Disparate opinions on the value of Vice Chairs of education in Departments of Surgery: A national survey of Department Chairs and other surgical education stakeholders

BACKGROUND

The position of Vice Chair of Education (VCE) is increasingly common in Surgery Departments. The role remains ill-defined. The purpose of this study was to explore perceptions of Department Chairs (DCs) and Other Education Stakeholders (OESs) regarding the VCE role.

METHODS

DCs and OESs at institutions with a VCE were surveyed. Descriptive statistics and cross-tabulations were calculated (SAS V9.4).

RESULTS

The overall response rate was 25% (166/666). There were significant differences in whether DCs and OESs agree that the VCE supports others in fulfilling educational roles (95.2% vs 49.5%, p = 0.0002), is critical in achieving education missions (90.5% vs 56.6%, p = 0.0032), enhances the quality of education (95.3% vs 65.7%, p = 0.0174), and is important to education teams (95.0% vs 68.7%, p = 0.0464).

CONCLUSIONS

DCs value the VCE role more so than OESs, whom VCEs support. In order for VCEs to be effective educational leaders in Departments of Surgery, the needs of key stakeholders deserve further clarification.

Leading by Design: Lessons for the Future From 25 Years of the Executive Leadership in Academic Medicine (ELAM) Program for Women

The Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program for Women is designed to promote the careers of senior female leaders in academic health care in a way that ultimately seeks to transform culture and promote gender equity far beyond the careers of its participants. In an era of increased awareness of gender inequity within academic medicine, the longevity of the ELAM program raises several important questions. First, why is such a program still needed? Second, what exactly does it do, and what has been its influence on its participants and beyond? And third, what lessons can ELAM's example provide to help guide the medical profession as it strives to promote gender equity in the field? In this Invited Commentary, the authors seek to answer these questions from the perspective of a recent program participant and the current program director. The authors review the evidence that identifies how women, even today, face accumulating disadvantage over the course of their academic careers, stemming from repeated encounters with powerful unconscious biases and stereotypes, societal expectations for a gendered division of domestic labor, and still-present overt discrimination and sexual harassment. They describe ELAM's approach, which builds the knowledge and skills of the women who participate in the program, while also intentionally raising their visibility within their home institutions so that they have opportunities to share with institutional leaders what they have learned in ways that not only promote their own careers but also support gender equity in the broader environment. The authors conclude by offering thoughts on how ELAM's model may be leveraged in the future, ideally in partnership with the numerous professional societies, funding agencies, and other organizations that are committed to accelerating the rate of progress toward gender equity at all levels of academic medicine.

The Revised Medical School Performance Evaluation: Does It Meet the Needs of Its Readers?

BACKGROUND

The Medical School Performance Evaluation (MSPE) is an important factor for application to residency programs. Many medical schools are incorporating recent recommendations from the Association of American Medical Colleges MSPE Task Force into their letters. To date, there has been no feedback from the graduate medical education community on the impact of this effort.

OBJECTIVE

We surveyed individuals involved in residency candidate selection for internal medicine programs to understand their perceptions on the new MSPE format.

METHODS

A survey was distributed in March and April 2018 using the Association of Program Directors in Internal Medicine listserv, which comprises 4220 individuals from 439 residency programs. Responses were analyzed, and themes were extracted from open-ended questions.

RESULTS

A total of 140 individuals, predominantly program directors and associate program directors, from across the United States completed the survey. Most were aware of the existence of the MSPE Task Force. Respondents read a median of 200 to 299 letters each recruitment season. The majority reported observing evidence of adoption of the new format in more than one quarter of all medical schools. Among respondents, nearly half reported the new format made the MSPE more important in decision-making about a candidate. Within the MSPE, respondents recognized the following areas as most influential: academic progress, summary paragraph, graphic representation of class performance, academic history, and overall adjective of performance indicator (rank).

CONCLUSIONS

The internal medicine graduate medical education community finds value in many components of the new MSPE format, while recognizing there are further opportunities for improvement.

Opioid Prescribing Education in Surgical Residencies: A Program Director Survey

BACKGROUND

Opioid abuse and misuse is a public health crisis. A national effort to reduce this phenomenon is ongoing. Residents represent a large pool of opioid prescribers but, are often not the target for opioid prescribing education (OPE). We developed a survey to assess current opioid prescribing practices and education among surgical residents.

