Residency Training Research Articles

Satisfaction survey on graduates of standardised training for resident doctors in Guizhou Province, China

ObjectivesThis study aimed to investigate the satisfaction levels of graduate residents in Guizhou Province and analyse the factors influencing their satisfaction.MethodsA cross-sectional survey was conducted using a simple random sampling...

Orthopedic Injections: A Longitudinal Musculoskeletal Curriculum in a Family Medicine Residency.

Musculoskeletal (MSK) complaints comprise more than 20% of all visits to health care providers each year. Despite required experiences in MSK care, family physicians report low confidence in diagnosing and treating MSK conditions. The purpose of this study was to analyze the effects of early and longitudinal exposure to MSK education on residents' confidence in and likelihood of performing MSK physical exams and injections in future practice. From 2017 to 2019, residents completed an annual survey assessing confidence in, frequency of, and future intentions to perform exams and injections for MSK conditions. We compared responses between family medicine residents who completed a 176-hour longitudinal sports medicine (LSM) curriculum distributed over all 3 years of residency and a comparable cohort of family medicine residents who completed a 188-hour concentrated MSK curriculum primarily in the final year of residency. We made comparisons using the Fisher exact test for categorical variables and an independent samples t test for numeric variables. We analyzed the 98 total responses from 50 residents. The proportion of residents reporting high ratings of their residency MSK education (26% to 60%), performing >5 injections (38% to 73%), reporting confidence in performing injections (12% to 40%), and indicating likelihood to perform MSK injections in the future (52% to 65%) were all greater in the LSM versus concentrated MSK curriculum cohorts (P<.05 for all). Early and longitudinal exposure to MSK care and sports medicine in family medicine residency led to both an increase in MSK injections during residency training and a greater desire to perform these injections in postresidency practice.

Exploring the Link Between Factors in Musculoskeletal Oncology Surgery Fellowships and Industry Supplemental Income.

Introduction In the complex landscape of healthcare economics, the financial relationship between physicians and industry remains a topic of significant interest and reflection. While the dynamics of industry relationships in certain orthopedic subspecialties have been well documented, the intricacies of industry payments within musculoskeletal (MSK) oncology programs have yet to be thoroughly explored. In this study, we aim to examine the relationship between academic and industry productivity at the fellowship level. Additionally, we seek to identify the associations between the flow of industry supplemental income to orthopedic oncologists and the specific residency and fellowship training programs they are affiliated with. Methodology A comprehensive retrospective analysis was conducted using data from the Centers for Medicare and Medicaid Services, Scopus, and other relevant databases in 2023. This study included 19 fellowship programs across the United States, encompassing a total of 68 faculty physicians. Various variables were examined, including H-index, lifetime supplemental income, geographical location, residency affiliation, and association with top-ranked hospitals. Results A statistically significant correlation was found between academic and industry productivity at the individual faculty level (p = 0.003), but not at the fellowship level (p = 0.198). The top 10% of earners accounted for approximately 70% of the total lifetime supplemental income among all fellowship faculty. Additionally, there was no statistically significant association between lifetime supplemental income or academic productivity per fellowship and geographical region, nor with the ranking of affiliated residency programs or hospitals. Conclusions Industry productivity among individual faculty in MSK oncology fellowship programs in the United States is significantly associated with academic productivity; however, this association was not observed at the fellowship level. Furthermore, no statistically significant relationship was found regarding the region or the ranking of the affiliated residency programs or hospitals.

Work stress and competency among radiology residents: the mediating effect of resilience.

