Internal Medicine Residency Training Research Articles

Evaluating the impact of structured POCUS training during internal medicine clerkship and residency training

Background: Point of Care Ultrasound (POCUS) is a vital tool in rheumatology for detecting pathologies like osteophytes and joint effusion. Its integration into rheumatology electives during internal medicine clerkship and residency is limited, despite its emphasis in pre-clinical years. Methods: In this QIRB-approved, single-center, prospective study (2022–2023), third- and fourth-year medical students and internal medicine residents in a two-week rheumatology elective voluntarily completed online surveys. These surveys assessed their confidence using POCUS in rheumatology, using a 5-point Likert scale. Results: A survey of 25 residents and 10 medical students found that 84% of residents and 90% of students rated POCUS training as valuable or very valuable. Both groups felt more confident identifying knee joint effusion (average scores: 3.5 for students, 2.6 for residents) compared to other ultrasound techniques and pathologies. Confidence was lower in hip ultrasounds (2.20 for students, 1.68 for residents) and chondrocalcinosis identification (2.20 for students, 1.76 for residents). Among participants, 28% of residents and 70% of students had prior informal POCUS training. Previous training significantly increased comfort levels, with average scores of 2.86 for students and 2.30 for residents, compared to 2.69 and 1.91 for those without prior training (P-values: <0.001). Conclusion: Prior experience significantly enhances confidence and comfort, reinforcing the need for early, comprehensive, and targeted POCUS training in medical curricula to address proficiency gaps. Keywords: Education, medical, undergraduate, rheumatology, point-of-care systems, ultrasonography

Longitudinal study of association between quality of life and grit in internal medicine residents in Ramathibodi Hospital

BackgroundGrit refers to a combination of perseverance and passion, which is essential for long-term success. Grit is associated with higher education attainment and a lower likelihood of burnout. Understanding how grit evolves during internal medicine residency training is important for providing better support to residents. The primary objective of the current study was to evaluate potential changes in the level of grit throughout the training program and investigate the association between grit and stress levels, quality of life (QoL), and satisfaction of learning scores.MethodsWe conducted a prospective study involving internal medicine residents enrolled in training programs from July 2022 to July 2023, except for the second-third-year residents of dermatology and neurology programs and the third-year residents of haematology and oncology programs, which are not part of the same training regimen. Data collection was conducted using questionnaires at the beginning of the training year and every three months until the end. Collected data included age, gender, habitat, working experience, financial burden, marital status, rotations, grit scores, QoL, stress score, and satisfaction of learning score during each trimester. Changes in grit over the year were examined using repeated measures analysis of variance adjusted by training program, financial status, working experience, habitat, marital status, and age. We performed multivariable linear regression models to explore associations between grit and the following domains: QoL, ST-5, and SoLs.ResultsOf 122 internal medicine residents in all three years of training, one resident dropped out during training, and another declined to participate. A total of 120 residents were included. Grit did not significantly change over time. Subgroup analysis of the first-year resident group revealed that grit significantly decreased (P = 0.049). Multivariable analysis revealed that grit was positively associated with QoL (β = 0.01, P < 0.001) and satisfaction of learning score (β = 0.07, P < 0.001) but inversely associated with stress score (β = − 0.04, P < 0.001).ConclusionsOf all residents, grit did not change over a year. However, only the first-year residents reported a decrease in grit during a training year. Throughout first-year residents’ internal medicine residency training, grit was positively associated with QoL and satisfaction of learning score but negatively associated with stress level. These findings suggest the need for targeted interventions to support first-year residents and enhance their resilience throughout training.

Safety of percutaneous dilatational tracheostomy performed by intensivists versus surgeons: A retrospective cohort study.

Percutaneous dilatational tracheostomy (PDT) is the preferred method for managing critically ill patients requiring prolonged mechanical ventilation. We aimed to compare the safety of PDT performed by intensivists versus surgeons. This retrospective, single center, cohort study included all the patients who underwent PDT from 2014 to 2023. Propensity score matching was performed to adjust the imbalances of covariates between the groups. The primary outcome was the occurrence of early complications after PDT. Secondary outcomes were the development of late complications of PDT and mortality directly related to tracheostomy. 1685 consecutive patients with critical illness were included in the analysis. Of these, 1396 (82.8%) PDTs were performed by surgeons and 289 (17.2%) by intensivists with background residency training in internal medicine. Early complications were reported in 80 (5.7%) of the patients in the surgeon group and in 13 (4.5%) patients in the intensivist group (p=0.40). Minor hemorrhage was the most common early complication. Secondary outcomes were comparable in both groups. In a propensity score-matched cohort, the findings remained consistent. This study suggests that PDT can be performed by intensivists, as well as surgeons, with the same safety profile. Our findings underscore the importance of incorporating PDT into the intensive care unit (ICU) training syllabus, ensuring the procedure is readily accessible with reliance on the expertise of ICU staff.

