were positively associated with residents publishing urotrauma literature (9/22 [41%] vs 4/31 [13%], P = .02), the presence of multidisciplinary trauma and urology conferences (3/22 [14%] vs 0/31 [0%], P = .03), and residents matriculating to GURS fellowships (15/22 [68%] vs 10/31 [32%], P = .009). Many contemporary urology residencies report poor resident exposure to urotrauma during training. Although presence of GURS faculty may influence resident career choice, additional strategies may be warranted to expose residents to urotrauma during training.

Current Status of Nutrition Training in Graduate Medical Education From a Survey of Residency Program Directors: A Formal Nutrition Education Course Is Necessary.

Nutrition leaders surmised graduate medical nutrition education was not well addressed because most medical and surgical specialties have insufficient resources to teach current nutrition practice. A needs assessment survey was constructed to determine resources and commitment for nutrition education from U.S. graduate medical educators to address this problem. An online survey of 36 questions was sent to 495 Accreditation Council for Graduate Medical Education (ACGME) Program Directors in anesthesia, family medicine, internal medicine, pediatrics, obstetrics/gynecology, and general surgery. Demographics, resources, and open-ended questions were included. There was a 14% response rate (72 programs), consistent with similar studies on the topic. Most (80%) of the program directors responding were from primary care programs, the rest surgical (17%) or anesthesia (3%). Program directors themselves lacked knowledge of nutrition. While some form of nutrition education was provided at 78% of programs, only 26% had a formal curriculum and physicians served as faculty at only 53%. Sixteen programs had no identifiable expert in nutrition and 10 programs stated that no nutrition training was provided. Training was variable, ranging from an hour of lecture to a month-long rotation. Seventy-seven percent of program directors stated that the required educational goals in nutrition were not met. The majority felt an advanced course in clinical nutrition should be required of residents now or in the future. Nutrition education in current graduate medical education is poor. Most programs lack the expertise or time commitment to teach a formal course but recognize the need to meet educational requirements. A broad-based, diverse universal program is needed for training in nutrition during residency.

Resources used to support postgraduate year 1 pharmacy residencies: Survey of residency program directors

The results of a survey to identify personnel time, funding, and other resources used to support existing postgraduate year 1 (PGY1) pharmacy residencies and to determine potential residency program expansion are reported. An electronic survey was distributed to PGY1 residency program directors (RPDs). Respondents were asked to provide demographic information and to characterize resources used to support their training programs. The survey response rate was 62%, representing 493 respondents. About 21% indicated their formal job descriptions identified them as a PGY1 RPD, and 8% replied that time expectations to perform the residency functions were specified. Up to 69% of respondents estimated that the time spent performing residency functions was 5-16 hours weekly. Other personnel who facilitated pharmacy residency logistics included administrative assistants, coordinators, and pharmacists, devoting approximately 1-8 hours weekly to the residency program. Half of respondents indicated their PGY1 programs received funding through the Centers for Medicare and Medicaid Services (CMS) pass-through reimbursement; 30% were not eligible, 11% had not considered such reimbursement due to the amount of work required, and 9% did not know if their sites received such funding. A survey of PGY1 RPDs collected a wide range of information about the resources used to support their programs and about future plans. Almost half of respondents anticipated expanding their PGY1 residency program capacity, and responses made it clear that adequate documentation was important for programs applying for CMS pass-through reimbursement and facing an audit.

Challenges with Duty Hour Reforms: A Survey of Residency Program Directors

Challenges with Duty Hour Reforms: A Survey of Residency Program Directors Lisa L. Willett, MD, Vineet Arora, MD, MAPP, Andrew J. Halvorsen, MS, Karen M. Chacko, MD, Saima Chaudhry, MD, Furman S. McDonald, MD, MPH University of Alabama at Birmingham; University of Chicago, Ill; Office of Educational Innovations, Internal edicine Residency Program, Mayo Clinic, Rochester, Minn; Department of Medicine, Division of General Internal edicine, University of Colorado at Denver and Health Sciences Center, Aurora, Colo; Hofstra North Shore-Long Island Jewish School of Medicine, Manhasset, NY; General Internal Medicine – Hospital Internal Medicine, Mayo Clinic, Rochester, Minn.