STUDY DESIGN

An Institutional Review Board and Association of Program Directors in Surgery approved survey was electronically mailed to surgical program directors (PDs). The survey included questions regarding residency type, location, number of graduates per year, perceived value of OPE, residency policy on prescribing outpatients controlled substances, presence of OPE, and preferred method of OPE.

MATERIALS AND METHODS

A total of 248 PDs were e-mailed the survey with 110 complete responses (44.4%). Of all 104 (94.5%) allow residents to prescribe outpatient opioids with 24 (23.1%) limiting the opioid class prescribed. A total of 29 (27.9%) programs require residents to obtain their own Drug Enforcement Administration registration. Only 22 (20.0%) programs had in place mandatory OPE, 7 (6.4%) PDs were unsure if OPE was a mandatory educational requirement. Furthermore, 70 (79.5%) of programs currently without OPE are considering adding it. Didactic lecture (18, 81.8%) is the most common modality for OPE. The mode time dedicated to OPE was 1 hour. When PDs were asked about which method would be best to deliver OPE, the most common response was case-based scenarios (39, 35.5%). Bivariate statistics were performed and no association was found between OPE and program characteristics'.

CONCLUSIONS

Most surgical residency programs allow residents to prescribe outpatient opioids, very few require OPE. The most common method of OPE was didactic lectures. To enhance a resident's knowledge in prescribing opioids, programs should incorporate OPE into their curriculum.

Associate Program Directors in Surgery: A Select Group of Surgical Educators

OBJECTIVE

The role of the Associate Program Director (APD) within surgical education is not clearly defined or regulated by the Accreditation Council for Graduate Medical Education, often leading to variations in the responsibilities among institutions. Required credentials are not specified and compensation and protected time are not regulated resulting in large discrepancies among institutions. APDs are brought into the fold of surgical education to parcel out the escalating responsibilities of program director (PD). The Association of Program Directors in Surgery, Associate Program Directors Committee sent a survey to all APDs to better understand the role of the APDs within the hierarchy of surgical education.

DESIGN

A survey was sent to all 235 general surgery residency programs through the Association of Program Directors in Surgery list serve. The survey collected information on APD demographics, characteristics, and program information, qualifications of the APD, time commitment and compensation, administrative duties, and projected career track.

SETTING

General surgery residency programs within the United States.

PARTICIPANTS

108 Associate Program Directors in general surgery RESULTS: A total of 108 (46%) APDs responded to the survey. Seventy-three (70.2%) of the APD's were males. Most (77.8%) were in practice for more than 5 years, and 69% were at a university-based program. Most of the respondents felt that the administrative and curricular tasks were appropriately distributed between the APD and PD and many shared tasks with the PD. A total of 44.6% were on the path to become a future PD at their institution. An equal number of APDs (42.6%) were compensated above their base salary for being an APD vs no compensation at all; however, 16 (14.8%) had a reduced clinical load as part of their compensation for being an APD.

CONCLUSION

This is the first study to describe the characteristics of APDs within the hierarchy of surgical education. Our data demonstrate that APDs have a substantial role in the function of a residency program and they need to be developed to better define their position in the program leadership.

Residents and Program Director Perspectives Often Differ on Optimal Preparation Strategies and the Value of the Orthopedic In-Training Examination

OBJECTIVES

The purpose of this work was to compare resident and program director (PD) perspectives on the value of the Orthopaedic In-Training Examination (OITE), resident study habits, and best resources for optimal performance.

DESIGN

A national survey of orthopedic surgery residents and PDs.

SETTING

Mayo Clinic, Rochester, MN PARTICIPANTS: The survey was completed by 445 (41.5%) eligible orthopedic surgery residents and 37 (77.1%) PDs.

