1
|
Jayas A, Sachdeva AK, Delman KA, Kabaker AS, Blair PG, Overton R, Grbic D, Andriole DA. Piloting a National Curricular Resource for the Transition to Surgical Residency: Characteristics of Participating Schools and Their Students. JOURNAL OF SURGICAL EDUCATION 2024; 81:344-352. [PMID: 38286724 DOI: 10.1016/j.jsurg.2023.12.007] [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: 10/13/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/31/2024]
Abstract
OBJECTIVE To determine the extent to which U.S. Liaison Committee of Medical Education (LCME)-accredited medical schools chose to participate in piloting a national curricular resource, the American College of Surgeons/Association of Program Directors in Surgery/Association of Surgical Education Resident Prep Curriculum ("ACS-surgery-prep curriculum"), and implications of such participation for student access nationally to this resource. DESIGN We examined the significance of school-level differences in ACS-surgery-prep curriculum pilot participation and student-level differences in curriculum access based on medical school attended in bivariate analysis. SETTING U.S. medical schools choosing to participate in the ACS-surgery-prep curriculum through 2021. Students graduating from U.S. LCME-accredited medical schools in 2020-2021 were invited to complete the Association of American Medical Colleges 2021 Graduation Questionnaire (GQ). PARTICIPANTS Our study included data for 2569 students intending surgery specialties (16% of 16,353 2021 GQ respondents) from ACS-surgery-prep curriculum pilot and non-pilot schools. RESULTS Of 148 medical schools attended by 2021 GQ respondents, 93 (63%) were identified as ACS-surgery-prep curriculum pilot schools. Pilot participation varied by school region, community-based designation, and research intensity (each p < 0.05) but not by ownership or transition to residency (TTR) course requirements (each p > 0.05). Of 2569 GQ respondents nationally intending surgery specialties, 1697 (66%) attended an ACS-surgery-prep curriculum pilot school; this proportion did not vary by gender or race/ethnicity (each p > 0.05) but varied by students' school TTR course requirements (p < 0.001). Findings were similar among the 1059 students intending general surgery specialties specifically (41% of all 2569 students intending surgery specialties). CONCLUSIONS Many U.S. LCME-accredited medical schools piloted this national TTR surgery curriculum. School-level characteristics associated with pilot participation can inform outreach efforts to encourage the participation of interested schools in piloting this TTR resource. With this curriculum distribution model, we observed no gender or racial/ethnic disparities in curriculum access nationally among students intending surgery specialties.
Collapse
Affiliation(s)
- Amy Jayas
- Association of American Medical Colleges, Washington, District of Columbia.
| | - Ajit K Sachdeva
- American College of Surgeons, Division of Education, Chicago, Illinois
| | - Keith A Delman
- Grady Memorial Hospital and Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Renee Overton
- Association of American Medical Colleges, Washington, District of Columbia
| | - Douglas Grbic
- Association of American Medical Colleges, Washington, District of Columbia
| | - Dorothy A Andriole
- Association of American Medical Colleges, Washington, District of Columbia
| |
Collapse
|
2
|
Park YS, Ryan MS, Hogan SO, Berg K, Eickmeyer A, Fancher TL, Farnan J, Lawson L, Turner L, Westervelt M, Holmboe E, Santen SA. Transition to Residency: National Study of Factors Contributing to Variability in Learner Milestones Ratings in Emergency Medicine and Family Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S123-S132. [PMID: 37983405 DOI: 10.1097/acm.0000000000005366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE The developmental trajectory of learning during residency may be attributed to multiple factors, including variation in individual trainee performance, program-level factors, graduating medical school effects, and the learning environment. Understanding the relationship between medical school and learner performance during residency is important in prioritizing undergraduate curricular strategies and educational approaches for effective transition to residency and postgraduate training. This study explores factors contributing to longitudinal and developmental variability in resident Milestones ratings, focusing on variability due to graduating medical school, training program, and learners using national cohort data from emergency medicine (EM) and family medicine (FM). METHOD Data from programs with residents entering training in July 2016 were used (EM: n=1,645 residents, 178 residency programs; FM: n=3,997 residents, 487 residency programs). Descriptive statistics were used to examine data trends. Cross-classified mixed-effects regression were used to decompose variance components in Milestones ratings. RESULTS During postgraduate year (PGY)-1, graduating medical school accounted for 5% and 6% of the variability in Milestones ratings, decreasing to 2% and 5% by PGY-3 for EM and FM, respectively. Residency program accounted for substantial variability during PGY-1 (EM=70%, FM=53%) but decreased during PGY-3 (EM=62%, FM=44%), with greater variability across training period in patient care (PC), medical knowledge (MK), and systems-based practice (SBP). Learner variance increased significantly between PGY-1 (EM=23%, FM=34%) and PGY-3 (EM=34%, FM=44%), with greater variability in practice-based learning and improvement (PBLI), professionalism (PROF), and interpersonal communication skills (ICS). CONCLUSIONS The greatest variance in Milestone ratings can be attributed to the residency program and to a lesser degree, learners, and medical school. The dynamic impact of program-level factors on learners shifts during the first year and across the duration of residency training, highlighting the influence of curricular, instructional, and programmatic factors on resident performance throughout residency.
