Views Of Trainees Research Articles

Agreement between trainees and supervisors on first-year entrustable professional activities for anaesthesia training

BackgroundEntrustable professional activities (EPAs) are commonly developed by senior clinicians and education experts. However, if postgraduate training is conceptualised as an educational alliance, the perspective of trainees should be included. This raises the question as to whether the views of trainees and supervisors on entrustability of specific EPAs differ, which we aimed to explore. MethodsA working group, including all stakeholders, selected and drafted 16 EPAs with the potential for unsupervised practice within the first year of training. For each EPA, first-year trainees, advanced trainees, and supervisors decided whether it should be possible to attain trust for unsupervised practice by the end of the first year of anaesthesiology training (i.e. whether the respective EPA qualified as a ‘first-year EPA’). ResultsWe surveyed 23 first-year trainees, 47 advanced trainees, and 51 supervisors (overall response rate: 68%). All groups fully agreed upon seven EPAs as ‘first-year EPAs’ and on four EPAs that should not be entrusted within the first year. For all five remaining EPAs, a significantly higher proportion of first-year trainees thought these should be entrusted as first-year EPAs compared with advanced trainees and supervisors. We found no differences between advanced trainees and supervisors. ConclusionsThe views of first-year trainees, advanced trainees, and supervisors showed high agreement. Differing views of young trainees disappeared after the first year. This finding provides a fruitful basis to involve trainees in negotiations of autonomy.

Orthopaedic Trainee Opinion on the Current Procedure-based Assessment Compared to its Predecessor: A UK Trauma Centre Perspective.

BackgroundProcedure-based assessments (PBAs) were introduced as a formative assessment of surgical performance. UK trainees are currently expected to complete at least 20 PBAs each training year. A new PBA tool was introduced in August 2016 in order to address several criticisms with its predecessor. These included mandatory written feedback and increasing the number of global levels of assessment.ObjectivesOur study sought to identify the impact of these modifications to the PBA tool on its perceived utility as a formative assessment of surgical skill.Study design & methodsOrthopaedic trainee registrars (ST3-ST8) holding a UK National Training Number (NTN) at a major UK trauma centre were invited to take part in the study. Each trainee completed an anonymous questionnaire that was designed to elicit the view of trainees towards the old and new PBA.ResultsTwelve trainees took part in the study. Most of them admitted receiving good quality feedback from their trainer using both tools (75% old PBA; 83% ew PBA). Most trainees (58%) felt that written feedback did not encourage verbal feedback from their trainer. Overall, trainees felt the new PBA global rating scale levels had made it a more accurate measure of surgical performance and allowed them to better appreciate the gradual improvement in their surgical skills throughout their training.ConclusionsFifty per cent of the trainees believed that the new PBA overall was a better formative assessment of surgical skill than its predecessor. A significant factor has been the introduction of a new global rating score rather than efforts to improve feedback. Further work should look to identify whether these views match those of other UK-based trainees on a larger scale.

15. Why choose anatomical pathology? An online survey of students and doctors

Background: Globally and nationally, there has been a significant decline in the proportion of medical graduates pursuing a career in pathology, corresponding with a broadening gap between workforce supply and demand. However, there is a paucity of evidence as to the causal influences in an Australian context. Aims: To perform an online survey of Australian medical students and junior medical officers, pathology trainees and pathologists to determine the factors which attract and deter graduates from pursuing a career in anatomical pathology. Methods: Literature review was performed to identify: (1) the factors that influence the choice of speciality for medical graduates; (2) the perceptions about anatomic pathology amongst medical graduates; (3) the influence of the delivery of pathology curriculum during medical school on these perceptions and reasons; and (4) the views of pathologists and pathology trainees regarding motivations for pursuing pathology training and career satisfaction. A short online survey including questions with binary answers, response spectrums and free text was circulated to medical students (via universities), pre-vocational junior medical officers (JMOs; via JMO units), pathology registrars and pathologists (via the Royal College of Pathologists of Australasia). Results and conclusions: PubMed searches using the terms ‘pathology’, ‘training’ and ‘career choice’ identified over 200 peer reviewed indexed articles in English language; 15 pertained specifically to factors determining anatomical pathology as a career choice, and one of these was Australian. This review guided the development of specific questions related to factors identified as influencing the choice of pathology as a career (for example, personality traits, expectations regarding remuneration, research opportunities and career satisfaction, and exposure to pathology during university). The questionnaire is currently being circulated and the responses will be collated and analysed, in order to inform future recruitment strategies improving uptake to this vital but undersubscribed specialty.