Improving Early Sepsis &amp; Severe Sepsis Identification and Management on Internal Medicine service at the Detroit John D. Dingell VA Medical Center

Background: Sepsis is a life-threatening organ dysfunction due to infection, with an incidence of nearly 50 million people each year, causing about 11 million in mortality worldwide. Adhering to Sepsis protocols is a quality metric monitored by both the Centers for Medicare &amp; Medicaid Services (CMS) via the SEP 1 measure and the VA Healthcare System through SEP 90, which consists of an all-or-nothing score comprised of individual metrics. These metrics include specific actions such as early management bundle utilization, lactate monitoring, timely fluid resuscitation, and vasopressor administration, all within defined timeframes. Based on FY 2023 Data, the John D. Dingell VAMC performed nationally in the last quintile with &gt; 72% fallouts. Given that the vast majority of our Sepsis patients are treated and managed by the inpatient Internal Medicine resident service, we initiated a Quality Improvement project to educate them and thereby decrease our number of fallouts. We aim to improve Sepsis, severe Sepsis, &amp; Septic shock Identification and Management by 50% over the course of 8 months on the internal medicine service. Methods: Internal medicine residents are central to the identification and management of early Sepsis and Severe Sepsis at the Detroit VA. Given the monthly turnover of resident teams, we focused on our model for improvement on interventions at the start of each month with targeted educational sessions to define Sepsis, severe Sepsis, and septic shock (and their management). We have also implemented targeted EMR training on utilizing a recently developed “Sepsis Bundle order set” for patients who have been identified as Sepsis. Sepsis Menu data usage was collected based on health factor tags on patients with Sepsis as their ICD-10 code on discharge from the internal medicine service. Results: Internal Medicine Resident educational sessions and EMR training commenced on July 1st, 2024. Sepsis Bundle was implemented in the EMR late 2022 due to rising fallouts of Sepsis and severe sepsis cases. However, its usage remained minimal, as depicted in Figure One, when compared to the number of discharged patients. Following the educational sessions and EMR training, both the identification and management of Sepsis have increased. Prior to intervention, from October 2022 to June 2023, a mean sepsis bundle usage rate of 10% was observed for identified sepsis patients, whereas post-intervention, from July 2023 to March 2024, the mean has increased to 30%. Conclusion/Discussion: Based on the early data, we can confidently note that our monthly education sessions, paired with our process measure (Sepsis bundle use), have been effective. Ongoing opportunities for improvement are improved coordination and handoff between ER and IM/MICU. We continue to see the need for ongoing resident education on identification and appropriate documentation of Sepsis severity along with obtaining labs within a certain time frame.

Internal Medicine Resident Addiction Training at the Veteran's Health Administration: A Qualitative Evaluation of Site Directors' Response to the 2022 ACGME Requirements.

Substance use disorders (SUDs) are prevalent in the USA yet remain dramatically undertreated. To address this care gap, the Accreditation Council for Graduate Medical Education (ACGME) approved revisions to the Program Requirements for Graduate Medical Education (GME) in Internal Medicine, effective July 1, 2022, requiring addiction medicine training for all internal medicine (IM) residents. The Veterans Health Administration (VHA) is a clinical training site for many academic institutions that sponsor IM residencies. This focus group project evaluated VHA IM residency site directors' perspectives about providing addiction medical education within VHA IM training sites. To better understand the current state, barriers to, and facilitators of IM resident addiction medicine training at VHA sites. This was a qualitative evaluation based on semi-structured video-based focus groups. Participants were VHA IM site directors based at a VHA hospital or clinic throughout the USA. Focus groups were conducted using a semi-structured group interview guide. Two investigators coded each focus group independently, then met to create a final adjudicated coding scheme. Thematic analysis was used to identify key themes. Forty-three participants from 38 VHA sites participated in four focus groups (average size: 11 participants). Six themes were identified within four pre-defined categories. Current state of training: most VHA sites offered no formal training in addiction medicine for IM residents. Barriers: addiction experts are often located outside of IM settings, and ACGME requirements were non-specific. Facilitators: clinical champions help support addiction training. Desired next steps: participants desired incentives to train or hire local champions and a pre-packaged didactic curriculum. Developing competent clinical champions and leveraging VHA addiction specialists from non-IM settings would create more addiction training opportunities for IM trainees at VHA sites. These insights can likely be applied to IM training at non-VHA sites.

