Trainee Perspectives Research Articles

Walking side-by-side: Supporting Aboriginal and Torres Strait Islander Australians to lead the way in alcohol research.

Several initiatives have sought to increase the number of First Nations individuals with a higher degree in research (i.e., PhD or research masters)-in Australia and in similarly colonised countries. However, little has been written on day-to-day support structures and mechanisms that might help First Nations Australian candidates thrive in postgraduate research degrees and beyond. For sensitive research fields such as alcohol, emerging Aboriginal and Torres Strait Islander researchers must grapple with topics which are stigmatising and in some instances associated with traumatic associations. There is also a lack of studies internationally that describe optimal support for First Nations students undertaking a higher degree by research with a primary focus on alcohol. Here we discuss what we have learned from the support offered through the Centre of Research Excellence in Indigenous Health and Alcohol-from the perspective of academic staff, students, trainees and early career researchers. We consider what may be generalisable lessons from this experience.

Taking time out of training: a Malawi experience.

There has been increased focus on global surgery in low-income and middle-income countries (LMICs) since the Lancet commission on global surgery was published in 2015. Interest from surgical trainees in overseas placements during their training is high with a number of motivating factors to engage in overseas work. In this article, we outline the overseas experience of a UK-based orthopaedic trainee during their time out of training in Malawi from both the trainee and training program director perspectives. Overseas LMIC placements during orthopaedic training are encouragingly becoming more established and are supported by a growing body of literature showing widespread benefits to the individual volunteer, donor and host institutions.

Trainee Perspectives on Race, Antiracism, and the Path toward Justice in Kidney Care.

Trainee Perspectives on Race, Antiracism, and the Path toward Justice in Kidney Care.

Assessing Well-Being in Milestones 2.0: A Case for Flourishing-Focused Advising.

Assessing Well-Being in Milestones 2.0: A Case for Flourishing-Focused Advising.

Call for Papers: Journal of Gynecologic Surgery

Journal of Gynecologic SurgeryVol. 38, No. 4 Call for PapersFree AccessCall for Papers: Journal of Gynecologic SurgeryEditor-in-Chief: Mitchel S. HoffmanEditor-in-Chief: Mitchel S. HoffmanMoffitt Cancer Center, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.Search for more papers by this authorPublished Online:11 Aug 2022https://doi.org/10.1089/gyn.2022.29006.cfpAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Dear Colleagues:I am pleased to share some important information for anyone considering submission of a gynecologic surgical article to our high-quality peer-reviewed journal, Journal of Gynecologic Surgery (www.liebertpub.com/gyn).Journal of Gynecologic Surgery has a unique focus on gynecologic surgery, unlike other journals broadly covering OB-GYN topics. Each issue appears in print and online, and there is no submission fee. The journal is devoted to publishing relevant surgical articles that will both enhance the surgical education of our readers and further the field of gynecologic surgery through new information.At this time, we are especially interested in submissions focused on surgical outcomes research, quality improvement related to surgical complications, innovations in gynecologic surgical practice, gynecologic surgical education, and the surgical challenges of obesity.The submission process is extremely user friendly, and the editorial staff is committed to working closely and responsively with authors. The peer-review process is prompt and efficient: our average time from submission to first decision is 27 days. We also accept and encourage supplementary videos to enhance submissions involving surgical techniques. A dedicated medical artist is available to work with authors to illustrate surgical content in an impactful way. If you have a gynecologic surgical manuscript that is still in progress, I encourage you to submit it to Journal of Gynecologic Surgery. Please take a look at the information below for more details about the journal and submission process.Sincerely,Mitchel S. Hoffman, MDEditor-in-Chief, Journal of Gynecologic SurgeryABOUT THE JOURNALJournal of Gynecologic Surgery is the only journal providing an essential peer-reviewed forum for clinical articles dealing with all aspects of operative gynecology. The journal provides the most current research on cutting-edge techniques and advances in gynecologic surgery from world-renowned experts. A special topic of interest to gynecologic surgeons is covered in a section of each issue. The journal also has a focus on residents, fellows, and new practitioners in a section titled “Trainee's Perspective.”The journal is under the editorial leadership of Editor-in-Chief Mitchel S. Hoffman, MD, Moffitt Cancer Center, Tampa, FL, and other leading investigators. View the entire editorial board at www.liebertpub.com/gyn.Journal of Gynecologic Surgery coverage includes: Open gynecologic surgeryVaginal surgeryLaparoscopyRobotic surgeryHysteroscopyPelvic reconstructive surgeryFemale urologySurgery related to reproductive medicineGynecologic cancer surgeryHealth care economics related to gynecologic surgeryBenefits of publishing in Journal of Gynecologic Surgery:Open access options availableIndexed in PubMed Central, Scopus, BenchSci, EMBASE/Excerpta Medica, and Web of Science Emerging Sources Citation IndexAverage time to first decision: 27 daysFast and user-friendly electronic submissionEfficient and constructive peer reviewPrompt online publicationHigh global visibility: accessible in 170 countries worldwideVisit the journal website to view more information for authors including manuscript guidelines, information on available author services, and publication costs.Visit the Instructions for Authors:www.liebertpub.com/gynSubmit your paper for peer review online:https://mc.manuscriptcentral.com/gynFiguresReferencesRelatedDetails Volume 38Issue 4Aug 2022 InformationCopyright 2022, Mary Ann Liebert, Inc., publishersTo cite this article:Editor-in-Chief: Mitchel S. Hoffman.Call for Papers: Journal of Gynecologic Surgery.Journal of Gynecologic Surgery.Aug 2022.257-258.http://doi.org/10.1089/gyn.2022.29006.cfpPublished in Volume: 38 Issue 4: August 11, 2022Online Ahead of Print:July 29, 2022PDF download

