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An Interactive, Multimodal Curriculum to Teach Pediatric Cardiology to House Staff. Pediatr Cardiol 2022; 43:1359-1364. [PMID: 35238959 PMCID: PMC8893060 DOI: 10.1007/s00246-022-02859-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/23/2022] [Indexed: 11/24/2022]
Abstract
Pediatricians must be able to diagnose, triage, and manage infants and children with congenital heart disease. The pediatric cardiology division at the Medical University of South Carolina updated their curriculum for pediatric residents to a format supported by constructivist learning theory. The purpose of this study is to determine if shorter, interactive learning with fellow and faculty involvement improved pediatric cardiology knowledge demonstrated through test scores and resident satisfaction. A curriculum of short lectures and interactive workshops was delivered over 6 weeks in August and September 2018. Residents answered a 10-question pretest prior to the curriculum, followed by a post-test immediately after the last session and a delayed post-test 8 months later. Residents also provided summative feedback on the educational sessions. Sixty-six residents were eligible to participate in the curriculum with 44 (67%) completing the pretest, 40 (61%) completing the post-test, and 33 (50%) completing the delayed post-test. The mean score increased significantly from 56 to 68% between the pretest and post-test (p = 0.0018). The delayed post-test mean score remained high at 71% without significant change (p = 0.46). Overall feedback was positive highlighting the interactive nature of lectures and the participation of cardiology fellows. Using an interactive, multimodal educational series, pediatric residents had a significant increase in pediatric cardiology test scores and demonstrated good retention.
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Breast Imaging Boot Camp Meets Milestones 2.0: A Match Made in Clinic. Acad Radiol 2022; 29 Suppl 1:S246-S254. [PMID: 33487540 DOI: 10.1016/j.acra.2020.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES Designed to provide broad-based training in all aspects of imaging, the diagnostic radiology residency program must provide educational experiences that not only provide technical training, but also meet accreditation standards. With the breadth of material to cover during training, carefully orchestrated educational experiences must be planned. This manuscript reports a breast imaging boot camp curriculum with longitudinal outcomes, highlighting the boot camp's pedagogy and adaptability for residencies to meet the challenges of the Accreditation Council for Graduate Medical Education (ACGME) Diagnostic Radiology Milestones Second Revision. MATERIALS AND METHODS Breast block curriculum analysis, faculty leader preparation, and evaluation of all objective external benchmarks were undertaken commencing in 2012 and continuing through 2019. Specific curriculum changes include fundamental didactic lectures and self-study education modules, hands-on simulation activities, and team-building time. Upon publication of The Diagnostic Radiology Milestones Second Revision December 2019, all competencies were assessed in the context of the boot camp resident educational experiences. RESULTS Following curriculum implementation, resident anonymous evaluation scores of the breast block, resident in-training examination scores, American Board of Radiology Core examination scores, and radiology residency educational website analytics all increased immediately and significantly. The curriculum meets twenty-four Diagnostic Milestones per participating resident when mapped against the newly implemented ACGME requirements. CONCLUSIONS Breast imaging boot camp is a successful innovative curriculum, readily meeting our learners' needs in all objective benchmarks. Further, the adaptable model has the potential to play important roles in assisting residencies to meet the challenges of the ACGME Diagnostic Radiology Milestones Second Revision July 1, 2020 implementation date.
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Pernar LI, Sachs TE, Tseng JF, Hess DT. Structuring Research Rotations to Facilitate Surgery Residents' Academic Productivity. JOURNAL OF SURGICAL EDUCATION 2022; 79:31-34. [PMID: 34366284 DOI: 10.1016/j.jsurg.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/06/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We sought to enhance opportunities for general surgery residents to conduct research during residency without having to take dedicated time out of clinical training. To this end, we created structured research rotations to facilitate and support resident research. DESIGN Research blocks of four week's duration were introduced for categorical interns and post-graduate year (PGY) 4 residents. Interns had no clinical responsibilities during their research blocks while PGY 4 residents shadowed their mentor in the clinical setting. Research projects were developed and prepared in advance to maximize productivity during the research rotation. SETTING General surgery residency program at an urban, academic, safety-net, tertiary care hospital PARTICIPANTS: Categorical general surgery interns and PGY 4 general surgery residents RESULTS: The research rotations were first offered in the 2019 to 2020 academic year (AY). 10 interns and 11 PGY 4 residents have since completed the rotations; of the PGY 4 residents, 6 had not previously taken any time off for research activities. Research projects varied between residents and focused on basic science, clinical outcomes, quality improvement, and education. CONCLUSIONS Through establishment of dedicated research rotations, we were able to increase resident engagement in a variety of research activities. We provide a simple model for training programs seeking increased research engagement and productivity for their residents without extending training time.
