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Moreira DC, Garrido C, Rosado R, Girón V, Letona T, Morales G, Valverde P, Velásquez T, Alfaro J, Orellana E, Ortega MA, Salguero P, Fox Irwin L, Andujar A, de Alarcón PA, Luna-Fineman S, Manco-Johnson M, Conter V, Verna M, Canesi M, Massimino M, Spreafico F, Ferrari A, Gassant PY, Vásquez R, Friedrich P, Mack R, Ribeiro R, Metzger ML, Rodriguez-Galindo C, Antillón-Klussmann F. Impact of a Regional Pediatric Hematology/Oncology Fellowship Program in Guatemala. JCO Glob Oncol 2024; 10:e2300474. [PMID: 38870436 DOI: 10.1200/go.23.00474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/12/2024] [Accepted: 04/11/2024] [Indexed: 06/15/2024] Open
Abstract
PURPOSE This study aimed to describe and assess the regional experience of a pediatric hematology/oncology fellowship program based in Guatemala. METHODS The Unidad Nacional de Oncología Pediátrica (UNOP) in Guatemala City, Guatemala, is the only hospital in Central America dedicated exclusively to childhood and adolescent cancer. To address the regional need for specialists, a fellowship program in pediatric hematology/oncology was launched in 2003. The UNOP fellowship program comprises 3 years of training. Although the program is based at UNOP, it also includes rotations locally and internationally to enhance clinical exposure. The curriculum is based on international standards to cover clinical expertise, research, professionalism, communication, and health advocacy. Trainees are selected according to country or facility-level need for pediatric hematologists/oncologists, with a plan for them to be hired immediately after completing their training. RESULTS Forty physicians from 10 countries in Latin America have completed training. In addition, there are currently 13 fellows from five countries in training. Of the graduates, 39 (98%) are now practicing in pediatric hematology/oncology in Latin America. Moreover, many of them have leadership positions within their institutions and participate in research, advocacy, and policy making. Graduates from the UNOP program contribute to institutions by providing care for an increasing number of patients with pediatric cancer. The UNOP program is the first pediatric hematology/oncology fellowship program in the world to be accredited by Accreditation Council for Graduate Medical Education-International, an international body accrediting clinical training programs. CONCLUSION The UNOP program has trained specialists to increase the available care for children with cancer in Latin America. This regional approach to specialist training can maximize resources and serve as a model for other programs and regions.
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Affiliation(s)
| | - Claudia Garrido
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Roy Rosado
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Verónica Girón
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Tomás Letona
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Gerson Morales
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | - Thelma Velásquez
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Jeanine Alfaro
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | - Elizabeth Orellana
- Laboratorio de Patología Dra. Elizabeth Orellana, Guatemala City, Guatemala
| | | | - Paola Salguero
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | | | | | - Sandra Luna-Fineman
- Children's Hospital Colorado, School of Medicine, University of Colorado, Aurora, IL
| | - Marilyn Manco-Johnson
- Pediatric Hematology/Oncology/SCT, University of Colorado Anschutz Medical Center, Aurora, IL
| | - Valentino Conter
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Center, Aurora, IL
| | - Marta Verna
- Tettamanti Center, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Marta Canesi
- Tettamanti Center, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Maura Massimino
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Andrea Ferrari
- Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | | | | | - Ricardo Mack
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Raul Ribeiro
- St Jude Children's Research Hospital, Memphis, TN
| | | | | | - Federico Antillón-Klussmann
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
