Trainee Demographics Research Articles

How can we make renal medicine careers more appealing to UK trainees?

BackgroundThere is a global decline in interest in careers in renal medicine. This is concerning given the increasing global burden of kidney disease. Previous studies in the USA and Australia have identified factors such as a poor work–life balance, lack of role models and the challenging nature of the speciality as possible reasons behind recruitment struggles. This study aimed to identify factors associated with declining interest among trainees in the UK.Methods We conducted a survey of 150 National Health Service Foundation trainees (interns) and Core Medical Trainees in Health Education West Midlands. Participants completed a 14-part paper-based questionnaire capturing data on trainee demographics, medical school and postgraduate exposure to renal medicine and perceptions of a career in renal medicine.Results There was limited early clinical exposure to renal medicine both in terms of time spent in the speciality and perceived exposure to the range of domains of the speciality. Trainees perceived the speciality as complex with a heavy workload. Very few trainees considered the speciality to be lifestyle oriented. There was also disinterest in taking on the associated general medicine commitments of the training programme. Job experience and identification of role models increased the likelihood of consideration of the speciality.Conclusion This survey has identified key areas to drive interest in the speciality, including early engagement, enthusiastic supervision and increased training flexibility. Urgent attention is required to address these areas and make renal medicine careers more appealing.

Current Policies and Support Services for Pregnant and Parenting Veterinary Medical Students and House Officers at United States Veterinary Medical Training Institutions.

Wellness and work-life balance are prominent concerns in the veterinary profession and data suggest that personal relationship-building with peers and family assist veterinary trainees and veterinarians with wellness. The demographics of veterinary medical trainees (students, interns, and residents) have shifted to a female-dominated cohort and veterinary training overlaps with peak reproductive age for the majority of trainees. Despite a robust body of literature in the human medical profession surrounding pregnancy, parenting, and family planning (PPFP) among human medical students, interns, and residents, no comparable data exist within the United States veterinary medical community. This study reviewed policies and support services in place to support PPFP at accredited United States veterinary medical training institutions through the use of an online administrator survey and the review of handbooks and relevant written material. Results from this study highlight a lack of consistency across veterinary medical training institutions for policy and support services for PPFP for trainees, especially related to lactation support and parental leave. Our data can help facilitate the development of standards or best practices for policies and support services that support PPFP among veterinary medical trainees, and opens the dialogue to consider the unique needs of our shifted trainee demographics.

Motivational Interviewing Training Outcomes Among Providers in a Children's Hospital.

Motivational interviewing (MI) has proven a well-established psychotherapeutic intervention designed to enhance motivation for behavior change. While the benefits of MI have been established, little research has systematically evaluated dissemination of MI efforts to healthcare providers, especially among pediatric providers. The present pilot study evaluated whether healthcare providers gained valuable knowledge, confidence and desire to utilize MI, and skills in MI techniques and if these outcomes varied based on provider characteristics or duration and intensity of MI training. Twenty pediatric healthcare professionals in a large academic pediatric hospital completed an advanced 20-h MI training and 103 pediatric healthcare professionals completed a basic 4-h MI workshop. The study demonstrated no significant differences in post-workshop MI knowledge, confidence, or desire based on trainee demographics. We also found no significant change from post-basic workshop to post-advanced workshop for advanced MI trainees. However, the advanced training workshop participants evidenced significant growth in utilizing MI skills (via MITI coding) and self-reported confidence in using MI skills. We therefore conclude that while the basic workshop allows participants to gain valuable MI knowledge and confidence and desire to utilize MI, it is through the advanced training that providers have the opportunity to practice these skills, receive feedback, and ultimately gain the expertise necessary to be effective MI providers. Overall, results from this pilot study suggest MI training in pediatric hospitals represents an important area of opportunity for multidisciplinary training, dissemination, and practice.

Increasing and Retaining African Surgeons Working in Rural Hospitals: An Analysis of PAACS Surgeons with Twenty-Year Program Follow-Up.

African surgical workforce needs are significant, with largest disparities existing in rural settings. Pan-African Academy of Christian Surgeons (PAACS), a primarily rural-based general surgery training program, has published successes in producing rural African surgeons; however, long-term follow-up data are unreported. The goal of our study was to define characteristics of PAACS alumni surgeons working in rural hospitals, documenting successes and illuminating strategies for trainee recruitment and retention. PAACS' twenty-year surgery residency database was reviewed for 12 programs throughout Africa regarding trainee demographics and graduate outcomes. Characteristics of PAACS' graduate surgeons were further analyzed with a 42-question survey. Among active PAACS graduates, 100% practice in Africa and 79% within their home country. PAACS graduates had 51% short-term and 35% long-term (beyond 5years) rural retention rate (less than 50,000 population). Our study shows that PAACS general surgery training program has a high retention rate of African surgeons in rural settings compared to all programs reported to date, highlighting a multifaceted, rural-focused approach that could be emulated by surgical training programs worldwide.

