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Zhang M, Gulati A, Páez-Carpio A, Zaki-Metias KM, Cledera T. How to Succeed as a Radiology Fellow. Radiographics 2024; 44:e240003. [PMID: 38602865 DOI: 10.1148/rg.240003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Affiliation(s)
- Meng Zhang
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Rd NE, Bldg C, Atlanta, GA 30322 (M.Z.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.G.); Department of Radiology, CDI, Hospital Clínic Barcelona, Barcelona, Spain (A.P.C.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.P.C.); Trinity Health Oakland Hospital/ Wayne State University School of Medicine, Pontiac, Mich (K.M.Z.M.); and Institute of Radiology, St. Luke's Medical Center Global City, Taguig, Philippines (T.C.)
| | - Aishwarya Gulati
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Rd NE, Bldg C, Atlanta, GA 30322 (M.Z.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.G.); Department of Radiology, CDI, Hospital Clínic Barcelona, Barcelona, Spain (A.P.C.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.P.C.); Trinity Health Oakland Hospital/ Wayne State University School of Medicine, Pontiac, Mich (K.M.Z.M.); and Institute of Radiology, St. Luke's Medical Center Global City, Taguig, Philippines (T.C.)
| | - Alfredo Páez-Carpio
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Rd NE, Bldg C, Atlanta, GA 30322 (M.Z.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.G.); Department of Radiology, CDI, Hospital Clínic Barcelona, Barcelona, Spain (A.P.C.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.P.C.); Trinity Health Oakland Hospital/ Wayne State University School of Medicine, Pontiac, Mich (K.M.Z.M.); and Institute of Radiology, St. Luke's Medical Center Global City, Taguig, Philippines (T.C.)
| | - Kaitlin M Zaki-Metias
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Rd NE, Bldg C, Atlanta, GA 30322 (M.Z.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.G.); Department of Radiology, CDI, Hospital Clínic Barcelona, Barcelona, Spain (A.P.C.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.P.C.); Trinity Health Oakland Hospital/ Wayne State University School of Medicine, Pontiac, Mich (K.M.Z.M.); and Institute of Radiology, St. Luke's Medical Center Global City, Taguig, Philippines (T.C.)
| | - Thurl Cledera
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Rd NE, Bldg C, Atlanta, GA 30322 (M.Z.); Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (A.G.); Department of Radiology, CDI, Hospital Clínic Barcelona, Barcelona, Spain (A.P.C.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.P.C.); Trinity Health Oakland Hospital/ Wayne State University School of Medicine, Pontiac, Mich (K.M.Z.M.); and Institute of Radiology, St. Luke's Medical Center Global City, Taguig, Philippines (T.C.)
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Neerhut T, Ninan J, Grills R, McLeod K. Defining the good surgical resident: a resident and registrar perspective. ANZ J Surg 2023; 93:2574-2579. [PMID: 37668282 DOI: 10.1111/ans.18689] [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: 05/15/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Surgical residency provides insight into the essential skills required to become a successful surgical registrar. However, the role of the surgical resident remains largely undefined. While the Royal Australasian College of Surgeon (RACS) JDocs framework provides a useful guide, no published research explores what defines a highly performing surgical resident. We investigate what constitutes a 'good' surgical resident from the surgical resident and accredited surgical registrar perspectives. We hope this knowledge will improve patient care and assist surgical residents towards becoming valuable team members and successful accredited surgical training candidates. METHODS A qualitative research approach was utilized employing reflexive thematic analysis. Using semi-structured interviews, 10 surgical residents and 10 accredited surgical registrars across eight surgical specialties were interviewed. RESULTS Amongst surgical residents five themes were identified: efficiency: mastering the mundane, 'stepping up' to more responsibility, enthusiasm to learn, first do no harm: a safe practitioner, and lastly no resident is an island: a team player. Four themes described by accredited registrars included: somebody you can trust, finding a safe 'balance', a perfect fit: teamwork and communication and finally eagerness to improve. CONCLUSION Themes correlated well with eight of 10 RACS competencies and the JDocs Framework. Our results reaffirmed the importance of developing early career non-technical skills. Explicit knowledge and understanding of these attributes used in conjunction with the core competency and JDocs frameworks may help those contemplating a career in surgery throughout their early surgical years.