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Ibrahim H, Mohamad MK, Elhag SA, Al-Habbal K, Harhara T, Shehadeh M, Oyoun Alsoud L, Abdel-Razig S. Components of effective letters of recommendation: A cross-sectional survey of academic faculty. PLoS One 2024; 19:e0296637. [PMID: 38261586 PMCID: PMC10805295 DOI: 10.1371/journal.pone.0296637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Conventional merit-based criteria, including standardized test scores and grade point averages, have become less available to residency programs to help distinguish applicants, making other components of the application, including letters of recommendation (LORs), important surrogate markers for performance. Despite their impact on applications, there is limited published data on LORs in the international setting. METHODS A cross-sectional survey of academic faculty was conducted between 9 January 2023 and 12 March 2023 at two large academic medical centers in the United Arab Emirates. Descriptive statistics were used to tabulate variable frequencies. RESULTS Of the 98 respondents, the majority were male (n = 67; 68.4%), Western-trained (n = 66; 67.3%), mid-career physicians (n = 46; 46.9%). Most respondents (n = 77; 78.6%) believed that the purpose of an LOR was to help an applicant match into their desired program. Letters rarely included important skills, such as leadership (n = 37; 37.8%), applicant involvement in research (n = 43; 43.9%), education (n = 38; 38.8%), or patient advocacy (n = 30; 30.6%). Most faculty (n = 81; 82.7%) were not familiar with standardized letters of recommendation. Only 7.3% (n = 7) of respondents previously received training in writing LORs, but 87.7% (n = 86) expressed an interest in this professional development opportunity. CONCLUSION There is variability in perceptions and practices related to LOR writing in our international setting, with several areas for improvement. Given the increasing importance of LORs to a candidate's application, faculty development is necessary.
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Affiliation(s)
- Halah Ibrahim
- Department of Medical Science, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | - Mohamad Kasem Mohamad
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Shahad Abasaeed Elhag
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Khairat Al-Habbal
- Department of Medical Science, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | - Thana Harhara
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Mustafa Shehadeh
- Department of Medical Science, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | - Leen Oyoun Alsoud
- Department of Medical Science, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | - Sawsan Abdel-Razig
- Department of Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Coria AL, Hassan A, Huang JY, Genadry KC, Kumar RK, Sergios A, Marshall RE, Russ CM. Consistency and quality in written accreditation protocols for pediatrician training programs: a mixed-methods analysis of a global sample, and directions for improvement. HUMAN RESOURCES FOR HEALTH 2023; 21:65. [PMID: 37592365 PMCID: PMC10433606 DOI: 10.1186/s12960-023-00852-2] [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: 11/14/2022] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND The World Federation for Medical Education (WFME) defines accreditation as 'certification of the suitability of medical education programs, and of…competence…in the delivery of medical education.' Accreditation bodies function at national, regional and global levels. In 2015, WFME published quality standards for accreditation of postgraduate medical education (PGME). We compared accreditation of pediatric PGME programs to these standards to understand variability in accreditation and areas for improvement. METHODS We examined 19 accreditation protocols representing all country income levels and world regions. For each, two raters assessed 36 WFME-defined accreditation sub-areas as present, partially present, or absent. When rating "partially present" or "absent", raters noted the rationale for the rating. Using an inductive approach, authors qualitatively analyzed notes, generating themes in reasons for divergence from the benchmark. RESULTS A median of 56% (IQR 43-77%) of WFME sub-areas were present in individual protocols; 22% (IQR 15-39%) were partially present; and 8.3% (IQR 5.5-21%) were absent. Inter-rater agreement was 74% (SD 11%). Sub-areas least addressed included number of trainees, educational expertise, and performance of qualified doctors. Qualitative themes of divergence included (1) variation in protocols related to heterogeneity in program structure; (2) limited engagement with stakeholders, especially regarding educational outcomes and community/health system needs; (3) a trainee-centered approach, including equity considerations, was not universal; and (4) less emphasis on quality of education, particularly faculty development in teaching. CONCLUSIONS Heterogeneity in accreditation can be appropriate, considering cultural or regulatory context. However, we identified broadly applicable areas for improvement: ensuring equitable access to training, taking a trainee-centered approach, emphasizing quality of teaching, and ensuring diverse stakeholder feedback.
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Affiliation(s)
- Alexandra L Coria
- SUNY Downstate College of Medicine, 450 Clarkson Ave Suite J, Brooklyn, NY, 11203, USA.
