891 results on '"Training Support"'
Search Results
2. Communication as a High-Stakes Clinical Skill: 'Just-in-Time' Simulation and Vicarious Observational Learning to Promote Patient- and Family-Centered Care and to Improve Trainee Skill
- Author
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Laura K. Rock
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Male ,media_common.quotation_subject ,Emotions ,education ,Observation ,Empathy ,Coaching ,Feedback ,Education ,Family centered care ,Patient safety ,Nonverbal communication ,Cognition ,Patient-Centered Care ,Humans ,Learning ,Observational learning ,Computer Simulation ,Conversation ,Aged ,media_common ,Medical education ,SARS-CoV-2 ,business.industry ,Communication ,Scholarly Perspectives ,COVID-19 ,General Medicine ,Training Support ,Clinical Competence ,Patient Safety ,Psychology ,business ,Meaning (linguistics) - Abstract
Patient–provider communication is a hallmark of high-quality care and patient safety; however, the pace and increasingly complex challenges that face overextended teams strain even the most dedicated clinicians. The COVID-19 pandemic has further disrupted communication between clinicians and their patients and families. The dependence on phone communication and the physical barriers of protective gear limit nonverbal communication and diminish clinicians’ ability to recognize and respond to emotion. Developing new approaches to teach communication skills to trainees who are often responsible for communicating with patients and their families is challenging, especially during a pandemic or other crisis. “Just-in-time” simulation—simulation-based training immediately before an intervention—provides the scaffolding and support trainees need for conducting difficult conversations, and it enhances patients’ and families’ experiences. Using a realistic scenario, the author illustrates key steps for effectively using just-in-time simulation-based communication training: assessing the learner’s understanding of the situation; determining what aspects of the encounter may prove most challenging; providing a script as a cognitive aid; refreshing or teaching a specific skill; preparing learners emotionally through reflection and mental rehearsal; coaching on the approach, pace, and tone for a delivery that conveys empathy and meaning; and providing specific, honest, and curious feedback to close a performance gap. Additionally, the author acknowledges that clinical conditions sometimes require learning by observing rather than doing and has thus provided guidance for making the most of vicarious observational learning: identify potential challenges in the encounter and explicitly connect them to trainee learning goals, explain why a more advanced member of the team is conducting the conversation, ask the trainee to observe and prepare feedback, choose the location carefully, identify everyone’s role at the beginning of the conversation, debrief, share reactions, and thank the trainee for their feedback and observations.
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- 2021
3. ENT trainees’ experience of redeployment during the coronavirus disease 2019 pandemic: a qualitative study
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F McClenaghan, A Hall, Annakan Victor Navaratnam, S Mackinnon, and P Lion
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Adult ,Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,education ,Decision Making ,Specialty ,State Medicine ,Education ,Interviews as Topic ,Otolaryngology ,03 medical and health sciences ,0302 clinical medicine ,Otolaryngologists ,Pandemic ,otorhinolaryngologic diseases ,Humans ,Medicine ,Health Workforce ,030212 general & internal medicine ,030223 otorhinolaryngology ,Qualitative Research ,Medical education ,SARS-CoV-2 ,business.industry ,Main Articles ,COVID-19 ,General Medicine ,Training Support ,United Kingdom ,Coronavirus ,Otorhinolaryngology ,Purposeful sampling ,Workforce ,Female ,Clinical Competence ,Thematic analysis ,business ,Qualitative research - Abstract
BackgroundAs a response to the acute strain placed on the National Health Service during the first wave of coronavirus disease 2019 in the UK, a number of junior doctors including ENT trainees were redeployed to other clinical specialties. This presented these trainees with novel challenges and opportunities.MethodsA qualitative study was performed to explore these experiences, undertaking semi-structured interviews with ENT trainees between 17th and 30th July. Participants were recruited through purposeful sampling. Interview transcripts underwent thematic analysis using Dedoose software.ResultsSeven ENT trainees were interviewed, ranging from specialty trainee years four to eight (‘ST4’ to ‘ST8’) in grade. Six core themes were identified: organisation of redeployment, utilisation of skill set, emotional impact of redeployment, redeployed team dynamics, concerns about safety and impact on training.ConclusionThe ENT trainees’ experiences of redeployment described highlight some important lessons and considerations for future redeployments.
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- 2021
4. COVID-19 and Graduate Medical Education Trainee Protections and Finances
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Harold A. Frazier, Jeffrey S. Berger, and Ryan J Keneally
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Graduate medical education ,MEDLINE ,COVID-19 ,Internship and Residency ,From the Editor ,General Medicine ,Training Support ,Occupational safety and health ,Education, Medical, Graduate ,Political science ,Family medicine ,medicine ,Humans ,Personal Protective Equipment ,Personal protective equipment ,Occupational Health - Published
- 2020
5. Student loan debt and financial education: a qualitative analysis of resident perceptions and implications for resident well-being
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Cameryn C. Garrett, Ronda L. Doonan, Casey Pyle, and Michelle B. Azimov
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Orthopedics ,COVID-19 ,Humans ,Internship and Residency ,General Medicine ,Training Support ,Pandemics ,Education - Abstract
High educational debt is prevalent among resident physicians and correlates with adverse well-being outcomes, including symptoms of stress and burnout. Residents also report low financial literacy levels, affecting financial well-being. Understanding resident viewpoints toward financial well-being initiatives is crucial to develop targeted resident financial well-being programs. This study aims to examine residents' experiences financing their medical education and how these experiences influence well-being and attitudes toward financial education in residency. We recruited residents from a Southern California health system with residency programs in Family Medicine, Internal Medicine, General Surgery, Orthopaedic Surgery, and Psychiatry. We contacted residents by email and text message to participate in semi-structured interviews. We conducted interviews from October 2020 to March 2021 and analyzed 59 resident interviews using reflexive thematic analysis. Among residents, 76% (45/59) had ≥ $200,000 in student loans. Residents perceived mounting medical education debt as unfairly burdensome for trainees engaged in socially beneficial work, leaving residents feeling undervalued - a feeling heightened by the stressors of the COVID-19 pandemic - and hampering well-being. Compartmentalizing debt attenuated financial stressors but often made financial education seem less pressing. A subset of residents described how financial planning restored some agency and enhanced well-being, noting that protected didactic time for financial education was crucial. Resident interviews provide practical guidance regarding designing financial education sessions. Desired education included managing debt, retirement planning, and the business of medicine. How residents framed educational debt and their degree of financial literacy impacted their well-being and sense of agency. Residents proposed that residency programs can aid in stress mitigation by providing residents with skills to help manage debt and plan for retirement. To reduce clinician indebtedness, this approach needs to occur in tandem with systemic changes to financing medical education.
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- 2022
6. LATIN AMERICAN RESIDENTS' SURGICAL EDUCATION AFTER THE PANDEMIC: WHAT STRATEGIES HAVE EMERGED FOR ADAPTING TO THIS NEW ERA?
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Eduardo Varela, Ignacio Castelli, Vania Szwarcfiter, Lawrence Turner, María Inés Gaete, Francisca Belmar, Matías Cortés, Gerónimo Jiménez, Marcia Corvetto, and Julián Varas
- Subjects
Latin America ,SARS-CoV-2 ,Surgical Procedures, Operative ,Humans ,COVID-19 ,General Medicine ,Prospective Studies ,Training Support ,Pandemics ,Education - Abstract
BACKGROUND: The COVID-19 pandemic has had a negative effect on surgical education in Latin America, decreasing residents’ surgical training and supervised clinical practice. AIMS: This study aimed to identify strategies that have been proposed or implemented to adapt surgical training and supervised clinical practice to COVID-19-related limitations in Latin America. METHOD: A literature review was performed between April and May 2021, divided into two searches. The first one sought to identify adaptation strategies in Latin America for surgical training and supervised clinical practice. The second one was carried out as a complement to identify methodologies proposed in the rest of the world. RESULTS: In the first search, 16 of 715 articles were selected. In the second one, 41 of 1,637 articles were selected. Adaptive strategies proposed in Latin America focused on videoconferencing and simulation. In the rest of the world, remote critical analysis of recorded/live surgeries, intrasurgical tele-mentoring, and surgery recording with postoperative feedback were suggested. CONCLUSIONS: Multiple adaptation strategies for surgical education during the COVID-19 pandemic have been proposed in Latin America and the rest of the world. There is an opportunity to implement new strategies in the long term for surgical training and supervised clinical practice, although more prospective studies are required to generate evidence-based recommendations.
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- 2022
7. Keeping Our Promise — Supporting Trainees from Groups That Are Underrepresented in Medicine
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Monica E. Peek, Monica B. Vela, and Marshall H. Chin
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Class (computer programming) ,Medical education ,Health Equity ,business.industry ,MEDLINE ,Internship and Residency ,Cultural Diversity ,General Medicine ,Training Support ,United States ,Article ,Humans ,Medicine ,Hospitals, Teaching ,business ,Minority Groups ,Prejudice ,Racial equity - Abstract
Keeping Our Promise After a recommitment to racial equity by academic medical centers, some institutions are celebrating recruiting their most diverse intern class to date. It will be important to ...
