Predictors of performance on the pediatric board certification examination

MCQs in-training examination scores of the surgical residency program in Thailand: the relationship between medical school vs public health-based training institutions

BACKGROUND

This study aims at investigating and evaluating the categorical knowledge of residency using an internet-based examination.

METHODS

All in-training examinees from 32 Thailand's general surgery residency training institutions participating in the online examination. One hundred fifty Multiple Choice questions (MCQs) were selected for this examination from a pool of previous MCQs used for board certification examinations. Baseline chracteristic of the examinee including residency year, training institution (medical schools and public health-based training institutions), regional-based area of the institution, overall test score, scoring by subcategory, total time to complete the examination, and the length of accredited as a training centre time were collected and analysed.

RESULTS

Total 613 examinees. The mean total score of 1st and 3rd year residency of a public health hospital institution differed from those with medical school-based training. On average, the scores in 4 out of 10 categories of residency from medical school training institutions were higher. However, residency from institutions with over 7 years of experience tended to score higher in the Liver, Biliary and Pancreas category.

CONCLUSIONS

The average scores of MCQs exams which reflect the medical knowledge for general surgical residency training at medical schools do not significantly differ from those of individuals undergoing public health training. Additionally, the mean scores of MCQs exams did not differ between high-experience training institutions and recent accredited training centers.

Peer Learning Has Double Effects in Clinical Research Education: A Qualitative Study

Background

Peer learning has been recognized for its effectiveness in health professional education. However, its effects on clinical research education are not clear and were explored qualitatively in this study.

Methods

The peer-learning method was implemented in a clinical research education seminar for early-career physicians at a children's and mothers' hospital in 2019. We conducted semistructured interviews with participants about peer-learning experience and qualitatively analyzed verbatim transcripts using Engeström's "activity theory" framework.

Results

From framework analysis, learning processes were extracted mainly in four domains, namely, (a) instrument and its usage: research design and its match with research question, (b) outcome: research result, (c) community: seminar, and (d) division of labor: roles of participants and staff.

Conclusions

In this report of a peer-learning trial in postgraduate clinical research education, the following two pathways of peer-learning effects were abstracted. The indirect pathway was the presentations by experienced participants providing concrete examples of research processes. The direct pathway was the questions from experienced participants to beginners about specific and concrete questions. There were also two points to consider in peer learning in clinical research education: gaps in premise knowledge and beginners' frustration about expected outcomes. We believe that these extracted pathways and points imply the significance and considerations for continuing the peer-learning trial in clinical research education. Future tasks are to promote clinical research education with a view to the learning effects, not only on individuals, but also on groups.

Association between residents' scholarly activities and publication requirement policy

BACKGROUND

Scholarship is recognized as important in residency training worldwide. The Japan Pediatric Society (JPS) enacted a reform in 2017 to require publication of an article as a prerequisite for taking the board certification test, with the goal of increasing scholarly activity.

METHODS

The purpose of this study was to provide a detailed description of the trends in residents' scholarly activities related to the JPS reform. A secondary analysis was performed on the cross-sectional database of pediatrics residents who took the certification test in 2015-2018.

RESULTS

The enrolled participants were 2399 residents of which 79.7% passed the test. Publication of any type of article increased significantly (21%-22% to 100%; 0.1 to 0.3/person-year) after the implementation of the JPS reform, whereas academic presentations did not (89% to 91%; 1.2 to 1.3/person-year), both in terms of the percentage of the number of those who created them and the average rate of research production. Not only Japanese articles (11%-13% to 49%-53%; 0.04 to 0.15-0.17/person-year) or case reports (10%-14% to 51%-52%; 0.03-0.05 to 0.16-0.17/person-year), but also English articles (4%-5% to 15%-16%; 0.01-0.02 to 0.05/person-year) and original articles (5% to 11%-17%; 0.01 to 0.03-0.05/person-year) increased significantly. The number of each type of article publication was correlated with success in the board certification test (odds ratio 1.5-1.8).

CONCLUSIONS

Scholarly activities of pediatrics residents were enhanced by the JPS implementation of the article requirement policy, which is crucial to fostering a scholarly culture. The most efficient measures to promote scholarship need to be persistently investigated.

Implementation and assessment of a pediatric point-of-care ultrasound training course in Japan: a pilot study

PURPOSE

The popularity of point-of-care ultrasound (POCUS) has led to the creation of educational guidelines for its use. In Japan, however, a comprehensive training course for POCUS use in pediatric emergency medicine has yet to be developed. The present study aimed to implement a pilot course for pediatric POCUS training in Japan and to compare participants' self-efficacy level before and after the course.

