Editors have a love-hate relationship with medical education review articles: they are wonderful in concept yet can prove gnarly in execution. We often feel like excavators digging for the “gold” within. For researchers and educators, a well-done review article can save considerable time when searching for best practices, methods, and next research steps. Yet good reviews are difficult to carry out in the medical education realm. Are there useful strategies for first-time authors of review papers? How does one decide which approach to use, such as narrative, systematic, realist, or scoping? This editorial summarizes best practices from the perspectives of
Skip to main content
Issues
Issues
Select Issue
FROM THE EDITOR
From the Editor
Sullivan emphasizes the importance of review articles in moving research and practice forward, discusses the challenges of conducting good reviews, and offers practical tips (p. 481).
Perspectives
Perspectives in this issue offer 10 tested steps for residents to become effective clinical teachers and team leaders (Hunter et al, p. 488); summarize how robotic surgery skills training may expose critical gaps in resident education (Green et al, p. 491); offer a psychotherapist's point of view on interventions to enhance resident well-being (Bhe and Servis, p. 494); and present a simple actionable model for providing residents with career guidance
PERSPECTIVES
MD,
MD, and
MD
I stepped into the workroom to announce the start of rounds. My 2 interns sat hunched at computers, scribbling on “scut” sheets. I paused. A few days prior, I had been in their shoes. Now, as a new second-year resident, I was (ostensibly) their supervisor, teacher, advocate, and coach. It felt daunting.
Newly hatched physicians looking to launch smoothly from medical school to intern year will find troves of literature to guide them. 1–6 However, the progression from the first to the second year of residency is less explored, 7 despite representing an equally
MD,
PhD,
MD, and
EdD
Integrating robotic surgery into resident training is challenging. The robotic environment requires reconsideration of the apprenticeship model for surgical training and development of new curricula and instructional approaches to ensure skill acquisition. The surgical literature has mentioned the need to improve resident training in robotic surgery. This article highlights components of the robotic teaching environment that limit the efficacy of current training models. By targeting these components, educators can begin to develop more effective curricula and instructional strategies for surgical residents.
The robotic learning environment is complex. It incorporates a physically distant operative field, separating the trainer and the trainee;
MD and
MD
Resident well-being is a vital issue in graduate medical education, with the Accreditation Council for Graduate Medical Education Common Program Requirements emphasizing programs' responsibility for interventions that promote well-being. 1 At the same time, residents continue to report experiencing burnout and depression. 2,3 We offer a different perspective on resident wellness that is rooted in a psychotherapeutic viewpoint.
The Psychotherapist Perspective
The academic community must prioritize resident wellness in order to minimize resident suffering and ensure that patient care is not compromised by the adverse effects of stress. A psychotherapy-informed approach to wellness, with a focus
MD, MPH and
MD
Medical educators frequently find themselves in conversations in which they are asked to offer career guidance. This may be part of a formal role as an assigned advisor, or in informal interactions with learners. Many medical schools have successfully integrated career advising for students in a multitude of ways, such as official mentoring programs, career services from nonmedical advisors, web-based resources, and career exploration courses. 1,2 By comparison, the literature about career advising at the graduate medical education level is relatively limited, and provides little guidance for framing these advising conversations. Given the lack of formalized career
COMMENTARY
DO
Clinical mastery is a shared aspiration for many who enter medical training, but only a select few truly achieve it. Those who do seem to share basic approaches to attain recognized excellence in diagnostic acumen, communication and interpersonal skills, medical knowledge, professionalism, negotiating the health care system, and lifelong learning. 1–4 However, the majority of practicing physicians arguably function on a spectrum from competent to proficient (rather than expert) clinicians. Referencing the 5-stage model of expertise acquisition, 5 the “competent performer” (stage 3) responds to feedback and an increased sense of responsibility as his or her
MD, MPH
Over the past 15 years, multiple graduate medical education training programs have established global health career pathways. These tracks, some of which have benefited from decades of experience with short-term elective rotations, 1 were developed in response to the sustained interest of a steady stream of medical school graduates intent on shaping their careers to address global health disparities. In this issue of the Journal of Graduate Medical Education, 2 articles highlight the promises and challenges faced by graduates of global health programs. Palazuelos and colleagues 2 describe the early career paths of graduates of a
ORIGINAL RESEARCH
MD, MSc,
PhD, and
MD
ABSTRACT
Background
Residents and fellows often seek to emulate master clinician role models; however, the activities these expert clinical faculty pursued early in their careers are not known.
