Residency Training Research Articles

Entrepreneurship-Based Economic Potential Development in Mekarsari Village, Cibalong District, Garut Regency

Mekarsari Village, Cibalong District, Garut Regency. Mekarsari Village has a variety of local economic potential that can be utilized to improve the standard of living and welfare of the local community. To make this happen, targeted and sustainable strategic steps are needed. In this article, we identify the economic potential that exists in Mekarsari Village, including natural resources, local expertise, superior products, and market opportunities that can be used as a basis for entrepreneurial activities. Additionally, this article outlines concrete steps that can be taken to encourage entrepreneurial growth in the region. Some of the steps proposed include training and entrepreneurship development programs for village residents, intensive assistance and guidance in the initial stages of business establishment, as well as the formation of cooperatives or joint business groups to strengthen their bargaining position and expand market access. Product diversification, innovation, and effective promotion and marketing are also important parts of the entrepreneurship-based economic development strategy in Mekarsari Village. This service also highlights the importance of collaboration with external parties, such as government agencies, research institutions, universities and private companies, as a means of supporting economic development at the local level. In this context, financial management and accountability are also important factors that need to be considered in order to maintain sustainability and sustainable business growth. Through these structured steps and approaches, it is hoped that this article can provide guidance and inspiration for stakeholders to jointly contribute to advancing the local economy in Mekarsari Village, creating new jobs, and improving the quality of life of the community as a whole.

Assessing the quality and standards of operative notes in general surgery; A teaching institute's experience in Pakistan.

To evaluate the quality and standard of hand-written operative notes in a teaching institute. This prospective study was carried out in the department of surgery, Fatima Hospital, Baqai Medical University, from January 2023 till May 2023. One hundred fifty operative notes from general surgery domain were considered. These notes were evaluated according to the guidelines of Royal College of Surgeons, with added-on a few variables by the author. All 150 notes were handwritten. Resident surgeon wrote the operative notes under the supervision of primary surgeon. There was a deficiency in mentioning medical record number, procedure starting time and duration of surgery. An important statement about the hemostasis is that it is secured-per-operatively was not documented. The residents were reluctant to explain the surgical procedures diagrammatically. The operative room number was missing in all notes. Post operative instructions lacked the information for nothing per oral, blood pressure, temperature, pulse rate, and input and output charting. It is observed that the operative surgical notes were however explainable about the procedure, but quality and standard was not matchable with that of Royal College of Surgeons notes. Hence, a lack of formal training for the resident surgeons in operative notes writing was observed. This study is a thought provoker to the surgeons and a guide to resident trainees, and hospital management to provide a handful operative notes writing theme in the form of performa provided in the department.

Therapeutic impact of basic critical care echocardiography performed by residents after limited training

BackgroundThe objective was to assess the agreement between therapeutic proposals derived from basic critical care echocardiography performed by novice operators in ultrasonography after a limited training (residents) and by experts considered as reference. Secondary objectives were to assess the agreement between operators’ answers to simple clinical questions and the concordance between basic two-dimensional measurements.MethodsThis observational, prospective, single-center study was conducted over a 3-year period in a medical-surgical intensive care unit. Adult patients with acute circulatory and/or respiratory failure requiring a transthoracic echocardiography (TTE) examination were studied. In each patient, a TTE was performed by a resident novice in ultrasonography after a short training program and by an expert, independently but within 1 h and in random order. Each operator addressed standardized simple clinical questions and subsequently proposed a therapeutic strategy based on a predefined algorithm.ResultsResidents performed an average of 33 TTE studies in 244 patients (156 men; age: 63 years [52–74]; SAPS2: 45 [34–59]; 182 (75%) mechanically ventilated). Agreement between the therapeutic proposals of residents and experienced operators was good-to-excellent. The concordance was excellent for suggesting fluid loading, inotrope or vasopressor support (all Kappa values > 0.80). Inter-observer agreement was only moderate when considering the indication of negative fluid balance (Kappa: 0.65; 95% CI 0.50–0.80), since residents proposed diuretics in 23 patients (9.5%) while their counterparts had the same suggestion in 35 patients (14.4%). Overall agreement of responses to simple clinical questions was also good-to-excellent. Intraclass correlation coefficient exceeded 0.75 for measurement of ventricular and inferior vena cava size.ConclusionsA limited training program aiming at acquiring the basic level in critical care echocardiography enables ICU residents novice in ultrasonography to propose therapeutic interventions with a good-to-excellent agreement with experienced operators.