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Affiliation(s)
- Thomas Neerhut
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - John Ninan
- Department of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Richard Grills
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Kathryn McLeod
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
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Wolfson RK, Fairchild PC, Bahner I, Baxa DM, Birnbaum DR, Chaudhry SI, Chretien KC, DeFranco DB, Deptola AZ, LaConte LE, Lin JJ, Petch Lee L, Powers MA, Ropson IJ, Sankaran SM, Sawarynski KE, Sozio SM. Residency Program Directors' Views on Research Conducted During Medical School: A National Survey. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1185-1195. [PMID: 37099328 PMCID: PMC10516175 DOI: 10.1097/acm.0000000000005256] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE With the United States Medical Licensing Examination Step 1 transition to pass/fail in 2022, uncertainty exists regarding how other residency application components, including research conducted during medical school, will inform interview and ranking decisions. The authors explore program director (PD) views on medical student research, the importance of disseminating that work, and the translatable skill set of research participation. METHOD Surveys were distributed to all U.S. residency PDs and remained open from August to November 2021 to query the importance of research participation in assessing applicants, whether certain types of research were more valued, productivity measures that reflect meaningful research participation, and traits for which research serves as a proxy. The survey also queried whether research would be more important without a numeric Step 1 score and the importance of research vs other application components. RESULTS A total of 885 responses from 393 institutions were received. Ten PDs indicated that research is not considered when reviewing applicants, leaving 875 responses for analysis. Among 873 PDs (2 nonrespondents), 358 (41.0%) replied that meaningful research participation will be more important in offering interviews. A total of 164 of 304 most competitive specialties (53.9%) reported increased research importance compared with 99 of 282 competitive (35.1%) and 95 of 287 least competitive (33.1%) specialties. PDs reported that meaningful research participation demonstrated intellectual curiosity (545 [62.3%]), critical and analytical thinking skills (482 [55.1%]), and self-directed learning skills (455 [52.0%]). PDs from the most competitive specialties were significantly more likely to indicate that they value basic science research vs PDs from the least competitive specialties. CONCLUSIONS This study demonstrates how PDs value research in their review of applicants, what they perceive research represents in an applicant, and how these views are shifting as the Step 1 exam transitions to pass/fail.
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Affiliation(s)
- Rachel K. Wolfson
- R.K. Wolfson is associate professor of pediatrics and assistant dean for medical school research, University of Chicago Pritzker School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-0326-1540
| | - Paige C. Fairchild
- P.C. Fairchild was manager of medical education, University of Chicago Pritzker School of Medicine, Chicago, Illinois, at the time of writing and is now an epidemiologist, Jefferson County Public Health, Jefferson County, Colorado
| | - Ingrid Bahner
- I. Bahner is professor, Department of Molecular Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida; ORCID: http://orcid.org/0000-0002-1416-2989
| | - Dwayne M. Baxa
- D.M. Baxa is associate professor, Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan; ORCID: https://orcid.org/0000-0002-6713-2927
| | - Deborah R. Birnbaum
- D.R. Birnbaum is scholarly concentrations program director and project manager for the executive associate dean, Medical Education and Institutional Improvement, Indiana University School of Medicine, Indianapolis, Indiana; ORCID: https://orcid.org/0000-0002-4344-6630
| | - Sarwat I. Chaudhry
- S.I. Chaudhry is professor of medicine and associate dean of student research, Yale School of Medicine, New Haven, Connecticut
| | - Katherine C. Chretien
- K.C. Chretien is associate dean for medical student affairs, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0003-2371-5052
| | - Donald B. DeFranco
- D.B. DeFranco is professor of pharmacology and chemical biology and associate dean of medical student research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; ORCID: https://orcid.org/0000-0002-7662-4886
| | - Amber Z. Deptola
- A.Z. Deptola was assistant professor of medicine and associate program director, Washington University in St. Louis School of Medicine, St. Louis, Missouri, at the time of writing and is now a physician, Norton Healthcare, Louisville, Kentucky; ORCID: https://orcid.org/0000-0002-3808-2780
| | - Leslie E.W. LaConte
- L.E.W. LaConte is associate professor of basic science education and assistant dean for research, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; ORCID: https://orcid.org/0000-0003-3747-0973
| | - Jenny J. Lin
- J.J. Lin is professor of medicine and associate director for the medical school research office, Icahn School of Medicine at Mount Sinai, New York, New York; ORCID: https://orcid.org/0000-0001-7104-8480
| | - Leslie Petch Lee
- L. Petch Lee is associate dean for academic enhancement, Augusta University/University of Georgia Medical Partnership, Athens, Georgia
| | - Maureen A. Powers
- M.A. Powers is associate professor of cell biology and director of the discovery phase, Emory University School of Medicine, Atlanta, Georgia
| | - Ira J. Ropson
