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Liu X, Xiao W, Yang Y, Yan Y, Liang F. Augmented reality technology shortens aneurysm surgery learning curve for residents. Comput Assist Surg (Abingdon) 2024; 29:2311940. [PMID: 38315080 DOI: 10.1080/24699322.2024.2311940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVES We aimed to prospectively investigate the benefit of using augmented reality (AR) for surgery residents learning aneurysm surgery. MATERIALS AND METHODS Eight residents were included, and divided into an AR group and a control group (4 in each group). Both groups were asked to locate an aneurysm with a blue circle on the same screenshot after their viewing of surgery videos from both AR and non-AR tests. Only the AR group was allowed to inspect and manipulate an AR holographic representation of the aneurysm in AR tests. The actual location of the aneurysm was defined by a yellow circle by an attending physician after each test. Localization deviation was determined by the distance between the blue and yellow circle. RESULTS Localization deviation was lower in the AR group than in the control group in the last 2 tests (AR Test 2: 2.7 ± 1.0 mm vs. 5.8 ± 4.1 mm, p = 0.01, non-AR Test 2: 2.1 ± 0.8 mm vs. 5.9 ± 5.8 mm, p < 0.001). The mean deviation was lower in non-AR Test 2 as compared to non-AR Test 1 in both groups (AR: p < 0.001, control: p = 0.391). The localization deviation of the AR group decreased from 8.1 ± 3.8 mm in Test 2 to 2.7 ± 1.0 mm in AR Test 2 (p < 0.001). CONCLUSION AR technology provides an effective and interactive way for neurosurgery training, and shortens the learning curve for residents in aneurysm surgery.
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Affiliation(s)
- Xinman Liu
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Weiping Xiao
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yibing Yang
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yan Yan
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Feng Liang
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
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Hoshijima H. In reply: Initial clinical experience may influence tracheal intubation success rates with indirect laryngoscopy among novice operators. Can J Anaesth 2024; 71:678. [PMID: 38570414 DOI: 10.1007/s12630-024-02757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
- Hiroshi Hoshijima
- Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Miyagi, Japan.
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Çalım-Gürbüz B, Güvendir İ, Söylemez-Akkurt T, Gürbüz G, Erdoğan-Durmuş Ş. The Journey of Material From Clinic to Pathology Laboratory: How Much Do Clinical Residents Know About This Process? Int J Surg Pathol 2024; 32:462-469. [PMID: 37437129 DOI: 10.1177/10668969231185090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Introduction. Pathology plays a major role in the management of patients. Specimen delivery to a pathology laboratory is the first step in the process. Sending materials to the pathology laboratory should be included as part of residency training. The aim of this study was to determine the level of knowledge and daily practice of residents who send materials to pathology laboratory. Methods. A 34-item questionnaire asking questions about biopsy/resection and cytology material handling and transportation was answered by 154 residents. Likert scaling and multiple-choice questions with a single answer were used to evaluate the responses. Their daily routines and levels of knowledge were statistically analyzed. Results. The mean age of the respondents was 29.1 ± 3.04 (range: 24-42 years), and 63% of the residents were male. The residents of the university hospital claimed that the clinical information they had learned about transferring material to the pathology laboratory was "sufficient" or "very sufficient" (statistically significant, P = .04). Correct answers about the process of sending biopsy/resection materials of experienced residents were statistically higher, while there was no statistical significance for questions about cytology materials (P = .005, P = .24, respectively). Conclusion. The pathway to correct diagnosis builds on an understanding of the significance of pathology material. In residency training, knowledge about delivering biopsy/resection material to pathology laboratory is mostly acquired through experience. Experienced residents seem to be less familiar with cytology materials. Clinicopathological meetings may solve the main problems, but both clinics and pathology departments need to emphasize this process.
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Affiliation(s)
- Begüm Çalım-Gürbüz
- Basaksehir Cam and Sakura City Hospital, Pathology Department, Istanbul, Turkey
| | - İrem Güvendir
- Umraniye Training and Research Hospital, Pathology Department, Istanbul, Turkey
| | | | - Gökhan Gürbüz
- Istanbul Bahcelievler State Hospital, Otorhinolaryngology Department, Istanbul, Turkey
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Behal ML, Fields PE, Cook AM, Morgan RJ, Flannery AH. Publication of pharmacy resident research projects: A systematic review and meta-analysis. Am J Health Syst Pharm 2024:zxae091. [PMID: 38530288 DOI: 10.1093/ajhp/zxae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Indexed: 03/27/2024] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Pharmacy residents often aspire to develop research skills through conducting a research project. Project publication rates among pharmacy residents are variable and at times low; however, previous studies have been limited to specific geographic regions and timeframes. This study sought to conduct a systematic review and meta-analysis to determine the proportion of pharmacy resident research projects published in the peer-reviewed literature. METHODS A systematic review of PubMed MEDLINE, Embase, and the Web of Science Core Collection was performed from database inception to May 25, 2023. Articles were included if they were full-text, peer-reviewed manuscripts of original research presenting observational data regarding pharmacy resident research project publication rates. Data extraction and assessment of risk of bias were conducted by 2 independent reviewers. A proportional meta-analysis using a random effects model of the included studies was conducted to generate a pooled, overall proportion. RESULTS The search yielded 5,225 records and 12 articles that met the inclusion criteria. All studies were retrospective and observational. Risk of selection and cohort identification biases was "high," whereas that of detection and timeframe biases was "low." The included studies represented 6,990 resident research projects, 777 of which were published in the peer-reviewed literature. Publication rates across individual studies ranged from 1.8% to 36.2%. The pooled proportion (scale of 0 to 1) of projects published was 0.13 (0.09-0.19). CONCLUSION Pharmacy resident research project publication rates are low at 13%. Furthermore, studies reporting project publication rates over time suggest a neutral or negative trend in publication rates despite an exponential increase in the number of pharmacy residents.
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Affiliation(s)
- Michael L Behal
- Acute Care Pharmacy Services, University of Kentucky Healthcare, Lexington, KY, and Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Paige E Fields
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA
| | - Aaron M Cook
- Acute Care Pharmacy Services, University of Kentucky Healthcare, Lexington, KY, and Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Rebecca J Morgan
- Medical Center Library, University of Kentucky Libraries, Lexington, KY, USA
| | - Alexander H Flannery
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA
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Fomina AV, Matytsin AA, Almadani AHA. [The studying of public health and health care as obligatory component of program of residency training]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2024; 32:246-251. [PMID: 38640220 DOI: 10.32687/0869-866x-2024-32-2-246-251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/02/2023] [Indexed: 04/21/2024]
Abstract
The article considers the teaching of the discipline "Public Health and Health Care" to residents of all specialties. For analyzing attitude of residents to studying the discipline "Public Health and Health Care", as well as improvement of training physicians at the stage of residency and their full mastery of necessary competencies, survey was carried out on sampling of 424 residents of the second (graduate) year of training. The number of questions were formulated to be included into questionnaire to obtain data about respondents (age, gender, region of study, citizenship, experience of working at medical position) and to identify their attitude to the study of the discipline "Public Health and Health Care" " in residency (sections of program as practically applicable, assessment of form of teaching the discipline and use of educational technologies, including remote and digital learning, choice of universal and general professional competencies). The majority of residents (65.1%) plan to be engaged not only in direct clinical activities in the future, but also to undergo additional training in health care management and work in positions related to organizational managerial activities from position of head of department to of head of medical organizations and administration of regional health care services.
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Affiliation(s)
- A V Fomina
- The Federal State Autonomous Educational Institution of Higher Education "The Patrice Lumumba Peoples' Friendship University of Russia" of Minobrnauka of Russia, 117198, Moscow, Russia,
| | - A A Matytsin
- The Federal State Budget Educational Institution of Higher Education "The Kursk State Medical University" of Minzdrav of Russia, 305041, Kursk, Russia
| | - Ali Hussein Ali Almadani
- The Federal State Autonomous Educational Institution of Higher Education "The Patrice Lumumba Peoples' Friendship University of Russia" of Minobrnauka of Russia, 117198, Moscow, Russia
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Wang J, Shi W, Huang X, Jiao Y. The prevalence of imposter syndrome and associated factors in Chinese medical students and residents: A single-center pilot study. Med Teach 2024; 46:380-386. [PMID: 37722837 DOI: 10.1080/0142159x.2023.2256955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
PURPOSE Here we aimed to define the prevalence of imposter syndrome (IS) and identify associated characteristics in Chinese medical students and residents enrolled at Peking Union Medical College Hospital (PUMCH). METHODS This was a single-center, cross-sectional study of medical students and residents enrolled at PUMCH conducted in September and October 2022. Participants were recruited to complete a 37-question survey on demographics, a Chinese version of the Clance Imposter Phenomenon Scale (CIPS), and self-assessments of anxiety, depression, burnout, sleep quality, challenges of clinical learning, and time allocation. IS prevalence and its associated factors were analyzed. RESULTS One hundred and forty-eight medical students and 89 residents completed the survey. IS was significant or severe in 62.8% of medical students and 57.2% of residents. Students enrolled in the eight-year program had significantly higher CIPS scores than those enrolled in the 4 + 4 program (66.4 vs. 60.7, p = .005). There were no gender differences in IS prevalence and severity. Participants with severe IS had significantly higher self-rated anxiety, depression, insomnia, and burnout than participants with mild/moderate IS. Participants significantly challenged by clinical learning had significantly higher CIPS scores. CONCLUSIONS IS is both prevalent and severe in Chinese medical students and residents. Classroom learning, an eight-year program, and being challenged by clinical learning are potentially associated with IS.
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Affiliation(s)
- Jingqiao Wang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China MD program
| | - Wen Shi
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoming Huang
- Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yang Jiao
- Department of General Practice (General Internal Medicine), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Prucnal CK. Scenes from a Sunday. Acad Emerg Med 2024; 31:308. [PMID: 37777850 DOI: 10.1111/acem.14812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Christiana K Prucnal
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Shikino K, Nishizaki Y, Fukui S, Yokokawa D, Yamamoto Y, Kobayashi H, Shimizu T, Tokuda Y. Development of a Clinical Simulation Video to Evaluate Multiple Domains of Clinical Competence: Cross-Sectional Study. JMIR Med Educ 2024; 10:e54401. [PMID: 38421691 PMCID: PMC10940988 DOI: 10.2196/54401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/14/2023] [Accepted: 01/28/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Medical students in Japan undergo a 2-year postgraduate residency program to acquire clinical knowledge and general medical skills. The General Medicine In-Training Examination (GM-ITE) assesses postgraduate residents' clinical knowledge. A clinical simulation video (CSV) may assess learners' interpersonal abilities. OBJECTIVE This study aimed to evaluate the relationship between GM-ITE scores and resident physicians' diagnostic skills by having them watch a CSV and to explore resident physicians' perceptions of the CSV's realism, educational value, and impact on their motivation to learn. METHODS The participants included 56 postgraduate medical residents who took the GM-ITE between January 21 and January 28, 2021; watched the CSV; and then provided a diagnosis. The CSV and GM-ITE scores were compared, and the validity of the simulations was examined using discrimination indices, wherein ≥0.20 indicated high discriminatory power and >0.40 indicated a very good measure of the subject's qualifications. Additionally, we administered an anonymous questionnaire to ascertain participants' views on the realism and educational value of the CSV and its impact on their motivation to learn. RESULTS Of the 56 participants, 6 (11%) provided the correct diagnosis, and all were from the second postgraduate year. All domains indicated high discriminatory power. The (anonymous) follow-up responses indicated that the CSV format was more suitable than the conventional GM-ITE for assessing clinical competence. The anonymous survey revealed that 12 (52%) participants found the CSV format more suitable than the GM-ITE for assessing clinical competence, 18 (78%) affirmed the realism of the video simulation, and 17 (74%) indicated that the experience increased their motivation to learn. CONCLUSIONS The findings indicated that CSV modules simulating real-world clinical examinations were successful in assessing examinees' clinical competence across multiple domains. The study demonstrated that the CSV not only augmented the assessment of diagnostic skills but also positively impacted learners' motivation, suggesting a multifaceted role for simulation in medical education.