Special care dentistry trainee views on the medical and oral medicine elements of the specialist training curriculum

Specialty training curricula are subject to periodic update, and trainee views are an important element in identifying which areas need particular focus. In this study, we wished to examine specialty trainee opinions on two areas of a curriculum for special care dentistry, in particular oral medicine, and the component elements of related systemic disease and therapies (RSDT), namely pathology, pharmacology and therapeutics, and human systemic disease. Following ethical approval, we identified 35 specialty registrars in special care dentistry in the UK and Ireland who were invited to use an online survey tool to gather demographic data and then to ask their views on the delivery of training in oral medicine and RSDT. Respondents were also asked whether sufficient importance was placed on these topics and whether they could be accessed and delivered appropriately. The 23 registrars surveyed comprised a representative group from all parts of the UK and Ireland and were at different stages of specialty training. The majority thought oral medicine and RSDT were key elements of the curriculum and could be given more prominence, especially in the context of an increasingly ageing population with associated oral manifestations of chronic disease, multiple drugs and disabilities. The registrars surveyed felt that oral medicine and RSDT and were integral to training and that emphasis and opportunities for training in these areas could be improved, especially for those trainees based outside of a dental hospital setting.

EP-1681 Modern radiotherapy learning: a quantitative study of trainer and trainee views

EP-1681 Modern radiotherapy learning: a quantitative study of trainer and trainee views

EP-1679 Modern radiotherapy learning: a qualitative study of trainer and trainee views

EP-1679 Modern radiotherapy learning: a qualitative study of trainer and trainee views

Feedback in conference interpreter education

Abstract Feedback is a key part of the teaching and learning process in conference interpreter education. However, there is little research on how feedback should be performed in order to promote learning, or on what trainers and trainees think of its role. This paper, based on a larger PhD research project, seeks to fill this gap by reporting on perceptions and practices in three postgraduate conference interpreter training programs. Data were collected from trainers and trainees through individual interviews, focus groups, and questionnaires, complemented by direct observation of lessons. Content analysis was used to identify points of divergence and convergence between the views of trainers and trainees regarding the usefulness of feedback, preferred practices, and the difficulty of providing feedback. Main findings include that feedback should be honest, concise, and meaningful for the trainees, and provide an analysis of the problems encountered as well as recommend specific strategies for overcoming them.

Postgraduate trainee views on eHealth at a distributed medical campus.

Purpose: e-Health is a rapidly evolving field that cuts across specialties however; there is a gap in development and evaluation of training for postgraduates in residency programs. This is a multicentre, collaborative effort among faculty from the departments of Psychiatry, Geriatrics and Internal Medicine in partnership with Ontario Telehealth Network to assess the needs of postgraduate residents in ehealth and build a pilot program to address identified learning gaps.
 Methodology: We conducted a needs assessment (Appendix A) through an online survey to investigate the self-perceived knowledge, gaps and barriers to eHealth of medical resident physicians at the McMaster University DeGroote School of Medicine Waterloo Regional Campus (WRC), Kitchener, Ontario, Canada
 Results: All respondents identified that they would be interested in education in telehealth and all of them felt that they would have to use telehealth in their future practices. However, 83.3% did not feel confident using telemedicine in clinical practice. Based on the results of the needs assessment, we have built a pilot rotation in which postgraduate trainees can practice telehealth skills in an interdisciplinary setting.