Cosmetic Gynecology: Is There Enough Exposure in the Obstetrics and Gynecology Residency?

Introduction While cosmetic gynecology has gained popularity, the training experience for obstetrics and gynecology residents in this area is limited and not standardized. The primary objective was to investigate the exposure of obstetrics and gynecology residents to cosmetic gynecologic procedures including hymenoplasty, labia majora reduction, vaginoplasty, G-spot amplification, labiaplasty, clitoral hood reduction, and vaginal laser therapy. The secondary objective was to assess their comfort in performing the procedures after graduation. Methods This is a non-validated cross-sectional survey of obstetrics and gynecology residents and their exposure to cosmetic gynecology procedures. Using the Fellowship and Residency Electronic Interactive Database Access System, the Accreditation Council for Graduate Medical Education-accredited Obstetrics and Gynecology residency programs in the United States were identified, and the residency program coordinators were asked to distribute the survey. Data regarding demographics, program-specific characteristics, and exposure to certain cosmetic gynecology procedures were obtained and reviewed. Participants' reported comfort with the independent practice of certain cosmetic gynecology procedures after graduation was also obtained. Descriptive statistics were completed. Results A total of 96 responses were received. Approximately 50% of participants were exposed to cosmetic gynecology during training. Moreover, 70.9% of residents disagreed that they would feel confident in defining the included procedures. Furthermore, 87.5% disagreed that they would feel comfortable performing the procedures independently. A minority of participants were also unsure of the indication for cosmetic gynecology procedures, with 15.4%, 7.1%, 5.7%, and 4% unaware of the surgical indication for hymenoplasty, vaginoplasty, labiaplasty, and labia majora reduction, respectively. No participant knew the indication of surgery for vaginal laser therapy or clitoral hood reduction. Conclusions In the setting of current cosmetic gynecology training, nearly 90% of residents were not comfortable with these surgeries after graduation. Exposure to cosmetic gynecology for obstetrics and gynecology residents was limited. Without adequate exposure, residents may face difficulty performing procedures and managing complications after graduation. Therefore, standardizing resident training for cosmetic gynecology should be considered.

Collective Strategies to Equip Graduating Medical Students from Racial/Ethnic Backgrounds Underrepresented in Medicine to Succeed in Residency

Phenomenon: Trainees from racial/ethnic backgrounds underrepresented in medicine (RE URiM) in the United States face challenges of racism and micro- and macro-aggressions during residency. Many have learned to navigate these challenges through successes and failures, but there is insufficient literature providing these lessons to graduating URiM medical students. Our study among medical school alumni explores strategies to help graduating URiM students prepare for success in residency. Approach: We conducted an online cross-sectional survey (Qualtrics) from February to March 2022. Graduates from a Northeast U.S. medical school identifying as URiM were invited to participate. With emphasis on “thriving” in residency training, we solicited rating-scale responses on preparedness for residency and open-text responses on strategies for success. Standard statistical and text content analysis were used to determine findings and themes. We used Word Cloud technology to further explore word frequency and patterns. Findings: Of the 43 alumni contacted, 23 (53%) completed the survey. Participants were trained in various specialties. We identified three themes with regard to strategies for thriving in residency: (1) importance of identifying and seeking early mentorship; (2) importance of identifying and having diverse forms of support; and (3) need for more education on navigating macro/microaggressions. Insight: While advocating for systems-level interventions to create inclusive learning environments, we highlight the gap in trainee awareness of the importance of seeking early mentorship. Our study provides strategies for graduating URiM medical students to succeed in residency based on respondent experiences. These recommendations should inform medical school curricula.

