"How To" Videos Improve Residents Performance of Essential Perioperative Electronic Medical Records and Clinical Tasks

OBJECTIVE

The ability to use electronic medical records (EMR) is an essential skill for surgical residents. However, frustration and anxiety surrounding EMR tasks may detract from clinical performance. We created a series of brief, 1-3 minutes "how to" videos demonstrating 7 key perioperative EMR tasks: booking OR cases, placing preprocedure orders, ordering negative-pressure wound dressing supplies, updating day-of-surgery history and physical notes, writing brief operative notes, discharging patients from the postanesthesia care unit, and checking vital signs. Additionally, we used "Cutting Insights"-a locally developed responsive mobile application for surgical trainee education-as a platform for providing interns with easy access to these videos. We hypothesized that exposure to these videos would lead to increased resident efficiency and confidence in performing essential perioperative tasks, ultimately leading to improved clinical performance.

METHODS

Eleven surgery interns participated in this initiative. Before watching the "how to" videos, each intern was timed performing the aforementioned 7 key perioperative EMR tasks. They also underwent a simulated perioperative emergency requiring the performance of 3 of these EMR tasks in conjunction with 5 other required interventions (including notifying the chief resident, the anesthesia team, and the OR coordinator; and ordering fluid boluses, appropriate laboratories, and blood products). These simulations were scored on a scale from 0 to 8. The interns were then directed to watch the videos. Two days later, their times for performing the 7 tasks and their scores for a similar perioperative emergency simulation were once again recorded. Before and after watching the videos, participants were surveyed to assess their confidence in performing each EMR task using a 5-point Likert scale. We also elicited their opinions of the videos and web-based mobile application using a 5-point scale. Statistical analyses to assess for statistical significance (p ≤ 0.05) were conducted using paired t-test for parametric variables and a Wilcoxon matched-pair test for nonparametric variables.

SETTING

Hospital of the University of Pennsylvania, Philadelphia, PA (a quaternary teaching hospital within the University of Pennsylvania Health System).

PARTICIPANTS

Eleven out of 15 interns (12 entered and 11 completed the study) from our categorical and preliminary general surgery residency programs during the 2016 academic year.

RESULTS

Before exposure to the brief "how to" videos, 6 of 11 interns were unable to complete all 7 EMR tasks; after exposure, all 11 interns were able to complete all 7 EMR tasks. Moreover, interns' times for each task improved following exposure. Interns self-reported improved confidence in booking an OR case (4 ± 0.9 vs. 4.7 ± 0.6, p = 0.05), ordering negative-pressure wound therapy supplies (3.1 ± 1.6 vs. 4.5 ± 0.7, p < 0.05), writing a brief operative note (3.7 ± 1.2 vs. 4.6 ± 0.7, p = 0.05), discharging patients from the postanesthesia care unit (3.3 ± 1.0 vs. 4.4 ± 0.8, p < 0.05), checking vital signs (2.5 ± 1.4 vs. 4.5 ± 0.8, p ≤ 0.01), and performing necessary EMR tasks during an emergency situation (2.4 ± 0.8 vs. 4.6 ± 0.7, p ≤ 0.0001). Participants also demonstrated a significant improvement in average clinical score on the emergency simulations (5.2 ± 1.7 vs. 6.6 ± 0.9, p < 0.05). Interns' opinions of the videos and the mobile phone application were favorable.

CONCLUSIONS

In our group of 11 surgery interns, exposure to a series of short "how to" videos led to increased confidence and shortened times in performing 7 essential EMR tasks. Additionally, during a simulated perioperative emergency, EMR tasks were performed significantly faster. Clinical performance also improved significantly following exposure to the videos. This just-in-time educational intervention could improve workflow efficiency and clinical performance, both of which may ultimately enhance perioperative patient safety.

Multicenter Validation of a Customizable Scoring Tool for Selection of Trainees for a Residency or Fellowship Program. The EAST-IST Study

RATIONALE

Few data have been published regarding scoring tools for selection of postgraduate medical trainee candidates that have wide applicability.

OBJECTIVES

The authors present a novel scoring tool developed to assist postgraduate programs in generating an institution-specific rank list derived from selected elements of the U.S. Electronic Residency Application System (ERAS) application.

METHODS

The authors developed and validated an ERAS and interview day scoring tool at five pulmonary and critical care fellowship programs: the ERAS Application Scoring Tool-Interview Scoring Tool. This scoring tool was then tested for intrarater correlation versus subjective rankings of ERAS applications. The process for development of the tool was performed at four other institutions, and it was performed alongside and compared with the "traditional" ranking methods at the five programs and compared with the submitted National Residency Match Program rank list.