The European Urology Residents Education Programme Hands-on Training Format: 4 Years of Hands-on Training Improvements from the European School of Urology

BackgroundThe European School of Urology (ESU) started the European Urology Residents Education Programme (EUREP) in 2003 for final year urology residents, with hands-on training (HOT) added later in 2007. ObjectiveTo assess the geographical reach of EUREP, trainee demographics, and individual quality feedback in relation to annual methodology improvements in HOT. Design, setting, and participantsFrom September 2014 to October 2017 (four EUREP courses) several new features have been applied to the HOT format of the EUREP course: 1:1 training sessions (2015), fixed 60-min time slots (2016), and standardised teaching methodology (2017). The resulting EUREP HOT format was verified by collecting and prospectively analysing the following data: total number of participants attending different HOT courses; participants’ age; country of origin; and feedback obtained annually. Results and limitationsA total of 796 participants from 54 countries participated in 1450 HOT sessions over the last 4 yr. This included 294 (20%) ureteroscopy (URS) sessions, 237 (16.5%) transurethral resection (TUR) sessions, 840 (58%) basic laparoscopic sessions, and 79 (5.5%) intermediate laparoscopic sessions. While 712 residents (89%) were from Europe, 84 (11%) were from non-European nations. Of the European residents, most came from Italy (16%), Germany (15%), Spain (15%), and Romania (8%). Feedback for the basic laparoscopic session showed a constant improvement in scores over the last 4 yr, with the highest scores achieved last year. This included feedback on improvements in tutor rating (p=0.017), organisation (p<0.001), and personal experience with EUREP (p<0.001). Limitations lie in the difficulties associated with the use of an advanced training curriculum with wet laboratory or cadaveric courses in this format, although these could be performed in other training centres in conjunction with EUREP. ConclusionsThe EUREP trainee demographics show that the purpose of the course is being achieved, with excellent feedback reported. While European trainees dominate the demographics, participation from a number of non-European countries suggests continued ESU collaboration with other national societies and wider dissemination of simulation training worldwide. Patient summaryIn this paper we look at methodological improvements and feedback for the European Urology Residents Education Programme hands-on-training over the last 4 yr.

Analysis of factors related to failure in the pressure test: a six-year experience in Taiwan

The Republic of China Navy instituted the pressure test as one of the selection tools for diving troops and submarine crews. We analyzed factors associated with failure in the pressure test. This was a retrospective cohort study designed to investigate pressure test failure in Navy recruits between January 2010 and August 2015. The recruits received pressurization in a hyperbaric chamber to a simulated depth of 112 feet of seawater (fsw) at a rate of 25 fsw/minute. Data describing trainee demographics, disease history, causes and depth of failure, as well as type of injury, were extracted from case notes and facility databases for statistical analysis. Of 3,608 trial cohorts, there were 435 failures, with an overall failure rate of 12.06%. About 95% of these failure trials were within a simulated depth of 60 fsw. Fifty-seven (57) failures did not record causes of failure. Among the other 378 failures, the most commonly identified causes were ear barotrauma (365 trials, 96.56%) and sinus barotrauma (10 trials, 2.65%). Statistical analysis revealed that recent upper respiratory tract infection, allergic rhinitis, and cigarette smoking were all significantly associated with higher incidence of middle ear barotrauma. Our results suggest that pressure testing to a depth of 60 fsw is effective in disqualifying personnel entering diving and submarine service. Recent infection of the upper respiratory tract, allergic rhinitis and cigarette smoking are risk factors for middle ear barotrauma, resulting in failure of the pressure test.

Mentorship Training for Postdoctoral Researchers: Results from a Four Week Intervention Program