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Allar BG, Weinstock J, Buss MK, Kent TS. Palliative Care Education for Surgical Residents: Current Practices and Future Directions. JOURNAL OF SURGICAL EDUCATION 2022; 79:3-7. [PMID: 34344640 DOI: 10.1016/j.jsurg.2021.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/27/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
Despite the benefits and increased clinical application of primary palliative care principles within surgery, palliative care education among surgical trainees remains varied and poorly defined. Through a survey of general surgery program directors, this perspective highlights current palliative care educational practices of general surgery residencies and existing curricula. Although program directors deemed palliative care education important to surgical training, barriers to improving resident education included limited overall educational time, few available palliative care experts, and the lack of a dedicated curriculum. There is a need for a surgical palliative care educational toolkit that is validated, easily available, incorporates local experts, and adjustable to the variety of educational practices of surgical programs and their residents.
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Chen YYK, Lekowski RW, Beutler SS, Lasic M, Walls JD, Clapp JT, Fields K, Nichols AS, Correll DJ, Bader AM, Arriaga AF. Education based on publicly-available keyword data is associated with decreased stress and improved trajectory of in-training exam performance. J Clin Anesth 2021; 77:110615. [PMID: 34923227 DOI: 10.1016/j.jclinane.2021.110615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/31/2021] [Accepted: 11/20/2021] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE This study aimed to assess the impact of data-driven didactic sessions on metrics including fund of knowledge, resident confidence in clinical topics, and stress in addition to American Board of Anesthesiology In-Training Examination (ITE) percentiles. DESIGN Observational mixed-methods study. SETTING Classroom, video-recorded e-learning. SUBJECTS Anesthesiology residents from two academic medical centers. INTERVENTIONS Residents were offered a data-driven didactic session, focused on lifelong learning regarding frequently asked/missed topics based on publicly-available data. MEASUREMENTS Residents were surveyed regarding their confidence on exam topics, organization of study plan, willingness to educate others, and stress levels. Residents at one institution were interviewed post-ITE. The level and trend in ITE percentiles were compared before and after the start of this initiative using segmented regression analysis. RESULTS Ninety-four residents participated in the survey. A comparison of pre-post responses showed an increased mean level of confidence (4.5 ± 1.6 vs. 6.2 ± 1.4; difference in means 95% CI:1.7[1.5,1.9]), sense of study organization (3.8 ± 1.6 vs. 6.7 ± 1.3;95% CI:2.8[2.5,3.1]), willingness to educate colleagues (4.0 ± 1.7 vs. 5.7 ± 1.9;95% CI:1.7[1.4,2.0]), and reduced stress levels (5.9 ± 1.9 vs. 5.2 ± 1.7;95% CI:-0.7[-1.0,-0.4]) (all p < 0.001). Thirty-one residents from one institution participated in the interviews. Interviews exhibited qualitative themes associated with increased fund of knowledge, accessibility of high-yield resources, and domains from the Kirkpatrick Classification of an educational intervention. In an assessment of 292 residents from 2012 to 2020 at one institution, there was a positive change in mean ITE percentile (adjusted intercept shift [95% CI] 11.0[3.6,18.5];p = 0.004) and trajectory over time after the introduction of data-driven didactics. CONCLUSION Data-driven didactics was associated with improved resident confidence, stress, and factors related to wellness. It was also associated with a change from a negative to positive trend in ITE percentiles over time. Future assessment of data-driven didactics and impact on resident outcomes are needed.
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Abstract
REASON FOR REVIEW A recent shift towards use of telehealth and remote learning has significant implications on resident and fellow education in urology. Implementation of multi-institutional online didactic programs, spurred on by the COVID epidemic, has changed the traditional resident teaching paradigm from individual institutional silos of knowledge and expertise to a shared nationwide database of learning. RECENT FINDINGS: In this article, we explore the current trend towards virtual education and its progress to date, lessons learned on the optimization of this teaching modality, and future direction and sustainability of collaborated, standardized and accessible didactic education in urology. Multi-institutional collaborative remote video didactics has emerged as a critical part of resident education. These lectures have been overwhelmingly successful and have persisted beyond the pandemic to become a part of the urologic training curricula. This collaborative and standardized approach to resident education provides access to national and international experts, encourages cross-institutional collaboration and discussion, and builds a repository of lectures with easy access for learners. Utilization of this teaching modality will continue to be impactful in urologic training and will require ongoing efforts and input from both collaborating intuitions and professional societies to continue to improve on and engage in this important learning tool.