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Affiliation(s)
- Kiyoshi Shikino
- Department of Community-Oriented Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Yuji Nishizaki
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Sho Fukui
- Department of Emergency and General Medicine, Kyorin University, Tokyo, Japan
| | - Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Hiroyuki Kobayashi
- Department of Internal Medicine, Mito Kyodo General Hospital, Tsukuba, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Yasuharu Tokuda
- Muribushi Okinawa Center for Teaching Hospitals, Okinawa, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
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Agarwal AK, Gonzales R, Scott K, Merchant R. Investigating the Feasibility of Using a Wearable Device to Measure Physiologic Health Data in Emergency Nurses and Residents: Observational Cohort Study. JMIR Form Res 2024; 8:e51569. [PMID: 38386373 PMCID: PMC10921319 DOI: 10.2196/51569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/20/2023] [Accepted: 01/07/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Emergency departments play a pivotal role in the US health care system, with high use rates and inherent stress placed on patients, patient care, and clinicians. The impact of the emergency department environment on the health and well-being of emergency residents and nurses can be seen in worsening rates of burnout and cardiovascular health. Research on clinician health has historically been completed outside of clinical areas and not personalized to the individual. The expansion of digital technology, specifically wearable devices, may enhance the ability to understand how health care environments impact clinicians. OBJECTIVE The primary objective of this pilot study was to assess the feasibility and acceptability of using wearable devices to measure and record physiologic data from emergency nurses and resident physicians. Understanding strategies that are accepted and used by clinicians is critical prior to launching larger investigations aimed at improving outcomes. METHODS This was a longitudinal pilot study conducted at an academic, urban, level 1 trauma center. A total of 20 participants, including emergency medicine resident physicians and nurses, were equipped with a wearable device (WHOOP band) and access to a mobile health platform for 6 weeks. Baseline surveys assessed burnout, mental health, and expectations of the device and experience. Participants provided open-ended feedback on the device and platform, contributing to the assessment of acceptance, adoption, and use of the wearable device. Secondary measures explored early signs and variations in heart rate variability, sleep, recovery, burnout, and mental health assessments. RESULTS Of the 20 participants, 10 consistently used the wearable device. Feedback highlighted varying experiences with the device, with a preference for more common wearables like the Apple Watch or Fitbit. Resident physicians demonstrated higher engagement with the device and platform as compared with nurses. Baseline mental health assessments indicated mild anxiety and depressive symptoms among participants. The Professional Fulfillment Index revealed low professional fulfillment, moderate workplace exhaustion, and interpersonal disengagement. CONCLUSIONS This pilot study underscores the potential of wearable devices in monitoring emergency clinicians' physiologic data but reveals challenges related to device preferences and engagement. The key takeaway is the necessity to optimize device and platform design for clinician use. Larger, randomized trials are recommended to further explore and refine strategies for leveraging wearable technology to support the well-being of the emergency workforce.
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Affiliation(s)
- Anish K Agarwal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Center for Health Care Transformation and Innovation, Penn Medicine, Philadelphia, PA, United States
| | - Rachel Gonzales
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Center for Health Care Transformation and Innovation, Penn Medicine, Philadelphia, PA, United States
| | - Kevin Scott
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Raina Merchant
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Center for Health Care Transformation and Innovation, Penn Medicine, Philadelphia, PA, United States
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Khan EK, Lockspeiser TM, Meier M, Liptzin DR, Baker CD. Improved tracheostomy-dependent patient outcomes after implementation of the Pediatric Resident Education in Pulmonary (PREP) Boot Camp. Pediatr Pulmonol 2024. [PMID: 38372490 DOI: 10.1002/ppul.26925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Children with tracheostomies are high risk for morbidity and mortality. Pediatric resident physicians are not routinely taught skills to care for this vulnerable patient population. Few reports link educational interventions to improved patient outcomes. This study evaluates the impact of an intensive educational training program on pediatric residents' observed skills and tracheostomy-dependent patient outcomes. METHODS Pediatric post-graduate year 2 (PGY2) resident physicians rotating through the inpatient pediatric pulmonology month at Children's Hospital Colorado July 2018-2019 participated in the Pediatric Resident Education in Pulmonary (PREP) Boot Camp, an intensive educational program with an interactive lecture and simulation experience on patients with tracheostomy-dependence. PGY2s who partook in PREP and PGY3s who rotated before PREP initiation were invited to be studied. Primary outcomes included: (1) resident skills assessed by direct observation during simulation encounters and (2) rates of intensive care unit (ICU) transfers in tracheostomy-dependent patients following acute events before and after introduction of PREP. We hypothesized that increased education would enhance resident skills and improve patient outcomes by decreasing the rate of ICU transfers. RESULTS PGY2 residents retained skills learned during PREP up to 11 months following initial participation, and significantly outperformed their PGY3 counterparts. There was a significant decrease in ICU transfer rate in patients with tracheostomies admitted to the pulmonary team during the 19 months following initiation of PREP. CONCLUSIONS Enhanced early education may improve resident physicians' ability to care for complex patients with tracheostomies and could improve outcomes in this high-risk population.
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Affiliation(s)
- Erin K Khan
- Department of Pediatrics, Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Tai M Lockspeiser
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Maxene Meier
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Deborah R Liptzin
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Christopher D Baker
- Department of Pediatrics, Division of Pulmonology and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Costanza M, Sobieraj J, Wang F. Evaluating Participation in Gender-Affirming Care: Cross-Sectional Analysis of Dermatology Program Websites in the United States. JMIR Dermatol 2024; 7:e54480. [PMID: 38345853 PMCID: PMC10897785 DOI: 10.2196/54480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 03/01/2024] Open
Affiliation(s)
- Marco Costanza
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Jeffrey Sobieraj
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Frank Wang
- University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
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12
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Song X, Ding N, Jiang N, Zhang X, Li H, Wen D. Moral distress from professionalism dilemmas and its association with self-rated professionalism behaviors among Chinese residents. Med Teach 2024:1-10. [PMID: 38329725 DOI: 10.1080/0142159x.2024.2307486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES Residents inevitably witness or participate in a diverse range of professionalism dilemmas. However, few studies have focused on residents' moral distress from professionalism dilemmas and its relationship with residents' professionalism. This study aimed to understand the moral distress that Chinese residents may face after exposure to professionalism dilemmas and to examine the associations between moral distress and residents' perceived fulfillment of professionalism behaviors. METHODS We conducted a cross-sectional survey of residents from four standardized residency training bases in Liaoning Province, China, using stratified cluster sampling. A checklist of professionalism dilemmas, the Moral Distress Scale, and the Behavior-based Medical Professionalism Inventory were used to assess residents' moral distress from professionalism dilemmas and their perceived fulfillment of professionalism behaviors. Descriptive statistics, non-parametric tests, multiple linear regressions, and binary logistic regressions were used to analyze the data. RESULTS A total of 647 (81.1%) residents effectively completed the survey. The proportion of residents suffering from moral distress ranged from 58.4 to 90.6% for different professionalism dilemmas. As the number of professionalism dilemmas associated with moral distress increased, residents reported lower fulfillment of professionalism behaviors (β < 0, p < 0.05). Compared with residents with no distress, residents suffering from distress reported lower fulfillment of professionalism behaviors (OR < 1, p < 0.05). Among residents suffering from distress, as the distress intensity increased, residents reported higher fulfillment of professionalism behaviors (OR > 1, p < 0.05). CONCLUSIONS Residents suffered a wide range of moral distress from professionalism dilemmas, and residents with moral distress reported lower fulfillment of professional behaviors. A responsive reporting system for residents and reflection on role modeling may help residents cope with the negative effects of moral distress and professionalism dilemmas.
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Affiliation(s)
- Xinzhi Song
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, P. R. China
| | - Ning Ding
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, P. R. China
| | - Nan Jiang
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, P. R. China
| | - Xu Zhang
- Department of Public Service, The First Hospital of China Medical University, Shenyang, P. R. China
| | - Honghe Li
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, P. R. China
| | - Deliang Wen
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, P. R. China
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Sevestre A, Dochez V, Souron R, Deschamps T, Winer N, Thubert T. Evaluation Tools for Assessing Autonomy of Surgical Residents in the Operating Room and Factors Influencing Access to Autonomy: A Systematic Literature Review. J Surg Educ 2024; 81:182-192. [PMID: 38160113 DOI: 10.1016/j.jsurg.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/16/2023] [Accepted: 11/01/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Surgical residents in France lack a clear pedagogical framework for achieving autonomy in the operating room. The progressive acquisition of surgical autonomy is a determining factor in the confidence of operators for their future independent practice. Currently, there is no autonomy scale commonly used in Europe. The objective of this study is to identify existing tools for quantifying the autonomy of residents and the factors that influence it. MATERIALS AND METHODS We conducted a qualitative systematic review following the recommendations of the Systematic Review Without Meta-Analysis (SWiM) guidelines. Publications were extracted from the MEDLINE (PubMed), EMBASE, and PSYCINFO databases. All publications without date restrictions up to July 2022 were identified. RESULTS Among the 231 identified publications, 21 met the inclusion criteria. Seventeen publications used a graded autonomy assessment tool by the student and/or the teacher, while 4 used evaluations by an observing third party. We found 8 different autonomy scales, with the Zwisch Scale representing 57.1% of the cases. Factors influencing autonomy were diverse, including the work context, experience, and gender of the resident and their teacher. DISCUSSION We found heterogeneity in the tools used to "measure" the autonomy of a resident in the operating room. The SIMPL tool or the Zwisch Scale appear to be the most frequently used tools. The relationship between autonomy, performance, confidence, and knowledge may require multidimensional tools that encompass various areas of competence, but this could make their daily application more challenging. The factors influencing autonomy are numerous; and understanding them would improve teaching in the operating room. There is a significant lack of data on surgical autonomy in France, as well as a lack of evaluation in the field of gynecology-obstetrics worldwide.
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Affiliation(s)
- Anaïs Sevestre
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
| | - Vincent Dochez
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France.
| | - Robin Souron
- Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
| | - Thibault Deschamps
- Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
| | - Norbert Winer
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, INRAE, Nantes, France
| | - Thibault Thubert
- Nantes Université, CHU Nantes, Service de Gynécologie-Obstétrique, Nantes, France; Nantes Université, CHU Nantes, Movement - Interactions - Performance, Nantes, France
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14
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Morrison AK, Kumar S, Amin A, Urban M, Kleinman B. An Ergonomic Risk Assessment of Ophthalmology Residents Using the Rapid Entire Body Assessment (REBA) Scale. Cureus 2024; 16:e53698. [PMID: 38455825 PMCID: PMC10919067 DOI: 10.7759/cureus.53698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The healthcare industry has one of the highest rates of work-related injuries. Ophthalmologists are at particularly high risk for developing musculoskeletal disorders (MSDs), which are often the result of repetitive movements, such as performing slit lamp examinations. Previous studies used the Rapid Entire Body Assessment (REBA) scale to determine the ergonomic risk of a particular task. Higher REBA scores correlate with increased risk of injury, which ranges from negligible risk (1) to very high risk (11+). OBJECTIVE Given the long-term implications of repetitive examinations by ophthalmologists, this study aims to describe the average ergonomic risk posed to residents using the REBA scale. METHODS This descriptive case study assessed four ophthalmology residents performing slit lamp examinations between September 2022 and February 2023. Photographs were taken of residents performing slit lamp examinations. Total REBA scores, Score A, Score B, and the REBA scores for each participant were calculated and compared. RESULTS The average REBA score across all participants was 4.59 (SD±0.89). The highest score was 7.00 and the lowest was 3.00. The average Score A, representing posture for the head, leg, and trunk, was 3.54 (SD±0.74) and the average Score B, representing posture for the upper arm, lower arm, and wrist, was 3.18 (SD±1.22). CONCLUSION Our study found that residents are at increased risk for developing MSDs. Furthermore, variation in REBA scores between residents indicates that not all residents are at equal ergonomic risk. This highlights an opportunity for ophthalmology residency programs to implement ergonomics training into their curriculum.
