Year Of Clinical Training Research Articles

Clinical Simulation Program for the Training of Health Profession Residents in Confidentiality and the Use of Social Networks.

In the transition to a professional learning environment, healthcare professionals in their first year of specialized postgraduate clinical training (known as residents in Spain) are suddenly required to handle confidential information with little or no prior training in the safe and appropriate use of digital media with respect to confidentiality issues. The aims of this study were: (1) to explore the usefulness of an advanced clinical simulation program for educating residents from different healthcare disciplines about confidentiality and the dissemination of clinical data or patient images; (2) to explore the use of social networks in healthcare settings; and (3) to explore participants' knowledge and attitudes on current regulations regarding confidentiality, image dissemination, and the use of social networks; Methods: This was a cross-sectional study. Data were collected from all 49 first-year residents of different health professions at a Spanish hospital between June and August 2022. High-fidelity clinical simulation sessions designed to address confidentiality and health information dissemination issues in hospital settings, including the use of social networks, were developed and implemented. Data were assessed using a 12-item ad hoc questionnaire on confidentiality and the use of social media in the healthcare setting. Descriptive of general data and chi-square test or Fisher's exact test were performed using the SPSS 25.0 software; Results: All the participants reported using the messaging application WhatsApp regularly during their working day. A total of 20.4% of the participants stated that they had taken photos of clinical data (radiographs, analyses, etc.) without permission, with 40.8% claiming that they were unaware of the legal consequences of improper access to clinical records. After the course, the participants reported intending to modify their behavior when sharing patient data without their consent and with respect to how patients are informed; Conclusions: The use of advanced simulation in the training of interprofessional teams of residents is as an effective tool for initiating attitudinal change and increasing knowledge related to patient privacy and confidentiality. Further follow-up studies are needed to see how these attitudes are incorporated into clinical practice.

Protocol for the SELECT study: a sequential mixed methods study of the selection of UK medical students into clinical academic training

BackgroundInternationally, there has been a move towards fostering diverse healthcare workforces that are representative of the patient populations they serve. Selection criteria for academic-clinicians often aim to capture skills and attributes that demonstrate both clinical and academic excellence. Currently, it is not known whether the selection criteria for early academic-clinical careers advantage or disadvantage certain ethnic or socioeconomic groups. The UK has a structured route of integrated clinical academic training with entry level training for newly qualified doctors administered through the ‘Specialised Foundation Programme’ which provides protected time for research within the first two years of postgraduate clinical training. In this study, we aim to identify what selection criteria are used within the UK Specialised Foundation Programme, and how these relate to demographic factors.MethodsWe will perform a mixed methods study consisting of a document analysis of person specifications and selection criteria used in the 2024 UK Specialised Foundation Programme, and a national cross-sectional survey of current medical students in the UK. We will obtain the person specifications, selection criteria, white space (open ended questions used during shortlisting) and interview questions and mark schemes from each Specialised Unit of Applications via information available on their websites or through Freedom of Information requests. Our survey will collect information relating to demographic data, selection criteria, and perceptions of specialised foundation programme selection.DiscussionInternational literature has demonstrated inequity in academic markers used in selection of post-graduate clinicians and that disadvantages caused by selection can compound over time. As such it is important to understand what inequity exists within the selection of early academic-clinicians, as this can help inform more equitable selection practices and help nurture a more diverse academic-clinical workforce.

Leveraging telementoring platforms to enhance PA capacity and education.

Telementoring is a valuable workforce development resource that connects subject matter experts with healthcare providers via videoconferencing. This technology can deliver training, education, and ongoing technical support to build workforce capacity. Arizona State University (ASU) has leveraged a widely used telementoring platform, Project ECHO, to disseminate best practices in palliative medicine. The model has increased clinician knowledge and confidence, and the learning network may provide protective factors for clinician wellness. The replicable and inclusive nature of telementoring platforms creates educational opportunities to align learners across the didactic and clinical years of medical training, as well as into early- and midcareer for physician associates/assistants (PAs). Telementoring programs can be used across the PA learning continuum, including in PA training programs.