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Daniel D, Avedian R, Johnson T, Michaud JB, Weimer-Elder B, Kline M, Nassar AK. Education research - Understanding the factors involved in inpatient communication for orthopedic trainees. Ann Med Surg (Lond) 2021; 72:103079. [PMID: 34876980 PMCID: PMC8632834 DOI: 10.1016/j.amsu.2021.103079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND "Interpersonal and Communication Skills" (ICS) is a core competency set forth by the ACGME. No structured curriculum exists to train orthopedics residents in ICS. METHODS Twenty-four out of thirty-five orthopedics residents completed the survey (69%). The survey had the following domains: [1] Demographics, [2] Communication Needs/Goals, and [3] Communication Barriers. RESULTS Eighty-three percent of respondents wanted to improve their communication skills and their patient's experience. Interns-PGY4s wanted to improve on similar specific communication skills. All residents desired training in conflict management. CONCLUSION There is a need among orthopedics residents for a communication skills curriculum early in residency training, specifically in conflict management.
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Wiseman JE, Morris-Wiseman LF, Hsu CH, Riall TS. Attending Surgeon Influences Operative Time More Than Resident Level in Laparoscopic Cholecystectomy. J Surg Res 2021; 270:564-570. [PMID: 34839227 DOI: 10.1016/j.jss.2021.09.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/23/2021] [Accepted: 09/21/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Prior studies on laparoscopic cholecystectomy (LC) have concluded that resident involvement lengthens operative time without impacting outcomes. However, the lack of effect of resident level on operative duration has not been explained. We hypothesized that attending-specific influence on average operative time for LC is more pronounced than resident post-graduate year level. MATERIALS AND METHODS We retrospectively analyzed all LC cases performed on patients 18 y and older between November 2018 and March 2020 at 2 academic medical center-affiliated hospitals. Regression models were used to compare operative times, conversion to open rates, and complication rates by attending surgeon and resident level. RESULTS Nine hundred twenty-five LCs were performed over the study period, 862 (93.1%) with resident participation. Of the 44.5% variation in operative time was explained by differences in attending surgeon, as compared to 11.0% attributable to differences in resident level (P < 0.0001). This effect persisted after adjusting for patient and disease factors (33.0% versus 7.1%, P < 0.0001). Neither attending surgeon (P = 0.80), nor the level of the involved resident (P = 0.94) demonstrated a significant effect on the conversion-to-open rate (4.9%). Similarly, neither the attending surgeon (P = 0.33), nor resident level (P = 0.81) significantly affected the complication rate (8.58%). CONCLUSIONS Operative time for LC is primarily determined by patient- and disease-specific factors; resident level has no effect on conversion to open or complication rates. Attending influence on operative time was more pronounced than resident level influence. These findings suggest attending surgeon-related factors are more important than resident experience in determining operative duration for LC.
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Selby LV, Woelfel IA, Eskander M, Chen X, Villarreal ME, Cochran AL, Harzman AE, Grignol VP. All Politics Are Local: A Single Institution Investigation of the Educational Impact of Residents and Fellows Working Together. J Surg Res 2021; 271:82-90. [PMID: 34856456 DOI: 10.1016/j.jss.2021.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/29/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Most general surgery residents pursue fellowship; there is limited understanding of the impact residents and fellows have on each other's education. The goal of this exploratory survey was to identify these impacts. MATERIALS AND METHODS Surgical residents and fellows at a single academic institution were surveyed regarding areas (OR assignments, the educational focus of the team, roles and responsibilities on the team, interpersonal communication, call, "other") hypothesized to be impacted by other learners. Impact was defined as "something that persistently affects the clinical learning environment and a trainee's education or ability to perform their job". Narrative responses were reviewed until dominant themes were identified. RESULTS Twenty-three residents (23/45, 51%) and 12 fellows (12/21, 57%) responded. Responses were well distributed among resident year (PGY-1:17% [4/23], PGY-2, 35% [8/23], PGY-3 26% [6/23], PGY-4 9% [2/23%], PGY-5 13% [3/23]). Most residents reported OR assignment (14/23, 61%) as the area of primary impact, fellows broadly reported organizational categories (Roles and responsibilities 33%, educational focus 16%, interpersonal communication 16%). Senior residents reported missing out on operations to fellows while junior residents reported positive impacts of operating directly with fellows. Residents of all levels reported that fellows positively contributed to their education. Fellows, senior residents, and junior residents reported positive experiences when residents and fellows operated together as primary surgeon and assistant. CONCLUSIONS Residents and fellows impact one another's education both positively and negatively. Case allocation concerns senior residents, operating together may alleviate this, providing a positive experience for all trainees. Defining a unique educational role for fellows and delineating team expectations may maximize the positive impacts in this relationship.
