Case study and pilot results: Stepwise approach to teach a resident tube shunt surgery

Purpose

To illustrate the utility of a previously published stepwise rubric for evaluating a resident's progress learning aqueous tube shunt surgery.

Method

Using a stepwise rubric, a single PGY3 ophthalmology resident and attending glaucoma surgeon evaluated the resident's performance after each aqueous tube shunt surgery. The rubric subdivides the surgery into 12 consecutive steps and scores the resident's proficiency in each step with either a 0 (observation), 2 (novice), 3 (beginner), 4 (advanced beginner), or 5 (competent).

Results

The resident's cumulative score increased significantly throughout the 17 surgeries performed, with the resident's self-evaluated score and attending's score increasing from 12 to 27 and 14 to 27 from the first to last surgery, respectively. Scores were consistent between the resident and attending; for any given surgery, the resident's own score never deviated from the attending's score by more than 1 point. The resident completed at least 50% of the steps in 11 of the 17 cases. While some surgical steps were mastered earlier on ("tube tying" and "suture implantation"), other steps were more challenging to master ("tunnel in sclera and enter the AC" and "close conjunctiva", as demonstrated by fewer overall attempts or never attaining a score of '5' despite multiple attempts.

Conclusions and Importance

This study demonstrates the utility of the stepwise rubric in tracking resident surgical scores chronologically via self and attending assessment. The ability to compare their own scores to that of an attending allows the resident to learn how to effectively evaluate their own performance. Most importantly, statistics obtained for each step provides the resident with personalized and real-time feedback for learning specific surgical steps. In conclusion, the stepwise rubric is a useful add-on to a resident's aqueous tube shunt surgery education.

Implementation of training level-specific self-study guides for diagnostic radiology residents

INTRODUCTION

Currently, there is no universally accepted diagnostic radiology curriculum for self-studying, so diagnostic radiology residents often have a challenging time knowing where to begin their independent studying away from work. In an effort to meet the needs of today's residents, we attempted to provide structured, comprehensive self-studying suggestions in a digestible and personalized format.

MATERIALS AND METHODS

Each radiology division attempted to create an optimal learning resource form for the residents to use for self-studying while on each rotation. Each self-study guide included hyperlinks to easily accessible online resources.

RESULTS

Training level-specific week-by-week recommendations were provided based on the expected types of cases a resident would typically encounter during that timeframe. All of the neuroradiology rotation forms and several of the other subspecialty forms were originally made available to the residents and faculty electronically on July 1, 2022. The forms are now distributed to newly rotating residents on a monthly basis.

DISCUSSION

There is a fine balance between providing residents with comprehensive review material and promoting realistic expectations. In addition, educators must keep in mind financial limitations of their residents and institutions. Learning resources must be affordable to be accessible to all residents. As radiology and technology continuously advance, there will undoubtedly be more and more excellent resources for trainees to learn from. To optimize self-studying, retention of information, and wellness, it is imperative to provide our residents with a structured, personalized, manageable curriculum including easily accessible high-yield resources.

Impact of a coaching program on resident perceptions of communication confidence and feedback quality

BACKGROUND

While communication is an essential skill for providing effective medical care, it is infrequently taught or directly assessed, limiting targeted feedback and behavior change. We sought to evaluate the impact of a multi-departmental longitudinal residency communication coaching program. We hypothesized that program implementation would result in improved confidence in residents' communication skills and higher-quality faculty feedback.

METHODS

The program was implemented over a 3-year period (2019-2022) for surgery and neurology residents at a single institution. Trained faculty coaches met with assigned residents for coaching sessions. Each session included an observed clinical encounter, self-reflection, feedback, and goal setting. Eligible residents completed baseline and follow-up surveys regarding their perceptions of feedback and communication. Quantitative responses were analyzed using paired t-tests; qualitative responses were analyzed using content analysis.

RESULTS

The baseline and follow-up survey response rates were 90.0% (126/140) and 50.5% (46/91), respectively. In a paired analysis of 40 respondents, residents reported greater confidence in their ability to communicate with patients (inpatient: 3.7 vs. 4.3, p < 0.001; outpatient: 3.5 vs. 4.2, p < 0.001), self-reflect (3.3 vs. 4.3, p < 0.001), and set goals (3.6 vs. 4.3, p < 0.001), as measured on a 5-point scale. Residents also reported greater usefulness of faculty feedback (3.3 vs. 4.2, p = 0.001). The content analysis revealed helpful elements of the program, challenges, and opportunities for improvement. Receiving mentorship, among others, was indicated as a core program strength, whereas solving session coordination and scheduling issues, as well as lowering the coach-resident ratio, were suggested as some of the improvement areas.

CONCLUSIONS

These findings suggest that direct observation of communication in clinical encounters by trained faculty coaches can facilitate long-term trainee growth across multiple core competencies. Future studies should evaluate the impact on patient outcomes and workplace-based assessments.

Does resident involvement in tonsillectomy affect outcomes?

OBJECTIVE

Tonsillectomy is essentially a solo surgery with a well-described complication profile. It may serve as a good benchmark to evaluate the resident-as-surgeon. This study examined complications such as post-tonsillectomy bleeding in children undergoing tonsillectomy by attending surgeons (AS) or pediatric otolaryngologist-supervised residents.

METHODS

Charts were reviewed of all children aged 12 and under who had tonsillectomy +/- adenoidectomy at a children's hospital between Jan 2019 and Dec 2020. Patient age, gender, BMI, indication for surgery, surgical technique, presence of a resident surgeon, primary bleeding, secondary bleeding, treatment of bleeding, other Emergency Room (ER) visits, and clinic phone calls were recorded. Binary logistic regression was performed.

RESULTS

2051 total children (1092 (53.2 %) males and 956 (46.6 %) females) with a mean age of 6.1 years (95 % CI 6.0-6.2) were included. 1910 (93.0 %) underwent surgery for tonsillar obstruction. 1557 (75.9 %) underwent monopolar cautery tonsillectomy. 661 (32.2 %) had a resident surgeon. 274 (13.4 %) had a related ER visit within 15 days. 18 (0.9 %) had a primary bleed and 155 (7.6 %) had a secondary bleed. Binary logistic regression showed that significant predictors of postoperative ER visits were patient age (OR = 1.101, 95 % CI = 1.050-1.154, p < .001) and resident involvement (OR = 0.585, 95 % CI = 0.429-,797, p < .001). Only age was associated with overall postoperative bleeding incidence (OR = 1.131, 95 % CI = 1.068-1.197, p < .001), as well as secondary bleeding (OR = 1.128, 95 % CI = 1.063-1.197, p < .001). There were no significant predictors of primary bleeding.

CONCLUSION

Resident involvement in pediatric tonsillectomy is associated with decreased postoperative ER utilization and does not appear to increase common postoperative complications including bleeding and dehydration.

The performance of ChatGPT on orthopaedic in-service training exams: A comparative study of the GPT-3.5 turbo and GPT-4 models in orthopaedic education

Introduction

The rapid advancement of artificial intelligence (AI), particularly the development of Large Language Models (LLMs) such as Generative Pretrained Transformers (GPTs), has revolutionized numerous fields. The purpose of this study is to investigate the application of LLMs within the realm of orthopaedic in training examinations.

Methods

Questions from the 2020-2022 Orthopaedic In-Service Training Exams (OITEs) were given to OpenAI's GPT-3.5 Turbo and GPT-4 LLMs, using a zero-shot inference approach. Each model was given a multiple-choice question, without prior exposure to similar queries, and their generated responses were compared to the correct answer within each OITE. The models were evaluated on overall accuracy, performance on questions with and without media, and performance on first- and higher-order questions.

Results

The GPT-4 model outperformed the GPT-3.5 Turbo model across all years and question categories (2022: 67.63% vs. 50.24%; 2021: 58.69% vs. 47.42%; 2020: 59.53% vs. 46.51%). Both models showcased better performance with questions devoid of associated media, with GPT-4 attaining accuracies of 68.80%, 65.14%, and 68.22% for 2022, 2021, and 2020, respectively. GPT-4 outscored GPT-3.5 Turbo on first-order questions across all years (2022: 63.83% vs. 38.30%; 2021: 57.45% vs. 50.00%; 2020: 65.74% vs. 53.70%). GPT-4 also outscored GPT-3.5 Turbo on higher-order questions across all years (2022: 68.75% vs. 53.75%; 2021: 59.66% vs. 45.38%; 2020: 53.27% vs. 39.25%).

Discussion

GPT-4 showed improved performance compared to GPT-3.5 Turbo in all tested categories. The results reflect the potential and limitations of AI in orthopaedics. GPT-4's performance is comparable to a second-to-third-year resident and GPT-3.5 Turbo's performance is comparable to a first-year resident, suggesting the application of current LLMs can neither pass the OITE nor substitute orthopaedic training. This study sets a precedent for future endeavors integrating GPT models into orthopaedic education and underlines the necessity for specialized training of these models for specific medical domains.

Anatomic Review in 3D Augmented Reality Alters Craniotomy Planning Among Residents

OBJECTIVE

Objectively examine the effect of 3D-Augmented Reality anatomic review on craniotomy planning among neurosurgical residents as it pertains to craniotomy size, skull positioning, and knowledge of significant anatomic relationships.

