Trainee Perspectives Research Articles

Entrustable Professional Activities: An Analysis of Faculty Time, Trainee Perspectives and Actionability

AbstractThe Royal College of Physicians and Surgeons of Canada introduced Competence by Design (CBD) as an educational model along with Entrustable Professional Activities (EPAs) as markers of achievement that could be directly observed on a frequent basis. In 2017, the University of Calgary Internal Medicine (IM) program piloted CBD. The purpose of this study was to (1) assess whether written feedback from EPAs were actionable, valuable, and disruptive to workflow and (2) assess the time required to complete an EPA. MethodsSeven Foundations of Discipline EPAs were used with 31 PGY-1 Calgary IM residents. The study used quantitative and qualitative data. Following a discussion on an EPA and completion of both the quantitative and written feedback, residents were asked to comment on the value of the encounter and the degree of disruption to workflow. Assessors provided time to complete an EPA. Data were anonymized. Trainee comments were coded for value and disruption, and assessor’s written feedback was coded for actionability. ResultsOne hundred and five EPA encounters were submitted. The majority of the comments provided to trainees were not actionable (94.3%, n = 99/105). While most residents did not comment on value (73.3%, n = 77/105) or disruption (44.8%, n = 47/105) of the encounter, those that did generally found the encounters valuable (25.7%, n = 27/105) and nondisruptive (35.2%, n = 37/105). A minority found the process nonvaluable (1%, n = 1/105) and disruptive (20%, n = 21/105). The mean time to complete an EPA form and provide feedback was 8.6 min. ConclusionMost written feedback was not actionable, suggesting a potential role for faculty development to guide assessors and help them coach trainees on EPAs. RÉSUMÉLe Collège royal des médecins et chirurgiens du Canada a introduit la compétence par conception (CPC) comme modèle d’enseignement, ainsi que les activités professionnelles confiables (APC) comme marqueurs de réussite qui pourraient être observés directement et souvent. En 2017, le programme de médecine interne (MI) de l’Université de Calgary a testé la CPC. L’objectif de cette étude était : 1) d’évaluer si la rétroaction écrite des APC était exploitable, utile et perturbatrice pour le déroulement du travail; 2) d’évaluer le temps nécessaire pour mener à bien une APC. MéthodesSept APC d’acquisition des fondements de la discipline ont été utilisées chez 31 résidents de première année en MI de l’Université de Calgary. L’étude a utilisé des données quantitatives et qualitatives. Après avoir discuté d’une APC et terminé la rétroaction quantitative et écrite, les résidents ont été invités à faire des commentaires sur l’utilité de la rencontre et le degré de perturbation du déroulement du travail. Les évaluateurs ont accordé du temps pour compléter une APC. Les données ont été anonymisées. Les commentaires des stagiaires ont été codés en fonction de l’utilité et du degré de perturbation, et la rétroaction écrite des évaluateurs a été codée en fonction de l’exploitabilité. RésultatsAu total, 105 rencontres d’APC ont été soumises. La majorité des commentaires fournis aux stagiaires n’étaient pas exploitables (94,3 %, n = 99/105). Bien que la plupart des résidents n’aient pas fait de commentaires sur l’utilité (73,3 %, n = 77/105) ou la perturbation (44,8 %, n = 47/105) de la rencontre, ceux qui l’ont fait ont généralement trouvé les rencontres très utiles (25,7 %, n = 27/105) et non perturbatrices (35,2 %, n = 37/105). Une minorité a trouvé le processus inutile (1 %, n = 1/105) et perturbateur (20 %, n = 21/105). Le temps moyen pour remplir un formulaire d’APC et fournir une rétroaction était de 8,6 minutes. ConclusionLa plupart des rétroactions écrites n’étaient pas exploitables, ce qui suggère un rôle que pourrait jouer le perfectionnement du corps professoral afin de guider les évaluateurs et de les aider à encadrer les stagiaires qui effectuent les APC.

Evaluation of Three-Dimensional Heads up Ophthalmic Surgery Demonstration From the Perspective of Surgeons and Postgraduate Trainees.