- Department of Population Health, Maimonides Medical Center and Division of Hospital Medicine, Maimonides Children's Hospital, 4802 10th Ave, Brooklyn, NY, 11219, USA.
| | - Areej Hassan
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Jui-Yen Huang
- Division of Adolescent Medicine, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City, 80756, Taiwan, ROC
| | - Katia C Genadry
- Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Rashmi K Kumar
- University of Nairobi, P.O Box 30197, GPO, Nairobi, Kenya
- Kenyatta National Hospital, P.O Box 20723-00202, Nairobi, Kenya
| | - Ayten Sergios
- SUNY Downstate College of Medicine, 450 Clarkson Ave Suite J, Brooklyn, NY, 11203, USA
| | - Roseda E Marshall
- AM Dogliotti College of Medicine, Capitol Hill, P.O Box 10-9020, 1000, Monrovia 10, West Africa, Liberia
| | - Christiana M Russ
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Intermediate Care Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
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Ibrahim H, Elhag SA, Elnour SM, Abdel-Razig S, Harhara T, Nair SC. Medical Resident Awareness of Predatory Journal Practices in an International Medical Education System. MEDICAL EDUCATION ONLINE 2022; 27:2139169. [PMID: 36268934 PMCID: PMC9590432 DOI: 10.1080/10872981.2022.2139169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/25/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Learning research methodology is increasingly becoming an essential part of graduate medical education worldwide, with many regulatory and accreditation bodies requiring residents to participate in scholarship. Research methodology workshops have become a standard part of medical curricula; however, there is limited data on how much training on journal selection and the publication process trainees receive. The alarming growth of predatory journals has made it increasingly difficult for researchers, especially trainees and early career physicians, to distinguish these publications from reputable journals. The purpose of this study is to assess the knowledge of reputable and predatory publishing practices amongst medical trainees in an international medical education setting in the United Arab Emirates. METHODS A survey on credible journal practices based on the 'Think. Check. Submit' initiative was sent to all graduate medical education trainees at two large academic medical centers in Abu Dhabi, United Arab Emirates. Descriptive statistics were used to tabulate variable frequencies. RESULTS Over half of the 160 respondents reported receiving prior research methodology training and 42.5% had at least one publication. The majority of the trainees selected impact factor and the quality of the peer-review process as characteristics of reputable journals. Ambiguous editorial board and rapid publication process were recognized as characteristics of predatory journals by >65% of trainees, however, 95% of all trainees were unaware of Beall's list or other resources to help select a journal for publication. 15.2% of trainees who received unsolicited emails from publishers submitted their manuscripts to the unfamiliar journals, citing peer recommendation and pressure to publish from their training programs as reasons. CONCLUSION Trainees in the United Arab Emirates were mostly unaware of reputable publication practices and are vulnerable to publishing in predatory journals. Policy and educational reform are necessary to maintain the credibility and integrity of the scientific process.