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Hung H, Kueh LL, Tseng CC, Huang HW, Wang SY, Hu YN, Lin PY, Wang JL, Chen PF, Liu CC, Roan JN. Assessing the quality of electronic medical records as a platform for resident education. BMC MEDICAL EDUCATION 2021; 21:577. [PMID: 34774027 PMCID: PMC8590775 DOI: 10.1186/s12909-021-03011-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Previous studies have assessed note quality and the use of electronic medical record (EMR) as a part of medical training. However, a generalized and user-friendly note quality assessment tool is required for quick clinical assessment. We held a medical record writing competition and developed a checklist for assessing the note quality of participants' medical records. Using the checklist, this study aims to explore note quality between residents of different specialties and offer pedagogical implications. METHODS The authors created an inpatient checklist that examined fundamental EMR requirements through six note types and twenty items. A total of 149 records created by residents from 32 departments/stations were randomly selected. Seven senior physicians rated the EMRs using a checklist. Medical records were grouped as general medicine, surgery, paediatric, obstetrics and gynaecology, and other departments. The overall and group performances were analysed using analysis of variance (ANOVA). RESULTS Overall performance was rated as fair to good. Regarding the six note types, discharge notes (0.81) gained the highest scores, followed by admission notes (0.79), problem list (0.73), overall performance (0.73), progress notes (0.71), and weekly summaries (0.66). Among the five groups, other departments (80.20) had the highest total score, followed by obstetrics and gynaecology (78.02), paediatrics (77.47), general medicine (75.58), and surgery (73.92). CONCLUSIONS This study suggested that duplication in medical notes and the documentation abilities of residents affect the quality of medical records in different departments. Further research is required to apply the insights obtained in this study to improve the quality of notes and, thereby, the effectiveness of resident training.
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Atthota S, Griffiths A, Kangas-Dick A, Jesneck J, Thanawala R, Savel R, Rhee R. The Attending Meritocracy: Implementation of a Novel Team-Based Approach to Provide Effective Resident Feedback. JOURNAL OF SURGICAL EDUCATION 2021; 78:e78-e85. [PMID: 34452853 DOI: 10.1016/j.jsurg.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Providing timely quality feedback is an essential responsibility of teaching faculty and is critical for resident assessment and development throughout training. Numerous evaluation platforms have been created to provide immediate and big picture end-of-rotation feedback. Faculty suffer burnout from electronic documentation demands and workload and as a result, evaluation activity is relegated to a lower priority leading to poor compliance. We implemented a novel team-based Attending Meritocracy (AM)1 program that encompasses monetary, automated reminder, and punitive components, while adding a competition element to further engage faculty. The aim of this study is to determine effectiveness of AM in increasing compliance with resident feedback. DESIGN, SETTING AND PARTICIPANTS Surgical faculty (n = 36) were divided into 5 teams according to service and subspecialty. Points could be earned by completing surgical (Firefly, MiniCEX) or rotation (New Innovations) evaluations, leaving comments, and other educational tasks. A prize for the highest scoring team was identified as a dinner financed by the non-winning teams. Data from evaluation platforms was extracted. Continuous variables were compared using Mann-Whitney-U test, and categorical variables using chi-squared test. RESULTS When comparing July 2019 to February 2020 (control period) with July 2020 to February 2021(initial implementation period), we found a 237% increase in submitted NI evaluations (n = 111-374) and a 42.5% decrease in median time to completion from 60.4 (33.2-106.9) days to 34.7 (24.0-64.5) days, (p = 0.001).2 We observed an increase in operative evaluations completed (Mini CEX n = 4-97, Firefly n = 150-1284). CONCLUSIONS Implementation of a team-based attending meritocracy program is an effective budget neutral method to increase completion of resident evaluations. Further investigation is needed to assess improvement in quality of feedback as well as to explore it's impact on progression of resident autonomy.
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Kolikonda MK, Blaginykh E, Brown P, Kovi S, Zhang LQ, Uchino K. Virtual Rounding in Stroke Care and Neurology Education During the COVID-19 Pandemic - A Residency Program Survey. J Stroke Cerebrovasc Dis 2021; 31:106177. [PMID: 34798435 PMCID: PMC8514647 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE During the coronavirus disease 2019 (COVID-19) pandemic, we instituted virtual inpatient stroke rounds and acute stroke evaluations via telemedicine in the emergency department. We sought to explore trainees' and experienced providers' views on stroke care and education. METHODS The implementation and the survey took place at a single academic comprehensive stroke center in northeast Ohio in the United States. "Virtual rounding" consisted of patient presentation and discussion in the morning in on-line virtual team format followed by in-person patient rounds in small groups. Acute stroke evaluations in the emergency department included direct in-person evaluation by neurology residents with supervision over telemedicine.The neurology residents, stroke fellows, stroke nurse practitioners, and stroke staff physicians were surveyed 2 months after implementation. Quantitative data was analyzed using descriptive statistical analysis, written responses in comment sections were analyzed using content analysis. RESULTS Thirty-two of 42 (73%) surveys were completed. Nine (45%) residents and 5 (42%) experienced providers responded that virtual rounds did not compromise learning and education on stroke service. Fifteen (75%) residents and all experienced providers agreed that virtual rounds protected caregivers from exposure to the virus. While more than a third of residents (37%) did not feel comfortable utilizing telemedicine in ED, the majority of experienced providers (89%) were at ease with it. A total of 58% of residents and 67% of experienced providers felt that they were spending less time at the bedside, and 42% of residents and 58% of experienced providers felt less connected to patients during the pandemic. CONCLUSION Majority of neurology residents' experience was not positive utilising telemedicine as compared to other staff providers. This is likely attributed to lack of prior exposure and unpreparedness. Incorporation of telemedicine curricula in medical school and residency training could prepare the next generation physicians to effectively use these technologies and meet the growing need for telehealth services for current and future pandemics.