RESULTS

The ERAS Application Scoring Tool correlated highly with subjective faculty rankings at the primary institution (average Spearman's r = 0.77). The ERAS Application Scoring Tool-Interview Scoring Tool method correlated well with traditional ranking methodology at all five institutions (Spearman's r = 0.54, 0.65, 0.72, 0.77, and 0.84).

CONCLUSIONS

This study validates a process for selecting and weighting components of the ERAS application and interview day to create a customizable, institution-specific tool for ranking candidates to postgraduate medical education programs. This scoring system can be used in future studies to compare the outcomes of fellowship training.

Proportion of doctors who stayed in the state of Tocantins after finishing medical residency: preliminary results from a cross-sectional study

CONTEXT AND OBJECTIVE

Few studies have assessed the impact of medical residencies on the public healthcare system. The aim here was to assess the number of specialists who remained in the state of Tocantins after finishing the medical residency program during the first two years of the first programs (2013 and 2014).

DESIGN AND SETTING

Cross-sectional and exploratory study conducted at the Federal University of Tocantins in Brazil.

METHODS

All graduates of medical residency programs in Tocantins, of the years 2013 and 2014, were interviewed by telephone and e-mail between May and July 2014.

RESULTS

Information was obtained from 37 graduates from medical residency. Seventeen (50.0%) were working in the state public healthcare system and only six (17.6%) in a municipal service in June 2014. Considering only the 24 doctors who had never worked in the state of Tocantins before their residency, it was observed that two who graduated in 2013 (20.0%) and five who graduated in 2014 (35.7%), i.e. seven out of the total number (29.2%), had established their homes in Tocantins.

CONCLUSIONS

The number of graduates from medical residency who stayed in the state of Tocantins in 2013 and 2014 was small. However, this was related to the absence of other programs for continuation of the specialization. The state healthcare system was primarily responsible for employment of these doctors within public services. On the other hand, hiring by municipal services was extremely low.

Factors Influencing Immediate Post-Residency Career Decisions for Graduating Anesthesiology Residents

BACKGROUND

Little is known regarding the factors that influence post-residency career decisions following anesthesiology residency training. The objective of this study was to assess the relationship between demographic and academic variables and immediate post-residency positions.

METHODS

The authors conducted a retrospective review of anesthesiology resident files from 2000 to 2014 at Mayo Clinic (Rochester, MN). Univariate and multivariable analyses were used to assess relationships between demographic and academic factors and post-residency positions.

RESULTS

Of the 263 anesthesiologists included, 120 (45.6%) pursued fellowship training, 110 (41.8%) entered private practice, and 33 (12.5%) entered directly into academic positions. Factors associated with career choice in univariate analyses included age, gender, country of citizenship, country of medical school, type of medical degree, and the number of peer-reviewed publications. In multivariable analyses, age, gender, and number of publications were significant predictors of post-residency career choice. Specifically, older residents were less likely to pursue fellowship training and more likely to directly enter academic positions. Males were more likely to obtain private practice positions compared to females, who were more likely to pursue advanced fellowship training. Nearly all residents entering into academic positions had at least one peer-reviewed publication.

CONCLUSIONS

In this 15-year analysis of anesthesiology resident career decisions, age, gender, and number of publications were the primary predictors of career decisions. Future studies are needed to determine generalizability and to evaluate additional socioeconomic factors with the ultimate goal of optimizing residency recruitment and training initiatives in congruence with resident career interests and departmental goals.

Physician Experiences With High Value Care in Internal Medicine Residency: Mixed-Methods Study of 2003-2013 Residency Graduates

Phenomenon: High healthcare costs and relatively poor health outcomes in the United States have led to calls to improve the teaching of high value care (defined as care that balances potential benefits of interventions with their harms including costs) to physicians-in-training. Numerous interventions to increase high value care in graduate medical education were implemented at the national and local levels over the past decade. However, there has been little evaluation of their impact on physician experiences during training and perceived preparedness for practice. We aimed to assess trends in U.S. physician experiences with high value care during residency over the past decade.

APPROACH

This mixed-methods study used a cross-sectional survey mailed July 2014 to January 2015 to 902 internists who completed residency in 2003-2013, randomly selected from the American Medical Association Masterfile. Quantitative analyses of survey responses and content analysis of free-text comments submitted by respondents were performed.

FINDINGS

A total of 456 physicians (50.6%) responded. Fewer than one fourth reported being exposed to teaching about high value care at least frequently (23.6%, 106/450). Only 43.8% of respondents (193/446) felt prepared to use overtreatment guidelines in conversations with patients, whereas 85.8% (379/447) felt prepared to participate in shared decision making with patients at the conclusion of their training, and 84.4% (380/450) reported practicing generic prescribing. Physicians who completed residency more recently were more likely to report practicing generic prescribing and feeling well prepared to use overtreatment guidelines in conversations with patients (p < .01 for both). Insights: In a national survey, recent U.S. internal medicine residency graduates were more likely to experience high value care during training, which may reflect increased national and local efforts in this area. However, being exposed to high value care as a trainee may not translate into specific tools for practice. In fact, many U.S. internists reported inadequate exposure to prepare them for patient discussions about costs and the use of overtreatment guidelines in practice.