To evaluate the satisfaction of surgeons and trainees with three-dimensional (3D) ophthalmic surgery during a demonstration compared to traditional surgery. This validated questionnaire-based study was conducted over 1-month during which Ngenuity 3D surgery was demonstrated. All surgeons and trainees exposed were recruited to complete a questionnaire comprising visualization, physical, ease of use, teaching and learning, and overall satisfaction. All 7 surgeons and 33 postgraduate students responded. Surgeons reported no significant difference except overall (P = 0.047, paired t-test). Postgraduate trainees reported significantly better experience with 3D for illumination (P = 0.008), manoeuvrability (P = 0.01), glare (P = 0.037), eye strain (P = 0.008), neck and upper back strain (P = 0.000), lower back pain (P = 0.019), communication (P = 0.002), comfortable environment (P = 0.001), sharing of knowledge (P = 0.000), and overall (P = 0.009). During early experience, surgeons and trainees reported better satisfaction with 3D overall. Trainees had better satisfaction with 3D in various subcomponents of visualization, physical, ease of use, and education.

COVID-19: trainee perspectives from unprecedented changes on the Paediatric Intensive Care Unit (PICU).

During the coronavirus disease 2019 (COVID-19) global pandemic, there has been a need to develop surge capacity. Since the disease is uncommon in children, working on a paediatric intensive care unit (PICU) has required an expansion of roles and responsibilities outside established confines. The most drastic change in practice involved having to care for both critically ill adults and children side by side on the PICU. Redeployment to work on an adult critical care unit as required was similarly momentous. Based on our experience of managing this surge in one of the UK’s worst hit tertiary hospitals, we are sharing our reproducible approaches that benefitted trainees. This will be relevant to paediatricians globally who are assisting in critical care strategies and future pandemic planning.

Out-of-programme experience in UK neurosurgery trainees: optimising the transition back into clinical practice

INTRODUCTION Out of programme (OOP) experience from training increases the skill pool of the neurosurgical workforce and drives innovation in the specialty. OOP approval criteria are well defined but transition back to clinical work can be challenging with a paucity of data published on trainee perspectives. Our study aimed to investigate factors influencing transition from OOP back to clinical work among neurosurgical trainees in the UK. METHODS An online survey was sent to all members of the Society of British Neurological Surgeons. Questions pertained to details of OOP and factors influencing transition back to clinical work. RESULTS Among the 73 respondents, 7 were currently on OOP and 27 had completed OOP in the past. Research was the most common reason for OOP (28/34, 82%) and this was generally motivated by the aspiration of an academic neurosurgery career (17/34, 50%). Although the majority (27/34, 79%) continued clinical work during OOP, 37% of this group (10/27) reported a reduction in their surgical skills. Fewer than half (15/34, 44%) had a return to work plan, of which only half (8/34, 24%) were formal plans. The majority of respondents who had completed OOP in the past (22/27, 81%) felt that they were able to apply the skills gained during OOP to their clinical work on return. CONCLUSIONS Skills learnt during OOP are relevant and transferable to the clinical environment but mainly limited to research with OOP for management and education underrepresented. Deterioration of surgical skills is a concern. However, recognition of this problem has prompted new methods and schemes to address challenges faced on return to work.

Impact of COVID-19 pandemic on postgraduate medical education – a survey of UK trainees

The COVID-19 pandemic has caused significant disruption to patient care delivery and medical training in the UK.1 However, the views of healthcare professionals on the impact of the pandemic has not been fully explored. This study aimed to identify the challenges experienced by healthcare professionals during the COVID-19 pandemic and proffer potential solutions, from the perspectives of postgraduate trainees. A SurveyMonkey® questionnaire was emailed to postgraduate trainees through Health Education England (HEE) deanery databases, to capture their experiences during the pandemic. The survey was also circulated informally via WhatsApp®, to include the views of individuals in non-training posts. Ethics review was …