- I.J. Ropson is associate professor of biochemistry and molecular biology and assistant dean for medical student research, Penn State University College of Medicine, Hershey, Pennsylvania; ORCID: https://orcid.org/my-orcid?orcid=0000-0002-9539-4596
| | - Saumya M. Sankaran
- S.M. Sankaran is assistant teaching professor of biomedical science, University of Washington Tacoma, Tacoma, Washington
| | - Kara E. Sawarynski
- K.E. Sawarynski is associate professor, Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan; ORCID: https://orcid.org/0000-0003-3008-0884
| | - Stephen M. Sozio
- S.M. Sozio is associate professor of medicine and epidemiology, Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland; ORCID: https://orcid.org/0000-0002-0099-0484
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Drum B, Lamb S, Gradick C. Values-Based Resident Selection in an Internal Medicine-Pediatrics Residency Program. J Gen Intern Med 2023; 38:1410-1416. [PMID: 36344647 PMCID: PMC10160323 DOI: 10.1007/s11606-022-07857-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is no consensus regarding values important for medical resident success, and current methods for selecting residents correlate poorly with success in residency. OBJECTIVE We developed and validated a set of values demonstrated by exemplary residents in the Internal Medicine-Pediatrics program at the University of Utah and used them to inform our resident selection process. DESIGN We utilized a modified Delphi method to identify and internally validate values of successful residents. We implemented these values into the interview evaluation rubric. PARTICIPANTS Four members of the Internal Medicine-Pediatrics residency program leadership and eleven current residents aided in value generation. Nine faculty from leadership positions in the residency programs of Internal Medicine-Pediatrics, Internal Medicine, and Pediatrics formed a local expert panel for validation. APPROACH We performed a literature review and engaged local stakeholders in a semi-structured group interview to generate 107 values. After consolidation based on redundancy, two iterative cycles of expert review using a modified Delphi approach, and alignment with the Accreditation Council for Graduate Medical Education core competencies, eleven values achieved expert agreement and were integrated into an interview rubric to aid in resident selection. KEY RESULTS We identified eleven values important for resident success: academic strength, intellectual curiosity, compassion, communication, work ethic, teamwork, leadership, self-awareness, DEI (diversity, equity, and inclusion), professionalism, and adaptability. The rank list from 2021 was found to correlate with a score based on values, but not Step 2 score, as it did in 2017. CONCLUSIONS We applied a modified Delphi method to generate eleven observable values present in the ideal Internal Medicine-Pediatric resident at one academic health center in the Intermountain West. Higher Step 2 scores no longer correlated with higher ranking when we used these values to inform our rank list.
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Affiliation(s)
- Benjamin Drum
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, USA.
| | - Sara Lamb
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
| | - Casey Gradick
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
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Saxena A, Desanghere L. A framework for residents' pursuit of excellence based upon non-cognitive and cognitive attributes. Postgrad Med J 2023; 99:17-24. [PMID: 36947425 DOI: 10.1093/postmj/qgac001] [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: 03/11/2022] [Revised: 08/16/2022] [Accepted: 09/25/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Excellence, although variably conceptualized, is commonly used in medicine and the resident excellence literature is limited. Both cognitive attributes (CAs) and non-cognitive attributes (NCAs) are essential for academic and clinical performance; however, the latter are difficult to evaluate. Undergirded by an inclusive and non-competitive approach and utilizing CAs and NCAs, we propose a criterion-referenced behavioral framework of resident excellence. METHODS Perceptions of multiple stakeholders (educational administrators, faculty, and residents), gathered by survey (n = 218), document analysis (n = 52), and focus group (n = 23), were analyzed. Inductive thematic analysis was followed by deductive interpretation and categorization using sensitizing concepts for excellence, NCAs, and CAs. Chi-squared tests were used to determine stakeholder perception differences. RESULTS All stakeholders had similar perceptions (P > .05) and 13 behavioral attributes in 6 themes undergirded by insight and conscientiousness were identified. The NCAs included: interpersonal skills (works with others, available, humble), professional (compassionate, trustworthy), commitment to profession (visible, volunteers), commitment to learn (proactively seeks feedback, creates learning opportunities), and work-life balance/integration (calm demeanor, inspirational). The CA (medical knowledge and intellect) included: applies knowledge to gain expertise and improves program's caliber. CONCLUSION Resident excellence is posited as a pursuit. The attributes are non-competitive, inclusionary, potentially achievable by all, and do not negatively affect freedom of choice. However, contextual and cultural differences are likely and these need validation across societal equity segments. There are implications for learners (adaptive reflection and learning goal orientation), faculty (reduced bias and whole-person feedback), and system leaders (enhancing culture and learning environments) to foster excellence.