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Affiliation(s)
- Halah Ibrahim
- Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | | | - Salma M Elnour
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | | | - Thana Harhara
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Dutta D, Stadler DJ, Cofrancesco J, Archuleta S, Ibrahim H. "I Find It Quite a Privilege to Be Involved in Their Lives": A Multinational Qualitative Study of Program Directors' Perspectives on Their Relationships with Residents. TEACHING AND LEARNING IN MEDICINE 2022; 34:473-480. [PMID: 34839762 DOI: 10.1080/10401334.2021.1997749] [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: 02/02/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
PHENOMENON Program director (PD)-resident relationships are important in shaping resident experiences and educational outcomes. Yet, there is limited literature on the development or meaning of these relationships, particularly from the PD perspective. Through qualitative interviews, we explore how PDs navigate their role to develop and maintain relationships with their trainees, and elucidate how these relationships impact the PDs personally and professionally. APPROACH Qualitative study using individual semi-structured interviews of former and current PDs (n = 33) from multiple specialties and hospitals in accredited residency programs in Qatar, Singapore, and the United Arab Emirates. We used attachment theory and narrative analysis to investigate how PDs perceive and describe relationship building with their residents amidst tensions of familiarizing themselves with their new role. FINDINGS PD-resident relationships are complex and multidimensional, shifting over time, changing patterns and evolving to respond to different contexts. PDs initially negotiate their own roles, while navigating their relationships with residents and other stakeholders to create their professional identities. PDs develop professional alliances, defining for the resident the profession and its expectations. As residents negotiate the various challenges of their training, the role of the PD emerges into one of providing emotional support and advocacy. The support and attachment are often enduring and extend beyond the period of residency training. INSIGHTS Our study examines the experiences of program directors as they negotiate complex educator-learner relationships. The PDs described roles that extended beyond their job description. Although all interviewees reported that the PD position was challenging, they focused on the rewarding aspects of the job and how their relationships helped sustain them through the difficulties. Through their reflections, the PDs described the personal satisfaction and benefits of their interactions with the residents, and how the engagement contributed to personal and professional success.
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Affiliation(s)
- Debalina Dutta
- School of Communication, Journalism and Marketing, Massey University, Palmerston North, New Zealand
| | - Dora J Stadler
- Department of Medicine, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
- Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Joseph Cofrancesco
- Johns Hopkins University School of Medicine Institute for Excellence in Education and Department of Medicine, Baltimore, Maryland, USA
| | - Sophia Archuleta
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Halah Ibrahim
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Internal medicine residents' perceptions and experiences in palliative care: a qualitative study in the United Arab Emirates. BMC Palliat Care 2022; 21:15. [PMID: 35105361 PMCID: PMC8809043 DOI: 10.1186/s12904-022-00908-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Palliative medicine is a newly developing field in the United Arab Emirates (UAE). The purpose of this study was to gain a deeper understanding of the experiences of internal medicine residents providing end-of-life care to patients and their families, and how those experiences shape their learning needs. Method Nine focus groups were conducted with internal medicine residents and recent graduates from two large academic health centers in the UAE between 2019 and 2020. Through an iterative process, data were collected and examined using constant comparison to identify themes and explore their relationships. Results Fifty-two residents and graduates participated. Residents frequently care for terminally ill patients and their families, but lack confidence in their skills and request more structured education and training. Cultural and system related factors also impact palliative care education and patient care. Five main themes and associated subthemes were identified: (1) clinical management of palliative patients, (2) patient and family communication skills, (3) religion, (4) barriers to end-of-life education, and (5) emotional impact of managing dying patients. Conclusion Our findings can help guide program development and curricular changes for internal medicine residents in the region. Structured education in end-of-life care, with a focus on fostering culturally sensitive communication skills and spirituality, can improve resident education and patient care. Clear and transparent policies at the institution level are necessary. Programs are also needed to assist residents in developing effective coping strategies and emotionally navigating experiences with patient death. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00908-5.
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Dutta D, Ibrahim H, Stadler DJ, Cofrancesco J, Nair SC, Archuleta S. International Residency Program Directors on Implementing Educational Transformation: A Qualitative Study of Their Experiences and Strategies for Overcoming Challenges. J Grad Med Educ 2021; 13:526-533. [PMID: 34434513 PMCID: PMC8370373 DOI: 10.4300/jgme-d-21-00050.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Residency program directors (PDs) need to navigate diverse roles and responsibilities as clinical teachers, administrators, and drivers of educational improvement. Little is known about the experience of PDs leading transformation of international residency programs. OBJECTIVE We explored the lived experiences of international residency PDs and developed an understanding of how PDs manage educational program transformation. METHODS Using a phenomenological approach, semi-structured interviews were conducted with current and former PDs involved in the transformation to competency-based medical education in the first international settings to be accredited by the Accreditation Council for Graduate Medical Education-International (ACGME-I). Thirty-three interviews with PDs from Qatar, Singapore, and the United Arab Emirates were conducted from September 2018 to July 2019, audio-recorded, and transcribed. Data were independently coded by 2 researchers. A thematic analysis was conducted and patterns that reflected coping and managing educational reform were identified. RESULTS PDs described distinctive patterns of navigating the educational transformation. Five themes emerged: PDs (1) embraced continuous learning and self-development; (2) managed change in the context of their local settings; (3) anticipated problems and built support networks to effectively problem-solve; (4) maintained relationships with stakeholders for meaningful and constructive interactions; and (5) focused on intrinsic qualities that helped them navigate challenges. CONCLUSIONS International PDs were presented with significant challenges in implementing educational transformation but coped successfully through distinctive patterns and methods.