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- 2021
8. Exploring How Personal, Social, and Institutional Characteristics Contribute to Geriatric Medicine Subspecialty Decisions: A Qualitative Study of Trainees’ Perceptions
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Denise L. Anthony, Shoou Yih Daniel Lee, Minakshi Raj, James T. Fitzgerald, and Jodyn Platt
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Adult ,Male ,medicine.medical_specialty ,020205 medical informatics ,Attitude of Health Personnel ,media_common.quotation_subject ,education ,02 engineering and technology ,Subspecialty ,Education ,Interviews as Topic ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,0202 electrical engineering, electronic engineering, information engineering ,Institution ,medicine ,Curriculum development ,Humans ,Narrative ,030212 general & internal medicine ,Qualitative Research ,Aged ,media_common ,Geriatrics ,Academic Medical Centers ,Medical education ,Career Choice ,Mentors ,Geriatricians ,Internship and Residency ,Grandparent ,General Medicine ,Training Support ,United States ,Female ,Perception ,Curriculum ,Personal experience ,Psychology ,Qualitative research - Abstract
PURPOSE To explore internal medicine residents' and geriatrics fellows' perceptions of how personal, social, and institutional characteristics contribute to their professional identity and subspecialty decisions related to geriatric medicine. METHOD The authors conducted 23 in-depth, semistructured interviews with internal medicine residents, with and without an interest in geriatrics, and geriatrics fellows across 3 academic medical centers in the United States from October 2018 through June 2019. They then used a qualitative narrative approach to analyze the interview data. RESULTS Trainees related personal experiences, such as exposure to physicians and experiences with grandparents, to their interest in medicine. Trainees with an interest in geriatrics at 2 institutions did not feel supported, or understood, by peers and mentors in their respective institutions but maintained their interest in the field. The following variations between institutions that are supportive and those that are not were noted: the number of geriatricians, the proximity of the institution to geriatrics clinics, and the ways in which institutional leaders portrayed the prestige of geriatric medicine. Institutional characteristics influenced trainees' understanding of what it meant to be a doctor, what meaning they garnered from work as a physician, and their comfort with different types of complexity, such as those presented when providing care to older adults. CONCLUSIONS Institutional characteristics may be particularly important in shaping trainee interest in geriatric medicine. Institutions should encourage leadership training and opportunities for geriatricians so they can serve as role models and as hands-on mentors for trainees beginning in medical school. Increasing the number of geriatricians requires institutions to increase the value they place on geriatrics to generate a positive interest in this field among trainees. Institutions facilitating formation of professional identity and sense of purpose in work may consider engaging geriatricians in leadership and mentoring roles as well as curriculum development.
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- 2020
9. Student Loans and Psychological Distress: A Cross-sectional Study of Young Adults in Japan
- Author
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Yasuaki Saijo, Yukihiro Sato, Ken Osaka, Richard G. Watt, and Eiji Yoshioka
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Adult ,Male ,Epidemiology ,Cross-sectional study ,media_common.quotation_subject ,education ,030209 endocrinology & metabolism ,Psychological Distress ,Young Adult ,03 medical and health sciences ,symbols.namesake ,student loans ,0302 clinical medicine ,Japan ,Debt ,student health ,Humans ,Medicine ,030212 general & internal medicine ,Poisson regression ,Students ,Socioeconomic status ,health care economics and organizations ,Student loan ,media_common ,lcsh:R5-920 ,business.industry ,Questionnaire ,General Medicine ,Training Support ,Mental health ,Confidence interval ,Social Epidemiology ,Cross-Sectional Studies ,symbols ,Female ,Original Article ,business ,lcsh:Medicine (General) ,Stress, Psychological ,mental health ,Demography - Abstract
Background: Levels of student loan debt have been increasing, but very little research has assessed if this is associated with poor health. The aim was to examine the association between student loans and psychological distress in Japan. Methods: We conducted a cross-sectional web-based self-administered questionnaire survey in 2017. The sample comprised of 4,149 respondents aged 20-34, with 3,170 graduates and 979 current university students. The independent variables were whether or not current students had student loans, and for graduates, the total amount of their student loan debt. The dependent variable was severe psychological distress assessed by the Kessler Psychological Distress Scale (K6: the cut-off point was 13/14). Covariates were demographic and parents' socioeconomic variables. A Poisson regression analysis with a robust error variance was conducted to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Because there was a significant interaction between current student status and the status of borrowing student loans, stratified analyses were conducted. Results: The percentage of those with student loans was 33.8% among graduates, and 35.2% among current university students, respectively. Among graduates, student loan debt was significantly associated with a high possibility of having severe psychological distress after adjusting for covariates (PR of ≥4 million yen = 1.44 [95% CI = 1.02, 2.03]). Among current university students, there was no significant association (PR of borrowing student loans = 0.91 [95% CI = 0.60, 1.37]). Conclusions: There was a significant association between student loan debt and psychological distress among graduates, but not current university students.
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- 2020
10. Core surgical field camps: a new deanery-based model for enhancing advanced skills in core surgical trainees through simulation
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S Kohli, H J Room, Ctp Choh, P Robinson, C Ji, J Knight, and S Dennis
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Models, Anatomic ,Models, Educational ,Educational measurement ,Pneumonia, Viral ,education ,Entry Level ,Specialty ,Personal Satisfaction ,030204 cardiovascular system & hematology ,Education ,Simulation training ,Craft ,Betacoronavirus ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,030212 general & internal medicine ,Pandemics ,Simulation Training ,Medical education ,SARS-CoV-2 ,business.industry ,Field (Bourdieu) ,Attendance ,COVID-19 ,General Medicine ,Training Support ,Self Concept ,United Kingdom ,Core (game theory) ,General Surgery ,Clinical Competence ,Educational Measurement ,Coronavirus Infections ,business - Abstract
Hands-on wet lab simulation training is a vital part of modern surgical training. Since 2010, surgical ‘boot camps’ have been run by many UK deaneries to teach core surgical trainees basic entry level skills. Training in advanced skills often requires attendance at national fee-paying courses. In the Wessex Deanery, multiple, free of charge, core surgical ‘field camps’ were developed to provide more advanced level teaching in the particular specialty preference of each core surgical trainee. After the COVID-19 pandemic, national hands-on courses will be challenging to provide and deanery-based advanced skills training may be the way forward for craft-based specialties. The experiences over 2 years of delivering the Wessex core surgical field camps are shared, giving a guide and advice for other trainers on how to run a field camp.
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- 2020
11. Feedback That Helps Trainees Learn to Practice Without Supervision
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James Brown, Rola Ajjawi, Catherine Narelle Kirby, and Margaret Bearman
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020205 medical informatics ,Attitude of Health Personnel ,02 engineering and technology ,Feedback ,Education ,Interpersonal process ,03 medical and health sciences ,0302 clinical medicine ,ComputingMilieux_COMPUTERSANDEDUCATION ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,030212 general & internal medicine ,Workplace ,Good practice ,Curriculum ,Medical education ,Internship and Residency ,General Medicine ,Training Support ,Organization and Administration ,Sociocultural perspective ,Clinical training ,Clinical Competence ,Psychology ,Relevant information - Abstract
Feedback pedagogies and research tend to focus on immediate corrective actions rather than learning for the longer term. This approach means that feedback may not support trainees who are managing complex, competing, and ambiguous practice situations, often with limited supervision. There is an opportunity to consider how feedback can help medical trainees sustain their own development into the future, including when they have completed formal training. This article explores how feedback pedagogies can facilitate medical trainees' abilities to develop challenging aspects of practice across multiple clinical environments to eventually practice without supervision. From a sociocultural perspective, clinical training takes place within a practice curriculum; each clinical environment offers varying opportunities, which the trainees may choose to engage with. The authors propose feedback as an interpersonal process that helps trainees make sense of both formal training requirements and performance relevant information, including workplace cues such as patient outcomes or colleagues' comments, found within any practice curriculum. A significant pedagogic strategy may be to develop trainees' evaluative judgment or their capability to identify and appraise the qualities of good practice in both themselves and others. In this way, feedback processes may help trainees surmount complex situations and progressively gain independence from supervision.