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Nitsche JF, Conrad S, Hoopes S, Carrel M, Bebeau K, Brost BC. Continued Validation of Ultrasound Guidance Targeting Tasks: Relationship with Procedure Performance. Acad Radiol 2021; 28:1433-1442. [PMID: 33036898 DOI: 10.1016/j.acra.2020.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES To determine if deliberative practice with novel ultrasound guidance targeting tasks improves simulated procedural skill. MATERIALS AND METHODS In a nonrandomized interventional trial first year medical students practiced the previous described dowel and straw targeting tasks 1 hour a week for 4 weeks (training group) or had no training (controls). Afterward, they each performed a simulated amniocentesis (AMN) and chorionic villus sampling (CVS) procedure. Procedures were scored using a global rating scale (GRS) and compared between groups with Mann-Whitney U tests. Two-way random effects intraclass correlation coefficients for the inter- and intra-rater variability were calculated for each item in both GRS's. RESULTS The training group (n = 22) had higher scores on several aspects and overall performance of AMN compared to controls (n = 15). There were no differences between groups for CVS. The inter-rater and intra-rater reliability of the GRS's for both AMN and CVS ranged from 0.16 to 0.89 with most values demonstrating good to excellent agreement. CONCLUSION This study demonstrates validity evidence in the content and internal structure domains for the AMN and CVS simulators and their accompanying GRS's. Repetitive practice of the targeting tasks improved student performance in simulated AMN, but modifications are needed for it to be relevant to other procedures such as CVS.
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Sasnal M, Miller-Kuhlmann R, Merrell SB, Beres S, Kipp L, Lee S, Threlkeld Z, Nassar AK, Gold CA. Feasibility and acceptability of virtually coaching residents on communication skills: a pilot study. BMC MEDICAL EDUCATION 2021; 21:513. [PMID: 34583691 PMCID: PMC8478605 DOI: 10.1186/s12909-021-02936-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Developing communication skills is a key competency for residents. Coaching, broadly accepted as a training modality in medical education, has been proven a successful tool for teaching communication skills. Little research is available thus far to investigate virtual coaching on communication skills for telemedicine encounters. The purpose of the study was to test the hypothesis that virtually coaching residents on communication skills is feasible and acceptable. We surveyed 21 resident-faculty pairs participating in a "fully virtual" coaching session (patient, coach, and resident were virtual). METHODS We asked 50 neurology resident-faculty coach pairs to complete one "fully virtual" coaching session between May 20 and August 31, 2020. After each session, the resident and coach completed a 15-item survey, including Likert-style scale and open-ended questions, assessing feasibility and acceptability. Descriptive statistics and qualitative content and thematic analyses were performed. RESULTS Forty-two percent (21/50) of all eligible residents completed "fully virtual" coaching sessions. The overall survey response rate was 91 % (38/42). The majority of respondents agreed that the direct observation and debriefing conversation were easy to schedule and occurred without technical difficulties and that debriefing elements (self-reflection, feedback, takeaways) were useful for residents. Ninety-five percent of respondents rated the coach's virtual presence to be not at all disruptive to the resident-patient interaction. Virtual coaching alleviated resident stress associated with observation and was perceived as an opportunity for immediate feedback and a unique approach for resident education that will persist into the future. CONCLUSIONS In this pilot study, residents and faculty coaches found virtual coaching on communication skills feasible and acceptable for telemedicine encounters. Many elements of our intervention may be adoptable by other residency programs. For example, residents may share their communication goals with clinic faculty supervisors and then invite them to directly observe virtual encounters what could facilitate targeted feedback related to the resident's goals. Moreover, virtual coaching on communication skills in both the in-person and telemedicine settings may particularly benefit residents in challenging encounters such as those with cognitively impaired patients or with surrogate decision-makers.
