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Objective: To investigate whether a gap year for either research or a master's degree is associated with interview offers or match outcomes among otolaryngology applicants., Methods: Using the Texas Seeking Transparency in Application to Residency (Texas STAR) database, we conducted a cross-sectional analysis of otolaryngology applicants from 2018 to 2022. Applicants were stratified based on the presence and type of gap year during medical school. Applicant characteristics, signaling, research productivity, and application costs were analyzed, with primary outcomes including number of interview offers and match status., Results: Among 564 otolaryngology applicant respondents to the Texas STAR survey, 160 (28%) reported a gap year, including 64 (40%) applicants participating in a research year, 65 (41%) completing a Master of Public Health or Science (MPH and MSc), and 31 (19%) completing a Master of Business Administration, Education, or other degree (MBA and MEd). Gap-year applicants who completed a research year or MPH/MSc degree received more interview offers ( P  < .01) than MBA, MEd applicants, or those without a gap year. Applicants with a research year had the most publications, oral presentations, abstracts, posters, and research experiences (all P  < .01). When controlling for USMLE scores, clerkship honors, and applications submitted, applicants completing a research year or an MPH/MSc-degree received increased interview offers ( P  < .01). No significant differences were seen in expenditures or match rates., Conclusions: Research and MPH/MSc gap years were associated with increased residency interview offers but not increased match success. Further longitudinal studies are needed to assess how yearlong experiences affect long-term career outcomes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Obesity is the most common chronic condition in the United States (US), yet primary care physicians face barriers in providing obesity treatment. This study examines the prevalence of American Board of Obesity Medicine (ABOM) certified obesity specialists on the faculty of US Family Medicine residency training programmes, the preparedness of graduating resident physicians to treat obesity, and residency training programme director preferences for supporting faculty development to improve residency education in obesity management. This cross-sectional on-line survey of programme directors addressed the number of ABOM-certified faculty, perceived graduate preparedness to treat obesity, and priorities to improve faculty expertise and obesity curriculum. Of 672 eligible programme directors, 298 (44%) responded to our survey. Most programmes (76%) had no ABOM-certified faculty. The proportion of programme directors assessing their graduates as prepared to care for patients with obesity has significantly decreased in the last 5 years (2018: 74%, 2022: 58%, p = .016). Residents in programmes with ABOM-certified faculty member were more likely to be assessed as very prepared to provide medical care (18% vs. 7.8% p = .047). A majority (54%) of programme directors identified limited faculty training and expertise as the biggest faculty and resident-level barrier to quality obesity care. This study demonstrates an important trend towards increasing ABOM-certification among Family Medicine residency programme faculty and an urgent need to prioritise faculty development to improve faculty expertise and resident training to address the obesity epidemic., (© 2024 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Phenomenon: Competency-based medical education (CBME) relies on workplace-based assessment (WBA) to generate formative feedback (assessment for learning-AfL) and make inferences about competence (assessment of learning-AoL). When approaches to CBME rely on residents to initiate WBA, learners experience tension between seeking WBA for learning and for establishing competence. How learners resolve this tension may lead to unintended consequences for both AfL and AoL. We sought to explore the factors that impact both decisions to seek and not to seek WBA and use the findings to build a model of assessment-seeking strategy used by residents. In building this model we consider how the link between WBA and promotion or progression within a program impacts an individual's assessment-seeking strategy. Approach : We conducted 20 semi-structured interviews with internal medicine residents at Queen's University about the factors that influence their decision to seek or avoid WBA. Using grounded theory methodology, we applied a constant comparative analysis to collect data iteratively and identify themes. A conceptual model was developed to describe the interaction of factors impacting the decision to seek and initiate WBA. Findings : Participants identified two main motivations when deciding to seek assessments: the need to fulfill program requirements and the desire to receive feedback for learning. Analysis suggested that these motivations are often at odds with each other. Participants also described several moderating factors that impact the decision to initiate assessments, irrespective of the primary underlying motivation. These included resident performance, assessor factors, training program expectations, and clinical context. A conceptual framework was developed to describe the factors that lead to strategic assessment-seeking behaviors. Insights : Faced with the dual purpose of WBA in CBME, resident behavior in initiating assessment is guided by specific assessment-seeking strategies. Strategies reflect individual underlying motivations, influenced by four moderating factors. These findings have broad implications for programmatic assessment in a CBME context including validity considerations for assessment data used in summative decision-making including readiness for unsupervised practice.

Objective: The aim of this study was to determine whether a flipped classroom curriculum coupled with case-based learning would improve residents' perceptions of the learning environment, improve education outcomes, and increase faculty engagement. Research suggests that active learning yields better educational results compared with passive learning. However, faculty are more comfortable providing lectures that require only passive participation from learners., Methods: A council was created to identify issues with the current format of the resident didactic curriculum and to redesign the neurosurgical curriculum and conference per Accreditation Council for Graduate Medical Education (ACGME) requirements. Trends from the authors' 2022 and 2023 ACGME Resident Surveys were tracked to assess changes in the organizational learning environment. Surveys of resident participants were conducted to assess learner satisfaction., Results: Between July 2022 and June 2023, the authors gathered 127 survey responses from neurosurgical residents. The majority of respondents, comprising 50.4% (n = 64), were postgraduate year (PGY)-4 and PGY-5 residents. Sixty-six percent (n = 84) reported that the new format ranked within the top third of sessions they had experienced. On analysis of trends from these 2022 and 2023 ACGME Resident Surveys, the authors observed a positive trajectory in various key components. Notably, there was an upward trend in achieving an appropriate balance between service and education, in the availability of protected time for structured learning, faculty engagement and interest in education, and amount of clinical and didactic teaching., Conclusions: The results of this study suggest that this innovative educational model can have a positive impact on residents' perceptions of the learning environment, their educational outcomes, and faculty engagement. As residency education continues to evolve, the flipped classroom model offers an exciting avenue for enhancing the quality of residency education.

Objective: Few data describe how general psychiatry residencies prepare trainees to care for individuals with neurocognitive disorders (NCDs), despite increasing recognition of the need for psychiatrists to provide care for the growing numbers of patients with NCD. This study aims to identify training needs and approaches, as the resident experience is one important perspective that can be added to others, such as milestones developed by expert educators., Methods: The authors conducted three focus groups of third- and fourth-year general adult psychiatry residency trainees from three different training programs in May and June of 2021. Focus groups consisted of three to eight unique participants per group. Qualitative data analysis techniques derived in grounded theory were utilized to identify themes., Results: Four main themes emerged from the focus groups: unique challenges of NCD care, intrinsic rewards of working with families, perceived gaps in educational experiences, and limited comfort in future practice., Conclusions: Participants expressed that aspects of NCD care were fundamentally different than care for other mental health conditions encountered in psychiatry residency. They found the progressive nature of the disease to be particularly challenging, and they also expressed challenges with clinical interviews and establishing rapport with individuals with NCDs. However, working with families was especially rewarding. Regardless of training program, participants expressed a need for additional longitudinal and diversified training opportunities to prepare them for future practice in this area., (© 2024. The Author(s), under exclusive licence to American Association of Chairs of Departments of Psychiatry, American Association of Directors of Psychiatric Residency Training, Association for Academic Psychiatry and Association of Directors of Medical Student Education in Psychiatry.)