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- 2020
12. An Incentive to Innovate: Improving Health Care Value and Restoring Physician Autonomy Through Physician-Directed Reinvestment
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Yoshimi Anzai, Paul M. Maggio, Stacie Vilendrer, and Steven M. Asch
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Cost Control ,020205 medical informatics ,media_common.quotation_subject ,Control (management) ,02 engineering and technology ,Capital Financing ,Education ,Reimbursement Mechanisms ,03 medical and health sciences ,Creative problem-solving ,0302 clinical medicine ,Physicians ,Research Support as Topic ,Health care ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,Professional Autonomy ,030212 general & internal medicine ,health care economics and organizations ,Reimbursement ,media_common ,Academic Medical Centers ,Motivation ,business.industry ,General Medicine ,Training Support ,Public relations ,Payment ,Quality Improvement ,Organizational Innovation ,Legal risk ,Incentive ,business ,Autonomy - Abstract
Problem Many health care systems in the United States are shifting from a fee-for-service reimbursement model to a value-based payment model. To remain competitive, health care administrators must engage frontline clinicians in their efforts to reduce costs and improve patient outcomes. Engaging physicians and other clinicians is challenging, however, as many feel overwhelmed with clinical responsibilities and do not view cost reduction as in their purview. Even if they are willing, providing a direct financial incentive to clinicians to control costs poses ethical and legal challenges. An effective incentive in the current system must motivate clinicians to engage in creative problem solving and mitigate ethical and legal risk. Approach Evidence suggests the most successful behavior change interventions in physicians are multi-faceted and combine intrinsic motivators, such as increased autonomy, with extrinsic motivators, such as access to funding or social recognition. Two academic health centers-the University of Utah Health and Stanford Health Care-have begun experimenting with an alternative value-sharing arrangement. Physician-directed reinvestment is an explicit agreement in which a health care system reinvests a portion of savings attributed to physician-led cost reduction initiatives back into areas of the physician's choosing, such as capital investment, research, or education. Outcomes Both organizations reported similar positive outcomes, including increased engagement from clinicians and administrators, sustained or improved quality of care, reduced costs of care, and benefits from reinvested funds. Many savings opportunities were previously unknown to administrators. Next steps Physician-directed reinvestment appears to effectively engage physicians in ongoing efforts to improve value in health care, although formal evaluation is still needed. This incentive structure may hold promise in other configurations, such as inviting non-physicians to apply as project leaders (clinician-directed reinvestment) and expanding the program to non-academic and ambulatory settings.
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- 2020
13. The Cost, Price, and Debt of Medical Education
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David A. Asch, Justin A. Grischkan, and Sean Nicholson
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Students, Medical ,Cost price ,media_common.quotation_subject ,MEDLINE ,030204 cardiovascular system & hematology ,Physicians, Primary Care ,03 medical and health sciences ,0302 clinical medicine ,Medical economics ,Debt ,Medicine ,030212 general & internal medicine ,Schools, Medical ,media_common ,Medical education ,Career Choice ,Education, Medical ,Salaries and Fringe Benefits ,business.industry ,Commerce ,General Medicine ,Training Support ,United States ,Costs and Cost Analysis ,business ,Career choice ,Graduation - Abstract
The Cost, Price, and Debt of Medical Education By 2018, the mean price of a U.S. medical education was about $300,000; 75% of students took on loans, and their average debt at graduation was $200,0...
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- 2020
14. A Cautionary Tale: The 2019 Orphaning of Hahnemann's Graduate Medical Trainees
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William C Boyer, David Jacob Aizenberg, and Lia S. Logio
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Medical education ,business.industry ,010102 general mathematics ,Graduate medical education ,Internship and Residency ,General Medicine ,Training Support ,University hospital ,01 natural sciences ,United States ,Hospital medicine ,03 medical and health sciences ,0302 clinical medicine ,Education, Medical, Graduate ,Internal Medicine ,Humans ,Medicine ,030212 general & internal medicine ,0101 mathematics ,Closure (psychology) ,business - Abstract
Hahnemann University Hospital provided care for Philadelphians starting in 1848, but its recent history has been riddled with financial turmoil that culminated in its rapid closure in summer 2019. As the hospital shuttered its doors to patients, it also orphaned 583 medical trainees. This crisis exposed vulnerabilities in graduate medical education (GME). In a firsthand account of the situation that developed in Philadelphia and reached academic institutions across the country, the authors reflect on lessons learned that may help leaders at other institutions mitigate the inevitable difficulties that arise when academic hospitals close. These lessons pertain to handling panic and administrative burdens in the aftermath of closure, the importance of well-defined processes, a clear understanding of GME funding, and strategies for placement of trainees that minimize disruption of their education.
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- 2020
15. Motivations for and Challenges in the Development of Global Medical Curricula: A Scoping Review
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Rouhi Fazelzad, Meredith Giuliani, Erik W. Driessen, Janneke M. Frambach, Michaela Broadhurst, Maria Athina Martimianakis, and Janet Papadakos
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Databases, Factual ,Delphi Technique ,020205 medical informatics ,CONSENSUS STATEMENT ,MEDLINE ,Reviews ,INTERNATIONAL SOCIETY ,02 engineering and technology ,PsycINFO ,CINAHL ,TRAINING CURRICULUM ,Education ,03 medical and health sciences ,EUROPEAN-UNION ,0302 clinical medicine ,Stakeholder Participation ,Health care ,CLINICAL THROMBOSIS ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,030212 general & internal medicine ,Curriculum ,Motivation ,Medical education ,Operationalization ,business.industry ,RADIOLOGY EDUCATION ,Internship and Residency ,General Medicine ,Training Support ,PROFESSIONAL-DEVELOPMENT ,CORE COMMUNICATION CURRICULUM ,Systematic review ,UNDERGRADUATE CURRICULUM ,HEALTH-CARE ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Perception ,business ,Psychology ,Delivery of Health Care ,Inclusion (education) - Abstract
Supplemental Digital Content is available in the text., Purpose The aim of this scoping review is to understand the motivations for the creation of global medical curricula, summarize methods that have been used to create these curricula, and understand the perceived premises for the creation of these curricula. Method In 2018, the authors used a comprehensive search strategy to identify papers on existing efforts to create global medical curricula published from 1998 to March 29, 2018, in the following databases: MEDLINE; MEDLINE Epub Ahead of Print, In-Process, and Other Non-Indexed Citations; Embase; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; PsycINFO; CINAHL; ERIC; Scopus; African Index Medicus; and LILACS. There were no language restrictions. Two independent researchers applied the inclusion and exclusion criteria. Demographic data were abstracted from publications and summarized. The stated purposes, methods used for the development, stated motivations, and reported challenges of curricula were coded. Results Of the 18,684 publications initially identified, 137 met inclusion criteria. The most common stated purposes for creating curricula were to define speciality-specific standards (50, 30%), to harmonize training standards (38, 23%), and to improve the quality or safety of training (31, 19%). The most common challenges were intercountry variation (including differences in health care systems, the operationalization of medical training, and sociocultural differences; 27, 20%), curricular implementation (20, 15%), and the need for a multistakeholder approach (6, 4%). Most curricula were developed by a social group (e.g., committee; 30, 45%) or Delphi or modified Delphi process (22, 33%). Conclusions The challenges of intercountry variation, the need for a multistakeholder approach, and curricular implementation need to be considered if concerns about curricular relevance are to be addressed. These challenges undoubtedly impact the uptake of global medical curricula and can only be addressed by explicit efforts to make curricula applicable to the realities of diverse health care settings.
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- 2020
16. Reflections on a Crisis in Graduate Medical Education
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William C Boyer, Jeffrey S. Berns, Antoinette Spevetz, David L. Paskin, and Susan Coull
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Universities ,020205 medical informatics ,education ,Graduate medical education ,Public policy ,Public Policy ,02 engineering and technology ,Centers for Medicare and Medicaid Services, U.S ,Accreditation ,Health Facility Closure ,Education ,Hospitals, University ,03 medical and health sciences ,0302 clinical medicine ,Political science ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,030212 general & internal medicine ,Schools, Medical ,Bankruptcy ,Philadelphia ,Medical education ,Ownership ,Stakeholder ,General Medicine ,Training Support ,University hospital ,United States ,Work (electrical) ,Education, Medical, Graduate ,Medicaid - Abstract
In June 2019, Hahnemann University Hospital (HUH) in Philadelphia became the largest U.S. teaching hospital to announce its closure and the closure of all of its graduate medical education (GME) programs, which displaced more than 550 residents, fellows, and other trainees. In addition to the displaced trainees, the HUH closure involved many stakeholders at both the closing hospital and hospitals willing to accept transferred residents and fellows-program directors and coordinators, designated institutional officials (DIOs), and hospital executives-as well as the Accreditation Council for Graduate Medical Education, the Centers for Medicare and Medicaid Services, the National Resident Matching Program, and other organizations. Given the rarity of such events, those involved had little experience or expertise in dealing with the closure of so many GME programs at one time. In this Invited Commentary, the DIOs of HUH and 4 other area teaching hospitals detail their experiences working to find new training opportunities for the displaced residents and fellows, discussing lessons learned and providing recommendations to prepare for any future teaching hospital closures. Stakeholder organizations should work together to develop a "playbook" for use during future closures so that the chaos that occurred this time can be avoided.
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- 2020
17. Evolution of an Accelerated 3-Year Pathway to the MD Degree
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Elisabeth J. Cohen, Rafael Rivera, Joan Cangiarella, Steven B. Abramson, and Colleen Gillespie
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Time Factors ,020205 medical informatics ,Career path ,MEDLINE ,Graduate medical education ,02 engineering and technology ,Education ,03 medical and health sciences ,0302 clinical medicine ,ComputingMilieux_COMPUTERSANDEDUCATION ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,030212 general & internal medicine ,Curriculum ,Schools, Medical ,Medical education ,Career Choice ,Mentoring ,Flexibility (personality) ,General Medicine ,Residency program ,Training Support ,Grossman ,Education, Medical, Graduate ,Student debt ,New York City ,Psychology ,Education, Medical, Undergraduate - Abstract
The revision of the curriculum at New York University Grossman School of Medicine in 2010, with a reduction of the preclerkship curriculum to 18 months, made it possible to offer an accelerated 3-year pathway in 2013 for students who know their career path. The goals of the program include individualizing education, reducing student debt, and integrating undergraduate and graduate medical education. This accelerated 3-year doctor of medicine (3YMD) pathway is the first program of its kind in the United States to offer conditional acceptance to residency programs in all specialties through the National Resident Matching Program. Since inception of the pathway 6 years ago, 81 students have graduated. Critical components to successfully launch and implement the program are described.Unwavering commitment to the program as a high institutional priority by the dean and vice dean for education facilitated the support required by department chairs and residency program directors and the flexibility needed for success. Alignment between the 3- and 4-year pathways has made it possible to add points of entry into the 3-year pathway during the second and third years and to shift back into the 4-year pathway, as warranted. Modifications to how 3YMD students are mentored included changing the role of the departmental advisor and adding a dedicated 3YMD pathway advisor who serves as an advocate for both the students and the program. Having a relatively large number of 3YMD students has contributed to the success of the program and facilitated acceptance by the residencies.
