Years Of Residency Training Research Articles

Appraising Medical Literature: The Effect of a Structured Journal Club Curriculum Using The Lancet Handbook of Essential Concepts in Clinical Research on Resident Self-Assessment and Knowledge in Milestone-Based Competencies.

Training in literature appraisal and statistical interpretation is one of the residency training requirements outlined by the Accreditation Council for Graduate Medical Education. Frequently, a journal club format is used to teach this competency although this teaching modality is not standardized or well studied in regard to its efficacy. This study sought to determine the effect of a structured journal club curriculum that incorporated The Lancet Handbook of Essential Concepts in Clinical Research on objective and self-assessed knowledge pertaining to study design and interpretation. The study was a retrospective observational study evaluating the effect of a structured journal club curriculum using the Lancet text with pre- and postimplementation assessment using a resident self-assessment survey. The study examined a monthly journal club curriculum that covered 1 topic/chapter from the assigned text, paired with a contemporary article to highlight the chapter topic. Resident self-assessed and objective knowledge was evaluated and compared using a survey taken before and after the curriculum change. The study was completed during 1 academic year at Madigan Army Medical Center in Tacoma, Washington, an academic military medical training and tertiary care center. Study surveys were distributed to all 17 obstetrics and gynecology residents throughout the 4 residency training years. Of the 17 potential participants, 13 (76%) participated in the precurriculum assessment and 14 (82%) participated after its completion. There was no significant improvement in resident self-assessed knowledge following curriculum implementation. There was a trend toward improved objective knowledge pertaining to study design and interpretation after curriculum completion, but this was not statistically significant. There is a lack of standardized and well-studied methods to teach residents how to evaluate and appraise medical literature and research. The Lancet Handbook of Essential Concepts in Clinical Research may be a useful tool to teach some of these tenets in the residency training environment, but this limited study did not prove this assertion. Three is a dearth of proven and well-studied means to teach the tenets of study design, statistical interpretation, and critical literature appraisal to trainees with any consistency or validity. This study demonstrated a trend toward better objective knowledge related to study design, interpretation, and understanding after a change in our training curriculum that implemented The Lancet Handbook of Essential Concepts in Clinical Research into the monthly journal club curriculum. Resident self-rated knowledge and proficiency in their abilities to understand research and study design were not significantly changed with the curriculum. Better evidence is needed to guide future educational curricula directed toward teaching the competency of medical literature review and appraisal.

Core Entrustable Professional Activities for Entry Into Residency: Curricular Gap or Unrealistic Expectations?

Core Entrustable Professional Activities for Entry Into Residency: Curricular Gap or Unrealistic Expectations?

Evaluation of clinical teaching quality in competency-based residency training in Lithuania

Background and aimIn 2013, all residency programs at the Lithuanian University of Health Sciences were renewed into the competency-based medical education curriculum (CBME). In 2015, we implemented the validated EFFECT questionnaire together with the EFFECT-System for quality assessment of clinical teaching in residency training.The aim of this study was to investigate the influence of characteristics of the resident (year of training) and clinical teacher (gender, age, and type of academic position) on teaching quality, as well as to assess areas for teaching quality improvement. Materials and methodsResidents from 7 different residency study programs filled out 333 EFFECT questionnaires evaluating 146 clinical teachers. We received 143 self-evaluations of clinical teachers using the same questionnaire. Items were scored on a 6-point Likert scale. Main outcome measures were residents’ mean overall (MOS), mean subdomain (MSS) and clinical teachers’ self-evaluation scores. The overall comparisons of MOS and MSS across study groups and subgroups were done using Student's t test and ANOVA for trend. The intraclass correlation coefficient (ICC) was calculated in order to see how residents’ evaluations match with self-evaluations for every particular teacher. To indicate areas for quality improvement items were analyzed subtracting their mean score from the respective (sub)domain score. ResultsMOS for domains of “role modeling”, “task allocation”, “feedback”, “teaching methodology” and “assessment” valued by residents were significantly higher than those valued by teachers (P<0.01). Teachers who filled out self-evaluation questionnaires were rated significantly higher by residents in role modeling subdomains (P<0.05). Male teachers in (sub)domains “role modeling: CanMEDS roles and reflection”, “task allocation”, “planning” and “personal support” were rated significantly higher than the female teachers (P<0.05). Teachers aged 40 years or younger were rated higher (P<0.01). Residents ratings by type of teachers’ academic position almost in all (sub)domains differed significantly (P<0.05). No correlation observed between MOS of a particular teacher and MOS as rated by residents (ICC=0.055, P=0.399). The main areas for improvement were “feedback” and “assessment”. ConclusionsResident evaluations of clinical teachers are influenced by teachers’ age, gender, year of residency training, type of teachers’ academic position and whether or not a clinical teacher performed self-evaluation. Development of CBME should be focused on the continuous evaluation of quality, clinical teachers educational support and the implementation of e-portfolio.