Orthopaedic surgery has not experienced the same increase in diversity as other surgical subspecialties over time. Professional orthopaedic societies across the nation, including the American Academy of Orthopaedic Surgeons, are now making sincere efforts to improve diversity, equity, and inclusion (DEI) within the field. Several national groups provide funding to support DEI -related research as well as scholarships to national meetings. Others are more focused on mentorship and mitigation of residency attrition amongst underrepresented minorities (URMs). Individual residency programs, including the Department of Orthopaedics at Brown University, are engaging in community outreach to attract more diverse candidates to orthopaedics and providing away rotation scholarship support for medical students that identify as female or URMs. These local and national efforts will hopefully lead to a more inclusive environment for all trainees and practitioners within orthopaedics and ultimately improved orthopaedic care for all patients.

Objective: The objective of this study was to evaluate the online component of a blended curriculum for psychiatry residents on the use of electroconvulsive therapy (ECT) to treat depression in older adults., Methods: Second- and third-year general psychiatry residents completed a blended learning curriculum during their core geriatric psychiatry rotation. The curriculum consisted of didactic seminars, hands-on clinical management, and two online clinical cases focused on the management of late-life depression with ECT. Knowledge acquisition following module completion was measured using a nine-question multiple-choice test. The authors adapted the Medical E-Learning Evaluation Survey (MEES) to measure resident satisfaction, clinical relevance, and instructional design., Results: A total of 37 residents completed both online modules. Of these, 35 residents completed the knowledge test and 23 completed the adapted MEES. Almost all participants (96%) agreed or strongly agreed that the modules were relevant to their clinical work, evidence-based, able to be completed in a reasonable amount of time, and a valuable learning experience. The average score on the knowledge test, after removing one outlier, was 83%., Conclusion: Psychiatry residents are very satisfied with the content and delivery of the online component of a blended curriculum for understanding the use of ECT for late-life depression. Future work should examine satisfaction with the remainder of the curricula as well as the impact on longer-term knowledge acquisition and patient care., (© 2023. The Author(s), under exclusive licence to American Association of Chairs of Departments of Psychiatry, American Association of Directors of Psychiatric Residency Training, Association for Academic Psychiatry and Association of Directors of Medical Student Education in Psychiatry.)

Purpose: This study sought to assess interest in global surgery rotations among current United States (US)-based oral and maxillofacial surgery (OMS) residents., Methods: An anonymous 23-question survey was distributed to 633 current OMS residents in the US to examine resident interest in global surgery rotations during residency. The primary outcome variable was resident interest in participating in global OMS rotations during residency training, whereas the primary predictor variable was the presence of residency faculty involved in global OMS work. Descriptive statistics were calculated for all study variables and univariate/multivariate logistic regression analyses were conducted to identify predictors of interest in global OMS rotations., Results: A total of 120 residents with an average age of 30.4 ± 3.2 years responded to the survey. At present, 22 (18.5%) residents stated that their residency programs offer some sort of global OMS rotation and 21 (95.5%) of these claimed they were willing to participate in global OMS rotations at their residency program. Out of the residents who stated their program did not offer a global OMS rotation, 86 (87.8%) respondents stated they would be interested in adding a dedicated global OMS rotation to their residency curriculum. The presence of OMS residency faculty involved in global OMS work (p = 0.030) and a resident's willingness to dedicate vacation time to participate in a global surgery rotation (p = 0.005) were associated with increased interest in a global surgery rotation., Conclusion: The majority of respondents would welcome a dedicated global OMS rotation during their residency training., (© 2023 American Dental Education Association.)

Objectives: With the recent implementation of Competency-based Medical Education (CBME) and emphasis on direct observation of learners, there is an increased interest in the concept of clinical coaching. While there is considerable literature on the role of attending physicians as coaches, little data is available on the role of residents as coaches, and residents' perceptions about effective coaching. We aimed to identify distinct characteristics of residents' coaching, to examine residents' perceptions on what they valued most in clinical coaches, and to explore trainees' ideas about how to optimize this role., Design: We performed an exploratory qualitative study, using 45 minutes semi-structured interviews. We did a thematic analysis of the interview transcripts using both inductive and deductive coding., Participants: We invited and interviewed 5 surgical and 5 nonsurgical residents, and 3 surgical and 3 nonsurgical attending staff. Residents were recruited from all post graduate levels and from a variety of programs., Setting: Our study was done in a large tertiary teaching hospital., Results: Residents perceived that they have a significant role as coaches for junior learners, different from the attending's role. The proximity between the coach and the coaches leads to a different supervisor-learner rapport. This was of benefit as learners described feeling more comfortable making mistakes and seeking feedback, which potentiates effective coaching. Residents reported feeling that it was easier to coach their recently-acquired skills as the subtleties of the tasks and the troubleshooting were fresher in memory. Residents expressed appreciating a coach who values autonomy and does not intervene except when patient safety is at risk. Strategies identified to further optimize residents' role as coaches include placing coaching as a priority, ensuring dedicated time, and offering teaching sessions on coaching., Conclusions: Residents have distinct roles as coaches, driven by their recent experience being coached and as near peers. More research is needed to evaluate concrete measures to optimize residents' role as coaches and to improve their coaching skills., Competing Interests: CONFLICT OF INTEREST None., (Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.)

Purpose: Residency programs must ensure resident competence for independent practice. The coronavirus disease-19 (COVID-19) pandemic disrupted health care delivery, impacting pediatric residencies. This study examines the impact on pediatric resident education., Methods: The authors conducted a mixed methods national survey of pediatric residency program directors (PDs) from May 2020 to July 2020. Data analysis included descriptive statistics, chi-square, and Wilcoxon rank sum tests. Multivariable modeling identified factors associated with resident preparation for more senior roles. Thematic analysis was performed on open-ended questions about PD COVID-19 pandemic recommendations to peers, Accreditation Council for Graduate Medical Education and American Board of Pediatrics., Results: Response rate was 55% (110/199). PDs reported the COVID-19 pandemic negatively affected inpatient (n = 86, 78.2%), and outpatient education (n = 104, 94.5%), procedural competence (n = 64; 58.2%), and resident preparation for more senior roles (n = 50, 45.5%). In bivariate analyses, increasingly negative impacts on inpatient and outpatient education were associated with an increasingly negative impact on resident preparation for more senior roles (P = .03, P = .008), these relationships held true in multivariable analysis. Qualitative analysis identified 4 themes from PD recommendations: 1) Clear communication from governing bodies and other leaders; 2) Flexibility within programs and from governing bodies; 3) Clinical exposure is key for competency development; 4) Online platforms are important for education, communication, and support., Conclusions: The COVID-19 pandemic negatively impacted inpatient and outpatient education. When these were more negatively impacted, resident preparation for more senior roles was worse, highlighting the importance of competency based medical education to tailor experiences ensuring each resident is competent for independent practice., (Copyright © 2022 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Rationale and Objectives: In order to help program directors satisfy the Accreditation Council for Graduate Medical Education common program requirement for health care disparities (HCD) education, a comprehensive web-based curriculum on HCDs in Radiology was developed. The curriculum was designed to educate trainees about existing HCDs, stimulate discussion, and spur research about HCDs in radiology. The curriculum was piloted to assess its educational value and feasibility., Material and Methods: A comprehensive curriculum comprised of four modules (1) Introduction to HCDs in Radiology, (2) Types of HCDs in Radiology, (3) Actions to Address HCDs in Radiology, and (4) Cultural Competency was created and housed on the Associate of Program Directors in Radiology website. Various educational media including recorded lectures or PowerPoint presentations, small group discussions, and journal clubs were employed. A pilot program was initiated to evaluate the benefits of this curriculum for resident education and consisted of a pre- and post-curriculum test for trainees, an experience survey for trainees, and a pre- and post-administration survey for facilitators., Results: Forty-seven radiology residency programs participated in the pilot of the HCD curriculum. Of those facilitating the curriculum, 83% indicated lack of standardized curriculum as a perceived barrier to implementing a HCD curriculum at their program on the pre-survey. Trainee knowledge scores increased from 65% (pre) to 67% (post) (p = 0.05). Following curriculum participation, residents indicated an increase in adequate understanding of HCDs in Radiology (81% post vs. 45% pre). Most program directors (75%) found the curriculum easy to implement., Conclusion: This pilot study demonstrated that the APDR Health Care Disparities curriculum increased trainee awareness of HCDs. The curriculum also provided a forum for important discussions about HCDs., (Copyright © 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Through a literature review in combination with qualitative analysis of course evaluations, this study examines aspects that contribute to enhancing e-learning for physicians in a residency education program. The literature review and the qualitative analysis outline three main factors (pedagogical, technological, and organizational), highlighting the importance of a holistic approach that includes learning and technology in context when integrating e-learning strategies in adult learning programs. The findings contribute insights and practical guidance for education organizers on how to conduct e-learning during and after the pandemic.