Postgraduate trainee views on eHealth at a distributed medical campus.

Purpose: e-Health is a rapidly evolving field that cuts across specialties however; there is a gap in development and evaluation of training for postgraduates in residency programs. This is a multicentre, collaborative effort among faculty from the departments of Psychiatry, Geriatrics and Internal Medicine in partnership with Ontario Telehealth Network to assess the needs of postgraduate residents in ehealth and build a pilot program to address identified learning gaps.
 Methodology: We conducted a needs assessment (Appendix A) through an online survey to investigate the self-perceived knowledge, gaps and barriers to eHealth of medical resident physicians at the McMaster University DeGroote School of Medicine Waterloo Regional Campus (WRC), Kitchener, Ontario, Canada
 Results: All respondents identified that they would be interested in education in telehealth and all of them felt that they would have to use telehealth in their future practices. However, 83.3% did not feel confident using telemedicine in clinical practice. Based on the results of the needs assessment, we have built a pilot rotation in which postgraduate trainees can practice telehealth skills in an interdisciplinary setting.

Disciplinary boundaries and integrating care: using Q-methodology to understand trainee views on being a good doctor

BackgroundRising numbers of patients with multiple-conditions and complex care needs mean that it is increasingly important for doctors from different specialty areas to work together, alongside other members of the multi-disciplinary team, to provide patient centred care. However, intra-professional boundaries and silos within the medical profession may challenge holistic approaches to patient care.MethodsWe used Q methodology to examine how postgraduate trainees (n = 38) on a range of different specialty programmes in England and Wales could be grouped based on their rankings of 40 statements about ‘being a good doctor’. Themes covered in the Q-set include: generalism (breadth) and specialism (depth), interdisciplinarity and multidisciplinary team working, patient-centredness, and managing complex care needs.ResultsA by-person factor analysis enabled us to map distinct perspectives within our participant group (P-set). Despite high levels of overall commonality, three groups of trainees emerged, each with a clear perspective on being a good doctor. We describe the first group as ‘generalists’: team-players with a collegial and patient-centred approach to their role. The second group of ‘general specialists’ aspired to be specialists but with a generalist and patient-centred approach to care within their specialty area. Both these two groups can be contrasted to those in the third ‘specialist’ group, who had a more singular focus on how their specialty can help the patient.ConclusionsWhilst distinct, the priorities and values of trainees in this study share some important aspects. The results of our Q-sort analysis suggest that it may be helpful to understand the relationship between generalism and specialism as less of a dichotomy and more of a continuum that transcends primary and secondary care settings. A nuanced understanding of trainee views on being a good doctor, across different specialties, may help us to bridge gaps and foster interdisciplinary working.

Augmented Reality Future Step Visualization for Robust Surgical Telementoring.

Surgical telementoring connects expert mentors with trainees performing urgent care in austere environments. However, such environments impose unreliable network quality, with significant latency and low bandwidth. We have developed an augmented reality telementoring system that includes future step visualization of the medical procedure. Pregenerated video instructions of the procedure are dynamically overlaid onto the trainee's view of the operating field when the network connection with a mentor is unreliable. Our future step visualization uses a tablet suspended above the patient's body, through which the trainee views the operating field. Before trainee use, an expert records a "future library" of step-by-step video footage of the operation. Videos are displayed to the trainee as semitransparent graphical overlays. We conducted a study where participants completed a cricothyroidotomy under telementored guidance. Participants used one of two telementoring conditions: conventional telestrator or our system with future step visualization. During the operation, the connection between trainee and mentor was bandwidth throttled. Recorded metrics were idle time ratio, recall error, and task performance. Participants in the future step visualization condition had 48% smaller idle time ratio (14.5% vs. 27.9%, P < 0.001), 26% less recall error (119 vs. 161, P = 0.042), and 10% higher task performance scores (rater 1 = 90.83 vs. 81.88, P = 0.008; rater 2 = 88.54 vs. 79.17, P = 0.042) than participants in the telestrator condition. Future step visualization in surgical telementoring is an important fallback mechanism when trainee/mentor network connection is poor, and it is a key step towards semiautonomous and then completely mentor-free medical assistance systems.