Competency of health professionals stands as a fundamental element in ensuring the quality of care. Notably, work stress and resilience are found to be associated with competency of health professionals. However, the role of resilience between work stress and competency remains unexplored. This study aims to investigate competency, work stress and resilience of radiology residents, and to examine the mediating effect of resilience. A cross-sectional survey was conducted among 3,666 radiology residents from 31 provinces of China in 2021. The diagnostic radiology milestones were used to measure the competency. Results of work stress and resilience were derived from self-reports and assessment of the Connor Davidson Resilience Scale (CD-RISC) respectively. To examine the association between work stress, resilience, and competency, Spearman correlation analysis and hierarchical linear regression were employed. The mediating effect of resilience was tested by bootstrapping analysis. Descriptive statistics show that the average score (mean ± SD) of work stress, competency and resilience among radiology residents were 1.55 ± 1.53 (range from 0 to 6), 28.14 ± 13 (range from 0 to 81) and 5.97 ± 1.92 (range from 0 to 8), respectively. Work stress was negatively associated with competency (β = -0.51, p < 0.001) and resilience (-0.57, p < 0.001). In particular, resilience mediated the relationship between work stress and competence, and the total mediating effect was -0.49 (= - 0.57 * 0.86), accounting for 49.06% of the total effect. Work stress is a significant contributor to competence among radiology residents. Resilience significantly mediated the association. This study highlights incorporating resilience training courses into the standardized residency training program to reduce intensive work stress and promote competency of radiology residents.

The Application of Case-Based Learning (CBL) Combined with PDCA Cycle in the Clinical Teaching Practice of Breast Ultrasound in Standardized Residency Training

Background: The integration of case-based learning (CBL) with the plan-do-check-act (PDCA) cycle has potential benefits for clinical education, yet its efficacy in ultrasound residency training, particularly for breast ultrasound, requires evaluation. Aim: This study aimed to assess the impact of a combined CBL and PDCA cycle teaching model on the clinical thinking and skills of ultrasound residents compared to traditional teaching methods. Methods: A comparative study was conducted at Sichuan Provincial People’s Hospital’s ultrasound medicine base, from August 2020 to June 2023, focusing on residents in training. Sixty-one trainees were randomly divided into two groups: a joint group (n = 31) taught using a PDCA cycle-based model integrated with CBL and a traditional group (n = 30) taught with conventional methods. Both groups underwent a 20-hour course and were subsequently evaluated on theoretical knowledge, clinical thinking, and skills. Comparative statistical analysis was performed to evaluate the performance differences between the two groups. Results: The joint group demonstrated significantly better clinical thinking and skills operation than the traditional group (P &lt; 0.05). No significant difference was observed between the groups regarding theoretical knowledge (P &gt; 0.05). Conclusions: The combined CBL-PDCA cycle teaching mode significantly enhances the clinical thinking abilities and operational skills of residents in breast ultrasound training. This innovative approach shows promise as an effective educational strategy to foster intrinsic motivation and higher order learning capabilities among ultrasound residents.

Geographical Distribution and Trends Analysis of Osteopathic General Surgery Residents.

In recent years, the number of Doctor of Osteopathic Medicine (DO) residents entering general surgery has increased. As DOs continue to solidify their role within the surgical domain, understanding their distribution, preferences, and the dynamics of their integration into residency programs becomes crucial for general surgery applicants. Publicly available data were gathered for each DO general surgery resident from residency programs across the nation, including details such as post-graduate year, degrees held, and residency program location. A comprehensive cross-sectional analysis was conducted to determine the geographical distribution and match trends of DO residents in these residency programs. Analysis revealed a significant rise in the number of DOs entering general surgery residencies, from 153 DO trainees beginning their residency training in 2019 to 274 DO trainees beginning their residency training in 2024. This upward trend indicates a growing presence of DOs in surgical practice. Examination of the geographical locations of programs for which DO applicants have matched showed variations nationwide. This analysis allows for a deeper understanding of the evolving match trends for DOs in surgery. It highlights the importance of addressing disparities in access to surgical training opportunities for osteopathic physicians nationwide.

An Analysis of the Otolaryngology Workforce in Pennsylvania.