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Affiliation(s)
| | | | - Abha Amin
- Ophthalmology, New York Medical College/Westchester Medical Center, Valhalla, USA
| | - Matthew Urban
- Ophthalmology, New York Medical College, Valhalla, USA
| | - Ben Kleinman
- Ophthalmology, New York Medical College, Valhalla, USA
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15
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Burkhardt E, Adeeb N, Terrell D, Proctor C, Musmar B, Griessenauer CJ, Kosty JA, Guthikonda B. Factors impacting neurosurgery residents' operative case volume: a nationwide survey. J Neurosurg 2024; 140:570-575. [PMID: 37542439 DOI: 10.3171/2023.5.jns222861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/30/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Neurological surgery residency remains one of the most competitive and longest specialties in terms of training in medicine. The Accreditation Council for Graduate Medical Education uses residents' case volume throughout residency as one of its measures for the quality of surgical training. The objective was to study the variability of residency case volume among US training programs and to analyze the factors that potentially influence that case volume. METHODS In line with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) guidelines, an online survey regarding department size, case volume, number of residents per year, number of dedicated research years, presence of fellows, and resident case volume by the time of graduation was created using Google Forms and distributed to all neurosurgery residency program directors and coordinators in the US. RESULTS A total of 97 of the 115 programs (84.3%) responded to the survey. Fifteen programs were excluded due to missing data or incomplete resident cohort at the time of the survey, and a total of 82 programs were included in the analysis. The average number of cases performed by residents as lead or senior surgeons by the time of graduation ranged from 900 to 2250 (median 1600 cases). The resident case volume did not have a significant correlation with the program case volume, number of operating attending neurosurgeons, number of residents, number of research years, or presence of fellows. The only factor that impacted the resident case volume was the number of cases performed per faculty. CONCLUSIONS The number of cases performed by residents throughout residency varied significantly between programs. Although other factors play important roles in the quality of training, including autonomy, variation, and complexity of cases, the resident case volume is one of the only measurable factors. This study sheds some light on the factors that potentially influence neurosurgical resident case volume.
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Affiliation(s)
- Edward Burkhardt
- 1Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana; and
| | - Nimer Adeeb
- 1Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana; and
| | - Danielle Terrell
- 1Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana; and
| | - Carlie Proctor
- 1Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana; and
| | - Basel Musmar
- 1Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana; and
| | - Christoph J Griessenauer
- 2Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
| | - Jennifer A Kosty
- 1Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana; and
| | - Bharat Guthikonda
- 1Department of Neurosurgery, Ochsner-Louisiana State University, Shreveport, Louisiana; and
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16
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Yu H, Shahi N, Robert SC, Supersad A, Anishchenko A, Lebel K, Dobson JL, Patlas MN. Characterizing the Variety of Call Structures Across Canadian Diagnostic Radiology Postgraduate Medical Education Programs. Can Assoc Radiol J 2024; 75:187-190. [PMID: 37312499 DOI: 10.1177/08465371231182415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Affiliation(s)
- Hang Yu
- Radiology Resident, University of Manitoba, Winnipeg, MB, Canada
| | - Niharika Shahi
- Radiology Resident, McMaster University, Hamilton ON Canada
| | | | - Alanna Supersad
- Radiology Resident, University of Alberta, Edmonton, AB, Canada
| | | | - Kiana Lebel
- Radiology Resident, Universite de Montreal, Montreal, QC, Canada
| | | | - Michael N Patlas
- Attending Radiologist, McMaster University, Hamilton, ON, Canada
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17
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Adams JK, Marinelli JP, De Jong R, Spear SA, Erbele ID. Modern Trends in Otologic Surgery and Implications for Residency Training. Otolaryngol Head Neck Surg 2024. [PMID: 38251771 DOI: 10.1002/ohn.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Placing a middle ear prosthesis is considered a key competency for the general otolaryngologist, but surgeons struggle to obtain and maintain this skill. The current study aims to characterize pre-coronavirus disease 2019 trends in stapedectomy and ossiculoplasty. STUDY DESIGN Database review. SETTING Tricare beneficiaries are treated at civilian and military facilities. METHODS The Department of Defense beneficiary population of more than nine million persons per year was reviewed for patients undergoing either stapedectomy or ossiculoplasty between 2010 and 2019, identified by the current procedural terminology code. RESULTS A total of 3052 stapedectomies and 7197 ossiculoplasties were performed. Over the 10-year study period, stapedectomy decreased by 23%, with an average annual rate of -2.7% per year (Pearson r = -.91, P = .0003). Ossiculoplasties declined by 18%, an average annual rate of -1.9% (r = -.8, P = .006). In combination, cases declined by 20%, an average annual rate of -2.2% (r = -.87, P = .001). CONCLUSION While declines in stapedectomy surgery have been well reported, here we show steady declines in ossiculoplasty as well. If these trends continue, more cochlear implantations may be performed annually than stapedectomy and ossiculoplasty combined, with cochlear implantation likely to overtake ossicular chain surgery in the near future. These changes in surgical volume have a direct implication on resident education and general otolaryngology expectations after graduation. Strong consideration should be made to replace "Stapedectomy/Ossiculoplasty" as resident key indicator with "Cochlear Implantation," a more professionally meaningful skill.
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Affiliation(s)
- Jason K Adams
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Russell De Jong
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Samuel A Spear
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
- Department of Defense Hearing Center of Excellence, San Antonio, Texas, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Isaac D Erbele
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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18
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Rutsky J, Schumacher D, Mallon D. Relevance, quick hits, and vibe: Features of meaningful teaching and learning during trainee consult interactions. J Hosp Med 2024; 19:24-30. [PMID: 38073059 PMCID: PMC10842903 DOI: 10.1002/jhm.13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND Consults are increasingly frequent in inpatient pediatric services. Consult interactions between trainees provide a rich opportunity for teaching and learning. What constitutes meaningful teaching interactions with trainees has not been described. OBJECTIVE Explore how consulting fellows and residents define "meaningful teaching interactions" associated with inpatient consult interactions. METHODS Four focus groups were conducted with 21 pediatric trainees (11 subspecialty fellows and 10 residents) at one institution. Transcriptions were analyzed using thematic analysis to inductively create categories and themes. RESULTS Five factors define meaningful teaching interactions: (1) Relevance; (2) Quick Hits; (3) Vibe; (4) Face-to-face Interactions; and (5) Timing and Busyness. Meaningful content was described as relevant to current or future patient care. Residents valued content that would enable them to explain the reasoning behind recommendations and think through the next steps. Trainees highlighted brief clinical pearls as superior to longer teaching sessions. The "vibe" between resident and fellow was described as a prerequisite to meaningful teaching and included aspects of interest, receptivity, tone, and attitude. Face-to-face interactions were preferred by many trainees, from initial consults to seeing patients or co-rounding. Timing and workload reflected discordant schedules, including time of day and week, but setting a planned time for teaching was beneficial. CONCLUSION Relevant, bite-sized educational content combined with a good vibe and optimal timing creates a context in which consult fellows can foster meaningful teaching opportunities for residents.
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Affiliation(s)
- Jessica Rutsky
- Department of Pediatrics and Communicable Disease, Division of Pediatric Gastroenterology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor MI 48109, U.S.A
| | - Daniel Schumacher
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio 45229-3026, U.S.A
- Department of Pediatrics, University of Cincinnati College of Medicine, 331 Albert Sabin Way, Cincinnati, Ohio 45229-3026, U.S.A
| | - Daniel Mallon
- Department of Pediatrics, University of Cincinnati College of Medicine, 331 Albert Sabin Way, Cincinnati, Ohio 45229-3026, U.S.A
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center
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Aglio T, Paul TK, Porter A, Bien K, Hashmi SK, Lyman J, Kaye EC. Longitudinal Impact of a Novel Condolence Expression Curriculum. J Palliat Med 2024; 27:90-92. [PMID: 37768836 PMCID: PMC10790550 DOI: 10.1089/jpm.2023.0304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 09/30/2023] Open
Abstract
Background: Pediatric residents lack training in expressing condolences to bereaved families after a child's death. We previously developed a novel curriculum that improved residents' comfort with expressing condolences, and now we report assessment of the longitudinal impact of this curriculum on residents' practices of condolence expression. Methods: We applied Kern's 6-step approach to develop, implement, and evaluate a condolence expression curriculum. Residents completed surveys before, immediately after, and six months after participating in the educational intervention to assess curricular impact over time. Results: Twenty pediatric residents participated in the curriculum. Residents reported an increase in their practice of expressing condolences following participation in the curriculum, as well as appreciation for the value of the intervention. Conclusion: A condolence expression curriculum has potential to increase residents' practice of condolence expression to bereaved families over time. Future work will focus on the impact of curricular dissemination across pediatric residency programs.
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Affiliation(s)
- Taylor Aglio
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Hartford, Connecticut, USA
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Trisha K. Paul
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Amy Porter
- Division of Supportive and Palliative Care, Mass General for Children, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kelly Bien
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Saman K. Hashmi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Joanna Lyman
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Erica C. Kaye
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Ulin L, Bernstein SA, Nunes JC, Gu A, Hammoud MM, Gold JA, Mirza KM. Improving Transparency in the Residency Application Process: Survey Study. JMIR Form Res 2023; 7:e45919. [PMID: 38145482 PMCID: PMC10775039 DOI: 10.2196/45919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/15/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Increasing numbers of residency applications create challenges for applicants and residency programs to assess if they are a good fit during the residency application and match process. Applicants face limited or conflicting information as they assess programs, leading to overapplying. A holistic review of residency applications is considered a gold standard for programs, but the current volumes and associated time constraints leave programs relying on numerical filters, which do not predict success in residency. Applicants could benefit from increased transparency in the residency application process. OBJECTIVE This study aims to determine the information applicants find most beneficial from residency programs when deciding where to apply, by type of medical school education background. METHODS Match 2023 applicants voluntarily completed an anonymous survey through the Twitter and Instagram social media platforms. We asked the respondents to select 3 top factors from a multiple-choice list of what information they would like from residency programs to help determine if the characteristics of their application align with program values. We examined differences in helpful factors selected by medical school backgrounds using ANOVA. RESULTS There were 4649 survey respondents. When responses were analyzed by United States-allopathic (US-MD), doctor of osteopathic medicine (DO), and international medical graduate (IMG) educational backgrounds, respondents chose different factors as most helpful: minimum United States Medical Licensing Examination (USMLE) or Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Step 2 scores (565/3042, 18.57% US-MD; 485/3042, 15.9% DO; and 1992/3042, 65.48% IMG; P<.001), resident hometown region (281/1132, 24.82% US-MD; 189/1132, 16.7% DO; and 662/1132, 58.48% IMG; P=.02), resident medical school region (476/2179, 22% US-MD; 250/2179, 11.5% DO; and 1453/2179, 66.7% IMG; P=.002), and percent of residents or attendings underrepresented in medicine (417/1815, 22.98% US-MD; 158/1815, 8.71% DO; and 1240/1815, 68.32% IMG; P<.001). CONCLUSIONS When applying to residency programs, this study found that the factors that respondents consider most helpful from programs in deciding where to apply differ by educational background. Across all educational groups, respondents want transparency around standardized exam scores, geography, and the racial or ethnic backgrounds of residents and attendings.