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Affiliation(s)
- Anurag Saxena
- Postgraduate Medical Education Office, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, S7N 5E5
| | - Loni Desanghere
- Postgraduate Medical Education Office, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, S7N 5E5
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Goel N, Saroya AS, Morya AK, Tejaswini A. What makes a resident a great resident? Indian J Ophthalmol 2023; 71:1045-1046. [PMID: 36872744 PMCID: PMC10229921 DOI: 10.4103/ijo.ijo_3051_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Affiliation(s)
- Nupur Goel
- Anterior segment and Oculoplasty, Icare Eye Hospital and PG Institute, Noida, Uttar Pradesh, India
| | - Arnav Singh Saroya
- Cataract, Cornea and Refractive Surgery, Dr Agarwals Eye Hospital, Chennai, Tamil Nadu, India
| | - Arvind Kumar Morya
- Cataract, Glaucoma, Refractive, Squint, Paediatric Ophthalmology and Medical Retina Services, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Antarvedi Tejaswini
- Cataract, Glaucoma, Refractive, Squint, Paediatric Ophthalmology and Medical Retina Services, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
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Lee SH, Phan PH, Desai SV. Evaluation of house staff candidates for program fit: a cohort-based controlled study. BMC MEDICAL EDUCATION 2022; 22:754. [PMID: 36320029 PMCID: PMC9628087 DOI: 10.1186/s12909-022-03801-0] [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: 04/14/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Medical school academic achievements do not necessarily predict house staff job performance. This study explores a selection mechanism that improves house staff-program fit that enhances the Accreditation Council for Graduate Medical Education Milestones performance ratings. OBJECTIVE Traditionally, house staff were selected primarily on medical school academic performance. To improve residency performance outcomes, the Program designed a theory-driven selection tool to assess house staff candidates on their personal values and goals fit with Program values and goals. It was hypothesized cohort performance ratings will improve because of the intervention. METHODS Prospective quasi-experimental cohort design with data from two house staff cohorts at a university-based categorical Internal Medicine Residency Program. The intervention cohort, comprising 45 house staff from 2016 to 2017, was selected using a Behaviorally Anchored Rating Scales (BARS) tool for program fit. The control cohort, comprising 44 house staff from the prior year, was selected using medical school academic achievement scores. House staff performance was evaluated using ACGME Milestones indicators. The mean scores for each category were compared between the intervention and control cohorts using Student's t-tests with Bonferroni correction and Cohen's d for effect size. RESULTS The cohorts were no different in academic performance scores at time of Program entry. The intervention cohort outperformed the control cohort on all 6 dimensions of Milestones by end-PGY1 and 3 of 6 dimensions by mid-PGY3. CONCLUSION Selecting house staff based on compatibility with Residency Program values and objectives may yield higher job performance because trainees benefit more from a better fit with the training program.
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Affiliation(s)
- Soo-Hoon Lee
- Strome College of Business, Old Dominion University, Norfolk, VA, USA
| | - Phillip H Phan
- Johns Hopkins Carey Business School, Johns Hopkins University, Baltimore, MD, USA.
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Sanjay V Desai
- Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Coughlin RF, Tsyrulnik A, Gottlieb M, Bod J, Barnicle R, Dziura J, Della‐Giustina D, Goldflam K. Differences in faculty feedback for high, expected, and below-expected clinically performing emergency medicine residents. AEM EDUCATION AND TRAINING 2022; 6:e10788. [PMID: 36189452 PMCID: PMC9482001 DOI: 10.1002/aet2.10788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/09/2022] [Accepted: 07/01/2022] [Indexed: 06/16/2023]
Abstract
Objectives A lifelong pursuit such as medicine is frequently paired with a framework of "deliberate practice" for improvement. It is unclear whether the quality of feedback varies across different learner levels. Our study aims to assess whether a difference exists in the quality of feedback delivered to high-, expected-, and below-expected performer emergency medicine (EM) residents based on their attending-identified performance level. Methods We conducted a retrospective review of written EM resident feedback collected between November 2018 and March 2021. Clinical performance level was subjectively determined by attending faculty in their feedback. Feedback was coded on a scale from 0-5 based on the presence (1) or absence (0) of the items modified from the Ende's SMART criteria: Specific (S), Measurable (M), Achievable (A), Relevant (R), and Time-bound (T). The primary outcome was any total modified SMART criteria score difference concerning performance level using logistic regression with Generalized Estimating Equations (GEE). Secondary outcomes were differences for individual criteria. Results We analyzed 1284 evaluations (311 high performers, 930 expected performers, and 43 below-expected performers) of 94 unique residents from 66 different evaluators. Mean total modified SMART scores were significantly higher in high and below-expected performers than those designated as expected performers by faculty evaluators. Achievable and Relevant written feedback was provided to high performers in a significantly larger proportion than expected and below-expected performers. Only 278 out of 1284 evaluations met criteria for Specific. Conclusions Mean total modified SMART feedback scores were significantly greater in high performers and below-expected performers when compared to expected performers. Achievable and Relevant feedback was provided in greater proportions to high performer residents compared to expected and below-expected performers. These findings are a challenge to academic faculty to engage in quality feedback delivery for residents at all performance levels.