Sex Diversity and Equity Among Fellows of the American Orthopaedic Association.

We hypothesized that women are underrepresented among fellows of the American Orthopaedic Association (AOA) relative to their prevalence among faculty at departments of orthopaedic surgery. Clinical faculty at departments of orthopaedic surgery that are affiliated with residency training programs were analyzed for AOA membership. Participation-to-prevalence ratios (PPRs) were calculated for men and women with AOA membership relative to their prevalence among orthopaedic surgeon faculty. A PPR of <0.8 or >1.2 indicated under- or overrepresentation, respectively. PPR values between 0.8 and 1.2 indicated equivalent representation. Sex disparities in AOA membership were explored by academic rank and orthopaedic subspecialty. There were 4,310 orthopaedic surgery faculty, and 998 (23.2%) had AOA membership. Overall, women formed the minority of members in the AOA study cohort (11.4%), but they had equivalent representation relative to their prevalence among faculty (10.0%, PPR = 1.14, p = 0.210). In the AOA study cohort, women were the minority at each academic rank, including assistant professor (20.2% versus 79.8%, p < 0.001), associate professor (16.8% versus 83.2%, p < 0.001), and full professor (7.0% versus 93.0%, p < 0.001). However, women had greater representation in the AOA study cohort at each academic rank than would be expected based on their prevalence among faculty, including the assistant (PPR = 1.45), associate (PPR = 1.56), and full (PPR = 1.27) professor levels. Similarly, in the AOA study cohort, women were the minority in each orthopaedic subspecialty, but were only underrepresented in pediatric orthopaedics (PPR = 0.74). Women had greater representation in the AOA study cohort than would be expected by their prevalence among faculty in hand surgery (PPR = 1.51) and orthopaedic sports medicine (PPR = 1.33). In contrast, men had equivalent representation in each orthopaedic subspecialty. Women form a minority group in the AOA, but they exhibit greater representation in the AOA than would be expected based on their prevalence among faculty at each academic rank, and they have greater representation than men, who exhibit equivalent representation across all academic ranks. Collectively, these results disproved our hypothesis, and suggest that women are participating in the AOA at rates that are greater than their prevalence among faculty. Equitable participation of women in orthopaedic surgery is necessary to promote diversity and inclusion in the specialty. The AOA may be an important catalyst for future positive diversity and inclusion efforts within orthopaedic surgery.

Medical training program size and clinical staff productivity and turnover.

The objective of this analysis was to evaluate the effect of resident program training size on clinician productivity and turnover in the Veterans Health Administration (VHA), the largest education and training platform for medical professionals in the United States. We retrieved administrative data on training programs and training facilities from the VA Office of Academic Affiliations and the VHA Corporate Data Warehouse. Data on primary care physician shortage areas were retrieved from the Health Resources and Services Administration. We used a quasi-experimental instrumental variables 2SLS design and constructed an exogenous predicted training allocation treatment variable as a function of the total national training program allocation. The outcome was clinical staff productivity and turnover. Secondary analyses stratified results using Health Professional Shortage Areas data (HPSA). Data were obtained for a national dataset of 141 VHA medical facilities and 26 specialties that hosted training programs across 11 years from 2011 to 2021 (N = 132,177). Instrumental variables results showed that on average, an increase of one training slot in a specialty leads to a decrease of 0.039 visits per standardized clinic day (p < 0.001) and a 0.02 percentage point increase in turnover (p < 0.001). The direction of this association varied by specialty: while psychiatry and psychology specialties saw a decline in productivity, fields such as primary care and cardiology experienced an increase in productivity. HPSA stratified results indicate that negative effects on productivity and turnover are driven by areas with little to no primary care physician shortage, whereas shortage areas experienced a small increase in productivity and no effect on turnover. This quasi-experimental evaluation indicates that resident training program size is associated with reduced productivity and increased turnover in specialties such as psychiatry and in facilities with high baseline productivity. However, in specialties like primary care and cardiology, as well as areas with shortages of primary care, larger training programs are associated with increased productivity.