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Affiliation(s)
- Debalina Dutta
- Debalina Dutta, PhD, is Senior Lecturer, School of Communication, Journalism and Marketing, Massey University, Palmerston North, New Zealand
| | - Halah Ibrahim
- Halah Ibrahim, MD, MEHP, is Internal Medicine Consultant, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates, and Adjunct Assistant Professor of Medicine, Johns Hopkins University School of Medicine
| | - Dora J. Stadler
- Dora J. Stadler, MD, is Clinical Assistant Professor of Medicine, Weill Cornell Medicine-Qatar, Education City, Qatar
| | - Joseph Cofrancesco
- Joseph Cofrancesco Jr, MD, MPH, is Professor of Medicine, and Director, Johns Hopkins University School of Medicine Institute for Excellence in Education
| | - Satish Chandrasekhar Nair
- Satish Chandrasekhar Nair, MBBCh, PhD, is Director of Clinical Research, Department of Academic Affairs, Tawam Hospital, Al Ain, United Arab Emirates
| | - Sophia Archuleta
- Sophia Archuleta, MD, is Associate Professor, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, and Head, Division of Infectious Diseases, National University Health System, Singapore
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Ibrahim H, Abdel-Razig S. Recalibrating our efforts: from globalisation to glocalisation of medical education. Postgrad Med J 2021; 97:545-546. [PMID: 33541922 DOI: 10.1136/postgradmedj-2020-139579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Halah Ibrahim
- Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, UAE .,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sawsan Abdel-Razig
- Department of Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.,Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Stadler DJ, Ibrahim H, Dutta D, Cofrancesco J, Archuleta S. Program Director Retention and Attrition Rates in International Graduate Medical Education. J Grad Med Educ 2020; 12:624-627. [PMID: 33149834 PMCID: PMC7594778 DOI: 10.4300/jgme-d-20-00014.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/28/2020] [Accepted: 06/29/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Program directors (PDs) are integral to the education of the next generation of physicians. Yet, administrative burdens, substantial patient care responsibilities, and lack of protected time for teaching may contribute to work-life imbalance and physician burnout, leading to high rates of attrition. Data on international residency program leadership turnover are lacking. OBJECTIVE This study aimed to quantify PD turnover in Accreditation Council for Graduate Medical Education-International (ACGME-I) accredited programs in Singapore, United Arab Emirates (UAE), and Qatar, and to compare to US PD attrition rates. METHODS Data on PD turnover in international programs was extracted from the ACGME-I Accreditation Data System for academic years 2010-2011 through 2018-2019 for Singapore and 2013-2014 through 2018-2019 for UAE and Qatar. Rates of PD turnover were calculated by country and by ACGME-I medical-, surgical-, and hospital-based specialty groupings and compared using χ2 test. Annual US PD turnover data was extracted from the ACGME's Data Resource Book. RESULTS Seventy programs met inclusion criteria. International PD attrition was high, with 56 programs (80%) changing PDs since program inception, and 16 programs (29%) having 2 or more PD turnovers. There was no significant difference between PD turnover rates in hospital (83%), medical (79%), or surgical (78%) specialties. International PD attrition rates varied from 7% to 20% annually and were comparable to PD turnover in US programs (range 12%-15%). CONCLUSIONS High PD turnover rates in newly accredited international residency programs were noted, although annual attrition rates were comparable to US residency programs.