Customised knowledge-sharing platform to foster resident quality improvement activities, tracking and scholarship

IntroductionMeeting accreditation requirements to train resident physicians in quality improvement (QI) may require more than education. Barriers to resident QI engagement underscore the need to demonstrate the impact and value...

Impacts of resident physician unionization on house staff compensation.

Physicians-in-training in the United States work long hours for relatively low wages. In response to increased economic burden, the popularity of unionization in residency training programs has increased dramatically. In this study, we conducted a cross-sectional investigation of the association between unionization status and Internal Medicine PGY-1 compensation and benefits. We compiled residency salary and benefits data from all Internal Medicine residency training programs in the United States. Using a mixed effects modeling approach, we evaluated the differences in salary and total compensation while adjusting for regional factors and cost-of-living differences. In aggregate, PGY-1 salary was higher for unionized vs. non-unionized programs ($69648 vs. $62214; [95% CI 670.7-3563.7]). However, there was no difference after adjusting for cost-of-living ($62515 vs $62475; [95% CI. -1317.5, 1299.7]). Unionized programs do however offer greater monetary benefits in the form of stipend disbursements, and total compensation is higher in unionized vs. non-unionized residency programs ($65887 vs $63515; [95% CI 607.6, 3551.5]). Unionized residency programs offer higher total compensation packages than their non-unionized counterparts. This increase in compensation is driven in large part by an increased variety and amount of stipend disbursement.

An internal medicine residency preparatory curriculum for fourth-year medical students.

Intern preparation courses are often broad in scope; there are few published specialty-specific programs outside of General Surgery and Obstetrics. We designed an internal medicine (IM) residency preparatory course at the University of Maryland School of Medicine, which aimed to prepare graduating medical students for the rigours of IM residency training, mapped to Entrustable Professional Activities (EPAs). Fourteen fourth-year medical students who were matriculating into IM residency programs enrolled in a 4-week long residency preparation course. The course was designed to teach skills using case-based learning modules, specialty topic seminars, simulation laboratories, procedure laboratories and clinical practice. Participants were surveyed before and after the course on their perceived knowledge and ability with the skills tested. With the exception of 'giving signout to a colleague', there was a significant difference in the participant's perceived ability for each skill taught within the course (P< 0.03 for each), with mean pre-course scores of 1.4-3.7 (SD=0.5-1.2) and mean post-course scores of 3.2-4.2 (SD=0.5-1.3). A second survey on course evaluation and perceived impact, completed 3months after starting intern year, resulted in all respondents reporting that the information learned during the course had directly affected their care of patients on a daily or weekly basis. The modified Ottawa scale was the primary assessment means for the EPAs, with participants approaching entrustment at the conclusion of the course. Implementation of an IM-specific residency preparation course is a useful adjunct in the fourth year of medical school.

Neurophobia among medical students and resident trainees in a tertiary comprehensive hospital in China

sBackgroundMedical students and residents have been revealed to have extraordinary difficulties in managing patients with neurological complaints. However, specific information on Chinese trainees is scarce. Herein, we aimed to uncover the presence of, contributing factors for, and potential solutions to neurophobia among medical students and resident trainees in China.MethodsQuestionnaires were administered to the medical students of Peking Union Medical College and residents of the Internal Medicine Residency Training Program at Peking Union Medical College Hospital. We asked about perceived difficulty, knowledge, interest, and confidence in neurology in contrast to six other specialties. The reasons why neurology is regarded as difficult and approaches for improving neurological teaching have been appraised.ResultsA total of 351 surveys were completed by 218 medical students and 133 residents. The response rate exceeded 70% in both groups. The prevalence of neurophobia was 66.1% and 58.6% among medical students and residents, respectively. Respondents declared that greater difficulty was observed in neurology than in other specialties, and the management of patients with neurological problems was the least comfortable (p < 0.0001). Neurophobia has various perceived causes, and neuroanatomy is regarded as the most important contributor. Nearly 80% of medical students felt that improvements in neurology teaching could be achieved through further integration of preclinical and clinical neurological teaching.ConclusionsThe findings of the first survey on neurophobia in China are in accordance with those of previous studies. Neurophobia is highly prevalent in Chinese medical students and residents. Strategies to improve teaching, including enhanced integration of teaching and more online resources, are needed to prevent neurophobia.