Workplace Violence against Residents in Emergency Department and Reasons for not Reporting Them; a Cross Sectional Study

INTRODUCTION

Due to the stressful nature of emergency Department (ED), residents in ED are at risk of violence from patients or their associates. This study aimed to determine the prevalence of workplace violence against ED residents and the reasons for not reporting them.

METHODS

This cross-sectional study was conducted on ED residents of three educational hospitals, Tehran, Iran, during 2015. The national questionnaire about workplace violence was used for data gathering. In addition, prevalence of reporting the violence and the reasons for not reporting them were determined.

RESULTS

280 questionnaires were analyzed. The mean age of residents was 32.2 ± 4.6 years (58.4% female). 224 (80%) residents stated that they had not passed any educational courses on violence management. The most prevalent type of violence was verbal (90.7%) and patients' associates (85.4%) were the most common source of aggression. The frequency of physical violence was higher in male aggressors (p = 0.001), resident age > 30 years (p = 0.044), aggressor age > 30 years (p = 0.001), and night shift (p = 0.001). The same trend was observed regarding verbal and racial-ethnic violence. There was no significant relationship between residents' sex, resident's specialty, and presence of security and police with frequency of violence. 214 (76.4%) residents did not report the violence, and the main reasons for not reporting from their viewpoint were uselessness of reporting (37.4%) and insignificance of the violence (36.9%).

CONCLUSION

Based on the findings of the present study more than 90% of ED residents had experienced at least one type of verbal, physical, or racial-ethnic violence during their shifts. It is necessary for residents in EDs to be trained about violence control and also report and follow these issues through legal channels.

Mentor-mentee Relationship: A Win-Win Contract In Graduate Medical Education

Scholarly activities (i.e., the discovery of new knowledge; development of new technologies, methods, materials, or uses; integration of knowledge leading to new understanding) are intended to measure the quality and quantity of dissemination of knowledge. A successful mentorship program is necessary during residency to help residents achieve the six core competencies (patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, interpersonal and communication skills) required by the Accreditation Council for Graduate Medical Education (ACGME). The role of the mentor in this process is pivotal in the advancement of the residents’ knowledge about evidence-based medicine. With this process, while mentees become more self-regulated, exhibit confidence in their performance, and demonstrate more insight and aptitude in their jobs, mentors also achieve elevated higher self-esteem, enhanced leadership skills, and personal gratification. As such, we may conclude that mentoring is a two-sided relationship; i.e., a 'win-win' style of commitment between the mentor and mentee. Hence, both parties will eventually advance academically, as well as professionally.

Characteristics of role models who influenced medical residents to choose surgery as a specialty: exploratory study

CONTEXT AND OBJECTIVE

Choosing a medical specialty and making decisions concerning a career are difficult processes for medical students and newly graduated physicians.This exploratory study aimed to investigate the influence of role models on the choice of surgery as a career, and to determine the most influential model characteristics.

DESIGN AND SETTING

Qualitative analysis on responses to a self-administered questionnaire, in different teaching-learning settings.

METHODS

Residents from all years of various surgical subspecialties in a university hospital were included in a survey about the factors that determined their choice of surgery. The questions included items on whether a role model had influenced them in choosing surgery, and the personal or professional characteristics of the models that had been most influential. The responses were subjected to qualitative content analysis.

RESULTS

Sixty-four out of 96 medical residents participated. Fifty-three residents (82.8%) acknowledged the influence of role models. Sixteen model characteristics were indicated as important, with 136 mentions. Characteristics classified as technical skills (55%), such as"medical knowledge"and "manual dexterity" predominated over humanistic characteristics (35%), such as "patient-physician relationships" and "ethical behavior". However, this difference was not statistically significant (Fisher test, P = 0.11).There were no age differences regarding the proportions mentioning "technical" and "non-technical" attributes, but female residents mentioned significantly more technical skills than their male colleagues did.

CONCLUSIONS

The influence of role models seems to be an important factor determining the choice of surgery as a career. The influential characteristics of the models include not only technical but also humanistic qualities.

General practitioner trainees' in-consultation generation of clinical questions for later answering: prevalence and associations

BACKGROUND

As well as generating patient-specific questions, patient consultations are a rich source of questions relating to clinicians' need to acquire or maintain wider clinical knowledge. This is especially so for GP trainees.

OBJECTIVES

To establish the prevalence and associations of GP trainees' generation of 'learning goals' (LGs: questions generated during clinical consultations for intended post-consultation answering). Also, to characterize the type of learning goals generated.