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Affiliation(s)
- Lindsey Ulin
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Simone A Bernstein
- Department of Psychiatry, Washington University in St Louis, St Louis, MO, United States
| | - Julio C Nunes
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Alex Gu
- Department of Orthopaedic Surgery, George Washington University School of Medicine, Washington, DC, United States
| | - Maya M Hammoud
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Jessica A Gold
- Department of Psychiatry, Washington University in St Louis, St Louis, MO, United States
| | - Kamran M Mirza
- Department of Pathology and Clinical Laboratories, University of Michigan Medicine, Ann Arbor, MI, United States
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21
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Tangadulrat P, Sono S, Tangtrakulwanich B. Using ChatGPT for Clinical Practice and Medical Education: Cross-Sectional Survey of Medical Students' and Physicians' Perceptions. JMIR Med Educ 2023; 9:e50658. [PMID: 38133908 PMCID: PMC10770783 DOI: 10.2196/50658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/17/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND ChatGPT is a well-known large language model-based chatbot. It could be used in the medical field in many aspects. However, some physicians are still unfamiliar with ChatGPT and are concerned about its benefits and risks. OBJECTIVE We aim to evaluate the perception of physicians and medical students toward using ChatGPT in the medical field. METHODS A web-based questionnaire was sent to medical students, interns, residents, and attending staff with questions regarding their perception toward using ChatGPT in clinical practice and medical education. Participants were also asked to rate their perception of ChatGPT's generated response about knee osteoarthritis. RESULTS Participants included 124 medical students, 46 interns, 37 residents, and 32 attending staff. After reading ChatGPT's response, 132 of the 239 (55.2%) participants had a positive rating about using ChatGPT for clinical practice. The proportion of positive answers was significantly lower in graduated physicians (48/115, 42%) compared with medical students (84/124, 68%; P<.001). Participants listed a lack of a patient-specific treatment plan, updated evidence, and a language barrier as ChatGPT's pitfalls. Regarding using ChatGPT for medical education, the proportion of positive responses was also significantly lower in graduate physicians (71/115, 62%) compared to medical students (103/124, 83.1%; P<.001). Participants were concerned that ChatGPT's response was too superficial, might lack scientific evidence, and might need expert verification. CONCLUSIONS Medical students generally had a positive perception of using ChatGPT for guiding treatment and medical education, whereas graduated doctors were more cautious in this regard. Nonetheless, both medical students and graduated doctors positively perceived using ChatGPT for creating patient educational materials.
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Affiliation(s)
- Pasin Tangadulrat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand
| | - Supinya Sono
- Division of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand
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22
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Strouf Motley H, Kerr B, Sklansky DJ, Eickhoff J, Moreno MA, Babal JC. Parent Perceptions of Trainees in Pediatric Care: Cross-Sectional Study. JMIR Form Res 2023; 7:e46631. [PMID: 38090789 PMCID: PMC10753426 DOI: 10.2196/46631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/22/2023] [Accepted: 11/20/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Clinical experience and progressive autonomy are essential components of medical education and must be balanced with patient comfort. While previous studies have suggested that most patients accept trainee involvement in their care, few studies have focused specifically on the views of parents of pediatric patients or examined groups who may not report acceptance. OBJECTIVE This study aims to understand parental profiles of resident and medical student involvement in pediatric care and to use latent class analysis (LCA) methodology to identify classes of responses associated with parent demographic characteristics. METHODS We used data from a national cross-sectional web-based survey of 3000 parents. The survey used a 5-point Likert scale to assess 8 measures of parent perceptions of residents and medical students. We included participants who indicated prior experience with residents or medical students. We compared responses about resident involvement in pediatric care with responses about student involvement, used LCA to identify latent classes of parent responses, and compared demographic features between the latent classes. RESULTS Of the 3000 parents who completed the survey, 1543 met the inclusion criteria for our study. Participants reported higher mean scores for residents than for medical students for perceived quality of care, comfort with autonomously performing an examination, and comfort with autonomously giving medical advice. LCA identified 3 latent classes of parent responses: Trainee-Hesitant, Trainee-Neutral, and Trainee-Supportive. Compared with the Trainee-Supportive and Trainee-Neutral classes, the Trainee-Hesitant class had significantly more members reporting age <30 years, household income < US $50,000, no college degree, and lesser desire to receive future care at a teaching hospital (all P<.05). CONCLUSIONS Parents may prefer greater clinical autonomy for residents than medical students. Importantly, views associated with the Trainee-Hesitant class may be held disproportionately by members of historically and currently socially marginalized demographic groups. Future studies should investigate underlying reasons for trainee hesitancy in these groups, including the possibility of mistrust in medicine.
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Affiliation(s)
- Haley Strouf Motley
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Bradley Kerr
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Daniel J Sklansky
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Jens Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Megan A Moreno
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Jessica C Babal
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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Lien WC, Lin P, Chang CH, Wu MC, Wu CY. The effect of e-learning on point-of-care ultrasound education in novices. Med Educ Online 2023; 28:2152522. [PMID: 36433837 PMCID: PMC9707377 DOI: 10.1080/10872981.2022.2152522] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Current studies assessed the learning efficacy of e-learning in ultrasound (US) training using questionnaires, or simulation in well-controlled conditions. This study investigates the effect of e-learning on the clinical US performance of the first postgraduate year (PGY-1) residents. METHODS In this prospective observational study, we enrolled PGY-1 and second postgraduate year (PGY-2) residents. The e-learning was introduced on the first day and each PGY-1 was authorized to access the e-learning platform. The point-of-care ultrasound (PoCUS) curriculum for the focused assessment of sonography for trauma (FAST) was conducted on the 7th day for PGY-1 and the objective structured clinical examination (OSCE) followed. The PGY-2 received bedside one-to-one random learning before the study and did not have the authorization to access the e-learning. The FAST examinations performed by the PGY-1 and PGY-2 were collected on the 30th day. The clinical FAST performance was assessed by the instructor not involved in the curriculum and blinded to the use of e-learning, including numbers, image quality, and diagnostic accuracy between PGY-1 e-learning users, non-users, and the PGY-2. RESULTS One hundred and seventy PGY-1 with 736 FAST examinations and 53 PGY-2 residents with 134 examinations were included. Seventy PGY-1 used e-learning with a median time spent of 13.2 mins (IQR, 6.5-21.1 mins) at the first access. The PGY-2 had more PoCUS experience than the PGY-1, however, the 70 e-learning users performed more FAST examinations than the PGY-2 (median [IQR], 4 [2-6] vs. 2 [1-3], p = 0.0004) and had better image quality than the PGY-2 (3 [3-3.2] vs. 3 [2.7-3], p = 0.044). There were no significant differences in the diagnostic accuracy between the PGY-1 and PGY-2. CONCLUSIONS E-learning has a positive effect on US learning. The PGY-1 users had comparable performance with the PGY-2 and even better image acquisition although the PGY-2 had more PoCUS experience. TRIAL REGISTRATION NCT03738033 at ClinicalTrials.gov.
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Affiliation(s)
- Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Phone Lin
- Department of Computer Science & Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Chih-Heng Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Diversion of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Fu-Jen Catholic University Hospital, New Taipei, Taiwan
| | - Meng-Che Wu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Yi Wu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Tofil NM, Gaither SL, Cohen C, Norwood C, Zinkan JL, Raju SS, Rutledge C. Observational Study on the Effect of Duration from Pediatric Advanced Life Support (PALS) Certification on PALS Performance in Pediatric Interns in Simulated Cardiopulmonary Arrest. J Pediatr Intensive Care 2023; 12:271-277. [PMID: 37970138 PMCID: PMC10631835 DOI: 10.1055/s-0041-1731787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/29/2021] [Indexed: 10/20/2022] Open
Abstract
Pediatric advanced life support (PALS) training is critical for pediatric residents. It is unclear how well PALS skills are developed during this course or maintained overtime. This study evaluated PALS skills of pediatric interns using a validated PALS performance score following their initial PALS certification. All pediatric interns were invited to a 45-minute rapid cycle deliberate practice (RCDP) training session following their initial PALS certification from July 2017 to June 2019. The PALS score and times for key events were recorded for participants prior to RCDP training. We then compared performance scores for those who took PALS ≥3 months, between 3 days to 3 months and 3 days after PALS. There were 72 participants, 30 (of 30) in 3 days, 18 in 3 days to 3 months, and 24 in ≥3 months groups (42 total of 52 residents, 81%). The average PALS performance score was 53 ± 20%. There was no significant difference between the groups (3 days, 53 ± 15%; 3 days-3 months, 51 ± 19%; ≥3 months, 54 ± 26%, p = 0.922). Chest compressions started later in the ≥3 months groups compared with the 3 days or ≤3 months groups ( p = 0.036). Time to defibrillation was longer in the 3 days group than the other groups ( p = 0.008). Defibrillation was asked for in 3 days group at 97%, 73% in 3 days to 3 months and 68% in ≥3 months groups. PALS performance skills were poor in pediatric interns after PALS certification and was unchanged regardless of when training occurred. Our study supports the importance of supplemental resuscitation training in addition to the traditional PALS course.
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Affiliation(s)
- Nancy M. Tofil
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Stacy L. Gaither
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Charli Cohen
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Carrie Norwood
- Children's of Alabama, Pediatric Simulation Center, Birmingham, Alabama, United States
| | - Jerry Lynn Zinkan
- Children's of Alabama, Pediatric Simulation Center, Birmingham, Alabama, United States
| | - Sai S. Raju
- Department of Pediatrics, University of Texas at Austin, Austin, Texas, United States
| | - Chrystal Rutledge
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Guldner G, Wells J, Ayutyanont N, Iyengar R, Sprenger S, Siegel JT, Kashyap R. COVID-19 related disruptions to medical education and perceived clinical capability of new resident physicians: a nationwide study of over 1200 first-year residents. Med Educ Online 2023; 28:2143307. [PMID: 36369921 PMCID: PMC9665094 DOI: 10.1080/10872981.2022.2143307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic transformed the final year of undergraduate medical education for thousands of medical students across the globe. Out of concern for spreading SARS-CoV-2 and conserving personal protective equipment, many students experienced declines in bedside clinical exposures. The perceived competency of this class within the context of the pandemic is unclear. We designed and distributed a survey to measure the degree to which recent medical school graduates from the USA felt clinically prepared on 13 core clinical skills. Of the 1283 graduates who matched at HCA Healthcare facilities, 90% (1156) completed the survey. In this national survey, most participants felt they were competent in their clinical skills. However, approximately one out of four soon-to-be residents felt they were clinically below where they should be with regard to calling consultations, performing procedures, and performing pelvic and rectal exams. One in five felt they were below where they should be with regard to safely transitioning care. These perceived deficits in important skill sets suggest the need for evaluation and revised educational approaches in these areas, especially when traditional in-person practical skills teaching and practice are disrupted.
