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We implemented and evaluated communication and interprofessional socialization after a unique rotation between final year pharmacy students and medical residents. Pharmacy students on an advanced pharmacy practice experience (APPE) in pediatric critical care completed a standard experience with (i.e. intervention group) or without (i.e. control group) a medical resident as part of the pharmacy team. The objectives of this study were to evaluate pharmacy student social phobia, communication apprehension, interprofessional socialization, value placed on interprofessional teams, and comfort interacting with a physician as a result of the APPE. Practicality and sustainability were also evaluated. Forty-six students participated (28 control, 18 intervention). Both groups had similar baseline characteristics and measure scores. No changes were observed in social phobia or communication apprehension. Both control and intervention groups showed improved scores in interprofessional socialization and valuing. Scores on the Self-Perceived Ability subscale of the Interprofessional Socialization and Valuing Scale increased for the intervention group, but not for the control group. Comfort interacting with a physician was higher in the intervention than the control group. Minimal changes to the APPE were made during the six-year study, and practicality and sustainability were positive. Limited data describe interactions between pharmacy students and medical residents on APPEs. Participating students increased their comfort and self-perceived ability in interacting with a physician. Due to the limited need for extra time or financial resources, this experience could be applied and studied in additional settings to assist in preparing practice ready pharmacists. [ABSTRACT FROM AUTHOR]

Medical residents experiencing depression can cause life-threatening harm to themselves and their patients. Treatment is available, but many do not seek help. The current set of three studies investigated whether depressive symptomatology in and of itself served as a help-seeking barrier—and whether expectations of help-seeking benefits provided insight into why this occurred. Nine waves of cross-sectional data were collected from medical residents across several different hospitals in the United States. There was a large negative association between levels of depressive symptomatology and help-seeking intentions (H1) in Studies 1 and 3. In Study 2, this association was significant for one of the two help-seeking measures. For all analyses, studies, and measures, there was a large negative association between residents' levels of depressive symptomatology and agreement that seeking help will lead to positive outcomes (H2). Likewise, there was a moderately large indirect effect for all analyses, studies, and measures such that the association between levels of depressive symptomatology and help-seeking intentions occurred through less favorable expectations of help-seeking benefits (H3). Lower agreement of the benefits associated with help-seeking explained between 43 and 65% of depressive symptomatology's negative association with help-seeking intentions across studies. The current findings indicate that depressive symptomatology itself represents a help-seeking barrier and underscore the importance of help-seeking expectations in explaining why this occurs. If future studies reveal a causal relationship between the perceived benefits of help-seeking and help-seeking intentions, then increasing such expectations could offer a potential path for increasing resident help-seeking. • The negative bias associated with depression extends to thoughts about help-seeking. • Medical residents with higher depression levels report lower help-seeking intentions. • Residents with higher depression expect less favorable help-seeking outcomes. • Help-seeking expectations partly explain the depression/help-seeking association. [ABSTRACT FROM AUTHOR]

Early medical residents are expected to have a higher prevalence of burnout due to physical and psychological stressors. However psychological distress associated with burnout has not been adequately investigated in a longitudinal manner. We therefore examined the longitudinal trajectory of depression and its associated factors among early medical residents. In this cohort study, medical residents (n = 215) who started rotation at the University of Yamanashi Hospital during 2012 to 2018 were recruited and asked to complete the Brief Job Stress Questionnaire (BJSQ), Center for Epidemiologic Studies Depression Scale (CES D), Brief Scale for Coping Profile (BSCP) and Athens Insomnia Scale (AIS) at the time of exit from each clinical department for up to two years over seven years. Factors associated with the CES-D scores were statistically explored, with a cutoff score of 16 to denote depression. The CES-D was completed by 205 residents. The average CES-D score was 10.3 ± 8.0 and the scores were lower in the 2nd versus 1st year of residency (11.3 ± 6.7 versus 9.2 ± 7.0). Multiple regression analysis of BJSQ/BSCP/AIS on CES-D revealed that insomnia had a significant impact on the CES-D scores. Apart from insomnia, avoidance and suppression and peer support had significant effects. Resilient residents, who showed the maximum CES-D score of under 16 consistently throughout the residency, was better in terms of changing a point of view, active solution and changing mood. Women were more likely to express emotions to others, while they reported more job control in the first year. Our results have high clinical relevance to challenge psychological burnout among early medical residents, offering some possible clues for prevention such as reduced burden, more flexibility during the first year and strengthening coworker support. Insomnia exerted moderate to strong effects on depression and monitoring of sleep appears indispensable in this specific population. • Psychological distress rated by 205 Japanese early medical residents over 7 years. • The CES-D scores lower in 2nd versus 1st year (11.3±6.7 versus 9.2±7.0). • Athens Insomnia Scale exerted moderate to strong effects on CES-D scores. • Resilient group better in changing point of view, active solution and changing mood. • Women more likely to express emotions to others, with more job control in 1st year. [ABSTRACT FROM AUTHOR]