3.35 Understanding the Influence of Sibling Support Group Facilitation on Mental Health Trainee Views and Skills of Family-Centered Care

Prior research suggests that family-centered interventions are among the least taught in training, yet most needed skills for practicing psychiatry. In this study, we sought to evaluate whether having mental health trainees lead a sibling support group could serve as a method to promote family-centered care among trainees.

The Importance of Determining Trainee Perspectives on Procedural Competencies During Spine Surgery Clinical Fellowship.

Study Design:Longitudinal survey.Objective:It remains important to align competence-based objectives for training as deemed important by clinical fellows to those of their fellowship supervisors and program educators. The primary aim of this study was to determine trainee views on the relative importance of specific procedural training competencies. Secondarily, we aimed to evaluate self-perceived confidence in procedural performance at the commencement and completion of fellowship.Methods:Questionnaires were administered to 68 clinical fellows enrolled in the AOSNA fellowship program during the 2015-2016 academic year. A Likert-type scale was used to quantify trainee perspectives on the relative importance of specific procedural competencies to their training base on an established curriculum including 53 general and 22 focused/advanced procedural competencies. We measured trainee self-perceived confidence in performing procedures at the commencement and completion of their program. Statistical analysis was performed on fellow demographic data and procedural responses.Results:Our initial survey response rate was 82% (56/68) and 69% (47/68) for the follow-up survey. Although most procedural competencies were regarded of high importance, we did identify several procedures of high importance yet low confidence among fellows (ie, upper cervical, thoracic discectomy surgery), which highlights an educational opportunity. Overall procedural confidence increased from an average Likert score of 4.2 (SD = 1.3) on the initial survey to 5.4 (SD = 0.8) by follow-up survey (P < .0001).Conclusions:Understanding trainee goals for clinical fellowship remains important. Identification of areas of low procedural confidence and high importance to training experience will better guide fellowship programs and supervisors in the strategic delivery of the educational experience.

Understanding Surgical Resident and Fellow Perspectives on Their Operative Performance Feedback Needs: A Qualitative Study

Operative performance feedback is essential for surgical training. We aimed to understand surgical trainees' views on their operative performance feedback needs and to characterize feedback to elucidate factors affecting its value from the resident perspective. Using a qualitative research approach, 2 research fellows conducted semistructured, one-on-one interviews with surgical trainees. We analyzed recurring themes generated during interviews related to feedback characteristics, as well as the extent to which performance rating tools can help meet trainees' operative feedback needs. Departments or divisions of general or plastic surgery at 9 US academic institutions. Surgical residents and clinical fellows in general or plastic surgery. We conducted 30 interviews with 9 junior residents, 14 senior residents, and 7 clinical fellows. Eighteen (60%) participants were in plastic and 12 (40%) were in general surgery. Twenty-four participants (80%) reported feedback as very or extremely important during surgical training. All trainees stated that verbal, face-to-face feedback is the most valuable, especially if occurring during (92%) or immediately after (65%) cases. Of those trainees using performance rating tools (74%), most (57%) expressed positive views about them but wanted the tools to complement and not replace verbal feedback in surgical education. Trainees value feedback more if received within 1 week or the case. Verbal, face-to-face feedback is very or extremely important to surgical trainees. Residents and fellows prefer to receive feedback during or immediately after a case and continue to value feedback if received within 1 week of the event. Performance rating tools can be useful for providing formative feedback and documentation but should not replace verbal, face-to-face feedback. Considering trainee views on feedback may help reduce perceived gaps in feedback demand-versus-supply in surgical training, which may be essential to overcoming current challenges in surgical education.