Future Directions for Global Clinical Neurosurgical Training: Challenges and Opportunities

Expanded access to training opportunities is necessary to address 5 million essential neurosurgical cases not performed annually, nearly all in low- and middle-income countries. To target this critical neurosurgical workforce issue and advance positive collaborations, a summit (Global Neurosurgery 2019: A Practical Symposium) was designed to assemble stakeholders in global neurosurgical clinical education to discuss innovative platforms for clinical neurosurgery fellowships. The Global Neurosurgery Education Summit was held in November 2021, with 30 presentations from directors and trainees in existing global neurosurgical clinical fellowships. Presenters were selected based on chain referral sampling from suggestions made primarily from young neurosurgeons in low- and middle-income countries. Presentations focused on the perspectives of hosts, local champions, and trainees on clinical global neurosurgery fellowships and virtual learning resources. This conference sought to identify factors for success in overcoming barriers to improving access, equity, throughput, and quality of clinical global neurosurgery fellowships. A preconference survey was disseminated to attendees. Presentations included in-country training courses, twinning programs, provision of surgical laboratories and resources, existing virtual educational resources, and virtual teaching technologies, with reference to their applicability to hybrid training fellowships. Virtual learning resources developed during the coronavirus disease 2019 pandemic and high-fidelity surgical simulators were presented, some for the first time to this audience. The summit provided a forum for discussion of challenges and opportunities for developing a collaborative consortium capable of designing a pilot program for efficient, sustainable, accessible, and affordable clinical neurosurgery fellowship models for the future.

The ward round: friend or foe in postgraduate training? A grounded theory study of residents’ perspectives

ABSTRACT The ward round has traditionally been a learning activity in medical education. Apart from education, ward rounds have multiple roles including patient care and communication. Some studies have described the ward round as an ideal place to learn patient management while others reported that little learning happens on rounds due to lack of time and patient volume. This study aimed to develop a deeper understanding of ward round learning from the perspective of postgraduate trainees. A constructivist grounded theory approach was used and data was collected during focus group discussions. Data were analyzed by initial coding, then grouped into focused codes and development of a theoretical framework by the process of constant comparison. Six categories evolved which contributed to the framework. Postgraduate trainees perceive the ward round as an important space where they use different learning activities to acquire knowledge, attitude and skills required of a specialist doctor. They progress from novices to experts under supervision of faculty who lead ward rounds. The round can achieve its full learning potential if planned and organized well but can become a missed opportunity if the learning environment is unfriendly. Patient- and learner-related barriers exist that hinder ward round learning. The framework explains how ward round learning occurs in postgraduate medical education from a trainee perspective. The findings can guide interventions to improve the learning experience. Studies comparing perspectives of teachers to those of learners are needed to further understand the complex learning milieu of the ward round.