THU006 Exploring Primary Care Resident Perspectives On Diabetes Education In Training

Abstract Disclosure: N. Francis: None. S. Cardillo: None. D.R. Nandiwada: None. Background: The training residents gain in Family Medicine (FM) and Internal Medicine (IM) residency programs provide a critical foundation for their knowledge in diabetes (DM) management. It is one of the most common diagnoses physicians-in-training will encounter in their residency training programs and in clinical settings. However, a 2012 study compared diabetes care in resident clinics versus private physicians and found significant decrease in patient satisfaction (56.5% vs. 71.3%) in resident clinics. A 2020 study surveying primary care (PC) residency program directors showed that most FM and IM residency training programs focus on the core diabetes care and management topics with much less focus on emerging topics, such as 2nd generation insulin analogs and digital health technologies. The purpose of our survey was to better assess current resident perceptions and attitudes towards their DM education and their perceived comfort level in comprehensive DM counseling, evaluation, and management. Methods: A 12 item survey was designed using the Qualtrics program. The survey link was sent via email to IM- PC and FM residents at a major academic medical center. Data was collected from September 13th, 2022 to present. The survey included a combination of multiple choice, Likert scale and ranking questions. Results: 14 residents responded to the survey to date with the majority (71%) belonging to the IM-PC group and the remainder (29%) family medicine. Residents felt most comfortable managing diabetes related complications and counseling on foot and eye care and hypoglycemia. Respondents reported being most uncomfortable in prescribing non-insulin medication (50%) and initiating an insulin regimen (43%) and less comfortable counseling patients on continuous glucose monitoring systems (83%) and insulin administration (66%). While majority of residents (72%) found their DM curriculum clinically relevant, 85% of residents reported there was not enough time allotted. Respondents felt a more longitudinal lecture series, with increased access to treatment frameworks and on-site feedback on their DM counseling and care would best supplement their DM curriculum. Conclusion: This survey data explores specific areas that residents have identified as being least comfortable and also expresses what they identified as the most preferable ways to modify and design an educational intervention. This information allows for tailored curricular intervention highlighting diabetes technologies, insulin and non-insulin prescribing practice in a longitudinal lecture style format that provides access to DM treatment frameworks and incorporates direct on-site feedback to the residents. This provides evidence for the development of a novel clinically integrated DM curriculum. Presentation: Thursday, June 15, 2023

Educational supervision in internal medicine residency training – a scoping review

BackgroundAlthough supervision is an important part of residency training, its scope and how it relates to other types of support, such as mentoring, precepting and feedback, remain unclear. While clinical supervision consists of ongoing instructions and feedback in the workplace setting, educational supervision is a formalized component of postgraduate medical educational and supports the process that facilitates a trainee’s progression throughout their training. Since medical specialties have different supervisory traditions, this study focuses on educational supervision in internal medicine. Our aim was to investigate what is known about educational supervision practices in internal medicine and the role of educational supervision in supporting residents’ learning.MethodsWe conducted a scoping review of the literature on educational supervision in residency training in internal medicine based on Levac et al.’s modification of Arksey and O’Malley’s six-step framework. The literature search was performed in the following databases: Medline, Embase, Web of Science and the Educational Resources Information Center. In addition, we conducted a handsearch in Medical Teacher and Google Scholar. We followed the PRISMA guidelines for systematic research.ResultsEighteen of the 3,284 identified articles were included in the analysis. We found few empirical studies describing how educational supervision is conducted and what effect routine educational supervision has on residents’ learning. Our findings suggest that the terminology can be confusing and that educational supervision practices in internal medicine has a weak theoretical foundation.ConclusionThe distinction between educational supervision and other support structures, such as mentoring and feedback, has not been clearly defined in the research literature. We argue that shared terminology is needed to better understand current educational practices and to facilitate clear communication about how to help residents learn.

Point-of-Care Ultrasound Overview and Curriculum Implementation in Internal Medicine Residency Training Programs in the United States.

Point-of-care ultrasonography (POCUS) augments physical examination and expedites diagnostic care and clinical decision-making. The use of POCUS in internal medicine (IM) appears inconsistent despite its commendable benefits. It is not fully incorporated into the IM residency core competency skills or academic curriculum. This narrative literature review explores the benefits of POCUS and evaluates the need for an IM-focused POCUS curriculum. The obstacles and a proposed curriculum are also described.