ACGME Duty-Hour Recommendations — A National Survey of Residency Program Directors

Taking into consideration the Institute of Medicine's 2008 recommendations regarding residents' duty hours,1 the 16-member Duty Hour Task Force of the Accreditation Council for GraduateMedical Education (ACGME) recently published proposed new recommendations,2 which, as eventually approved, would go into effect in July 2011. These recommendations represent a continuing commitment by the ACGME to both “foster a humanistic environment for graduate medical education” and ensure “excellent and safe patient care.”2 The ACGME has solicited comments from the educational community and will modify its proposal as needed. The recommendations represent an attempt to address elements of the 2003 ACGME standards that generated . . .

Funding of Educational Opportunities in Orthopaedic Surgery Residency Training

As funding for graduate medical education continues to decline, finding sources of funding for orthopaedic resident education is a major issue for residency programs, health systems, the American Academy of Orthopaedic Surgeons (AAOS), and the American Orthopaedic Association (AOA). The majority of funding for orthopaedic residency programs in the United States includes federal funding from Medicare and Medicaid to the academic health center, funding from faculty and endowments, contributions from individual hospitals and institutions, and industry financial support of courses and the provision of other educational resources1-10. With the continued decrease in federal government funding for graduate medical education and the decrease in funding from industry secondary to concerns about conflicts of interest, many residency programs may need to evaluate other sources of funding to meet the educational needs of their residents. We conducted a survey of residency program directors and chairs to better understand the funding sources for their educational programs. In addition, we sought to define the role of industry funding in resident education. The AAOS staff and the AAOS Washington Health Policy Fellows designed a survey regarding funding for orthopaedic graduate medical education and the impact of industry support in funding graduate medical education activities (see Appendix). A web-based survey was developed and administered to orthopaedic residency program directors or chairs in the AAOS database. Questions were formatted and the data collection tool was developed by the Department of Research and Scientific Affairs of the AAOS to ensure proper survey format and to minimize response bias11-13. In August 2008, residency program directors or chairs were contacted to apprise them of the survey. One week after the announcement, the survey link was distributed to 149 residency program directors or chairs (one contact per residency program). Three reminder e-mails were subsequently …

Board certification of pharmacy residency program directors

A survey was conducted of residency program directors (RPDs) to identify the extent of their Board of Pharmaceutical Specialties (BPS) certification and their motivations and incentives to obtain certification, to determine the number of RPDs who meet the new American Society of Health-System Pharmacists (ASHP) post-graduate year 2 (PGY2) residency standard for board certification, and to investigate the relationships between RPDs' characteristics and BPS certification. A 35-item, electronic questionnaire was developed to obtain data on the type of residency program or geographic setting and the RPD's practice setting, job title, faculty rank, education and training, length of practice, length of time served as an RPD, and certifications obtained. Of 717 surveys, 327 were completed. More than one third of all RPDs were currently BPS certified compared with a 30% RPD certification rate according to the BPS directory. A higher percentage of PGY2 RPDs were BPS certified overall compared with PGY1 RPDs. Eighty-two RPDs had completed an ASHP-accredited specialized residency program and were more likely to be BPS certified. In a survey of RPDs, more than one third of the respondents were BPS certified; professional and personal development was the most common motivation to earn certification. New pharmacy residency accreditation standards did not appear to be an important motivator for certification. Of the RPDs who will require board certification with the new standards, 71% already met the requirement. RPDs who practiced in academia or focused on critical care were more likely to be certified than those with training or positions in community practice or practice management.