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Affiliation(s)
- Ryan F. Coughlin
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Alina Tsyrulnik
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Michael Gottlieb
- Department of Emergency MedicineRush Medical CollegeChicagoIllinoisUSA
| | - Jessica Bod
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Ryan Barnicle
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - James Dziura
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - David Della‐Giustina
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Katja Goldflam
- Department of Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
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Abstract
By the end of their training, all orthopaedic residents should be competent in understanding musculoskeletal research enough to navigate the literature and base clinical decisions on it. To accomplish this, the Accreditation Council for Graduate Medical Education requires involvement in scholarly activity. For those interested in academics and having additional involvement in research, there can be many benefits including professional achievement and intellectual /personal satisfaction. A number of potential career models exist for those interested in being engaged in musculoskeletal research, so trainees should seek the training and level of involvement in research that will help them achieve their individual academic goals. To that end, trainees should become involved with research early and identify research mentors in their field of interest (at home or from afar). Training programs and faculty members should create a milieu conducive to research productivity and support and equip trainees who have such aspirations.
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Feinman M, Hsu ATW, Taylor S, Torbeck L. Cutting the fat: Utilizing LEAN methodology to improve rounding efficiency of surgical residents. Am J Surg 2021; 223:1100-1104. [PMID: 34916037 DOI: 10.1016/j.amjsurg.2021.12.005] [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: 07/10/2021] [Revised: 11/10/2021] [Accepted: 12/03/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND LEAN was developed by Toyota to provide a systematic way to eliminate waste and standardize processes. We sought to introduce LEAN methodology to surgical residents with the goal of increasing rounding efficiency. METHODS A Kaizen event was used as a rounding efficiency improvement strategy. A multidisciplinary healthcare team participated in the event; first to identify the current state of rounds, second to create the ideal state. Value-stream maps were created and improved efficiency was seen by increased ratio of productive time to lead time. RESULTS Two interventions were prioritized. The first introduced table rounds before walk rounds and the second changed the sign-out tool from Baton to Microsoft Word with file encryption. The ratio of productive time to lead time during morning rounds was higher after implementing these interventions (3.73 vs. 2.03). CONCLUSIONS This Kaizen event introduced surgical trainees to LEAN and resulted in improved efficiency of morning rounds.
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Affiliation(s)
- Marcie Feinman
- Department of Surgery, Sinai Hospital of Baltimore, 2435 Belvedere Ave, Hoffberger Building, Suite 42, Baltimore, MD, 21215, USA.
| | - Angela Ting Wei Hsu
- Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe St, Blalock 607, Baltimore, MD, USA
| | - Stephanie Taylor
- Department of Surgery, Sinai Hospital of Baltimore, 2435 Belvedere Ave, Hoffberger Building, Suite 42, Baltimore, MD, 21215, USA
| | - Laura Torbeck
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH 543, Indianapolis, IN, 46202, USA
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The Experience of Virtual Interviews in Resident Selection: A Survey of Program Directors in Surgery. J Surg Res 2021; 270:208-213. [PMID: 34706297 DOI: 10.1016/j.jss.2021.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND MATCH 2021 was short of the classic "in-person" component. Herein, we assess the impact of virtual interviews (VIs) on resident selection, from the perspectives of program directors (PDs) across all surgical specialties. MATERIALS AND METHODS We conducted a cross-sectional survey-based study of ACGME-accredited US residency program directors (PDs) of all surgical specialties. The survey was designed based on a review of relevant literature and inquired about the strengths, limitations, and overall utility of VIs. RESULTS A total of 365 PDs responded to our survey. Almost all respondents (90%) found VIs to be less expensive than in-person interviews, while only 34% agree that VIs were less time-consuming. Only a median of 5% of interviews was complicated by technical difficulties. Most PDs found it more challenging to assess applicants' fit (75%), personality and communication skills (71%), and commitment to specialty (60%). Only 14% found VIs to be overall better for assessing residency applicants. In future cycles, most PDs are planning to host both virtual and in-person interviews (57%), while 35% and 8% will host exclusive in-person and virtual interviews, respectively. CONCLUSIONS VIs are a novel way of dealing with the restrictions imposed by COVID-19. Despite their cost and time benefit, they present particular challenges in evaluating residency applicants. A combination of both virtual and in-person interviews will likely be implemented in the coming cycles.