Trauma Anesthesiology as Part of the Core Anesthesiology Residency Program Training: Expert Opinion of the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness (ASA COTEP).

Trauma Anesthesiology as Part of the Core Anesthesiology Residency Program Training: Expert Opinion of the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness (ASA COTEP).

A Novel Approach to Training Pediatrician-Scientists During Intern Year of Pediatric Residency Training (Descriptive Abstract)

A Novel Approach to Training Pediatrician-Scientists During Intern Year of Pediatric Residency Training (Descriptive Abstract)

Is there a "July effect" in pediatric neurosurgery?

The belief that July, when resident physicians' training year begins, may be associated with increased risk of patient morbidity and mortality is known as the "July effect." This study aimed to compare complication rates after pediatric neurosurgical procedures in the first versus last academic quarters in two national datasets. Data were extracted from the National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) database for year 2012 for 30-day complication events and the Kids' Inpatient Database (KID) for year 2012 for in-hospital complication events after pediatric neurosurgical procedures. Descriptive and analytic statistical methods were used to characterize the impact of seasonal variation between the first and last quarters on complications. Three thousand six hundred twenty-four procedures in the NSQIP-P dataset and 14,855 hospitalizations in KID were included in the study cohort. No significant difference was observed between the first and fourth quarters for these complication events: wound disruption/dehiscence, wound infection, nerve injury, bleeding requiring transfusion, central line-associated BSI, deep venous thrombosis/pulmonary embolism, urinary tract infection, renal failure, re-intubation/pulmonary failure, cardiac arrest, stroke, coma, and death. There was no difference in the average length of stay or average length of surgical time. In the NSQIP-P, the first quarter was associated with a significantly increased incidence of pneumonia and unplanned re-operation; there was a trend towards increased incidence of unplanned re-admission and sepsis. In KID, there was no difference in the rate of pneumonia or sepsis. For the majority of morbidity and mortality events, no significant difference was found in occurrence rates between the first and last quarters.

PGY 3 Chief Residents in a 4-Year Emergency Medicine Residency Training Program: A Unique Paradigm.

Emergency medicine (EM) chief residents are traditionally drawn from the most-senior class of residents. Our training program's chief residency structure is, to our knowledge, unique in that it is the only 4-year EM training program to select PGY 3 residents as chief residents. This structure allows PGY 4 residents enrolled in a 4-year curriculum to focus their final year of residency training on their professional development and on laying a foundation for a career in academic EM while unencumbered with the responsibilities of chief residency. Conventional thinking holds that the most senior individual is the most capable of serving in a leadership role as chief resident; our experience has shown, however, that selecting chief residents from the PGY 3 class of a 4-year residency program is not only feasible and well received by our residents, our residency training program, and our department, but is invaluable to the development of all individuals in the PGY 4 class regardless of whether or not they served as a chief resident. We recommend that 4-year EM residency training programs in development as well as 4-year programs that currently use-or plan to incorporate-longitudinal academic development or track systems consider this model.