Objective: Telemedicine use in pediatrics increased during the coronavirus disease-2019 (COVID-19) pandemic. Despite rapid uptake by pediatric residency programs, consensus on essential telemedicine skills for pediatric residents is lacking. We used a modified Delphi methodology to identify essential telemedicine skills and behaviors for pediatric residents., Methods: A focused literature search was performed to identify items for review by pediatric telemedicine experts. A modified Delphi methodology consisting of iterative rounds of anonymous surveys was conducted until consensus for each item was reached. Consensus was defined as >80% of experts identifying a topic as "very important." All items were mapped to one of the Accreditation Council for Graduate Medical Education (ACGME) core competencies., Results: Seventeen pediatric telemedicine skills and behaviors achieved a consensus of "very important." Most items mapped to the ACGME core competency domains of interpersonal and communication skills and professionalism., Conclusions: There was a high degree of agreement among pediatric telemedicine experts on the importance of 17 telemedicine skills and behaviors for pediatric trainees. These skills can inform pediatric telemedicine curricula and provide validity evidence for pediatric telemedicine assessment tools., (Copyright © 2022 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

This article reviews current medical literature to assess the benefits and drawbacks of virtual interviews for radiology residencies as well as the downstream effects of these changes, best practices, and potential future recruitment methods. Topics covered include the effects of remote recruitment in promoting accessibility and applicant diversity and equality as well as fiscal, environmental, and time savings in combination with technical challenges, the complications of over application, challenges in assessment of program culture and location, impact on morale, and hidden financial and emotional costs. Learnings from other medical specialties are highlighted in addition to the process of signaling, guidelines for conducting and participating in virtual interviews, and matters for future consideration., (Copyright © 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this qualitative study was to investigate the lived experiences, beliefs, attitudes, and needs of psychiatry residents learning cognitive behavioral therapy (CBT)., Method: Eight general psychiatry residents beginning their outpatient psychotherapy training in July 2020, answered open-ended questions about their experiences learning CBT in October 2020. The residents learned CBT through didactics, role-play, observation, video review, and individual and group supervision. Participants were asked to describe their experiences broadly, reflect on the simple and challenging aspects of learning, identify the most and least helpful learning modalities, and share thoughts or personal reflections activated through their journey. Written data were analyzed using Colaizzi's phenomenological methodology, including the extraction of significance statements and collapsing of meaning statements into key thematic clusters. Verification strategies were used to ensure the trustworthiness and credibility of data analysis., Results: Participants found various learning modalities effective, most notably individual and group supervision. While rapport building and mood checks were least challenging, many found adhering to structure or implementation of advanced techniques to be the more arduous parts of learning. Patient progress tended to stimulate resident engagement, whereas incomplete action plans or lack of observable treatment gains led to some automatic negative thoughts. Many participants applied CBT techniques to themselves to address their own automatic thoughts, biases, or behavioral patterns., Conclusions: The results of this study offer valuable insight about learners' experiences of becoming a therapist that could help normalize residents' experiences and help educators guide residents through the learning process., (© 2022. Academic Psychiatry.)

Background: Despite recognition by both the Accreditation Council of Graduate Medical Education (ACGME) and the American Board of Paediatrics (ABP) of the importance of bioethics education, curricular crowding, lack of perceived significance, and insufficient administrative support remain significant barriers to trainees gaining competency in bioethics. Few bioethics curricula at the graduate medical education level are evidence-based or comprehensive. We sought to develop and assess the effectiveness of a Team Based Learning (TBL) curriculum in improving residents' bioethics knowledge and their ability to evaluate ethical dilemmas., Methods: We integrated L. Dee Fink's curricular design principles of "Significant Learning," Jonsen et. al 's "Four-Box Method" of ethical analysis, and ABP bioethics content specifications to create 10 TBL bioethics sessions. Paediatric residents at a major academic centre then completed a 3-year longitudinal, integrated TBL-based bioethics curriculum. Primary outcomes included individual and group readiness assessment tests (iRAT/gRAT), pre-work completion, and satisfaction with sessions., Results: The TBL-based bioethics curriculum contains 10 adaptable modules. Paediatric residents ( n  = 348 total resident encounters) were highly engaged and satisfied with the curriculum. gRAT scores (mean 89%) demonstrated significant improvement compared to iRAT scores (72%) across all TBLs and all post-graduate years ( p  < .001). Higher gRAT scores correlated with higher level of training. Although pre-work completion was low (28%), satisfaction was high (4.42/5 on Likert scale)., Conclusions: Our TBL-based bioethics curriculum was effective in improving knowledge, practical and flexible in its implementation, and well-received. We attribute its success to its grounding in ethical theory, relevance to ABP specifications, and a multi-modal, engaging format. This curriculum is easily modified to different specialties, virtual formats, or other specific institutional needs.Key messagesDespite formidable challenges to teaching bioethics in residency education, evidence-based methods such as Team-Based Learning (TBL) can be employed to increase knowledge and satisfaction.This study reports the first successful TBL bioethics curriculum, planned and executed longitudinally over 3 years, with paediatric residents at a large academic children's hospital in the US.TBL can be utilised to teach bioethics at the graduate medical education level and is adaptable to different situational factors, disciplines, and levels of clinical experience.

Moving from the role of resident into that of a young attending is one of the most anticipated transitions in a medical trainee's career path. Radiation oncology residency training is typically apprentice-style focused in the outpatient setting, which carries additional unique challenges. Twenty-seven junior attendings at academic institutions within their first 5 years of practice were sent an online open-ended questionnaire in 2018 regarding aspects of their practice using a snowball sampling method. Responses were collected, and a thematic analysis was conducted in which two independent reviewers coded the responses. Nineteen junior attendings (70%) from 18 institutions completed the questionnaire. General themes included the importance of cultivating relationships for peer support and to be professional and polite as confidence was gained to enable them to be seen as an attending. All respondents felt that bringing an open mind, balance, and adaptability was crucial in their transition. Respondents stayed up to date on literature and practices by subscribing to journals, courses, and participation in resident education. Forty-two percent of young attendings were matched with a mentor at their new institution through a formal mentor-mentee relationship. Respondents wished that they had more autonomy during residency to prepare for independent practice. Transitioning from residency to a junior attending provides unique stressors and challenges. Allowing for residents to have more autonomy during their training, such as a senior resident clinic, may help improve this transition by providing an opportunity for independent decision-making with guidance as appropriate., (© 2021. American Association for Cancer Education.)