METHODS

Postgraduate year 1-7 neurosurgery residents were instructed to review standard 2D radiographs, pin a skull, and tailor a craniotomy for 6 different lesions and case vignettes. Participants then reviewed the lesion in a 3D-augmented reality (AR) environment, followed by repeating the craniotomy station for a variety of lesion types and locations (superficial, subcortical, deep, skull base). Quiz with case-specific anatomic and surgical questions followed by an exit survey for qualitative impressions.

RESULTS

Eleven of thirteen eligible residents participated. Skull position significantly changed in 5 out of 6 cases after 3D-AR view (P < 0.05, 20° angular adjustment). No significant change in incision length or craniotomy size. Subgroup analysis of junior versus senior residents revealed that craniotomy size was significantly altered in 2 out of 6 cases. Qualitative testimonials (Likert scale 5 = strongly agree) reported a change in craniotomy approach after 3D-review (3.5), improved appreciation of anatomy (4.2), increased confidence in surgical approach (4.33 junior residents, 3.5 senior residents), smaller incision (3.5 junior residents, 1.75 senior residents), better appreciation of white matter tracts (4.6).

CONCLUSIONS

The augmented reality platform offers a medium to examine surgical planning skills. Residents uniformly appreciated 3D-AR as a valuable tool for improving appreciation of critical anatomic structures and their relationship to lesional pathology. 3D-AR review significantly altered skull positioning for various lesions and craniotomy approaches, particularly among junior residents.

A "just in time" educational intervention for opioid overprescribing in dialysis access surgery

BACKGROUND

Despite widespread efforts to combat the opioid epidemic, an ongoing contributor to opioid misuse remains post-operative opioid overprescribing by residents. The goal of this study was to evaluate the impact of a low-cost, reproducible "just in time" intervention on opioid prescribing in dialysis access operations.

METHODS

Standardized opioid prescribing guidelines were emailed to residents on the vascular service on the first day of the rotation. Opioid prescriptions were reviewed for four years before and one year after this intervention. Wilcoxon rank-sum test and tests of proportions were used to compare groups.

RESULTS

Overall, 299 patients underwent dialysis access procedures. There was a decrease in patients discharged with opioids following the intervention from 58% to 36% (p ​= ​0.003). For patients prescribed opioids, the median quantity decreased from 90 to 45 oral morphine equivalents (p ​= ​0.03).

CONCLUSIONS

This low-cost and timely learning intervention may be a useful adjunct to reduce post-operative opioid prescriptions.

Transgender and non-binary patient simulations can foster cultural sensitivity and knowledge among internal medicine residents: a pilot study

Transgender and nonbinary patients face unique healthcare challenges, such as harassment, discrimination, and/or prejudice, at higher rates than their cisgender counterparts. These experiences, or even the fear of these experiences, may push patients to delay or forego medical treatment, thus compounding any existing conditions. Such extraneous issues can be combatted through cultural sensitivity. The authors designed blended education consisting of an online module followed by a live simulation to educate and promote sensitivity. Internal medicine (IM) residents (n = 94) completed the module, which introduced them to transgender community terminology and medical disparities, and ways to incorporate affirming behaviors into their practice. Afterward, they engaged in a simulation with true transgender-simulated patients (SPs) - either trans-masculine, trans-feminine, or non-binary. Residents were expected to conduct a patient interview mirroring an intake appointment. Residents then engaged in a debriefing session with the lead investigator and the SP to reflect on the experience, receive feedback and constructive criticism, and ask questions. After the education, the residents' knowledge significantly increased, t(66) = 3.69, p ≤ 0.00, d = 0.45, and their attitude toward members of the transgender community also increased significantly, t(62) = 7.57, p ≤ 0.00, d = 0.95. Furthermore, nearly all residents (99%) reported the training allowed them to practice relevant skills and was a worthy investment of their time. Nearly half (45%) of the residents who listed changes they will make to their practice pledged to ask patients for their preferred name and pronouns. Most comments were positive (75%), praising the education's effectiveness, expressing gratitude, and reporting increased confidence. Results provided evidence that the education was effective in increasing IM residents' knowledge and attitudes. Further research is needed to investigate the longitudinal effects of this education and to extend the education to a broader audience. The investigators plan to adapt and expand the research to other specialties such as gynecology and emergency medicine.

Correlation between research productivity during and after orthopaedic surgery training

Background

Research experience is mandatory for all Orthopaedic Surgery residency programs. Although the allocation of required protected time and resources varies from program to program, the underlying importance of research remains consistent with mutual benefit to both residents and the program and faculty. Authorship and publications have become the standard metric used to evaluate academic success. This study aimed to determine if there is a correlation between the research productivity of Orthopaedic Surgery trainees and their subsequent research productivity as attending Orthopaedic Surgeons.

Methods

Using the University of Mississippi Orthopaedic Residency Program Research Productivity Rank List, 30 different Orthopaedic Surgery Residency Programs were analyzed for the names of every graduating surgeon in their 2013 class. PubMed Central was used to screen all 156 physicians and collect all publications produced by them between 2008 and August 2022. Results were separated into two categories: Publications during training and Publications post-training.

Results

As defined above, 156 Surgeons were analyzed for publications during training and post-training. The mean number of publications was 7.02 ± 17.819 post-training vs. 2.47 ± 4.313 during training, P < 0.001. The range of publication post-training was 0-124 vs. 0-30 during training. Pearson correlation between the two groups resulted in a value of 0.654, P < 0.001.

Conclusion

Higher research productivity while training correlates to higher productivity post-training, but overall Orthopaedic surgeons produce more research after training than during. With the growing importance of research, more mentorship, time, and resources must be dedicated to research to instill and foster greater participation while in training.

Virtual Reality-Enabled Resident Education of Lateral-Access Spine Surgery

OBJECTIVE

Lateral-access spine surgery has many benefits, but adoption has been limited by a steep learning curve. Virtual reality (VR) is gaining popularity and lends itself as a useful tool in enhancing neurosurgical resident education. We thus sought to assess whether VR-based simulation could enhance the training of neurosurgery residents in lateral spine surgery.

METHODS

Neurosurgery residents completed a VR-based lateral spine module on lateral patient positioning and performing lateral lumbar interbody fusion using the PrecisionOS VR system on the Meta Quest 2 headset. Simulation occurred 1×/week every other week for a total of 3 simulations over 6 weeks. Pre- and postintervention surveys as well as intrasimulation performance metrics were assessed over time.

RESULTS

The majority of resident participants showed improvement in performance scores, including an automated PrecisionOS precision score, number of radiographs used within the simulation, and time to completion. All participants showed improvement in comfort with anatomic landmarks for lateral access surgery, confidence performing lateral surgery without direct supervision, and assessing fluoroscopy in spine surgery for hardware placement and image interpretation. Participant perception on the utility of VR as an educational tool also improved.

CONCLUSIONS

VR-based simulation enhanced neurosurgical residents' ability to understand lateral access surgery. Immersive surgical simulation resulted in improved resident confidence with surgical technique and workflow, perceived improvement in anatomical knowledge, and simulation performance scores. Trainee perceptions on virtual simulation and training as a curriculum supplement also improved following completion of VR training.

Assessing the debt and current state of financial literacy in a cohort of diagnostic & interventional radiology residents

RATIONALE AND OBJECTIVES

The purpose of this study is to assess diagnostic and interventional radiology resident physicians' knowledge of core facets of financial literacy: loans, real estate, investments and retirement, and insurance, with the goal of determining the need for formal financial literacy education within radiology residency programs.

METHODS

From May 2021 to March 2022, surveys were sent to 196 diagnostic and 90 interventional radiology residency programs. Residents were asked 10 knowledge multiple choice questions to assess areas of financial literacy. Custom R programming was used to evaluate responses.

RESULTS

A total of 149 diagnostic radiology residents and 49 interventional radiology residents responded to portions of the survey, for a total of 198 respondents. Of the cohort with demographic data collected, 84 out of 141 residents (60 %) had over $100,000 of debt following medical school graduation, with 115 out of 146 DR residents (79 %) and 41 out of 47 (87 %) IR residents reporting no coursework in finance.

CONCLUSIONS

Many radiology resident physicians have a significant debt burden, no official financial education, and clear knowledge gaps in areas of financial literacy. A structured financial education curriculum could better prepare residents for the financial realities of post-residency life.

Resident Education Curriculum in Pediatric and Adolescent Gynecology: The Short Curriculum 4.0

Exposure to pediatric and adolescent gynecology (PAG) varies across residency programs in obstetrics and gynecology, family medicine, and pediatrics, as well as both adolescent medicine and PAG fellowship programs. Nevertheless, these programs are responsible for training residents and fellows and providing opportunities to fulfill PAG learning objectives. To that end, the North American Society for Pediatric and Adolescent Gynecology has taken a leadership role in PAG trainee education by creating and maintaining this Short Curriculum. The curriculum outlines specific learning objectives central to PAG education and lists high-yield, concise resources for learners. This updated curriculum replaces the previous 2021 publication with a new focus toward accessible online content and updated resources.

