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Mohamed I, Hom GL, Jiang S, Nayate A, Faraji N, Wien M, Ramaiya N. Psychological Safety as a New ACGME Requirement: A Comprehensive All-in-One Guide to Radiology Residency Programs. Acad Radiol 2023; 30:3137-3146. [PMID: 37743164 DOI: 10.1016/j.acra.2023.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023]
Abstract
RATIONALE AND OBJECTIVES With the Accreditation Council for Graduate Medical Education recently updating their common program requirements to include components of psychological safety as a core principle, radiology training programs and academic radiology institutions will need to evaluate psychological safety within their residency programs and implement practices to sustain a safety culture. This article reviews current literature to present a concise guide for radiology programs on best practices for implementing psychological safety, considering the plethora of literature that is available. MATERIALS AND METHODS We searched PubMed for published studies evaluating safety culture in medical education and residency. The key words used were Psychological Safety, Education, Radiology, Workplace Culture, and Leadership. RESULTS Ninety two studies were reviewed that contributed to the topics examined throughout this manuscript, including a brief history of psychological safety, evolving challenges, and a summation of best practices at the institutional, interpersonal, and individual levels that can result in a sustainable psychologically safe culture for radiology residents. CONCLUSION This article will highlight unique considerations pertinent to a radiology residency program, including suggestions for creating a less stressful environment during case conferences, fostering and supporting residents who are struggling, and inclusive psychological safety practices that also consider non-resident contributors to a residency program, such as attending physician faculty and non-physician radiology technicians.
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Affiliation(s)
- Inas Mohamed
- University Hospitals, Department of Radiology, Cleveland, Ohio (I.M., G.L.H., S.J., A.N., N.F., M.W., N.R.).
| | - Grant L Hom
- University Hospitals, Department of Radiology, Cleveland, Ohio (I.M., G.L.H., S.J., A.N., N.F., M.W., N.R.); Case Western Reserve University School of Medicine, Cleveland, Ohio (G.L.H.)
| | - Sirui Jiang
- University Hospitals, Department of Radiology, Cleveland, Ohio (I.M., G.L.H., S.J., A.N., N.F., M.W., N.R.)
| | - Ameya Nayate
- University Hospitals, Department of Radiology, Cleveland, Ohio (I.M., G.L.H., S.J., A.N., N.F., M.W., N.R.)
| | - Navid Faraji
- University Hospitals, Department of Radiology, Cleveland, Ohio (I.M., G.L.H., S.J., A.N., N.F., M.W., N.R.)
| | - Michael Wien
- University Hospitals, Department of Radiology, Cleveland, Ohio (I.M., G.L.H., S.J., A.N., N.F., M.W., N.R.)
| | - Nikhil Ramaiya
- University Hospitals, Department of Radiology, Cleveland, Ohio (I.M., G.L.H., S.J., A.N., N.F., M.W., N.R.)
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Shaker L, Amilcar C, Kothari N, Murano T. KNOWLEDGE, ATTITUDES AND PERCEPTIONS OF REMEDIATION AMONG TRAINEES IN GRADUATE MEDICAL EDUCATION PROGRAMS. J Emerg Med 2023; 65:e41-e49. [PMID: 37355420 DOI: 10.1016/j.jemermed.2023.04.008] [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: 11/20/2022] [Revised: 02/06/2023] [Accepted: 04/10/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Remediation of medical trainees is a universal challenge, yet studies show that many residents will need remediation to improve performance. Current literature discusses the importance and processes of remediation and investigates how to recognize residents needing remediation. However, little is known about trainees' attitudes and perception of remediation. OBJECTIVES To assess trainees' knowledge of remediation as well as their attitudes and perceptions toward remediation and its process. We hypothesized that trainees have limited knowledge and a negative perception of remediation. METHODS A cross-sectional anonymous electronic survey was sent to all graduate medical education trainees at a single institution. RESULTS The survey was completed by 132/1095 (12.1%) trainees. Of the respondents, 7.6% were not familiar with the term "remediation." Trainees' knowledge of remediation processes was variable, and they reported overwhelmingly negative thoughts and attitudes toward remediation. Shame was felt by 97/132 (73.5%), 71/132 (53.8%) felt disadvantaged, and 121/132 (91.7%) viewed the term "remediation" negatively. Most trainees felt using a more positive term would improve perceptions, and 124/132 (93.9%) felt residents should be involved in creating individualized remediation plans. Open-ended responses on reactions to being placed on remediation included disappointment, shame, incompetency, anxiety and worry, embarrassment, unhappiness, suicidality, worthlessness, sense of failure, and doubting one's capabilities as a physician. CONCLUSION Trainees have limited knowledge and understanding of remediation and strong negative perceptions and attitudes toward the remediation process. Trainees suggested that reframing of remediation using more positive terminology and including residents in creating individualized plans, may improve attitudes and perceptions of this process.