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- 2020
18. Perception and Usage of Point of Care Devices: A Cross-sectional Study Targeting Residents and Trainers in Oman
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Laila Mohammed Al Mbeihsi, Abdulhakeem Al Rawahi, Amna Al Harrasi, and Mohammed Al Shafaee
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Oman ,Cross-sectional study ,media_common.quotation_subject ,Clinical Decision-Making ,education ,Specialty ,cross-sectional studies ,lcsh:Medicine ,Perception ,Health care ,computers ,internship and residency ,Medicine ,In patient ,Mobile technology ,media_common ,Point of care ,Medical education ,handheld ,business.industry ,lcsh:R ,General Medicine ,training support ,Computers, Handheld ,clinical decision-making ,oman ,Original Article ,business ,Mobile device ,human activities ,point-of-care systems - Abstract
Objectives: The use of mobile technologies and handheld computers by physicians has increased worldwide. However, there are limited studies globally regarding training physicians on the use of such devices in clinical practice. In addition, no studies have been conducted previously in Oman addressing this issue among postgraduate medical trainees and trainers. The present study explores the practice and perception of resident doctors and trainers towards the use of mobile technologies and handheld devices in healthcare settings in Oman. Methods: This cross-sectional study was conducted using a validated questionnaire disseminated via email to all residents and trainers in five major training programs of the Oman Medical Specialty Board (OMSB). The questionnaire explored three main areas; perception, usage, and perceived barriers of handheld devices. Results: Overall, 61.4% of the residents and 28.3% of the trainers responded to the questionnaire. Both types of participants agreed that the use of such devices positively affects clinical decision-making. In total, 98.8% of the participating residents and 86.7% of the trainers frequently used handheld devices. Both OMSB residents and trainers agreed that lack of time, training, and applications were the most common factors limiting the use of these devices. Participants emphasized the need for constructive training regarding the use of handheld devices as healthcare resources. Conclusions: Point-of-care devices are positively perceived and frequently used by OMSB trainees and trainers. However, constructive training on the effective usage of these devices in clinical decision-making is needed. Further future studies to evaluate the impact of using such devices in patient care should be conducted.
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- 2021
19. Avanços e limitações das redes sociais como estratégia de comunicação no Sistema Único de Saúde
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Costa, Sedruoslen Guelir Cavalcanti, Pedrosa, Mikaely Martins, Santos, Josilene Soares Carvalho, Amorim, Janaina Gomes de Paiva, and Noro, Luiz Roberto Augusto
- Subjects
Apoio ao Desenvolvimento de Recursos Humanos ,Unified Health System ,Rede Social ,General Medicine ,Training Support ,Sistema Único de Saúde ,Social Networking - Abstract
Social networks can perform an important role in Unified Health System (SUS) regarding access and dissemination of information. This study aims to report the experiences developed by interns and professors of UFRN’s Dentistry course, and by preceptors of USF Panatis and USF Parque das Dunas, at Natal/RN. The activities were planned in a discipline previous to the internship, and the same actors participated in them. Considering the COVID-19 pandemic context, the activities were adapted into virtual format. From Instagram, WhatsApp, and Google Meet, it was possible to disseminate information on the functioning and actions developed at the USF, to create informative posts on oral health, to involve pregnant people in educational actions, to promote closeness with the community, to give automated responses to the most frequent questions, among other activities. Social networks are a powerful tool in communication and dissemination on health care, allowing links to be established as yet another way of accessing information and keeping a permanent dialogue with the population, indicating possible advancements in social control. The prior knowledge that interns and preceptors had on social networking enabled the development of actions which are not part of the traditional context of dental training, so it benefited everyone’s learning and allowed advancements in the relationship between the USF and the community. It is crucial for the government to enable the necessary infrastructure and logistics for the inclusion of social networking in the work process of Primary Care teams, incorporating it as element of its policy on health communication. As redes sociais podem representar importante papel na Atenção Básica do Sistema Único de Saúde no acesso e divulgação de informações. É objetivo desse estudo relatar as experiências desenvolvidas por estagiários e professores do curso de Odontologia da UFRN e preceptores das USF Panatis e Parque das Dunas, Natal/RN. As atividades realizadas foram planejadas em disciplina anterior ao estágio e contaram com a participação desses mesmos atores. Considerando o contexto da pandemia da COVID-19, as atividades foram adaptadas para serem desenvolvidas em formato virtual. A partir do Instagram, WhatsApp e Google Meet foi possível divulgar informações sobre o funcionamento e ações desenvolvidas nas USF, criar posts informativos sobre saúde bucal, envolver gestantes em ações educativas, promover maior aproximação com a comunidade, criação de respostas automáticas às perguntas mais frequentes, entre outras atividades. As redes sociais são potente ferramenta na comunicação e divulgação em saúde, permitindo estabelecimento de vínculos, como mais uma via no acesso às informações e relação de diálogo permanente com a população, sinalizando possíveis avanços no controle social. O conhecimento prévio de estagiários e preceptores sobre as redes sociais viabilizou o desenvolvimento de ações que não fazem parte do contexto tradicional da formação em Odontologia, trazendo benefícios ao aprendizado de todos e avanços na relação das USF com a comunidade. É fundamental que o poder público viabilize infraestrutura e logística necessárias para a inclusão das redes sociais no processo de trabalho das equipes da Atenção Básica, incorporando-as como elemento de sua política de comunicação em saúde.
- Published
- 2022
20. Effects of Covid‐19: The Need to Assess the Real Value of Anatomy Education
- Author
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Darrell J. R. Evans and Wojciech Pawlina
- Subjects
Value (ethics) ,Models, Educational ,Embryology ,Histology ,Higher education ,Coronavirus disease 2019 (COVID-19) ,media_common.quotation_subject ,Physical Distancing ,Education, Distance ,ComputingMilieux_COMPUTERSANDEDUCATION ,Humans ,Learning gain ,Quality (business) ,Curriculum ,media_common ,Infection Control ,Medical education ,business.industry ,Teaching ,COVID-19 ,General Medicine ,Training Support ,Anatomy education ,Scholarship ,Editorial ,Educational Status ,Anatomy ,Psychology ,business - Abstract
Anatomy educators are focused on designing and developing learning and teaching approaches that provide for the most effective learning experience, lead to measurable learning gain and prepare students for the next phase of their learning journey and career track The eagerness of educators to evaluate and challenge approaches and pedagogy has seen an exponential increase in scholarship within anatomical education over recent years as demonstrated by the number and quality of published outputs across many educational journals including Anatomical Sciences Education Such activity bodes well for the provision of effective learning opportunities for students, the continued advancement of evidence-based practice in the teaching of the anatomical sciences, and the ability to adapt and respond to disruptions within the higher education environment
- Published
- 2021
21. The Value of Supporting Education Research in the Academic Environment: The Hospital for Special Surgery Academy of Rheumatology Medical Educators
- Author
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Stephen A. Paget, Anne R. Bass, Juliet Aizer, Michael D Tiongson, Edward J Parrish, Jessica R. Berman, and Laura Robbins
- Subjects
Male ,Value (ethics) ,medicine.medical_specialty ,Biomedical Research ,Students, Medical ,media_common.quotation_subject ,education ,MEDLINE ,Translational research ,Hospitals, Special ,Electronic learning ,Education ,Promotion (rank) ,Rheumatology ,Physicians ,Political science ,ComputingMilieux_COMPUTERSANDEDUCATION ,medicine ,Humans ,Learning ,Fellowships and Scholarships ,Meeting Abstracts ,Curriculum ,health care economics and organizations ,media_common ,Education, Medical ,Academies and Institutes ,Mentoring ,General Medicine ,Training Support ,humanities ,Surgery ,Scholarship ,Female ,New York City - Abstract
Problem Medical education academies have been instrumental in providing greater recognition of and promotion for clinician-educators. However, producing education scholarship is essential for clinician-scholar-educator career advancement. Grant funding for education research and protected time to produce scholarship are still lacking for interested physicians, in part due to institutional budget constraints and competing priorities. Approach The Hospital for Special Surgery Academy of Rheumatology Medical Educators was founded in 2011 to promote education scholarship though grants awarded to educators interested in research. Educators were asked to submit proposals aimed at the development of new teaching programs and curricular change. Selected applicants received up to $50,000 per year for one year. Grant money was obtained through directed fundraising from donors. Information from annual grant updates and survey responses from grant recipients in 2017 were used to assess the academy's effectiveness. Outcomes Since 2012, 32 grants have been awarded, totaling $954,045 in funding. Recipients have produced national meeting abstracts, posters, oral presentations, and manuscripts and created unique curricula and electronic learning tools for medical students, residents, fellows, faculty, and patients. Four educators with demonstrated interest and research outcomes were identified during the pilot and received additional funding and support from a dedicated education research assistant. Next steps The academy and the innovation grants program highlight the talents of under-supported and under-recognized teaching faculty by allowing them to distinguish themselves academically as clinician-scholar-educators. The success of these educators emphasizes the clear advantages of a formalized structure to achieve the hospital's education goals. Next steps include providing support for a rheumatology fellow to develop an education research career rather than one in bench, clinical, or translational research.