Background: The use of three-dimensional (3D) printing in neurosurgery has become more prominent in recent years for surgical training, preoperative planning, and patient education. Several smaller studies are available using 3D printing; however, there is a lack of a concise review. This article provides a systematic review of 3D models in use by neurosurgical residents, with emphasis on training, learning, and simulation., Methods: A structured literature search of PubMed and Embase was conducted using PRISMA guidelines to identify publications specific to 3D models trialed on neurosurgical residents. Criteria for eligibility included articles discussing only neurosurgery, 3D models in neurosurgery, and models specifically tested or trialed on residents., Results: Overall, 40 articles were identified that met inclusion criteria. These studies encompassed different neurosurgical areas including aneurysm, spine, craniosynostosis, transsphenoidal, craniotomy, skull base, and tumor. Most articles were related to brain surgery. Of these studies, vascular surgery had the highest overall, with 13 of 40 articles, which include aneurysm clipping and other neurovascular surgeries. Twenty-two articles discussed cranial plus tumor surgeries, which included skull base, craniotomy, craniosynostosis, and transsphenoidal. Five studies were specific to spine surgery. Subjective outcome measures of neurosurgical residents were most commonly implemented, of which results were almost unanimously positive., Conclusions: 3D printing technology is rapidly expanding in health care and neurosurgery in particular. The technology is quickly improving, and several studies have shown the effectiveness of 3D printing for neurosurgical residency education and training., (Copyright © 2021. Published by Elsevier Inc.)

Quality improvement (QI) is part of the future of medicine. However, QI concepts are often poorly understood by physicians. Although teaching QI is required in resident training, an effective QI curriculum is difficult to design due to competing demands from clinic schedules and required rotations. The objective of this project was to teach family medicine residents the basic concepts of QI and practical implementation skills based on use of a clinic population, electronic medical record (EMR) system, and Plan-Do-Study-Act (PDSA) cycles. To do this, the Family Medicine residents and faculty at the University of Hawai`i participated in a QI curriculum to improve diabetes care from October 2018 to February 2019 with 5 sessions consisting of lectures, videos, discussions about QI data for diabetes patients, and group activities. Residents and faculty used quality measures pulled from the EMR and PDSA cycles to discuss, select, and implement QI projects for diabetes patients. Pre- and post-tests measured participants' baseline and end QI knowledge and skills. All 18 residents and 12 faculty in the program participated in the curriculum. The pre- and post-test comparisons showed significant improvement in knowledge of QI concepts and the comfort level among residents showing a 59% average improvement in knowledge questions and a 57% average improvement in comfort level in implementing a QI project (Table 4). This study shows that a 5-session QI curriculum based on EMR and PDSA cycles successfully increased family medicine residents' and faculty's knowledge of QI concepts and skills., Competing Interests: None of the authors identify a conflict of interest., (©Copyright 2022 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Introduction : To assist with the professional development of physical therapists in Kenya, a post-graduate residency program was developed and implemented in the country. Purpose : The purpose of this study was to explore the influence of residency training on the professional development of physical therapists. Methods : The influence of the program on professional development of residents was explored through a mixed-methods research design, including a survey and semi-structured interviews with residents at program completion. Results : The graduates reported a positive impact of residency education on their ability to perform a comprehensive evaluation, utilize clinical reasoning, provide an effective treatment to achieve projected outcomes, treat complex patients, communicate with patients and other health professionals, perform overall patient management, and implement a treatment plan based on scientific literature. Four themes emerged from the interviews: 1) evolution of practice from protocol-driven to individualized treatment plans; 2) promotion of professional development within the wider physical therapy community; 3) positive change in physical therapy practice; and 4) commitment to lifelong learning. Conclusion : The residents expressed how their new knowledge and skills fostered their commitment to providing mentorship to colleagues and lifelong learning. This commitment can provide the framework for advancing the practice of physical therapy in their respective communities.

Global health electives in neurology residencies provide opportunities for high-income country trainees, but have limited benefits-and may create burdens-for lower-income country hosts. Current suspension of global health electives for U.S. neurology residents due to the COVID-19 pandemic provides an opportunity to reflect on ways to reimagine global health education during this period and beyond. The framework proposed in this article underscores the need for equitable, bidirectional international partnerships and highlights global health educational innovations developed during the pandemic., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: There are few objective measures for evaluating individual performance throughout surgical residency. Two commonly used objective measures are the case log numbers and written board examination scores. The objective of this study was to investigate possible correlations between these measures., Methods: We conducted a retrospective review of the American Board of Neurological Surgery (ABNS) written board scores and the Accreditation Council for Graduate Medical Education case logs of 27 recent alumni from neurologic surgery residency training programs at The Ohio State Wexner Medical Center and the University of Nebraska Medical Center., Results: The number of spine cases logged was significantly correlated with the ABNS written examination performance in univariate linear regression (r 2  = 0.182, P = 0.0265). However, case numbers from all other neurosurgical subspecialties did not significantly correlate with ABNS written board performance (P > 0.1)., Conclusions: Identifying which objective measures correlate most closely with resident education could help optimize the structure of residency training programs. We believe that early exposure to focused aspects of neurosurgery helps the young resident learn quickly and efficiently and ultimately score highly on standardized examinations. Therefore program directors may want to ensure focused exposure during the early years of residency, with particular attention to worthwhile rotations in spine neurosurgery., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To determine whether attainment of an additional graduate-level degree during general surgery residency, such as an MSc, MPH, MBA, or PhD, is associated with increased research productivity beyond completion of training., Design: Observational cohort study comparing publication productivity of general surgery residency graduates who did and did not obtain a degree. PubMed queries and the Web of Science Core Collection were used to capture publication metrics. Graduate characteristics, including degree attainment, were obtained from an institutional database. Practice webpages were reviewed to designate an academic surgical practice, defined as an assistant, associate, or full professorship appointment., Setting: Single academic general surgery residency program., Participants: Categorical general surgery residency graduates who performed at least 1 year of dedicated research., Results: 1768 total publications, representing 1500 unique publications, were authored by 54 residents, of which 18 (33.3%) residents attained an additional graduate-level degree during dedicated research. 1369 (91.3%) publications had identifiable Journal Impact Factors and citation data. Degree attainers were more likely to be female (55.6% vs. 25.0%, p = 0.03) and spend more time in dedicated research (mean 2.2 vs. 1.8 years, p = 0.02). Overall, degree attainers published more frequently during residency (median 4.4 vs. 2.1 publications/year, p < 0.001) and fellowship (median 2.0 vs. 1.0 publications/year, p = 0.046). Analysis of the first 4 post-training years demonstrated degree attainers produced 1.2 more publications per year among all graduates (2.3 vs. 1.1 publications/year, p = 0.02) and 1.6 more publications per year among graduates practicing academic surgery (3.3 vs. 1.7 publications/year, p = 0.02). There were no differences in the Journal Impact Factor or publication citations per year among degree and nondegree attaining graduates., Conclusions: Attainment of an additional graduate-level degree was associated with increased research productivity that was sustained beyond surgical residency. Programs with the goal of training academic surgeons should support professional degrees during dedicated research years., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: The American Board of Emergency Medicine identifies medical toxicology as an essential curricular element for emergency medicine (EM) residencies; however, access to medical toxicology education varies widely by institution. We hypothesized that EM residents are uncomfortable with core toxicology content and would be interested in  a dedicated toxicology curriculum., Methods: An electronic needs assessment survey developed by experts in EM and medical toxicology was sent to residents and program leadership at nine EM programs participating in the Emergency Medicine Education Research Alliance (EMERA), a geographically diverse sampling of academic EM residency programs. We queried the presence of a current toxicology curriculum, interest in a dedicated toxicology curriculum, and comfort with core toxicology concepts for board examinations and in clinical practice.  RESULTS: A total of 148 residents and 8 faculty leadership completed the survey.  Only 29% of resident respondents felt comfortable with toxicology concepts, and only 66% of respondents reported access to a toxicology curriculum. Of those without a known toxicology curriculum, most were interested in a formal curriculum. Faculty respondents reported 6/8 programs offered a toxicology curriculum. Faculty at the two programs without a formal curriculum expressed interest in a dedicated curriculum., Conclusions: Emergency medicine residents remain uncomfortable with the core toxicology content in clinical practice. The majority of residents without a known toxicology curriculum would be interested in a dedicated toxicology curriculum.