The perceived impact of duty hour restrictions on the residency environment: A survey of residency program directors

The purpose of this study was to characterize residency program director baseline perceptions regarding the effect of resident duty hour limitations on key components of the graduate medical education environment. This was a survey of directors of accredited obstetrics and gynecology residency programs in the United States (excluding New York State) between June 21st and July 16th, 2004. Participants were queried on views regarding the need for duty hour limitations, and the perceived effect of these changes on various issues related to the residency environment. Fifty-eight percent (123/211) of the study population completed the questionnaire. Seventy-one percent of respondents supported duty hour restrictions, 19% opposed restrictions, and 10% were undecided. Forty-one percent of respondents preferred a maximum duty hour limitation of 80 hrs/wk or less, 55% preferred one at least 90 hrs/wk, and 4% preferred no upper limit. A significantly greater proportion of female program directors supported limits > 80 hrs/wk than males (73% vs 53%, P = .04). A majority of participants believed resident education, surgical skills, and work ethic have been negatively impacted by the limitations, while patient safety and the overall quality of patient care have remained unchanged or declined, and resident well-being has improved. Opposition to duty hour regulations and a preference for higher limits was associated with a higher prevalence of negative impressions regarding the impact of duty hour regulations on the residency environment. Variations in current opinions regarding the impact of residency duty hour restrictions reflect ongoing bias in those most influential to resident education.

NATIONAL UROLOGY RESIDENT PRECEPTORSHIP PROGRAM IN FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY

There is a shortage of urologists specializing in female pelvic medicine and reconstructive surgery (FPMRS). We assessed the effects of an educational preceptorship program on the resident perception and desire to pursue careers in FPMRS. Between 2002 and 2004, 113 mid level residents from approximately 120 urology residency programs who were nominated by their respective program directors attended a 4-day course in FPMRS. The preceptorship course included live surgical FPMRS cases, didactic lectures, and discussions of research opportunities and career options. Participants in 2002 and 2003 evaluated the program content. Participants in 2004 completed a questionnaire to determine the effect of the course on their perception of FPMRS, and research and career opportunities in FPMRS. In 2002 to 2004, 113 residents participated in the program. An informal survey of residency program directors showed that 10 of 36 participants in 2002 had applied and enrolled in fellowship programs in FPMRS. Of the 32 of 40 participants in 2004 who completed the program evaluation 71% stated that greater than 50% of the material on female urology research was new to them and 90% of participants stated that their interest in female urology was "much higher to somewhat higher" as a result of the program. A preceptorship program in FPMRS incorporating in-depth review of the subject and demonstration of surgical cases has been successful in promoting and encouraging career selection in FPMRS. This approach may also encourage interest in other underrepresented subspecialties in urology or other medical specialties.

The Initial Employment Status of Physicians Completing Training in 1994

To gain information about the career status of residents who completed graduate medical education training programs in selected specialties and subspecialties during the 1993-1994 academic year. A descriptive one-page survey of residency program directors, including two mailed follow-up surveys, was conducted from January 1, 1995 to June 1, 1995. Directors of residency programs in 26 specialties and subspecialties accredited by the Accreditation Council for Graduate Medical Education, totaling 4369 programs. Program directors identified the number of resident physicians who completed the program, the known career status of those physicians, the number of physicians who had experienced difficulty finding a practice position, the characteristics of the full-time clinical practice positions, and the number of physicians who could not find full-time employment. The perceptions about likely trends in the availability of practice opportunities for graduates in the future and the likely change in the number of resident positions were also assessed. A total of 3090 program directors (70.7%) completed the survey. Respondents reported that 15999 resident physicians completed training in one of the 26 specialties and subspecialties, and 63.2% of these graduates were potentially seeking a professional position. Most of those not seeking a position were pursuing additional training (92.9%). Of those seeking employment, the percentage who did not find a full-time position in their specialty or subspecialty ranged between none in urology to 10.8% in pathology. Across all specialties, about 70% of graduates looking for full-time positions entered clinical practice in their specialty of training. Physicians pursuing generalist careers had fewer problems finding preferred positions than those pursuing nongeneralist specialties. Finally, program directors in most nongeneralist specialties believed that the degree of difficulty their graduates will experience in finding a full-time practice position will increase during the next year. Physicians attempting to enter practice in some specialties and in some regions of the country are experiencing difficulty. In some cases up to 10% of the resident physicians did not find full-time positions in their specialty or subspecialty. The differences noted between the generalist and nongeneralist specialties are consistent with widespread perceptions about the current market. These data establish the baseline for analyzing trends.