Core surgical trainee perspectives on a career in vascular surgery

Core surgical trainee perspectives on a career in vascular surgery

UK trainee perspectives on leadership in the COVID-19 pandemic

There has been redeployment, ‘up-skilling’, halted rotations and an earlier than planned start to work for many new foundation year-1 (F1) doctors, to name just a few of the events impacting trainees in the UK during these ‘unprecedented times’. At times of crisis we look to leaders for guidance and support; but it is not only in these times that leadership plays a pivotal role – note the General Medical Council (GMC) leadership and management guidance. This snapshot survey was designed to explore trainee experience of leadership during the COVID-19 pandemic in the UK. An online survey …

'Dimensions and tensions?': embracing the complexity of 'working in a rural area' through qualitative research interpreting perspectives of dermatologists and dermatology trainees.

Challenges to addressing workforce maldistribution for equitable rural healthcare access continue, including for dermatology services. The conceptual complexity of the notion of 'rural' adds to the challenges, with the term 'rural' reflecting socially constructed meanings. In relation to healthcare workforce strategies, socially constructed meanings of 'rural' indicate preferences for quantifiable framings and tendencies towards deficit-based portrayals. While quantifiable framings provide impetus for implementing and evaluating important rural healthcare workforce strategies, their tendency towards deficit-based portrayals risks overlooking positives of rural healthcare practice and stereotyping rural areas as problematic environments for health care. The importance of balancing deficit-based portrayals of 'rural' with more positive orientations is recognised as important for addressing the maldistribution of the healthcare workforce. Adding further to the complexity of addressing workforce maldistribution is the range of strategies required. Encompassed in these strategies are socially constructed approaches and conflicting interests. The notion of 'tensions' has potential for making sense of, and addressing, the complexity of these competing interests. Importantly, not all 'tensions' need to be resolved. By identifying, embracing and holding 'tensions' rather than necessarily resolving them, space for ongoing rich discussion can be deliberately created. This qualitative research used a wide-angle, strength-based lens to explore the topic of working in a rural area, from the perspectives of dermatologists and dermatology trainees. The wide-angle lens allowed consideration of the multiplicity of approaches. The strength-based lens allowed the research to go beyond deficit-based portrayals and embrace 'tensions' inherent in the complexities of addressing workforce maldistribution. This study, undertaken in the interpretive research paradigm, was informed by philosophical hermeneutics. The research question was, 'How can working in a rural area be conceptualised from the perspectives of dermatologists and dermatology trainees?'. Data collected through semi-structured interviews with 17 participants providing dermatology services in rural areas (11 dermatologists and 6 dermatology trainees) were iteratively interpreted. Data were initially coded descriptively, with iterations moving towards more conceptual themes. A conceptual model of dimensions and tensions of working in a rural area, from the perspective of dermatologists and dermatology trainees, is presented to illustrate the interpreted key themes, subthemes and implications. The four key themes are dimensions of working in a rural area: choosing to work in a rural area, transitioning out of a metropolitan area, embedding into the rural community and working within the complexity of 'rural'. As illustrated in the model, subthemes are characteristics capturing inherent diversity within each dimension, and the implications are 'tensions'. Issues for ongoing discussion arising from these 'tensions' include metropolitan as a gravitational force to be overcome; complexities of individual choice, including implications for absence of choice; importance of community as people at the core of the strategies; and the taken-for-granted language for 'rural' inadvertently reinforcing deficit-based portrayals. A set of reflective questions related to these issues is provided. The reflective questions posed can be discussed, grappled with and considered when developing strategies that address workforce maldistribution and when exploring different experiences within the complex social construction of 'rural'.

The unspoken reality of gender bias in surgery: A qualitative systematic review.