Objective: CanMEDS competencies have been established and guide residency education in Canada, yet their inclusion in a formalized mentorship program for competency-based medical education (CBME) has yet to be explored., Methods: A mixed methods study was conducted to investigate the perceptions of residents and faculty members in psychiatry who participated in a formalized CBME mentorship program. The authors conducted secondary analysis of intake survey data from program participants and collected semi-structured interview data. Chi-square analysis of survey data determined associations between participant demographics and perceptions of mentorship. Thematic analysis techniques were used to analyze interview data. Finally, survey and interview data were triangulated and transformed into broad themes., Results: Survey data from 46 residents and 41 faculty members and semi-structured interview data from 8 residents and 6 faculty members were analyzed. Data analysis revealed support for the informal use of the CanMEDS roles framework in a mentoring context. Factors that influenced participant satisfaction with the program included mentor qualities, the mentor-mentee pairing strategy, informality of mentoring sessions, and the presence of administrators and other program coordinators to maintain and support the program., Conclusions: The perceptions of participants in this study suggest that formal mentorship programs can be beneficial for residents, in terms of enhancing clinical competencies, advancing overall well-being, ensuring preparedness to undertake professional careers, and the provision of essential psychosocial support. Future work is needed to assess the implementation of formal mentorship programs in other residency training programs.

Introduction: With increased demands on surgeon productivity and outcomes, residency robotics training increasingly relies on simulations. The objective of this study is to assess the validity and effectiveness of an ex vivo porcine training model as a useful tool to improve surgical skill and confidence with robot-assisted partial nephrectomy (RAPN) among urology residents. Methods: A 2.5 cm circular area of ex vivo porcine kidneys was marked as the area of the tumor. Tumor excision and renorrhaphy was performed by trainees using a da Vinci Si robot. All residents ranging from postgraduate year (PGY) 2 to 5 participated in four training sessions during the 2017 to 2018 academic year. Each session was videorecorded and scored using the global evaluative assessment of robotic skills (GEARS) by faculty members. Results: Twelve residents completed the program. Initial mean GEARS score was 16.7 and improved by +1.4 with each subsequent session ( p  = 0.008). Initial mean excision, renorrhaphy, and total times were 8.2, 13.9, and 22.1 minutes, which improved by 1.6, 2.0, and 3.6 minutes, respectively (all p  < 0.001). Residents' confidence at performing RAPN and robotic surgery increased after completing the courses ( p  = 0.012 and p  < 0.001, respectively). Overall, residents rated that this program has greatly contributed to their skill (4/5) and confidence (4.1/5) in robotic surgery. Conclusions: An ex vivo porcine simulation model for RAPN and robotic surgery provides measurable improvement in GEARS score and reduction in procedural time, although significant differences for all PGY levels need to be confirmed with larger study participation. Adoption of this simulation in a urology residency curriculum may improve residents' skill and confidence in robotic surgery.

Purpose: Surgical site infections (SSI) are a significant source of peri-operative morbidity and a financial burden on the healthcare system. Effective pre-operative skin preparation has been shown to reduce SSI incidence, however studies demonstrated that most healthcare providers do not adhere to proper techniques. Skin prep technique is not taught to U.S. surgical residents in a standardized format. The objective of this study was to perform a survey of U.S. surgical training programs to determine the practice patterns of surgical resident education on the proper techniques of pre-operative antiseptic surgical prep., Methods: An 18-question anonymous survey was created using the Qualtrics platform. The survey was distributed to members of the Association of Program Directors in Surgery listserv over a 2-month period. Responses were compiled and data analysis was performed., Results: The survey response rate was 30% (n = 85/280). 81% of respondents reported that surgery residents are responsible for performing pre-operative skin prep at their institutions. The same proportion (81%) reported that they feel surgical skin prep techniques are an important component of surgical resident education. However, only 42% reported that their residents are provided formal education regarding proper skin prep techniques and only 6% reported that their residents are required to take a written or practical proficiency exam. 42% of respondents felt that formal skin prep education for residents is likely to affect the rate of surgical site infections., Conclusions: Surgical residents commonly perform pre-operative skin preparation. However, few residents receive formal education or evaluation of these skills. Given the importance of pre-operative skin preparation in reducing SSIs and the potential for patient harm if performed incorrectly, the results from this study raise the question of whether formal surgical resident education regarding pre-op skin prep should be more widely adopted and standardized., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: To (1) summarize strategies proposed in the recent otolaryngology-head and neck surgery (OTO-HNS) literature for improving the residency application and selection process, (2) evaluate the effects of recently implemented changes to the OTO-HNS match, and (3) discuss recommendations for future changes to the OTO-HNS residency application and selection process., Data Sources: PubMed, Medline Ovid database, and article reference lists., Review Methods: A structured literature search was performed to identify current English language articles relating to the objectives of this study using the aforementioned data sources, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. The search was limited to submissions published between January 1, 2015, and January 1, 2020., Conclusions: Numerous proposals have been made for improving the otolaryngology residency application and selection process and addressing the competitive nature of the Match. These proposals include but are not limited to mandating a secondary essay, implementing consortia and early match processes, using a signaling system, conducting regional and web-based interviews, offering early engagement with interest groups, instituting a hard cap on applications, increasing costs of applying, counseling self-restraint to prospective applicants, and creating application filters., Implications for Practice: As the volume of literature surrounding the OTO-HNS Match continues to increase, this review aims to provide a summary of past proposals and serve as a guide for possible future innovations. We propose 3 initiatives that may improve the residency application and selection process for both program and resident, with minimal impact to the current National Resident Matching Program (NRMP) Match structure.