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Affiliation(s)
- Gregory Guldner
- Graduate Medical Education, HCA Healthcare, Brentwood, TN, USA
| | - Jessica Wells
- Graduate Medical Education, HCA Healthcare, Brentwood, TN, USA
| | | | - Rahul Iyengar
- Southern Hills Medical Center, TriStar Division, HCA Healthcare, Nashville, TN, USA
| | - Steven Sprenger
- Tristar Centennial Medical Center, HCA Healthcare, Nashville, TN, USA
| | - Jason T. Siegel
- Department of Behavioral and Organizational Science, Claremont Graduate University, Claremont, CA, USA
| | - Rahul Kashyap
- Tristar Centennial Medical Center, HCA Healthcare, Nashville, TN, USA
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Tungsupreechameth A, Tanpowpong P, Puranitee P. Mistreatment in paediatric residency programs in Thailand: a national survey. Med Educ Online 2023; 28:2220176. [PMID: 37270793 DOI: 10.1080/10872981.2023.2220176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/03/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND AIMS Mistreatment in the learning environment is associated with adverse outcomes for residents. Most studies with that regard have been performed in western countries which may have different socio-cultural background and educational and training systems than the non-Western Asian countries. This study aimed (1) to determine the national prevalence of mistreatment in Thai paediatric residents and a correlation with the risk for burnout and other factors and (2) to launch a mistreatment awareness program (MAP) in our training program. METHODS The study was divided into two phases. Phase 1, an online survey of mistreatment-related questions, was sent to current paediatric residents across the country. Burnout and depression were also self-evaluated by formal screening questions. The results were categorized by the Negative Acts Questionnaire-Revised into five domains of mistreatment: workplace learning-related bullying (WLRB), person-related bullying (PRB), physically intimidating bullying, sexual harassment, and ethnic harassment. Frequent mistreated exposure was defined as if mistreatment occurred >1/week. Phase 2, MAP was conducted by distributing the results of the first phase with some examples of mistreatment events and mistreatment-related videos. After 3 months, at our centre, the survey was resent to evaluate mistreatment. RESULTS The response rate was 27% (n = 140). We found that 91% experienced ≥1 mistreated situation in the prior 6 months. Most mistreatment domains were WLRB and PRB, and residents were commonly instigated by clinical faculty and nurses. Most (84%) mistreated residents did not report the events. An association between frequent mistreated exposure and burnout was also found (P < 0.001). For Phase 2, the mistreated situations especially the WLRB and PRB domains dropped after the launch of MAP. CONCLUSIONS Thai paediatric residents frequently perceive mistreatment in their learning environment. Specific aspects of mistreatment, such as WLRB and PRB, should be carefully explored and managed through particular groups of instigators.
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Affiliation(s)
| | - Pornthep Tanpowpong
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongtong Puranitee
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Leavitt J, Hager M, Edgerton C, Hooks WB, Hope W. Educating Residents in Abdominal Wall Closure: An Overview. J Abdom Wall Surg 2023; 2:12159. [PMID: 38312420 PMCID: PMC10831644 DOI: 10.3389/jaws.2023.12159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/22/2023] [Indexed: 02/06/2024]
Abstract
Background and Aims: Incisional hernia prevention has become an important concept for surgeons operating on the abdominal wall. Several techniques have been proposed to help decrease incisional hernia formation with suture closure of the abdominal wall being one of the cornerstones. Technical details that have been reported to decrease incisional hernia rates include achieving a 4:1 Suture to Wound length ratio and the use of a small bites technique. Despite evidence to support many of these techniques there appears to be a gap in practice patterns amongst practicing surgeons. Introducing and promoting these principles in surgical residency may help to close this gap. This paper reviews our experience with surgical training for abdominal wall closures at our institution. Materials and Methods: Programs and projects related to abdominal wall closure were reviewed from our institution from 2010-Present. Type of project, intervention, and impact on education was evaluated and summarized. Results: Seven projects were identified relating to surgical training and abdominal wall closure. Three projects dealt with skills training using an abdominal wall simulation model and related to suturing techniques. Two projects were clinical studies focused on suture to wound length ratios and improving outcomes with this variable in a residency training program. Two projects dealt with models relating to abdominal wall closure and education. Conclusion: Implementation of educational programs in surgical residency programs can lead to improvements in technique and knowledge around abdominal wall closure and help in research endeavors.
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Affiliation(s)
| | | | | | | | - William Hope
- Department of Surgery, Novant Health New Hanover Regional Medical Center, Wilmington, NC, United States
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Jalolova M, Jankovic D, Sasaki K, Tanaka R, Kato Y. Simulation-Based Bypass Training and Learning Curves- Resident Experience. Asian J Neurosurg 2023; 18:773-776. [PMID: 38161618 PMCID: PMC10756769 DOI: 10.1055/s-0043-1775859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Introduction Bypass surgery is a challenging operative procedure that requires surgical excellence. Achieving the skills required for vascular surgery is difficult to master in the operating room without intensive microsurgical training. Various models have been developed to provide training to young neurosurgeons and increase dexterity and patient safety. Bypass surgery requires complex microsurgical techniques. Methods Microanastomosis training was performed on plastic tubes and chicken wings for 2 months. Each microanastomosis was evaluated by a senior author. Results An improvement in the quality and patency of microanastomosis was observed. Conclusion Microsurgical simulation training can contribute to the improvement of surgical skills and dexterity.
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Affiliation(s)
- Mohira Jalolova
- Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan
- Republican Scientific Center of Neurosurgery, Tashkent Medical Academy, Uzbekistan
| | - Dragan Jankovic
- Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany
- Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia
| | - Kento Sasaki
- Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan
| | - Riki Tanaka
- Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan
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Ore AS, Liu BS, Chen HW, Kent TS, Parsons CS, Narula N. General Surgery Trainee Cases Over Time: Postgraduate Year Matters. Am Surg 2023; 89:5325-5331. [PMID: 36564886 DOI: 10.1177/00031348221146932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Trainees and attending surgeons alike have concerns about resident and fellow operative volume/breadth, competency, and overall readiness for practice. This is an important topic within surgical graduate medical education. Our goal was to analyze the change in general surgery trainee operative experience over time by postgraduate year. METHODS Institutional operative records from two corresponding three-month time periods in 2009 and 2018 at the residency program's main hospital site were reviewed. Cases assisted on by general, vascular, or thoracic surgery trainees were included. The number of cases per level, combination of trainees in each case, and categories of cases were compared over time. RESULTS There were 1940 cases in 2009 and 1967 cases in 2018 over the respective time periods. The distribution of trainees was different (P < .001), with a similar number of PGY-1 and fellow cases, a decrease in PGY-2 and PGY-5 cases, and an increase in PGY-3 and PGY-4 cases. The number of cases with two trainees, double scrubbed cases, increased from 19.6% to 26.8% (P < .001). In addition, there were differences in the resident years that double scrubbed cases together, an increase in robotic and endovascular surgery, and a decrease in open cases. CONCLUSIONS This analysis of cases shows that resident operative volume over approximately a decade has been largely preserved, with some change in the distribution of cases based on trainee level, an increase in cases with more than one trainee, and a rise of minimally invasive surgery with a corresponding decrease in open cases.
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Affiliation(s)
- Ana Sofia Ore
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Betty S Liu
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hao W Chen
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Charles S Parsons
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Nisha Narula
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Sahiti Q, Shearer C, Thomson C, Sutherland L, Bowes D. Addressing medical resident mistreatment: A resident-centred approach. Med Teach 2023:1-7. [PMID: 37972586 DOI: 10.1080/0142159x.2023.2279903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Mistreatment negatively impacts the wellbeing of medical learners and is related to worse patient outcomes and team functioning. Resident perspectives on improving mistreatment reporting structures and investigations have not been explored. We aimed to understand residents' views on safe reporting structures, investigations, and resolution processes. METHOD We conducted an exploratory sequential mixed method study beginning with a series of qualitative interviews to inform an anonymous online survey to all Dalhousie University residents (N = 645). RESULTS When interviewed, residents (N = 10) discussed personal experiences with mistreatment, barriers to reporting, and how these processes could better serve them. Themes from the interviews were imbedded in an anonymous online survey to explore their prevalence among a larger group. Residents (N = 120; 19%) completed the online survey and revealed that mistreatment was very common yet underreported. Barriers to reporting included confidentiality concerns, perceptions that reporting would not change anything, and fear of retaliation. Desired outcomes for perpetrators depended on the perpetrator's position and incident severity, and most prefer a remedial approach. CONCLUSION Resident mistreatment remains prevalent and current processes of dealing with reports may be inadequate. Residents have thoughtful insights for improving institutional policies and procedures and should be meaningfully engaged.
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Affiliation(s)
| | - Cindy Shearer
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Postgraduate Medical Education, Dalhousie University, Halifax, Canada
| | - Carolyn Thomson
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Postgraduate Medical Education, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Family Medicine, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Office of Resident Affairs, Dalhousie University, Halifax, Canada
| | - Lisa Sutherland
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Office of Resident Affairs, Dalhousie University, Halifax, Canada
| | - David Bowes
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Postgraduate Medical Education, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Radiation Oncology, Dalhousie University, Halifax, Canada
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Arany S, Eliav E, Medina-Walpole A, Caprio TV. Postgraduate dental resident education: A pilot in age-friendly "mentation" training. Spec Care Dentist 2023; 43:765-771. [PMID: 37147183 DOI: 10.1111/scd.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Postdoctoral dental education in caring for older adults lacks didactic and clinical training in mentation topics, one of the core elements of the Age-Friendly Health Systems (AFHS) framework. Our primary goal was to launch a pilot project in clinical geriatrics focusing on older adults' mentation concerns, with a secondary goal to improve dental residents' confidence and competence in dental care and oral health. BACKGROUND Age-friendly care elements are not routinely incorporated into the dental education of residents caring for older adults with cognitive impairment or dementia. Therefore, we implemented a pilot educational project, providing the missing educational opportunity for residents in geriatric training covering cognitive impairment and focusing on Alzheimer's disease and related dementias. MATERIALS AND METHODS We designed educational sessions through a needs assessment, focus group discussions, and expert validation. We developed three e-Learning modules covering mentation concerns and dementia screening. We tested the modules in a pilot study of 15 dental postdoctoral residents as an essential part of their clinical practice. RESULTS The dementia dental learning module increased the residents' satisfaction with didactic preparedness (4.45 ± $ \pm \ $ 0.97) and knowledge acquisition (4.36 ± $ \pm \ $ 0.84). Residents strongly believed that learning about the AFHS-mentation topic would improve patient care. CONCLUSION Our pilot study is a pioneer project in support of a new AFHS-themed dental curriculum for clinical education. Further expansion of the age-friendly principles to include mobility, medications, and what matters to older adults will establish a model framework of redesigned geriatric dental education for academic centers.
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Affiliation(s)
- Szilvia Arany
- Department of Dentistry, Eastman Institute of Oral Health, University of Rochester, Rochester, New York, USA
| | - Eli Eliav
- Department of Dentistry, Eastman Institute of Oral Health, University of Rochester, Rochester, New York, USA
| | - Annette Medina-Walpole
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Thomas V Caprio
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, New York, USA
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Neerhut T, Ninan J, Grills R, McLeod K. Defining the good surgical resident: a resident and registrar perspective. ANZ J Surg 2023; 93:2574-2579. [PMID: 37668282 DOI: 10.1111/ans.18689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Surgical residency provides insight into the essential skills required to become a successful surgical registrar. However, the role of the surgical resident remains largely undefined. While the Royal Australasian College of Surgeon (RACS) JDocs framework provides a useful guide, no published research explores what defines a highly performing surgical resident. We investigate what constitutes a 'good' surgical resident from the surgical resident and accredited surgical registrar perspectives. We hope this knowledge will improve patient care and assist surgical residents towards becoming valuable team members and successful accredited surgical training candidates. METHODS A qualitative research approach was utilized employing reflexive thematic analysis. Using semi-structured interviews, 10 surgical residents and 10 accredited surgical registrars across eight surgical specialties were interviewed. RESULTS Amongst surgical residents five themes were identified: efficiency: mastering the mundane, 'stepping up' to more responsibility, enthusiasm to learn, first do no harm: a safe practitioner, and lastly no resident is an island: a team player. Four themes described by accredited registrars included: somebody you can trust, finding a safe 'balance', a perfect fit: teamwork and communication and finally eagerness to improve. CONCLUSION Themes correlated well with eight of 10 RACS competencies and the JDocs Framework. Our results reaffirmed the importance of developing early career non-technical skills. Explicit knowledge and understanding of these attributes used in conjunction with the core competency and JDocs frameworks may help those contemplating a career in surgery throughout their early surgical years.