Evaluation of the impact of short term manual small incision cataract surgery (MSICS) training program on trainees with varying prior surgical experience using international council of ophthalmology-ophthalmology surgical competency assessment rubrics (ICO-OSCAR).

To assess the learning curve of MSICS in three different groups of trainees with varying prior MSICS experience. To evaluate the effectiveness of ICO OSCAR for objective assessment of surgical skill transfer. Ninety-five MSICS trainees were divided into three groups as 1st year resident, fellow and external trainee. Each group were evaluated for their surgical skill acquisition during one month MSICS training program using ICO-OSCAR. Each trainee performed an average of 19 surgeries. The progress in the learning curve of the three groups of trainees was analyzed by evaluating the mean scores in sets of five consecutive cases. Complications during the training period were also noted. The study evaluated a total of 1842 cases. The fellows and external trainees, with prior MSICS experience, had an initial mean score of 57.57 ± 16.16 and 56.86 ± 17.82 respectively, whereas the 1st year resident group had a relatively low initial mean score of 45.91(p = 0.009). The difference in mean scores between the 1st year resident group and other groups significantly reduced towards the end of training. The most common complications made by 1st year residents were in sclero-corneal tunnel construction. The external trainee group had statistically significant higher rates of zonular dialysis in the study. ICO-OSCAR is an effective tool for assessing MSICS training program. Structured short term MSICS surgical training program is effective in surgical skill transfer, especially in novice surgeons.

Educational perspectives in cardiothoracic anesthesia in the United States using a survey of educators and learners.

Cardiothoracic anesthesiology training presents learners with unique challenges, procedural skills, and the management of high-intensity critical scenarios. An effective relationship between educator and learner can serve as the backbone for effective learning, which is crucial for the development of budding anesthesiologists. Strengthening this educational alliance between teachers and trainees involves understanding the educational values educators and learners find most important to their learning experiences. This study aimed to identify the key educational values related to cardiothoracic anesthesia for both learners and educators. By identifying these values in separate cohorts (learners and educators), the importance of various educational values can be examined and compared between the trainees and teachers. Two separate surveys (one for learners and one for teachers) were adapted from the Pratt and Collins Teaching Perspectives Inventory to establish the importance of various educational values related to cardiothoracic anesthesia. Surveys were sent to 165 Accreditation Council for Graduate Medical Education-accredited anesthesiology residency training programs in the United States to trainees (residents and cardiothoracic anesthesiology fellows) and educators (board-certified cardiothoracic anesthesiologists). Analysis of survey results from 19 educators and 57 learners revealed no statistical differences across the two groups, except Q15: "Let trainee perform critical technical steps" (P value = 0.02). While learners and educators in cardiothoracic anesthesia hold similar values regarding cardiac anesthesia education, they differ in the degree to which critical technical steps should be performed by learners.

Application in Parallel to U.S. Residency Training Programs in Multiple Specialties: Trends and Differences by Applicant Educational Background, 2009-2021.