This study aims to analyze the distribution of otolaryngologists between urban and rural counties in Pennsylvania. Retrospective database. American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) database and Centers for Medicare and Medicaid Services (CMS) Database. The AAO-HNS database (Entnet.org) and the CMS Database were used to identify otolaryngologists, their primary location, and their state of training. The 2023 Rural-Urban Continuum Codes were used to classify metropolitan (codes 1-3) and nonmetropolitan counties (codes 4-9) and determine county populations. A total of 388 otolaryngologists were identified across 67 Pennsylvania counties (33 metropolitan, 34 nonmetropolitan), 80% of which were male. There were 354 otolaryngologists in metropolitan counties serving 11.2 million people, with an average of 2.4 otolaryngologists per 100,000 people (/100 k). The majority of otolaryngologists (n = 235, 60.6%) are located in counties designated by code 1. There were 34 otolaryngologists in nonmetropolitan counties serving 1.8 million people, with an average of 2.4 otolaryngologists/100 k. Montour County (code 6) is home to a large academic center and accounts for 14/34 otolaryngologists in the nonmetropolitan counties. With the exception of Montour County, the remaining nonmetropolitan counties averaged 1.0 otolaryngologist/100 k. Only 3 metropolitan counties did not have otolaryngologists compared to 19 nonmetropolitan counties without otolaryngologists. Most otolaryngologists received their residency training in Pennsylvania (n = 177). New York (n = 35) and Maryland (n = 24) were the second most common states for training. There is a lack of otolaryngologists in rural counties of Pennsylvania, except in counties home to large academic centers.

Telerehabilitation as a Teaching–Learning Tool in Physical Medicine and Rehabilitation Residency Training in the Philippines

Background:Prepandemic, Physical Medicine and Rehabilitation (PM&amp;R) residency training curricula in the Philippines did not include telerehabilitation. The impact of virtual care on residents’ competencies during the pandemic has not been evaluated locally.Objective:The objective of the study is to determine residents’ ability to achieve PM&amp;R competencies through telerehabilitation.Methods:This mixed-methods study included an original survey among residents and a focus group discussion with training/administrative staff.Findings:Residents reported professionalism, interpersonal/communication skills, and medical ethics/public health as the top three competencies facilitated by telerehabilitation, while procedural skills were the least facilitated. Training/administrative staff perceived telerehabilitation could be incorporated into PM&amp;R training curricula.Conclusions:Telerehabilitation contributed to residents’ achievement of training competencies and learning of PM&amp;R topics/skills.

The Impact of Diagnosis-Specific Plan Templates on Admission Note Writing Time: A Quality Improvement Initiative.

Background There are limited objective studies regarding the effectiveness of strategies to alleviate the documentation burden on resident physicians. Objective To develop and implement diagnosis-specific templates for the plan of care section of inpatient admission notes, aiming to reduce documentation time. Methods Twelve templates for the plan of care section of admission notes were written by the study authors, reviewed by attending physicians, and shared with the residents through the electronic health record (EHR) on September 23, 2022. EHR audit log data were collected to examine admission note writing times, supplemented by resident feedback on acceptability via an anonymous survey. Feasibility measures included time investment, experience with the EHR, and resident training. Results Between July 1, 2021 and June 30, 2023, 62 pediatric residents contributed 9840 admission notes. The templates were used in 557 admission notes. The mean total time spent on an admission note decreased from 97.9 minutes pre-intervention to 71.0 minutes post-intervention with the use of a template; an adjusted reduction of 23% (95% CI 16%-30%; P<.001). The mean attending time spent editing an admission note was unchanged. The survey results underscored wide acceptability of the templates among the residents. Feasibility data showed that the project required minimal time investment from the health care informatics team and minimal resident training. Conclusions Using templates in the care plan section of admission notes reduces the time residents spend writing admission notes.

Professional Behavior Assessment During Residency Training: Can We Identify Outliers?