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Affiliation(s)
- Thomas Neerhut
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - John Ninan
- Department of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Richard Grills
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Kathryn McLeod
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
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Ho B, Kukan S, McIsaac W. Do family medicine residents optimally prescribe antibiotics for common infectious conditions seen in a primary care setting? J Assoc Med Microbiol Infect Dis Can 2023; 8:192-200. [PMID: 38058504 PMCID: PMC10697098 DOI: 10.3138/jammi-2022-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/24/2023] [Indexed: 12/08/2023]
Abstract
Background Antimicrobial resistance is a worldwide phenomenon that leads to a significant number of unnecessary deaths and costly hospital admissions. More than 90% of antibiotic use happens in the community and of this, family physicians account for two-thirds of these prescriptions. Our study aims to determine whether family medicine residents are optimally trained in antibiotic prescribing for common infectious conditions seen in a primary care setting. Methods This study is a secondary analysis of a prior study of antimicrobial stewardship in two urban primary care clinics in central Toronto, Ontario. A total of 1099 adult patient visits were included that involved family medicine resident trainees, seen between 2015 and 2016. The main outcome measures were resident antibiotic prescription rates for each condition and expert-recommended prescribing practices, the rate prescriptions were issued as delayed prescriptions, and the use of first-line recommended narrow-spectrum antibiotics. Results Compared to expert-recommended prescribing rates, family medicine residents overprescribed for uncomplicated upper respiratory tract infections (URI) (5.0% [95% CI 2.2% to 9.7%] versus 0% expert recommended) and sinusitis (44.2% [95% CI 32.8% to 55.9%] versus 11%-18% expert range), and under prescribed for pneumonia (53.5% [95% CI 37.7% to 68.8%] versus 100% expert range]). Prescribing rates were within expert recommended ranges for pharyngitis (28.6% [95% CI 16.6% to 43.3%]), bronchitis (3.6% [95% CI 0% to 18.4%]), and cystitis (79.4% [95% CI 70.6% to 86.6%]). Conclusions The antibiotic prescribing practices of family medicine residents during their training programs indicated overprescribing of antibiotics for some common infection presentations. Further study of antibiotic prescribing in primary care training programs across Canada is recommended to determine if future family physicians are learning appropriate antibiotic prescribing practices.
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Affiliation(s)
- Bernard Ho
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Sahana Kukan
- Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Warren McIsaac
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Ray D. Wolfe Department of Family Medicine, Sinai Health System, Toronto, Ontario, Canada
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Chen Y, Wu Z, Wang P, Xie L, Yan M, Jiang M, Yang Z, Zheng J, Zhang J, Zhu J. Radiology Residents' Perceptions of Artificial Intelligence: Nationwide Cross-Sectional Survey Study. J Med Internet Res 2023; 25:e48249. [PMID: 37856181 PMCID: PMC10623237 DOI: 10.2196/48249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/07/2023] [Accepted: 09/01/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI) is transforming various fields, with health care, especially diagnostic specialties such as radiology, being a key but controversial battleground. However, there is limited research systematically examining the response of "human intelligence" to AI. OBJECTIVE This study aims to comprehend radiologists' perceptions regarding AI, including their views on its potential to replace them, its usefulness, and their willingness to accept it. We examine the influence of various factors, encompassing demographic characteristics, working status, psychosocial aspects, personal experience, and contextual factors. METHODS Between December 1, 2020, and April 30, 2021, a cross-sectional survey was completed by 3666 radiology residents in China. We used multivariable logistic regression models to examine factors and associations, reporting odds ratios (ORs) and 95% CIs. RESULTS In summary, radiology residents generally hold a positive attitude toward AI, with 29.90% (1096/3666) agreeing that AI may reduce the demand for radiologists, 72.80% (2669/3666) believing AI improves disease diagnosis, and 78.18% (2866/3666) feeling that radiologists should embrace AI. Several associated factors, including age, gender, education, region, eye strain, working hours, time spent on medical images, resilience, burnout, AI experience, and perceptions of residency support and stress, significantly influence AI attitudes. For instance, burnout symptoms were associated with greater concerns about AI replacement (OR 1.89; P<.001), less favorable views on AI usefulness (OR 0.77; P=.005), and reduced willingness to use AI (OR 0.71; P<.001). Moreover, after adjusting for all other factors, perceived AI replacement (OR 0.81; P<.001) and AI usefulness (OR 5.97; P<.001) were shown to significantly impact the intention to use AI. CONCLUSIONS This study profiles radiology residents who are accepting of AI. Our comprehensive findings provide insights for a multidimensional approach to help physicians adapt to AI. Targeted policies, such as digital health care initiatives and medical education, can be developed accordingly.
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Affiliation(s)
- Yanhua Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Ziye Wu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Peicheng Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Linbo Xie
- Vanke School of Public Health, Tsinghua University, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Mengsha Yan
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Maoqing Jiang
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianjun Zheng
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, China
| | - Jingfeng Zhang
- Department of Radiology, Ningbo No. 2 Hospital, Ningbo, China
| | - Jiming Zhu
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
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Walters J, Paradise Black N, Yurttutan Engin N, Cohen DE, Ben Khallouq B, Chen JG. Race and Gender Differences in Pediatric Milestone Levels: A Multi-Institutional Study. Clin Pediatr (Phila) 2023:99228231200985. [PMID: 37735881 DOI: 10.1177/00099228231200985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
The Accreditation Council for Graduate Medical Education milestones assess resident competency in 6 domains. We hypothesized that disparities in milestones exist across race and gender in pediatric residencies. This is a retrospective, cross-sectional, multi-institutional study (3 pediatric residencies, 1446 scores; 316 residents). African American residents received the lowest scores in patient care (PC) (P = .030), medical knowledge (MK) (P = .005), practice-based learning and improvement (PBLI) (P = .003), professionalism (PROF) (P < .001), and interpersonal communication skills (ICS) (P = .005). Differences were most pronounced in PROF (African American mean 3.35 [SD .75], Asian 3.51 (.66), Hispanic 3.58 (.66), white 3.59 (.67)). Female residents received higher scores than male residents in PC (P = .002) and system-based practice (SBP) (P = .049). Female interns received higher MK scores, 2.53 (.44) versus 2.48 (.48), P = .044, but lower scores as third years, 4.00 (.43) versus 4.14 (.45), P = .030. In this study, pediatric milestones differed based on race and gender.
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Affiliation(s)
- Jamee Walters
- Johns Hopkins All Children's Hospital Pediatric Residency Program, St. Petersburg, FL, USA
| | - Nicole Paradise Black
- Division of Medical Education, Department of Pediatrics, University of Florida Pediatric Residency, Gainesville, FL, USA
| | - Nesrin Yurttutan Engin
- Studer Family Children's Hospital, Ascension Sacred Heart, Community Health Northwest Florida-Trinity Pediatrics, University of Florida Pediatric Residency Program, Pensacola, FL, USA
| | - Debra E Cohen
- Studer Family Children's Hospital, Ascension Sacred Heart, University of Florida Pediatric Residency Program, Pensacola, FL, USA
| | - Bertha Ben Khallouq
- Department of Gynecology and Obstetrics, Orlando Health Winnie Palmer Hospital, Orlando, FL, USA
| | - J Gene Chen
- Department of Pediatric Medical Education, University of Florida Pediatric Residency Program at Orlando Health, Orlando, FL, USA
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Zubair AS, Sivakolundu DK, DeVito M, Dewey JJ. Financial Literacy Among Medical Trainees and Faculty: A Pilot Study. Cureus 2023; 15:e44829. [PMID: 37809136 PMCID: PMC10559332 DOI: 10.7759/cureus.44829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION Medical education systems are trained to produce efficient, thorough clinicians. These programs provide limited training on personal finances. The current socioeconomic climate for medical trainees includes increasing education debt and stagnating reimbursement. We conducted a survey-based cross-sectional pilot study at an academic institution targeted at residents, fellows, and attendings of all medical specialties. Our aim was to understand baseline levels of financial literacy at different training and career stages, which can inform targeted interventions to improve this crucial aspect of physician well-being. METHODS A survey was devised with the assistance of a certified financial planner. This survey was distributed at an academic institution targeting residents, fellows, and attendings. The survey was anonymous, and no identifying data were collected. Two reminders were sent to subjects to complete the survey. RESULTS A total of 50 physicians completed the survey in 2021. There were eight responses from interns, 14 responses from residents (post-graduate year 2 or later), 14 responses from fellows, and nine responses from attendings. The majority of our respondents reported not having any particular financial education, and over 70% of respondents reported that their graduate education had not provided them with the tools needed for personal financial success. CONCLUSION Financial education and financial literacy are important topics that need to be further incorporated into the medical education pathway. Physicians are not well equipped in this realm, and further training is necessary. This study provides pilot data that highlight important aspects of physician knowledge and practices in regard to finances.
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Affiliation(s)
| | | | | | - Jeffrey J Dewey
- Neurology, Yale New Haven Hospital, New Haven, USA
- Neurology, Yale School of Medicine, New Haven, USA
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Denham C. Disabilities and Medicine: From Stairs to Stares. HCA Healthc J Med 2023; 4:321-324. [PMID: 37753412 PMCID: PMC10519626 DOI: 10.36518/2689-0216.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Description The current state of medicine has done little to correct the imbalance of underrepresented groups in the physician workforce. In this editorial, a psychiatric resident physician retells his experience as an individual who is completing his medical training while being affected by a neuromuscular disorder and how it impacts his daily life. The primary goal of this paper is to elucidate the need for greater representation and understanding of the disabled physician workforce.
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Shah AS, Sobolewski B, Chon S, Cruse B, Glisson MD, Zackoff MW, Davis D, Zhang Y, Schumacher DJ, Geis GL. Just-in-Time, Just-in-Place Virtual Training in the Pediatric Emergency Department: A Novel Approach to Impact the Perfusion Exam. Adv Med Educ Pract 2023; 14:901-911. [PMID: 37614829 PMCID: PMC10443635 DOI: 10.2147/amep.s414022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/02/2023] [Indexed: 08/25/2023]
Abstract
Background Early identification of shock is vital in decreasing morbidity and mortality in the pediatric population. Although residents are taught the perfusion portion of the rapid cardiopulmonary assessment at our institution, they perform it at the bedside with 8.4% completing 1 part of the assessment and 9.7% verbalizing their findings. Newer technologies, including virtual reality (VR), offer immersive training to close this clinical gap. Objective To assess senior pediatric residents' performance of a perfusion exam and verbalization of their perfusion assessment following VR-based Just-in-Time/Just-in-Place (JITP) training compared to video-based JITP training. We hypothesized that JITP media training was feasible, and VR JITP was more effective than video-based training. Methods Residents were randomized to VR or video-based training during shifts in the emergency department. Clinical performance was assessed by review of a video-recorded patient encounter using a standardized assessment tool and by an in-person, two question shock assessment. Residents completed a survey assessing attitudes toward their intervention at the time of training. Results Eighty-five senior pediatric residents were enrolled; 84 completed training. Sixty-four (76%) residents had a patient encounter available for video review (VR 33; Video 31). Fourteen residents in the VR group (42.4%, 95% CI 25.5% to 60.8%) and 13 residents in the video group (41.9%, 95% CI 24.6% to 60.9%) completed a perfusion exam AND verbalized an assessment during their next clinical encounter (X2 p-value 1.00). Fifty-one of 64 residents (79.7%) completed the two-step shock assessment; 50 (98%) agreed with supervising physician's assessment. VR was rated more effective than reading, low-fidelity manikin, standardized patient encounters, traditional didactic teaching, and online learning. Video was rated more effective than online learning, traditional didactic teaching, and reading. Conclusion Novel video and VR JITP perfusion exam and assessment trainings are impactful and well-received by senior pediatric residents.