The medical education community is pursuing reforms addressing unsustainable growth in the number of residency applications per applicant and application costs. Little research has examined the prevalence or contributions of parallel applications (application to residency in multiple specialties) to this growth. A retrospective analysis of Electronic Residency Application Service® data provided by the Association of American Medical Colleges was conducted. The percentage of applicants applying to ≥1 specialty, mean number of specialties applied, number of submitted applications, and percentage of applicants to each specialty who were parallel applying were determined. MD, DO, and international (U.S. international medical graduate [IMG] and IMG) applicants were included. The sample contained 586,246 applicant records from 459,704 unique applicants. The percentage of applicants who parallel applied decreased from 41.3% to 35.4% between 2009 and 2021. DO applicants were the only group for whom the percentage parallel applying increased (30.6% vs. 32.1%). IMG (60.4% vs. 49.1%) or USIMG applicants (69.6% vs. 63.1%) were groups with the greatest percentage of applicants parallel applying each year (2009-2021). The mean number of specialties applied to when parallel applying also decreased from 2.96 in 2009 to 2.79 in 2021, overall. Between 2009 and 2021, mean number of applications increased for all applicant types amongst both single-specialty applicant and parallel-applying applicants. Among applicants who were single-specialty applying, mean number of applications grew from 38.6 in 2009 to 74.6 in 2021 and from 95.2 to 149.8 for parallel-applying applicants. All applicant groups experienced decreases in percentages parallel applying except for DO applicants. Parallel application appears to be common and slowly declining, and does not appear to significantly contribute to increasing numbers of applications per candidate. Efforts to control the growth of applications per applicant should continue to focus on applicants' numbers of applications submitted to each specialty.

Roadmap for Research and Scholarship in General Surgery Residency Training: Report of The Research Subcommittee of Blue Ribbon Committee II on Surgical Education and Training.

To review the current state of research training during surgical residency and make recommendations commensurate with current surgical training and academic environment. Research training has been a mainstay of academic surgical programs, yet the scientific disciplines have evolved significantly from the traditional years of bench research. It is time to reconsider how research training should prepare surgeons for future academic practice and ensure the foundational knowledge of research evidence. As part of the Blue Ribbon Committee II, a research subcommittee was tasked to make recommendations on research training during surgical residency. Our eight-member panel brought diverse perspectives of the roles and goals of research training. We also sought input from a convenience sample of current and recent surgical residents on impact of research training during their residency. We identified a lack of a common framework and foundational research training for all surgical residents. Participation in dedicated years of scholarly activity helped trainees meet several professional and personal goals. The lack of an integrated, dedicated research track may dissuade some medical school graduates from pursuing surgery. We recommend incorporating a minimum standard for all trainees and flexibility in dedicated scholarly training to meet the needs of future academic surgeons.

Which obstetrics-gynecology residency programs are training future reproductive endocrinology and infertility fellows? An observational study

To identify where reproductive endocrinology and infertility (REI) fellows trained for residency. Observational, cross-sectional study. Not applicable. Reproductive endocrinology and infertility fellows. Not applicable. Percentage of fellows who completed residency training at an institution with an REI fellowship program. A total of 289 fellows were identified among the graduating fellowship classes from 2023-2027. Of those fellows, 69.9% completed residency at an institution that had an associated REI fellowship program, and 19.7% remained at the same institution for residency and fellowship. In the last 5 years, 34.4% of obstetrics and gynecology residency programs have had at least 1 resident enter REI fellowship. Most matriculated REI fellow physicians train at residency programs that have an associated REI fellowship program.

Utilizing neuroimaging visualization technology to enhance standardized neurosurgical training for Traditional Chinese Medicine residents: A neuroanatomical education study

ObjectiveThis study aims to address the difficulties encountered by Traditional Chinese Medicine (TCM) students in learning neuroanatomy during clinical training by utilizing neuroimaging visualization technology. Methods81 students were divided into a control group (40 students) and an observation group (41 students). The control group followed traditional teaching methods as prescribed by the curriculum, while the observation group received additional training with the neuroimaging visualization software DSI Studio. This included whole-brain neural fiber reconstruction and cortical spinal tract evaluation in the context of stroke. Upon completion of the training, both groups were assessed on neuroanatomical theory, case analysis, neurological examination, and clinical skills. The teaching effectiveness was compared based on assessment results and feedback from questionnaires administered to the observation group. ResultsThe observation group significantly outperformed the control group in theoretical knowledge, case analysis, and physical examination (P < 0.05). Over 90 % of students in the observation group reported via questionnaire that the integration of neuroimaging visualization technology significantly enhanced their understanding of neuroanatomy and clinical reasoning skills. ConclusionThe clinical teaching approach augmented with neuroimaging visualization technology significantly improves the standardized training outcomes for TCM neurosurgical residents.