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Palacios Huatuco RM, Liaño JE, Bono GM, González Vargas GA, Panichelli L, Pereyra Ferrero R, Ponce Beti MS. Concerns and reflections on the second wave of COVID-19 in Argentina: A perspective by general surgery residents. Ann Med Surg (Lond) 2021; 70:102860. [PMID: 34540225 PMCID: PMC8437692 DOI: 10.1016/j.amsu.2021.102860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/11/2021] [Accepted: 09/11/2021] [Indexed: 11/05/2022] Open
Abstract
In Argentina, the second wave of COVID-19, which started in May, clearly differentiates us from the rest of the Latin American countries, whose current growth may be the announcement of the expected autumn-winter expansion. There is a lot of uncertainty about how the pandemic will evolve, which contrasts with the expectations that had been generated in society after the end of the confinement, both of the control of the health system and access to effective vaccines. Thus, a group of surgeons in training raised a series of concerns concerning the critical situation that we are facing.
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Lin JA, Im CJ, O'Sullivan P, Kirkwood KS, Cook AC. The surgical resident experience in serious illness communication: A qualitative needs assessment with proposed solutions. Am J Surg 2021; 222:1126-1130. [PMID: 34565516 PMCID: PMC9365675 DOI: 10.1016/j.amjsurg.2021.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/04/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022]
Abstract
Background: Serious illness communication skills are important tools for surgeons, but training in residency is limited. Methods: Thirteen senior surgical residents at an academic center were interviewed about their experiences with serious illness communication. Conventional content analysis was performed using established communication frameworks and inductive development of themes. Results: Residents had frequent conversations and employed known communication strategies. Three themes highlighted challenges they face. Illness severity included factors attributed to the illness that made serious illness communication more challenging: symptoms, poor prognosis, and urgency. Knowledge and feelings included the factual understanding and emotional experience of residents, patients, and families. Academic structure included hierarchy and the residents’ dual role as learners and teachers. On reflection, residents identified needing greater experiential practice, analogous to learning procedural skills. Conclusions: Surgical residents regularly face serious illness conversations with little training beyond observation of role models. Dedicated training may help meet this need.
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Kirkpatrick L, Wiener S, Bell L, Szoko N, Collins A, Russell M, Harrison E, Weiss M, Syed T. A Curriculum for Pediatric Residents in Pregnancy Options Counseling: A Pilot Program. Acad Pediatr 2021; 21:1300-1302. [PMID: 33940205 DOI: 10.1016/j.acap.2021.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 02/16/2021] [Accepted: 04/23/2021] [Indexed: 11/18/2022]
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Goodloe JB, Bailey EP, Luce LT, Corrigan CS, Dow MA, Barfield WR, Murphy RF. A Standardized Order-Set Improves Variability in Opioid Discharge Prescribing Patterns After Surgical Fixation of Pediatric Supracondylar Humerus Fractures. JOURNAL OF SURGICAL EDUCATION 2021; 78:1660-1665. [PMID: 33839079 DOI: 10.1016/j.jsurg.2021.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/03/2021] [Accepted: 03/13/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate institutional opioid prescribing patterns following percutaneous fixation of pediatric supracondylar humerus fractures before and after implementation of a standardized discharge order set. DESIGN A retrospective review of patients who underwent closed reduction and percutaneous skeletal fixation of a Type II or III supracondylar humerus fracture in 2017 (prior to pain protocol implementation) and again in 2019 (after pain protocol implementation) SETTING: Single Tertiary Care Children's Hospital PARTICIPANTS: In total, 106 patients met inclusion criteria between years 2017 (n = 49) and 2019 (n = 57). Exclusion criteria included miscoded patients, open fractures, patients who presented with vascular injury or nerve palsy, polytrauma patients with multiple fractures in the same upper extremity, and supracondylar humerus fractures that underwent an open procedure. RESULTS There were no significant differences between inpatient pain scores (p = 0.91) and MDE prescribed (p = 0.75) between the 2 cohorts. In 2017, large variability was noted in day supply of opioids (0-11.4 days) and MDE (0-8.45 mg/kg), with significant differences between prescribing patterns of junior and senior level residents (mean day supply of opioids (p = 0.045), mean MDE prescribed on discharge (p = 0.001)). After implementation of a standardized opioid discharge order set, there was a tenfold increase in the number of patients discharged without an opioid prescription (2017: 4%, 2019: 44%). Additionally, any discrepancies between prescribing practices of junior and senior level residents were eliminated (mean day supply of opioids (p = 0.65), mean MDE prescribed on discharge (p = 0.69)). CONCLUSIONS The introduction of a standardized post-operative opioid discharge order set led to a 10-fold increase in the number of patients discharged without an opioid prescription. Additionally, the order set decreased the variability in the prescribing patterns of discharge opioid medications without change in pain control. The resident prescribing variability based upon level of experience resolved with the use of the order set.