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Levine JM, Rentko VT, Austin J, Hardie E, Davis EG, Fubini SL, Katzman SA, Wells KL, Yaxley PE, Marcovici O, Birkenheur A, Fingland RB, Arthur W. Assessment and Revision of the Veterinary Internship and Residency Matching Program Standardized Letter of Reference. JOURNAL OF VETERINARY MEDICAL EDUCATION 2021; 48:528-532. [PMID: 33661088 DOI: 10.3138/jvme-2019-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The Veterinary Internship and Residency Matching Program (VIRMP) recently revised its electronic standardized letter of reference (SLOR) to improve the quality and usefulness of the data obtained from it and to enhance the relevance of non-cognitive and cognitive candidate attributes assessed. We used a stepwise process including a broad survey of SLOR readers and writers, analysis of past SLORs, and a multi-wave iterative revision that included key stakeholders, such as residency and internship program directors from academia and private practice. Data from the SLOR survey and analysis of past SLOR responses identified opportunities to improve applicant differentiation, mitigate positive bias, and encourage response consistency. The survey and other analytics identified and confirmed performance domains of high relevance. The revised SLOR assesses four performance domains: knowledge base and clinical skills, stress and time management, interpersonal skills, and personal characteristics. Ratings within the revised SLOR are predominantly criterion-referenced to enhance discernment of candidate attributes contained within each domain. Questions assessing areas of strength and targeted mentoring were replaced with free-text boxes, which allow writers to comment on positive and neutral/negative ratings of attributes within domains. Minor revisions were made to certain questions to enhance readability, streamline responses, or address targeted concerns identified in the SLOR survey or stakeholder review. The revised SLOR was deployed in the 2020 VIRMP; data from a survey of writers (n = 647) and readers (n = 378) indicate that the redesign objectives were achieved.
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Belovich AN, Bahner I, Bonaminio G, Brenneman A, Brooks WS, Chinn C, El-Sawi N, Haight M, Haudek SB, Ikonne U, McAuley RJ, McKell D, Rowe R, Taylor TAH, Vari RC. USMLE Step-1 is Going to Pass/Fail, Now What Do We Do? MEDICAL SCIENCE EDUCATOR 2021; 31:1551-1556. [PMID: 34109056 PMCID: PMC8177252 DOI: 10.1007/s40670-021-01337-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 06/04/2023]
Abstract
The Winter 2021 Webinar Audio Series (WAS) of the International Association of Medical Science Educators (IAMSE), titled, "USMLE Step-1 is Going to Pass/Fail, Now what do we do?" was broadcast live to audiences at academic institutions worldwide in five weekly webinars from January 7, 2021, to February 4, 2021. Recognized experts from various stakeholder groups discussed the impact of the decision to score the United States Medical Licensing Examination (USMLE) Step 1 exam Pass/Fail (P/F). The speakers identified challenges to their respective programs and explored creative ways to address potential consequences. Sessions included the perspectives of allopathic and osteopathic residency program directors, basic science faculty, undergraduate medical education curriculum designers, clinical educators, and programs for international medical students matriculating to the United States. On February 25, 2021, a bonus session provided cutting-edge updates from a co-chair of the Coalition for Physician Accountability Undergraduate Medical Education (UME) to Graduate Medical Education (GME) Review Committee (UGRC).
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Affiliation(s)
| | - Ingrid Bahner
- Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | | | | | - William S. Brooks
- University of Alabama at Birmingham School of Medicine, AL Birmingham, USA
| | - Cassie Chinn
- International Association of Medical Science Educators, Huntington, WV USA
| | - Nehad El-Sawi
- Des Moines University Medicine & Health Sciences, Des Moines, IA USA
| | - Michele Haight
- Sam Houston State University College of Medicine, Huntsville, TX USA
| | | | - Uzoma Ikonne
- Eastern Virginia Medical School, Norfolk, VA USA
| | - Robert J. McAuley
- Oakland University William Beaumont School of Medicine, MI Auburn Hills, USA
| | | | - Rebecca Rowe
- University of New England College of Osteopathic Medicine, Biddeford, ME USA
| | - Tracey A. H. Taylor
- Oakland University William Beaumont School of Medicine, MI Auburn Hills, USA
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Medical Student Mobilization During a Pandemic: The Ochsner Clinical School Response to COVID-19. Ochsner J 2020; 20:146-150. [PMID: 32612468 PMCID: PMC7310173 DOI: 10.31486/toj.20.0069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Mankowski P, Demsey D, Brown E, Knox A. Resident Behaviours to Prioritize According to Canadian Plastic Surgeons. Plast Surg (Oakv) 2020; 28:148-155. [PMID: 32879870 DOI: 10.1177/2292550320903424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Many articles have been published outlining the resident selection process for plastic surgery training programs. However, which qualities Canadian plastic surgeons value most in their current residents remains unclear. A national survey study was conducted to identify which attributes surgeons associate with the highest resident performance and which behaviours trainees should prioritize during their training. Methods A literature review was performed to identify studies that documented attributes valued in plastic surgery applicants and characteristics of high-performing surgical residents. These qualities were extracted to construct a survey consisting of both ranking and open-ended questions. After an iterative review process, the survey was disseminated nationally to consultants and trainees of Canadian plastic surgery training programs. Results Survey responses were obtained from 120 invitees and a weighted rank was calculated for each evaluated attribute. The terms integrity, professional, and work ethic were viewed as the most important attributes prized by surgeons. Dishonesty, lack of dependability, and unprofessionalism were viewed as the most concerning behaviours. Additionally, disinterest and arrogance were identified by the open-ended questions as behaviours surgeons would like to see less frequently in their trainees. When compared to surgeons, trainees undervalued the importance of knowledge and the impact of unprofessional behaviour. Conclusions With the multiple roles that a resident must fulfill, understanding which attributes are of the most importance will help focus self-directed learning and development within residency programs. Ultimately, instilling the importance of integrity and professionalism is most highly valued by members of the Canadian plastic surgery community.