METHODS

A cross-sectional analysis (2010-15) of an ongoing cohort study of Australian GP trainees' consultations. Once each 6-month training term, trainees record detailed data of 60 consecutive consultations. The primary outcome was generation of an LG. Analysis was at the level of individual problem/diagnosis managed. The secondary outcome was the problems/diagnoses to which the LGs related.

RESULTS

One thousand one hundred and twenty-four trainees contributed data for 154746 consultations including 222307 problems/diagnoses. LGs were generated for 16.6% [95% confidence intervals (CI) = 16.4-16.7] of problems/diagnoses, in 22.1% (95% CI = 21.9-22.3%) of consultations. Associations of LGs included patient factors: younger age and having seen the trainee previously; trainee factors: earlier training stage, being overseas-trained and the trainee's training organization; consultation factors: longer duration, addressing a chronic disease, referring the patient, organizing follow-up, organizing investigations and accessing in-consultation information. LGs were commonly generated for skin (12.9% of all learning goals), musculoskeletal (12.7%) and respiratory (8.7%) problems. LGs were generated for 31.8% of male genital, 27.0% of neurological and 23.3% of eye problems.

CONCLUSION

Australian GP trainees frequently generate questions in-consultation to be pursued post-consultation. Prevalence, 'complexity' and familiarity of clinical topic area influenced LG generation.

Internal Medicine Resident Engagement with a Laboratory Utilization Dashboard: Mixed Methods Study

The objective of this study was to measure internal medicine resident engagement with an electronic medical record-based dashboard providing feedback on their use of routine laboratory tests relative to service averages. From January 2016 to June 2016, residents were e-mailed a snapshot of their personalized dashboard, a link to the online dashboard, and text summarizing the resident and service utilization averages. We measured resident engagement using e-mail read-receipts and web-based tracking. We also conducted 3 hour-long focus groups with residents. Using grounded theory approach, the transcripts were analyzed for common themes focusing on barriers and facilitators of dashboard use. Among 80 residents, 74% opened the e-mail containing a link to the dashboard and 21% accessed the dashboard itself. We did not observe a statistically significant difference in routine laboratory ordering by dashboard use, although residents who opened the link to the dashboard ordered 0.26 fewer labs per doctor-patient-day than those who did not (95% confidence interval, -0.77 to 0.25; 𝑃 = 0 .31). While they raised several concerns, focus group participants had positive attitudes toward receiving individualized feedback delivered in real time.

Use of Nonprostate Ultrasound in Urology Practice

INTRODUCTION

Ultrasound imaging is necessary for the care of urology patients, and urology residents are encouraged to learn ultrasound technique and interpretation. However, there is limited mandated education in this field. Currently the only ultrasound procedure considered an index case is transrectal ultrasound for prostate biopsy. We investigated the current use of nonprostate ultrasound in urological practice.

METHODS

We reviewed ABU (American Board of Urology) certification and recertification logs of practicing urologists from 2012 to 2014. We obtained data for the codes 76700-76776 (kidney), 76870 (scrotal), 76999 (unlisted) and 93975-93981 (Doppler including penile). Codes 51798 (post-void residual) and 76950 (ultrasound for interstitial radiotherapy) were excluded from the study. We analyzed the results based on self-identified demographic information provided by the urologists.

RESULTS

The practices of 2,427 urologists were reviewed and of these, 43% billed for at least 1 renal, scrotal or penile ultrasound. General and subspecialist urologists perform similar percentages of ultrasound studies, except for pediatrics (0% penile) and andrology (40% penile). Of those who reported on practice type (2,067) 82% self-identify as in private practice and performed more ultrasound studies than academic urologists, including renal 42% vs 23%, scrotal 33% vs 15% and penile 8% vs 6%, respectively. Men performed more nonprostate ultrasounds than women (44% vs 36%, p <0.001).

CONCLUSIONS

In addition to prostate ultrasound, renal and scrotal ultrasound is relevant to all urologists regardless of practice model or subspecialty. Graduating residents can expect to perform ultrasound examinations in their practices and, therefore, in addition to prostate ultrasound we should train residents in renal and scrotal ultrasound.

Who's Managing Otolaryngologic Conditions in the United States?

Growth of an aging US population, coupled with implementation of the Patient Protection and Affordable Care Act, will pose logistical challenges for the primary care provider (PCP) workforce for the foreseeable future. In particular, the burden of otolaryngologic care placed on PCPs is substantial, based on research dating back to the 1970s and confirmed by a recent analysis of the US National Ambulatory Medical Care Survey. Collaboration between the otolaryngology and primary care communities will be needed to ensure that PCPs gain adequate exposure and training in routine otolaryngology care to improve the clinical management of ear, nose, and throat conditions in an expanding population.

How do family medicine residents choose an anticoagulation regimen for patients with nonvalvular atrial fibrillation?