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Affiliation(s)
- Ashish S Shah
- Department of Pediatrics, University of California – San Diego, San Diego, CA, USA
- Division of Emergency Medicine, Rady Children’s Hospital, San Diego, CA, USA
| | - Brad Sobolewski
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Sabina Chon
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bradly Cruse
- Center for Simulation and Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Mike D Glisson
- Center for Simulation and Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Matthew W Zackoff
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Center for Simulation and Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - David Davis
- Center for Simulation and Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Yin Zhang
- Emergency Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel J Schumacher
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Gary L Geis
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Center for Simulation and Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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McQuade CN, Simonson MG, Ehrenberger KA, Kohli A. Developing a Web-Based Asynchronous Case Discussion Format on Social Media to Teach Clinical Reasoning: Mixed Methods Study. JMIR Med Educ 2023; 9:e45277. [PMID: 37556191 PMCID: PMC10448285 DOI: 10.2196/45277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Case-based learning conferences are valuable to trainees, but growing clinical demands hinder consistent attendance. Social media increasingly acts as a venue for trainees to supplement their education asynchronously. We designed and implemented a web-based asynchronous clinical case discussion series on the Twitter social media platform to fill this educational gap. OBJECTIVE The aim of this mixed methods study is to examine the nature of interactions among web-based case discussion participants and assess local attitudes regarding the educational intervention. METHODS Starting in February 2018, we posted clinical vignettes to a dedicated Twitter account with the prompt "What else do you want to know?" to stimulate discussion. The authors replied in real time when case discussion participants requested additional details. Additional data about the case were posted at regular intervals to the discussion thread to advance the overall case discussion. Participants were asked to explain their reasoning and support their conclusions when appropriate. Web-based engagement was assessed using Twitter Analytics. Participants' posts were qualitatively analyzed for themes, with special attention to examples of using clinical reasoning skills. A codebook of types of participant posts and interactions was refined iteratively. Local engagement and attitudes at our institution were assessed by surveying internal medicine trainees (n=182) and faculty (n=165) after 6 months. RESULTS Over a 6-month period, 11 live case discussions were engaged with by users 1773 times. A total of 86 Twitter profiles spanning 22 US states and 6 countries contributed to discussions among participants and the authors. Participants from all training levels were present, ranging from students to faculty. Interactions among participants and the case moderators were most commonly driven by clinical reasoning, including hypothesis-driven information gathering, discussing the differential diagnosis, and data interpretation or organization. Of 71 respondents to the local survey, 29 (41%) reported having a Twitter account. Of the 29 respondents with Twitter accounts, 17 (59%) reported participating in the case discussions. Respondents agreed that case participation increased both their clinical reasoning skills (15/17, 88%) and clinical knowledge (13/17, 76%). CONCLUSIONS A social media-based serialized case discussion was a feasible asynchronous teaching method for engaging web-based learners of all levels in a clinical reasoning discussion. Further study should examine what factors drive trainee participation in web-based case discussions and under what circumstances asynchronous discussion might be preferred over in-person teaching activities.
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Affiliation(s)
- Casey N McQuade
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Michael G Simonson
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Kristen A Ehrenberger
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Amar Kohli
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Lu KJQ, Meaney C, Guo E, Leung FH. Evaluating the Applicability of Existing Lexicon-Based Sentiment Analysis Techniques on Family Medicine Resident Feedback Field Notes: Retrospective Cohort Study. JMIR Med Educ 2023; 9:e41953. [PMID: 37498660 PMCID: PMC10415947 DOI: 10.2196/41953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 03/20/2023] [Accepted: 05/26/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Field notes, a form for resident-preceptor clinical encounter feedback, are widely adopted across Canadian medical residency training programs for documenting residents' performance. This process generates a sizeable cumulative collection of feedback text, which is difficult for medical education faculty to navigate. As sentiment analysis is a subfield of text mining that can efficiently synthesize the polarity of a text collection, sentiment analysis may serve as an innovative solution. OBJECTIVE This study aimed to examine the feasibility and utility of sentiment analysis using 3 popular sentiment lexicons on medical resident field notes. METHODS We used a retrospective cohort design, curating text data from University of Toronto medical resident field notes gathered over 2 years (from July 2019 to June 2021). Lexicon-based sentiment analysis was applied using 3 standardized dictionaries, modified by removing ambiguous words as determined by a medical subject matter expert. Our modified lexicons assigned words from the text data a sentiment score, and we aggregated the word-level scores to a document-level polarity score. Agreement between dictionaries was assessed, and the document-level polarity was correlated with the overall preceptor rating of the clinical encounter under assessment. RESULTS Across the 3 original dictionaries, approximately a third of labeled words in our field note corpus were deemed ambiguous and were removed to create modified dictionaries. Across the 3 modified dictionaries, the mean sentiment for the "Strengths" section of the field notes was mildly positive, while it was slightly less positive in the "Areas of Improvement" section. We observed reasonable agreement between dictionaries for sentiment scores in both field note sections. Overall, the proportion of positively labeled documents increased with the overall preceptor rating, and the proportion of negatively labeled documents decreased with the overall preceptor rating. CONCLUSIONS Applying sentiment analysis to systematically analyze field notes is feasible. However, the applicability of existing lexicons is limited in the medical setting, even after the removal of ambiguous words. Limited applicability warrants the need to generate new dictionaries specific to the medical education context. Additionally, aspect-based sentiment analysis may be applied to navigate the more nuanced structure of texts when identifying sentiments. Ultimately, this will allow for more robust inferences to discover opportunities for improving resident teaching curriculums.
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Affiliation(s)
- Kevin Jia Qi Lu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Elaine Guo
- Department of Economics, University of Toronto, Toronto, ON, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Sialakis C, Sialaki PA, Frantzana A, Iliadis C, Ouzounakis P, Kourkouta L. Prevalence of anxiety and depression of health care workers during COVID-19 - a systematic review and meta-analysis. Med Pharm Rep 2023; 96:246-253. [PMID: 37577023 PMCID: PMC10419692 DOI: 10.15386/mpr-2579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/25/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction During the COVID-19 pandemic, the workload of healthcare workers managing the disease, increased significantly. The objective of this review is to determine the anxiety and depression prevalence among healthcare workers during the pandemic period. Methods We searched systematically the literature in five electronic databases such as PubMed, CINAHL, ScienceDirect, MEDLINE, and Cochrane COVID-19 study register. The last online research was performed in May 2022. We included only cross-sectional studies and performed a meta-analysis of pooled prevalence. Publication bias was assessed with a funnel plot and Egger's and Begg's tests. A random effect was applied and heterogenicity I2 was calculated. Quality assessment of included studies was performed using the Joanna Briggs Institute tool. Results In this review, we included 14 cross-sectional studies comprising 7780 healthcare workers. Participants were from the whole spectrum of healthcare workers. The pooled prevalence of depression was 33.8% (95% CI: 24.6 - 43.6), heterogenicity I2: 98.69%. The pooled prevalence of anxiety was 41.3% (95% CI: 30.2 - 52.9), heterogenicity I2: 99.01%. Conclusion One-third of healthcare workers suffered from depression, and more than one-third suffered from anxiety during the COVID-19 pandemic. Increased measures of surveillance of mental health should have been taken, as well as the support of healthcare workers running a high risk of psychological distress during the COVID-19 pandemic.
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Affiliation(s)
- Christos Sialakis
- General Hospital “Agios Dimitrios-G. Gennimatas”, Thessaloninki, Greece
| | | | - Aikaterini Frantzana
- School of Sciences, Department of Health Sciences, School of Medicine, European University Cyprus, Nicosia, Cyprus
- George Papanikolaou General Hospital of Thessaloniki, Greece
| | | | | | - Labrini Kourkouta
- Nursing Department, International University of Greece, Thessaloniki, Greece
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Wotipka EK, Wright AJ, Fan JZ, Fuhriman D, Chuang AZ, Lindhorst GC, Feldman RM, Crowell EL. Postoperative Complications of True Dropless Cataract Surgery versus Standard Topical Drops. J Acad Ophthalmol (2017) 2023; 15:e144-e153. [PMID: 37564162 PMCID: PMC10411064 DOI: 10.1055/s-0043-1771043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 06/12/2023] [Indexed: 08/12/2023]
Abstract
Purpose Compare postoperative outcomes in cataract surgery between eyes with standard drop regimen versus dropless protocol by residents. Design Retrospective cohort study between April 1, 2018 and March 31, 2020. Methods The study was performed at Lyndon B. Johnson General Hospital in Houston, Harris County, Texas. A total of 547 eyes (234 dropless vs. 313 standard) with phacoemulsification cataract surgery and minimum of 1-month follow-up with best-corrected visual acuity (BCVA) were included. Dropless received 40 mg sub-Tenon's triamcinolone and intracameral moxifloxacin. Patients were followed at postoperative day 1 (POD1), week 1 (POW1), and month 1 (POM1). Postoperative rate of BCVA better than 20/40 (Good vision) and rate of complications were compared between groups. Results Good vision on POM1 in dropless (77.8%) was noninferior to standard (75.1%, p = 0.80). Complication rate in dropless (28.6%) was noninferior to standard (24.0%, p = 0.13). Intraocular pressure (IOP) elevation on POD1 ( p = 0.041) and anterior chamber (AC) cells on POW1 and POM1 ( p < 0.001) were more frequent in dropless. Mean spherical equivalent at POM1 was better in dropless (-0.37 D [±0.81 D]) compared with standard (-0.61D [±0.77 D], p = 0.001). Early posterior capsular opacification (early PCO) was more frequent in dropless ( p = 0.042). Conclusions Postoperative rate of BCVA better than 20/40 and rate of postoperative complications were noninferior, although dropless had higher rates of AC inflammation, IOP elevation, and early PCO.
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Affiliation(s)
- Evan K. Wotipka
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Alex J. Wright
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - James Z. Fan
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - David Fuhriman
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Alice Z. Chuang
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Grace C. Lindhorst
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Robert M. Feldman
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Eric L. Crowell
- Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
- Department of Ophthalmology, Dell Medical School, Austin, Texas
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Babenko O, Gentilini S, Turner N, Szafran O, Koppula S. Psychological need fulfillment in virtual teaching: insights of residents and faculty. Int J Med Educ 2023; 14:77-83. [PMID: 37351937 PMCID: PMC10693391 DOI: 10.5116/ijme.6488.2625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
Objective To explore benefits and challenges experienced by residents and faculty when teaching in virtual settings. Methods This was a qualitative descriptive study employing one-on-one semi-structured interviews with 10 residents and 12 faculty in the Department of Family Medicine at the University of Alberta, Canada, from May 2021 to May 2022. Participants were recruited via social media, resident and department events and email lists. Interview transcripts were analyzed descriptively and thematically employing the Self-Determination Theory (SDT) framework to map the identified benefits and challenges as facilitators and barriers to fulfilling teacher's basic psychological needs for autonomy, competence, and relatedness in virtual settings. Results Resident and faculty participants used virtual technology not only to deliver education, but also leveraged various platform features to support their needs in virtual settings. The emerging themes within benefits and challenges of virtual teaching were amenable to mapping onto three basic psychological needs of the SDT framework - autonomy (e.g., increased accessibility; lack of control over teaching environment), competence (e.g., increased self-confidence; technological limitations hindering skill development), and relatedness (e.g., timely exchange of information; difficulty with professional identity formation). Conclusions Despite the inherent challenges, teaching in virtual settings can support teachers' psychological needs. Recommendations for the future delivery and facilitation of virtual learning include: giving high priority to engagement and active participation; nurturing autonomy and greater individual responsibility for learning; and creating an environment of emotional support. The SDT-informed strategies shown to be effective in in-person teaching need to be examined for their applicability in virtual settings.