METHODS

A half-day training course in pediatric POCUS was implemented at a meeting of the Japan Society of Point-of-Care Ultrasound. A standardized training course, including pre-learning materials, live lectures, and hands-on sessions, was developed based on the US consensus educational guidelines. Physicians interested in pediatric POCUS were recruited for participation and completed a self-evaluation survey before and after the course to access their background, self-efficacy in performing selected ultrasound procedures before and after the course, and their overall satisfaction with the course.

RESULTS

In total, 31 physicians participated. Of these, 25 completed the survey. Ten participants were in post-graduate year (PGY) 1-2, 13 were in PGY 3-5, and eight were in PGY 6 or higher. The post-training self-efficacy score was significantly higher than the pre-course assessment score (86.0 [standard deviation (SD): 19.2] vs. 35.6 [SD 17.6], p =  < 0.05, mean difference: 49.6 [95% confidence interval 39.6-61.2]). Furthermore, overall satisfaction with the course was high at 8.6 (SD 1.8).

CONCLUSION

The present study implemented a pilot training course in pediatric POCUS and found the participants' self-efficacy level to be significantly higher after the course.

Long-term impact of overnight shiftwork implementation on pediatric residents' mental wellness: A repeated cross-sectional survey

Objectives

The Japanese government partially enacted the “Work Style Reform Bill” in 2019. The National Center for Child Health and Development (NCCHD) introduced an Overnight Call Shift (OCS) system for pediatrician training. We conducted a follow‐up survey in 2019 to investigate the long‐term effectiveness of the OCS system to improve the pediatric residents' mental wellness at NCCHD.

Methods

We conducted a questionnaire‐based cross‐sectional survey for pediatric residents in 2019 to compare the data with those of the previous survey in 2012. The questionnaire includes demographic data, working conditions data, and mental wellness assessment by the Center for Epidemiologic Studies Depression scale (CES‐D) and the Maslach Burnout Inventory (MBI).

Results

The collection rate for the 2019 survey was 94.5% (37 participants/39 eligible). Compared to 2012, there were no significant changes in demographic data and working hours, a significant increase by about 30% in residents who took daytime off after night work, about 10% decrease in residents who scored 16 and above on the CES‐D, and a significant decrease in the mean score for depersonalization (DP) in the MBI. Multiple regression analyses showed that daytime off after night work was the decreasing factor for CES‐D and Emotional exhaustion (EE).

Conclusions

The overnight shiftwork system shortened the pediatric residents' duty hours somewhat, and imposed an impact on the pediatric residents' mental wellness.

Creating Clinical Reasoning Assessment Tools in Different Languages: Adaptation of the Pediatric Emergency Medicine Script Concordance Test to Japanese

Introduction: Clinical reasoning is a crucial skill in the practice of pediatric emergency medicine and a vital element of the various competencies achieved during the clinical training of resident doctors. Pediatric emergency physicians are often required to stabilize patients and make correct diagnoses with limited clinical information, time and resources. The Pediatric Emergency Medicine Script Concordance Test (PEM-SCT) has been developed specifically for assessing physician's reasoning skills in the context of the uncertainties in pediatric emergency practice. In this study, we developed the Japanese version of the PEM-SCT (Jpem-SCT) and confirmed its validity by collecting relevant evidence.

Methods: The Jpem-SCT was developed by translating the PEM-SCT into Japanese using the Translation, Review, Adjudication, Pretest, Documentation team translation model, which follows cross-cultural survey guidelines for proper translation and cross-cultural and linguistic equivalences between the English and Japanese version of the survey. First, 15 experienced pediatricians participated in the pre-test session, serving as a reference panel for modifying the test descriptions, incorporating Japanese context, and establishing the basis for the scoring process. Then, a 1-h test containing 60 questions was administered to 75 trainees from three academic institutions. Following data collection, we calculated the item-total correlations of the scores to optimize selection of the best items in the final version of the Jpem-SCT. The reliability of the finalized Jpem-SCT was calculated using Cronbach's α coefficient for ensuring generalizability of the evidence. We also conducted multiple regression analysis of the test score to collect evidence on validity of the extrapolation.

Results: The final version of the test, based on item-total correlation data analysis, contained 45 questions. The participant's specialties were as follows: Transitional interns 12.0%, pediatric residents 56.0%, emergency medicine residents 25.3%, and PEM fellows 6.7%. The mean score of the final version of the Jpem-SCT was 68.6 (SD 9.8). The reliability of the optimized test (Cronbach's α) was 0.70. Multiple regression analysis showed that being a transitional intern was a negative predictor of test scores, indicating that clinical experience relates to performance on the Jpem-SCT.

Conclusion: This pediatric emergency medicine Script Concordance Test was reliable and valid for assessing the development of clinical reasoning by trainee doctors during residency training.