RESULTS

Although residents and PDs agreed on when (p = 0.896) and how much (p = 0.171) residents currently study, residents felt that the OITE was not as valuable of an assessment of their knowledge, and also felt their individual scores were less likely to remain confidential compared to PDs (p < 0.001). The mean OITE score below which residents were concerned about their ability to pass American Board of Orthopaedic Surgeons Part 1 was 9.7 percentile points higher than PDs threshold (42.3% vs. 32.6%, respectively, p = 0.003). Both groups agreed that it is important to dedicate focused study time to the OITE (p = 0.680) and to perform well (p = 0.099). Regarding the best resources and preparation strategies, both residents and PDs tended to agree on the value of most (6 of 10) study methods. Residents ranked practice question websites (mean ranking of 2.6 vs. 3.8 of 10, respectively; p < 0.001) and formal rotations in a subspecialty (6.0 vs. 7.7 respectively, p < 0.001) higher than PDs. In contrast, PDs tended to value their program's formal OITE prep program (4.1. vs. 5.3, respectively, p = 0.012) and reading primary literature (5.6 vs. 6.6, respectively, p = 0.012) more than residents.

CONCLUSION

Residents and PDs agreed on many critical components of this process; however, a number of key differences in perspectives exist.

Evaluating the Evaluators: Implementation of a Multi-Source Evaluation Program for Graduate Medical Education Program Directors

BACKGROUND

Multi-source evaluation has demonstrated value for trainees, but is not generally provided to residency or fellowship program directors (PDs).

OBJECTIVE

To develop, implement, and evaluate a PD multi-source evaluation process.

METHODS

Tools were developed for PD evaluation by trainees, department chairs, and graduate medical education (GME) leadership. Evaluation questions were based on PD responsibilities, including Accreditation Council for Graduate Medical Education (ACGME) requirements. A follow-up survey assessed the process.

RESULTS

Evaluation completion rates were as follows: trainees in academic year 2012-2013, 53% (958 of 1824), and in academic year 2013-2014, 42% (800 of 1898); GME directors in 2013-2014, 100% (95 of 95); and chairs/chiefs in 2013-2014, 92% (109 of 118). Results of a follow-up survey of PDs (66%, 59 of 90) and chairs (74%, 48 of 65) supports the evaluations' value, with 45% of responding PDs (25 of 56) and 50% of responding chairs (21 of 42) characterizing them as "extremely" or "quite" useful. Most indicated this was the first written evaluation they had received (PDs 78%, 46 of 59) or provided (chairs 69%, 33 of 48) regarding the PD role. More than 60% of PD (30 of 49) and chair respondents (24 of 40) indicated trainee feedback was "extremely" or "quite" useful, and nearly 50% of PDs (29 of 59) and 21% of chairs (10 of 48) planned changes based on the results. Trainee response rates improved in 2014-2015 (52%, 971 of 1872) and 2015-2016 (69%, 1276 of 1837).

CONCLUSIONS

In our institution, multi-source evaluation of PDs was sustained over 4 years with acceptable and improving evaluation completion rates. The process and assessment tools are potentially transferrable to other institutions.

Expectations of the Competencies of Entering Family Medicine Residents: Do Members of the Family Agree? A CERA Study

BACKGROUND AND OBJECTIVES

Little information is available on what competencies family medicine program directors expect of incoming residents and whether those incoming residents can deliver on such expectations. Our aim was to determine whether there is a common set of skills that both family medicine clerkship directors and program directors agree are important for entering residents to possess and how often these are being demonstrated.

METHODS

This study is an analysis of data obtained in the 2014 CERA Family Medicine Clerkship Director and Program Director surveys. Clerkship directors and program directors were provided with a list of skill areas and professional characteristics and asked to rate how important it is for medical school graduates to demonstrate them as well as how many medical school graduates consistently demonstrate each skill or characteristic.

RESULTS

Both groups placed highest importance on honesty, professionalism, and communication skills among incoming residents. Clerkship directors placed higher importance on several skill areas, with program directors emphasizing professional characteristics. This division was also seen in the opinions of the two groups for how well entering residents demonstrated each area.

CONCLUSIONS

Clerkship directors identify several skill sets as being more important for graduating medical students to possess compared with program directors. Program directors seem to value more personal characteristics as important for entering residents to possess rather than skills. Future implications may include a focus from family medicine clerkships on skills that are valued by program directors but not rated as commonly seen among incoming residents.

Global Health in Family Medicine Residency Programs: A Nationwide Survey of US Residency Directors: A CERA Study

BACKGROUND AND OBJECTIVES

Interest in global health (GH) has increased significantly among medical trainees in the past 3 decades. Despite the potential for family medicine to be a major contributor to GH, there are no recent, large-scale studies of GH education and experiences in family medicine training. This study was designed to assess current opportunities, educational activities, resident interest, perceived program benefits, and barriers to international and domestic GH training in US family medicine residencies.