Do Interns Learn On-The-Job How to Obtain Proper Informed Consent for Surgical Procedures?

Obtaining surgical informed consent (SIC) is a critical skill most residents are expected to learn "on-the-job." This study sought to quantify the effect of 1 year of clinical experience on performance obtaining SIC in the absence of formal informed consent education. In this case-control cohort study, PGY1 and PGY2 surgical residents in an academic program were surveyed regarding their experiences and confidence in obtaining SIC; then assessed obtaining informed consent for a right hemicolectomy from a standardized patient. Single academic general surgery residency program in Buffalo, NY. Ten PGY1 and eight PGY2 general surgery residents were included in the study, after excluding residents with additional years of training. PGY2 residents had significantly more experience obtaining SIC compared to PGY1 residents (median response: ">50" vs "between 6 and 15," p = 0.001), however there was no difference in self-reported confidence in ability obtaining SIC (mean 3.2/5 in PGY1 vs 3.4/5 in PGY2, p = 0.61), self-reported knowledge of SIC (mean 3.1/5 in PGY1 vs 3.6/5 in PGY2, p = 0.15), performance on a test regarding SIC (mean score 9.0/20, SD 3.9 for PGY1 vs mean score 9.6/20, SD 3.5, t = 0.387, p = 0.739) or performance during a standardized patient interview (mean 11.2/20, SD 2.78 for PGY1 vs mean 11.4/20, SD 1.51 for PGY2, p = 0.87). In the interviews all residents addressed general risks (bleeding/infection), however both groups performed worse in addressing procedure-specific risks including anastomotic leak as risk for hemicolectomy. A year of clinical training between PGY1 to PGY2 did not improve performance in obtaining surgical informed consent when lacking formal education, despite self-confidence in their ability. A curriculum covering the content, delivery and assessment of informed consent should be initiated for residents upon arrival to surgical training.

Attitude of Medical and Dental Undergraduate Students Towards Learning of Communication Skills at a Medical College: A Descriptive Cross-sectional Study.

Proper physician-patient communication has shown to impact patients' satisfaction, and better health outcomes. On the contrary, negative impacts of poor communication have been attributed as one of the causes of increasing workplace violence. It is imperative to identify the attitude of the students towards communication skill learning. The aim of the study was to find out the attitude of undergraduate students towards communication skill learning using the communication skill attitude scale. This cross-sectional study was carried out from October, 2022 to July 2023 among undergraduate medical and dental students. Data was collected after obtaining the ethical approval from Institutional Review Committee (IRC number 2079/80/82) using a preformed proforma and the previously validated communication skills attitude scale questionnaire. Convenience sampling was done. The demographic details, educational characteristics, opinions regarding communication learning and median of positive and negative attitude scale scores were calculated using Statistical Package for the Social Sciences (SPSS). The total median (interquartile range) positive attitudes scale (PAS) and negative attitudes scale (NAS) scores were 52.00 (48.00-87.00) and 31.00 (28.00-34.00) respectively. The first year of undergraduates had higher PAS scores 56.00 (50.00-60.00) than final year 48.50 (44.25-55.00). The students who were in favour of CS learning during the clinical years of training had a higher PAS median score, 54.00 (49.00-58.00). The undergraduates had overall positive attitude towards CS learning but negative attitudes were also noted, with deterioration in the scores from first to final year of undergraduation, reiterating the importance of strengthening CS learning in the curriculum early-on in the study period.

Implementing a research methods curriculum for first year hematology oncology fellows.