The acquisition of mentoring skills in biomedical research has traditionally been a passive process via apprenticeships. Moreover, mentorship quality directly affects scientific productivity. Consequently, the National Institutes of Health (NIH) has strongly encouraged formal mentorship training for academic researchers including postdoctoral trainees (postdocs). While the acquisition of knowledge and skills in mentoring is encouraged, it is unclear whether postdocs value these skills and how greatly their mentoring ability can be improved by formal training. Furthermore, outcomes assessment following formal mentor training is necessary to ensure effective instruction. The present program and programmatic assessment was designed to address these important questions.The Offices of Postdoctoral Affairs and Career Development implemented a mentoring intervention program for postdoctoral trainees with the goals to increase awareness of trainee mentoring ability as well as improve trainee mentoring skills. This program, which consisted of four, two hour weekly sessions, included facilitated discussions and case studies centered around key competencies of mentoring: Elements of a mentoring relationship, effective communication, problem solving, and self‐evaluation. Program participants rated the importance and their development of 15 mentoring skills that aligned with these competencies in a pre and post intervention assessment via a Likert scale. Data were compiled across seven cohorts from 2012 to 2016 (n=34).All postdocs highly valued each of the mentoring skills prior to participation in this intervention program. These views were unchanged after intervention. In contrast to unchanged valuation of mentoring skills upon completion of the program, postdocs reported a substantial positive gain in skill development in all mentoring skills. The greatest skill improvement was ‘setting reasonable goals for a mentee’. The lowest skill improvement was ‘keeping a mentee engaged’.Postdoctoral research trainees highly value mentoring skills. Of importance, a formal process for mentorship training aids in trainee development of vital mentoring skills. Future studies are needed to address additional variables that may impact the outcomes of formal mentor training among postdoctoral trainees. Among these are trainee demographics including gender, area of research emphasis, duration of postdoctoral research training, trainee citizenship status, and the international location of predoctoral studies. Equally important will be consideration of the sustained impact of short term mentor training.Support or Funding InformationSupported in part San Antonio Biomedical Education and Research (SABER) K12 GM11726 and Clinical Translational Science Award (CTSA) 1KL2RR025766‐01.

Are Future Radiation Oncologists Equipped With the Knowledge to Manage Elderly Patients With Cancer?

To assess radiation oncology (RO) trainee knowledge, attitudes, and clinical practice relating to geriatric oncology. A custom online survey was anonymously administered to RO trainees across Australia, New Zealand, and Singapore. The survey assessed 3 domains: (1) trainee demographics and prior training in geriatric medicine; (2) current clinical practice and attitudes regarding elderly cancer patients and radiation therapy; and (3) opinions regarding educational opportunities around geriatric oncology. The survey was developed and reviewed by radiation oncologists with expertise in education and training. A total of 61 trainees (52%) responded to the survey. More than half had not undertaken a geriatric medicine term before RO speciality training. A total of 91.8% of respondents had not received teaching during RO training specifically regarding geriatric oncology. The use of geriatric assessment (GA) tools for determining suitability for radiation therapy was uncommon, with 80.3% of respondents rarely or never using them. More than two-thirds of respondents reported not seeking or rarely seeking multidisciplinary input from a geriatrician when assessing suitability for treatment. Trainees had low confidence levels in managing complex issues commonly observed in the elderly. Only 39.3% felt they had the confidence to manage these issues, with 31.2% not confident/not at all confident. Respondents reported functional status, assessment of comorbidity, physiologic age, and cognition as the major factors applied to treatment decisions. Input from a geriatrician was lowest ranked. Of factors influencing choice of dose/fractionation schedule, physiologic age ranked highest, whereas use of GA tool ranked the lowest. The majority of trainees (85.3%) agreed or strongly agreed they would benefit from more training around RO in elderly patients, and 65.6% felt the addition of learning objectives to RO curriculum around geriatric oncology would be valuable. Radiation oncology trainees report inadequate training and experience in geriatric oncology and geriatric medicine. Radiation oncology trainees rarely use and poorly understand the rationale for GA tools and geriatrician input in clinical practice. Trainees strongly support improved education in geriatric oncology.

Pulmonary and Critical Care In-Service Training Examination Score as a Predictor of Board Certification Examination Performance.

Most trainees in combined pulmonary and critical care medicine fellowship programs complete in-service training examinations (ITEs) that test knowledge in both disciplines. Whether ITE scores predict performance on the American Board of Internal Medicine Pulmonary Disease Certification Examination and Critical Care Medicine Certification Examination is unknown. To determine whether pulmonary and critical care medicine ITE scores predict performance on subspecialty board certification examinations independently of trainee demographics, program director competency ratings, fellowship program characteristics, and prior medical knowledge assessments. First- and second-year fellows who were enrolled in the study between 2008 and 2012 completed a questionnaire encompassing demographics and fellowship training characteristics. These data and ITE scores were matched to fellows' subsequent scores on subspecialty certification examinations, program director ratings, and previous scores on their American Board of Internal Medicine Internal Medicine Certification Examination. Multiple linear regression and logistic regression were used to identify independent predictors of subspecialty certification examination scores and likelihood of passing the examinations, respectively. Of eligible fellows, 82.4% enrolled in the study. The ITE score for second-year fellows was matched to their certification examination scores, which yielded 1,484 physicians for pulmonary disease and 1,331 for critical care medicine. Second-year fellows' ITE scores (β = 0.24, P < 0.001) and Internal Medicine Certification Examination scores (β = 0.49, P < 0.001) were the strongest predictors of Pulmonary Disease Certification Examination scores, and were the only significant predictors of passing the examination (ITE odds ratio, 1.12 [95% confidence interval, 1.07-1.16]; Internal Medicine Certification Examination odds ratio, 1.01 [95% confidence interval, 1.01-1.02]). Similar results were obtained for predicting Critical Care Medicine Certification Examination scores and for passing the examination. The predictive value of ITE scores among first-year fellows on the subspecialty certification examinations was comparable to second-year fellows' ITE scores. The Pulmonary and Critical Care Medicine ITE score is an independent, and stronger, predictor of subspecialty certification examination performance than fellow demographics, program director competency ratings, and fellowship characteristics. These findings support the use of the ITE to identify the learning needs of fellows as they work toward subspecialty board certification.