Family medicine training in Africa: Views of clinical trainers and trainees.

BackgroundThis article reports on the findings of a workshop held at the joint 5th World Organisation of Family Doctors (WONCA) Africa and 20th National Family Practitioners Conference in Tshwane, South Africa, in 2017. Postgraduate training for family medicine in Africa takes place in the clinical workspace at the bedside or next to the patient in the clinic, district hospital or regional hospital. Direct supervisor observation, exchange of reflection and feedback, and learning conversations between the supervisor and the registrar are central to learning and assessment processes.ObjectivesThe aim of the workshop was to understand how family medicine registrars (postgraduate trainees in family medicine) in Africa learn in the workplace.MethodsThirty-five trainers and registrars from nine African countries, the United Kingdom, United States and Sweden participated. South Africa was represented by the universities of Cape Town, Limpopo, Pretoria, Sefako Makgatho, Stellenbosch, Walter Sisulu and Witwatersrand.ResultsSix major themes were identified: (1) context is critical, (2) learning style of the registrar and (teaching style) of the supervisor, (3) learning portfolio is utilised, (4) interactions between registrar and supervisor, (5) giving and receiving feedback and (6) the competence of the supervisor.ConclusionThe training of family physicians across Africa shares many common themes. However, there are also big differences among the various countries and even programmes within countries. The way forward would include exploring the local contextual enablers that influence the learning conversations between trainees and their supervisors. Family medicine training institutions and organisations (such as WONCA Africa and the South African Academy of Family Physicians) have a critical role to play in supporting trainees and trainers towards developing local competencies which facilitate learning in the clinical workplace dominated by service delivery pressures.

What is Known About the Attributes of a Successful Surgical Trainer? A Systematic Review

Surgical training has been subject to significant upheaval in recent years with an increasingly rigorous assessment regimen for trainees. The assessment of surgical trainers is less well evolved by comparison. Recent proposals from the Royal College of Surgeons of England recommend "professionalising the trainers." However, they do not suggest any accepted or validated methods of trainer assessment, nor do they indicate how these might be implemented and monitored in a real-world training program to determine their effect on trainee outcomes. To determine what is known about the attributes of successful surgical trainers. We conducted a systematic review of the scientific literature using the preferred reporting items for systematic reviews and meta-analyses and Cochrane guidelines of the Medline database using specific search criteria. The qualitative analysis involved grouping trainer attributes together into "themes" within 4 "super-themes." Each theme needed to be mentioned by a minimum of 5 studies. After review of the full study texts a total of 14 studies met the inclusion criteria. Thirteen studies involved the views of trainees, whereas only 1 study solely assessed the views of trainers. There was a wide variety of study designs and types of participants. The attribute themes are listed in brackets after each super-theme: "character" (approachability, patience, enthusiasm, encouraging/supportiveness), "procedural" (willingness to let trainee operate, balance between supervision and independence), "teamwork and communication" (sets educational aims and objectives, ability to use appropriate feedback, communication skills, and time availability to train) and "clinical" (capable, good relationships with patients, and the health care team). This detailed review describes several perceived important themes for the positive attributes of surgical trainers. The identification of these key attributes is only of value if their presence is confirmed by effective and feasible evaluation, and if the possession of such attributes in trainers is proven to have a positive effect on training. In times of reduced training opportunities, exploring the topics raised by this review through future education research is warranted.