Rural Surgery Preparedness After Graduation From a Surgical Residency.

General surgeons in rural communities face unique challenges due to broad scopes of practice with limited support and difficulties providing training. In 1998, this academic medical center initiated a rural program consisting of senior level rotations in rural communities. We surveyed past residents to determine scope of practice, level of preparedness, and recommendations. The survey was sent to n = 89 residents and n = 34 surveys were completed. Of those, 85% took part in the rural program, 23.5% practice in a zip code defined as rural by HRSA, and 53% had fellowship training most commonly vascular (n = 5), critical care (n = 5), cardiothoracic (n = 3), and MIS (n = 3). Most common procedures reported were MIS (64.7%), vascular (38.2%), cardiothoracic (26.5%), hepatobiliary (23.5%), and pediatric (23.5%). Over 97% of participants were satisfied/very satisfied with their overall program, and 94% were satisfied/very satisfied with their preparedness for rural surgery. When prompted with, "A general surgery program must have some type of rural specific specialized curriculum and extended rotations to facilitate a career path in rural general surgery," 41.2% responded strongly agree, 47.1% agree, and 11.8% neutral. Recommendations for bolstering a rural program included urology (59%), MIS (59%), vascular (56%), OBGYN (47%), and pediatrics (38%). Regarding non-surgical education, residents felt underprepared for billing (79.4%) and administration (50.0%). Although satisfaction scores were high, improvements to better prepare surgeons for rural practice include increasing residents' exposure and training in OBGYN, MIS, vascular, urology, and billing and administration. These results should direct programs to prepare surgeons for effective rural practice.

Real-time surgical simulation training for recurrent laryngeal nerve and facial nerve dissection

BackgroundHead and neck surgical simulation training (SST) is an important part in otolaryngology head and neck surgical education. In this study, we provide a live porcine model for SST in recurrent laryngeal nerve (RLN) and facial nerve (FN) dissection for otolaryngology head and neck residents. MethodsA lecture with surgical manual is provided to illustrate the surgical landmarks of pig, and step-by-step procedures for thyroid and parotid surgery, as well as neck dissection. We used 4-month-old pig weighting 32 kg for the SST. The mentor demonstrated result of RLN injury with continuous nerve monitoring. Participants used monopolar stimulation probe (4 pulse/s, 100 μs, 3-8 mA; Medtronic) to identify and intermittent monitor the RLN and FN during the SST. After the dissection course, we conducted a questionnaire survey to check the effectiveness of this training model. ResultsTotal 30 participants were recruited, including 16 female and 14 male resident doctors. There were 1, 4 and 25 learners for 3rd year, 4th and 5th years residents, respectively. Before this training course, 53 % (16/30) and 63 % (19/30) had successful experience in finding the RLN and FN, respectively. After the SST, all of our participants had successful identify the RLN and FN (p-value <0.01); all had positive response to stimulation and familiar with the procedure. ConclusionsThe live porcine model is effectiveness in SST for RLN and FN dissection. Live porcine model with real-time RLN and FN monitoring should be provided for otolaryngology head and neck resident training.