Abstract Background and purpose The Society of Teachers of Family Medicine Group on Pharmacotherapy recommends a formal curriculum during family medicine residency training and describes benefits of utilizing pharmacists. Limited literature exists on how programs have incorporated questions from family medicine board preparation sources into pharmacotherapy academic education. The primary objective was to assess the impact on family medicine residents' perceived knowledge after incorporation of board review items into pharmacotherapy sessions. Educational activity and setting Pharmacists affiliated with the University of Alabama Family Medicine Residency program incorporated questions from board preparation sources into monthly interactive pharmacotherapy sessions as part of a didactic curriculum between 2014 and 2016. An anonymous survey was administered for two consecutive years in 2015 and 2016 to assess residents' perceptions of the sessions and utilization of board-type questions as an active learning component. The change in residents' perception of knowledge was quantitatively analyzed and written comments were evaluated for recurring themes. Findings The cumulative survey response was 78% (68/87). Over 80% of residents reported that pharmacotherapy sessions and the use of board-type questions was quite or very helpful. The percent of residents that rated their knowledge as good or excellent significantly increased after every session compared to baseline. Residents noted the sessions' information, applicability, interactive nature, and relevance as strengths. Summary Incorporation of board preparation questions into interactive pharmacotherapy sessions was well received and improved residents' perception of pharmacotherapy knowledge. Utilizing this model in a formal pharmacotherapy curriculum taught by pharmacists is beneficial for family medicine resident learners. [ABSTRACT FROM AUTHOR]

Negative attitudes and discrimination against Latinos exist in the dominant U.S. culture and in healthcare systems, contributing to ongoing health disparities. This article provides findings of a pilot test of Yo Veo Salud (I See Health), an intervention designed to positively modify attitudes toward Latinos among medical trainees. The research question was: Compared to the comparison group, did the intervention group show lower levels of implicit bias against Latinos versus Whites, and higher levels of ethnocultural empathy, healthcare empathy, and patient-centeredness? We used a sequential cohort, post-test design to evaluate Yo Veo Salud with a sample of 69 medical trainees. The intervention setting was an academic medical institution in a Southeastern U.S. state with a fast-growing Latino population. The intervention was delivered, and data were collected online, between July and December of 2014. Participants in the intervention group showed greater ethnocultural empathy, healthcare empathy, and patient-centeredness, compared to the comparison group. The implicit measure assessed four attitudinal dimensions (pleasantness, responsibility, compliance, and safety). Comparisons between our intervention and comparison groups did not find any average differences in implicit anti-Latino bias between the groups. However, in a subset analysis of White participants, White participants in the intervention group demonstrated a significantly decreased level of implicit bias in terms of pleasantness. A dose response was also founded indicating that participants involved in more parts of the intervention showed more change on all measures. Our findings, while modest in size, provide proof of concept for Yo Veo Salud as a means for increasing ethno-cultural and physician empathy, and patient-centeredness among medical residents and decreasing implicit provider bias toward Latinos. [ABSTRACT FROM AUTHOR]