This study was conducted to better understand the pervasive gender barriers obstructing the progression of women in surgery by synthesising the perspectives of both female surgical trainees and surgeons. Five electronic databases, including Medline, Embase, PsycINFO, CINAHL and Web of Science Core Collection, were searched for relevant articles. Following a full-text review by three authors, qualitative data was synthesized thematically according to the Thomas and Harden methodology and quality assessment was conducted by two authors reaching a consensus. Fourteen articles were included, with unfavorable work environments, male-dominated culture and societal pressures being major themes. Females in surgery lacked support, faced harassment, and had unequal opportunities, which were often exacerbated by sex-blindness by their male counterparts. Mothers were especially affected, struggling to achieve a work-life balance while facing strong criticism. However, with increasing recognition of the unique professional traits of female surgeons, there is progress towards gender quality which requires continued and sustained efforts. This systematic review sheds light on the numerous gender barriers that continue to stand in the way of female surgeons despite progress towards gender equality over the years. As the global agenda towards equality progresses, this review serves as a call-to-action to increase collective effort towards gender inclusivity which will significantly improve future health outcomes.

The end of conferences as we know them? Trainee perspectives from the Virtual ACCESS Conference 2020.

The end of conferences as we know them? Trainee perspectives from the Virtual ACCESS Conference 2020.

Pediatric Faculty and Trainee Attitudes Toward the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented event in modern medicine. In this study, we evaluate pediatric faculty and trainee attitudes and perspectives related to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their roles in the COVID-19 pandemic. We surveyed a pediatric hospital's faculty and trainees (n = 701) in April 2020 about their concerns related to SARS-CoV-2, trust in current recommendations, and attitudes toward trainee roles. We used descriptive statistics to analyze results and compared across sex and roles using logistic regression. Among 320 respondents (46% response rate), 73% were concerned with personal risk of SARS-CoV-2 infection and 88% were concerned with loved ones' risk. Twenty-four percent were concerned because of personal risk factors. Nearly half expressed concerns as their family's major provider and about salary changes (48% and 46%). Seventy-nine percent were concerned about lack of personal protective equipment and 43% about redeployment. Respondents endorsed varying levels of trust in recommendations related to COVID-19. Nearly three-fourths (72%) felt trainees are essential personnel. The majority were receptive to returning to usual patient care and training as the pandemic progresses. Significant differences exist across sex and roles related to levels of concern, trust, and trainee roles. In this study, we assess the concerns and perspectives of pediatric faculty and trainees related to the COVID-19 pandemic. Most view trainees as essential personnel and recognize the importance of direct patient care in their training. These results can be used to inform policy changes and trainee roles as the COVID-19 pandemic progresses.

Interprofessional Education: Psychology Trainee Experiences and Perspectives on Team Skills.

Interprofessional education (IPE) is defined as educational activities involving trainees from two or more professions learning about, from, and with each other with the goal of building team-based collaboration skills. The degree to which psychology trainees are involved in IPE is unknown. A national survey was distributed to gather information regarding the nature and prevalence of IPE experiences and psychology trainees' perceived competence in collaboration skills. Participant responses (n = 143) are presented overall and by training level. Some respondents reported no IPE activities in their training, especially trainees earlier in their training. Highest rated competencies were in acting with honesty and integrity and developing/maintaining mutual respect and trust of other professions. Lowest rated were in giving feedback to others and managing differences in opinion. More research related to the nature and impact of IPE on psychology trainees is critical.

Spanish PIBID: a space that brings school and future teachers together

This paper proposes a reflection on the Spanish Teaching Initiation Institutional Scholarship Program [Spanish PIBID] at the Federal University of Santa Catarina as a space that brings together schools and future teachers, in schools of the Florianópolis Metropolitan Region, showing actions and challenges faced for the consolidation of the program in the region. Based on a research done with the participants of the Spanish subproject—2012-2020—the project was analyzed from the perspective of PIBID teacher trainees, according to the topics highlighted by them, such as the relation between theory and practice, their presence in school, or the relation between the university and basic school. Based on official data on filled and unfilled school capacity, current challenges faced by teaching programs in universities were also taken into account, especially in the case of Spanish as a foreign language program, considering the need to keep teaching-fostering public policies in place. As a formative experience, the subproject is perceived as rewarding, having as a theoretical basis the training of reflective teachers and researchers, concerned with collaborating to maintaining high quality standards for public school as an institution that educates critical and autonomous citizens.