9034 Background: The Hematology/Oncology Fellowship Program at the University of Alabama at Birmingham is an ACGME accredited, three-year academic training program. Fellows are expected to participate in at least one mentored research project during their second and third years of training. The program, however, did not provide formal training in research methods. Here, we provide the results of implementing a research methods curriculum for first year fellows to fulfill that educational need and to facilitate engagement in research projects throughout their fellowship training. Methods: We developed a structured curriculum composed of 10 didactic sessions covering the fundamental concepts of epidemiology and biostatistics. Based on the core competencies of research methods, learning objectives integrated concepts of 1) study design; 2) identifying bias and confounding; 3) exploratory data analysis, statistical inference, hypothesis testing; and results interpretation; and 4) critical appraisal of research evidence. The course was designed to promote self-directed learning and build on individual experiences and interests. One-on-one meetings between curriculum faculty and fellows facilitated identification of fellow research interests and pairing with mentors with aligned expertise. The didactic sessions were evaluated using a 21 question pre- and post- knowledge assessment. Fellows also self-rated on a 10-point scale their level of confidence performing research related activities. Following the course, fellows were expected to complete at least i) one research project, present it at a scientific meeting and submit for publication in peer-reviewed journal; and/or ii) one research proposal grant application. Results: To date, 13 first-year fellows across three cohorts have participated in the course, two of which have been completed, and the third will conclude in March 2024. Complete pre- and post- assessment scores were available for 8 fellows. Mean score difference was statistically significant comparing pre- to post- knowledge scores (3.79 points (SD= 4.43), paired t-test p-value=0.02). Self- ratings improved across all components on average from 3.7 pre- to 6.5 post-course (p<0.001). The largest change in self-ratings were in understanding study design concepts, basic principles of research and critical appraisal, followed by interpreting statistical outputs. All fellows are leading at least one mentored research project and 7 out of 8 fellows have presented abstracts at national meetings including the American Society of Clinical Oncology and the American Society of Hematology. Conclusions: Implementing a dedicated research methods curriculum to clinical fellows is feasible, and improved learner knowledge, skills, and engagement in research activities. Research methods principles can be effectively incorporated into the first year of clinical fellowship training.

Knowledge, perception, and attitudes of medical students towards antimicrobial resistance and stewardship: an observational cross-sectional study from Palestine

BackgroundAntimicrobial resistance is a global health concern that contributes to significant mortality and morbidity. This study investigated knowledge, perceptions, and attitudes of medical students in Palestinian universities towards antimicrobial resistance and stewardship. The study also investigated associations between variables of students with their knowledge, perceptions, and attitudes.MethodsA questionnaire was used in this cross-sectional study. Medical students in Palestinian universities were surveyed in this study. In addition to the demographic variables of the medical students, the questionnaire measured knowledge, perceptions, and attitudes of medical students in Palestinian universities towards antimicrobial resistance and stewardship.ResultsIn this study, 384 medical students returned complete questionnaires. Of the medical students, 269 (70.1%) were female, 215 (56.0%) lived in urban areas, and 244 (63.5%) were in their clinical training years. Medical students in the clinical phase demonstrated higher knowledge about microbial resistance compared to preclinical students as evidenced by a mean score of 89.7 ± 15.9 compared to 74.0 ± 26.4, respectively (p < 0.05). Similarly, clinical students displayed higher score regarding antimicrobial resistance perception, with a mean score of 85.7 ± 15.6, contrasted with 72.6 ± 24.1 among preclinical students. In terms of knowledge pertaining to antimicrobial stewardship, clinical students scored higher with a mean of 63.4 ± 28.5 compared to 54.5 ± 31.5 among preclinical students. Regarding attitudes, clinical students also demonstrated a higher mean score of 67.6 ± 22.6 in contrast to 61.1 ± 24.6 among preclinical students.ConclusionThe medical students are the future workforce of physicians in any healthcare system. Therefore, increasing knowledge of the medical students about and how to combat antimicrobial resistance can help save lives and improve patient outcomes. More studies are needed to find the best ways to increase knowledge, perceptions, and attitudes of medical students towards antimicrobial resistance and antimicrobial stewardship.

Multivariate analysis of the factors affecting medical students' decision to join the cardiovascular surgery department.