Aim To examine the choices Canadian family medicine residents make for oral anticoagulation (OAC) for patients with nonvalvular atrial fibrillation (AF).

BACKGROUND

AF increases the risk of strokes. An important consideration in AF management is risk stratification for stroke and prescription of appropriate OAC. Family physicians provide the vast majority of OAC prescriptions.

METHODS

We administered a survey to residents in multiple Canadian family medicine training programmes. Questions explored the experiences and attitudes towards risk stratification and choices of OAC when presented with standardized clinical scenarios. In each scenario, a novel oral anticoagulant (NOAC) would be the preferred treatment according to the contemporary Canadian and European guidelines. Findings A total of 247 residents participated in the survey. Most used the congestive heart failure, hypertension, age ≥ 75, diabetes mellitus, stroke or TIA (2 points) (81%) and congestive heart failure, hypertension, age ≥ 75 (2 points) or age 65-74 (1 point), diabetes mellitus, stroke or TIA, vascular disease including peripheral arterial disease, myocardial infarction, or aortic plaque, sex (female) (67%) risk stratification schemes while the preferred bleeding risk stratification scheme was hypertension, abnormal liver or renal function, stroke, bleeding, labile international normalized ratio, elderly (age ≥ 65), drugs or alcohol (84%). In the clinical scenarios, residents generally preferred warfarin in favour of NOACs, independent of training level. Residents ranked the risk of adverse events and the cost to the patient as their most and least important consideration when prescribing OAC, respectively. Therefore in patients with nonvalvular AF, Canadian family medicine residents prefer warfarin in comparison with NOACs despite the latest Canadian and European guideline recommendations. This knowledge gap may be enhanced by multiple factors, including a sometimes magnified fear of adverse events and a rapidly changing landscape in stroke prophylaxis.

Formal Academic Training on Ethics May Address Junior Physicians' Needs

BACKGROUND

Surveys have highlighted perceived deficiencies among ICU residents in end-of-life care, symptom control, and confidence in dealing with dying patients. Lack of formal training may contribute to the failure to meet the needs of dying patients and their families. The objective of this study was to evaluate junior intensivists' perceptions of triage and of the quality of the dying process before and after formal academic training.

METHODS

Formal training on ethics was implemented as a part of resident training between 2007 and 2012. A cross-sectional survey was performed before (2007) and after (2012) this implementation. This study included 430 junior intensivists who were interviewed during these periods.

RESULTS

More responders attended a dedicated training course on ethics and palliative care during 2012 (38.5%) than during 2007 (17.4%; P < .0001). During 2012, respondents reported less discomfort and fewer uncertainties regarding decisions about limiting life-sustaining treatment (17.7% vs 39.1% in 2007; P < .0001) or the triage process (48.5% vs 69.4% in 2007; P < .0001). Factors independently associated with positive perceptions of the dying process were physician's age (OR, 1.19 per year; 95% CI, 1.09-1.25) and male sex (OR, 1.61; 95% CI, 1.05-2.47). Conversely, anxiety about family members' reactions (OR, 0.58; 95% CI, 0.0.37-0.87) and lack of training (OR, 0.29; 95% CI, 0.17-0.50) were associated with negative perceptions of this process.

CONCLUSIONS

Formal training dedicated to ethics and palliative care was associated with a more comfortable perception of the dying process. This training may decrease the uncertainty and discomfort of junior intensivists in these situations.

Twitter Use among Academic Urology Programs

INTRODUCTION

Twitter is a popular social media platform that has an important role in the urological community. Benefits include dissemination of knowledge, cross-institutional communication, amplification of conference content and greater engagement of the public, with increased departmental exposure. However, to date the use of Twitter by academic urology programs has yet to be examined.

METHODS

The existence and profile of institutional Twitter accounts of each United States urology residency program was recorded and reassessed in 6 months. Geographic stratification of Twitter presence was evaluated with chi-square analysis. The relationship between Twitter variables and U.S. News and World Report ranking was evaluated using Pearson's correlation coefficient. Detailed account data were collected for the top 5 accounts by tweet volume. Conference hashtag activity for the 2013 to 2015 AUA (American Urological Association) annual meetings was compared.

RESULTS

The total number of residency programs with a Twitter account is 38 (30%). Median number of tweets, followers, following and age of account was 58, 154, 107.5 and 20 months, respectively. Geographic stratification failed to show significant difference (p=0.73). Of the 38 accounts 11 were inactive over 6 months. The 27 active accounts had an average percent increase of 161% in tweets and 148% in followers. Twitter presence showed no difference in U.S. News and World Report ranking (p=0.51). The conference hashtags #AUA13 to #AUA15 increased in activity each year.

CONCLUSIONS

A minority of academic urology programs use Twitter. Account activity grew significantly with time. The role of Twitter is still being defined but is rapidly gaining traction as a new powerful communication tool among urologists and with the public.