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Affiliation(s)
- Peter Mankowski
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Demsey
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erin Brown
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron Knox
- Division of Plastic Surgery, University of Calgary, Alberta, Canada
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Binkley J, Bukoski AD, Doty J, Crane M, Barnes SL, Quick JA. Surgical Simulation: Markers of Proficiency. JOURNAL OF SURGICAL EDUCATION 2019; 76:234-241. [PMID: 29983346 DOI: 10.1016/j.jsurg.2018.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/30/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Surgical simulation has become an integral component of surgical training. Simulation proficiency determination has been traditionally based upon time to completion of various simulated tasks. We aimed to determine objective markers of proficiency in surgical simulation by comparing novel assessments with conventional evaluations of technical skill. DESIGN Categorical general surgery residents completed 10 laparoscopic cholecystectomy modules using a high-fidelity simulator. We recorded and analyzed simulation task times, as well as number of hand movements, instrument path length, instrument acceleration, and participant affective engagement during each simulation. Comparisons were made to Objective Structured Assessment of Technical Skill (OSATS) and Accreditation Council for Graduate Medical Education Milestones, as well as previous laparoscopic experience, duration of laparoscopic cholecystectomies performed by participants, and postgraduate year. Comparisons were also made to Fundamentals of Laparoscopic Surgery task times. Spearman's rho was utilized for comparisons, significance set at >0.50. SETTING University of Missouri, Columbia, Missouri, an academic tertiary care facility. PARTICIPANTS Fourteen categorical general surgery residents (postgraduate year 1-5) were prospectively enrolled. RESULTS One hundred forty simulations were included. The number of hand movements and instrument path lengths strongly correlated with simulation task times (ρ 0.62-0.87, p < 0.0001), FLS task completion times (ρ 0.50-0.53, p < 0.0001), and prior real-world laparoscopic cholecystectomy experience (ρ -0.51 to -0.53, p < 0.0001). No significant correlations were identified between any of the studied markers with Accreditation Council for Graduate Medical Education Milestones, Objective Structured Assessment of Technical Skill evaluations, total previous laparoscopic experience, or postgraduate year level. Neither instrument acceleration nor participant engagement showed significant correlation with any of the conventional markers of real-world or simulation skill proficiency. CONCLUSIONS Simulation proficiency, measured by instrument and hand motion, is more representative of simulation skill than simulation task time, instrument acceleration, or participant engagement.
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Affiliation(s)
- Jana Binkley
- School of Medicine, University of Missouri, Columbia, Missouri
| | - Alex D Bukoski
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, Missouri
| | - Jennifer Doty
- Department of Surgery, University of Missouri, Columbia, Missouri
| | - Megan Crane
- Department of Surgery, University of Missouri, Columbia, Missouri
| | - Stephen L Barnes
- Department of Surgery, University of Missouri, Columbia, Missouri
| | - Jacob A Quick
- Department of Surgery, University of Missouri, Columbia, Missouri.