The purpose of this study was to statistically analyze the factors that influence cardiovascular surgery recruitment. Fifth- and sixth-year medical students and first-year residents who participated in cardiovascular surgery-related events at our university over a 10-year period from April 2013 to August 2022 were included. The primary endpoint was admission to the department of cardiovascular surgery. Gender, participation in sixth-year elective clinical training, participation in national academic conferences, participation in cardiovascular surgery summer school, and the cost of participation in these events (airfares and lodging) were included as analytic factors. Fifty-three participants attended cardiovascular surgery events during the study period. The sample included 48 males (84%) and 9 females (16%), and 3 fifth-year medical students (5%), 45 sixth-year students (79%), and 9 students in their first year of clinical training (16%). Eighteen (32%) of the participants eventually joined the department. Gender, participation in national academic conferences, cardiovascular surgery summer school, and cost of participation were not significantly related to the decision to join the department, but participation in elective clinical training was significantly positively related to the decision to join the department for sixth-year students (p < 0.01). We statistically analyzed the factors involved in the recruitment of students and initial clinical residents to the department of cardiovascular surgery. The results showed that participation in elective clinical training was significantly positively associated with the decision to join the department, suggesting that efforts to encourage participation in elective clinical training are important.

Learning Theories Versus Practice: How Do Internal Medicine Residents Study for Licensing Examinations?

The ability to recall relevant medical knowledge within clinical contexts is a critical aspect of effective and efficient patient diagnosis and management. The ever-growing and changing body of medical literature requires learners to develop effective life-long learning techniques. Learners can more successfully build their fund of knowledge and ability to retrieve it by using evidence-based learning strategies. Our objective was to evaluate the study habits of internal medicine (IM) residents at an academic institution to understand if they apply key learning strategies for the American Board of Internal Medicine (ABIM) exam preparation. We also briefly review various learning strategies that can be applied to IM residency curricula. A web-based survey consisting of 16 multiple-response questions on study habits was filled out by the IM residents in 2019 at Tufts Medical Center. Of the 75 residents invited to participate in the study, 69 responded (response rate = 92%). Of the responders, n=25 (36.2%) were post-graduate year (PGY)-1, n=20 (29.0%) were PGY-2, and n=24 (34.8%) were PGY-3 residents. More than half the residents (n=40, 58%) had Step 2 Clinical Knowledge (CK) scores > 250. Residents self-reported applying spaced learning (67%), interleaving (64%), retrieval (64%), and elaboration practices (46%) for exam preparation. There was a significant association between the Step 2 CK score and elaboration (p=0.017) technique but not with spaced learning, interleaving, or retrieval. The majority of residents felt not at all prepared (n=42, 60.9%) for the ABIM exam. Despite two years of clinical training, 33% of the third-year residents felt inadequately prepared for the board certification exam. Incorporating evidence-based learning strategies into their daily curriculummay help them better prepare for the ABIM exam.

What do medical students and their clinical preceptors understand by primary health care in South Africa? A qualitative study

BackgroundThe definition of Primary Health Care (PHC) issued by the World Health Organisation in 1978 indicated that essential health care should be made accessible to individuals and their communities close to where they live and work. In 1992 Starfield articulated the four pillars of PHC: the patient’s first contact with healthcare, comprehensive care, coordinated care and continuous care. Using this literature guidance, this study sought to explore what undergraduate medical students and their clinical preceptors understood by PHC in four South African medical schools.MethodsA qualitative study using the phenomenological design was conducted among undergraduate medical students and their clinical preceptors. The setting was four medical schools in South Africa (Sefako Makgatho Health Sciences University, Walter Sisulu University and the University of KwaZulu-Natal and the Witwatersrand University). A total of 27 in-depth interviews were conducted among the clinical preceptors and 16 focus group discussions among the students who were in their clinical years of training (MBChB 4–6). Interviews were digitally recorded and transcribed verbatim, followed by thematic data analysis using the MAXQDA 2020 (Analytics Pro) software.ResultsFour themes were identified in which there were similarities between the students and their preceptors regarding their understanding of PHC: (1) PHC as the patient’s first contact with the healthcare system; (2) comprehensive care; (3) coordination of care and (4) continuity of care. A further two themes were identified in which these two groups were not of similar understanding: (5) PHC as a level or an approach to healthcare and (6) the role of specialist clinical preceptors in PHC.ConclusionsMedical students and their clinical preceptors displayed an understanding of PHC in line with four pillars articulated by Starfield and the WHO definition of PHC. However, there remains areas of divergence, on which the medical schools should follow the guidance provided by the WHO and Starfield for a holistic understanding of PHC.