METHODS

Data for this study were elicited as part of a 2015 survey conducted by the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA). The nationwide, web-based survey was sent to 452 family medicine residency program directors.

RESULTS

A total of 257 program directors completed the GH portion of the survey. A total of 74.3% of programs offered international or domestic GH experiences. Program directors identified preparing physicians to practice underserved medicine and teaching community medicine or public health as primary goals for GH training. Program directors also reported that GH opportunities were important for attracting future residents. Programs offered a variety of preparatory activities to their residents. Funding and time constraints were identified as the primary barriers to GH training in residency.

CONCLUSIONS

Global health continues to be a focus of interest in the training of family medicine residents while attracting the passion of student applicants and residents.

The Importance of Continuing Education for Transplant Coordination Staff

Continuous quality improvement activities are necessary to achieve excellence at any institution. The Başkent University Hospitals have implemented continuous in-service training programs to improve all health services provided. Also, continuing medical education programs are being instituted in organ procurement and transplantation centers. In addition to receiving basic orientation and training upon hiring, transplant coordination staff complete forms that detail their current training status, further job training needed, and other courses of interest. The information is used to monitor skill levels, to determine the success of educational programs, and to identify further education that is needed. Our aim is to improve the quality of transplant coordination activities and increase organ donation at the hospitals in our network through effective monitoring and evaluation of continuous in-service training. These training programs enhance staff members' understanding of and participation in procedures related to transplantation and improves the total quality of the transplantation process. In the near future, this training model may be used to improve the donor hospital education program in Turkey.

Buggies, villi, cornelia, and genes: My extended mentorship with LG Jackson

Although Laird G. Jackson, M.D., has mentored many individuals, most in the field of Medical Genetics, he remains inspirational and true to his basic tenets. This invited comment describes how he shaped the professional course of one of his "mentees." © 2016 Wiley Periodicals, Inc.

Family Medicine Department Chairs' Opinions Regarding Scope of Practice

PURPOSE

Family physicians are trained broadly to provide the majority of health care across multiple settings; however, their scope of practice has narrowed. Department chairs' role modeling of a broad scope of practice may set the tone for faculty and trainees.

METHOD

In 2013, the authors surveyed family medicine department chairs about their scope of practice, personal and department characteristics, and attitudes and beliefs about scope of practice and role modeling. They used descriptive statistics and bivariate analyses to test for associations between scope of practice, personal and department characteristics, and attitudes and beliefs. They created a Scope of Practice Index by summing the number of services each respondent provided to compare scope of practice across chairs.

RESULTS

Of 146 chairs, 88 responded (60.3% response rate); 85 were included in the final analysis. Sixty-five (77.4%) respondents were male; 73 (86.9%) were 51 years or older. Respondents spent a mean of 19.7% of their time in direct patient care and had a mean Scope of Practice Index of 11.9. Fifty-three (62.4%) disagreed that the scope of practice of family medicine was too broad for practicing physicians to keep up in all areas, and 56 (65.9%) believed that faculty should role model the full scope of practice to learners. Responses generally did not vary by respondents' personal scope of practice.

CONCLUSIONS

Family medicine department chairs believe that role modeling a broad scope of practice increases students' interest in family medicine and encourages residency graduates to provide a wide range of services.