Collapse
Affiliation(s)
- Yoon Soo Park
- Y.S. Park is head, Department of Medical Education, and The Ilene B. Harris Endowed Professor, University of Illinois College of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-8583-4335
| | - Michael S Ryan
- M.S. Ryan is associate dean for assessment, evaluation, research, and innovation, and professor of pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia; ORCID: https://orcid.org/0000-0003-3266-9289
| | - Sean O Hogan
- S.O. Hogan is director of outcomes research and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois; ORCID: https://orcid.org/0009-0008-9006-1857
| | - Katherine Berg
- K. Berg is associate dean of assessment, director, Rector Clinical Skills and Simulation Center, and professor of medicine, Sydney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Adam Eickmeyer
- A. Eickmeyer is director of medical school education, University of Chicago Pritzker School of Medicine, Chicago, Illinois, and a PhD candidate, Maastricht University School of Health Professions Education, Maastricht, the Netherlands
| | - Tonya L Fancher
- T.L. Fancher is associate dean for workforce innovation and education quality improvement and professor of medicine, University of California, Davis, School of Medicine, Sacramento, California
| | - Jeanne Farnan
- J. Farnan is associate dean for undergraduate medical education and professor of medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Luan Lawson
- L. Lawson is senior associate dean of medical education and student affairs and professor of emergency medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Laurah Turner
- L. Turner is assistant dean for evaluation and assessment and assistant professor of medical education, The University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Marjorie Westervelt
- M. Westervelt is director of educational assessment, scholarship, improvement, and innovation, Office of Medical Education, University of California, Davis, School of Medicine, Sacramento, California
| | - Eric Holmboe
- E. Holmboe is chief, research, milestones development and evaluation officer, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Sally A Santen
- S.A. Santen is senior associate dean, Virginia Commonwealth University, Richmond, Virginia, and professor, emergency medicine and medical education, University of Cincinnati, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-8327-8002
| |
Collapse
|
3
|
Helliwell LA, Hyland CJ, Gonte MR, Malapati SH, Bain PA, Ranganathan K, Pusic AL. Bias in Surgical Residency Evaluations: A Scoping Review. JOURNAL OF SURGICAL EDUCATION 2023; 80:922-947. [PMID: 37142488 DOI: 10.1016/j.jsurg.2023.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/21/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Given widespread disparities in the surgical workforce and the advent of competency-based training models that rely on objective evaluations of resident performance, this review aims to describe the landscape of bias in the evaluation methods of residents in surgical training programs in the United States. DESIGN A scoping review was conducted within PubMed, Embase, Web of Science, and ERIC in May 2022, without a date restriction. Studies were screened and reviewed in duplicate by 3 reviewers. Data were described descriptively. SETTING/PARTICIPANTS English-language studies conducted in the United States that assessed bias in the evaluation of surgical residents were included. RESULTS The search yielded 1641 studies, of which 53 met inclusion criteria. Of the included studies, 26 (49.1%) were retrospective cohort studies, 25 (47.2%) were cross-sectional studies, and 2 (3.8%) were prospective cohort studies. The majority included general surgery residents (n = 30, 56.6%) and nonstandardized examination modalities (n = 38, 71.7%), such as video-based skills evaluations (n = 5, 13.2%). The most common performance metric evaluated was operative skill (n = 22, 41.5%). Overall, the majority of studies demonstrated bias (n = 38, 73.6%) and most investigated gender bias (n = 46, 86.8%). Most studies reported disadvantages for female trainees regarding standardized examinations (80.0%), self-evaluations (73.7%), and program-level evaluations (71.4%). Four studies (7.6%) assessed racial bias, of which all reported disadvantages for trainees underrepresented in surgery. CONCLUSIONS Evaluation methods for surgery residents may be prone to bias, particularly with regard to female trainees. Research is warranted regarding other implicit and explicit biases, such as racial bias, as well as for nongeneral surgery subspecialties.
Collapse
Affiliation(s)
| | | | - Madeleine R Gonte
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Wayne State University School of Medicine, Detroit, Michigan
| | | | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts
| | | | | |
Collapse
|