Perceptions towards Inter-Professional Education (IPE) among Pre-Registration Health Professional Students in Sri Lanka

Introduction of Inter-Professional Education (IPE) into healthcare professions’ curricula has become an important aim globally. Health professional students experience informal interprofessional learning opportunities during their clinical training years. Investigating the attitudes toward IPE and the factors that affect these attitudes among pre-registration students in the different health professions will illuminate the needs and challenges of IPE in Sri Lanka. A cross sectional study was conducted with the students from 8 health professional groups (Medicine, Physiotherapy, Nursing Diploma/ Degree, Medical Laboratory Science (MLS), Pharmacy, Audiology, Speech and Language Therapy) at different health educational institutions. A total of 686 students were invited to complete the self-administered questionnaire. The questionnaire mainly consists of the Readiness for Inter-Professional Learning Scale (RIPLS). The RIPLS data was analyzed using factor analysis, descriptive statistics, t-test and ANOVA. The response rate for the survey was 83%. Only 18.9% of the students reported previous IPE experiences. We sought a three-factor solution but the analysis highlighted that a single factor predominates. According to the 14 items which loaded to this factor, it was named as ‘value of teamwork’. The findings suggest that students’ attitudes towards IPE are generally positive. The variable factor loading than the original validation suggests that students may need more clarity on the aim of IPE. This study suggests some focused approaches for IPE in Sri Lanka. Promoting the importance of interprofessional learning through educational methods might assist to improve the attitudes toward IPE.

The effect of COVID-19 pandemic on respiratory therapy students’ clinical practice: a cross-sectional study

BackgroundDue to the 2019 Coronavirus disease (COVID-19) precaution, educational systems and learners’ practices from all specialties have been negatively affected, especially university students. COVID-19 has a massive effect on the practice of allied health students. The students’ hospital exposure has been severely affected by the cancelation of the clinical practice. This study aims to investigate the effect of COVID-19 pandemic on the clinical practice of respiratory therapy students in different universities around Jeddah, Saudi Arabia.MethodsAnalytical cross-sectional online questionnaire was distributed from August 2021 to November 2021 to respiratory therapy students. The study’s sampling technique was non-probability consecutive, and the calculated sample size was 183 participants. The survey contained questions to identify the clinical exposure of the participants. The participants included RT students in their clinical training years from King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz University, and Batterjee Medical College in Jeddah. The survey evaluated the effects of the pandemic on students’ clinical practice, confidence and clinical preparation, and education.ResultsA total of 187 respiratory therapy students completed the questionnaire. The results revealed that 145 (77.5%) of respiratory therapy students agreed that the pandemic had disrupted their clinical practice. The percentage of respiratory therapy students who felt that they were less confident and less prepared for the next academic year due to practical session cancellation was 141 (75.4%). Out of the total students, 135 (72.2%) students reported difficulty in connecting the clinical and theoretical part because of the pandemic.ConclusionThe majority of respiratory therapy students from the three universities similarly reported that the pandemic disrupted their practice and interfered with their ability to connect between clinical and theoretical part. Moreover, it had affected their confidence and preparedness for the next year.

Training Medical Students to Recognize, Understand, and Mitigate the Impact of Racism in a Service-Learning Course.