The medical director and quality requirements in the dialysis facility

Four decades after the successful implementation of the ESRD program currently providing life-saving dialysis therapy to >430,000 patients, the definitions of and demands for a high-quality program have evolved and increased at the same time. Through substantial technological advances ESRD care improved, with a predominant focus on the technical aspects of care and the introduction of medications such as erythropoiesis-stimulating agents and active vitamin D for anemia and bone disease management. Despite many advances, the size of the program and the increasingly older and multimorbid patient population have contributed to continuing challenges for providing consistently high-quality care. Medicare's Final Rule of the Conditions for Coverage (April 2008) define the medical director of the dialysis center as the leader of the interdisciplinary team and the person ultimately accountable for quality, safety, and care provided in the center. Knowledge and active leadership with a hands-on approach in the quality assessment and performance improvement process (QAPI) is essential for the achievement of high-quality outcomes in dialysis centers. A collaborative approach between the dialysis provider and medical director is required to optimize outcomes and deliver evidence-based quality care. In 2011 the Centers for Medicare & Medicaid Services introduced a pay-for-performance program-the ESRD quality incentive program (QIP)- with yearly varying quality metrics that result in payment reductions in subsequent years when targets are not achieved during the performance period. Success with the QIP requires a clear understanding of the structure, metrics, and scoring methods. Information on achievement and nonachievement is publicly available, both in facilities (through the facility performance score card) and on public websites (including Medicare's Dialysis Facility Compare). By assuming the leadership role in the quality program of dialysis facilities, the medical director is given an important opportunity to improve patients' lives and effect true change in a patient population dealing with a very challenging chronic disease. This article in the series on the role of the medical director summarizes the medical director's specific role in the quality improvement process in the dialysis facility and the associated requirements and programs, including QAPI and QIP.

Balancing education and service in graduate medical education: data from pediatric trainees and program directors

PURPOSE

To measure pediatric program directors' (PDs') and trainees' perceptions of and expectations for the balance of service and education in their training programs.

METHOD

In fall 2011, an electronic survey was sent to PDs and trainees at Boston Children's Hospital. Respondents described perceptions and expectations for service and education and rated the education and service inherent to 12 vignettes. Wilcoxon rank sum tests measured the agreement between PD and trainee perceptions and ratings of service and education assigned to each vignette.

RESULTS

Responses were received from 28/39 PDs (78%) and 223/430 trainees (52%). Seventy-five (34%) trainees responded that their education had been compromised by excessive service obligations; only 1 (4%) PD agreed (P < .0001). Although 132 (59%) trainees reported that service obligations usually/sometimes predominated over clinical education, only 3 (11%) PDs agreed (P < .0001). One hundred trainees (45%) thought rotations never/rarely/sometimes provided a balance between education and clinical demands compared with 2 PDs (7%) (P < .0001). Both groups agreed that service can, without formal teaching, be considered educational. Trainees scored 6 vignettes as having greater educational value (P ≤ .01) and 10 as having lower service content (P ≤ .04) than PDs did.

CONCLUSIONS

Trainees and medical educators hold mismatched impressions of their training programs' balance of service and education. Trainees are more likely to report an overabundance of service. These data may impact the interpretation of Accreditation Council for Graduate Medical Education survey results and should be incorporated into dialogue about future curricular design initiatives.

[Teaching child and adolescent psychiatry and psychotherapy in Germany-inventory and implications]

OBJECTIVE

Dissemination of knowledge concerning normal and deviant development as well as child and adolescent psychiatric (CAP) disorders with a focus on diagnosis and treatment should represent an integral part of medical training at every medical school. Furthermore, it is of utmost importance that medical students acquire skills in communication and basic psychiatric assessment of children and adolescents. The article summarizes the current state of affairs of teaching in CAP in German medical schools.

METHOD

All chairs of child and adolescent psychiatry were asked for detailed information on involvement in compulsory and noncompulsory medical training, scope of lectures in CAP, and courses for students of other disciplines.

RESULTS

In 25 out of 26 medical schools with a chair for CAP this medical specialty is already part of compulsory medical training. CAP is either taught in independent lectures or is integrated into lectures on psychiatry, pediatrics, and/or psychosomatics. The main lecture of 1.2 semester periods per week on average (range 0.1 to 2, the equivalent of 2 to 28 teaching units per semester) is complemented by numerous additional offers (internships, advanced courses, compulsory elective subjects). The CAP elective tertial of the "practical year" (final year of medical school in Germany) can be completed at all medical faculties with a CAP chair. CAP is often taught students of other disciplines as well, e.g., psychology or education.

CONCLUSIONS

Given the importance of CAP, the overall goal should be to anchor CAP as a required specialty in all 35 medical schools in Germany.

Essential hand surgery procedures for mastery by graduating orthopedic surgery residents: a survey of program directors

PURPOSE

To establish the essential hand surgery procedures that should be mastered by graduating orthopedic surgery residents. This framework can then be used as a guideline for developing an Objective Structured Assessment of Technical Skill to teach and document technical skill in hand surgery.