Relating professionalism and conscientiousness to develop an objective, scalar, proxy measure of professionalism in anaesthetic trainees

BackgroundThe concept of professionalism is complex and subjective and relies on expert judgements. Currently, there are no existing objective measures of professionalism in anaesthesia. However, it is possible that at least some elements of professionalism may be indicated by objective measures. A number of studies have suggested that conscientiousness as a trait is a significant contributor to professionalism.MethodsA ‘Conscientiousness Index’ (CI) was developed by collation of routinely collected data from tasks expected to be carried out by anaesthetic trainees such as punctual submission of holiday and ‘not-on-call’ requests, attendance at audit meetings, timely submission of completed appraisal documentation and sickness/absence notifications. The CI consists of a sum of points deducted from a baseline of 50 for non-completion of these objective and measurable behaviours related to conscientiousness. This was correlated with consultants’ formal and informal subjective measures of professionalism in those trainees.Informal, subjective measures of professionalism consisted of a ‘Professionalism Index’ (PI). The PI consisted of a score developed from consultants’ expert, subjective views of professionalism for those trainees. Formal, subjective measures of professionalism consisted of a score derived from comments made by consultants in College Tutor feedback forms on their views on the professionalism of those trainees (College Tutor feedback; CT). The PI and CT scores were correlated against the CI using a Pearson or Spearman correlation coefficient.ResultsThere was a negative, but not statistically significant, relationship between the CI and formal, subjective measures of professionalism; CT scores (r = -0.341, p = 0.06), but no correlation between CI and consultants informal views of trainees’ professionalism; the PI scores (rs = -0.059, p = 0.759).ConclusionsThis may be due the ‘failure to fail’ phenomenon due to the high stakes nature of raising concerns of professionalism in postgraduate healthcare professionals or may be that the precision of the tool may be insufficient to distinguish between trainees who generally show highly professional behaviour. Future development of the tool may need to include more of the sub-facets of conscientiousness. Independently of a relationship with the construct of professionalism, a measure of conscientiousness might be of interest to future employers.

Training in general internal medicine: what do trainees want and what can we deliver?

General internal medicine (GIM) training, usually as part of a dual accreditation programme, is increasingly challenging to deliver as a result of increased numbers of acute admissions, changes to consultant input into medical 'on call' and the reduction in the numbers of units taking unselected medical patients. GIM has become synonymous with acute medical take, reducing the scope of programmes to deliver a true general medical experience. The role of the 'medical registrar' is reported to be increasingly unpopular with trainees. Differing models of the delivery of training are in place. We have carried out a two-stage questionnaire in order to determine the views of both trainees and trainers on different models of training and their deliverability. The first stage defined the key areas of concern for trainees and the second focused on these areas and the ability of local education providers to deliver an expanded GIM programme. Our data suggest that trainees would value a face-to-face annual review of competence progression (ARCP) for GIM, separate from their specialty ARCP, and would support more structured blocks of GIM training in order to allow later specialty-focused training. However, -significant concerns were raised about the ability of many units to deliver such training beyond the acute medical 'take'.

Written reflection in assessment and appraisal: GP and GP trainee views

Background: In the UK, evidence of written reflection is part of licensing and revalidation for general practitioners (GPs). However, there is little evidence of specific benefits compared to other forms of reflective practice. Aim: To seek GPs’ and general practice (GP) trainees’ views on the role of written reflection in learning and assessment. Design and setting: An online survey of 1005 GPs and GP trainees (GPTs) in the UK. Method: An anonymous questionnaire containing 38 attitudinal items was administered. Descriptive statistics were used to analyse Likert scale responses, thematic analysis for free-text responses. Results: In total 544 GPs and 461 GPTs completed the survey, with 842 (83.8%) agreeing they find verbal reflection with a colleague more useful than written reflection. Three quarters disagreed that written reflection is a way of identifying poorly performing GPs. Over 70% of respondents stated that summative, written reflection is a time-consuming, box-ticking exercise which distracts from other learning. They question its validity as part of assessment and state that its use may contribute to current difficulties with recruitment and retention to GP. Conclusions: For many GPs, written reflection is an onerous process rather than beneficial to their learning, indicating its continued use in assessment needs to be critically examined.

How do we train the modern day surgeon in open conversion of minimally invasive procedures? – Trainee, trainer and educator perceptions and views. A qualitative study

How do we train the modern day surgeon in open conversion of minimally invasive procedures? – Trainee, trainer and educator perceptions and views. A qualitative study