[Use of mobile applications by interns at Ibn-Rochd University Hospital in Casablanca, Morocco]

Introduction: Mobile applications are now increasingly used by trainee and practising physicians due to the wide range of applications available in the field of healthcare and their ease of use. The objective of this study was to estimate the frequency and describe the use of these applications by interns at Ibn-Rochd University Hospital in Casablanca. Methods: A cross-sectional survey was conducted in December 2014 on a sample of Ibn-Rochd interns. Participants from multiple disciplines and medical specialties completed an anonymous self-administered questionnaire. Results: One hundred and thirteen interns participated in the study with a 94.2% response rate: 95% of these interns had a smartphone and 85.2% had at least one healthcare mobile applications with an average of 3.57 applications per interns (SD = 3.14). Interns used these applications at least once a day and the most frequently downloaded applications were those devoted to diagnosis and patient care (61%). No statistically significant correlation was observed between the number of applications and the intern’s specialty, the type of operating system used or the intern’s gender. Conclusion: The use of healthcare mobile applications and the support they provide to Ibn-Rochd interns allowed an assessment of the importance of these new tools in medical training and practice. However, supervision and support by seniors are essential in view of the risks involved.

Perspectives on International Urological Volunteerism: A Survey of IVUmed Resident Scholar Alumni

INTRODUCTION

The primary intentions of international surgical programs are to directly benefit those receiving medical care, educate local physicians and staff, and improve care delivery models. IVUmed, a nonprofit organization dedicated to providing urological care to resource poor areas of the world, provides scholarship opportunities for urology trainees. We assessed the motivations and barriers of IVUmed traveling resident scholars regarding continuing international surgical work after completion of the program.

METHODS

An Internet based survey was sent to all previous IVUmed resident scholars assessing potential factors associated with repeat international service. Logistic regression was used to examine the association between survey responses and the likelihood of repeating an international service trip after completion of training.

RESULTS

Of 196 IVUmed resident scholar participants 100 (51%) responded to the survey. Of the 69 attending surgeons 17 (25%) had repeated an international service trip. Altruism (100%), personal fulfillment (99%) and practicing in a resource limited setting (94%) were the most frequently cited motivating factors for repeat participation, while lack of time (96%) was the most commonly reported barrier. Respondents in private practice were less likely to participate in a subsequent trip compared to those in an academic setting (OR 0.16, CI 0.03-0.80, p = 0.03). No other factors were associated with the likelihood of repeating an international service trip.

CONCLUSIONS

Among urologists who participated in a funded international scholarship program during residency repeat participation during the subsequent 7 years was modest. Private practitioners were less likely to repeat international service compared to academic urologists.

The Impact of Resident Training on Communication with Families in the Intensive Care Unit. Resident and Family Outcomes

RATIONALE

In high-acuity settings such as intensive care units (ICUs), the quality of communication with patients' families is a particularly important component of care. Evidence shows that ICU communication is often inadequate and can negatively impact family outcomes.

OBJECTIVES

To assess the impact of a communication training program on resident skills in communicating with families in an ICU and on family outcomes.

METHODS

We conducted a prospective, single-site educational intervention study. The intervention featured a weekly required communication training program (4 h total) during the ICU rotation, which included interactive discussion, and role play with immediate feedback from simulated family members. All internal medicine residents on ICU rotation between July 2012 and July 2014 were invited to participate in the study. Family members who had a meeting with an enrolled resident were approached for a survey or interview. The primary outcome was family ratings of how well residents met their informational and emotional needs.

MEASUREMENTS AND MAIN RESULTS

The response rate for the resident baseline survey was 93% (n = 149 of 160), and it was 90% at postcourse and 84% at 3-month follow-up. Of 303 family members approached, 237 were enrolled. Enrolled family members who had a confirmed meeting with a resident were eligible to complete a survey or interview. The completion rate was 86% (n = 82 of 95). Family members were more likely to describe residents as having "fully met" (average rating of 10/10 on 0-10 scale) their informational and emotional needs when the resident had completed two or three course sessions (84% of family members said conversation with these residents "fully met" their needs), as compared with residents who had taken one session or no sessions (25% of family members said needs were "fully met") (P < 0.0001). Residents described improvements across all domains. All differences are statistically significant, most with large effect sizes.

CONCLUSIONS

At our institution, an on-site communication training program designed for integration into medical residency programs was associated with strongly positive family member outcomes and significant improvements in residents' perceived skills. This intervention may serve to prepare residents for optimal communications with patients and family members in ICUs and elsewhere.