Radiation Oncology Milestones 1.0 was developed in 2011 using the Accreditation Council of Graduate Medical Education's (ACGME) 6 core competencies to standardize the competency-based assessment of radiation oncology medical residents conducted by Clinical Competency Committees biannually. Critiques of Milestones 1.0 included the lack of clear progression between levels of the subcompetencies, and the complex language made it difficult to interpret by residents and faculty. The development of Milestones 2.0 aimed to simplify the language, clarify the expected progression of residents' competence, and provide supplemental resources for implementation. The ACGME assembled a 9-member working group (academic radiation oncologists, residents, community members) to compose Milestones 2.0 for Radiation Oncology using a modified Delphi method consisting of multiple asynchronous small-group meetings interspersed with four web-based whole-group meetings until consensus was reached for each competency. Milestones 2.0 replaced disease-specific Patient Care subcompetencies (e.g., Lymphoma, Genitourinary) with those that emphasize the care delivery pathway (e.g., Consult, Simulation, Contouring and Target Delineation, Treatment Planning and Plan Evaluation, Treatment Delivery, Follow-up), restructured the Medical Knowledge competency, revised all subcompetency descriptions to chart a clear progression between levels, removed research from level 5 criteria, and provided a supplemental guide to aid implementation. Patient Care subcompetencies in Milestones 1.0 limited direct assessment of residents to specific rotations while revised subcompetencies in Milestones 2.0 can be assessed on every rotation. Level 5 in each subcompetency now reflects skills exhibited by the top 10% of residents and includes items such as "leads the multidisciplinary care team" under Consult. Previously, Medical Knowledge was an assessment of Medical Physics and Radiation/Cancer Biology. This has been modified to include Applied Sciences and Evidence-Based Foundations of Radiation Oncology with specific constructs to guide assessment. The supplemental guide gives real-life examples for each level within the subcompetencies to promote consistency in the implementation of Milestones 2.0 across residencies. The guide is designed as a living document to be tailored by programs to align with individual practices and allow for a shared mental model for faculty expectations. Milestones 2.0 builds on the foundation laid by Milestones 1.0 by aligning subcompetencies with clinical practice and represents a comprehensive approach to assessing core competencies necessary to succeed as a competent clinical radiation oncologist. The new framework will be put into practice in July 2022. Real-time feedback and additions to the supplemental guide will continue to refine and improve assessment of radiation oncology residents' clinical competence. [ABSTRACT FROM AUTHOR]

Today’s medical students are digital natives who, for their entire life, have been surrounded by digital technology. Our research focuses on a tablet computer’s usability in medical education, and the subsequent transfer from the classroom to the work environment. For a period of three years, all incoming pediatric residents at a large southeastern university were provided an iPad. At the end of the 3-year program, we surveyed the residents measuring perceptions of iPad use and satisfaction. Fifty-six (60%) of the residents responded to the survey. A statistically significant number reported an increased amount of time spent with the tablet throughout their medical education. Similarly, a significant difference exists between those who believe the device to be a necessary part of medical education versus those stating it would be nice but not necessary. We present figures detailing how three conceptual areas: receiving information , inputting information , and collaboration (consisting of ten different facets of the tablet’s use) impacted their medical education. Residents throughout their medical education use the tablet extensively. There is variance in the areas where the tablet is the preferred tool versus a smartphone or computer. A clear majority of students expect to transition the tablet into their workplace upon completing residency. We argue a tablet is a useful tool for graduate medical education and later medical practice. [ABSTRACT FROM AUTHOR]

Objective To explore the attitudes and perceptions of Portuguese residents towards Clinical Communication Skills (CCS) and the need for complementary training. Methods 78 medical residents responded to an on-line questionnaire which comprised demographic data, open-ended questions and a Portuguese version of the Communication Skills Attitude Scale (CSAS). Results Residents gave significantly higher scores ( P < 0.001) on CSAS1 (attitudes towards communication skills in general, compared to CSAS2 (attitudes towards the teaching/learning process of CCS). Residents doing their residency training in other parts of the country, other than the north, reveal a higher perception of insufficient training (72.7% vs. 38.7%, P = 0.036). Conclusion Residents showed more positive attitudes towards communication skills than towards the teaching/learning process. They admit to need more training in CCS in their residency year and highlight that the clinical cycle of undergraduate education should integrate these topics. Content analysis indicates that residents’ perceptions are context-influenced. Practice implications Integration of CCS in the undergraduate education, enhanced during post-graduate training. Training of clinical faculty and supervisors/tutors and the role that stakeholders have to play in order to promote continuous training in CCS; encourage patient-centeredness and reflective practice, as to facilitate transfer of acquired skills to clinical practice. [ABSTRACT FROM AUTHOR]