- Published
- 2020
22. Comparison of Medical School Financing Plans Among Matriculating US Medical Students From 2017 to 2019
- Author
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Varun Sagi, Renée Crichlow, Arman A. Shahriar, Lorenzo Adolfo Castañón-Gonzalez, Thomas E. Kottke, and Gabriela Vazquez-Benitez
- Subjects
Medical education ,Students, Medical ,Research ,education ,Medical school ,Ethnic group ,General Medicine ,macromolecular substances ,Training Support ,United States ,Online Only ,Medical Education ,Political science ,Research Letter ,Humans ,Students medical ,Schools, Medical - Abstract
This survey study explores US students’ financing plans for medical school overall and by several demographic factors, focusing on race/ethnicity and household income.
- Published
- 2021
23. Litigation in otology, and diagnosis and treatment delay; prognosis of olfactory disorders in coronavirus disease 2019; and ENT redeployment in the pandemic
- Author
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Edward W Fisher and Jonathan Fishman
- Subjects
medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Time to treatment ,Time-to-Treatment ,Olfaction Disorders ,Otolaryngology ,Otology ,Pandemic ,Otolaryngologists ,medicine ,Humans ,Intensive care medicine ,Jurisprudence ,business.industry ,SARS-CoV-2 ,Treatment delay ,COVID-19 ,General Medicine ,Training Support ,Prognosis ,United Kingdom ,Otorhinolaryngology ,Workforce ,Clinical Competence ,business - Published
- 2021
24. Waiting to 'make it' versus 'making it happen': empowering physician-scientists in training
- Author
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Audra N. Iness
- Subjects
Medical education ,Biomedical Research ,Extramural ,APSA Presidential Address ,MEDLINE ,Internship and Residency ,Cultural Diversity ,General Medicine ,Training Support ,Training (civil) ,United States ,Physicians ,Cultural diversity ,Presidential address ,Humans ,Association (psychology) ,Psychology ,Minority Groups ,Societies, Medical - Published
- 2019
25. A Qualitative Study Exploring the Determinants, Coping, and Effects of Stress in United Kingdom Trainee Doctors
- Author
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Peter Bower, Anli Yue Zhou, Raymond Agius, Martie van Tongeren, Annemarie Money, and Aneez Esmail
- Subjects
Coping (psychology) ,020205 medical informatics ,Attitude of Health Personnel ,media_common.quotation_subject ,education ,02 engineering and technology ,Education ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,Adaptation, Psychological ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,030212 general & internal medicine ,Qualitative Research ,media_common ,Medical education ,Work-Life Balance ,Stressor ,General Medicine ,Focus Groups ,Training Support ,Focus group ,Work environment ,Supportive interventions ,Psychiatry and Mental health ,Feeling ,North west ,Psychology ,Stress, Psychological ,Qualitative research - Abstract
Evidence suggests United Kingdom trainee doctors are experiencing high levels of stress; however, little is known about what determinants contribute to stress, coping mechanisms to mitigate stress, and the effects of stress are in current trainee doctors. Hence, this study aims to explore the determinants, coping mechanisms as well as the effects of stress in this group. Focus groups were undertaken with trainee doctors in North West England to better understand the determinants, coping mechanisms, and effects of stress. Informed written consent was obtained and focus groups were recorded and transcribed. Transcriptions were analyzed using QSR NVivo v11. A total of 44 trainee doctors participated in 11 focus groups. Respondents comprised UK graduates and international medical graduates, across all stages of training in a range of different specialties. Four main themes were identified as determinants: (1) Expectations and guilt, (2) Feeling undervalued, (3) Managing uncertainty and risk, (4) Work environment. Four main themes were identified as coping mechanisms: (1) Reflection and insight, (2) Work-life balance, (3) Work and training environment, (4) Development as a doctor. Two main themes were identified as effects of stress: (1) Negative outcome on wellbeing, (2) Outcome on career. A range of determinants contributes to stress in trainee doctors and they utilize a range of mechanisms to cope. Stress in their working lives can also affect their wellbeing and careers. These findings could be used to improve the understanding of stress in trainee doctors and assist in the development of supportive interventions.
- Published
- 2019
26. Where Do Pediatric Dental Residents Intend to Practice? Exploring the Influence of Loan Repayment Programs and Other Factors
- Author
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Alan M. Garrett, Charles W. LeHew, Sahar Alrayyes, and Anne Ashley Compton
- Subjects
Adult ,Male ,Rural Population ,Financing, Government ,medicine.medical_specialty ,020205 medical informatics ,media_common.quotation_subject ,02 engineering and technology ,03 medical and health sciences ,0302 clinical medicine ,Pediatric Dentistry ,Surveys and Questionnaires ,Debt ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Humans ,Student loan ,media_common ,Response rate (survey) ,Government ,business.industry ,Rural health ,Professional Practice Location ,Internship and Residency ,030206 dentistry ,General Medicine ,Middle Aged ,Training Support ,United States ,Cross-Sectional Studies ,Incentive ,Loan ,Family medicine ,Rural area ,business - Abstract
The high cost of dental education and consequent loan burdens contribute to the shortage of pediatric dental providers in rural areas (RAs). Economic incentives are meant to recruit practitioners to RAs. The aim of this study was to assess the ability of government subsidized loan repayment programs (GSLRPs) to recruit pediatric specialists to practice in RAs. A 26-item questionnaire was emailed to all 921 pediatric dental residents across the U.S. in 2015 for a cross-sectional study of factors influencing their choice of practice location. The instrument included information about GSLRPs, enabling the study to serve as a quasi-experiment on the level of funding needed to make GSLRPs effective. A total of 169 residents responded, for an 18% response rate; 74% of respondents were women and 86% had student loan debt. Among the respondents, 40.6% said they would like to practice in RAs, but only 4.1% actually intended to do so. Over one-third initially reported interest in GSLRPs for practicing in RAs. However, after being informed that the average GSLRP is $30,000 annually, one-third of those lost interest. Although 14.2% said no amount would convince them to consider practice in an RA, over half (53.3%) indicated willingness to consider it if the GSLRP were $40,000-$60,000. These results suggest that current GSLRP levels are insufficient to induce pediatric dentists to practice in RAs.
- Published
- 2019
27. Caring for Our Trainees: Lessons From Around the World
- Author
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Maria T Bourlon, Ranjana Srivastava, and Deborah Mukherji
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Medical education ,Emotional support ,media_common.quotation_subject ,MEDLINE ,Mentoring ,Empathy ,General Medicine ,Models, Theoretical ,Training Support ,Education ,ComputingMilieux_COMPUTERSANDEDUCATION ,Humans ,Psychology ,media_common - Abstract
Continuing progress in the science of oncology must be matched by an increased responsibility toward providing oncology trainees around the world with the academic guidance, emotional support, and lifelong mentoring needed to navigate an increasingly complex environment. Although the realities on the ground determine the practicalities, there are important universal lessons to be learned from heeding diverse experiences. In this paper, three faculty at different stages of their careers from countries with different resources and infrastructure share their insights into caring for trainees.
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- 2019
28. A Remarkable Legacy: The Wayne F. Placek Fund Grant Program
- Author
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Elisabeth R. Straus, Douglas C. Kimmel, and Stephen F. Morin
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Male ,Financial Management ,Social Psychology ,050109 social psychology ,Education ,Gender Studies ,Sexual and Gender Minorities ,03 medical and health sciences ,Empirical research ,Political science ,Humans ,Psychology ,0501 psychology and cognitive sciences ,Marriage ,General Psychology ,Service (business) ,030505 public health ,05 social sciences ,Homosexuality ,General Medicine ,History, 20th Century ,Training Support ,United States ,Management ,Female ,0305 other medical science - Abstract
Gregory M. Herek, PhD, made an important professional contribution through his service as chair of the Scientific Review Committee of the Wayne F. Placek Fund of the American Psychological Foundation (APF). The scholars funded by this grant benefited from the prestige of the grant, which provided an important credential for early career professional development. Many of them went on to become significant researchers in the field of sexual and gender minorities. The studies funded by the Placek Grant also had important political and social effects, such as on legalizing adoption by lesbian and gay parents, passage of same-sex marriage, and demonstrating that lesbians and gay men were at elevated risk for physical health problems. The purpose of the present article is to document the history and impact of the Placek Grant and to describe Greg Herek's central role in this grant program.