Pediatric and Adolescent Gynecology WebEd: A Brief Report of an Underutilized Online Learning Module

Pediatric and adolescent gynecology (PAG) is a unique subspecialty for which accessible educational resources and clinical exposure have historically been limited; surveys show that trainees in both obstetrics and gynecology and pediatrics agree. In 2014, the North American Society for Pediatric and Adolescent Gynecology (NASPAG) introduced PAG WebEd, an original and interactive online case-based curriculum designed to bridge this learning gap. As of 2023, there are 35 published PAG WebEd clinical cases with key learning points that present, test, and discuss a variety of current PAG topics. The NASPAG Resident Education Committee (REC) compiled and reviewed administrative data from the module platform to investigate trainee utilization and performance. The activity data and assessment scores for 161 registered users are included and reported in this article. This brief report highlights that a relatively small number of medical trainees use PAG WebEd and aims to raise awareness of this resource through publication. There is potential for many more users to benefit from this resource; its efficacy as an examination and clinical practice tool could also be measured. The NASPAG REC hopes to ultimately show, with increased utilization, that PAG WebEd deserves to be a key piece of PAG-focused medical education. For PAG WebEd information and faculty registration, as well as a link that allows faculty to submit new learners, please visit https://www.naspag.org/pagwebed-information.

Filling a gap in OBGYN education: a pilot lecture series on perinatal mental health

Perinatal mood and anxiety disorders (PMADs) are one of the most common complications in the peripartum period. The Council for Resident Education in Obstetrics and Gynecology (CREOG) includes diagnosis and management of PMADs as educational objectives, but no formal curriculum for trainees exists. Consequently, providers often struggle to identify and treat these disorders. We aimed to assess the effects of a pilot lecture series on obstetrics and gynecology (OBGYN) residents' knowledge and comfort in the diagnosis and management of PMADs. As part of an educational cross-sectional study, a Qualtrics survey was distributed to OBGYN residents at a single center in New York City. Residents were exposed to a 10-h virtual lecture series on perinatal mental health, and a follow-up survey was distributed. Initially, few residents were familiar with screening tools (45%), and few felt comfortable providing resources (5-45%), diagnosing (0-55%), and managing (0-30%) patients with the PMADs presented. After the pilot, improvement was seen in residents' familiarity with screening tools (86%), and their comfort in providing resources (11-67%) and diagnosing (11-78%) PMADs. However, comfort in management did not improve (0-22%). The majority of trainees (75%) found the virtual setting appropriate. There is a deficit in OBGYN residents' knowledge and comfort regarding diagnosis and discussion of PMADs that can be improved with a focused lecture series, though a greater emphasis on treatment is needed. The majority of OBGYN learners found the virtual setting conducive to learning this material. Their preferences should guide the development of a formal, national curriculum.

Clinical application of a three-dimensional-printed model in the treatment of intracranial and extracranial communicating tumors: a pilot study

BACKGROUND

Surgical management for intracranial and extracranial communicating tumors is difficult due to the complex anatomical structures. Therefore, assisting methods are urgently needed. Accordingly, this study aimed to investigate the utility of a three-dimensional (3D)-printed model in the treatment of intracranial and extracranial communicating tumors as well as its applicability in surgical planning and resident education.

METHODS

Individualized 3D-printed models were created for eight patients with intracranial and extracranial communicating tumors. Based on these 3D-printed models, a comprehensive surgical plan was made for each patient, after which the patients underwent surgery. The clinicopathological data of patients were collected and retrospectively analyzed to determine surgical outcomes. To examine the educational capability of the 3D-printed models, specialists and resident doctors were invited to review three of these cases and then rate the clinical utility of the models using a questionnaire.

RESULTS

The 3D-printed models accurately replicated anatomical structures, including the tumor, surrounding structures, and the skull. Based on these models, customized surgical approaches, including the orbitozygomatic approach and transcervical approach, were designed for the patients. Although parameters such as operation time and blood loss varied among the patients, satisfactory surgical outcomes were achieved, with only one patient developing a postoperative complication. Regarding the educational applicability of the 3D-printed model, the mean agreement for all eight questionnaire items was above six (seven being complete agreement). Moreover, no significant difference was noted in the agreement scores between specialists and residents.

CONCLUSION

The results revealed that 3D-printed models have good structural accuracy and are potentially beneficial in developing surgical approaches and educating residents. Further research is needed to test the true applicability of these models in the treatment of intracranial and extracranial communicating tumors.

Deformity, etiology, solution, sequence (DESS): Facial analysis in rhinoplasty

PURPOSE

Rhinoplasty is amongst the most challenging surgeries to perfect and can take decades. This process begins during residency; however, residents often have limited exposure to rhinoplasty during their training and lack a standardized method for systematically analyzing and formulating a surgical plan. The DESS (Deformity, Etiology, Solution, Sequence) is a novel educational format for residents that serves to increase their pre-operative comfort with the surgical evaluation and intraoperative planning for a rhinoplasty.

MATERIALS AND METHODS

A qualitative study performed at a tertiary academic institution with an otolaryngology residency program evaluating three consecutive residency classes comprised of four residents per class. A 9-item questionnaire was distributed to measure change in resident comfort after utilizing the DESS during their facial plastics rotation. Questionnaire responses highlighted resident comfort with facial nasal analysis, identifying deformities, suggesting surgical maneuvers, and synthesizing a comprehensive surgical plan.

RESULTS

Ten of the twelve residents surveyed responded. Of those that responded, comfort in facial nasal analysis, identification of common nasal deformities, surgical planning, and development of an overall surgical plan were significantly improved after completion of the facial plastic rotation. These residents largely attributed their success to the systematic educational format, with an average score of 4.8/5.0 (SD 0.42).

CONCLUSION

While rhinoplasty is a challenging artform to master, systematic approaches to analysis and operative planning are vital for teaching and guiding residents. Through this novel methodology, residents display significant improvement in their comfort with facial nasal analysis and overall surgical preparation.

Virtual Interviews During COVID-19 Changed Neurosurgery Match-for Better or Worse

OBJECTIVE

The COVID-19 pandemic forced neurosurgery residency application processes to adopt a virtual interview model. This study analyzes the trends in program and applicant residency match behavior due to virtual interviews.

METHODS

National Resident Matching Program data from Main Residency Match, National Resident Matching Program Director and Applicant Survey, Electronic Residency Application Service, and Charting Outcomes in the Match were collected for neurosurgery residents for all available years, providing information on neurosurgery residency application, interview, and match outcomes. Studied years were dichotomized to account for virtual versus in-person interviews and analyzed for differences.

RESULTS

Although the average number of applications received during in-person versus virtual years was not statistically different, 245 versus 290 (P = 0.115), programs interviewed more applicants when interviews were virtual, 37.2 versus 46, (P = 0.008). Similarly, matched U.S. senior applicants did not submit a statistically higher number of applications in person versus virtual, 54 versus 77 (P = 0.055), but they did attend more interviews virtually, 20.5 versus 16.6 (P = 0.013), and ranked more programs, 20 versus 16.2 (P = 0.002). Although White applicants did not have a statistically significant difference in number of applications submitted (55 vs. 68, P = 0.129), Black applicants submitted more applications during virtual match compared with in-person match (52 vs. 74, P = 0.012). The number of applicants that programs needed to rank to fill each position was not statistically different when comparing in-person versus virtually conducted interviews, 4.6 versus 5.4 (P = 0.070).

CONCLUSIONS

Despite no change in the overall number of applications submitted per applicant, Black applicants submitted more applications virtually, suggesting potential benefits of virtual format for Black applicants. Interview format was strongly correlated to the use of perceived fitness by applicants in rank decision making. Virtual interviews provide major financial advantages to candidates and could help improve Black representation in neurosurgery. However, they impose limitations on ability access fitness.

Applying GPT-4 to the Plastic Surgery Inservice Training Examination

BACKGROUND

The recent introduction of Generative Pre-trained Transformer (GPT)-4 has demonstrated the potential to be a superior version of ChatGPT-3.5. According to many, GPT-4 is seen as a more reliable and creative version of GPT-3.5.

OBJECTIVE

In conjugation with our prior manuscript, we wanted to determine if GPT-4 could be exploited as an instrument for plastic surgery graduate medical education by evaluating its performance on the Plastic Surgery Inservice Training Examination (PSITE).

METHODS

Sample assessment questions from the 2022 PSITE were obtained from the American Council of Academic Plastic Surgeons website and manually inputted into GPT-4. Responses by GPT-4 were qualified using the properties of natural coherence. Incorrect answers were stratified into the consequent categories: informational, logical, or explicit fallacy.

RESULTS

From a total of 242 questions, GPT-4 provided correct answers for 187, resulting in a 77.3% accuracy rate. Logical reasoning was utilized in 95.0% of questions, internal information in 98.3%, and external information in 97.5%. Upon separating the questions based on incorrect and correct responses, a statistically significant difference was identified in GPT-4's application of logical reasoning.

CONCLUSION

GPT-4 has shown to be more accurate and reliable for plastic surgery resident education when compared to GPT-3.5. Users should look to utilize the tool to enhance their educational curriculum. Those who adopt the use of such models may be better equipped to deliver high-quality care to their patients.