Practices and perspectives of teacher trainees upon online language education programme

Instructional technologies have been used extensively after the spread of COVID19. Council of Higher Education in Turkey closed down all the universities and embarked on online education by issuing a statement that all universities were free to choose the platform they wished to use. This study aims at discovering how online language teacher education programmes yielded emerging patterns and how teacher trainees’ perspectives were in relation with these online language teacher education programmes. To reach this aim, 275 teacher trainees at the Department of English Language Teaching participated in the study and semi-structured interviews were held with them. This discussion illuminates critical issues and attitudes of teacher trainees along with the challenges unique to programmes as a future research agenda.

Status of minimally invasive HPB surgery in the UK from consultant and trainee perspectives

Introduction: This survey took a snapshot of current attitudes towards minimally invasive HPB surgery from a consultant and trainee perspective. Methods: Two google surveys were emailed to all identified HPB centres in the UK to consultants and trainees (ST5+). The questionnaire contained 33 and 31 questions respectively regarding minimally invasive HPB practice and training. Results: Thirty-five HPB consultants completed the survey. The most common indications for conversion to open surgery were failure to progress in 91.4% (n=32), excessive intraoperative blood loss in 85.7% (n=30) and access issues in 85.7% (n=30). The majority (78.8%, n=26) of HPB surgeons surveyed undertook MIDP while 21.2% (n=7) did not as they deferred them to other surgeon(s) who regularly performed them. Only one consultant undertook minimally invasive pancreaticoduodenectomy (MIPD), robotically; 48.4% (n=15) declared not performing MIPDs as they were not convinced MIS is superior to an open approach. Eighty-five-point seven percent (n=30) performed minimally invasive minor liver resection and segmentectomy (MImLRS), 70.6% (n=24) reported better outcomes with an MIS approach, 23.5% (n=8) reported no difference in outcomes between the MIS and open approaches. Seventy percent (n= 5) performed minimally invasive major liver resection (MIMLR) laparoscopically and 30% (n=3) robotically; 56.3% (n=17) reported equivalent or better outcomes with an open approach while 23.3% (n=7) reported better outcomes with MIMLR. Half of polled HPB trainees did not have access to laparoscopic HPB procedures (excluding laparoscopic cholecystectomy); 22.2% (n=4) of trainees had a mentor in laparoscopic HPB procedures. Forty-four-point four percent of trainees (n=8) reported going to laparoscopic courses on cadaveric/live models while 44.4% (n=8) used internet-based media to improve their laparoscopic skills; 72.2% (n=13) desired an extension to training (or fellowship) to consolidate their laparoscopic training. Conclusion: MImLRS and MIDP would appear to be accepted approaches by most HPB consultants which correlates with a perception that outcomes are better/comparable to open approaches. This is less clear for MIPD and MIMLR. HPB trainees suffer from a lack of laparoscopic HPB exposure leading to seek further laparoscopic HPB experience with fellowships post certificate of completion of training.

Exploring the residents’ perspective on smart learning modalities and contents for virtual urology education: Lesson learned during the COVID-19 pandemic

PurposeThe COVID-19 outbreak has substantially altered residents’ training activities.While several new virtual learning programs have been recently implemented, the perspective of urology trainees regarding their usefulness still needs to be investigated. MethodsA cross-sectional, 30-item, web-based Survey was conducted through Twitter from April 4th, 2020 to April 18th, 2020, aiming to evaluate the urology residents’ perspective on smart learning (SL) modalities (pre-recorded videos, webinars, podcasts, and social media [SoMe]), and contents (frontal lessons, clinical case discussions, updates on Guidelines and on clinical trials, surgical videos, Journal Clubs, and seminars on leadership and non-technical skills). ResultsOverall, 501 urology residents from 58 countries completed the survey. Of these, 78.4, 78.2, 56.9 and 51.9% of them considered pre-recorded videos, interactive webinars, podcasts and SoMe highly useful modalities of smart learning, respectively. The contents considered as highly useful by the greatest proportion of residents were updates on guidelines (84.8%) and surgical videos (81.0%). In addition, 58.9 and 56.5% of responders deemed seminars on leadership and on non-technical skills highly useful smart learning contents.The three preferred combinations of smart learning modality and content were: pre-recorded surgical videos, interactive webinars on clinical cases, and pre-recorded videos on guidelines. ConclusionOur study provides the first global “big picture” of the smart learning modalities and contents that should be prioritized to optimize virtual Urology education. While this survey was conducted during the COVID-19 outbreak, our findings might have even more impact in the future.