- Published
- 2019
29. The Power of Subjectivity in the Assessment of Medical Trainees
- Author
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Glenn Regehr and Olle ten Cate
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Subjectivity ,020205 medical informatics ,MEDLINE ,02 engineering and technology ,Education ,Objective assessment ,03 medical and health sciences ,0302 clinical medicine ,Health care ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,030212 general & internal medicine ,Workplace ,Objectivity (science) ,Competence (human resources) ,Legitimacy ,Medical education ,business.industry ,General Medicine ,Training Support ,Competency-Based Education ,Education, Medical, Graduate ,Clinical Competence ,Educational Measurement ,business ,Psychology ,Clinical skills - Abstract
Objectivity in the assessment of students and trainees has been a hallmark of quality since the introduction of multiple-choice items in the 1960s. In medical education, this has extended to the structured examination of clinical skills and workplace-based assessment. Competency-based medical education, a pervasive movement that started roughly around the turn of the century, similarly calls for rigorous, objective assessment to ensure that all medical trainees meet standards to assure quality of health care. At the same time, measures of objectivity, such as reliability, have consistently shown disappointing results. This raises questions about the extent to which objectivity in such assessments can be ensured.In fact, the legitimacy of "objective" assessment of individual trainees, particularly in the clinical workplace, may be questioned. Workplaces are highly dynamic and ratings by observers are inherently subjective, as they are based on expert judgment, and experts do not always agree-for good, idiosyncratic, reasons. Thus, efforts to "objectify" these assessments may be problematically distorting the assessment process itself. In addition, "competence" must meet standards, but it is also context dependent.Educators are now arriving at the insight that subjective expert judgments by medical professionals are not only unavoidable but actually should be embraced as the core of assessment of medical trainees. This paper elaborates on the case for subjectivity in assessment.
- Published
- 2019
30. Parental Leave in Graduate Medical Education: Recommendations for Reform
- Author
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Patricia Vassallo, Frances A. Collichio, Alpesh Amin, Leanne Forman, Debra L. Simmons, Lauralee Dubois, Katherine C. Chretien, Jennifer Jeremiah, and David L. Coleman
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Medical education ,Salaries and Fringe Benefits ,business.industry ,MEDLINE ,Graduate medical education ,Internship and Residency ,Workload ,General Medicine ,Training Support ,Organizational Policy ,United States ,Parental Leave ,Education, Medical, Graduate ,Humans ,Medicine ,Parental leave ,Clinical Competence ,Health Workforce ,Fellowships and Scholarships ,Clinical competence ,business - Published
- 2019
31. Aligning Strategic Interests in an Academic Medical Center: A Framework for Evaluating GME Expansion Requests
- Author
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Jordan S. Peck, Robert G. Bing-You, Mark G. Parker, and Kalli Varaklis
- Subjects
Academic Medical Centers ,Medical education ,010102 general mathematics ,Graduate medical education ,Internship and Residency ,General Medicine ,Focus Groups ,Training Support ,Strategic Planning ,01 natural sciences ,03 medical and health sciences ,New graduate ,0302 clinical medicine ,Education, Medical, Graduate ,Political science ,Educational Innovation ,Humans ,Center (algebra and category theory) ,030212 general & internal medicine ,Maine ,0101 mathematics - Abstract
Background In 2017, the Maine Medical Center Graduate Medical Education Committee received an unprecedented number of requests (n = 18) to start new graduate medical education (GME) programs or expand existing programs. There was no process by which multiple programs could be prioritized to compete for scarce GME resources. Objective We developed a framework to strategically assess and prioritize GME program expansion requests to yield the greatest benefits for patients, learners, and the institution as well as to meet regional and societal priorities. Methods A systems engineering methodology called tradespace exploration was applied to a 6-step process to identify relevant categories and metrics. Programs' final scores were peer evaluated, and prioritization recommendations were made. Correlation analysis was used to evaluate the relevance of each category to final scores. Stakeholder feedback was solicited for process refinement. Results Five categories relevant to GME expansion were identified: institutional priorities, health care system priorities, regional and societal needs, program quality, and financial considerations. All categories, except program quality, correlated well with final scores (R2 range 0.413–0.662). Three of 18 requested programs were recommended for funding. A stakeholder survey revealed that almost half of respondents (48%, 14 of 29) agreed that the process was unbiased and inclusive. Focus group feedback noted that the process had been rigorous and deliberate, although communication could have been improved. Conclusions Applying a systems engineering approach to develop institution-specific metrics for assessing GME expansion requests provided a reproducible framework, allowing consideration of institutional, health care system, and regional societal needs, as well as program quality and funding considerations.
- Published
- 2019
32. Trainees’ perspectives of assessment messages: a narrative systematic review
- Author
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Neville Chiavaroli, Steve Trumble, Margaret Bearman, and Catherine E Scarff
- Subjects
Educational measurement ,Medical education ,MEDLINE ,Internship and Residency ,Context (language use) ,Qualitative property ,General Medicine ,PsycINFO ,Training Support ,Education ,Systematic review ,Education, Medical, Graduate ,Humans ,Perception ,Clinical Competence ,Educational Measurement ,Thematic analysis ,Workplace ,Psychology ,Inclusion (education) - Abstract
Objectives This study was designed as a narrative systematic literature review of medical specialist trainees' perspectives of the assessment messages they receive in the context of clinical performance assessments. The aim of the study was to determine if trainees value the information they receive through the formats designed to promote their development and, if not, the reasons for this. Methods The authors searched the ERIC, EMBASE, Ovid MEDLINE and PsycINFO databases for articles published up to 16 June 2018 that present original data on trainees' perspectives of the assessment messages they receive in the context of work-based assessments (WBAs) and in-training assessments (ITAs) used within their training programmes. All authors screened 938 abstracts and 139 full-text articles were assessed after this. Descriptions of quantitative data and thematic analysis of qualitative data were used to present the opinions of trainees. Results Thirty-three articles met the inclusion criteria. Twenty-six articles (79%) described trainees' perspectives in the context of WBA and the remaining articles referred to ITA formats. Wide-ranging opinions were reported. The analysis categorised these into three themes: trainees value developmental assessment messages; trainees become disengaged when assessment messages are not developmental, and trainees' views depend on the environment, the assessor and themselves. Some trainees reported that the assessment messages were valuable and provided input on their performance to guide their development, but many disagreed. In particular, the trainee's own level of engagement with the assessments influenced his or her perspectives on the messages received. Conclusions Trainees do not universally perceive that clinical performance assessments provide them with the valuable developmental input on their performance they were designed to do. Factors related to the environment, the assessor and themselves influence their perspectives.
- Published
- 2019
33. Barriers and Enablers to Direct Observation of Trainees’ Clinical Performance
- Author
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Sylvain Boet, Jason R. Frank, Warren J Cheung, Andrea M. Patey, and Meredith Mackay
- Subjects
Adult ,Male ,Faculty, Medical ,Medical psychology ,020205 medical informatics ,MEDLINE ,Identity (social science) ,Observation ,Context (language use) ,02 engineering and technology ,Education ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,030212 general & internal medicine ,Qualitative Research ,Social influence ,Ontario ,Medical education ,Education, Medical ,Direct observation ,Internship and Residency ,General Medicine ,Middle Aged ,Training Support ,Content analysis ,Female ,Clinical Competence ,Educational Measurement ,Psychology ,Qualitative research - Abstract
Purpose Direct observation is essential to assess and provide feedback to medical trainees. However, calls for its increased use in medical training persist as learners report that direct observation occurs infrequently. This study applied a theory-driven approach to systematically investigate barriers and enablers to direct observation in residency training. Method From September 2016 to July 2017, semistructured interviews of faculty and residents at The Ottawa Hospital were conducted and analyzed. An interview guide based on the theoretical domains framework (TDF) was used to capture 14 domains that may influence direct observation. Interview transcripts were independently coded using direct content analysis, and specific beliefs were generated by grouping similar responses. Relevant domains were identified based on the frequencies of beliefs reported, presence of conflicting beliefs, and perceived influence on direct observation practices. Results Twenty-five interviews (12 residents, 13 faculty) were conducted, representing 10 specialties. Ten TDF domains were identified as influencing direct observation: knowledge, skills, beliefs about consequences, social/professional role and identity, intention, goals, memory/attention/decision processes, environmental context and resources, social influences, and behavioral regulation. Discord between faculty and resident intentions, coupled with social expectations that residents should be responsible for ensuring that observations occur, was identified as a key barrier. Additionally, competing demands identified across multiple TDF domains emerged as a pervasive theme. Conclusions This study identified key barriers and enablers to direct observation. These influencing factors provide a basis for the development of potential strategies aimed at embedding direct observation as a routine pedagogical practice in residency training.