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Udyavar R, Smink DS, Mullen JT, Kent TS, Green A, Harlow AF, Castillo-Angeles M, Columbus AB, Haider AH. Qualitative Analysis of a Cultural Dexterity Program for Surgeons: Feasible, Impactful, and Necessary. JOURNAL OF SURGICAL EDUCATION 2018; 75:1159-1170. [PMID: 29456075 DOI: 10.1016/j.jsurg.2018.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/19/2017] [Accepted: 01/21/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Ineffective cross-cultural communication contributes to adverse outcomes for minority patients. To address this, the authors developed a novel curriculum for surgical residents built on the principle of cultural dexterity, emphasizing adaptability to clinical and sociocultural circumstances to tailor care to the needs of the individual patient. This study's objective was to evaluate the feasibility, acceptability, and perception of this program upon conclusion of its first year. DESIGN, SETTING, AND PARTICIPANTS The curriculum was implemented at 3 general surgery programs. The flipped classroom model combined independent study via e-learning modules with interactive role-playing sessions. Sessions took place over 1 academic year. Four focus groups were held, each with 6 to 9 participants, to gain feedback on the curriculum. Focus groups were recorded and transcribed, and the data were analyzed using a grounded theory approach. RESULTS Five major themes emerged: (1) Role modeling from senior colleagues is integral in developing communication/interpersonal skills and attitudes toward cultural dexterity. (2) Cultural dexterity is relevant to the provision of high-quality surgical care. (3) Barriers to providing culturally dexterous care exist at the system level. (4) "Buy-in" at all levels of the institution is necessary to implement the principles of cultural dexterity. (5) The shared experience of discussing the challenges and triumphs of caring for a diverse population was engaging and impactful. CONCLUSION Early implementation of the curriculum revealed that the tension between surgical residents' desire to improve their cultural dexterity and systemic/practical obstacles can be resolved. Combining surgically relevant didactic materials with experiential learning activities can change the paradigm of cross-cultural training.
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Affiliation(s)
- Rhea Udyavar
- Department of Surgery, Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, Massachusetts.
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - A Green
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Alyssa F Harlow
- Department of Surgery, Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, Massachusetts
| | - Manuel Castillo-Angeles
- Department of Surgery, Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, Massachusetts
| | - Alexandra B Columbus
- Department of Surgery, Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Adil H Haider
- Department of Surgery, Brigham and Women's Hospital, Center for Surgery and Public Health, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Dinglasan LAV, Scanlon MH. The High-Performing Radiology Residency: A Case Study. Curr Probl Diagn Radiol 2017; 46:373-376. [DOI: 10.1067/j.cpradiol.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/04/2017] [Accepted: 01/12/2017] [Indexed: 11/22/2022]
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McArthur TA, Flug JA, Restauri N. Behavioral Interviewing: Integrating ACGME Competency-Based Questions Into the Radiology Resident Selection Process. Curr Probl Diagn Radiol 2017; 46:91-94. [DOI: 10.1067/j.cpradiol.2016.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/02/2016] [Accepted: 11/08/2016] [Indexed: 11/22/2022]
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Loftus PD, Elder CT, D'Ambrosio T, Langell JT. Addressing challenges of training a new generation of clinician-innovators through an interdisciplinary medical technology design program: Bench-to-Bedside. Clin Transl Med 2015; 4:15. [PMID: 25984273 PMCID: PMC4424228 DOI: 10.1186/s40169-015-0056-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/25/2015] [Indexed: 11/10/2022] Open
Abstract
Graduate medical education has traditionally focused on training future physicians to be outstanding clinicians with basic and clinical science research skills. This focus has resulted in substantial knowledge gains, but a modest return on investment based on direct improvements in clinical care. In today's shifting healthcare landscape, a number of important challenges must be overcome to not only improve the delivery of healthcare, but to prepare future physicians to think outside the box, focus on and create healthcare innovations, and navigate the complex legal, business and regulatory hurdles of bringing innovation to the bedside. We created an interdisciplinary and experiential medical technology design competition to address these challenges and train medical students interested in moving new and innovative clinical solutions to the forefront of medicine. Medical students were partnered with business, law, design and engineering students to form interdisciplinary teams focused on developing solutions to unmet clinical needs. Over the course of six months teams were provided access to clinical and industry mentors, $500 prototyping funds, development facilities, and non-mandatory didactic lectures in ideation, design, intellectual property, FDA regulatory requirements, prototyping, market analysis, business plan development and capital acquisition. After four years of implementation, the program has supported 396 participants, seen the development of 91 novel medical devices, and launched the formation of 24 new companies. From our perspective, medical education programs that develop innovation training programs and shift incentives from purely traditional basic and clinical science research to also include high-risk innovation will see increased student engagement in improving healthcare delivery and an increase in the quality and quantity of innovative solutions to medical problems being brought to market.
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Affiliation(s)
- Patrick D Loftus
- Center for Medical Innovation, University of Utah, 10 North 1900 East, Spencer S. Eccles Health Sciences Library Room 15, Salt Lake City, Utah 84132 USA
| | - Craig T Elder
- Center for Medical Innovation, University of Utah, 10 North 1900 East, Spencer S. Eccles Health Sciences Library Room 15, Salt Lake City, Utah 84132 USA
| | - Troy D'Ambrosio
- Lassonde Entrepreneur Institute, University of Utah, 105 Fort Douglas, Bldg. #604, Salt Lake City, Utah 84113 USA
| | - John T Langell
- Center for Medical Innovation, University of Utah, 10 North 1900 East, Spencer S. Eccles Health Sciences Library Room 15, Salt Lake City, Utah 84132 USA
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