In this article, we describe a multi-patient, team-based simulation experience in an academic setting. We included participants from clinical laboratory science, respiratory therapy, nursing, and medical residents. This simulation allowed students to function as credentialed professionals, focusing on critical thinking, prioritization, effective communication, and teamwork. In order to fully incorporate all professions, we designed an extended-time simulation in which we strategically planned the sequencing of clinical events in each scenario. Because of the complexity of the scenarios, debriefing progressed through three levels: in-room, whole group, and profession specific. Although designing and implementing such a detailed simulation was challenging, we feel it is essential to prioritize teamwork and communication in the academic setting. [ABSTRACT FROM AUTHOR]

Abstract: Despite international recommendations, vaccination coverage among European healthcare workers, including physicians, is widely recognized as unsatisfactory. In order to plan tailored vaccination campaigns and increase future coverage, we investigated reasons for refusing vaccination and determinants associated with influenza vaccine uptake among young health care workers. A survey was carried out during September and October 2010 on medical residents attending post-graduate Schools of the Medical Faculty at the University of Palermo (Italy). Each participant completed an anonymous web-based questionnaire including items on demographic and occupational characteristics, knowledge, attitudes and behaviours with regard to influenza and influenza vaccination, and main sources of information. A total of 202 (66.9%) out of 302 medical residents participated in the survey. During the 2009–2010 influenza vaccine campaign, 44 residents (21.8%) were vaccinated against seasonal influenza and 84 (41.6%) against pandemic influenza A (H1N1) 2009. For the impending 2010–2011 influenza season, 45 (22.3%) stated their intention to get vaccinated against seasonal influenza, 40 (19.8%) were uncertain and 117 (57.9%) were opposed. Considering themselves to be a high risk group for developing influenza was significantly associated with vaccination against both 2009–2010 seasonal (adj-OR=1.46; 95% CI=1.05–2.04) and pandemic A (H1N1) influenza (adj-OR 1.38; 95% CI=1.08–1.75). Intention to get vaccinated against 2010–2011 seasonal influenza was significantly more frequent in participants who had a high perception of efficacy/safety (adj-OR=1.49; 95% CI=1.05–2.12). After adjusting for confounding, vaccinations against seasonal 2009–2010 influenza, pandemic influenza A (H1N1) 2009 and seasonal 2010–2011 influenza were significantly more frequent in residents who were vaccinated against influenza at least once in the previous five influenza seasons. Influenza vaccination among medical residents appears to be habitual, with little comprehension of the rationale and logic for vaccination, including the need to be vaccinated to protect patients from nosocomial influenza infection. Our study suggests the importance of prioritizing residents for vaccination campaigns, as they represent “the future” and include a core group that habitually accepts vaccination. [Copyright &y& Elsevier]

Abstract: Objectives:: To assess the sleepiness among Family Practice residents using subjective data, the Epworth sleepiness scale (ESS), as well as objective assessment, the multiple sleep latency test (MSLT). Method:: We conducted the study on Family Practice residents at Texas A&M University, Corpus Christi. Sixteen residents, aged 21–40 yrs, were recruited and divided into two groups. The study group was comprised of residents who were on night-float rotation for at least three days and underwent MSLT post-call, and the control group was comprised of residents who were not on night-float and were not post-call. Daytime sleepiness was evaluated using both the ESS and MSLT. Respondents also completed a questionnaire assessing their beliefs regarding effects of sleep loss. Results:: Sleep latencies <10min were observed in 6 out of the 8 day shift-work interns, while only 1 out of 8 night-float residents had an average sleep latency <10min (p =0.0195). Following night-float, despite less sleep, residents had sleep latencies which were higher [14.2 (±5.0) min] than those in the control group [8.4 (±5.4) min, (p =0.043)]. Despite the difference in objective sleepiness, subjective sleepiness (Epworth scores) did not differ. Over 80% of interns reported having driven while sleepy. Conclusion:: Sleepiness continues to be a significant issue among medical residents despite recently mandated reductions in resident work hours. MSLT values in the pathologic range are seen in the majority of residents studied, but in those who were post-night call there seemed to be a paradoxical improvement. [Copyright &y& Elsevier]