Purpose: To determine whether an on-call system serviced by junior residents can safely triage patients with symptoms concerning for posterior vitreous detachment, retinal tear, and retinal detachment., Design: Quality improvement study structured as a prospective cohort study., Participants: All symptomatic patients seen in 2017 by an on-call junior resident were followed up (257 patients). Those with follow-up within 6 months of initial presentation (228 patients, 246 unique encounters) were included., Methods: We prospectively tracked all symptomatic patients seen on-call by a junior resident in 2017 at a major academic medical center., Main Outcome Measures: Incidence and predictors of true retinal tears or detachments, false-positive tears or detachments, false-negative tears or detachments, and resource use., Results: Of 246 symptomatic encounters, 83 (33.7%) had a perceived retinal tear or detachment. Residents used B-scan ultrasonography in a high number of encounters (41.0%). Ten (4.1%) false-positive tears or detachments were identified, with the presence of intraretinal hemmorhage predicting a false-positive examination (adjusted odds ratio, 3.86; 95% confidence interval, 1.1-13.5). Thirteen (5.3%) false-negative tears and no false-negative detachments were identified. Eleven (84.6%) false-negative tears underwent follow-up within days based on high-risk characteristics, and no false-negative tears progressed to detachment at follow-up. Measures of resource use included an in-person confirmation of examination findings by the senior resident or fellow in 59 encounters (24.0%) and shorter follow-up times to a retina rather than a nonretina clinic for 52 of 151 patients who showed no pathologic features on initial examination., Conclusions: Junior residents can safely provide on-call triage of patients with symptoms concerning for a posterior vitreous detachment, retinal tear, or retinal detachment. The system requires moderate resource use, including occasional confirmatory examinations by a second physician and shorter follow-up times to retina clinic for high-risk patients., (Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Over the last decade, strict duty hour policies, pressure for increased work related value units from faculty, and the apprenticeship model of education have coalesced to make opportunities for intraoperative teaching more challenging. Evidence is emerging that graduating residents are not exhibiting competence by failing to recognize major complications, and perform routine operations independently. In this pilot study, we combine Vygotsky's social learning theory with a modified version of the competency-based scale called TAGS to study 1 single operation, anterior cervical discectomy and fusion, with 3 individual residents taught by a single faculty member. In order for the 3 residents to achieve "Solo and Observe" in all 4 zones of proximal development, the number of cases required was 10 cases for postgraduate year (PGY)-3a, 19 cases for PGY 3b, and 22 cases for the PGY 2. In this pilot study, the time required to complete an independent 2-level anterior cervical discectomy and fusion by the residents correlated with the number of cases to reach competence. We demonstrate the Surgical Autonomy Program's ability to track neurosurgical resident's educational progress and the feasibility of using the Surgical Autonomy Program (SAP) to teach residents in the operating room and provide immediate formative feedback. Ultimately, the SAP represents a paradigm shift towards a modern, scalable competency-focused subspecialty teaching, evaluation and assessment tool that provides increases in resident's autonomy and metacognitive skills, as well as immediate formative feedback., (© Congress of Neurological Surgeons 2021.)

Background: It is vital for orthopedic residents and residency programs to have a current understanding of the materials and resources utilized on the Orthopedic In-Training Examination (OITE) to tailor resident educational curricula accordingly. This study presents an updated analysis of the hip and knee section of the OITE., Methods: All OITE questions related to hip and knee reconstruction over six examinations between 2014 and 2019 were analyzed for topic, subtopic, taxonomy, imaging modalities, resident performance, and references., Results: There were 166 hip and knee reconstruction questions of 1600 OITE questions (10.4%) over a six-year period. The most commonly tested topics include mechanical properties of total knee and hip implants (10.8%), instability after THA (10.8%), periprosthetic fracture (10.2%), and prosthetic joint infection (10.2%). A total of 362 references were cited from 68 different sources. The most common sources were JOA, JBJS, JAAOS, and CORR, which were collectively responsible for 68% of all citations. There was an average publication lag of 7.1 years, with 75% of all citations falling within 10 years of the question date. Compared with a prior analysis from 2005 and 2009, there were significantly more complex multistep questions regarding treatment and fewer one-step knowledge recall questions (P = .003). Similarly, recent tests had significantly more questions involving interpretation of radiographs (55%, P < .001) and advanced imaging (9.6%, P < .001), compared with a decade ago., Conclusions: The OITE continues to evolve over time, incorporating recent literature and topics. The current analysis identifies high-yield topics and resources that can guide resident preparation for the OITE hip and knee section., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: While orthopedic residency training varies among programs, an inevitable phenomenon is a transition for interns from consistent oversight to independent call with indirect supervision. It is therefore crucial to reliably assess trainees' ability to perform basic procedures. The objective of the study was to evaluate the utility of a novel Orthopaedic Intern Skills Assessment (OISA) to assess skill level., Design: In a cohort study, participants were evaluated on their ability to complete eleven skills in a simulated environment. Using a standardized patient and/or cadaveric specimen, we assessed skeletal traction, joint aspiration, joint injection, laceration repair, ankle brachial index measurement, compartment pressure monitoring, upper and lower extremity splinting, informed consent, spine trauma exam, and cervical spine clearance abilities., Setting: The assessment took place in a medical simulation lab at the Oregon Health & Science University in Portland, Oregon., Participants: Third- or fourth-year medical students interested in orthopedics, incoming interns (preinterns), and residents within 1 month of completing their intern year (postinterns) were invited to participate in the study. All interested individuals were included. Of the 20 individuals contacted, 14 (70%) consented: 4 medical students (40%), 5 preinterns (100%), and 5 postinterns (100%). All consenting individuals finished their participation in the research., Results: Postintern skill completion rate was significantly higher than preinterns (p = 0.006) and medical students (p < 0.001). Completion rates for preinterns were also significantly higher rate than medical students (p = 0.035)., Conclusions: Our OISA found that postinterns had reached a basic orthopedic skill level expected of a junior resident without in-house supervision. Our OISA also highlighted areas of training that needed further attention, which will help orthopedic training programs verify an appropriate level of skill as trainees' progress from a supervised intern year to taking indirectly supervised junior resident call, and help identify areas where increased training is needed., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Introduction: Coronavirus disease 2019, or COVID-19, has become a global pandemic. Given that the highest viral load of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is found in the airway, otolaryngologists are at high risk of infection. As a result, multiple recommendations have emerged regarding protective measures for surgical teams, including suspending non-urgent procedures and surgeries., Objectives: To evaluate the impact of the COVID-19 pandemic on otolaryngology residency training programs nationwide., Methods: A cross-sectional survey-based study was completed in April 2020. The participants were recruited through an online survey, sent by email to all Chilean otolaryngology residents. Demographics, clinical activities, on-call shifts, COVID-19 infection status, exposure to COVID-19 patients, deployment to other specialties, diagnostic/therapeutic procedures, and surgeries performed were analyzed. Self-reported surgical data logs from previous years were used to compare results., Results: Forty-seven residents completed the survey (84% response rate); 64% of residents refer seeing patients ten days or less during April 2020. Commonly performed procedures such as flexible nasolaryngoscopy, rigid nasal endoscopy, and peritonsillar abscess drainage were not performed by over 40% of the residents in that month. Only 38% participated in surgeries, with an average of 0.6 surgeries as a first surgeon, a dramatic decrease in surgical exposure when comparing the data logs from previous years. Most residents refer the following measures taken by their residency program to improve residency training: bibliographic videoconferences (87%), online clinical case seminars (60%), weekly journal clubs (38%), among others., Conclusions: Clinical and surgical opportunities decreased dramatically during April 2020. Adjustments to the regular academic curricula should be considered to decrease the negative impact of this pandemic on residency training.

