Search

BackgroundResidency program directors (PDs) need to navigate diverse roles and responsibilities as clinical teachers, administrators, and drivers of educational improvement. Little is known about the experience of PDs leading transformation of international residency programs.ObjectiveWe explored the lived experiences of international residency PDs and developed an understanding of how PDs manage educational program transformation.MethodsUsing a phenomenological approach, semi-structured interviews were conducted with current and former PDs involved in the transformation to competency-based medical education in the first international settings to be accredited by the Accreditation Council for Graduate Medical Education-International (ACGME-I). Thirty-three interviews with PDs from Qatar, Singapore, and the United Arab Emirates were conducted from September 2018 to July 2019, audio-recorded, and transcribed. Data were independently coded by 2 researchers. A thematic analysis was conducted and patterns that reflected coping and managing educational reform were identified.ResultsPDs described distinctive patterns of navigating the educational transformation. Five themes emerged: PDs (1) embraced continuous learning and self-development; (2) managed change in the context of their local settings; (3) anticipated problems and built support networks to effectively problem-solve; (4) maintained relationships with stakeholders for meaningful and constructive interactions; and (5) focused on intrinsic qualities that helped them navigate challenges.ConclusionsInternational PDs were presented with significant challenges in implementing educational transformation but coped successfully through distinctive patterns and methods.

Background Program directors (PDs) are integral to the education of the next generation of physicians. Yet, administrative burdens, substantial patient care responsibilities, and lack of protected time for teaching may contribute to work-life imbalance and physician burnout, leading to high rates of attrition. Data on international residency program leadership turnover are lacking. Objective This study aimed to quantify PD turnover in Accreditation Council for Graduate Medical Education-International (ACGME-I) accredited programs in Singapore, United Arab Emirates (UAE), and Qatar, and to compare to US PD attrition rates. Methods Data on PD turnover in international programs was extracted from the ACGME-I Accreditation Data System for academic years 2010–2011 through 2018–2019 for Singapore and 2013–2014 through 2018–2019 for UAE and Qatar. Rates of PD turnover were calculated by country and by ACGME-I medical-, surgical-, and hospital-based specialty groupings and compared using χ2 test. Annual US PD turnover data was extracted from the ACGME's Data Resource Book. Results Seventy programs met inclusion criteria. International PD attrition was high, with 56 programs (80%) changing PDs since program inception, and 16 programs (29%) having 2 or more PD turnovers. There was no significant difference between PD turnover rates in hospital (83%), medical (79%), or surgical (78%) specialties. International PD attrition rates varied from 7% to 20% annually and were comparable to PD turnover in US programs (range 12%–15%). Conclusions High PD turnover rates in newly accredited international residency programs were noted, although annual attrition rates were comparable to US residency programs.

Background Vague quantifiers used in the Accreditation Council for Graduate Medical Education–International (ACGME-I) resident survey are open to interpretation, raising concerns about the validity of survey scores. Residency programs may be unduly cited if survey responses are affected by differing judgments of vague quantifiers. Objective Through investigating frequency judgment overlap, we assessed the validity of vague quantifiers by quantifying variation in residents' frequency judgment of the following response options: never, rarely, sometimes, very often, and extremely often. Methods We conducted a cross-sectional survey of residents in 2 ACGME-I accredited institutions in Singapore. Participants assigned a frequency judgment to response options in 8 questions in the ACGME-I Resident Survey. Overlap in frequency judgment was computed using the minimum and maximum frequency judgment for each response option. This was ascertained to have occurred when the maximum frequency of the preceding category exceeded the minimum frequency of the downstream categories. The percentage of participants whose frequency judgment overlapped was computed. Results Of 652 residents, 289 (44%) responded; after exclusions of incomplete and careless responses, 119 responses (18%) were included in the study. Frequency judgment overlap was more frequent for vague quantifiers that are adjacent, ranging from 11% to 50% for questions in faculty, evaluation, and resources domains. The percentage of frequency judgment overlap was greatest for duty hour questions, with an overlap between 21% and 47% for adjacent categories. Conclusions Residents demonstrated wide variation in frequency judgment of vague quantifiers, especially on the duty hour questions in the ACGME-I resident survey.