Abstract: Background: Burnout poses a substantial problem for physicians'' well-being and for the quality of health care. The role of workload in comparison to subjective work characteristics has been rarely studied. The purpose of this study was to explore the associations of burnout with workload and subjective work characteristics in internal medicine specialists and residents. Methods: A cross-sectional study using an anonymous mailed survey was used. Some 103 specialists and 143 residents participated in the study. Burnout was measured using the Maslach Burnout Inventory. Subjective work characteristics included perceived job demands in terms of time pressure, mental effort and emotional labor. Workload was assessed in terms of average number of hours worked per week. Results: Emotional exhaustion in medical specialists was only predicted by perceived job demands [odds ratio 3.7 (CI 1.7–7.9), P <0.001]. Emotional exhaustion in medical residents was only predicted by emotional labor [odds ratio 1.9 (CI 1.2–3.0), P =0.003]. Depersonalization among medical specialists was only predicted by emotional labor [odds ratio 2.7 (CI 1.1–6.7), P =0.032], while depersonalization among medical residents was only predicted by number of hours worked per week [odds ratio 1.1 (CI 1.1–1.2), P =0.007]. Discussion: Perceived working conditions were more important than workload in explaining the variance in burnout. In addition, burnout in medical specialists and residents was linked to different characteristics of their working environment. [Copyright &y& Elsevier]

Abstract: Introduction and aims: Medical residents in training have long work shifts that lead increases the risk of traffic accidents. The Asde Driver Test is a test battery with equipment homologated by the Spanish traffic authorities designed to assess psychological and physical aptitude for obtaining the driving license in Spain. We study whether driving ability is objectively affected in this test. Materials and methods: The Asde Driver Test was applied before and in the morning after duty The data were evaluated using the SPSS statistical package, analyzing the variations in score with the Student t-test for paired samples. The results were also compared with the validated assessment criteria of the class B driving license test, based on passing of the cutoff points for each analyzed variable. Subjects with physical limitations precluding test conduction were excluded, as were those with a resting period during the duty shift of over 4h. Results: Of the 25 residents, 22 cases were therefore included in the data analysis. There were no significant differences in the paired global pre- and post-duty comparison of results, though there were cases in which the results obtained after duty fell short of the recommended criteria for passing the aptitude test. Comments: The Asde Driver Test includes tests relating to anticipation speed, bimanual visual–motor coordination, multiple reaction times, concentrated attention, and resistance to monotony. The results obtained show that fatigue in some cases, though not on a generalized basis, adversely affects skills needed for driving, such as reaction time, resistance to monotony, anticipation speed, or visual–motor coordination. In conclusion, following the resident duty shift, impaired driving ability is observed in some cases that could increase the risk of traffic accidents. [Copyright &y& Elsevier]

Purpose: The aim of this study was to compare the quality of medical physics education for radiation oncology medical residents. Methods: An independent survey regarding physics education was carried out using e-mail. The survey contained 12 questions addressing the duration, length, and quality of education. Responses were tabulated and compared with the recommended educational scheme. Results: Nearly 56% of institutions participated in this survey. Educational patterns were found to be significantly variable among institutions. Some have minimum physics education (10 lectures), and some have 90 lectures per year. In general, two-thirds of the institutions require residents to attend classes up to the third year. Conclusions: Significant variability of physics education for radiation oncology medical residents was observed, contrary to the national recommendations. With advanced treatment techniques, physics education should be given more importance, and the number of lectures should be increased to accommodate every aspect of radiation oncology practice. [Copyright &y& Elsevier]