Orthopaedic surgery residents report little subjective or objective familiarity with healthcare costs

PURPOSE

Residents have limited education regarding the cost of orthopaedic interventions. Orthopaedic residents' knowledge was surveyed in three scenarios involving an intertrochanteric femur fracture: 1) uncomplicated course with 2-day hospital stay; 2) complicated course necessitating ICU admission; and 3) readmission for pulmonary embolism management.

METHODS

From 2018 to 2020, 69 orthopaedic surgery residents were surveyed. Respondents estimated hospital charges and collections; professional charges and collections; implant cost; and level of knowledge depending on the scenario.

RESULTS

Most residents (83.6%) reported feeling "not knowledgeable". Respondents reporting "somewhat knowledgeable" did not perform better than those who reported "not knowledgeable". In the uncomplicated scenario, residents underestimated hospital charges and collections (p < 0.01; p = 0.87), and overestimated hospital charges and collections and professional collections (all p < 0.01) with an average percent error of 57.2%. Most residents (88.4%) were aware the sliding hip screw construct costs less than a cephalomedullary nail. In the complex scenario, while residents underestimated the hospital charges (p < 0.01), the estimated collections were closer to the actual figure (p = 0.16). In the third scenario, residents overestimated the charges and collections (p = 0.04; p = 0.04).

CONCLUSIONS

Orthopaedic surgery residents receive little education regarding healthcare economics and feel unknowledgeable therefore a role for formal economic education during orthopaedic residency may exist.

Assessment of cardiopulmonary point-of-care ultrasound objective structured clinical examinations in graduating anesthesiology residents across multiple residency programs

STUDY OBJECTIVE

To implement and assess a cardiopulmonary point-of-care ultrasound (POCUS) objective structured clinical examination (OSCE) in a large cohort of graduating anesthesia residents.

DESIGN

Observational cohort study.

SETTING

University-affiliated hospitals.

SUBJECTS

150 graduating anesthesia residents in their last nine months of training.

INTERVENTIONS

A standardized cardiopulmonary OSCE was administered to each resident.

MEASUREMENTS

The cardiac views evaluated were parasternal long axis (PLAX), apical 4 chamber (A4C), and parasternal short axis (PSAX). The pulmonary views evaluated were pleural effusion (PLE) and pneumothorax (PTX). In addition, a pre- and post-exam survey scored on a 5-point Likert scale was administered to each resident.

MAIN RESULTS

A4C view (mean 0.7 ± 0.3) scored a lower mean, compared to PSAX (mean 0.8 ± 0.3) and PLAX (mean 0.8 ± 0.4). Residents performed well on the PTX exam (mean 0.9 ± 0.3) but more poorly on the PLE exam (mean 0.6 ± 0.4). Structural identification across cardiac and pulmonary views were mostly high (means >0.7), but advanced interpretive skills and maneuvers had lower mean scores. Pre- and post- OSCE survey results were positive with almost all questions scoring >4 on the Likert scale.

CONCLUSION

Our study demonstrates that a cardiopulmonary POCUS OSCE can be successfully implemented across multiple anesthesia training programs. While most residents were able to perform basic ultrasound views and identify structures, advanced interpretive skills and maneuvers performed lower.

National assessment of obstetrics and gynecology and family medicine residents' experiences with CenteringPregnancy group prenatal care

OBJECTIVE

To examine family medicine (FM) and obstetrician-gynecologist (OB/GYN) residents' experiences with CenteringPregnancy (CP) group prenatal care (GPNC) as a correlate to perceived likelihood of implementing CP in future practice, as well as knowledge, level of support, and perceived barriers to implementation.

METHODS

We conducted a repeated cross-sectional study annually from 2017 to 2019 with FM and OB/GYN residents from residency programs in the United States licensed to operate CP. We applied adjusted logistic regression models to identify predictors of intentions to engage with CP in future practice.

RESULTS

Of 212 FM and 176 OB/GYN residents included in analysis, 67.01% of respondents intended to participate as a facilitator in CP in future practice and 51.80% of respondents were willing to talk to decision makers about establishing CP. Both FM and OB/GYN residents who spent more than 15 h engaged with CP and who expressed support towards CP were more likely to participate as a facilitator. FM residents who received residency-based training on CP and who were more familiar with CP reported higher intention to participate as a facilitator, while OB/GYN residents who had higher levels of engagement with CP were more likely to report an intention to participate as a facilitator.

CONCLUSION

Engagement with and support towards CP during residency are key factors in residents' intention to practice CP in the future. To encourage future adoption of CP among residents, consider maximizing resident engagement with the model in hours of exposure and level of engagement, including hosting residency-based trainings on CP for FM residents.

Management of Urologic Complications After Genital Gender-Affirming Surgery in Transgender and Nonbinary Patients

Transgender and nonbinary (TGNB) patients are a population with unique urologic needs that are often overlooked in urologic training. Most urology residents think that learning to take care of this population is important in their training; however, there is much variation in this educational content within urology residency programs. This review provides information on the current state of teaching regarding the unique needs of caring for TGNB patients as urologists and overviews some basic principles that every urologist should know.

Neurosurgery Resident Attrition Rates Defy Trends and Decrease During COVID-19 Pandemic

OBJECTIVE

We sought to determine the effects of the coronavirus disease 2019 (COVID-19) pandemic on U.S. neurosurgery resident attrition. We report the changes in resident attrition due to transfers, withdrawal, or dismissal from program training during the COVID-19 pandemic.

METHODS

Neurosurgery resident attrition data reported by the American Council of Graduate Medical Education for the academic year starting in July 2007 to the academic year ending in June 2022 were collected, and the rate of attrition was calculated. Individual postgraduate year program transfer rates were also calculated for the previous 7 consecutive academic years. The attrition rates for the academic years before the pandemic were compared with those during the pandemic.

RESULTS

A total of 465 residents did not graduate from neurosurgical training during the past 15 academic years, of which 3 years were at least partially during the COVID-19 pandemic, resulting in a mean attrition rate of 2.5%. The attrition rates during the pandemic were lower than those before the pandemic (1.7% vs. 2.7%; P < 0.001), driven largely by a nearly twofold decrease in the withdrawal rate (0.67% vs. 1.2%; P = 0.003). Bivariate regression between the withdrawal and attrition rates showed a statistically significant correlation (r = 0.809; P < 0.001; r2 = 0.654). The first full year of the COVID-19 pandemic saw the most dramatic changes, with a z score for attrition of -1.9. Linear regression of the effect of training during the COVID-19 pandemic on attrition revealed a statistically significant difference (r = 0.563; P = 0.029; r2 = 0.317). The rate of withdrawal was most affected by training during the pandemic (r = 0.594; P = 0.010; r2 = 0.353).

CONCLUSIONS

A statistically significant decline occurred in the rate of neurosurgery resident attrition during the COVID-19 pandemic that was most notable during the first full academic year (2020-2021). These findings were largely driven by a decrease in residents withdrawing from training programs. This contrasts with the overall trend toward resignation among healthcare workers during the pandemic. It is unclear what enduring ramifications this will have on neurosurgery residencies moving forward and whether we will see higher attrition rates as we transition toward a new normal. Future studies should examine trends in the attrition rates after the COVID-19 pandemic and determine the long-term effects of decreased attrition rates of residents during the pandemic.

The Impact of Trainee Involvement on Outcomes in Metabolic and Bariatric Surgery

BACKGROUND

The number of bariatric operations performed in the USA rises annually. Trainee exposure to this field is necessary to ensure competency in future surgical generations. However, the safety of trainee involvement of these operations has been called into question.

OBJECTIVES

The aim of our study is to describe differences in outcomes between trainees and non-trainees as first assistants (FA) in sleeve gastrectomy (SG).

SETTING

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database METHODS: Patients from the MBSAQIP database who underwent primary SG from 2015 to 2020 were identified. Statistical analysis included two-tailed t-tests and χ2-tests to evaluate the impact of trainees (residents and fellows) compared to non-trainees on post-operative morbidity and operative time.

RESULTS

Of the 559,324 cases, 25.8% were performed with trainees as FA. Operative length was 27.9% longer in trainee cases. In the trainee group, there was a higher risk of conversion to open procedure (OR 1.32), readmission (OR 1.19), and specific complications (cardiac arrest, myocardial infarction, progressive renal insufficiency, pulmonary embolism, sepsis, transfusion, intubation, UTI, VTE, ICU admission, and reintervention), though overall rates were < 1% in each group. Non-trainees had a higher rate of septic shock (OR 1.4). No significant difference was seen in all other perioperative outcomes.

CONCLUSION

Trainee involvement in SG leads to longer operative times without a clinically significant increase in morbidity and mortality. Such findings should be used to counsel patients and shape expectations for surgeons and hospitals. A focused bariatric surgery trainee curriculum may lessen this gap.

The impact of gamification and potential of kaizen in radiology education

Gamification is an emerging tool in medical education that has been increasingly adopted in the field of radiology. The purpose of this non-systematic review is to explore the use of gamification in medical education with a particular focus on new generations of learners and radiology education. This manuscript begins by examining the effectiveness of gamification in improving learning outcomes in medicine and radiology. Future research recommendations and the potential impact of gamification on new learners are discussed. Finally, this review provides insight into a gaming platform, Kaizen, as a promising approach to enhance education by improving motivation and increasing interest in radiology knowledge.