Internal medicine intern performance on the gastrointestinal physical exam.

The gastrointestinal (GI) physical exam provides critical information about underlying disease states. However, since assessment of physical examination skills is rarely conducted as part of internal medicine residency training, little is known about resident performance on the GI physical exam. During a clinical skills assessment that took place between November 2019 and February 2020, internal medicine interns examined the same patient with chronic liver disease while being observed by faculty preceptors. We compared the exam maneuvers performed with those expected by the faculty evaluators. We noted which maneuvers were performed incorrectly, whether physical exam technique correlated with identification of physical exam findings, and if performance on the physical exam was associated with building an appropriate differential diagnosis. This four-hour assessment was required for internal medicine interns within two different residency programs in the Baltimore area. More than half of the 29 participating interns (n=17, 58.6 %) received a "needs improvement" score on their physical exam technique. Technique was highly correlated with identifying the correct physical signs (r=0.88, p<0.0001). The most commonly excluded maneuvers were assessing for splenomegaly and hepatomegaly. The most commonly missed findings were splenomegaly and hepatomegaly. Most interns included chronic liver disease as part of their differential diagnosis even if they received "needs improvement" scores on physical exam technique or identifying physical signs. Internal medicine interns would benefit from learning an organized approach to the gastrointestinal exam. This would likely lead to increased identification of important gastrointestinal findings.

Editorial introductions.

Editorial introductions.

The Morning Report Practice and Its Contribution to Education of Internal Medicine Residents: A Multicenter Cross-Sectional Survey in the Eastern Province, Saudi Arabia.

Morning Report (MR) is a ubiquitous traditional educational activity in internal medicine residency training. It is under-researched; hence, this study was conducted. It aimed to examine the practice of MR by internal medicine residents, their motivation to engage with it, and their perception of its contribution to education. This was a multi-center cross-sectional study. The data was collected using an online self-administered 12-item questionnaire that covered MR practice, respondents' motivation for participation, MR contribution to education, and its impact on the practice of evidence-based medicine and quality improvement and patient safety. One hundred seventy residents returned the online questionnaire (54.7%). The respondents' gender and year of training were balanced (P > 0.05). The most common MR frequency and duration were five days per week (85.4%) and 45-60 minutes (47.1%), respectively. The most common format was handover combined with an emergency long case presentation (55.8%), and consultants were the most common facilitators (79.7%). The respondents' motivation to engage with MR was predominantly intermediate. The top reasons for attending and not attending MR were mandatory attendance and embarrassing questions, respectively. The perceived MR contribution to residents' different roles development was predominantly intermediate; however, it was predominantly very low/low (42%) for overall education. The perceived MR impact on the practice of EBM and QIPS were both predominantly intermediate. MR was found to be a commonly practiced educational activity in internal medicine residency training programs in the eastern province of Saudi Arabia. The case discussion was the core format for education. The respondents' motivation to participate in MR and their perception of its contribution to education was predominantly intermediate. To our best knowledge, this is the first study in Saudi Arabia that examined MR. We hope its findings will be taken for further MR studies and actions for improvement.

Meet the First Authors.

Meet the First Authors.

Comparison of internal medicine applicant and resident characteristics with performance on ACGME milestones

ABSTRACT Internal medicine (IM) residency programs select applicants based on several metrics. Factors predicting success during residency are unclear across studies. To identify whether specific applicant or resident factors are associated with IM resident performance using ACGME milestones. We tested for associations between applicant factors available prior to the start of IM residency and resident factors measured during IM residency training, and resident performance on ACGME milestones across three consecutive years of IM training between 2015-2020. Univariable and multivariable linear regression modeling was used to test associations. Eighty-nine categorical IM residents that completed 3 consecutive years of training were included. Median age was 28 years (IQR 27-29) and 59.6% were male. Mean ACGME milestone scores increased with each post-graduate year (PGY) from 3.36 (SD 0.19) for PGY-1, to 3.80 (SD 0.15) for PGY-2, to 4.14 (SD 0.15) for PGY-3. Univariable modeling suggested referral to the clinical competency committee (CCC) for professionalism concerns was negatively associated with resident performance during each PGY. No applicant or resident factors included in the final multivariable regression models (age at starting residency, USMLE Step scores, interview score, rank list position, ITE scores) were associated with ACGME milestone scores for PGY-1 and PGY-2. Referral to the CCC for professionalism was negatively associated with resident performance during PGY-3. Residency selection factors did not predict resident milestone evaluation scores. Referral to the CCC was associated with significantly worse resident evaluation scores, suggesting professionalism may correlate with clinical performance.