METHODS

A select group of 10 expert hand surgeons was surveyed regarding the essential hand surgery procedures that should be mastered by graduating orthopedic surgery residents. The top 10 procedures from this survey were then used to survey all 155 American Council of Graduate Medical Education-approved orthopedic surgery program directors regarding the essential procedures that should be mastered by graduating orthopedic surgery residents.

RESULTS

We had a 39% response rate to the program director survey. The top 8 hand surgery procedures as determined by the orthopedic surgery program directors included open carpal tunnel release, open A1 pulley release, open reduction internal fixation of distal radius fracture, flexor tendon sheath steroid injection, excision of dorsal or volar ganglion, closed reduction and percutaneous pinning of metacarpal fracture, open cubital tunnel release, and incision and drainage of flexor tendon sheath for flexor tenosynovitis.

CONCLUSIONS

Surgical educators need to develop objective methods to teach and document technical skill. The Objective Structured Assessment of Technical Skill is a valid method to accomplish this task. However, there has been no consensus regarding which hand surgery procedures should be mastered by graduating orthopedic surgery residents. We have identified 8 procedures that were overwhelmingly supported by orthopedic surgery program directors. These 8 procedures can be used as a guideline for developing an Objective Structured Assessment of Technical Skill to teach and document technical skill in hand surgery.

CLINICAL RELEVANCE

This study addresses the future of orthopedic surgery education as it pertains to hand surgery.

Building a leaderships web. Strengthen your organization with five strategies for physician alignment

Aligned physicians enhance an organization's strength and agility. Use these five strategies to reach them.

Teaching and assessing technical proficiency in surgical subspecialty fellowships

OBJECTIVES

To determine how programs are teaching and assessing procedural skills, and their perceived success.

DESIGN

Cross-sectional survey.

SETTING

Accreditation Council for Graduate Medical Education (ACGME) approved training programs in pediatric urology and colorectal surgery.

PARTICIPANTS

Program directors and recent graduates (2007-2009).

RESULTS

Thirty-nine program directors (60%), and 57 graduates (64%) responded; 89.5% of graduates and 94.9% of program directors felt training occurred successfully for the procedures that trainees were performing in their present practice. Nearly 90% of trainees and all program directors reported that there was no formal assessment of procedural competency at the beginning of training, although 66.7% of program directors reported that trainees were assessed "informally." Both program directors and trainees reported dialogue with faculty was the most frequent method used in preparing for operative procedures. Other methods (textbook/atlas, journals, web-based programs, videos) were used less frequently. Program directors with shorter tenure were more likely to use web-based and video methods; younger trainees were less likely to use textbooks/atlases. Faculty feedback on clinical decision-making and postprocedural review were perceived by both program directors and trainees as the most effective assessment methods for improving performance; however, trainees were more likely than program directors to report that postprocedure reviews were not included in their training (15.8% vs 9%, p = 0.045). Patient outcomes, written feedback from peers, and self-assessment were included in most programs, but valued less. Simulation was used in only about half the programs and was valued more highly by trainees than program directors (p = 0.011).

CONCLUSIONS

Training in procedural proficiency was viewed as successful by both program directors and graduates. Dialogue with, assessment by, and feedback from faculty were frequently used and most valued; stressing the importance of the facilitator role of faculty in the education of the trainee. These findings provide guidance for the development of newer methods of teaching and assessment.

The utility of the ABS in-training examination (ABSITE) score forms: percent correct and percentile score in the assessment of surgical residents

OBJECTIVE

The American Board of Surgery (ABS) provides program directors with ABS In-Training Examination (ABSITE) scores in the following forms: Percent correct score and percentile score. It is of interest to note how residency programs utilize the different forms of ABSITE scores in assessment of surgical residents for progression in training. We conducted a survey of program directors to ascertain the present situation.

METHODS

A structured questionnaire was sent to all program director members of the Association of Program Directors in Surgery.

RESULTS

114/210 program directors (54%) answered the survey. To assess residents, 3 programs used only the percentage correct score, 23 programs used only the percentile score, and 88 programs used both scores. The majority (70/89 or 79%) of the programs used a 30th percentile score as the minimum passing score. 88/111 (79%) programs had a remedial process for residents with poor performance on ABSITE. 60 percent of the programs had never used poor ABSITE performance to defer individual resident promotion. Programs that used ABSITE performance for remediation and deferral of promotion did it based on percentile score rather than percent correct score. Program directors felt that the better indicator of a resident's knowledge and progression in surgical residency was percent correct score (42%) vs percentile score (32%), while 10% felt that neither was an adequate indicator.