The American Board of Orthopaedic Surgery (ABOS) Knowledge, Skills, and Behavior (KSB) project sets up a framework for competency-based medical education for orthopaedic surgery residency training. The Behavior aspect of KSB includes use of the American Board of Orthopaedic Surgery Behavior Tool (ABOSBT) to assess 5 domains of professional behavior. The purpose of this study was to analyze the results of 2 years of ABOSBT assessments and to characterize the low score ratings. All ABOSBT assessments from January 1, 2022, to December 31, 2023, were reviewed totaling 51,678 completed assessments with 48,648 (94%) assessments from a 360° process and 3,030 (6%) as end-of-rotation assessments. Distribution of 51,678 ABOSBT assessments with 258,390 scores demonstrated low scores (disagree or strongly disagree) in 0.9% of assessments. All 5 domains identified low scores in a small percentage at all years-in-training with the greatest number in second- and third-year residents. Comparison of scores from 360° vs. end-of-rotation requests demonstrated a higher percentage of low scores given during the 360° process (p < 0.0001). Three thousand seven hundred seven unique evaluators completed ABOSBT assessments, with attending physicians as the most frequent evaluator type (44%); inpatient nurses assessed residents with low ABOSBT scores more frequently (4.5%) than any other evaluator type. Residents with 2 or more low scores by 2 or more different evaluators were analyzed for each of the 5 domains; low scores were most frequently observed in the reliability domain. The ABOSBT was originally validated 5 years ago in 18 programs with 9,892 assessments; this article updates results using the ABOSBT across 95 programs assessing 2,397 residents with 3,707 evaluators. The ABOSBT demonstrates that most residents demonstrate professional behavior across 5 domains of assessment; the ABOSBT identifies residents with low scores. A strength of KSB is the ability to identify professionalism deficiencies while residents are in training and can focus on individualized educational improvement. Tracking residents with low scores on the ABOSBT assessment over time will help determine its effectiveness in identifying unprofessional behavior.

Influences of Global Health Initiatives in Plastic and Reconstructive Surgical Residents

Purpose: Over the last decade there is an increased awareness that the need for surgical care in under-resourced countries is contributing to significant health inequities and financial hardship across the globe. Plastic surgery has long been recognized as a surgical discipline that has been successful in deploying resources to help address these inequities but to be sustainable there must be a lasting commitment through teaching and education. The purpose of this study is to answer the question “In plastic and reconstructive surgical residents, how does participation in global health initiatives influence independent clinical practice and their perceptions of global health?” Methods: A survey was administered through Redcap to 59 total eligible current or previous Wake Forest School of Medicine plastic and reconstructive surgical residents. Results: About 33 out of 34 participants have had some kind of global health exposure with the majority being through mission trips, volunteering, and external rotations. There was a 33.3% improvement in awareness of global surgical disease burden ( P = .000093 &lt; .05), 23.5% improvement in obligations to create global change ( P = .00021 &lt; .05), 26.3% improvement in comfortability with language and cultural barriers ( P = .0013 &lt; .05), and 20.9% improvement in doctor-patient relationships with patients of differing backgrounds ( P = .0019 &lt; .05) when comparing participant’s views prior and after residency training. Overall, participants were inclined to continue with global health initiatives in the future as 75.8% see themselves participating in another global health experience and 90.9% believed participating in global health has an impact on independent clinical practice and professional development post-residency. Conclusions: Global health initiatives within surgical residency curriculums have had tremendous effects on the perceptions of global health amongst plastic and reconstructive surgical residents, which may improve physician shortage and global health needs in the future.

National needs assessment of emergency medicine faculty regarding scholarly activity practices and support.

We aimed to assess the attitudes and perceptions of scholarly activity (SA) practices among emergency medicine (EM) physicians who are engaged in training residents. This study examined the belief and need for modern-day SA, potential barriers, and department resources provided. We conducted a descriptive cross-sectional survey study of EM physicians across the United States identified from the American College of Emergency Physicians and American College of Osteopathic Physicians directories. The survey consisted of 18 items regarding demographics, attitude toward SA, department support, and questions regarding residency programs. A total of 660 survey recipients completed the survey out of a possible pool of 4296 individuals (15% response rate), of which 530 (80%) indicated they were core faculty. Of core faculty, 428 (80.8%) were part of an allopathic program, whereas 102 (19.2%) were part of an osteopathic program. Department support was provided for protected time (385; 58.3%), research staff (346; 52.4%), Institutional Review Board preparation (240; 36.4%), and biostatistics (314; 47.6%). Of all the institutional roles, the largest percentage (82/125, 65.6%) of chair/vice chair/associate chairs strongly agreed or agreed (score of 5 or 4 of 5) with the statement, "Overall, I am satisfied with the scholarly support provided by my department." There was no difference in agreement with this statement between respondents in an allopathic versus osteopathic program (210/428, 49.1% allopathic; 45/102, 44.1% osteopathic). There is a need for increased departmental support for SA. To optimally implement the Accreditation Council for Graduate Medical Education (ACGME) SA requirements into strategy and action, the ACGME should consider providing EM residency programs with an outline of best SA practices to foster a uniform consensus across academic institutions.