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Affiliation(s)
- Lana Shaker
- Hackensack University Medical Center, Hackensack, New Jersey
| | - Cindy Amilcar
- Department of Emergency Medicine, University of Texas Health-McGovern Medical School, Houston, Texas
| | - Neil Kothari
- Office of Graduate Medical Education, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Tiffany Murano
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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Price T, Wong G, Withers L, Wanner A, Cleland J, Gale T, Prescott-Clements L, Archer J, Bryce M, Brennan N. Optimising the delivery of remediation programmes for doctors: A realist review. MEDICAL EDUCATION 2021; 55:995-1010. [PMID: 33772829 DOI: 10.1111/medu.14528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 05/15/2023]
Abstract
CONTEXT Medical underperformance puts patient safety at risk. Remediation, the process that seeks to 'remedy' underperformance and return a doctor to safe practice, is therefore a crucially important area of medical education. However, although remediation is used in health care systems globally, there is limited evidence for the particular models or strategies employed. The purpose of this study was to conduct a realist review to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety. METHOD We conducted a realist literature review consistent with RAMESES standards. We developed a programme theory of remediation by carrying out a systematic search of the literature and through regular engagement with a stakeholder group. We searched bibliographic databases (MEDLINE, EMBASE, PsycINFO, HMIC, CINAHL, ERIC, ASSIA and DARE) and conducted purposive supplementary searches. Relevant sections of text relating to the programme theory were extracted and synthesised using a realist logic of analysis to identify context-mechanism-outcome configurations (CMOcs). RESULTS A 141 records were included. The majority of the studies were from North America (64%). 29 CMOcs were identified. Remediation programmes are effective when a doctor's insight and motivation are developed and behaviour change reinforced. Insight can be developed by providing safe spaces, using advocacy to promote trust and framing feedback sensitively. Motivation can be enhanced by involving the doctor in remediation planning, correcting causal attribution, goal setting and destigmatising remediation. Sustained change can be achieved by practising new behaviours and skills, and through guided reflection. CONCLUSION Remediation can work when it creates environments that trigger behaviour change mechanisms. Our evidence synthesis provides detailed recommendations on tailoring implementation and design strategies to improve remediation interventions for doctors.
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Affiliation(s)
- Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Geoff Wong
- Nuffield Department of Primary Care, Health Sciences, University of Oxford, Oxford, UK
| | | | - Amanda Wanner
- NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), Community and Primary Care Research Group, University of Plymouth, Plymouth, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Tom Gale
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Julian Archer
- Faculty of Medicine, Nursing and Healthcare, Monash University, Melbourne, Vic., Australia
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
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Price T, Brennan N, Wong G, Withers L, Cleland J, Wanner A, Gale T, Prescott-Clements L, Archer J, Bryce M. Remediation programmes for practising doctors to restore patient safety: the RESTORE realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
An underperforming doctor puts patient safety at risk. Remediation is an intervention intended to address underperformance and return a doctor to safe practice. Used in health-care systems all over the world, it has clear implications for both patient safety and doctor retention in the workforce. However, there is limited evidence underpinning remediation programmes, particularly a lack of knowledge as to why and how a remedial intervention may work to change a doctor’s practice.
Objectives
To (1) conduct a realist review of the literature to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety; and (2) provide recommendations on tailoring, implementation and design strategies to improve remediation interventions for doctors.
Design
A realist review of the literature underpinned by the Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.
Data sources
Searches of bibliographic databases were conducted in June 2018 using the following databases: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Education Resources Information Center, Database of Abstracts of Reviews of Effects, Applied Social Sciences Index and Abstracts, and Health Management Information Consortium. Grey literature searches were conducted in June 2019 using the following: Google Scholar (Google Inc., Mountain View, CA, USA), OpenGrey, NHS England, North Grey Literature Collection, National Institute for Health and Care Excellence Evidence, Electronic Theses Online Service, Health Systems Evidence and Turning Research into Practice. Further relevant studies were identified via backward citation searching, searching the libraries of the core research team and through a stakeholder group.
Review methods
Realist review is a theory-orientated and explanatory approach to the synthesis of evidence that seeks to develop programme theories about how an intervention produces its effects. We developed a programme theory of remediation by convening a stakeholder group and undertaking a systematic search of the literature. We included all studies in the English language on the remediation of practising doctors, all study designs, all health-care settings and all outcome measures. We extracted relevant sections of text relating to the programme theory. Extracted data were then synthesised using a realist logic of analysis to identify context–mechanism–outcome configurations.