CONCLUSIONS

ABSITE score is being used as one of the measures to assess residents. Programs need to ensure that an effective remedial process is in place to assist residents with poor performance.

Needs assessment of family medicine residency programs and predoctoral directors

BACKGROUND AND OBJECTIVES

Both predoctoral directors and residency program directors are invested in the education of students in family medicine. However, the perspectives and goals of each group can be diverse. Improved collaboration between these groups of educators would be anticipated to enhance the education of students in family medicine, allow for greater interaction between family medicine resident and faculty physicians and students, and eventually entice more students to enter family medicine as a career.

METHODS

We conducted a survey of family medicine residency program directors and predoctoral directors to assess the views of the members of each group on how they could be useful to the other group, how the other group could be more useful to them, and what the barriers are to successful collaboration. The survey was open for 1 month, and the response rate was a little over one third from both groups.

RESULTS

We found that each group values its counterpart and finds them important in enhancing the success of family medicine, improving students' perceptions of family medicine, and attracting students to the field. The amount of contact between program directors and predoctoral directors is directly related to their geographical proximity.

CONCLUSIONS

A collaborative effort between family medicine residency programs and predoctoral directors could increase medical students' interest in family medicine. The biggest barrier to an effective relationship is the perception of a lack of sufficient time to devote to improving the relationship.

Most wired. CMIOs steadily on the rise

These tech-savvy physicians will play a big role as meaningful use requirements put more emphasis on integrating IT and quality. Just asking doctors to volunteer some time to serve on a committee "just doesn't fly anymore".

Developing a national role description for medical directors in long-term care: survey-based approach

OBJECTIVE

To develop a national role description for medical directors in long-term care (LTC) based on role functions drawn from the literature and the LTC industry.

DESIGN

A questionnaire about the role functions identified from the literature was mailed or e-mailed to randomly selected medical directors, directors of care or nursing (DOCs), and administrators in LTC facilities.

SETTING

Long-term care facilities in Canada randomly selected from regional clusters.

PARTICIPANTS

Medical directors, DOCs, and administrators in LTC facilities; a national advisory group of medical directors from the Long Term Care Medical Directors Association of Canada; and a volunteer group of medical directors.

MAIN OUTCOME MEASURES

Respondents were asked to indicate, from the list of identified functions, 1) whether medical directors spent any time on each activity; 2) whether medical directors should spend time on each activity; and 3) if medical directors should spend time on an activity, whether the activity was "essential" or "desirable."

RESULTS

An overall response rate of 37% was obtained. At least 80% of the respondents from all 3 groups (medical directors, DOCs, and administrators) highlighted 24 functions they deemed to be "essential" or "desirable," which were then included in the role description. In addition, the advisory group expanded the role description to include 5 additional responsibilities from the remaining 18 functions originally identified. A volunteer group of medical directors confirmed the resulting role description.

CONCLUSION

The role description developed as a result of this study brings clarity to the medical director's role in Canadian LTC facilities; the functions outlined are considered important for medical directors to undertake. The role description could be a useful tool in negotiations pertaining to time commitment and expectations of a medical director and fair compensation for services rendered.

Setting a new standard of care in nursing homes

The Winnipeg Regional Health Authority's introduction of a full-time nurse practitioner in a 116-bed non-profit nursing home provided an opportunity to explore a collaborative relationship between an NP acting as the primary care provider and a single physician serving as the consultant for complex care and after-hours care. The outcomes were measured in terms of resident and family satisfaction, quality of care indicators and cost effectiveness. Data were collected from pre-existing quality indicators, including a resident/family satisfaction survey, transfers to acute care, and medication use statistics. Unstructured interviews were also conducted with nursing staff and members of the interdisciplinary team. Dramatic improvements in medication use were observed, including a 17 per cent reduction in overall drug costs, a 55 per cent decrease in polypharmacy rates and a 63 per cent reduction in antipsychotic drug use. Transfers to emergency decreased by 20 per cent. Family satisfaction with the quality of health care provided to residents increased by 24 per cent. The collaborative practice of an NP with physician consultation is an effective way of delivering quality care to nursing home residents.