The Impact of Using Mean Versus Mode When Assessing Resident Competency.

The Accreditation Council for Graduate Medical Education Milestone Project was implemented in 2014 to standardize assessments and progression of residents. While it is recommended that milestones not be used as tools for direct assessments of resident competency, many programs have used or adapted milestone tools for this purpose. We sought to explore use of the most frequent milestone level at which a resident was evaluated (ie, the mode), and compared this to the standard practice of using the arithmetic mean for summarizing performance. We reviewed all Family Medicine Milestone evaluations from 1 program for the first 2 academic years of milestone implementation. Mean and mode scores were calculated across 24 unique residents, 841 evaluation forms, and 5897 measurements. The proportion of overestimation errors (where the mean is at least 0.5 larger than the mode) and underestimation errors (where the mean is at least 0.5 less than the mode) were then compared across resident training year and subcompetency. For the 24 residents, an estimation error occurred in 175 of 792 of the comparisons (22%). Of these errors, 118 (67%) were overestimation errors. First-year residents accounted for 55% (96 of 175) of all estimation errors. All subcompetencies had some estimation errors, with 6 having greater than 5%. If the trend for using the milestones as stand-alone assessment tools is to continue, aggregating data by using frequency distributions and mode would be a more stable and appropriate approach given their nominal or, at best, ordinal nature.

Anaesthesia and Intensive Care Residents' Perception of Simulation Training in Four Romanian Centres.

IntroductionSimulation training offers an opportunity to educate anaesthesia and intensive care (AIC) residents safely. At present, it is not yet a mandatory part of residency curriculum.The aim of the study was to evaluate the residents’ perception of the inclusion of simulation-based training in the Romanian AIC residency program.Material and methodsRomanian AlCs in anaesthesia and intensive care from four training centres completed a twenty-question survey regarding their views on simulation during their residency training. Residents were divided into junior, in the first three years, or senior groups, in the last two years of residency training. The questionnaire included Likert-scale multiple-choice, open-ended, and “yes” or “no”questions regarding simulator learning, the frequency of simulation sessions, and the value of the simulation sessions in improving practice, skills or teamwork. The open-ended questions, asked which were the respondents’ preferred topics to be included in simulation sessions.ResultsFifty-six percent of residents completed and returned the questionnaire. Ninety-eight percent of them considered simulation-learning useful once a month or every three months especially in the first two years of training. All residents thought simulation sessions would improve their skills, communication abilities, and teamwork. Senior residents paid more attention to clinical scenarios (p=0.007), haemodynamic monitoring (p=0.017) and mechanical ventilation (p=0.004) as compared to juniors. All residents considered difficult airway management, and cardiac life support to be very important issues to be included in simulation sessions.ConclusionThe survey demonstrated that simulation-based training should play a greater role and eventually became compulsory in training program in AIC academic centres.

The JeffSTARS Advocacy and Community Partnership Elective: A Closer Look at Child Health Advocacy in Action.

Advocacy and service-learning increasingly are being incorporated into medical education and residency training. The Jefferson Service Training in Advocacy for Residents and Students (JeffSTARS) curriculum is an educational program for Thomas Jefferson University and Nemours trainees. The JeffSTARS Advocacy and Community Partnership Elective is one of two core components of the larger curriculum. The elective is a monthlong rotation that provides trainees in their senior year of medical school or residency training the opportunity to learn about health advocacy in depth. Trainees develop a basic understanding of social determinants of health, learn about health policy, participate in legislative office visits, and work directly with community agencies on a mutually agreeable project. The elective provides advocacy training to self-selected trainees from area medical schools and residency programs to develop a cadre of physicians empowered to advocate for child health. JeffSTARS has advanced the field of child health advocacy locally by forging new partnerships and building a network of experts, agencies, and academic institutions. After this experience, trainees realize that their health expertise is very valuable to health advocacy and policy development. JeffSTARS is recognized nationally as one of a growing number of advocacy training programs for students and residents, with trainees presenting selected projects at national meetings. Teaching advocacy has raised awareness about social determinants of health, community resources, and the medical home. One of the many benefits of the elective has been to strengthen the skills and expertise of trainees and faculty members alike.