Skin Biopsies and Diagnostic Outcomes at a Multisite Family Medicine Residency Network.

Physicians other than dermatologists evaluate nearly 60% of all skin diseases, and 22% of these physicians are family physicians. Dermatology education is therefore an important aspect of Family Medicine training. Dermatologic procedural training in Family Medicine residency is not standardized, however, so family physicians graduate with highly variable skills. This study describes the scope and diagnostic outcomes of skin biopsies performed by residents at a multisite Family Medicine residency network in comparison with those performed by attendings at a Family Medicine faculty community practice. We performed a retrospective chart review of patients evaluated at eight Family Medicine residency training sites and one Family Medicine faculty community practice within a regional academic health system between January 2020 and October 2022. Patients with a skin finding who underwent at least one skin biopsy during their visit were included in the study. Among all of the skin findings, the incidence of skin biopsy was 3.6% (258/7104) for residents and 1.8% (175/9917) for attendings (P < 0.001). Family Medicine residents performed fewer shave biopsies (57.8% vs 77.7%, P < 0.001) and more punch biopsies (25.6% vs 11.4%, P < 0.001) compared with attendings. Most biopsies performed by residents and attendings were benign, although residents biopsied significantly more benign (79.1% vs 64.6%, P < 0.001) and malignant lesions (11.2% vs 5.7%, P = 0.049). Attendings biopsied significantly more low-to-moderate-grade dysplastic (22.3% vs 5.0%, P < 0.001) and high-grade atypical lesions (4.0% vs 0.8%, P = 0.034). Family Medicine residents at this residency network receive training in a variety of skin biopsy types. Distinct skin biopsy practices and outcomes between residents and attendings may reflect differences in patient populations, clinical expertise, and dermatology referral patterns.

Improving the quality of psychiatric residency training in Isfahan University of Medical Sciences by learning teams and changing curriculum implementation: An action research study

BACKGROUND: The deficiencies in the training of psychiatric residents in Isfahan, including the segregation of residency programs by year, the confinement of training to hospital departments, and the residents’ limited exposure to the perspectives of other faculty members, had not been given significant attention. However, the inevitable alterations in the Department of Psychiatry and the impact of the coronavirus disease 2019 pandemic have brought these issues to the forefront, highlighting the need for program modifications. The objective of this study is to enhance the quality of psychiatric residency training by changing the implementation of the curriculum. METHODS AND MATERIALS: This proactive action research was conducted in six steps. In the first step, the expectations of a new action were identified. In the second step, the new action – creating learning teams – was designed and implemented; thus, eight learning teams comprising experienced professors, novice professors, and residents from various academic levels were created, who collectively engaged in patient visits, psychotherapy, counseling, and educational sessions. Additionally, the portfolio was used in the training and evaluation of the residents. Steps 3 to 6 involved evaluation using a researcher-made questionnaire, analysis and interpretation of results, and reflection and making decisions for future actions. RESULTS: Step 1 resulted in preparing a list of department expectations from new action. The second step yielded the design of a new action. The survey results showed that more than 60% of respondents agreed that the program had a positive impact on 12 out of 15 items in the questionnaire, particularly in enhancing teamwork skills, facilitating discussions about patients, and fostering residents’ accountability. However, in items related to portfolio, this percentage ranged from 40% to 53%. CONCLUSION: The implementation of learning teams as the main action in the current study has yielded positive outcomes; however, the portfolio intervention requires some adjustments. Hence, it is advisable to employ learning teams in comparable circumstances. The research team anticipates that these outcomes will enhance the quality of psychiatric residency training, positioning the country among the leading and influential nations in the region.

Accuracy of Diagnosis of Benign Vocal Fold Lesions among Ear, Nose, and Throat Residents.