Ethnic and Gender Diversity in Hand Surgery Trainees

To evaluate whether the lack of diversity in plastic and orthopedic surgery persists into hand surgery through assessment of trainee demographics. Demographic data were obtained from compilations on graduate medical education by the Journal of the American Medical Association. Ethnic diversity was assessed using the proportions of minority trainees. We analyzed the trends in ethnic diversity in hand, orthopedic, and plastic surgery from 1995 to 2012 by evaluating changes in proportions of African American, Hispanic, and Asian trainees. In addition, we compared the proportions of minority trainees in various surgical specialties during 2009 to 2012. Trends in gender diversity were similarly analyzed using the proportions of female trainees. During 1995 to 2012, the proportions of minority and female trainees increased significantly in the fields of orthopedic, plastic, and hand surgery. To assess the current state of diversity in various specialties, we compared minority and female population proportions using pooled 2009 to 2012 data. The percentage of non-Caucasian trainees in hand surgery was significantly higher than that in orthopedic sports medicine and orthopedic surgery and significantly lower than in general surgery. The percentage of female trainees in hand surgery was significantly higher than that in orthopedic sports medicine and orthopedic surgery and significantly lower than in plastic and general surgery. Ethnic and gender diversity in hand surgery increased significantly between 1995 and 2012. Women constitute a fifth of hand surgery trainees. Efforts to increase diversity should be further pursued using proven strategies and innovating new ones. Diversity in the medical field has shown to be a beneficial factor in many aspects including research productivity and patient care. Understanding how the field of hand surgery has changed with regard to the diversity of its trainees may aid in providing more equitable and effective health care.

Exploring ethnic diversity on placement: Service user demographics within Staffordshire and Shropshire

Whilst some progress has been made in enhancing access to clinical training for applicants from black and minority ethnic backgrounds, there is often a disparity between trainee demographics and the communities they serve. This evaluation aims to explore service user ethnicity on placement.

Psychotherapy trainees’ multicultural case conceptualization content: Thematic differences across three cases.

This study examined thematic differences in the multicultural case conceptualization content of 61 psychotherapy trainees across three different cases and trainee demographics (number of multicultural courses completed, years of supervised clinical practicum completed, and White trainee vs. trainee of color). Themes across cases included general counseling skills (attend to affect, build rapport, focus on specific client concerns, use of specific clinical interventions, and use of external resources not related to culture), as well as multicultural specific counseling skills (focus on culture, focus on discrimination, use of culturally competent interventions, and use of external resources related to culture). Thematic differences across case were found in three of the nine themes (affect, culture, discrimination). No systematic differences were found across multicultural training, clinical training, or race. Implications of these results are discussed.

The rich get richer: predicting participation in voluntary diversity training

AbstractThis research examined whether trainee demographics and pre‐training competence predicted participation in voluntary diversity training. Results indicate that demographic variables had no impact on interest in training (Study One) or on actual training participation (Study Two). However, pre‐training competence levels had a positive effect on both outcomes. More competent trainees expressed more interest in additional training (Study One) and were more likely to attend a voluntary training session (Study Two). The authors suggest that trainees with low competence in the diversity domain are unaware of their low competence levels and therefore are not motivated to participate in training programs designed to increase diversity competence. Implications of these findings for organizations offering voluntary diversity training are discussed. Copyright © 2007 John Wiley &amp; Sons, Ltd.

Creating an international comprehensive web-based curriculum in pediatric radiology.

This article describes the creation of a standardized comprehensive resident curriculum in pediatric radiology that uses adult learning principles authored by international experts and addresses the six general competencies required by the Accreditation Council for Graduate Medical Education. Web-based learning with an online curriculum has the potential to become an integral component of residency training. The use of radiology experts as authors allows compilation of an authoritative, comprehensive, and current body of knowledge that enhances the current teaching file approach to Web-based instruction in radiology. We describe the approach, design, and tools necessary for the construction of a complete Web-based curriculum in pediatric radiology that includes self-assessment through pre- and post-testing, text with interactive images, curriculum evaluation, and the ability to record trainee demographics.