Using Longitudinal Curriculum to Improve Psychiatry Residents' Attitudes Regarding Firearm Anticipatory Guidance

OBJECTIVE

Over the last decade, there has been an increased focus on firearm use in violent acts and suicides. There is no known published firearm safety curriculum specific to psychiatric training and limited guidance on curriculum development from national organizations. The authors' goals were to develop a firearm lecture series that would encompass essential knowledge related to firearm safety and risk assessments and assess its effect on psychiatric residents' interest and confidence in firearm safety guidance.

METHODS

The authors developed a six-lecture series on firearm safety that was conducted over all post-graduate year (PGY) training levels and a grand rounds on basic firearm safety. All levels of psychiatry residents at one urban academic center participated in a pre- and post-lecture series questionnaire designed to evaluate attitudes related to firearm safety guidance. They developed and administered the questionnaire through New Innovations collecting qualitative and quantitative data for analysis. The quantitative analysis was completed using paired t-test.

RESULTS

Forty-seven residents participated. Twenty-seven respondents met inclusion criteria: attended at least one lecture or the grand rounds, completed pre- and post-lecture surveys, and submitted their pre-lecture survey before their first lecture. After the educational intervention, there was a statistically significant increase (p<0.05) in interest in firearm safety, and confidence in all areas surveyed-risk assessment, safety guidance, and pertinent legislation.

CONCLUSIONS

The curriculum increased residents' interest and confidence in providing firearm safety guidance. Areas of development include assessing the curriculum's impact on clinical practice.

Development of a New Resident-Centric Sex Trafficking Education Program for Obstetrics/Gynecology, Emergency Medicine, and Family Medicine Programs

Introduction

Human sex trafficking is widespread and a nationally recognized public health crisis. Trafficked individuals and survivors often utilize the healthcare system, yet healthcare professionals cite a lack of formal training to identify and provide appropriate care. This study aims to increase obstetrics/gynecology, emergency medicine, and family medicine residents' knowledge and confidence when caring for individuals involved in sex trafficking.

Methods

Obstetrics/gynecology, emergency medicine, and family medicine residents voluntarily attended an evidence-based education session and received an electronic pre-, immediate post-, and 5-month post-session survey measuring knowledge, attitudes, beliefs, and confidence. Validated survey items were adapted from previous studies. Paired t-tests (p<0.05) and descriptive analyses were used to determine differences. A concluding focus group was facilitated to further understand trainee experiences and awareness when caring for suspected sex-trafficked individuals and survivors. Thematic analysis determined reoccurring themes.

Results

Between 2019 and 2021, 48 pre-session, 28 immediate post-session, and 13 5-month post-session surveys were collected. Resident knowledge and confidence increased from the pre-session to the immediate post-session period. Session pre- and post-surveys were linked (n=14) and showed a statistically significant increase in knowledge (p<0.05) and an increase in confidence. The mean number of correct knowledge questions remained higher 5 months after the session than in the pre-session period. Focus group themes included increased resident knowledge and confidence.

Conclusions

Improvement and retention in resident knowledge and confidence in caring for sex-trafficked individuals illustrate the utility of this education intervention and expand on current literature. This study provides an example of an education session that can be adapted for other medical trainees.

Results of the 2021-2022 Survey of the American Alliance of Academic Chief Residents in Radiology

RATIONALE AND OBJECTIVES

An annual survey of chief residents in accredited North American radiology programs is conducted by the American Alliance of Academic Chief Residents in Radiology (A3CR2). Special topics surveyed for the 2021-2022 academic year were procedural competency and virtual radiology education in the COVID-19 pandemic. The purpose of this study is to summarize the 2021-2022 A3CR2 chief resident survey.

MATERIALS AND METHODS

An online survey was distributed to chief residents from 197 Accreditation Council on Graduate Medical Education-accredited radiology residency programs. Chief residents responded to questions regarding their individual procedural readiness and attitudes on virtual radiology education. A single chief resident from each residency answered programmatic questions including the use of virtual education, faculty coverage, and fellowship choices among their graduating classes.

RESULTS

We received 110 individual responses from 61 programs, yielding a 31% program response rate. Although the majority (80%) of programs maintained purely in-person attending readout throughout the COVID 19 pandemic, only 13% of programs reported purely in-person didactics and 26% converted to all virtual didactics. The majority (53%-74%) of chief residents perceived virtual learning (in read-out, case conference, and didactic formats) to be less effective than in-person learning. One third of chief residents reported decreased procedural exposure during the pandemic, and 7%-9% of chief residents felt uncomfortable with basic procedures (basic fluoroscopy examinations, basic aspiration/drainage procedures, and superficial biopsy procedures). The number of programs with 24/7 attending coverage increased from 35% in 2019 to 49% in 2022. Body, neuroradiology, and interventional radiology were the most popular advanced training options among graduating radiology residents.

CONCLUSION

The COVID-19 pandemic had a profound impact on radiology training, particularly in terms of virtual learning. These survey results suggest that although digital learning offers increased flexibility, most residents still prefer in-person readout and didactics. Despite this, virtual learning will likely remain a viable option as programs continue to evolve following the pandemic.

The integrative feedback tool: assessing a novel feedback tool among emergency medicine residents

OBJECTIVE

Feedback is critical to the growth of learners. However, feedback quality can be variable in practice. Most feedback tools are generic, with few targeting emergency medicine. We created a feedback tool designed for emergency medicine residents, and this study aimed to evaluate the effectiveness of this tool.

METHODS

This was a single-center, prospective cohort study comparing feedback quality before and after introducing a novel feedback tool. Residents and faculty completed a survey after each shift assessing feedback quality, feedback time, and the number of feedback episodes. Feedback quality was assessed using a composite score from seven questions, which were each scored 1 to 5 points (minimum total score, 7 points; maximum, 35 points). Preintervention and postintervention data were analyzed using a mixed-effects model that took into account the correlation of random effects between study participants.

RESULTS

Residents completed 182 surveys and faculty members completed 158 surveys. The use of the tool was associated with improved consistency in the summative score of effective feedback attributes as assessed by residents (P=0.040) but not by faculty (P=0.259). However, most of the individual scores for attributes of good feedback did not reach statistical significance. With the tool, residents perceived that faculty spent more time providing feedback (P=0.040) and that the delivery of feedback was more ongoing throughout the shift (P=0.020). Faculty felt that the tool allowed for more ongoing feedback (P=0.002), with no perceived increase in the time spent delivering feedback (P=0.833).

CONCLUSION

The use of a dedicated tool may help educators provide more meaningful and frequent feedback without impacting the perceived required time needed to provide feedback.

Predictive value of medical school ranking in the academic scholarship of ophthalmology residents

Objective

To determine whether a resident's medical school ranking predicts their scholarship during residency.

Design

The authors stratified ophthalmology residents in ACGME accredited programs into tiers based off their medical school background's US News & World Report ranking: T1 (schools 1-20), T2 (21-50), and T3 (51-90). Investigators queried PubMed and Scopus for number of total publications, first/second author publications, publications in the top 10 impact factor journals in ophthalmology, and publications with the senior author affiliated with the resident's residency program/medical school. Authors collected data from start of ophthalmology residency to December 5th, 2021, and performed Pearson chi squared, ANOVA, Eta squared, Tukey, and multivariable logistic regression tests.

Results

1054 residents were included for analysis, with 370 from T1 schools, 296 from T2 schools, and 388 from T3 schools. T3 residents had a significantly decreased likelihood of publishing at least one (OR = 0.659;95%CI = 0.481,0.905;p = .010), two (OR = 0.643;95%CI = 0.436,0.949;p = .026), or five (OR = 0.407;95%CI = 0.187,0.886;p = .024) total publications compared to T1 residents. T3 residents also were partially predicted to publish fewer first author works, high impact journal articles, and articles with senior authors affiliated with their medical school. T2 residents were more likely to publish at least one second author work than T1 residents (OR = 1.604;95%CI = 1.101,2.337;p = .014). There was no significant difference between tiers in publications with senior authors affiliated with the same residency program.

Conclusions

The authors observed little difference in scholarship between residents from T1 and T2 schools, but some differences may exist between T3 and T1/T2 residents. Merit of rankings should be further explored.

A novel 6-day cycle surgical pathology rotation improves resident satisfaction and maintains Accreditation Council for Graduate Medical Education (ACGME) milestone performance

Surgical pathology residency training in the United States lags behind other specialties in quality control and graduated responsibility to train independent pathologists capable of seamlessly entering practice after training. We observed that our traditional 3-day-cycle surgical pathology cycle (day 1-grossing; day 2 -biopsies/frozens/preview; day 3 - sign-out) consistently and negatively impacted resident education by reducing preview time, case follow-up, immunohistochemical stain (IHC) interpretation, and molecular study integration. We aimed to create a modern surgical pathology rotation that improved performance and outcomes. We innovated our rotation to enhance resident education and ensure graduated responsibility. A novel 6-day cycle was created composed of 2 grossing days, 1 frozens/biopsies/preview days, 2 dedicated sign-out days, and 1 frozens/biopsies/case completion day. Residents completed surveys before implementing the new rotation and 6 months after implementation to track self-assessment of Accreditation Council for Graduate Medical Education (ACGME) milestone performance and internal quality control metrics. Clinical Competency Committee (CCC) annual evaluations were assessed in paired PGY levels pre- and post-intervention. After implementation, there was a statistically significant improvement in self-assessment of levels 4 and 5 of ACGME milestones and improved satisfaction of quality metrics, including time for previewing, reviewing IHC, graduated responsibility, and perceived readiness for independent practice. CCC evaluations showed overall maintained performance levels, with trends towards improvements in junior resident classes. Our 6-day cycle adequately fulfills the current demands of our sizeable academic center's surgical pathology training and can be a model for pathology residencies looking to modernize their surgical pathology rotations and resident education.