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Affiliation(s)
- Oksana Babenko
- Department of Family Medicine, University of Alberta, Canada
| | | | - Nathan Turner
- Department of Family Medicine, University of Alberta, Canada
| | - Olga Szafran
- Department of Family Medicine, University of Alberta, Canada
| | - Sudha Koppula
- Department of Family Medicine, University of Alberta, Canada
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Babiker S, Ogunmwonyi I, Georgi MW, Tan L, Haque S, Mullins W, Singh P, Ang N, Fu H, Patel K, Khera J, Fricker M, Fleming S, Giwa-Brown L, A Brennan P, Irune E, Vig S, Nathan A. Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN): Protocol for a Cross-Sectional Study. JMIR Res Protoc 2023; 12:e40545. [PMID: 37327055 DOI: 10.2196/40545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 04/18/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The unequal distribution of academic and professional outcomes between different minority groups is a pervasive issue in many fields, including surgery. The implications of differential attainment remain significant, not only for the individuals affected but also for the wider health care system. An inclusive health care system is crucial in meeting the needs of an increasingly diverse patient population, thereby leading to better outcomes. One barrier to diversifying the workforce is the differential attainment in educational outcomes between Black and Minority Ethnic (BME) and White medical students and doctors in the United Kingdom. BME trainees are known to have lower performance rates in medical examinations, including undergraduate and postgraduate exams, Annual Review of Competence Progression, as well as training and consultant job applications. Studies have shown that BME candidates have a higher likelihood of failing both parts of the Membership of the Royal Colleges of Surgeons exams and are 10% less likely to be considered suitable for core surgical training. Several contributing factors have been identified; however, there has been limited evidence investigating surgical training experiences and their relationship to differential attainment. To understand the nature of differential attainment in surgery and to develop effective strategies to address it, it is essential to examine the underlying causes and contributing factors. The Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN) study aims to describe and compare the factors and outcomes of attainment between different ethnicities of doctors and medical students. OBJECTIVE The primary aim will be to compare the effect of experiences and perceptions of surgical education of students and doctors of different ethnicities. METHODS This protocol describes a nationwide cross-sectional study of medical students and nonconsultant grade doctors in the United Kingdom. Participants will complete a web-based questionnaire collecting data on experiences and perceptions of surgical placements as well as self-reported academic attainment data. A comprehensive data collection strategy will be used to collect a representative sample of the population. A set of surrogate markers relevant to surgical training will be used to establish a primary outcome to determine variations in attainment. Regression analyses will be used to identify potential causes for the variation in attainment. RESULTS Data collected between February 2022 and September 2022 yielded 1603 respondents. Data analysis is yet to be competed. The protocol was approved by the University College London Research Ethics Committee on September 16, 2021 (ethics approval reference 19071/004). The findings will be disseminated through peer-reviewed publications and conference presentations. CONCLUSIONS Drawing upon the conclusions of this study, we aim to make recommendations on educational policy reforms. Additionally, the creation of a large, comprehensive data set can be used for further research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40545.
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Affiliation(s)
| | | | - Maria W Georgi
- University College London Medical School, London, United Kingdom
| | | | - Sharmi Haque
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - William Mullins
- St Georges University Hospital National Health Service Trust, London, United Kingdom
| | - Prisca Singh
- University of Birmingham Medical School, Birmingham, United Kingdom
| | - Nadya Ang
- Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Howell Fu
- South West London Elective Orthopaedic Centre, London, United Kingdom
| | - Krunal Patel
- University College London Medical School, London, United Kingdom
| | - Jevan Khera
- University Hospital Coventry & Warwickshire, Coventry, United Kingdom
| | | | - Simon Fleming
- Institute of Health Sciences Education, Queen Mary University of London, London, United Kingdom
| | - Lolade Giwa-Brown
- Barts Health National Health Service Trust, Royal London Hospital, London, United Kingdom
| | - Peter A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Ekpemi Irune
- Department of Otolaryngology, Head and Neck Surgery, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom
| | - Stella Vig
- Department of Vascular and General Surgery, Croydon University Hospital, London, United Kingdom
| | - Arjun Nathan
- Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
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Wang J, Ren M, Wang H, Bai Z, Zeng K. Analysis of urgent inpatient neurologic consultations in a large tertiary hospital center: Follow-up on the effect of standardized training of residents. Brain Behav 2023; 13:e2983. [PMID: 36974339 PMCID: PMC10176006 DOI: 10.1002/brb3.2983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Clinical neurology is difficult for young residents. To familiarize with neurological emergencies as soon as possible for young doctors, the urgent inpatient neurologic consultations were analyzed. METHODS A retrospective study was conducted on the urgent inpatient neurologic consultations in a large tertiary hospital for 4 consecutive years. RESULTS A total of 1437 cases were included, and the annual consultation cases gradually decreased from 573 to 257, involving 29 clinical departments. The disorders of urgent inpatient neurologic consultations were divided into three categories: neurological disorders (77.8%), non-neurological disorders (10.4%), and undiagnosed disorders (11.8%), common causes in consultation were disturbance of consciousness (36.0%), convulsions/stiffness (13.6%), limb weakness (8%), and mental disorder (5.6%). Common neurological disorders included acute cerebrovascular disease (33.6%), epilepsy/status epilepticus (15.8%), and metabolic or infectious toxic encephalopathy (14.9%). CONCLUSION Urgent inpatient neurologic consultations involve multidisciplinary critical diseases, mainly neurological diseases. The standardized training of residents may help to rapidly improve the comprehensive diagnosis and treatment ability of young residents and is suitable for use in hospitals at all levels.
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Affiliation(s)
- Jiafang Wang
- Department of NeurologyFirst Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Department of NeurologyAffiliated Hospital of Chongqing Three Gorges Medical CollegeChongqingChina
| | - Min Ren
- Department of NeurologyFirst Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Department of NeurologyPeople's Hospital of Shapingba DistrictChongqingChina
| | - Hong Wang
- Finance DepartmentFirst Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Zhenzhen Bai
- Department of NeurologyFirst Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Kebin Zeng
- Department of NeurologyFirst Affiliated Hospital of Chongqing Medical UniversityChongqingChina
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Perennoù E. [Ethical reflection in structures, a compass in the crisis]. Soins Gerontol 2023; 28:38-42. [PMID: 37328206 DOI: 10.1016/j.sger.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Morality, ethics, ethical approach are words that are often used in our daily lives as health care providers. What meaning do they have? How important are they? If ethics is an individual notion, the question arises of its application in our accompaniment.
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Alimena S, Freret TS, King C, Lassey SC, Economy KE, Easter SR. Simulation to improve trainee knowledge and comfort in managing maternal cardiac arrest. AJOG Glob Rep 2023; 3:100182. [PMID: 36941863 PMCID: PMC10023915 DOI: 10.1016/j.xagr.2023.100182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Maternal cardiac arrest is a rare outcome, and thus there are limited opportunities for specialists in obstetrics and gynecology to acquire the skills required to respond to it through routine clinical practice. OBJECTIVE This study aimed to evaluate gaps in medical education in maternal cardiac arrest and whether a simulation-based training program improves resident knowledge and comfort in the diagnosis and treatment of maternal cardiac arrest. STUDY DESIGN A 2-hour training for obstetrics and gynecology residents at an academic medical center was conducted, consisting of a didactic presentation, defibrillator skills station, and 2 high-fidelity simulations. Consenting residents completed a 21-item pretest followed by a 12-item posttest exploring knowledge of and exposure to maternal cardiac arrest. The McNemar and Wilcoxon signed-rank tests were used to compare pre- and posttest data. RESULTS Of 21 residents, 15 (71.4%) had no previous education about maternal cardiac arrest, and 17 (81.0%) had never responded to a maternal code. Participants demonstrated increased knowledge about maternal cardiac arrest after the session, providing more correct answers on the reversible causes of pulseless electrical activity arrest (median 4 vs 7 correct responses; P<.01). After the training, more residents were able to identify the correct gestational age to perform a cesarean delivery during maternal cardiac arrest (19.0% vs 90.5%; P<.01) and the correct location for this procedure (52.4% vs 95.2%; P<.01). All residents reported that maternal cardiac arrest training was important and that they would benefit from additional sessions. Median composite comfort level in managing maternal cardiac arrest significantly increased after participation (pretest, 24.0 [interquartile range, 21.5-28.0]; posttest, 37.0 [interquartile range, 34.3-41.3]; P<.01). CONCLUSION Residents report limited exposure to maternal cardiac arrest and desire more training. Simulation-based training about maternal cardiac arrest is needed during residency to ensure that graduates are prepared to respond to this high-acuity event.
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Affiliation(s)
- Stephanie Alimena
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Dr Alimena)
- Corresponding author: Stephanie Alimena, MD.
| | - Taylor S. Freret
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA (Dr Freret)
| | - Chih King
- Department of Anesthesia, Brigham and Women's Hospital, Boston, MA (Dr King)
| | - Sarah C. Lassey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Drs Lassey, Economy, and Easter)
| | - Katherine E. Economy
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Drs Lassey, Economy, and Easter)
| | - Sarah Rae Easter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Drs Lassey, Economy, and Easter)
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Bischofreiter M, Kölblinger C, Stumpner T, Gruber MS, Gattringer M, Kindermann H, Mattiassich G, Ortmaier R. Learning Curve for Short-Stem Total HIP Arthroplasty through an Anterolateral Approach. Medicina (Kaunas) 2023; 59:medicina59050832. [PMID: 37241064 DOI: 10.3390/medicina59050832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/05/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Short-stem total hip arthroplasty has become increasingly popular in recent years. While many studies have shown excellent clinical and radiological results, very little is known about the learning curve for short-stem total hip arthroplasty through an anterolateral approach. Therefore, the aim of this study was to determine the learning curve for short-stem total hip arthroplasty among five residents in training. Materials and Methods: We performed retrospective data analysis of the first 30 cases of five randomly selected residents (n = 150 cases) with no experience before the index surgery. All patients were comparable, and several surgical parameters and radiological outcomes were analyzed. Results: The only surgical parameter with a significant improvement was the surgical time (p = 0.025). The changes in other surgical parameters and radiological outcomes showed no significant changes; only trends can be derived. As a result, the correlation between surgical time, blood loss, length of stay, and incision/suture time can also be seen. Only two of the five residents showed significant improvements in all examined surgical parameters. Conclusions: There are individual differences among the first 30 cases of the five residents. Some improved their surgical skills faster than others. It could be assumed that they assimilated their surgical skills after more surgeries. A further study with more than 30 cases of the five surgeons could provide more information on that assumption.
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Affiliation(s)
- Martin Bischofreiter
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Christina Kölblinger
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Thomas Stumpner
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Michael Stephan Gruber
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Michael Gattringer
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Harald Kindermann
- Department of Marketing and Electronic Business, University of Applied Sciences Upper Austria, 4400 Steyr, Austria
| | - Georg Mattiassich
- Department of Orthopedic and Trauma Surgery, Clinic Diakonissen Schladming, 8970 Schladming, Austria
| | - Reinhold Ortmaier
- Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
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Abstract
Although several strategies have been developed to support medical students during their studies in order to prevent burnout, depression and suicide, not all of them are equally effective. Simulation is an interesting strategy: it gives students the tools to detect and intervene in signs of distress in their colleagues, and helps them break the barrier of silence in the face of psychological distress.
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Affiliation(s)
- Nathalie Nadon
- Centre hospitalier de l'université de Montréal, 1000 rue Saint-Denis, Montréal, QC H2X 0A9, Canada.
| | - Pierre Laramée
- Centre hospitalier de l'université de Montréal, 1000 rue Saint-Denis, Montréal, QC H2X 0A9, Canada
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Barr J, Pappas TN, Kennedy M, Nakayama DK. Medicine and History: a Surgical Model for National Integration. J Hist Med Allied Sci 2023; 78:114-120. [PMID: 36545832 DOI: 10.1093/jhmas/jrac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Historians and physicians have struggled to incorporate history into American medical education for over a century. Most efforts focus on local initiatives targeting a narrow audience. We describe a novel method involving the American College of Surgeons, a national organization with tens of thousands of members. Capitalizing on its infrastructure and influence over the field, we have implemented a variety of ventures that include panel sessions at meetings, poster competitions, travel grants, themed breakfasts, online communities, and other such projects. This programming has reached thousands of participants, ranging from pre-medical students to retired physicians, and it has increased both the exposure to and production of surgical history. Our article describes the process of establishing this nationally coordinated enterprise in the hopes that other medical specialties can emulate it and further the study of and appreciation for medical history.
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