Introduction Benign vocal fold lesions (BVFLs) disrupt the superficial lamina propria, impacting vocal fold pliability. Investigating the diagnostic competency of ear, nose, and throat (ENT) residents in identifying BVFLs, we hypothesize that factors such as residency year, subspecialty focus, and training center influence diagnostic accuracy. Objectives To assess the accuracy of diagnosis of BVFLs among ENT residents and to correlate diagnostic accuracy with the year of residency. Methods An observational cross-sectional study included all ENT residents in Saudi Arabia. It was performed in August and September 2021 using a self-administered online questionnaire that assessed demographic variables and included three images with open-ended questions on diagnosing vocal fold lesions. Results A total of 61 ENT residents (62.3% male) were included in this study. The images of vocal fold cyst, vocal fold polyp, and vocal fold nodule were correctly diagnosed by 60.7%, 88.5%, and 91.8% of residents, respectively. There was a correlation between the year of residency and the accuracy of diagnosing a vocal fold cyst ( p = 0.029). Residents interested in laryngology correctly diagnosed all three lesions more frequently than other residents. Conclusion The ability of residents to diagnose vocal fold cysts was moderate. In particular, the senior residents were able to diagnose polyps and nodules with excellent accuracy.

Assessment and improvement of goals of care discussion by internal medicine residents.

191 Background: End-of-life goals and quality of life are intrinsically connected, focusing on providing care that maximizes comfort, dignity, and personal satisfaction during the final stages of life. Residents are primarily involved in Goals of care (GOC) discussion in hospitalized patients it is an integral component in Internal Medicine (IM) resident education. Literature has shown improved outcomes in delivering bad news by residents and oncology fellows after workshops, lectures, and courses. We aimed to improve Residents' competency in effective GOC discussion. Methods: We devised a questionnaire with the help of palliative care specialists and distributed it via a Google survey to the IM residents. After the survey, a palliative care specialist lectured about understanding the POLST form and components of Code Status Discussions. The same questionnaire was sent again. Five survey questions were used as post-lecture improvement parameters, and residents were stratified among three different classes: Interns, Year 2, and Year 3. Results: Before the lecture, residents were asked about their comfort level on a scale from 1-10, with 10 being the most comfortable conducting GOC discussions with the patient or the patient's family. As per the combined survey of all three classes, 50% of residents scored seven or above. Post lecture, 69.3% of intern year residents and 100% of 2nd and 3rd-year residents scored seven and above, which showed significant improvement in residents' comfort level while conducting GOC discussions. The parameters analyzed were the ability to explain SPIKES protocol for 'Breaking Bad News. Initially, 58.3% of the residents were comfortable explaining it, while 41.7 % answered negatively. After the survey, 84.6% from the intern year, 92.3% in 2nd year, and 77.8% of 3rd-year residents stated being comfortable with explaining SPIKES protocol. Another evaluated paradigm was the residents' ability to determine the patient's prognosis using any given scale/score (like the UCSF prognosis calculator). 33.3 % of the residents said 'yes' while 30.6% answered 'maybe.' Post-intervention, 100% of 3rd-year residents and 61.5% of 2nd-year residents, while 30.8% of intern-year residents said 'yes.' The cumulative mean of all three combined classes was 64.1%, which showed significant improvement compared to pre-intervention 33.3%. Conclusions: The results show that residents' comfort level of conducting GOC discussions improved with a single lecture on the topic. Further interventions and mentorship are needed. Intern-year residents were found to have a lower level of subjective comfort in conducting these discussions, which can be explained by their being relatively new to the work environment. A more integrated approach at the beginning of the residency training regarding GOC discussion training can improve interns' confidence and comfort for ensuing such discussions.

Disparities in cataract surgical training at the University of Toronto based on sex and medical school graduate type

ObjectiveTo compare sex and medical school graduate type differences in cataract surgical training volumes at Canada's largest residency program, the University of Toronto (UoT). DesignRetrospective cohort study ParticipantsOphthalmology residents completing cataract surgical training from 2015 to 2020. MethodsData collected from surgical logbooks at the main cataract surgical teaching site at UoT were analyzed from July 1, 2015, to June 30, 2020. Data collected included stage of resident training and degree of participation for each case. The main outcome measure was mean number of complete cataract cases as a function of resident sex, medical school graduate type, and level of training. ResultsThirty-five (19, 54.3% female) residents completed cataract surgical training during the study period. There were 24 (68.6%) Canadian medical graduates (CMGs) and 11 (31.4%) international medical graduates (IMGs). Female residents performed a lower mean number of complete cataract cases compared to males (464.2 versus 504.8, respectively). IMGs completed on average 110.0 (22.8%) fewer cataract cases compared to CMGs. Compared to all residents, female IMGs had the lowest number of complete cataract cases (mean of 380.8 versus 465.7, respectively). The greatest difference occurred between male CMGs and female IMGs, with male CMGs performing 153.8 (40.4%) more complete cases (534.6 vs 380.8, respectively). ConclusionThe greatest difference in surgical volumes occurred between CMGs and IMGs. Female IMGs had the lowest complete cataract case volumes compared to all residents. Our study highlights novel medical school graduate type disparities in cataract surgical training warranting further exploration.