Artificial Intelligence Literacy: Developing a Multi-institutional Infrastructure for AI Education

RATIONALE AND OBJECTIVES

To evaluate the effectiveness of an artificial intelligence (AI) in radiology literacy course on participants from nine radiology residency programs in the Southeast and Mid-Atlantic United States.

MATERIALS AND METHODS

A week-long AI in radiology course was developed and included participants from nine radiology residency programs in the Southeast and Mid-Atlantic United States. Ten 30 minutes lectures utilizing a remote learning format covered basic AI terms and methods, clinical applications of AI in radiology by four different subspecialties, and special topics lectures on the economics of AI, ethics of AI, algorithm bias, and medicolegal implications of AI in medicine. A proctored hands-on clinical AI session allowed participants to directly use an FDA cleared AI-assisted viewer and reporting system for advanced cancer. Pre- and post-course electronic surveys were distributed to assess participants' knowledge of AI terminology and applications and interest in AI education.

RESULTS

There were an average of 75 participants each day of the course (range: 50-120). Nearly all participants reported a lack of sufficient exposure to AI in their radiology training (96.7%, 90/93). Mean participant score on the pre-course AI knowledge evaluation was 8.3/15, with a statistically significant increase to 10.1/15 on the post-course evaluation (p= 0.04). A majority of participants reported an interest in continued AI in radiology education in the future (78.6%, 22/28).

CONCLUSION

A multi-institutional AI in radiology literacy course successfully improved AI education of participants, with the majority of participants reporting a continued interest in AI in radiology education in the future.

What Is the Effect of Resident Involvement on Short-Term Outcomes after Distal Radius Fracture Surgery?

Background: The objective of this study was to assess whether resident involvement in distal radius fracture open reduction internal fixation (ORIF) affect 30-day postoperative complication, hospital readmission, reoperation and operative time. Methods: A retrospective study was performed using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database by querying the Current Procedural Terminology (CPT) codes for distal radius fracture ORIF from 1 January 2011 to 31 December 2014. A final cohort of 5,693 adult patients who underwent distal radius fracture ORIF during the study period were included. Baseline patient demographics and comorbidities, intraoperative factors, including operative time and 30-day postoperative outcomes, including complications, readmission and reoperations, were collected. Bivariate statistical analyses were performed to identify variable associated with complication, readmission, reoperation and operative time. The significance level was adjusted using a Bonferroni correction as multiple comparisons were performed. Results: In this study of 5,693 patients who underwent distal radius fracture ORIF, 66 patients had a complication, 85 patients were readmitted and 61 patients underwent reoperation within 30 days of surgery. Resident involvement in the surgery was not associated with 30-day postoperative complication, readmission or reoperation, but was associated with longer operative time. Moreover, 30-day postoperative complication was associated with older age, American Society of Anesthesiologists (ASA) classification, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hypertension and bleeding disorder. Thirty-day readmission was associated with older age, ASA classification, diabetes mellitus, COPD, hypertension, bleeding disorder and functional status. Thirty-day reoperation was associated with higher body mass index (BMI). Longer operative time was associated with younger age, male sex and the absence of bleeding disorder. Conclusions: Resident involvement in distal radius fracture ORIF is associated with longer operative time, but no difference in rates of episode-of-care adverse events. Patients may be reassured that resident involvement in distal radius fracture ORIF does not negatively impact short-term outcomes. Level of Evidence: Level IV (Therapeutic).

Hybrid Delivery of Mindfulness Meditation and Perceived Stress in Pediatric Resident Physicians: A Randomized Clinical Trial of In-Person and Digital Mindfulness Meditation

Physicians are experiencing epidemic levels of work-related stress and burnout. Determine efficacy of mindfulness meditation delivered as a hybrid (in-person and digital) format to reduce perceived stress in pediatric residents. Pediatric residents (n = 66) were block randomized to a hybrid Mindful Awareness Practices (MAPs) intervention, comprised of one in-person 60-min session and 6-week access to a digitally delivered MAPs curriculum (n = 27) or wait-list control (n = 39). Perceived Stress Scale (PSS) was administered at baseline and post-intervention as the primary outcome measure. A priori secondary outcomes were measured using the Abbreviated Maslach Burnout Inventory-9, Beck Depression Inventory, Beck Anxiety Inventory, UCLA Loneliness Scale, and Pittsburgh Sleep Quality Index. After the first session, 58% participated at least one digital session (M = 2.0; SD = 1.3). MAPs participants showed significant decrease in PSS compared to controls, with between-group mean difference of 2.20 (95% CI 0.47-3.93) at post-intervention (effect size 0.91; 0.19-1.62). No secondary outcome group differences were detected. Exposure to a hybrid mindfulness intervention was associated with improvement in perceived stress among pediatric residents.Trial Registration: NCT03613441.

Preparing future physicians for complexity: a post-graduate elective in HIV psychiatry

BACKGROUND

Patients with complex care needs have multiple concurrent conditions (medical, psychiatric, social vulnerability or functional impairment), interfering with achieving desired health outcomes. Their care often requires coordination and integration of services across hospital and community settings. Physicians feel ill-equipped and unsupported to navigate uncertainty and ambiguity caused by multiple problems. A HIV Psychiatry resident elective was designed to support acquisition of integrated competencies to navigate uncertainty and disjointed systems of care - necessary for complex patient care.

METHODS

Through qualitative thematic analysis of pre- and post-interviews with 12 participants - residents and clinic staff - from December 2019 to September 2022, we explored experiences of this elective.

RESULTS

This educational experience helped trainees expand their understanding of what makes patients complex. Teachers and trainees emphasize the importance of an approach to "not knowing" and utilizing integrative competencies for navigating uncertainty. Through perspective exchange and collaboration, trainees showed evidence of adaptive expertise: the ability to improvise while drawing on past knowledge.

CONCLUSIONS

Postgraduate training experiences should be designed to facilitate skills for caring for complex patients. These skills help residents fill in practice gaps, improvise when standardization fails, and develop adaptive expertise. Going forward, findings will be used to inform this ongoing elective.

Bilateral trauma case conferences: an approach to global surgery equity through a virtual education exchange

Purpose

With increased interest in international surgical experiences, many residency programs have integrated global surgery into their training curricula. For surgical trainees in low- and middle-income countries (LMICs), physical exchange can be costly, and laws in high-income countries (HICs) prevent LMIC trainees from practicing surgery while on visiting rotations. To enrich the educational experience of trainees in both settings, we established a monthly virtual trauma conference between surgery training programs.

Methods

General surgery teams from two public institutions, a public university with two surgical training programs in Kenya and a public university with two level I trauma centers in the United States, meet monthly to discuss complex and interesting trauma patients. A trainee from each institution presents a clinical case vignette and supplements the case with pertinent peer-reviewed literature. The attendees then answer a series of multiple-choice questions like those found on surgery board exams.

Results

Monthly case conferences began in September 2017 with an average of 24 trainees and consultant surgeons. Case discussions serve to stimulate dialogue on patient presentation and management, highlighting cost-conscious, high-quality care and the need to adapt practice patterns to meet resource constraints and provide culturally appropriate care.

Conclusion

Our 5-year experience with this virtual case conference has created a unique and robust surgical education experience for trainees and surgeons who have withstood the effects of the pandemic. These case conferences have not only strengthened the camaraderie between our departments, but also promoted equity in global surgery education and prioritized the learning of trainees from both settings.

The Case for Needed Financial Literacy Curriculum During Resident Education

OBJECTIVE

Personal physician finance is an overlooked source of stress that negatively impacts resident wellbeing with formal financial education often left out of medical training. This study attempts to (1) evaluate the perceptions of financial literacy, (2) determine the level of financial education incorporated across residency programs, and (3) evaluate the resources that residents utilize to obtain information about managing their personal finances.

DESIGN

A systematic literature search of articles published between January 2012 to January 2022, in the MEDLINE, EMBASE, and Cochrane databases was performed during February 2022]. The combination of search terms included: (financial literacy OR debt) AND (residency OR graduate medical education). The primary outcome measures included the perception of financial literacy during residency and the type of financial education incorporated during residency. Secondary outcomes included resources utilized to obtain financial education.

PARTICIPANTS

Twenty-three studies evaluating a total of 5146 residents were included in this systematic review.

RESULTS

The 42% to 79% of residents responded in surveys that they had "below average" understanding of finance, investing, and savings and that they felt unprepared to handle future financial decisions. 79% to 95% of respondents agreed that personal finance should be taught during residency training. The included studies also demonstrate that residents seek education through personal research, through a family member, or through attending outside financial planning seminars or courses.