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Volaric AK, Zadeh SL, Dusenbery AC, Coppock JD, Dibbern ME, Jenkins TM, González JO, Rodríguez D, Burt DR, Frierson HF, Rodas B. Global Health Education in Pathology Residency. Am J Clin Pathol 2021; 156:478-490. [PMID: 33834192 DOI: 10.1093/ajcp/aqaa262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pathology and laboratory medicine (PALM) services in low- and middle-income countries are essential to combat the increasing prevalence of cancer in addition to providing documentation of cancer types and trends for future allocation of public health resources. There are many ways PALM as a whole can engage on the global health front. This study summarizes the efforts and results of a global health educational and clinical elective for pathology residents in Quetzaltenango, Guatemala. METHODS Pathology residents led and implemented the project, working alongside an in-country pathologist and project collaborator to instill project sustainability and allow for future capacity building. RESULTS An educational elective was established between the pathology departments of the University of Virginia and Hospital Regional de Occidente in Quetzaltenango, Guatemala. Two residents at a time engaged in a month-long educational elective assisting and learning from the in-country pathologist in anatomic pathology clinical work. CONCLUSIONS The project is an example of a global health initiative centering on the enhancement of PALM services in a low-resource environment via a bidirectional, sustainable educational exchange.
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95
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Soldozy S, Yağmurlu K, Akyeampong DK, Burke R, Morgenstern PF, Keating RF, Black JS, Jane JA, Syed HR. Three-dimensional printing and craniosynostosis surgery. Childs Nerv Syst 2021; 37:2487-2495. [PMID: 33779807 DOI: 10.1007/s00381-021-05133-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/15/2021] [Indexed: 12/15/2022]
Abstract
OVERVIEW The goal of this study was to review the current application and status of three-dimensional printing for craniosynostosis surgery. METHODS A literature review was performed using the PubMed/MEDLINE databases for studies published between 2010 and 2020. All studies demonstrating the utilization of three-dimensional printing for craniosynostosis surgery were included. RESULTS A total of 15 studies were ultimately selected. This includes studies demonstrating novel three-dimensional simulation and printing workflows, studies utilizing three-dimensional printing for surgical simulation, as well as case reports describing prior experiences. CONCLUSION The incorporation of three-dimensional printing into the domain of craniosynostosis surgery has many potential benefits. This includes streamlining surgical planning, developing patient-specific template guides, enhancing residency training, as well as aiding in patient counseling. However, the current state of the literature remains in the validation stage. Further study with larger case series, direct comparisons with control groups, and prolonged follow-up times is necessary before more widespread implementation is justified.
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96
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Will I make a difference? Practical pointers for trainees interested in global radiology. Clin Imaging 2021; 80:142-144. [PMID: 34325222 DOI: 10.1016/j.clinimag.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/04/2021] [Accepted: 07/10/2021] [Indexed: 11/22/2022]
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Ballard DH, Summers D, Hoegger MJ, Salter A, Gould JE. Results of the 2019 Survey of the American Alliance of Academic Chief Residents in Radiology. Acad Radiol 2021; 28:1018-1028. [PMID: 32546338 DOI: 10.1016/j.acra.2020.04.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES An annual survey of chief residents in accredited North American radiology programs is conducted by the American Alliance of Academic Chief Residents in Radiology (A3CR2). The purpose of this study is to summarize the 2019 A3CR2 chief resident survey. MATERIALS AND METHODS An online survey was distributed to chief residents from 194 Accreditation Council on Graduate Medical Education-accredited radiology residencies. Questions were designed to gather information about residency program details, call and weekend coverage, interventional radiology training, fellowship, social media use, healthcare reform, artificial intelligence, and job market status. RESULTS One hundred and forty-two unique responses from 99 programs were provided, yielding a 51% program response rate. There was a mean of 7.3 women per residency with a mean program size of 28 residents (26% women). Only 3 of the 99 (3%) programs had a proportion of women that was 50% or higher. The proportion of women in radiology residencies is unchanged since 2014 (p= 0.93) and is significantly lower than 2019 graduating women medical students (49.3%; p < 0.001). Thirty-five percent of programs had 24/7 attending coverage and 40% of programs had extended hours attending shifts. Of programs without 24/7 attending coverage, the proportion of programs without face-to-face readout has increased from 34% in 2014 to 55% in 2019 (p = 0.015). The majority (67%) of respondents had no concerns about the radiology job market; compared to 2014, where only 4% had no concerns (p < 0.001). CONCLUSION Women remain underrepresented in radiology, face-to-face readout is decreasing, and there has been a shift towards a positive job market outlook.