Intracorporal knot tying techniques – which is the right one?

IntroductionIntracorporal knot tying (ICKT) and suturing in minimal invasive surgery (MIS) represent a key skill for advanced procedures such as Nissen fundoplication. Suture placement under tension is particularly challenging during MIS. The aim of this study was to compare ICKT of the common surgical square knot and the slipping knot on a simulated suture placement under tension. Furthermore, we objectively assessed the surgical skill of ICKT following 3hours of hands-on training. MethodsA box trainer was used for laparoscopic knot tying with predefined openings. A 12cm suture was placed in central view. We used a standardized silicon suture pad with a defined wound dehiscence of 0.5cm and marked needle entrance and exit targets next to the incision. Twenty participants were divided among three groups in this study. The first group (n=5) consisted of senior physicians. The second group (n=5) was made up of surgical residents in the first to fourth year of residency training. The third group (n=10) contained medical students between their third and sixth year of study without any prior experience in laparoscopic surgery. Residents and students received a 3-hour hands-on training in surgical square and slipping knot tying. Each participant tied two of each knot types before and after the hands-on training. Knot quality, performance, total time and suture placement accuracy were the parameters for assessment in this study. ResultsThe knot quality was greater for the slipping knot compared with the square knot in all groups. There were no significant intragroup differences in knot tying performance, task time and accuracy of both suture methods. Students and residents improved in all categories for both ICKT techniques after training. DiscussionWe compared ICKT of the surgical square knot with the slipping knot on a simulated suture placement under tension during a standardized training program for medical students and surgical residents. In our study, the average quality of the slipping knot was significantly superior to the square knot in all participants. The knot tying performance, task time, and accuracy of students and residents after hands-on training were not significantly different between both suture methods. This suggests that the two ICKT techniques have similar properties except the quality advantages of the slipping knot. Although students and residents improved in all categories for both ICKT techniques after training, they did not achieve expert level for task times and accuracy. ConclusionsIn this pilot trail, the quality of the slipping knot was superior to the surgical square knot during intracorporal suturing under tension. Our 3-hour sequential training program improved laparoscopic suturing and knot tying skills in all participants. Our findings suggest that training centers for MIS using validated training programs should be a continuous and integral part of surgical education. Level of evidenceUSPSTF Level III: monocentric, prospective, pilot Trial.

Pharmacy residency training measured through a standardized knowledge test

The use of a standardized knowledge test to assess postgraduate year 1 (PGY1) pharmacy residency training was evaluated. This was a retrospective review of a prospectively administered exam. A bank of questions was developed by preceptors from each of the core rotation disciplines: general medicine (including ambulatory care and oncology), pediatrics, critical care (including transplantation), drug information, operations, practice management, and psychiatry. Board-certified pharmacy specialists at our institution were asked to submit 5-10 questions with answers that would likely be encountered by residents during rotation in their specific specialty area. The exam was administered at the beginning and the end of the resident's PGY1 year. A total of 49 PGY1 residents completed the examination during the first and last months of their residency training. Residents' overall scores improved 5-10% annually from baseline to completion of their residency. The mean overall exam score significantly improved from baseline after completion of a PGY1 residency at our institution for all four class years. All four residency classes demonstrated an increase from baseline scores in most core disciplines with the exception of practice management, which decreased every year of the examination. Scores on a standardized exam developed to assess the baseline knowledge of incoming PGY1 residents and the effect of one year of residency training improved in the majority of practice areas at the end of the year compared to scores at the beginning of the year.