The Morehouse School of Medicine's Community Health Course (CHC) trains first-year medical students to work with people of racial and ethnic minorities and economically and medically disadvantaged communities. This service-learning course includes the diagnosis/assessment of the health of a community and the development, implementation, and evaluation of a plan to improve some aspect of the community's health. The CHC teaches about the impact of racism on the health of communities through lectures, educational games, and videos focused on social determinants of health, cultural competence, and effective community engagement. Students complete small group assessments, interventions, and service activities at assigned sites. This pedagogical approach integrates the Association of Medical Colleges' Diversity, Equity, and Inclusion competencies and engages many community partners. The course's strengths include a multidisciplinary faculty, a culturally and educationally diverse student body, and community partners with varied backgrounds and resources. Opportunities exist for collaborations with other degree programs to sustain and increase the impact of community interventions and link this community-based educational activity to clinical training years. Course evaluations, exams, and short essays assess students' awareness of racism and the extent to which unconscious bias affects students' completion and interpretation of community assessment data and their engagement with community partners.

PC7. Competency-based, Time-variable Resident Education: A Programmatic Update

PURPOSE: In 2018, the University of Pittsburgh Medical Center (UPMC) adopted a Competency-Based, Time-Variable (CBTV) model for plastic surgery training, the first of its kind in the United States. This educational model emphasizes performance and skill mastery, rather than time-based benchmarks, as the measure by which residents are deemed fit for graduation. METHODS: Starting in the PGY1 year, each resident is evaluated regularly via oral exam to assess knowledge of plastic surgery principles. Resident self-assessment of technical competency is directly compared to faculty assessment utilizing the Zwisch Rating Scale, a validated scoring system in rating resident autonomy. Our department has reorganized its rotation schedule to shift Chief-level rotations from the PGY6 year to the PGY5 year. RESULTS: UPMC matched its first CBTV resident class in 2018. Of this three-resident cohort, two residents (66%) were deemed competent for graduation after five clinical years of training. One resident elected to defer graduation until after six years of training due to fellowship application timing constraints. The other resident elected to pursue a year of research and subsequently graduate after five clinical years of training. Thus, all three residents will graduate after six years at UPMC, but with customized experiences based on their specific interests and educational needs. CONCLUSION: The CBTV model has increased the flexibility of our training program to accommodate individualized educational needs of each resident, allowing them variable rotation schedules to address surgical deficiencies as well as to further develop their clinical interests. This is a paradigm shift in surgical education.

Is it time for integrated academic pathways in SET training?