Psychological and pedagogical conditions for teaching residents of foreign language professional communication based on an integrated approach

Importance. Proficiency in a professional foreign language at the present stage is one of the key requirements determining competitiveness in the labor market. The formation of professional foreign-language communicative competence of medical specialists gives them access to specialized research and journals, since most of them are published exclusively in English. However, in practice, when receiving medical education in residency, the main attention is paid to the study of natural sciences, while learning a foreign language is of secondary importance. Using an integrated approach to learning, it becomes possible to organize a more effective educational process through a comprehensive study of a subject discipline and a foreign language in a single educational space. The purpose of this work is to identify the psychological and pedagogical conditions of training residents of foreign language professional communication based on an integrated approach.Research Methods. The study was conducted using theoretical and empirical methods that allow to study and analyze scientific and methodological literature on the organization of foreign language teaching based on an integrated subject-language approach. The analysis of the literature revealed certain patterns that actualize the need to comply with a number of psychological and pedagogical conditions when teaching residents of foreign language professional communication based on an integrated approach. Based on the available research, the external and internal factors underlying the psychological and pedagogical conditions aimed at optimizing the educational process were summarized.Results and Discussion. In the course of the conducted research, the following psychological and pedagogical conditions for teaching residents of foreign language professional communication based on an integrated approach were identified: 1) motivation of residents to study professional English; 2) possession of professional foreign language competence by residents at the Advanced Mid level on the ACTFL scale; 3) formation of an integrated course of professional foreign language communicative competence and competence in the field of professional communication by the teacher; 4) the methodological dominant in the educational process are professionally oriented cases.Conclusion. The process of teaching residents of foreign language professional communication is not an axiomatic phenomenon, therefore it is directly dependent on a number of psychological and pedagogical conditions. The identified psychological and pedagogical conditions are of a recommendatory nature and act as a starting point for teaching residents of foreign language professional communication based on an integrated approach. The results of the study can be used in the methodology of teaching foreign languages to medical students and residents.

Application of Mini-CEX combined with DOPS in standardized training of community outpatient residents

ObjectiveTo explore the application effect of mini clinical evaluation exercise (Mini-CEX) combined with direct observation of procedural skills (DOPS) in the standardized training of general practitioners in community clinics.MethodsFrom June 2022 to June 2023,20 general practitioners who received standardized training for residents in the general outpatient department of Changqing Community Health Service Center of Wuhan Fourth Hospital were collected as the research objects. Mini-CEX combined with DOPS was used to evaluate the general practitioners at the time of admission, 2 weeks of training and 4 weeks of training, and the results were fed back.ResultsThe scores of 20 general practitioners at 2 weeks and 4 weeks of training were compared with the scores at the time of admission, and the difference was statistically significant, p < 0.05.ConclusionMini-CEX combined with DOPS can improve the teaching effect of standardized training of residents in community general clinics.

Collaboration cognizance: Development of a self-assessment tool to measure intra-professional collaborative practices (IPCP) in postgraduate medical residents at tertiary care hospitals

BackgroundThe ever-evolving healthcare system of today demands physicians who steer their roles as treatment providers, managers and collaborators. Professionals are highly interdependent due to increased complexity of health problems and risk of errors increases with transitions in care. In hospitals, the main workforce is postgraduate residents; therefore, intraprofessional collaboration amongst residents is essential. Several instruments are available to evaluate interprofessional collaboration amongst physicians, nurses and hospital teams but none specifically assessed intra-professional collaborative practices amongst residents working in tertiary care hospitals in multi-disciplinary teams. This study intends to develop and validate an instrument to self-assess intraprofessional collaborative practices in postgraduate residents undergoing residency in multiple specialties at tertiary care hospitals.ApproachThis study on Instrument Development employed mixed method study design executed in two phases. In phase 1, six domains of intraprofessional collaborative practices were identified from literature and 35 items were developed. Fifteen experts participated in qualitative content validation and provided comments. To establish content validity in phase 2, content validity index (CVI) and content clarity average (CCA) were assessed by seventeen experts. Response process validity was established by cognitive interviewing of 5 postgraduate residents. Pilot testing was done on a sample of 407 residents. Cronbach’s alpha was determined, and confirmatory factor analysis established construct validity.ResultsDuring phase 1, items were modified based on qualitative feedback from 15 experts. In round 2, CVI and CCA were determined based on responses of 17 experts. The items having an I-CVI greater than 0.90 were accepted and six items underwent modifications as their I-CVI fell between 0.78 and 0.90. Similarly, four items with a CCA of less than 2.4 were modified to increase clarity. Cognitive interviews of participants on 30 items resulted in the deletion of 1 item and changes in 5 items. The final instrument had 29 items categorized under six constructs. All items had good factor loadings during CFA, so none was deleted. Cronbach’s Alpha α was 0.937.ConclusionIntraprofessional collaborative practices in residents is a valid and reliable self-assessment tool comprising 29 items measuring six constructs. It may be used by residents to assess their collaborative practices and incorporated in curricula to help develop collaborative practices and their assessment during training of postgraduate residents.