Pediatric Workforce Statement

Developing accurate forecasts for physician workforce needs is an extraordinarily difficult task. In 1980 the Graduate Medical Education National Advisory Committee (GMENAC) completed a comprehensive workforce study. Based on estimates of growth of the number of pediatricians, GMENAC predicted a potential excess of 4950 pediatricians by 1990.1 The American Academy of Pediatrics (AAP) studied the report and issued a response in 1981 that questioned many elements in the model.2 However, the Academy was concerned that an excess number of pediatricians would be produced by the 1990s, and a statement published in 1985 and revised in 1987 recommended government and academic policies ensuring the production of pediatricians of the highest quality, but in fewer numbers.3 Subsequent to the 1987 statement, consistent evidence has pointed to shortages of pediatricians rather than the projected surplus in all regions of the country. A 1990 survey of residency program directors provided the strongest empirical evidence to date that the supply of new pediatricians is not meeting the demand.4 In 1990, the Council on Graduate Medical Education (COGME) contracted with the consulting firm of Abt Associates, Inc to reexamine the adequacy of physician workforce supply. The resulting report, commonly referred to as the Abt report, contends there would be an even greater oversupply of peditricians than projected in the 1980 GMENAC report.5 The AAP concerns with this report's methodology and conclusions were strongly voiced to the COGME and in the literature.6,7 Subsequent to the Abt Report, the COGME published a report which emphasizes a growing shortage of practicing generalists (ie, general pediatricians, general internists, and family physicians) and calls for an increase in the percentage of residents who complete a 3-year training program in the generalist specialties.8

Impact of pharmaceutical company representatives on internal medicine residency programs. A survey of residency program directors

To survey internal medicine residency program directors regarding interactions between their residents and pharmaceutical company (PC) representatives (PCRs) a questionnaire was sent to the directors of all Accreditation Council for Graduate Medical Education-approved internal medicine residency programs. The survey included 444 program directors, of whom 272 (61.16%) responded. The majority of program directors, 228 (83.8%), allowed PCRs to meet with residents during working hours and 241 (88.6%) permitted PC sponsorship of conferences. About half of the program directors were "moderately" or "very" concerned about the potential adverse effects of PC marketing on resident attitudes and prescribing practices. Seventy percent "agreed" or "strongly agreed" that the benefits of PC sponsorship outweigh the adverse effects and 41.5% believed that refusal to allow PCRs to meet with residents would jeopardize PC funding of other departmental activities. Most program directors reported that alternate funds for conferences were available if PC support was withdrawn. "Unethical" marketing activities were observed by 14.3% of program directors and 37.5% reported that residents had participated in PC-sponsored trips during the 3 years prior to the survey. At the time of this survey, only 35.3% of programs had developed formal policies regulating PCR activities and 25.7% provided residents with formal instruction on marketing issues. Knowledge of the current extent of PCR interactions with residents may be helpful to program directors in developing policies regulating PC-marketing activities.

Career Plans of New Pediatricians: Results from a Survey of Residency Program Directors

Directors of pediatric residency programs in the United States, Puerto Rico, and Canada were surveyed regarding plans of graduating residents to determine whether new pediatricians experienced problems finding employment in light of a decreasing growth rate in the child population. Nearly 90% of directors responded, providing information on 1915 residents. Of the 1782 nonmilitary residents in the United States, 815 were entering general pediatric practice and one third (596) were entering subspecialty training. Nearly one half (379) of residents entering general pediatric practice were joining a small group practice, almost one fourth (184) were joining a larger group, 6% (48) were becoming solo practitioners, 7% (57) were joining a health maintenance organization, and nearly 8% (62) were joining a hospital or academic staff. Most residents in the United States experienced no difficulty finding a position and received multiple offers for jobs. Canadian residents were similar to residents in the United States, whereas the postresidency situations of graduates of military and Puerto Rican programs were very different. Despite manpower predictions to the contrary, comments by program directors indicated a demand for general pediatricians. This paper presents only the viewpoint of program directors; whether this perceived need illustrates an avid market for young general pediatricians merits further study.