Trainee experience and success of urgent airway management

BackgroundThere are limited data regarding emergent, non-operating room, intubations performed by all levels of anesthesia residents. This study was a large retrospective review of all non-operating room emergent intubations performed at a single tertiary medical center. The study evaluated the rate of difficult intubations by level of resident training, compared success rates for direct versus video laryngoscopy and evaluated the rate and success of rescue video laryngoscopy following failed direct laryngoscopy. MethodsAll emergent non-operating room intubations at a tertiary university medical center from July 1, 2009, to August 1, 2012, were reviewed and all study data were collected from the medical records. Intubations were classified as being initiated with either direct or video methods. The total number of attempts required and the rate of success were compared by resident year and intubation type. ResultsOut of a total of 788 emergent intubations, 741 were performed by anesthesia residents. The higher level anesthesia residents (CA-2 and CA-3) had a statistically significant decrease in the number of attempts needed when compared to CA-1 residents. Rate of success did not vary by resident training year, but success rates were higher for cases initiated with video laryngoscopy. Among direct initiated cases, 8% failed initial direct laryngoscopy and were then successfully intubated with rescue video laryngoscopy. ConclusionsDuring emergent, non-operating room intubations, senior level residents used fewer attempts at intubations with direct laryngoscopy. Successful intubation was improved by beginning residents when video laryngoscopy was utilized. Complications were not affected by the presence of the attending anesthesiologist.

Treatment-Planning Metrics for Radiation Oncology Residents: A Longitudinal Analysis of Time to Contour and Year of Training

Hypothesizing that metrics on contouring efficiency improve through years of training, we evaluated treatment planning efficiency to improve clinical and educational operations in an academic program. Since 2009, an electronic whiteboard built with Oracle Apex has been used at our institution to track treatment courses through all phases of active planning. From scheduling of the CT simulation through plan generation to completion of QA, all steps are tracked and task notifications are sent to staff automatically. Both our main facility (three linear accelerators) and a satellite facility (two linear accelerators) are included. This study analyzes courses for the time residents required to contour and its relationship to each resident's year of training. Time to contour is the interval from importing the CT to being ready for attending evaluation. Only treatment courses containing the requisite time points in order (ready for contours, ready for attending review, contours approved, plan approved) recording the involvement of a resident with at least three consecutive years of data were utilized. Of the 9,863 courses, 4,620 (46.8%) contained the necessary time points reflecting participation of longitudinally evaluable residents. Excluded plans included brachytherapy, stereotactic radiosurgery, simulation and treatment plans, plans contoured by attendings, and others in which temporal waypoints were not included or were documented in an unusual sequence. Within each year of training, residents demonstrated substantial differences both in the number of contours and the time required (see table). While the total number of cases completed annually decreased as residents invested progressively more time on research and other elective rotations, there was no clinically significant alteration in the mean time required to complete contouring of each case. When data from individual residents were evaluated over at least 3 years of training, only 3 of 13 residents had longitudinal differences in contouring times; of these, 2 decreased mean contouring times by 7.6 and 2.2 hours annually (P = 0.024, 0.012) while 1 increased mean time by 5.8 hours annually (P = 0.045). Furthermore, the number of contours a resident completed annually did not correlate with the mean time required to complete each contour (P = 0.36). Although residents consistently contoured fewer patients during subsequent years of training, the time to complete this task did not diminish either when data were evaluated in aggregate or when residents' individual longitudinal performances were compared. This study provides benchmarks for treatment planning process improvement in academic centers with residency programs.Abstract 3025; Table 1.Year of TrainingPGY2PGY3PGY4PGY5Number of Residents16161312Mean Number of Cases (SD)100.3 (54.9)85.7 (38.0)72.7 (27.9)58.7 (15.5)Mean Hours to Contour (SD)33.6 (40.0)34.8 (42.3)31.6 (41.0)38.1 (46.7) Open table in a new tab

