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Danielle L Terry, Prabhdeep Bajwa Guthrie Medical Group, Sayre, PA, USACorrespondence: Danielle L Terry, Director of Behavioral Science, Guthrie Medical Group, One Guthrie Square, Sayre, PA, 18840, USA, Tel +1 570 887 3337, Fax +1 570 887 3585, Email Danielle.terry@guthrie.orgIntroduction: Supervision is considered a collaboration between a supervisor and supervisee and includes perceptiveness, responsiveness of the supervisor, a state of rapport, and specific learning tasks that allow the individual to work towards a goal. The alliance in supervision has been identified as a key ingredient of effective supervision, regardless of the type of treatment, population, or supervision model being used. While it is known that the medical training environment hosts high rates of burnout, little research has examined the role of supervisory alliance in regard to burnout, distress, and self-esteem. This study aimed to apply previous models of supervisory alliance to medical education, and explore associations between educational alliance and trainee self-esteem, burnout, and distress.Methods: Participants included 108 medical trainees (response rate = 81%). Medical trainees were recruited from a rural Pennsylvanian teaching hospital and asked to complete a voluntary and anonymous electronic survey. Multiple linear regression was used to examine the association between supervisory alliance and burnout and distress, while controlling for average hours worked and slept.Results: Results suggested that supervisory alliance was associated with burnout, distress, and self-esteem among medical trainees.Conclusion: Given the high rates of depression and burnout among medical providers, it may be helpful to understand the factors that may impact medical trainee’s distress and esteem. Future longitudinal research might examine the role of the supervisory alliance over time, and whether strong mentorship and guidance may serve to protect trainees from burnout throughout training and into their career.Keywords: medical residents, supervisory alliance, burnout

Jamiu O Busari,1,2 Huriye Yaldiz,3 Daniëlle Verstegen4 1Pediatric Residency Program, Department of Pediatrics, Zuyderland Medical Center, Heerlen, the Netherlands; 2Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands; 3Faculty of Medicine, Radboud University, Nijmegen, the Netherlands; 4Health Professions Education Program, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands Background: Previous research has shown that medical residents are in need of additional training in management and leadership skills. One of the possible ways of teaching this competency is the use of a serious game. This study explores residents’ views of the potential use of a serious game to teach a module on negotiation in practice management and leadership curriculum. Method: The aim of this study was to identify the features required to design a serious game for management and leadership education, including potential scenarios for such a game. Qualitative interviews were conducted with six medical residents. After transcription and coding of data, thematic analysis was used to group the data into four themes, namely: 1) CanMEDS leader competency, 2) personal views about negotiation, 3) views about serious games, and 4) educational needs in a serious game. Results: Our findings revealed that leadership and negotiation were two domains where residents felt they needed additional training. Those who were already familiar with medical applications and had them installed on their smartphones or tablets had a more positive attitude toward gaming than those who did not. The residents were mostly interested in how realistic the content of a serious game was and its ability to combine management and leadership skills with medical knowledge and clinical expertise. Conclusions: The findings in this study demonstrate that serious games have the potential to teach certain aspects of management and leadership. The study shows that residents are receptive to the use of serious games and, if well designed, believe that it can be used to improve their management and leadership competencies. Keywords: serious games, postgraduate medical education, medical residents, management, leadership

Background: The purpose of this study was to analyze the perceptions and practices of internal medicine residents in the western region of Saudi Arabia regarding the implementation of do not resuscitate (DNR) orders to improve future training practices among physicians., Methods: Medical residents involved in training programs in the western region of Saudi Arabia, including Jeddah, Makah, Medinah, and Taif, were invited to participate in a cross-sectional, anonymous, online survey regarding DNR orders. The 16-question survey was distributed to residents in all training programs in the region using surveymonkey.com, and the results were collected and tabulated., Results: Of 364 residents, 157 completed the questionnaire, resulting in a 43% response rate. The study showed that most (66%) internal medicine residents in the western region of Saudi Arabia participate in DNR discussions with patients and family or surrogate decision-makers. In addition, 43% were observed by faculty members, and half of them (51.9%) reported feeling comfortable during these discussions. Furthermore, most residents believed that additional educational programs would enhance their competence in addressing issues related to DNR discussions., Conclusion: This study highlights the need for a structured curriculum to teach skills relating to end-of-life issues such as DNR orders to residents in the Saudi Arabian medical system. The majority of residents surveyed believe they would benefit from additional training in DNR discussions. Therefore, an evidence-based curriculum providing instruction for improving discussions regarding DNR orders would improve physician confidence and effectiveness in caring for critically ill patients.