Urinary Catheter Management for Nonurologists: A Resident Driven Educational Initiative

INTRODUCTION

Prevention of catheter associated urinary tract infection relies on timely catheter removal and care of indwelling catheters. Educational and quality improvement initiatives to prevent catheter associated urinary tract infection should address the basics of urinary catheter placement and management. Internal medicine residents are an appropriate target for these efforts and they may lack formal training in these issues. We developed a resident driven orientation session that covers basic Foley catheter management principles called the TIPS (Troubleshooting, Indications and Practice Sessions) program.

METHODS

Urology residents at our institution were queried on common consultations for urinary catheter related issues. The incoming intern internal medicine class at our institution completed a pre-TIPS survey that evaluated their baseline urological experience and knowledge. A 1-hour didactic session led by urology residents was followed by hands-on directed practice with mannequins. The web based survey was repeated 1 month later.

RESULTS

Of the total of 60 residents 54 (90%) completed the initial survey. In medical school 38 of 54 residents (70%) had never rotated in urology. Upon repeating the survey at 1 month the response rate was 34 of 60 residents (57%). The proportion of residents confident in their ability to troubleshoot catheter problems increased from 50% to 88% (p <0.05). Knowledge of indications, clot retention and proper catheter technique also improved (p <0.05).

CONCLUSIONS

A focused educational session about common urological catheter management scenarios resulted in improved internal medicine resident confidence in catheter troubleshooting and knowledge of basic urinary catheter placement indications. These educational sessions may be a method to improve nonurology resident education and awareness of common urological issues.

The Current State of Urological Education for Medical Students

INTRODUCTION

Providing medical students with a basic urological education is important as the geriatric population expands and the need for urological care increases. In the last decades there have been considerable changes to medical school curricula and graduation requirements that may impact medical student exposure to urology. We reviewed the literature pertaining to urological education for medical students in the United States.

METHODS

We searched the PubMed® and Medline® databases to identify articles pertaining to medical student education in urology. We summarized these articles according to 4 themes, including 1) medical student electives in urology, 2) medical student career interest in urology, 3) new interventions in urology education and 4) the urology match.

RESULTS

We identified 25 articles, which showed that 1) medical student exposure to urology has markedly declined, 2) medical students remain highly interested in pursuing a career in urology, 3) the AUA (American Urological Association) medical student curriculum has provided a key resource for medical school urological education and 4) applying for urology residency may be expensive and challenging.

CONCLUSIONS

Medical school urological education has changed in the last decades. Although it appears that fewer medical students are required to rotate through urology, new materials are available to educate medical students in urology and many students are highly interested in pursing a career in the field.

Surgical Resident Radiation Knowledge, Attitudes, Practices, and Exposures

OBJECTIVE

To investigate the level of ionizing radiation exposure among surgical residents and to evaluate resident knowledge, attitudes, and practices regarding exposures.

DESIGN

An observational study was conducted using radiation exposure data for surgical residents who wore film badge dosimeters. A cross-sectional survey was electronically administered at the end of the year, examining resident knowledge, attitudes, and practices concerning radiation exposures.

SETTING

Community teaching hospital in the Midwest.

PARTICIPANTS

Surgical residents who wore a badge for the full calendar year and completed study survey. Excluded were graduating chiefs and interns who only had 6 calendar months of data.

RESULTS

A total of 14 surgical residents (100%) were engaged in 168 rotations during study year. Primarily-general surgery (n = 103, 61%), night float (n = 16, 10%), trauma (n = 15, 9%), and vascular (n = 13, 8%). Radiation exposures were greater than a null value during most rotations (i.e., general surgery and night float), with no exposure above occupational thresholds. Certain rotations, namely vascular and trauma, had episodic high exposures. When asked if protective efforts changed during higher-risk rotations, responses revealed they increased (64%) or did not change (36%). A low Cronbach alpha (α = 0.2634) demonstrated that precaution use was not universal and had varied rationale. Percentage of correct radiation knowledge questions was 62%. A multilevel model predicting exposure had a significant multiplicative cross-level interaction term (p < 0.0001) between resident-level exposure and rotation type.

CONCLUSIONS

Radiation exposure levels for surgical residents have not been previously investigated. Data demonstrated that surgical residents were not at a greater risk than other medical personnel. However, the study demonstrated detectable radiation exposures that were statistically greater than a null value for the most common rotations. Stochastic and dose-response effects of radiation make any exposure a concern. Attempts to lessen exposures are worthwhile, with study results identifying a need for greater safety precaution education and adherence.

Reduced Resident Work Hours in Urology: The History and Impact of Duty Hour Restrictions

INTRODUCTION

The ACGME first mandated duty hour restrictions for resident physicians in 2003, setting a limit of 80 hours per week. While the goals of this and later reforms were to improve patient care and safety, the outcomes have been mixed. In this review we report on the history of duty hour regulations and how these changes have impacted resident and patient outcomes.

METHODS

A literature search was performed, and articles discussing surgical training, resident duty hours, resident wellness and patient outcomes were reviewed.