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Hammad N, Stockley D, Hastings-Truelove A, Vanderpuye V, Rubagumya F, Caruso T. Accreditation Improves Quality of Oncology Education in Low- and Middle-Income Countries: Perspectives of African Oncologists. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:563-570. [PMID: 30806905 DOI: 10.1007/s13187-019-01497-3] [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: 06/09/2023]
Abstract
The purpose of this study is to understand the perspectives of African Oncologists on the role of accreditation and on global standards. We developed a survey that addressed African oncologists' opinions on the role of accreditation. The survey also included 187 standards from World Federation of Medical Education Postgraduate medical education (PGME) standards, American Council of Graduate Medical Education (ACGME)-I standards for hematology/oncology, and the Royal College of Physician and Surgeons of Canada Medical Oncology standards. A 3-point scale was employed for each standard: 1 = not important, 2 = important but not essential, 3 = essential. The survey was sent to 79 physicians, 38 responded. Eighty-seven percent agreed that accreditation ensures quality. Forty-five percent agreed it will not increase migration of qualified doctors. Twenty-two individuals who completed the entire survey were analyzed for the standards. Five standards received the highest ratings of 3 (essential) from all respondents. One standard received a rating of < 2.0. The majority of standards had ratings between 2.6 and 2.94 indicating African oncologists found most standards to be useful. Ratings < 2.6 were mostly related to resource constraints. Most African Oncologists believed that accreditation ensures quality of education, and most standards were considered important. This data is useful for developing and adapting accreditation standards in resource-constrained settings.
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Affiliation(s)
- Nazik Hammad
- Department of Oncology, Queen's University, Kingston, Canada.
- Cancer Centre of Southeastern Ontario, Queen's University, 25 King Street W, Kingston, ON, K7L 5P9, Canada.
| | - Denise Stockley
- Faculty of Health Sciences and Faculty of Education, Queen's University, Kingston, Canada
| | | | | | - Fidel Rubagumya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Thomas Caruso
- Departments of Graduate Medical Education and of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA
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Jones CA, Watkins FS, Williams J, Lambros A, Callahan KE, Lawlor J, Williamson JD, High KP, Atkinson HH. A 360-degree assessment of teaching effectiveness using a structured-videorecorded observed teaching exercise for faculty development. MEDICAL EDUCATION ONLINE 2019; 24:1596708. [PMID: 30973089 PMCID: PMC8870659 DOI: 10.1080/10872981.2019.1596708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Filming teaching sessions were reported in the medical literature in the 1980s and 1990s but appear to have been an underreported and/or underutilized teaching tool since that time. National faculty development programs, such as the Harvard Macy Institute (HMI) Program for Educators in Health Professions and the Stanford Faculty Development Center for Medical Teachers program, have attempted to bridge this gap in formal instruction in teaching skills through microteaching sessions involving videos for self- and peer-assessment and feedback. OBJECTIVE Current video-feedback faculty development initiatives are time intensive and impractical to implement broadly at an institutional level. Further, results of peer feedback have not been frequently reported in the literature at the institutional level. Our research aims to propose a convenient and effective process for incorporating video analysis into faculty devleopment programs. DESIGN Our work describes a novel technique using video-recorded, simulated teaching exercises to compile multi-dimensional feedback as an aid in faculty development programs that promote teaching-skill development. This research evaluated the effectiveness of a focused teaching practicum designed for faculty in multiple specialty departments with large numbers of older patients into a geriatrics-based faculty development program. Effectiveness of the practicum is evaluated using quantitative scoring and qualitative analysis of self-reflection as well as peer and trainee input. RESULTS VOTE sessions demonstrate an important exportable product which enable faculty to receive a detailed 360-degree assessment of their teaching. CONCLUSION This intervention can be easily replicated and revised, as needed, to fit into the educational curriculum at other academic medical centers.