CONCLUSION

This study demonstrates that the majority of residents feel underprepared when making financial decisions and that formal financial education should be incorporated during their residency training. Educating residents can help mitigate financial stress which can improve physician well-being, reduce attrition, and result in better patient care.

LEVEL OF EVIDENCE

IV.

Evaluation of a Plastic and Reconstructive Surgery Resident Non-surgical Cosmetic Clinic Experience

INTRODUCTION

An important component of plastic surgery residency training is independent cosmetic patient management. A resident cosmetic clinic was created at Oregon Health & Science University in 2007 to expand this experience. The cosmetic clinic has traditionally been most successful in offering nonsurgical facial rejuvenation with neuromodulators and soft tissue fillers. This study focuses on the demographics of the patient population and the treatments provided over a 5-year period and compares this experience to those of the same program's attending cosmetic clinics.

METHODS

A retrospective chart review of all patients seen at Oregon Health & Science University's Plastic and Reconstructive Surgery Resident Cosmetic Clinic between January 1, 2017, and December 31, 2021 was performed. Patient demographics, type of injectable received (neuromodulator versus soft tissue filler), location of injection, and additional cosmetic procedures were evaluated.

RESULTS

Two hundred patients met the study criteria, which included 114 seen in the resident clinic (RC), 31 seen in attending clinic (AC), and 55 patients seen in both. A primary analysis compared the two groups seen in the resident and attending only clinics. The average age of patients seen in the RC was younger, 45 versus 51.5 (P ≤ 0.05). There was a trend toward more patients in the RC being involved in healthcare as compared to those patients seen in the AC, but this difference was not found to be statistically significant. The median number of neuromodulator visits in the RC was 2 (1, 4) versus 1 (1, 2) in the AC (P ≤ 0.05) The most common location for neuromodulator injections in both clinics was the corrugators.

CONCLUSIONS

Patients in the resident cosmetic clinic were younger females, most receiving neuromodulator injections. No statistically significant differences were identified in patient population, injections received, and location of injections between the two clinics, indicating a similar trainee skill set and patient care plan between the two clinics.

A feasibility study of utilizing a cadaveric training model for novel robotic bladder cancer brachytherapy techniques

PURPOSE

The current standard of care for muscle-invasive bladder cancer is neoadjuvant chemotherapy followed by radical cystectomy with lymph node dissection. Although this treatment provides therapeutic benefit, it is associated with notable morbidity. Bladder sparing techniques, such as concurrent chemo-radiation, are less invasive and prioritize organ preservation in individuals with invasive bladder cancer and offer comparable disease control. High-dose-rate brachytherapy is an emerging paradigm in the management of muscle-invasive bladder cancer. During high-dose-rate brachytherapy, radioactive sources are introduced to the area of the primary tumor through specialized catheters. The specific placement of brachytherapy catheters results in heightened effectiveness of the radiation treatment with less radiation damage to surrounding structures. For bladder-sparing therapies such as brachytherapy to rival radical cystectomy, these techniques need to be refined further by radiation oncologists.

PROCEDURE

One such modality for developing and practicing these techniques is the use of cadaveric models in innovation-focused clinical training facilities, which provide a simulated sterile surgical environment without the concern for extending intraoperative time.

FINDINGS AND CONCLUSIONS

The objective of this technical note is to demonstrate how clinical training facilities such as the Houston Methodist Institute for Technology, Innovation & Education are ideal for the development, testing, and training of novel brachytherapy techniques using cadaveric models. By utilizing a network of similarly innovative training centers, research and development of brachytherapy techniques can be expedited, and novel bladder-sparing treatment methods can be implemented as the standard of care for bladder cancer.

Journal Selection Primer for Neuroradiology Researchers

Junior Neuroradiology investigators face a rapidly expanding universe of potential journals for manuscript submission. Each journal possesses many unique features, including scope/breadth of research focus, willingness to accept specific types of articles (for example, Review Articles, or Case Reports), status of indexing on major academic indices, scholarly relevance (usually defined as Impact Factor) and access type (Open Access, subscription, or Hybrid Access). An uninformed choice of target journal can burden not only Editors and Reviewers but also increase the effort and frustration level of relatively inexperienced investigators and ultimately result in a worthy manuscript not getting published. In order to assist Junior Neuroradiology investigators in optimizing journal selection for manuscript submission, we provide a Primer that includes background information on all the journal features listed previously. We also provide detailed tabular data for all Radiology, Neuroradiology, and associated Neuroscience Clinical Journals that follow proper academic standards as a quick and useful reference guide for optimal journal selection.

Getting Ahead: A Resident Led Quality Improvement Project to Increase Diabetic Nephropathy Screening in an Underserved Hispanic-Predominant Population

Introduction

Diabetes is the leading cause of end-stage renal disease (ESRD) in the United States (US), with 37 million having chronic kidney disease. Despite national guidelines recommendations for diabetic nephropathy screening with urine albumin-to-creatinine ratio (UACR), less than 50% receive full screening.Our Internal Medicine residents led a quality improvement project to increase diabetic nephropathy screening rate with UACR in our resident clinic by 50% in one academic year.

Methods

We conducted the resident-led quality improvement project from July 2021 to April 2022. We reviewed the electronic medical records (EMR) from our clinic pre-intervention July 2020 to June 2021 and compared this to post intervention July 2021 to March 2022 determining the nephropathy screening rates in patients with diabetes. Our interventions included resident education, pre and post surveys to test foundational knowledge, adding UACR in the affordable laboratory order form and establishing normal reference range of UACR in the EMR.

Results

We collected 217 patients with diabetes, 27% were uninsured, 38% had Medicare/Medicaid and 90% identified as Hispanic. Comparing pre to post intervention, there was a significant change of 45 (20.7%) vs 71 (32.7%) patients screened for diabetic nephropathy with a UACR. The correct average score of knowledge-based questions was 82% on the pre survey, which increased to 88% in the post survey.

Conclusion

Our study showed promising results on improving diabetic nephropathy screening. The comprehensive approach including resident education about diabetic nephropathy screening with UACR and more so facilitating the order set in the EMR were key to achieve this goal.

Everything but the squeal: a guide for head and neck surgery training on the live porcine model

PURPOSE

The porcine model has been demonstrated to be cost-effective for head and neck surgery training. There is no literature describing the porcine head and neck anatomy. The purpose of this study is to provide a porcine surgical guide for training head and neck residents.

METHODS

Five head and neck dissections were performed under general anesthesia on the Large White pig model in the animal facilities of the University Hospital Fundación Jiménez. Sessions were photographed, and reference anatomical measurements were taken.

RESULTS

The sternum-chin distance (x = 15.80 cm, σ = 0.44), chin-chin distance (x = 11.10 cm, σ = 2.30), prelaryngeal musculature length (x = 10.30 cm, σ = 1.92) and supraomohyoid triangle area (x = 7.07 cm², σ = 3.91) were among the measurements obtained. The porcine head and neck anatomy was detailed.

CONCLUSIONS

Head and neck porcine anatomy was thoroughly described, with emphasis on the similarities with human anatomy. The porcine model is capable of simulating human anatomy for surgery training.

Setting Common Standards for Reproductive Psychiatry Education: Effectiveness of the National Curriculum in Reproductive Psychiatry

OBJECTIVE

The National Curriculum in Reproductive Psychiatry (NCRP) provides standardized education for psychiatry residency training programs. The authors hypothesized that residents' preparedness to treat reproductive psychiatric concerns and their medical knowledge would improve following teaching with the NCRP.

METHODS

Pre- and post-assessments were administered to residents enrolled in two waves of pilot NCRP training (Early-Modules and All-Modules). Data were collected by individual survey, and pre- and post-responses matched via anonymous ID. Statistical analyses were conducted using R version 3.5.3 and included paired Student's t-tests and a chi-square test.

RESULTS

Thirty-eight residents completed the Early-Modules survey and 16 the All-Modules survey. In both groups, there was significant improvement in preparedness to treat pregnant and postpartum women with mental illness (p<0.05). Scores on the 29-point knowledge test rose by 2.5 points in the Early-Modules group and 4.3 points in the All-Modules group (p<0.001 for both). In both cohorts, a majority of residents felt reproductive psychiatry was among the top three specialties needed to become competent independent adult psychiatrists.

CONCLUSIONS

Classroom training with local faculty using a standardized curriculum is feasible and results in substantial and significant improvements in both feelings of preparedness and medical knowledge. Psychiatry trainees view training in reproductive psychiatry as an important and missing aspect of their education. Dissemination of a standardized curriculum may help to forge a path toward subspecialty certification for reproductive psychiatry, and can be used as a model for other specialties.

A Peer-to-Peer, Longitudinal Reproductive Psychiatry Educational Curriculum for Obstetrics/Gynecology Residents

OBJECTIVE

Pregnant patients with psychiatric diagnoses are commonly advised to stop their psychiatric medications. Few studies assess the knowledge of, attitude toward, or comfort levels of obstetrics and gynecology (OB/GYN) residents in managing psychiatric conditions, which carry adverse and potentially life-threatening risks to mother and fetus. A gap remains between evidence advocating for active psychopharmacological treatment during pregnancy and implementation of curricula targeting OB/GYN physicians in mental health. The authors' goals are to assess the knowledge, attitude, and comfort that OB/GYN residents have toward assessing and managing active psychiatric conditions in pregnant/postpartum women and to develop an educational, case-based intervention targeting these conditions in the perinatal/postpartum period.