Results
A total of 141 records were included. Of the 141 studies included in the review, 64% related to North America and 14% were from the UK. The majority of studies (72%) were published between 2008 and 2018. A total of 33% of articles were commentaries, 30% were research papers, 25% were case studies and 12% were other types of articles. Among the research papers, 64% were quantitative, 19% were literature reviews, 14% were qualitative and 3% were mixed methods. A total of 40% of the articles were about junior doctors/residents, 31% were about practicing physicians, 17% were about a mixture of both (with some including medical students) and 12% were not applicable. A total of 40% of studies focused on remediating all areas of clinical practice, including medical knowledge, clinical skills and professionalism. A total of 27% of studies focused on professionalism only, 19% focused on knowledge and/or clinical skills and 14% did not specify. A total of 32% of studies described a remediation intervention, 16% outlined strategies for designing remediation programmes, 11% outlined remediation models and 41% were not applicable. Twenty-nine context–mechanism–outcome configurations were identified. Remediation programmes work when they develop doctors’ insight and motivation, and reinforce behaviour change. Strategies such as providing safe spaces, using advocacy to develop trust in the remediation process and carefully framing feedback create contexts in which psychological safety and professional dissonance lead to the development of insight. Involving the remediating doctor in remediation planning can provide a perceived sense of control in the process and this, alongside correcting causal attribution, goal-setting, destigmatising remediation and clarity of consequences, helps motivate doctors to change. Sustained change may be facilitated by practising new behaviours and skills and through guided reflection.
Limitations
Limitations were the low quality of included literature and limited number of UK-based studies.
Future work
Future work should use the recommendations to optimise the delivery of existing remediation programmes for doctors in the NHS.
Study registration
This study is registered as PROSPERO CRD42018088779.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Jennifer Cleland
- Medical Education Research and Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Amanda Wanner
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Thomas Gale
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Julian Archer
- Medicine, Nursing and Health Sciences Education Portfolio, Monash University, Melbourne, VIC, Australia
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
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Kwan BYM, Mussari B, Moore P, Meilleur L, Islam O, Menard A, Soboleski D, Cofie N. A Pilot Study on Diagnostic Radiology Residency Case Volumes From a Canadian Perspective: A Marker of Resident Knowledge. Can Assoc Radiol J 2020; 71:490-494. [PMID: 32037849 DOI: 10.1177/0846537119899227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Purpose: New guidelines from the Accreditation Council for Graduate Medical Education (ACGME) have proposed minimum case volumes to be obtained during residency. While radiology residency programs in Canada are accredited by the Royal College of Physicians and Surgeons of Canada, there are currently no minimum case volumes standards for radiology residency training in Canada. New changes in residency training throughout Canada are coming in the form of competency-based medical education. Using data from a pilot study, this article examines radiology resident case volumes among recently graduated cohorts of residents and determines whether there is a correlation between case volumes and measures of resident success. Materials and Methods: Resident case volumes for 3 cohorts of graduated residents (2016-2018) were extracted from the institutional database. Achievement of minimum case volumes based on the ACGME guidelines was performed for each resident. Pearson correlation analysis (n = 9) was performed to examine the relationships between resident case volumes and markers of resident success including residents’ relative knowledge ranking and their American College of Radiology (ACR) in-training exam scores. Results: A statistically significant, positive correlation was observed between residents’ case volume and their relative knowledge ranking ( r = 0.682, P < .05). Residents’ relative knowledge ranking was also statistically significant and positively correlated with their ACR in-training percentile score ( r = 0.715, P < .05). Conclusions: This study suggests that residents who interpret more cases are more likely to demonstrate higher knowledge, thereby highlighting the utility of case volumes as a prognostic marker of resident success. As well, the results underscore the potential use of ACGME minimum case volumes as a prognostic marker. These findings can inform future curriculum planning and development in radiology residency training programs.
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Affiliation(s)
- Benjamin Y. M. Kwan
- Department of Radiology, School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Benedetto Mussari
- Department of Radiology, School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Pam Moore
- Department of Radiology, School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Lynne Meilleur
- Department of Radiology, School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Omar Islam
- Department of Radiology, School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Alexandre Menard
- Department of Radiology, School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Don Soboleski
- Department of Radiology, School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Nicholas Cofie
- Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada
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Privacy, Trainee Rights, and Accountability in Radiology Education. Acad Radiol 2017; 24:717-720. [PMID: 28526512 DOI: 10.1016/j.acra.2016.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/27/2016] [Accepted: 09/28/2016] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES Academic radiologists commonly hold multiple simultaneous roles within the landscape of physician training. This paper analyzes theoretical scenarios describing relationships between medical students, residents, and physician educators in radiology. MATERIALS AND METHODS The scenarios presented involve medical student supervision, radiology resident recruitment, and resident termination with respect to relevant ethical, regulatory, and legal considerations. Legal precedents and the medical social contract are addressed. RESULTS The Family Educational Rights and Privacy Act defines a framework for the privacy practices of medical schools, but it does not confer individual rights. Resident physicians rarely win wrongful termination lawsuits. Physician educators are ethically bound to act in the best interest of society. CONCLUSIONS Courts have ruled that medicine is intended to be a self-regulatory profession. Such a power requires that physicians remain accountable to the public while providing a fair learning environment for medical trainees.
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