Host Perspectives of High-Income Country Orthopaedic Resident Rotations in Low and Middle-Income Countries.

International orthopaedic resident rotations in low and middle-income countries (LMICs) are gaining popularity among high-income country (HIC) residency programs. While evidence demonstrates a benefit for the visiting residents, few studies have evaluated the impact of such rotations on the orthopaedic surgeons and trainees in LMICs. The purpose of this study was to further explore themes identified in a previous survey study regarding the local impact of visiting HIC resident rotations. Using a semistructured interview guide, LMIC surgeons and trainees who had hosted HIC orthopaedic residents within the previous 10 years were interviewed until thematic saturation was reached. Twenty attending and resident orthopaedic surgeons from 8 LMICs were interviewed. Positive and negative effects of the visiting residents on clinical care, education, interpersonal relationships, and resource availability were identified. Seven recommendations for visiting resident rotations were highlighted, including a 1 to 2-month rotation length; visiting residents at the senior training level; site-specific prerotation orientation with an emphasis on resident attitudes, including the need for humility; creation of bidirectional opportunities; partnering with institutions with local training programs; and fostering mutually beneficial sustained relationships. This study explores the perspectives of those who host visiting residents, a viewpoint that is underrepresented in the literature. Future research regarding HIC orthopaedic resident rotations in LMICs should include the perspectives of local surgeons and trainees to strive for mutually beneficial experiences to further strengthen and sustain such academic partnerships.

Trainee Perspectives on Internship and Fellowship Training Experiences in Pediatric Health Service Psychology during a Global Pandemic

ABSTRACT The impact of COVID-19 on the psychology training community has included modifications to internship and postdoctoral fellowship training programs to assure the safety of patients, trainees, and staff. Studies assessing the impact of COVID-19 on training in health service psychology are emerging; however, few studies have provided the opportunity for psychology trainees to candidly report about their experiences during the ongoing pandemic. This paper aims to describe how the pandemic effected internship and fellowship training experiences from the trainee’s perspective. Participants included 58 trainees from pediatric psychology internship and postdoctoral fellowship programs in the United States. A survey containing open- and close-ended questions was distributed to trainees via their training directors to assess training experiences during COVID-19. Qualitative analysis of responses revealed four themes describing 1) reduced depth and breadth of training opportunities, 2) social isolation and limited professional and personal support, 3) increased use of telepsychology and reduced in-person training, and 4) increased levels of stress and burnout combined with decreased morale. Many internship trainees described pandemic-related challenges to completion of dissertation, and postdoctoral fellows experienced altered or delayed professional trajectories due to financial, mental health, and career readiness factors. Implications and future directions include the need for increased support both professionally and personally for trainees who are completing internship and postdoctoral fellowship training in the midst of COVID-19.

Perspectives of trainees and examiners on communication skills assessment during online postgraduate psychiatry examination in Ireland

IntroductionCovid-19 pandemic caused a pivot to online clinical education and assessment across the globe.ObjectivesTo explore the views of psychiatric trainees and examiners on assessment of communication skills during online high stakes postgraduate examination.MethodsThis study was designed as interpretive descriptive qualitative research. All candidates and examiners of the online Irish Basic Specialist Training exam in September and November 2020 were included. The respondents were interviewed by Zoom which were transcribed verbatim. Data was coded using NVivo20 pro and Braun and Clarke thematic analysis was used to draw various themes and subthemes.ResultsA total of seven candidates and seven examiners from different training deaneries and specialties were interviewed with average duration of 29m 45s and 24m 20s respectively. The participants were largely satisfied with the online examination but did not consider it equal to face-to-face for picking nonverbal cues. The candidates were very conscious of eye contact while examiners placed more emphasis on overall professional behavior and patient engagement. All candidates preferred to continue online format post pandemic for practical reasons e.g., avoiding travel and overnight stay, while all examiners preferred to go back to in-person Objective Structured Clinical Examination due to some limitations in assessing physical and cognitive examination. However, continuation of online Clinical Formulation and Management Examination was agreed by both groups.ConclusionsThe results of the study have shown different insights of two important stakeholders in a professional postgraduate psychiatry examination which can be useful to improve same exam and design similar assessments in other settings.DisclosureNo significant relationships.