Purpose: Brachytherapy in the management of cervical cancer is directly linked to improved survival. Unfortunately, we continue to see a decline in its utilization. A recent survey of U.S. residents demonstrated limited caseload as the greatest barrier to achieving independence in brachytherapy practice. To improve residents' brachytherapy skills and confidence in performing brachytherapy independently, a gynecologic brachytherapy simulation course was developed and tested., Methods and Materials: The gynecologic brachytherapy curriculum and simulation modules were developed using a combination of didactic education, self-study, practicums, and patient-centered cases. The simulation modules consisted of 2-h sessions. The first hour occurred within a simulated OR environment, where residents independently performed all aspects of applicator insertion in a cadaver model. The second hour consisted of contouring, dosimetric planning, and treatment evaluation. A brachytherapy training survey developed by the Association of Residents in Radiation Oncology was given before and after the course., Results: The perceived ability to perform brachytherapy independently for a given disease site correlated directly with number of cases performed. Most residents believed that after performing five cases they would be capable of performing additional cases independently (10 of 18). All strongly agreed (8 of 18) or agreed (10 of 18) this to be true after 15 cases. Compared with survey data before the brachytherapy simulation course, trainees felt that their ability to independently perform brachytherapy (p < 0.001) improved., Conclusions: A brachytherapy simulation course can be used to gain further experience in a controlled environment. Our results demonstrate that gynecologic brachytherapy simulation increased trainees' confidence in performing the procedures independently., (Copyright © 2020 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)

Rationale and Objectives: To introduce a process that allows for development of standardized competency based testing modules (CBTM) for evaluating resident progress and competence during their radiology training. This work focuses on the development of pediatric imaging CBTMs to be utilized during general radiology residency., Materials and Methods: Multiple in-patient and ER imaging request audits along with surveys of training programs and text recommendations were obtained. A list of 200 total diagnoses accumulated by review was distributed into one of four CBTM folders. Imaging cases which made ≥90% of the indications of the audits were added to Folder 1. Distribution of remaining imaging diagnoses was based on consensus by three subspecialists. A pilot study was performed with residents dictating selected imaging cases in their usual manner mimicking a typical rotation., Results: The pilot study demonstrated resident grading mean scores significantly associated with both the American College of Radiology (ACR) rank (rho = 0.636, p = 0.035) and the objective structured clinical examinations (OSCE) scores (rho = 0.694, p = 0.018). The mean scores positively associated with the ACR score (rho = 0.466), but fell short of statistical significance (p = 0.149). As expected, the ACR score, ACR rank and OSCE scores all significantly correlated with each other ( < 0.01). PGY also significantly correlated with the ACR score (rho = 0.683, p = 0.021) and the OSCE (rho = 0.767, p = 0.006) but not with the ACR rank (rho = 0.408, p = 0.213)., Conclusion: The process utilized to develop a standardized CBTM can be used as a simulation tool to assess radiology resident competence during their training. The format allows for assessment of resident reasoning skills and knowledge base, which provides documentation of progression and throughout residency., (Copyright © 2020 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Background: There are limited training opportunities for pediatricians in caring for children with medical complexity (CMC) in the home and community. Prior studies have described a lack of comfort caring for CMC among pediatric residents., Objective: 1) To evaluate the impact of participation in a virtual home visit curriculum on pediatric residents' confidence, knowledge, and application of knowledge in complex care; 2) to explore changes in perspectives relating to the care of CMC after participation in the curriculum., Methods: This was a prospective pre-post intervention study in 2019 with first-year pediatric residents, using quantitative and qualitative methods. The intervention, co-created with a family partner, was an online video-based curriculum followed by an in-person seminar. Pre- and postassessments were compared using paired t tests. Follow-up interviews and focus groups were performed 5 to 8 weeks after training. Transcripts were analyzed using inductive thematic analysis., Results: Twenty-four residents (100%) participated. Residents reported increased confidence in all aspects of complex care presented in the curriculum, with significant increase in knowledge and application of knowledge (all P < .001). Twelve residents (50%) participated in a follow-up interview or focus group. Four themes were identified: 1) recognizing prior attitudes toward complexity, 2) new mental framework for complex care at home, 3) drivers of behavior change, and 4) commitment to change practice., Conclusions: Participation in this curriculum was associated with increased confidence, knowledge, and application of knowledge in complex care outside of the hospital. Qualitative findings align with transformative learning theory, lending insight into effective approaches to complex care training., (Copyright © 2020 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: Delivering feedback is an integral part of graduate medical education. This paper will present how feedback research informed the development of a new feedback model and discuss its implementation and evaluation by residents in an outpatient psychiatry clinic., Method: After reviewing research, a new feedback model of self-determined goal setting with guided objectives and quarterly formal in-person feedback sessions was implemented with 10 psychiatry residents during their 12-month outpatient experience in postgraduate year (PGY)-3. Residents received a pre-intervention survey to assess existing opinions of feedback and goal setting and a post-intervention survey to evaluate experiences with the new feedback model., Results: On the pre-intervention survey, 3 of 8 resident respondents indicated they had previously set goals, and only 4 of 8 predicted goal setting would be helpful, with average helpfulness rating of 3.62 (scale of 1 to 5). Cumulatively, 10 PGY-3 residents set 31 goals over the academic year. On the post-intervention survey, resident respondents rated the helpfulness of goal setting at 4.71 and quarterly, formal, in-person feedback meetings at 4.86. Success at reaching their self-determined goals was rated at 5 by all respondents., Conclusions: Utilizing self-determined goals and formal in-person feedback sessions seemed to provide the framework for an effective feedback model in an outpatient resident clinic. This pilot project suggests that introducing formal feedback models can have a positive impact on resident clinical and educational growth. The data support expanding the model to assess its generalizability with the goal of furthering development of evidence-based feedback models.

Objective: Behavioral science faculty in family medicine residencies work on inpatient medicine teaching service settings. However, there is limited research on the roles and responsibilities that behavioral science faculty fill while working in such settings., Method: Using a modified sequential explanatory study, researchers clarified the roles and responsibilities of behavioral science faculty. Participants completed a web-based survey ( N  = 60) on roles and a semistructured interview ( N  = 24) about the responsibilities on inpatient medicine teaching service., Results: Results suggest that behavioral science faculty assume the roles of educator, patient care supporter, evaluator, mentor/advisor, and scholar/researcher and perform multiple responsibilities., Conclusions: Implications for this research inform the hiring process and training for behavioral science faculty and resident education.