Patients benefit from receiving care in hospitals with a strong engagement in clinical research. Some of these benefits result from institutional factors such as hospital volume and resources, but the academic competencies of surgical teams play a significant role in high quality patient care.1, 2 Surgeons with doctorate degrees are more likely to publish and obtain research grants throughout their career, and units they work in report higher rates of trainee research success and satisfaction, improved patient outcomes and greater clinical guideline adherence.3 When research is fully integrated into organizational structures, health-care performance is superior to less formal research.3 Whilst not all trainees aspire for long-term academic career trajectories, it is important for surgical training programs to address the sustainability of academic pathways. Prevalent models of surgical training do not readily support simultaneous acquisition of clinical competencies alongside more focused academic training and higher research degrees. In Australia and Aotearoa New Zealand, most surgical education and training (SET) programs allow trainees to suspend training for up to 1–2 years to complete higher research degrees. Some trainees can arrange less-than-full-time (LTFT) training positions that allow them extra time for research, but these LTFT positions can be difficult to arrange, and often are not geographically located near the trainee's research centre. Engaging in part-time research is also hindered by financial concerns, as most RACS research scholarships are only available for trainees undertaking full-time research. When re-entering clinical training after prolonged research-related absence, trainees can encounter significant challenges. The stress of returning to work, combined with loss of confidence and skills, significantly impacts trainee wellbeing and performance.4 In Nash's study of paediatric surgical trainees returning to clinical work after an interval away from training, clinical confidence needed time to be re-established: ‘I don't think your hands forget how to operate, I think it's your brain that does not have the confidence to do it’.4 Clinical and technical skills may need to be redeveloped, and time-based training programs have little flexibility to allow for this. Reestablishment of professional identity and connections with peers was also important, with many returning trainees feeling doubts about their career.4, 5 Trainees returning to academia after completing a full-time training period, typically have a considerable reduction in their research output and publications. Reduced academic output during these clinical training years hinder future competitiveness for larger research grant funding, and limit their eligibility for grants targeted towards early career researchers. Experiences from international training programs provide insights into how we can address this challenge. The integrated Clinical Academic Fellowship pathways for surgical training in the United Kingdom (UK) are well established and have been demonstrated to improve both research output and clinical skill development.6, 7 Research pathways integrated into residency training in the United States resulted in participants scoring higher on national board examinations, improved research productivity and sustained academic success.8, 9 UK ENT trainees who undertook LTFT in dedicated integrated research programs achieved more publications and academic output than non-integrated trainees in both full-time and part-time clinical positions.10 Trainees benefit from the cognitive synergy of combining clinical training and academic research relevant to their areas of expertise.11, 12 Integration of research within clinical practice, rather than prolonged intervals of full-time research, is a mechanism to provide support, link clinical skill acquisition to academic competency development, and recognize progression through training pathways.13 Trainees who participate in integrated research programs report positive work-life balance, ability to develop longitudinal research interests and sustained engagement in academic surgery.6 Despite inbuilt pathways in other surgical training systems, academic trainees continue to face challenges, including accessing protected time away from clinical duties, negative attitudes from others in the workplace, and difficulties accessing academic supervision.6 In vascular surgery, we are undertaking research to explore and codesign alternative models of training, including integrated pathways for academic development in clinical training. It is important to obtain input from trainees, supervisors and healthcare employers as to how these models can be implemented in our local context in Australia and Aotearoa. We anticipate logistical, educational and cultural challenges as these pathways are developed. Ensuring trainees are able to complete higher degrees will require strong partnerships with universities, with a clear vision for a sustainable academic surgical workforce. As we move forward in this process, we aspire for training to be flexible and adaptive to the needs of our trainees, hospitals and communities. Carina Cutmore: Conceptualization; data curation; writing – original draft; writing – review and editing. Hamid Hajian: Conceptualization; data curation; writing – review and editing. Sarah Aitken: Conceptualization; data curation; resources; supervision; writing – original draft; writing – review and editing.

Model-Based Operative Performance Expectations for Quantifying Competency in General Surgery

Understanding how to translate workplace-based assessment (WBA) ratings into metrics that communicate the ability of a surgeon to perform a procedure would represent a critical advancement in graduate medical education. To evaluate the association between past and future performance in a comprehensive assessment system for the purpose of assessing point-in-time competence among general surgery trainees. This case series included WBA ratings from September 2015 to September 2021 from the WBA system of the Society for Improving Medical Professional Learning (SIMPL) for all general surgery residents who were provided a rating following an operative performance across 70 programs in the US. The study included ratings for 2605 trainees from 1884 attending surgeon raters. Analyses were conducted between September 2021 and December 2021 using bayesian generalized linear mixed-effects models and marginal predicted probabilities. Longitudinal SIMPL ratings. Performance expectations for 193 unique general surgery procedures based on an individual trainee's prior successful ratings for a procedure, clinical year of training, and month of the academic year. Using 63 248 SIMPL ratings, the association between prior and future performance was positive (β, 0.13; 95% credible interval [CrI], 0.12-0.15). The largest source of variation was postgraduate year (α, 3.15; 95% CrI, 1.66-6.03), with rater (α, 1.69; 95% CrI, 1.60-1.78), procedure (α, 1.35; 95% CrI, 1.22-1.51), case complexity (α, 1.30; 95% CrI, 0.42-3.66), and trainee (α, 0.99; 95% CrI, 0.94-1.04) accounting for significant variation in practice ready ratings. After marginalizing overcomplexity and trainee and holding rater constant, mean predicted probabilities had strong overall discrimination (area under the receiver operating characteristic curve, 0.81) and were well calibrated. In this study, prior performance was associated with future performance. This association, combined with an overall modeling strategy that accounted for various facets of an assessment task, may offer a strategy for quantifying competence as performance expectations.