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Song A, Americo L, Myers H, DeBenedectis C, Slanetz PJ, Sarkany D. Addressing the ACGME Mandate for Healthcare Disparities Education in Residency Programs: A Needs Assessment. Acad Radiol 2021; 28:930-937. [PMID: 34140205 DOI: 10.1016/j.acra.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess current opinions and efforts from radiology residency program leadership regarding healthcare disparities (HCD) education for residents. METHODS Radiology residency program directors across the United States were sent a 10-item survey and asked a series of qualitative questions regarding their opinions about HCD and current methods of implementation into their residency curriculum, in addition to demographic information such as program location and setting. RESULTS 73 out of 334 program directors responded. 49.3% were located in the Northeast, 16.4% in the Southeast, 16.4% in the Midwest, 12.3% in the Southwest, and 5.5% in the Pacific. Community programs made up 16.4% of respondents, while academic programs made up 76.7%. 6.8% identified as "other". 98.6% agreed with the provided definition of HCD. 83.6% agreed or strongly agreed that HCD present an obstacle to providing imaging care. 74.0% agreed or strongly agreed that HCD education is an essential component of residency training. However, 74.0% agreed or strongly agreed that HCD education is difficult to implement due to competing educational requirements. Only 16.4% agreed or strongly agreed that they had sufficient material on HCD to train residents. CONCLUSION Although many radiology residency programs agree that HCD education is essential in residency training, the majority feel that a curriculum is difficult to implement and that they lack sufficient resources. This study confirms the need to address this gap with a standardized curriculum which has been developed and is discussed.
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Gonzalez-Urquijo M, Hinojosa-Gonzalez DE, Rodarte-Shade M, Gil-Galindo G, Flores-Villalba E, Rojas-Mendez J. Use of the self-reported critical view of safety in laparoscopic cholecystectomy during residency. Surg Endosc 2021; 36:3110-3115. [PMID: 34159462 DOI: 10.1007/s00464-021-08612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Even though the goal of safely performing cholecystectomy is already a priority in general surgical training programs, we aimed to study how many residents and attendings reached the critical view of safety (CVS) in laparoscopic cholecystectomy. MATERIALS AND METHODS Retrospective review of prospectively collected data of all patients with biliary surgical conditions, which underwent laparoscopic cholecystectomy and their corresponding postoperative notes with self-reported CVS from May 2019 to May 2020 in an academic hospital. Comparisons of operative variables between postgraduate year and attendings were made. RESULTS Laparoscopic cholecystectomy was performed in 126 elective cases (62.6%) and 75 (37.3%) emergency cases. On 105 (83.3%) of the elective cases and on 54 (66.7%) emergency cases, a CVS was successfully performed. PGY3 and PGY5 had higher odds of achieving CVS compared to attendings OR 6.09 (95% CI 2.05 to 8.07) and 4.51 (95% CI 1.0 to 10.20), respectively. Overall, attendings had decreased odds ratio of achieving CVS of 0.488 when compared to all residents. Elective procedures had increased odds ratios of achieving CVS of 3.44 (95% CI 1.52 to 7.74). On elective cases, attendings performed significantly faster procedures when compared to PGY2-4, but not PGY5. No differences were seen between operative speeds between PGY. Third-year residents were identified as having the highest frequency of CVS; however, these differences were not statistically significant. In emergency cases, blood loss, operative time, CVS, and bile duct injuries revealed non-significant differences between operators. CONCLUSION CVS was reached significantly more often in elective than in emergency surgeries. There is still a lack of residents and attending surgeons who still failed to complete CVS during LC, highlighting the need for further education. Future studies should be attempted to repeat this study with a larger sample size and multiple coaching sessions to determine long-term efficacy.
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Yu JL, Cho DY, DeSanti RL, Kneib CJ, Friedrich JB, Colohan SM. Resident experiences with virtual education during the COVID-19 crisis. J Plast Reconstr Aesthet Surg 2021; 74:1931-1971. [PMID: 34148839 DOI: 10.1016/j.bjps.2021.05.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/13/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Residency education has adapted to current social distancing recommendations by relying heavily on videoconferences. There is concern however, that this new paradigm may lead to over-saturation or burnout. METHODS A 12-question survey investigating resident experiences with educational videoconferences was distributed to University of Washington plastic surgery residents. A modified Maslach Burnout Inventory was used to assess resident burnout from virtual conferences. Conference attendance and reasons for missing conferences were compared using paired two-tailed t-tests. RESULTS A total of 24 residents were given the survey with 100% response rate. There was a significant decrease in the total number of weekly attended videoconferences (p<0.01) and in the number of attended educational videoconferences (p<0.01) over time. Reasons for absences included clinical duties (92% of respondents) followed by symptoms of burnout, including forgetfulness (67%) and feeling fatigued by videoconferencing lectures (54%), and to a lesser extent the belief that the lecture was not educational (25%). 79% of residents reported at least occasionally feeling emotionally drained from videoconferencing and 88% reported at least occasionally feeling burned out due to the number of videoconferencing activities. Despite declining attendance and burnout, 96% believe that videoconferences should continue after the end of quarantine but in a limited quantity. CONCLUSION Videoconferences have become a valued means of resident education. The data suggests however that attendance has waned, largely due to what can be perceived as burnout. Residents remain interested in continuing educational videoconferences, although prioritizing quality over quantity will remain essential to prevent emotional fatigue and burnout.
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