Application and evaluation of Flipped Teaching based on Video Conference in standardized training for internal medicine residents.

In view of the importance of infectious diseases in public health, Shanghai Municipal Health Commission designated a hospital ("Designated Hospital") to carry out infectious diseases training for internal medicine residents in those hospitals ("Dispatching Hospitals") that didn't have an infectious disease ward or could not meet the training standards of infectious diseases. I aimed to explore Flipped Teaching with Video Conference as the carrier in infectious diseases training for internal medicine residents, to make up for the lack of actual training time of the Department of Infectious Diseases for those residents caused by subjective or objective reasons, and to ensure the smooth implementation and quality assurance of infectious diseases training for those residents. Vertical management mode was adopted, management and lecture teams were established, and training program and teaching implementation were formulated. Flipped Teaching based on Video Conference was carried out for internal medicine residents of Dispatching Hospitals who planned to participate in infectious diseases training of the Designated Hospital in April. The quantitative analysis was applied to this teaching evaluation, and the evaluation indexes were included into statistical analysis to evaluate the effect of the teaching model. All 19-member internal medicine residents participated in the Flipped Teaching based on Video Conference from April 1 to 4, of which 12 residents were scheduled to participate in infectious diseases training from March 1 to April 30, and 7 residents were scheduled to participate in infectious diseases training from April 1 to May 31 in the Designated Hospital. A management team of 6 internal medicine residents was built, and a lecture team was composed of 12 internal medicine residents who were scheduled to receive infectious diseases training in the Designated Hospital from March 1 to April 30. According to the training requirements in the Department of Infectious Diseases, 12 contents were selected to be taught, and implementation rate of the teaching plan was over 90%. A total of 197 feedback questionnaires were collected. The feedback that the teaching quality was "good" and "very good" accounted for more than 96%, and the attendance rate of the whole teaching process reached more than 94%. Six internal medicine residents put forward 18 "Improvement suggestions", accounting for 9.1%; and 11 internal medicine residents gave 110 suggestions of "Praise highlights", accounting for 55.8%. The overall evaluation feedback of Flipped Teaching was good, P<0.001. Flipped Teaching based on Video Conference was generally effective in delivering lectures and learning for internal medicine residents participating in the infectious diseases training, and it could be used as a supplementary training method for standardized training of internal medicine residents to make up for the shortage of actual training period in a certain stage.

Implementing case-based collaborative learning curriculum via webinar in internal medicine residency training: A single-center experience.

This study aimed to investigate the effects of the Case-based collaborative learning (CBCL) curriculum in webinar format on internal medicine residents' knowledge covering cardiologic topics and their attitudes toward the CBCL teaching module. CBCL is a novel small-group approach, that incorporates elements of problem-based learning and case-based learning, and it has shown to improve medical students' knowledge mastery. However, few studies have explored its applicability for internal medicine residents, especially in the webinar format. This prospective cohort study included internal medicine residents in a residency program in Beijing, China. Eight CBCL sessions in webinar format covering cardiologic topics were delivered to them from February to April 2020. Pre-session reading materials included textbook and guidelines published by the academic societies. Multiple-choice questions were delivered to assess participants' knowledge before and after the sessions. Changes in participants' knowledge were determined using the paired t test to compare mean values. In addition, surveys based on 5-point Likert scale scores assessed satisfaction at the end of the second and eighth sessions. The Wilcoxon signed-rank test was used to identify any potential satisfaction improvement. In total, 9 internal medicine residents participated in the study, of whom 33.3% were male, and the overall rate of participation in CBCL sessions in webinar format was 94.4%. The mean scores of 50 multiple-choice questions were 68.0 ± 12.3 and 75.1 ± 9.9 in the pre- and post-curriculum assessments (P = .029). In the first survey performed at the second week, 5 (55.6%) residents chose "like" or "extremely like" in overall satisfaction, "neutral" by 3 (33.3%) residents and "dislike" by 1 (11.1%) resident. In the second survey, only 1 (11.1%) resident selected a neutral reply in satisfactory assessment, and the other 8 (88.9%) residents selected either "like" or "extremely like" choices. Compared with the results of the first survey, the overall satisfaction rate significantly improved (P = .031). Implementing the CBCL sessions in webinar format for cardiology residents was resulted in the improved knowledge mastery and a high acceptance rate.

Embracing our responsibility to ensure trainee competency.

Embracing our responsibility to ensure trainee competency.