Reimagining Gastroenterology Fellowship Training: The Third Year of the Future

Reimagining Gastroenterology Fellowship Training: The Third Year of the Future

Prevalence and Impact of Musculoskeletal Pain Due to Operating Among Surgical Trainees

Upwards of 79%-88% of practicing surgeons report musculoskeletal pain due to operating. However, little is known about when these issues begin to become clinically significant. This survey evaluates the prevalence and impact of musculoskeletal pain among surgical residents. After IRB approval, an anonymous 19-question survey based on Cornell Musculoskeletal Discomfort Questionnaire was sent to current surgical residents measuring frequency and degree of pain at 5 sites (neck, shoulder, upper back, lower back, and elbow/wrist) as well as impact on activities both at work and outside of work. Chi square analysis was used to identify differences between groups. Single academic medical center. Trainees in all surgical-based specialties. Fifty-three residents responded from 8 different specialties (38% response rate). Respondents were a representative balance of male (53%)/female (47%) with a mean age of 30 ± 2 years. Residents in all specialties and all years of clinical training responded, with the greatest number from general surgery (the largest program with 48% of respondents), second year of clinical training (30%) and an overwhelming 96% of residents reported experiencing pain they felt was due to operating. The most common sites of pain were the neck (92%) and lower back (77%). This pain was a frequent issue for most with 74% reporting multiple times per month and 26% reporting pain nearly every day. Nearly half of residents reported that pain slightly to substantially interfered with their ability to work (44%) and with activities outside of work (47%). Most residents (75%) sought no treatment. No residents missed work despite reporting pain. Musculoskeletal pain begins during training, occurs regularly, and affects function. Neck pain is the most frequent, severe, and disabling site. This provides a target for interventions to reduce the impact of chronic pain on patient care, surgeon wellness, and career longevity.

Feelings toward medicine in remote areas among medical students aiming to become generalists : A comparison with other specialists

Geographic maldistribution of physicians is a serious problem in Japan, resulting in a few physicians in remote areas. We distributed questionnaires to 396 medical students at Tokushima University from 2013 to 2016. We examined the intensity of medical students toward medicine in remote areas by using a visual analog scale and investigated what medical specialty they chose after two years of clinical training. The intensity of interest in medicine and the intensity of willingness to contribute to it in remote areas were statistically higher among medical students who intended to choose general medicine. After graduation, only five participants chose to specialize in general medicine. Of the 14 medical students who originally chose general medicine, six chose internal medicine, three chose general medicine, and the others chose surgery, neurosurgery, anesthesiology, orthopedics, or emergency medicine. This study demonstrated that medical students who intend to choose general medicine have a higher intensity of willingness to contribute to medicine in remote areas, indicating that the support program for these students to become general practitioners after graduation increases the number of physicians in remote areas. J. Med. Invest. 70 : 129-134, February, 2023.

Using entrustable professional activities to better prepare students for their postgraduate medical training: Amedical student's perspective.

Medical students graduate underprepared for postgraduate medical training despite years of classroom and clinical training. In this article, amedical student shares her personal perspectives on three factors contributing to this problem in undergraduate medical education: students' peripheral roles in the clinical environment impede learning, students receive inadequate feedback, and assessments do not measure desired learning outcomes. The authors describe how using entrustable professional activities (EPAs) could address these issues and promote students' clinical engagement by clarifying their roles, providing them with frequent and actionable feedback, and aligning their assessments with authentic work. These factors combined with grading schemes rewarding improvement could contribute to agrowth mindset that reprioritizes clinical skill acquisition. The authors explore how medical schools have begun implementing the EPA framework, highlight insights from these efforts, and describe barriers that must be addressed. Incorporating EPAs into medical school curricula could better prepare students for postgraduate training while also alleviating issues that contribute to student burnout by defining students' roles, improving feedback, and aligning assessments with desired learning outcomes.