Risk Factors for Return to the Operating Room after Resident-Performed Cataract Surgery

ABSTRACTObjective: Investigate risk factors for unplanned return to the operating room after resident-performed cataract surgery. Design: Retrospective case-control study. Setting: Institutional. Methods: Study population: All patients with reoperation within 90 days of resident-performed phacoemulsification were matched to four control eyes which had surgery within 30 days of the reoperation at the same institution. Observation Procedure: Billing codes were used to identify all patients who underwent resident-performed intended phacoemulsification with intraocular lens placement from January 2005 to December 2010. Main Outcome Measures: Investigated risk factors for reoperation included cataract characteristics and preexisting ocular co-morbidities, including diabetic retinopathy, retinal detachment history, glaucoma, corneal pathology, and uveitis. Additional preoperative risk factors studied included resident training year, history of tamsulosin use, phacodonesis, pupillary dilation, presence of pseudoexfoliation, myopia, history of trauma, visual acuity, and monocular status. Intraoperative variables were the use of iris expansion devices, use of capsular stain, attending type, incision type, use of sutures, vitreous loss, anesthesia type, and phacoemulsification technique. Results: There were 67 returns to the operating room (i.e., cases) over five years that were assigned to 268 control eyes. In preoperative multivariate analysis, phacoemulsification done by a first- or second-year resident (OR 3.2, 95% CI: 1.7–6.0, p < 0.001) was associated with an increased risk of reoperation. In postoperative multivariate analysis, only the use of the divide-and-conquer technique (OR 4.0, 95% CI:1.7–9.2, p = 0.001) was associated with an increased risk of reoperation. Conclusions: Phacoemulsification done by a junior resident or using the divide-and-conquer technique had the highest risk of reoperation.

The Society of Thoracic Surgeons Thoracic Surgery Practice and Access Task Force: 2014 Workforce Report

The Society of Thoracic Surgeons (STS) has intermittently surveyed its workforce, providing isolated accounts of the current state of thoracic surgical practice. The 63-question survey instrument was received by 4,343 surgeon members of the STS, and responses were gathered between October 1 and November 5, 2014. The return rate was 29.1%. The median age of the active United States thoracic surgeons is 54 years. Women comprise 6.9% of the responders, constituting 6.3% of adult cardiac, 6.1% of congenital heart, and 11.8% of general thoracic surgeons. The decision to pursue a career in thoracic surgery was made before or in medical school by 48.3% of surgeons. Most survey respondents had a mean of 8.7 years of residency training after medical school graduation. The cumulative average educational debt was $62,815. Overall career satisfaction was 43.5% (very or extremely satisfied). STS Database participation greatly increased (89.9%) compared with the 2009 survey. Operative volume over the past 12 months decreased for 26% of surgeons. Malpractice premiums over the past 5 years have averaged between $54,310 and $$57,281. Of those who responded, 43.8% plan to retire between the age of 66 and 70 years. These data provide a current, detailed profile of the specialty. Ongoing challenges remain length of training and educational debt. Case volumes, scope of practice, malpractice costs, and career satisfaction have remained relatively constant. With contraction of the current resident pool and the workforce ages, significant cardiothoracic surgeon shortages may develop as the United States population expands.

Neurocritical Care Education During Residency: Opinions (NEURON) Study.