Trainee and program director perspectives of parental leave and parenthood in oncologic specialties.

11051 Background: Delays in pregnancy exacerbate infertility. Thus, trainees are forced to make complex family planning decisions while juggling all aspects of training. In addition to a lack of parental leave and financial constraints, trainees are often concerned with the perceptions of leave and parenthood. Two single specialty surveys found that most program directors (PDs) felt parenthood negatively impacted trainee performance, disproportionately for women. We aim to understand PD and trainee perspectives of parental leave and parenthood in oncologic trainees. Methods: Contact information for PDs in oncologic specialties was gathered from FRIEDA. Surveys were distributed to all eligible PDs with a request to forward a parallel survey to their trainees. Social media links for both surveys were shared on Twitter. Tests of association for descriptive analyses included Fisher's exact test, Chi-square test, or the Mantel-Haenszel Chi-Square test, as appropriate. All computations were performed using SAS version 9.4. Results: 195 PDs and 286 trainees completed the survey with 49% and 56% female and 89% and 41% parent respondents, respectively. Per PDs, 73% of programs have a maternity leave policy, 48% have a paternity leave policy, and 5% have a fertility services policy. PDs and non-parent trainees (NPTs) rated the negative impact of parenthood on overall education (p < 0.001 for PDs, p < 0.001 for NPTs) and academic productivity (p < 0.001 for PDs, p < 0.001 for NPTs) as higher for women trainees than men trainees. PDs and NPTs also rated the burden of parental leave on co-trainees as greater for women trainees as compared to men trainees (p < 0.001 for PDs, p < 0.001 for NPTs). Among PDs, no significant differences by gender or specialty were found in advising for or against parenthood in training, but PDs in surgical specialties reported providing less support for trainees starting a family (p < 0.001) and trainees in surgical specialties reported being less supported (p < 0.001). Women trainees were more likely than men trainees to indicate that they would have started a family sooner if not in medicine (p < 0.001). 89% of parent trainees would choose to have children in training again, and 84% would recommend parenthood in training. Conclusions: Although many programs have parental leave policies, a substantial number continue to lack them. Concerns about negative perceptions of parenthood by trainees are valid, particularly for women who are significantly more likely to be seen as having their education and academic productivity impacted by parenthood. In addition, specialty choice impacts the support given to trainees as they start families. Despite these barriers, the vast majority of parent trainees would still choose to have children in training and recommend this path to fellow trainees. Additional initiatives to normalize and support family planning in medical training for interested trainees are warranted.

Perspectives of Female Cardiology Trainees on Interventional Cardiology Training and Careers: A Canadian Nationwide Survey.

Women remain distinctly under-represented in cardiology and interventional cardiology (IC) in particular. Female physicians have reported harassment and discrimination based on gender. Respecting the principles of diversity, equality and inclusivity is crucial in a modern workforce. In this nationwide survey, we aimed to investigate Canadian female resident perceptions of cardiac catheterization training and examine barriers to women pursuing a career in IC. A high perception of sexism and concerns around family were identified as potential barriers to an IC career amongst females.

Educational impact of inpatient hematology-oncology service structure.