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Affiliation(s)
- Christopher A. Jones
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Franklin S. Watkins
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Ann Lambros
- Health and Exercise Science, Wake Forest University, Winston Salem, NC, USA
| | - Kathryn E. Callahan
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Janice Lawlor
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeff D. Williamson
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kevin P. High
- Department of Internal Medicine, Section on Infectious Diseases, Vice President Health System Affairs, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hal H. Atkinson
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Stadler DJ, Archuleta S, Cofrancesco J, Ibrahim H. Successful International Medical Education Research Collaboration. J Grad Med Educ 2019; 11:187-189. [PMID: 31428279 PMCID: PMC6697287 DOI: 10.4300/jgme-d-18-01061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Lindeman B, Ibrahim H, Stadler D, Archuleta S, Cofrancesco J. Characterization and Perceptions of Surgical Clinician Educators: An International Survey. JOURNAL OF SURGICAL EDUCATION 2018; 75:1513-1519. [PMID: 29935924 DOI: 10.1016/j.jsurg.2018.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/01/2018] [Accepted: 05/16/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Surgeons worldwide face unique time and practice pressures differentiating them from other types of physicians, specifically as clinician educators (CEs). The purpose of this study is to identify and describe academic surgical clinician educators (SCEs) in international graduate medical education systems, characterize their perceptions of roles, preparedness, and factors affecting job satisfaction and retention, as compared to nonsurgical international CEs. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional survey of CEs was conducted June 2013-June 2014 at academic medical centers in Singapore, Qatar, and the United Arab Emirates that adopted competency-based graduate medical education and received accreditation by the Accreditation Council for Graduate Medical Education-International. RESULTS Two hundred seventy-six (76.3%) of 359 eligible physicians responded; 64 (23.2%) were SCEs. SCEs were predominantly male (80%), less than 50 years of age (83%), with 64% having been in their current position less than 5 years. Overall, SCEs were significantly less confident, as compared to nonsurgical CEs, in aspects of educational programs, including curriculum development, assessment, and mentorship. SCEs spent significantly more time engaged in patient care activities, as compared to nonsurgeon colleagues. There were no significant differences between SCEs and nonsurgical CEs in terms of work-life balance and satisfaction with responsibilities, position, or potential promotion, with most SCEs intending to stay in academic medicine. CONCLUSIONS Academic SCEs working in the international programs reported overall job satisfaction with a desire to remain in academic medicine. However, SCEs have several faculty development needs. International surgical training programs can develop and expand offerings in teaching and education to improve skills and maintain SCE satisfaction and retention, necessary to successfully train the next generation of surgeons.
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Affiliation(s)
| | - Halah Ibrahim
- Johns Hopkins Graduate School of Education, Baltimore, Maryland.
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Abdulrahman M, Nair SC, Farooq MM, Al Kharmiri A, Al Marzooqi F, Carrick FR. Burnout and depression among medical residents in the United Arab Emirates: A Multicenter study. J Family Med Prim Care 2018; 7:435-441. [PMID: 30090790 PMCID: PMC6060937 DOI: 10.4103/jfmpc.jfmpc_199_17] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Persistent imbalance between work demands and resources seems to be a crucial contributor to the development of burnout among medical professionals. Yet, it seems that Middle East is lacking studies analyzing psychological well-being's of medical residents. Hence, we aimed to conduct a nationwide study to understand and address burnout and depression in medical residents in the UAE. Methods: A multicenter, cross-sectional study was designed to evaluate professional burnout and depression among medical residents to address the gap. Results: Our results indicate that 75.5% (216/286) of UAE medical residents had moderate-to-high emotional exhaustion (EE), 84% (249/298) had high depersonalization (DP), and 74% (216/291) had a low sense of personal accomplishment. In aggregate, 70% (212/302) of medical residents were considered to be experiencing at least one symptom of burnout based on a high EE score or a high DP score. Depression ranging from 6% to 22%, depending on the specialty was also noted. Noticeably, 83% (40/48) of medical residents who had high scores for depression also reported burnout. Conclusions: This study shows that burnout and depression are high among medical residents in UAE. There is a crucial need to address burnout through effective interventions at both the individual and institutional levels. Professional counseling services for residents will certainly be a step forward to manage resident burnout provided the social stigma associated with counseling can be eliminated with awareness. The work hour regulations suggested by the Accreditation Council for Graduate Medical Education partly provides a solution to improve patient safety and care quality. There is an urge to reconfigure the approach to medical training for the well-being of the next generation of physicians in the Arab world.