Opportunities and challenges of an older adult placement during Covid: Reflections from a supervisor and trainee clinical psychologist

Despite the importance of placements to clinical psychology training, the Covid-19 pandemic has made offering placements challenging. In this article, the experience of providing an older adult placement from trainee and supervisor perspectives are outlined, with opportunities and learning discussed.

Chinese doctors’ views on workplace-based assessment: trainee and supervisor perspectives of the mini-CEX

ABSTRACT Purpose: This study investigated whether the mini-clinical evaluation exercise (mini-CEX) has been successfully integrated into the Chinese context, following its introduction as part of the national general training programme. Materials and methods: Online questionnaires (N = 91) and interviews (N = 22) were conducted with Year 1 trainee doctors and clinical supervisors at a cancer hospital in China to explore users’ experiences, attitudes and opinions of the mini-CEX. Results” Trainees were more likely than supervisors to report understanding the purpose of the mini-CEX and agree that it encouraged reflection and helped improve overall performance. Both trainees and supervisors felt that it provided a framework for learning, that it was useful in identifying underperformance, and that it informed learning progression. Groups were equally positive about the commitment of their counterpart in the process and valued the focus on detailed feedback. It was perceived as cultivating the learner–teacher relationship. Overall, both groups felt they ‘bought in’ to using the mini-CEX. However, concerns were raised about subjectivity of ratings and lack of benchmarking with expected standards of care. Conclusions: Chinese trainees and supervisors generally perceived the mini-CEX as an acceptable and valuable medical training tool, although both groups suggested enhancements to improve its efficacy.

A Novel Ticket System for Capping Residency Interview Numbers: Reimagining Interviews in the COVID-19 Era.

The 2019 novel coronavirus (COVID-19) pandemic has led to dramatic changes in the 2020 residency application cycle, including halting away rotations and delaying the application timeline. These stressors are laid on top of a resident selection process already under duress with exploding application and interview numbers-the latter likely to be exacerbated with the widespread shift to virtual interviewing. Leveraging their trainee perspective, the authors propose enforcing a cap on the number of interviews that applicants may attend through a novel interview ticket system (ITS). Specialties electing to participate in the ITS would select an evidence-based, specialty-specific interview cap. Applicants would then receive unique electronic tickets-equal in number to the cap-that would be given to participating programs at the time of an interview, when the tickets would be marked as used. The system would be self-enforcing and would ensure each interview represents genuine interest between applicant and program, while potentially increasing the number of interviews-and thus match rate-for less competitive applicants. Limitations of the ITS and alternative approaches for interview capping, including an honor code system, are also discussed. Finally, in the context of capped interview numbers, the authors emphasize the need for transparent preinterview data from programs to inform applicants and their advisors on which interviews to attend, learning from prior experiences and studies on virtual interviewing, adherence to best practices for interviewing, and careful consideration of how virtual interviews may shift inequities in the resident selection process.

Estudio exploratorio-descriptivo de la direccionalidad de la traducción: la perspectiva del traductor en formación

Los programas de formación de traductores a nivel universitario a menudo se organizan en torno a asignaturas de traducción práctica en varias combinaciones lingüísticas y direcciones. Por norma general, cada asignatura se centra en una combinación lingüística y una dirección, y una de las características implícitas de esta organización es que el docente debe ser un hablante nativo de la lengua de destino. Este artículo tiene dos objetivos: de una parte, señalar las claves que permiten explicar la deslegitimación de la traducción A-B desde una perspectiva teórica; de la otra, presentar los resultados de un estudio exploratorio que analiza la perspectiva de un grupo de traductores en formación acerca de la direccionalidad a través del grupo de discusión como técnica de recogida de información.