Background: Previous studies of pediatric residents have identified educational gaps in caring for children with medical complexity. Training opportunities in complex care vary across residency programs. Defining core curricular topics in complex care is a priority in medical education., Objective: To identify core topics to include in a standard complex care curriculum for pediatric residents., Methods: An initial topic list was generated through literature review and proceedings of national meetings. Expert panelists were identified based on experience in complex care and residency education. A modified Delphi method was used to determine group consensus by asking participants to rate the importance of complex care curricular topics for pediatric residents. Consensus was defined as >70% of experts identifying a topic as essential. There was a predetermined maximum of 3 iterative, electronic survey rounds, with feedback provided to participants between each round., Results: Sixteen experts participated. Response rate was 100% for all rounds. Experts were from the United States (44%) and Canada (56%); most were affiliated with an academic medical center (96%) involved in both inpatient and outpatient care (69%). Eleven topics were identified as essential across 3 rounds: feeding difficulties, pain/irritability, transition, feeding tube management, difficult discussions, team management/care coordination, dysmotility, aspiration, safety/emergency planning, neuromuscular/skeletal issues, and advocacy. Essential topics were organized according to the International Classification of Functioning, Disability and Health., Conclusions: Eleven curricular priorities in complex care were identified across multiple domains of the International Classification of Functioning, Disability and Health framework, serving as a guide for standardized curriculum development for future pediatricians., (Copyright © 2020 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: Residency programs emphasize effective doctor and patient interaction. However, training can be time intensive and logistically challenging. This paper examines a blog providing resident peer feedback and an opportunity to explore how residents think about patient communication., Methods: A grounded theory approach examined peer commenting on doctor patient interactions. Between 2012-2015, at a U.S. East Coast Family Medicine Clinic, 35 family medicine residents were recorded interacting with patients, producing a total of 84 videos which were posted to a blog. Residents reflected on these videos resulting in 356 responses, 3162 meaning units and 211 codes. Codes were grouped into 10 themes. Further analysis explored how residents signaled positive and negative doctor communications-related behavior., Results: Most common themes identified were Rapport/Relationship building skills, Negotiating the appointment, and Peer interaction. Most common themes discussed in light of both positive and negative behavior were Education, Use of technology, and Negotiating the appointment., Conclusions: Residents view their communication with patients as more of a transmission of critical information than an opportunity for dialogue., Practice Implications: Findings support how online tools can be used for resident reflections. These tools can reveal resident perceptions of salient communication information in a clinical encounter., (Copyright © 2019. Published by Elsevier B.V.)

Objectives: The neurosurgery residency match is becoming increasingly competitive, with numerous factors being considered as part of the application. We aim to determine whether USMLE Step 2 scores were a significant predictor of neurosurgery board performance., Patients and Methods: Residents who entered a neurological surgery residency program at a single academic institution during 2000-2017 provided scores for all ABNS attempts, USMLE Step 1 and Step 2 scores. Data were deidentified and analyzed for correlation and regression. Pearson's correlation coefficients were determined., Results: USMLE Step 1, Step 2, and maximum ABNS scores were all normally distributed. Step 1 and Step 2 scores were less variable than ABNS scores. USMLE Step 2 and residents' best ABNS written examination scores were not correlated (Pearson Correlation of 0.228 with a 2-tailed significance of 0.272). No outliers were present. When comparing USMLE Step 2 scores with year in residency at which residents scored over 300 on the ABNS written examination, Pearson correlation was -0.500 (p = .015). A simple linear regression was calculated using Step 2 scores to predict the passing year of ABNS written examination (F(1,14) = 6.984, p = .015, R 2  = 0.25)., Conclusion: Although other studies have found correlations between USMLE Step 2 scores and performance before graduating medical school and during residency for other specialties, this is the first study comparing USMLE Step 2 scores with the ABNS written examination scores of neurosurgical residents. Our data showed that USMLE Step 2 was not a reliable predictor of ABNS written examination scores., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Phenomenon: The American Academy of Pediatrics and Canadian Pediatric Society recommend that pediatricians incorporate literacy promotion during well child care, but literacy promotion education during pediatric training remains understudied. We sought to understand how literacy promotion training is currently implemented in pediatric residency programs from the perspective of program directors. Approach: We conducted semistructured interviews with all 9 residency program directors in 1 state. We analyzed data iteratively coding transcripts using an immersion/crystallization approach to identify themes. Findings: We achieved saturation after 9 interviews with 11 participants. We identified 3 major themes: (a) Residency programs rely on an existing primary-care-based literacy promotion intervention (Reach Out and Read) and the resident continuity clinic for literacy promotion training; (b) program directors encourage early and repeated exposure to facilitate literacy promotion education; and (c) service obligations, content specifications, and pressure on faculty create competing time demands that function as key barriers to literacy promotion training. Insights: Residency program directors used an existing, widely used intervention and the infrastructure provided by continuity clinics to facilitate training on literacy promotion, a relatively new pediatric care standard. Additional work is needed to overcome the barriers identified by program directors.

Introduction: The Competency Based Training in Intensive Care Education (CoBaTrICE) programme developed common standards of ICM training by describing competencies of an intensivist. Entrustable Professional Activities (EPAs) of Intensive Care Medicine (ICM) (EPAsICM) are presented as a new workplace-based assessment tool in competency-based training of intensivists. EPAs are activities to be entrusted to a trainee once he (or she) has attained competence. EPAs emphasise the role of trust between trainees and supervisors. EPAs bridge the gap between competencies and competence., Methods: An expert panel of ICM (vice)programme directors and intensivists in The Netherlands integrated the CoBaTrICE and CanMEDS competencies into EPAsICM. Comment and feedback was sought from other ICM programme directors and educational experts and processed in the final version of EPAsICM before implementation in the Dutch ICM training programme., Results: A list of 15 EPAsICM are considered to reflect the spectrum of clinical practice while incorporating the competencies of CoBaTrICE and CanMEDS. The grading system is designed as a 5-point entrustment scale based on the amount of supervision a trainee needs, aligning with daily judgement of trainees by intensivists., Conclusion: EPAsICM is an assessment tool that formalises entrustment decisions and can be a valuable addition in international ICM training., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Simulation involves the re-creation of real-life situations, processes, or structures for the purpose of improving safety, effectiveness, and efficiency of health care services: simulation provides a controlled and safe environment for training and assessment. In an age in which regulatory burdens, fiscal challenges, and renewed focus on patient safety increasingly constrain surgical residency programs, innovation in teaching is vital for the future of oral and maxillofacial surgery (OMS) training. Of the simulation technologies in modern day health care education, many have found their way into OMS training. This article reviews these technologies, and some examples of their uses in OMS., (Copyright © 2019 Elsevier Inc. All rights reserved.)

A strong foundation in diagnostic imaging is essential to the practice of radiation oncology. This study evaluated radiology training in radiation oncology residency. An online survey was distributed to current radiation oncology residents in the USA by e-mail in 2017. Responses were summarized using frequency and percentages and compared with chi-square test and Spearman's rank correlation when appropriate. One hundred five residents completed the survey. Although most residents felt that a strong knowledge base in diagnostic radiology was moderately or extremely important (87%, n = 90/104), the majority were only somewhat confident in their radiology skills (61%, n = 63/104) and were only somewhat, minimally, or not at all satisfied with their training (79%, n = 81/103). Although there was an association between increasing post-graduate training and confidence level (p = 0.01062, ρ = 0.24959), the majority of graduating residents feel only somewhat confident in radiology skills (63%, n = 12/19). Residents were most commonly exposed to radiology via multidisciplinary conferences (96%, n = 100/104), though only 15% (n = 16/104) of residents ranked these as the most beneficial component of their radiology training and 13% (n = 13/101) of residents felt these were the least beneficial. Most residents (60%, n = 63/105) believe there is a need for dedicated radiology training during residency, preferring monthly formal didactics (68%, n = 71/105) co-taught by a radiologist and radiation oncologist (58%, n = 61/105). Radiation oncology residents feel their radiology training is suboptimal, suggesting a need for more guidance and standardization of radiology curriculum. A preferred option may be monthly didactics co-taught by radiologists and radiation oncologists; however, future studies should assess the effectiveness of this model.