e23013 Background: Literature suggests that inpatient hematology-oncology (heme-onc) clinical experiences may have a deleterious impact on trainee interest in heme-onc. However, the impact of inpatient heme-onc service structure on trainee education is not known. To delineate the factors affecting trainee education, we aimed to characterize the structure of inpatient heme-onc services at comprehensive cancer centers (CCCs) and the associated impact on trainees. Methods: We designed a survey with Likert-type and open-ended questions using established procedures. We surveyed heme-onc fellowship program directors (PDs) at all 50 U.S. CCCs with fellowship programs. We performed point biserial and Pearson correlations on Likert-type responses and content analysis on open-ended responses. Results: Eighteen out of 50 (36%) PDs responded and described 117 services. Services were either primary (35%), consult (44%), or both (21%). Fellows were present on 93% and residents on 54% of services. PDs rated the educational value of most inpatient services as either “very high” or “somewhat high” for both fellows (73% very high, 13% somewhat high) and residents (49% very high, 33% somewhat high). PDs perceived that fellows derived greater educational value from consult-only vs primary/mixed services [R(105) = 0.25, p= 0.01] and provided greater reciprocal benefit to consult-only vs primary/mixed services [R(100) = 0.28, p= 0.004]. Hospital type (county, university, or veteran’s) and the presence or absence of a formal curriculum on the service did not correlate with perceived educational benefit. Multiple open-ended comments suggested that heme-onc attendings and fellows should be consultative rather than primary service providers, programs should separate teaching and non-teaching services, and service/education balance optimization should be prioritized. Inadequate service staffing and lack of institutional support were identified as barriers to inpatient education. Conclusions: PDs felt that inpatient heme-onc services had high educational value for trainees, particularly for fellows. Both fellows and services may derive mutual benefit from fellow participation on inpatient consult services structured separately from non-teaching primary services. Hospital type and the presence or absence of a structured curriculum may not be critical for education on inpatient heme-onc services. Appropriate service/education balance, staffing, and institutional support are crucial to optimize inpatient education. Future studies should explore the trainee perspective around the educational value of inpatient clinical experiences. PDs and institutions can use the study findings to craft beneficial inpatient educational experiences for heme-onc trainees.

The negative factors influencing the career intention of general practice trainees in eastern China: a qualitative study

BackgroundThere is an acute shortage of general practitioners (GPs) in China, and GP trainees seem to be less willing to develop their career as a GP. This study aimed to investigate negative factors influencing the career intention of GPs in eastern China from the perspective of trainees taking standardized residency training, as to identify the barriers of GP trainees becoming registered GPs, and to provide a policy-making basis for GP recruitment and retention.MethodsA qualitative description design by the purposive sample was carried out in two training bases of Jinan and Qingdao in eastern China. Face-to-face, in-depth, semi-structured interviews were conducted, audiotaped, and transcribed using thematic analysis.ResultsTwenty-one trainees participated in this study. Thematic analysis generated five major themes: (1) low social recognition, (2) low professional identity, (3) low remuneration level, (4) imperfect training system, and (5) influence of policy factors.ConclusionsOur results identified various negative factors influencing the career intentions of trainees. In order to overcome the hurdles and increase the attractiveness of GP, it is recommended that the government and the public should create a supportive environment, which can be beneficial to the construction and development of GP.

Reviewing perianal abscess management and recurrence: lessons from a trainee perspective.

BackgroundPerianal abscesses are a common surgical emergency. Due to their perceived ease, drainage is often delegated to junior trainees with varying levels of experience. The purpose of this study is to evaluate the current trend in perianal abscesses management at our institution, and identify factors that predict subsequent fistula formation or abscess recurrence.MethodsAll acute patients admitted to a major teaching hospital who required surgical drainage of a perianal abscess were analysed over a two‐year period from January 2019 to December 2020. Patient demographics, clinical and laboratory findings were retrospectively reviewed. Proceduralist experience, operative management strategy and recurrence rates (fistula or abscess) were analysed.ResultsThe mean age of patients was 43 years old, and 73% were male. Trainees performed 96% of the procedures. Re‐presentation with a fistula or abscess recurrence requiring further surgery was 31%. Comorbidities of IBD, diabetes, or malignancy were present in one‐third of patients and significantly increased the risk of recurrence (P = 0.01). Searching for a fistula tract was performed in 41% of cases but did not reduce recurrence (P = 0.9). Seton insertion occurred in 10%, and fistulotomy in 2%.ConclusionPerianal abscess drainage at our institution is almost exclusively performed by trainees, the majority of which occurs after‐hours. Patients who present with a fever, inflammatory bowel disease, diabetes mellitus or malignancy are at an increased risk of recurrent abscess or a subsequent fistula after drainage, and input from an experienced surgeon may be of value when considering seton insertion or fistulotomy.