Mapping out Remediation: An Actionable Roadmap to Support Trainees Through Remediation

What’s NewThis qualitative analysis offers an actionable, stepwise approach to remediation. IntroductionThe goal of graduate medical education is for trainees to develop the competence needed to practice independently; however, some residents struggle to achieve competency and require remediation. Evidence around how to best facilitate remediation is lacking. The objective of this study was to understand best practices for remediation in pediatrics. MethodA national web-based survey of pediatric residency program directors (PDs) on remediation practices was performed. The survey included 3 open-ended questions about PDs’ experiences with remediation. Self-reported barriers to and strategies for remediation were systematically analyzed using inductive thematic analysis to develop a theory of effective remediation in pediatric residency training. ResultsA total of 99 out of 195 (50.8%) program directors responded. Two main themes emerged: developing a personalized plan that ensures competency attainment and fostering psychological safety. Twelve categories outline actionable steps that PDs can take to make the remediation process successful. DiscussionBuilt from insight from pediatric PDs, we propose a conceptual model for effective remediation that accounts for competency attainment while safeguarding the emotional health of the resident. The conceptual model breaks the remediation process down into four phases: identification of the learner who struggles, planning the remediation process, implementation of the plan, and assessing the outcome of the process.

393 How Many Central Venous Lines Do Supervising Physicians Believe Resident Trainees Require to Be Competent?

393 How Many Central Venous Lines Do Supervising Physicians Believe Resident Trainees Require to Be Competent?

Learning curves of novice residents on cataract surgery simulator: the E3CAPS pedagogic study

IntroductionTraining novice ophthalmology residents on the EyeSi® simulator increases cataract surgery safety. However, there is no consensus regarding how much training residents should perform before their first time on patients. We evaluated the French national training program through the analysis of the learning curves of novice residents.MethodsThis prospective multicentric pedagogic study was conducted with French novice residents. Each resident completed the recommended four two-hour training sessions and performed a standardized assessment simulating standard cataract surgery before the first session (A0), at the end of the first (A1), second (A2), third (A3) and fourth (A4) sessions. For each surgical step of each attempt, the following data were collected: score, odometer, completion time, posterior capsular rupture and cumulative energy delivered (ultrasounds) during phacoemulsification. A performance threshold was set at a score of 80/100 for each surgical step, 400/500 for the overall procedure. Only descriptive statistics were employed.ResultsSixteen newly nominated ophthalmology residents were included. Median score progressively increased from 95 [IQR 53; 147]) at A0 to 425 [IQR 411; 451] at A4. Despite a significant progression, the “emulsification” step had the lowest A4 scores 86 [IQR 60; 94] without reduction in completion time, odometer or ultrasounds delivered. The rate of posterior capsular rupture decreased linearly from 75% at A0 to 13% at A4 during “emulsification” and from 69 to 0% during “irrigation and aspiration”. At A4, only 25% [8; 53] of residents had > 80 at each step and only 75% [47; 92] had > 400/500 overall.ConclusionA training program consisting of four two-hour sessions on the EyeSi simulator over four consecutive days effectively enhances the surgical skills of novice ophthalmology residents. Undergoing more training sessions may improve scores and decrease the incidence of surgical complications, particularly at the emulsification step of cataract surgery. The learning curves presented here can reassure residents who are progressing normally and help identify those who need a further personalized training program. Trial registrationClinicalTrials registration number: NCT05722080 (first submitted 22/12/2022, first posted 10/02/2023).