The argument for two-handed cataract surgery in veterinary ophthalmology.

Despite access to contemporary phacoemulsification technology and the strong shift to two-handed nucleofractis techniques in human medicine, a one-handed, single incision approach has persisted among Diplomates of the American College of Veterinary Ophthalmologists. The perpetuation of techniques such as bowl-sculpting one-handed phacoemulsification in veterinary medicine is multifactorial; it is likely associated with the lack of two-handed training in residency programs, the challenges of learning on complex cases, the ease of teaching one-handed versus two-handed techniques to a resident, and the lack of specific instrumentation available designed for larger lens size, among other factors. Additionally, variation in globe and palpebral fissure size in veterinary patients complicates the training of cataract surgery. Finally, many mentors or mentors' mentors, were trained alongside previous generations of MD surgeons who performed bowl sculpting techniques during the transition from extracapsular cataract extraction to phacoemulsification, and understandably, are not comfortable teaching a two-handed technique consistently. The authors have observed an unwillingness to convert from one-handed to two-handed technique in the post-residency career for most veterinary ophthalmologists; this could be due to the high expectations becoming a specialist, especially when the stakes are as high as in phacoemulsification. Therefore, the authors advocate for hands-on training in multiple nucleofractis techniques, including two-handed methods during residency training. Simply put, if residents are not trained and comfortable with two-handed techniques by the end of residency, they are less likely to make further changes later in their career. In this article, we aim to explore the proposed rates of one-handed versus two-handed mentors currently teaching veterinary phacoemulsification, the history of cataract surgery, and to discuss the benefits of two-handed nucleofractis techniques. The authors will also illustrate and provide videos as well as some tools for veterinary ophthalmologists wishing to learn two-handed techniques.

Practice Readiness? Trends in Chief Resident Case Logs vs Subsequent Case Log Data in Clinical Practice.

Limited information exists regarding the association between resident surgical case experience and subsequent case mix in practice. We compare the case log distribution residents completed during their chief year to those completed by these graduates in their first 2 years in independent practice. Resident chief year case logs from 10 institutions were analyzed across 4 categories of index procedures: (1) general urology, (2) endourology, (3) reconstructive urology, and (4) urologic oncology. Current Procedural Terminology codes for associated index procedures were used to query case log data during their first 2 years in practice collected by the American Board of Urology. Interactions were tested between the trends of chief year case logs relative to trends in practice case logs. Amongst 292 residents, a total of 104,827 cases were logged during chief year and 77,976 cases in the first 2 years as an attending. Most cases completed during chief year were in oncology followed by general urology, endourology, and reconstructive urology. As attendings, most cases completed were in general urology, followed by endourology, reconstructive urology, and oncology. Chief year case logs showed decreasing trends in the median number of case logs in reconstructive urology, endourology, and general urology, while case logs in independent practice noted increasing trends in all index procedure categories over time. Urology residents perform more cases during their chief year compared to their first 2 years of independent practice. Case types completed as chief residents vs subsequent clinical practice also differ significantly. These observations may have implications for residency training, particularly regarding curriculum design.