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Affiliation(s)
- Mahera Abdulrahman
- Department of Medical Education, Dubai Health Authority, Dubai Medical College, Dubai, United Arab Emirates.,Department of Primary Health Care, Dubai Medical College, Dubai, United Arab Emirates
| | - Satish Chandrasekhar Nair
- Department of Academic Affairs, Tawam Hospital-Johns Hopkins Medicine International Affiliate, College of Medicine, UAE University, Al Ain, United Arab Emirates
| | | | - Aisha Al Kharmiri
- Department of Academic Affairs, Tawam Hospital, College of Medicine, UAE University, Al Ain, United Arab Emirates
| | - Farida Al Marzooqi
- Department of Academic Affairs, Tawam Hospital, College of Medicine, UAE University, Al Ain, United Arab Emirates
| | - Frederick Robert Carrick
- Bedfordshire Centre for Mental Health Research in Association with University of Cambridge, Cambridge, UK,Department of Neurology, Carrick Institute, Cape Canaveral, FL, USA,Department of Medical Education, Harvard Macy and MGH Institutes, Boston, MA, USA
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dos Santos RA, Snell L, Tenorio Nunes MDP. The link between quality and accreditation of residency programs: the surveyors' perceptions. MEDICAL EDUCATION ONLINE 2017; 22:1270093. [PMID: 28178919 PMCID: PMC5328332 DOI: 10.1080/10872981.2016.1270093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/22/2016] [Accepted: 11/27/2016] [Indexed: 05/29/2023]
Abstract
UNLABELLED Accreditation of medical residency programs has become globally important. Currently it is moving from the goal of attaining minimal standards to a model of continuous improvement. In some countries, the accreditation system engages peers (physicians) to survey residency programs. The surveyors are sometimes volunteers, usually engaged in multiple clinical and education activities. Few studies have investigated the benefits of residency program evaluation and accreditation from the perspective of the surveyors. As peers they both conduct and receive accreditation surveys, which puts them in a privileged position in that it provides the surveyor with an opportunity to share experiences and knowledge and apply what is learned in their own context. The objective of this study is to obtain the perceptions of these surveyors about the impact of an accreditation system on residency programs. Surveyors participated in semi-structured interviews. A thematic analysis was performed on the interview data, and resulting topics were grouped into five themes: Burden (of documentation and of time needed); Efficiency and efficacy of the accreditation process; Training and experience of surveyors; Being a peer; Professional skills and recognition of surveyors. These categories were organized into two major themes: 'Structure and Process' and 'Human Resources'. The study participants proposed ways to improve efficiency including diminish the burden of documentation to the physicians involved in the process and to increase efforts on training programs and payment for surveyors and program directors. Based on the results we propose a conceptual framework to improve accreditation systems. ABBREVIATIONS PD: Program director.
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Affiliation(s)
- Renato Antunes dos Santos
- Department of Education and Health, Faculty of Medicine, University of São Paulo (USP), São Paulo, Brazil
- Mental Health Unit, University Hospital of Brasília, University of Brasília (UnB), Brasília, Brazil
| | - Linda Snell
- McGill’s Centre for Medical Education, Montreal, QC, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
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