Response of US psychiatric programs to the COVID-19 pandemic and the impact on trainees

BackgroundMedical training program and hospital response to the COVID-19 pandemic has varied greatly and has impacted trainee well-being. Which factors have specifically related to trainee wellness, however, has not yet been examined in depth. The aim of the study was to understand trainee perspectives on the individual psychiatry trainee programs’ hospitals’ objective COVID-19 preparedness management. We also sought and to gauge how program changes, and general pandemic-related concerns, have been associated with trainee satisfaction and burnout.MethodsA cross-sectional survey study of psychiatric trainees was distributed electronically throughout the country via various psychiatry residency program listservs in April 2020. Statistical analyses were performed utilizing simple linear regression.ResultsFrom 352 respondents (346 complete responses and 6 partial responses), the most frequent program changes were “decreased number of rotations requiring in-person patient care” and “increased call hours or duties.” Of pandemic-related concerns surveyed, the two greatest were “spreading COVID-19 to family/friends” and “co-residents’ burnout and anxiety.” A positive relationship was found between trainee satisfaction with perceived COVID-19 departmental response and comfort level of residents/fellows in expressing concerns with attending clinicians and department leadership.ConclusionsSince the start of the COVID-19 pandemic, trainees have experienced a variety of changes to trainee program policies and guidelines. Overall, poor communication and trainee dissatisfaction with departmental response correlated with concern of infection and anxiety/burnout. Insights garnered from this study could provide scaffolding for the best practices to reduce trainee physician anxiety/burnout for the current and future pandemics of this variety and magnitude.

Systemic Challenges in Internship Training for Health-Service Psychology: A Call to Action From Trainee Stakeholders.

The challenges observed in health service psychology (HSP) training during COVID-19 revealed systemic and philosophical issues that preexisted the pandemic, but became more visible during the global health crisis. In a position paper written by 23 trainees across different sites and training specializations, the authors use lessons learned from COVID-19 as a touchstone for a call to action in HSP training. Historically, trainee voices have been conspicuously absent from literature about clinical training. We describe longstanding dilemmas in HSP training that were exacerbated by the pandemic and will continue to require resolution after the pandemic has subsided. The authors make recommendations for systems-level changes that would advance equity and sustainability in HSP training. This article advances the conversation about HSP training by including the perspective of trainees as essential stakeholders.

Supplemental Material for Psychology Trainee and Supervisor Perspectives of Multicultural Supervision

Supplemental Material for Psychology Trainee and Supervisor Perspectives of Multicultural Supervision

Visions by WIMIN: Global Mentorship to Retain Underrepresented Trainees.

Mentorship is a fundamental aspect that contributes to the success of a career in science, technology, engineering, and mathematics (STEM), particularly in academia. Research suggests that underrepresented minorities (URMs) often experience less quality mentorship and face barriers to finding successful mentor–mentee relationships. URM trainees in STEM face challenges that are not encountered by their majority peers or mentors, adding another level of complexity to establishing important relationships. Mentors of URM trainees must therefore mentor beyond general scientific training and tailor their mentorship to be more culturally appropriate and inclusive, allowing URM trainees to bring their whole selves to the table and leading to their effective socialization. Herein, we present the perspectives of group leaders and trainees from around the globe to highlight key aspects of creating successful mentor–mentee relationships that are sustainable and productive for both parties.

Student-Led Initiatives and Advocacy in Academic Medicine: Empowering the Leaders of Tomorrow.

Trainees' value as effective leaders within academic medicine has been increasingly recognized. From their perspective as adult learners who enter medical education from diverse backgrounds, trainees offer significant value to the teaching, learning, and practice of medicine. As such, trainees have developed and led various successful initiatives throughout academic medicine. In this Invited Commentary, 2 medical students with national leadership roles provide their perspectives on how student-led initiatives and advocacy can help push academic medicine forward. The authors first provide an overview of the success of student-led initiatives throughout medical education as evidenced by the Trainee-Authored Letters to the Editor in this issue, highlighting the unique contributions and perspectives of trainees in the development and implementation of new initiatives or ways of thinking. Although trainees add value to many areas in academic medicine, here the authors highlight 4 current areas that align with Association of American Medical Colleges priorities: (1) public health emergencies including the COVID-19 pandemic; (2) equity, inclusion, and diversity; (3) wellness and resilience amongst trainees and health care providers; and (4) recent changes to the United States Medical Licensing Examination and the transition to residency. By sharing their experiences with student-led initiatives within each of these domains, the authors provide lessons learned and discuss successes and obstacles encountered along the way. Overall, there is a critical need for increased engagement of trainees in medical education. Empowering trainees now ensures the academic medicine leaders of tomorrow are prepared to face the challenges that await them.