- Published
- 2019
34. The evolution of response and management training at the FEMA Center for Domestic Preparedness
- Author
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Jeffrey R. Ryan, Amanda Stewart, MA Tony Russell, MA Roy Marlow, and Denis Campeau
- Subjects
Program evaluation ,Emergency Medical Services ,Medical education ,Capacity Building ,Emergency management ,business.industry ,Emergency Responders ,Management training ,Disaster Planning ,General Medicine ,Training Support ,Bioterrorism ,United States ,First responder ,Government Agencies ,Preparedness ,Agency (sociology) ,Emergency Medicine ,Humans ,Terrorism ,Safety, Risk, Reliability and Quality ,Training program ,business ,Safety Research ,Program Evaluation - Abstract
The Federal Emergency Management Agency (FEMA) Center for Domestic Preparedness (CDP) was established in 1998 and is now 20 years old. In its short history, the CDP has significantly evolved the relevance and responsiveness of its courses and its capability to provide high-fidelity, hands-on training, and exercises to meet the demanding needs of today’s responders. This article discusses the basis of need for a competent, responder training program; the genesis of the CDP as a no-cost provider of responder training for state, local, tribal, and territorial responders; describes the current training opportunities available to responders; previews emerging training opportunities that are under development or envisioned in the very near future; and provides insight to the future progression of the CDP as it continues to expand and evolve its role as FEMA’s premiere, responder focused, hands-on training provider.
- Published
- 2019
35. Effectiveness of a training program for the nursing staff on the oral health of institutionalised aged. Randomised trial
- Author
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Tiril Willumsen, José Antonio Gil Montoya, and Dairo Javier Marín Zuluaga
- Subjects
medicine.medical_specialty ,Nursing staff ,business.industry ,medicine.medical_treatment ,lcsh:R ,Nursing homes ,Nursing care ,lcsh:Medicine ,Caries prevalence ,Oral Health ,General Medicine ,Oral health ,Training Support ,lcsh:RK1-715 ,Family medicine ,Intervention (counseling) ,lcsh:Dentistry ,medicine ,Oral examination ,Dentures ,business ,Training program ,Aged - Abstract
Background: it has been suggested that nursing-staff’ should be educated in maintaining the oral health (OH) of institutionalised elder people. Objective: this work aimed for measuring the effectiveness of a 3-hour oral health training-programme (OHTP) provided to nursing-staff by assessing the residents’ OH gains. Materials and methods: this was a one-year longitudinal-controlled-interventional study evaluated via a nursing-staff’ questionnaire and residents’ oral examinations. Managers of 30 nursing homes in Granada, Spain, were contacted and offered three oral examinations for their residents and an OHTP for the nursing-staff; nine of them consequently agreed to participate for all consenting people. 269 residents were examined at baseline and 12 months. After the baseline examination, the nursing homes were randomised into an intervention or control group; the OHTP was then carried out on the intervention group. Results: the residents’ denture hygiene (p=0.03) and wearing of dentures at night (p=0.003) improved significantly in the intervention group; caries prevalence increased in both groups. Conclusions: the OHTP was effective for improving caregivers’ knowledge and OH care routines, but the improvements were not enough to improve residents’ overall OH.
- Published
- 2019
36. Global Health Education in the Time of COVID-19: An Opportunity to Restructure Relationships and Address Supremacy
- Author
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Harriet Mayanja-Kizza, Tracy L. Rabin, and Michele Barry
- Subjects
020205 medical informatics ,Restructuring ,International Cooperation ,Developing country ,02 engineering and technology ,Global Health ,Experiential learning ,Education ,03 medical and health sciences ,0302 clinical medicine ,Political science ,0202 electrical engineering, electronic engineering, information engineering ,Global health ,Humans ,030212 general & internal medicine ,Developing Countries ,Health Education ,Health Equity ,SARS-CoV-2 ,business.industry ,COVID-19 ,International health ,General Medicine ,Training Support ,Public relations ,Health equity ,Disadvantaged ,Leadership ,Invited Commentaries ,Interdisciplinary Communication ,Health education ,business - Abstract
Global health and its predecessors, tropical medicine and international health, have historically been driven by the agendas of institutions in high-income countries (HICs), with power dynamics that have disadvantaged partner institutions in low- and middle-income countries (LMICs). Since the 2000s, however, the academic global health community has been moving toward a focus on health equity and reexamining the dynamics of global health education (GHE) partnerships. Whereas GHE partnerships have largely focused on providing opportunities for learners from HIC institutions, LMIC institutions are now seeking more equitable experiences for their trainees. Additionally, lessons from the COVID-19 pandemic underscore already important lessons about the value of bidirectional educational exchange, as regions gain new insights from one another regarding strategies to impact health outcomes. Interruptions in experiential GHE programs due to COVID-19-related travel restrictions provide an opportunity to reflect on existing GHE systems, to consider the opportunities and dynamics of these partnerships, and to redesign these systems for the equitable benefit of the various partners. In this commentary, the authors offer recommendations for beginning this process of change, with an emphasis on restructuring GHE relationships and addressing supremacist attitudes at both the systemic and individual levels.
- Published
- 2021
- Full Text
- View/download PDF
37. Interviewing for residency on a budget
- Author
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Jodi-Ann Edwards
- Subjects
Medical education ,Interview ,Cost Control ,business.industry ,Medical school ,Internship and Residency ,General Medicine ,Training Support ,Interviews as Topic ,Medicine ,Humans ,Surgery ,School Admission Criteria ,business - Published
- 2021
38. Preparing historically underrepresented trainees for biomedical cancer research careers at Huntsman Cancer Institute/University of Utah Health
- Author
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Kathryn Browning Hawes, Donald E. Ayer, Ana Maria Lopez, Donna Harp Ziegenfuss, Kola Okuyemi, José E. Rodríguez, and Anna Marsden
- Subjects
Male ,Medicine (General) ,Biomedical Research ,Higher education ,Universities ,Huntsman Cancer Institute ,education ,partnership ,underrepresented trainees ,Pipeline program ,Cancer Care Facilities ,Education ,Young Adult ,Mentorship ,R5-920 ,health care career ,Utah ,Health care ,Humans ,Sociology ,Cultural Competency ,Curriculum ,Minority Groups ,health equity ,Medical education ,LC8-6691 ,Career Choice ,business.industry ,Professional development ,Mentoring ,Social Support ,General Medicine ,Training Support ,Special aspects of education ,Health equity ,Leadership ,Socioeconomic Factors ,Workforce ,Cancer research ,Female ,business ,Research Article - Abstract
Given the well-documented inequities in health care outcomes by race, ethnicity, and gender, many health career pipeline programs have focused on supporting the development of a diverse and inclusive workforce. The State of Utah, is vast, but sparsely populated outside the Salt Lake City metropolitan area. More than 96% of our nearly 85,000 square miles is designated rural (
- Published
- 2021
39. A Trainee-Led Way to Help International Medical Graduates Meet the Challenges of a U.S. Residency
- Author
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Nicha Wongjarupong, Tolulope Odebunmi, Serin Edwin Erayil, and Mats Steffi Jennifer
- Subjects
Adult ,Male ,Career Choice ,Internship and Residency ,Guidelines as Topic ,General Medicine ,Training Support ,United States ,Education ,Young Adult ,Professional Competence ,Humans ,Female ,Foreign Medical Graduates - Published
- 2021
40. Trainee Perspectives on Breast Imaging Training during COVID-19: Where We Are Now
- Author
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Bonnie N. Joe and Wendy Tu
- Subjects
Medical education ,Breast imaging ,SARS-CoV-2 ,Social distance ,education ,Graduate medical education ,COVID-19 ,Internship and Residency ,Breast Neoplasms ,General Medicine ,Training Support ,Editorial ,Pandemic ,Humans ,Female ,Breast ,Psychology ,Set (psychology) ,Radiology ,Personal protective equipment ,Curriculum ,Accreditation - Abstract
The first documented case of SARS-CoV-2 in the United States occurred in January of 2020 [1], and by March of 2020 the World Health Organization declared a global pandemic [2]. Hospitals and facilities deferred elective patient visits to reduce exposure and virus transmission and to conserve medical resources including personal protective equipment. Position statements from multiple societies suggested to “postpone all breast screening exams (to include screening mammography, ultrasound, and MRI) effective immediately” [3, 4]. Diagnostic breast imaging cases were triaged and were often deferred, delayed, or cancelled, depending on the pre-test probability of disease, institution guidelines, and patient preference. A predictive model from the National Cancer Institute following the effect of COVID-19 on screening showed that an anticipated 10,000 excess deaths could be expected from breast and colorectal cancers, with the majority of these deaths occurring within two years [5]. As we work towards recovery and reestablishing screening, we will also need to be mindful of the effect of pandemic on our radiology trainees. COVID-19 has undoubtedly affected the way that curriculum is taught and received with many programs relegated to a virtual curriculum [6]. The reported effects of this shift in education style varied greatly with those residents closer to certifying exams and transition to practice being most affected. To counteract this change, the Accreditation Council for Graduate Medical Education set out a framework to prioritize learning based on different levels of restrictions imposed [7]. These frameworks consisted of three stages; stage 1 – “Business as Usual”, 2 – “Increased Clinical Demands” and 3 – “Pandemic Emergency Status” [7], to provide guidance and resources in maintaining resident education while balancing ongoing disaster preparedness and safety of trainees. As on-site personnel decreased to provide social distancing, institutions shifted to remote work and training. These changes, while met with enthusiasm [6], may have had a negative impact on education as compared with traditional face-to-face teaching and procedural skills training. Programs were required to rapidly integrate with new technology to continue to teach, sometimes without necessarily providing adequate training in use of videoconference software. While online learning may be more feasible in certain specialties, we wonder if others, such as breast imaging, will be more detrimentally affected, due to the requirements for case volume and hands-on training in procedural skills. The significant volume drop in imaging resulted in a considerable decrease in opportunities for learners. The altered training experience is multi-factorial, affecting many facets of resident training. We wanted to look at the potential learning and training gaps that occurred over 2020. As such, we surveyed our various trainee editorial boards at the Radiological Society of North America (Radiology, Radiology: Imaging Cancer, Radiology: Artificial Intelligence, and RadioGraphics) from academic programs across the United States, Canada, and Brazil to assess the impact of COVID-19 on their respective breast radiology rotations and measures to compensate for this. We write this piece in December 2020, to bring together a snapshot of how the pandemic has impacted breast imaging and trainees based on responses to the following questions.