METHODS

Eight perinatal/postpartum psychiatric topics were developed into interactive cases designed for OB/GYN residents. Two weeks before the curriculum administration, OB/GYN residents were surveyed on prior knowledge in, attitudes toward, and comfort levels in assessing and discussing psychiatric conditions in pregnant patients. The assessment was administered again after the intervention to assess its effectiveness.

RESULTS

Pre- (N = 19) and post-intervention (N = 15) surveys of residents were analyzed. Most residents (94%) felt it was both important and their responsibility to discuss mental health conditions with pregnant patients. Comfort levels with counseling psychiatric patients increased for all eight topics after the educational intervention was implemented, with statistically significant increases (p < 0.05) for five of the topics.

CONCLUSIONS

OB/GYN residents feel responsible for caring for pregnant patients with psychiatric illness, and case-based interventions offer an interactive, helpful tool for increasing residents' knowledge and comfort level in treating this patient population.

Reducing seizure to needle times in nonconvulsive status epilepticus with multifaceted quality improvement initiatives

OBJECTIVES

Delayed management of nonconvulsive status epilepticus (NCSE) can lead to an increased morbidity and mortality. We previously established that inefficient treatment of NCSE at our institution stemmed from delayed initiation of emergent anti-seizure medications (ASM). In the present study, we assessed the trajectories of these time parameters and determined patient outcomes following the specific quality improvement (QI) interventions.

METHODS

The QI interventions, including the revision of the educational content for trainees and pharmacy workflow optimization were implemented between January 2019 and September 2021 by a dedicated multidisciplinary task force. The times needed to initiate and administer the ASMs for patients with NCSE as well as patient mortality were assessed in comatose and noncomatose patients and compared with the corresponding values prior to the interventions.

RESULTS

There were 79 occurrences of NCSE in 74 patients. The median time from seizure detection on EEG to the order of the first and second ASM for NCSE was reduced by 4 (p = 0.83) and 8 min (p = 0.52), respectively compared to the times prior to the initiation of interventions. The median times from the order to administration of the first and third ASM for all NCSE occurrences were reduced by 8 and 10 min, respectively (p = 0.28 and p = 0.10). In the present cohort of comatose patients, the median time spent to order the first ASM was reduced by 16.5 min and the time to administer it reduced by 35 min compared to that in our previous study. The overall patient mortality was decreased by 11.1%.

SIGNIFICANCE

More efficient delivery of rescue ASMs in patients with NCSE and improvement in their mortality can be achieved with multidisciplinary team efforts aimed at streamlining the functioning of pharmacy and strengthening the education of trainees and nurses.

"Play How We Practice": A Residency Program's Snapshot of Pediatric Resident Perspectives on Education During the COVID-19 Pandemic

OBJECTIVES

Our objective was to understand the perspectives of current and recently graduated pediatric residents concerning the impact of the COVID-19 pandemic, and subsequent curriculum changes, to their education.

INTRODUCTION

Residency programs have experienced unprecedented alterations to education in the form of changing expectations, schedules, and opportunities during the COVID-19 pandemic. Little is known regarding resident perceptions of how these changes impact their education and ultimate career preparation.

METHODS

An anonymous and voluntary electronic IRB exempt survey was sent to pediatric residents at a mid-sized residency program in the mid-Atlantic in August of 2020. This cross-sectional study survey consisted of a series of multiple choice questions with optional short answer responses.

RESULTS

Twenty-two pediatric residents across all training years completed the survey for a response rate of 36%. The majority of residents, 59.1%, were interested in directly caring for COVID + patients; however, the minority (36%) felt prepared to care for COVID + patients. Most residents (63%) responded that graduate medical education programs should not have authority to exclude residents from taking care of patients with certain diagnoses and 95% of respondents indicated that they would prefer an opt out system instead.

CONCLUSION

The majority of resident respondents had a strong interest in caring for COVID + patients and report that they value frequent updates from program leadership to guide their patient care. Residents also overwhelmingly support an opt out system when caring for future patients with particular infectious diagnoses rather than a mandated exclusion approach.

Congenital Heart Surgery Training Experiences and Perceptions Among Cardiothoracic Surgery Residents

Interest and core training in congenital heart surgery (CHS) has not been characterized among current cardiothoracic surgical trainees. This study aimed to evaluate perceptions, interest, exposure, and experience among current trainees. A 22 question survey was distributed to all cardiothoracic surgical trainees in ACGME-accredited thoracic surgery residencies. Questions included demographics, exposure to CHS during, perceptions of, participation in and quality assessment of CHS training. There were 106 responses (20.1% response rate) of which 31 (29.0%) were female and 87 (81.3%) were cardiothoracic track. While 69 (64.5%) reported having an interest in CHS at some point during training, only 24 (22.4%) were actively pursuing CHS. All but 7 (6.5%) residents reported having easy access to congenital mentorship, with 35 (32.7%) actively participating in CHS research. Three months was the median duration of congenital rotations. Residents reported less operative participation on CHS compared to adult cardiac surgery. Several residents noted the need for earlier exposure and increased technical/operative experience as areas in need of improvement. The most cited primary influences to pursue CHS included: mentorship, breadth of pathology, and technical nature of the specialty. Lack of consistent job availability and length of additional training were reported as negative influences. Cardiothoracic residents report adequate exposure to obtain case requirements and knowledge for board examinations in CHS but highly variable operative involvement. Mentorship and early exposure remain important for those interested in CHS, while additional training time and limited job availability remain hurdles to CHS.

Multicenter retrospective cohort Italian study on elective laparoscopic cholecystectomy performed by the surgical residents

PURPOSE

This retrospective multicenter cohort study aimed to evaluate the clinical outcomes (mortality rate, operative time, complications) of elective laparoscopic cholecystectomy (LC) when performed by a surgical resident in comparison to experienced consultant in the backdrop of Italian academic centers.

METHODS

Retrospective review of all patients undergoing elective LC between January 2016 and January 2022 at six teaching hospitals across Italy was performed. Cases were identified using the Current Procedural Terminology (CPT) code 5123 (LC without cholangiogram). All cases of emergency surgery, ASA score > 3, or when cholecystectomy was performed with another surgical procedure, were excluded. All suitable cases were divided into 2 groups based on primary surgeon: consultant or senior resident. Main outcome was complication rates (intraoperative and peri/postoperative); secondary outcomes included operative time, the length of stay, and the rate of conversion to open.

RESULTS

A total of 2331 cases (1425 females) were included, of which, consultants performed 1683 LCs (72%), while the residents performed 648 (28%) surgeries. The groups were statistically comparable regarding demographics, history of previous abdominal surgery, operative time, or intraoperative complications. The rate of conversion to open cholecystectomy was 1.42% for consultant and none for resident (p = 0.02). A statistically significant difference was observed between groups regarding the average length of stay (2.2 ± 3 vs 1.6 ± 1.3 days p = 0.03). Similarly, postoperative complications (1.7% vs 0.5%) resulted in statistically significant (p = 0.02) favoring resident group.

CONCLUSIONS

Our study demonstrates that in selected patients, senior residents can safely perform LC when supervised by senior staff surgeons.

Declining commercial market share in facial reconstructive surgery: Implications for academic plastic surgery and training future generations

BACKGROUND

As a surgical discipline without anatomic boundaries, plastic surgery overlaps with several other specialties. This study aims to measure longitudinal trends in the proportion of commercially reimbursed procedures performed by plastic surgeons compared to other specialists. We hypothesize that there is encroachment in commercial market share by anatomically defined subspecialists within otolaryngology, ophthalmology, and dermatology.

METHODS

The IBM® MarketScan® Research Databases were queried to extract patients who underwent rhinoplasty, eyelid procedures, and skin cancer reconstruction covered by commercial insurance from 2007 to 2016 in the USA. Surgeon specialty was identified. Poisson regression modeled predictors of provider specialty for each procedure over time, adjusting for patient gender, region, facility setting, and diagnosis.

RESULTS

A total of 430,472 rhinoplasty, eyelid, and skin cancer procedures were performed during the study period. For each year, the proportion of cases performed by plastic surgeons decreased by 2.1% for rhinoplasty compared to otolaryngologists, 2.0% for eyelid procedures compared to ophthalmologists, and 3.0% for skin cancer reconstruction compared to dermatologists (p<0.001). Plastic surgeons were less likely to perform the procedure if the underlying diagnosis or preceding procedure drew from referral bases of "anatomic" specialists, such as sinonasal disease for otolaryngologists (incidence rate ratio [IRR] 0.829), disorders of the eyelid or orbit for ophthalmologists (IRR 0.646), and Mohs excision for dermatologists (IRR 0.381) (p<0.001).

CONCLUSIONS

Plastic surgeons are losing ground on commercially reimbursed facial reconstructive procedures historically performed by the specialty. Plastic surgeons must develop strategies to preserve the commercial market share of these procedures and avoid compromise to academic centers and resident education.