RESULTS

After implementation of duty hour restrictions in 2003, the Harvard Work Hours Health and Safety Group published 3 hallmark studies that suggested duty hour restrictions were associated with improved outcomes. A recently published systematic review reported mixed results from the growing body of research. While 71% of the reviewed studies reported improvement in resident wellness, only 4% illustrated an improvement in resident education, 19% reported improved patient safety outcomes and 13% demonstrated improved patient morbidity.

CONCLUSIONS

Resident duty hour restrictions were based on a body of evidence illustrating that fatigue and sleeplessness negatively impact decision making, resident wellness and patient care. While initial outcomes suggested that these regulations resulted in better resident and patient outcomes, more recent evidence suggests otherwise. There is very little urology specific evidence addressing these matters.

Challenges Facing Program Directors in the Urology Match

INTRODUCTION

We investigate urology residency program directors' perspectives on the current residency matching system.

METHODS

A survey was emailed to Society of Urology Chairpersons and Program Directors members. The survey queried respondents' perspectives on the current residency matching system, with special attention to the recent surge in application volume and the usefulness of the Medical Student Performance Evaluation. Participants were also asked about their perspective on a possible application limit for students applying to urology residencies.

RESULTS

A total of 70 members of the Society of Urology Chairpersons and Program Directors responded to the survey. The majority of respondents received more than 200 applications for their program's residency positions (77.1%) and used a Step 1 cutoff score to screen applications (81.4%). Approximately half of the respondents (51.4%) were in favor of imposing a limit to the number of applications that applicants are permitted to submit. The Medical Student Performance Evaluation was considered important or very important by 20% and 94.3% favored including an applicant's class rank in the evaluation. An applicant's projected likelihood of attending a respondent's program was considered by 76%, and 60% had previously not offered superior candidates interviews because they estimated the applicants were not truly interested in the program.

CONCLUSIONS

Urology program directors exclude a large number of applications based on board scores and applicants' perceived levels of interest in the programs. A significant number of program directors favored an application limit as well as including class rank in the Medical Student Performance Evaluation.

Participating in university entrance exam despite repeated failure: a qualitative study of participants' experiences

OBJECTIVES

To explore the experiences of general practitioners who continue to sit a highly-competitive residency entrance examination, despite repeated failure.

METHODS

This qualitative, exploratory study employed semi-structured, in-depth interviews with 35 candidates of a residency entrance exam who had failed the examination at least twice and were preparing to sit it again. Interview questions addressed the challenges they faced and how they managed these challenges. Interview data were audiotaped, transcribed, and analysed to identify themes.

RESULTS

The results demonstrated that more than 50% (n=19) of candidates struggled continuously and internally with different aspects of the exam. These include being under a great deal of pressure to succeed, failing to prioritize study materials, inefficient review during the final days  of preparation, and sitting the exam with an afflicted body. Furthermore, during the examination, they frequently used inefficient strategies to answer questions. Afterwards, they experienced feelings of freedom associated with having finished the exam.

CONCLUSIONS

Participation in a highly-competitive examination exerts a considerable amount pressure on low-performing candidates. This climate not only results in burn out of participants, but it also influences their learning styles and identities as future physicians. It is therefore necessary to design a syllabus for both test candidates and policy makers, in order better to manage this environment. Candidates also should be aware of their individual weaknesses in order to improve their studying skills.

The prevalence of binge drinking among primary care residents

BACKGROUND

Over one quarter of American adults binge drink, resulting in significant alcohol-related morbidity and mortality. Although brief interventions can decrease patients' alcohol use, many physicians in training do not provide this service. This study examines the prevalence of binge drinking among primary care residents, and the association of resident drinking behaviors with addressing patients' hazardous alcohol use.

METHODS

Between July 2013 and August 2014, the authors surveyed all trainees in 6 primary care residency programs. The survey assessed self-reported frequency of binge drinking, confidence working with hazardous drinkers, and the performance of brief interventions when hazardous drinking was detected in patients.

RESULTS

221 of 246 residents completed the survey (response rate 89.8%). Half of residents (109/221) reported at least one episode of binge drinking in the prior year, and 18% (39/221) reported binge drinking at least once a month. In multivariable analysis, monthly binge drinking was associated with male gender (OR 2.5, 95% CI 1.1-5.4) and year of training (OR 0.25 for Year 3 vs. Year 1, 95% CI 0.07-0.90). Few residents felt confident they could help patients cut down or quit alcohol, regardless of personal binge drinking history (19% for those who binged monthly, 24% for those who binged 1-11 times a year, and 27% for those who never binged, p for trend = 0.31). Performance of brief interventions did not vary by personal binge drinking history.

CONCLUSIONS

Binge drinking is common among primary care residents. In addition to training residents to effectively intervene with hazardous drinkers, residency programs should address the high prevalence of binge drinking by their physicians in training.