- Published
- 2021
41. A Video and Case-Based Transport Curriculum for Neonatal-Perinatal Medicine Trainees Using a Flipped Classroom Methodology
- Author
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Gary M. Weiner, Carly Gisondo, and Kate Stanley
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Educational measurement ,2019-20 coronavirus outbreak ,Medicine (General) ,Michigan ,Coronavirus disease 2019 (COVID-19) ,Physiology ,education ,Original Publication ,Video Recording ,Transport Medicine ,Computer-Assisted Instruction ,Communication Skills ,Flipped classroom ,Pediatrics ,Education ,R5-920 ,ComputingMilieux_COMPUTERSANDEDUCATION ,Humans ,Neonatal perinatal medicine ,Curriculum ,Pandemics ,Medical education ,integumentary system ,SARS-CoV-2 ,Infant, Newborn ,COVID-19 ,General Medicine ,Problem-Based Learning ,Training Support ,Online/Distance Learning ,Problem-based learning ,Education, Medical, Graduate ,Neonatal-Perinatal Medicine ,Educational Measurement ,Neonatology ,Psychology - Abstract
Introduction Neonatal-perinatal medicine (NPM) providers actively manage medical transports. However, there is wide variation in transport education among fellowship programs. Using the flipped classroom methodology, we developed a video and case-based transport education curriculum. Methods A national needs assessment identified safety, communication skills, and physiology as the most important aspects of transport management. Three 10-minute video modules and two 20-minute case-based discussions were developed to address this content. Using the flipped classroom format, seven NPM fellows from all three postgraduate years of training took part in the curriculum by individually viewing each video followed by participation in group case-based discussions. Cognitive and affective outcomes were assessed using a knowledge and attitude pretest, individual video module posttests, and a postcurriculum follow-up survey. Results NPM fellows showed significant improvements in transport knowledge and reported increased confidence in their ability to perform important transport roles. Case discussions were adaptable to learners who had different levels of training and had variable transport experience. Case discussions were successfully executed both in person and by video telecommunications during the 2020 COVID-19 pandemic. Discussion This transport curriculum addressed a national education gap in NPM fellowship training. Using the flipped classroom methodology, cognitive and affective objectives were achieved by improving knowledge and confidence in transport skills among NPM learners. The video and case-based formats were easily implemented, applicable to multiple types of learners, and adaptable to different environments.
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- 2021
42. 'I Can’t Breathe'—COVID-19 Perspectives as a Black Trainee
- Author
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Anase Asom
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Chicago ,2019-20 coronavirus outbreak ,Medical education ,Students, Medical ,Coronavirus disease 2019 (COVID-19) ,SARS-CoV-2 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Clinical Decision-Making ,COVID-19 ,Internship and Residency ,General Medicine ,Training Support ,Physicians, Primary Care ,Trainee-Authored Letters to the Editor ,Education ,Black or African American ,Dyspnea ,Patient Admission ,Clinical decision making ,Humans ,Female ,Healthcare Disparities ,Psychology ,Students medical ,Aged - Published
- 2021
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43. The NHS bursary: what am I entitled to?
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Penelope P J, Sucharitkul, Emma, Shorrock, and Erin, Lawson-Smith
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Humans ,General Medicine ,Training Support ,State Medicine - Published
- 2022
44. Retirement-a time to dread or to cherish?
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Simon D. Taylor-Robinson
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Retirement ,business.industry ,media_common.quotation_subject ,Taboo ,Health Behavior ,Subject (philosophy) ,General Medicine ,Taboo (idea) ,Training Support ,Education ,03 medical and health sciences ,0302 clinical medicine ,Aesthetics ,General & Internal Medicine ,Medicine ,Humans ,030212 general & internal medicine ,Ill health ,business ,11 Medical and Health Sciences ,media_common - Abstract
Retirement is often a taboo subject amongst medical professionals. Many have dedicated a major part of their lives to the practice of medicine to the exclusion of anything else. The thought of empty days or lack of externally driven purpose is something that unsettles many who are approaching pensionable age. In reality, such fears rarely materialize. The challenge of transition to a new phase of life is all the more poignant if ill health intervenes early, causing premature cessation of work.
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- 2020
45. Telemedicine: don’t discount the value of in-person GP clinics to the medical trainee
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Adam M J Peer
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Value (ethics) ,2019-20 coronavirus outbreak ,Telemedicine ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,General Practice ,Pneumonia, Viral ,030204 cardiovascular system & hematology ,State Medicine ,03 medical and health sciences ,Betacoronavirus ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Pandemics ,Pace ,SARS-CoV-2 ,COVID-19 ,General Medicine ,Training Support ,medicine.disease ,United Kingdom ,General practice ,Medical emergency ,Psychology ,Coronavirus Infections - Abstract
The move towards telemedical consultation in light of the covid-19 pandemic is driving innovation in general practice at pace. Omitted from consideration in Stokel-Walker’s otherwise excellent piece,1 however, is the impact digitalised consultation will have on the development of medical trainees. …
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- 2020
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46. How to better support Black trainees in the biomedical sciences
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Angeline J. Dukes
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0301 basic medicine ,Medical education ,Biomedical Research ,biology ,Career Choice ,MEDLINE ,General Medicine ,Training Support ,General Biochemistry, Genetics and Molecular Biology ,Black or African American ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Toll ,biology.protein ,Humans ,Psychology ,Career choice ,Biomedical sciences - Abstract
The relentless violence against Black people takes an overwhelming emotional toll on Black trainees. In those we continue to lose, we see our families, our friends and our own lives being taken.
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- 2020
47. Lift as You Rise: Conference Panel Comoderation With Female Trainees
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Shikha Jain, Maren Loe, Mamta Swaroop, and Katherine M Gerull
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Physicians, Women ,Faculty, Medical ,Aeronautics ,Lift (data mining) ,Computer science ,Humans ,Female ,General Medicine ,Congresses as Topic ,Training Support ,Education - Published
- 2020
48. New Zealand plastic and reconstructive surgery workforce: update and future projections
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Amanda Peacock, Swee T. Tan, and Brandon Adams
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Reconstructive surgery ,medicine.medical_specialty ,education.field_of_study ,Population ageing ,workforce ,Population statistics ,RD1-811 ,Population ,forecasting ,General Medicine ,training support ,reconstructive surgical procedures ,Workforce ,medicine ,Population data ,Population growth ,Demographic economics ,Surgery ,Business ,surgeons ,education - Abstract
Objectives: Population growth in New Zealand (NZ) has occurred faster than previously forecast. As a result, previous workforce predictions are outdated and must be adjusted to ensure adequate access to plastic and reconstructive surgery (PRS) services. This paper presents an update of the PRS workforce and its projected needs, and the distribution of reconstructive surgeons (PRSn) in NZ. Methods: The number of practising PRSn and trainees, and the total medical workforce were reviewed, along with population statistics modelling with a focus on the ageing population. Comparisons were made to previous data and forecasts from 2013. Results: Previous population modelling predicted that NZ would reach five million by 2027. However, updated population data show that this figure was surpassed in 2020 and that the population will be approximately 5,374,655 in 2028. The PRS workforce has continued to grow in relation to overall population growth. The PRSn to population ratio (PRSPR) has improved since 2013 with a current ratio of approximately 1/69,000. However, a vast workforce maldistribution remains. Conclusion: The overall PRSPR in NZ appears satisfactory for the ageing population. However, the vast workforce maldistribution remains unchanged and this presents a barrier to equitable access to public PRS services, especially in provincial NZ.
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- 2020
49. Microsurgery training for plastic surgery trainees in Australia
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David Lu, Courtney Hall, and Rodrigo P Teixeira
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medicine.medical_specialty ,RD1-811 ,business.industry ,medicine.medical_treatment ,General surgery ,General Medicine ,microsurgery ,Microsurgery ,training support ,reconstructive surgical procedures ,Plastic surgery ,medicine ,Surgery ,business - Published
- 2020
50. Trends in NIH-supported career development funding: implications for institutions, trainees, and the future research workforce
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M. Bishr Omary, Santiago Schnell, Adrienne Ettinger, and Marisa L. Conte
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Medical education ,Financing, Government ,Biomedical Research ,MEDLINE ,General Medicine ,Training Support ,Biological Science Disciplines ,Research Personnel ,United States ,National Institutes of Health (U.S.) ,Political science ,Research Support as Topic ,Workforce ,Perspective ,Humans ,Medicine ,Career development - Published
- 2020
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