The American Academy of Neurology (AAN) has established a core curriculum of topics for residency training in neurocritical care. At present there is limited data evaluating neurology residency education within the neurological intensive care unit. This study evaluates learner concerns with the neurological intensive care unit. The Communication Committee and Resident & Fellow Taskforce within the Neurocritical Care Society (NCS) developed an online survey that consisted of 20 selection and free-text based questions. The survey was distributed to NCS members and then to neurology residency program directors. Statistical analysis of neurocritical care exposure were completed with t or Fisher exact test with p-value <0.05 considered significant. A total of 95 individuals from 32 different residency programs (36.5% response rate) responded to the questionnaire. Most individuals train with neurocritical care attendings, fellows and advanced practitioners and have neurocritical care exposure during multiple years of residency training. 54% of responders cite improvement in education as a means to improve neurocritical care training. Those that raised concern had no difference in time in the neurocritical care unit (9.4 weeks vs 8.8 weeks), exposure to trained neurointensivists, neurocritical care fellows or advanced providers (p value 0.53, 0.19, 0.83, respectively). There is significant learner concern regarding education within the neurointensive care unit. Although there are educational guidelines and focused neurocritical care educational materials, these alone do not satisfy residents' educational needs. This study demonstrates the need for educational changes, but it does not assess best strategies nor curricular content.

Beyond the learning curve: length of global health electives.

Beyond the learning curve: length of global health electives.

Fulfilling outpatient medicine responsibilities during internal medicine residency: a quantitative study of housestaff participation with between visit tasks.

BackgroundInternal Medicine residents experience conflict between inpatient and outpatient medicine responsibilities. Outpatient “between visit” responsibilities such as reviewing lab and imaging data, responding to medication refill requests and replying to patient inquiries compete for time and attention with inpatient duties. By examining Electronic Health Record (EHR) audits, our study quantitatively describes this balance between competing responsibilities, focusing on housestaff participation with “between visit” outpatient responsibilities.MethodsWe examined EHR log-in data from 2012–2013 for 41 residents (R1 to R3) assigned to a large academic center’s continuity clinic. From the EHR log-in data, we examined housestaff compliance with “between visit” tasks, based on official clinic standards.We used generalized estimating equations to evaluate housestaff compliance with between visit tasks and amount of time spent on tasks. We examined the relationship between compliance with between visit tasks and resident year of training, rotation type (elective or required) and interest in primary care.ResultsHousestaff compliance with logging in to complete “between visit” tasks varied significantly depending on rotation, with overall compliance of 45 % during core inpatient rotations compared to 68 % during electives (p = 0.01). Compliance did not significantly vary by interest in primary care or training level. Once logged in, housestaff spent a mean 53 min per week logged in while on electives, compared to 55 min on required rotations (p = 0.90).ConclusionsOur study quantitatively highlights the difficulty of attending to outpatient responsibilities during busy core inpatient rotations, which comprise the bulk of residency at our institution and at others. Our results reinforce the need to continue development and study of innovative systems for coverage of “between visit” responsibilities, including shared coverage models among multiple residents and shared coverage models between residents and clinic attendings, both of which require a balance between clinic efficiency and resident ownership, autonomy and learning.

Effectiveness of a Core-Competency-based Program on Residents' Learning and Experience.

BackgroundThe Care of the Elderly (COE) Diploma Program is a six-to-twelve-month enhanced skills program taken after two years of core residency training in Family Medicine. In 2010, we developed and implemented a core-competency–based COE Diploma program (CC), in lieu of one based on learning objectives (LO). This study assessed the effectiveness of the core-competency–based program on residents’ learning and their training experience as compared to residents trained using learning objectives.MethodsThe data from the 2007–2013 COE residents were used in the study, with nine and eight residents trained in the LO and CC programs, respectively. Residents’ learning was measured using preceptors’ evaluations of residents’ skills/abilities throughout the program (118 evaluations in total). Residents’ rating of training experience was measured using the Graduate’s Questionnaire which residents completed after graduation.ResultsFor residents’ learning, overall, there was no significant difference between the two programs. However, when examined as a function of the four CanMEDS roles, there were significant increases in the CC residents’ scores for two of the CanMEDS roles: Communicator/Collaborator/Manager and Scholar compared to residents in the LO program. With respect to residents’ training experience, seven out of ten program components were rated by the CC residents higher than by the LO residents.ConclusionThe implementation of a COE CC program appears to facilitate resident learning and training experience.