Objective
We studied the early career clinical experiences and learning behaviors of peer-defined master academic clinicians.
Methods
We performed a retrospective, qualitative interview study of 17 members of the University of California, San Francisco, Department of Medicine Council of Master Clinicians. Between March 1 and May 31, 2016, we interviewed participants using a semistructured interview guide surveying their early career clinical experiences and learning habits. Interviews were audio-recorded and transcribed. We used a general inductive approach to code transcripts and to identify consistent themes.
Results
Of the 28 council members invited to participate, 17 (61%) responded and were interviewed. Participants included 12 men and 5 women, with an average of 27 years in clinical practice (range, 13–50 years). Six participants were general internists, and 11 were internal medicine subspecialists. Based on thematic analysis of interview transcripts, 4 themes of clinical development emerged: (1) consistent learning efforts; (2) rigorous skill development; (3) cultivating habits of mind; and (4) clinically rich environments.
Conclusions
Our study describes the early career experiences and learning behaviors of master clinicians. We aggregated key dimensions of the findings into a guide for residents, fellows, and junior clinicians interested in the pursuit of clinical excellence.
MD, MPH,
MD,
MPH, MSc,
BA,
NP-C, MSN, MAR,
MD, and
MD
ABSTRACT
Background
The Doris and Howard Hiatt Residency in Global Health Equity and Internal Medicine at Brigham and Women's Hospital provides global health training during residency, but little is known about its effect on participants' selection of a global health career.
Objective
We assessed the perceptions of residency graduates from the first 7 classes to better understand the outcomes of this education program, and the challenges faced by participants.
Methods
We interviewed 27 of 31 physicians (87%) who graduated from the program between 2003 and 2013 using a convergent mixed-methods design and a structured interview tool that included both open-ended and forced-choice questions. We independently coded and analyzed qualitative data using a case study design, and then wove together the qualitative and quantitative data at the interpretation phase using a parallel convergent mixed-methods design.
Results
Entering a career focused on social justice was cited as the most common motivator for selecting to train in global health. Most respondents (83%, 20 of 24) reported they were able to achieve this goal despite structural barriers, such as lower salaries compared with peers, a lack of mentors in the field, poorly structured and undersupported career pathways at their institutions, and unique work-life challenges.
Conclusions
A majority of graduates from 1 dedicated residency program in global health and internal medicine reported they were able to continue to engage in global health activities after graduation and, despite identified challenges, reported that they planned long-term careers in global health.
MD, MPH,
MD,
MD,
MD, MPH,
BA, and
MD
ABSTRACT
Background
Fellowships in global health are increasingly popular and seek to equip physicians with the skills necessary to be effective global health practitioners. Little objective guidance exists on which skills make graduates competitive applicants from the perspective of potential global health employers.
Objective
We sought to provide objective evidence for the qualifications that make applicants competitive for global health positions by analyzing the listed qualifications for current job openings in large global health organizations.
Methods
The websites of 48 global health employers were systematically searched for current job postings between May and August 2017. Jobs were included for analysis if a medical degree was listed among the primary degrees accepted, and the job was based primarily in a low- or middle-income country.
Results
A total of 5849 employment opportunities were posted during the search period, and 81 (1.4%) of these met inclusion criteria. Twenty-two (27%) jobs required and 35 (43%) preferred a relevant master's degree. Few jobs requested a candidate with a PhD and none mentioned tropical medicine training as a requirement or preference. Twenty-three jobs (28%) required and 19 (23%) preferred candidates to speak another language. Most jobs (69%, 56 of 81) required more than 5 years of relevant experience. Only 11 (13%) jobs were primarily clinical positions.
Conclusions
For physicians pursuing a career in global health, most publicly searchable jobs require substantial previous experience and involvement in global health activities beyond clinical practice. Master's degree and language skills are frequently requested candidate qualifications.
MD, FACP,
MD, FACP,
MS,
MS,
MD, FACP,
MD, FACP, and
MD, MSHS
ABSTRACT
Background
Residents and practicing physicians displaying signs of stress is common. It is unclear whether stress during residency persists into professional practice or is associated with future burnout.
Objective
We assessed the persistence of stress after residency and its correlation with burnout in professional practice. We hypothesized that stress would linger and be correlated with future burnout.
Methods
A prospective cohort study was conducted over 10 years using survey instruments with existing validity evidence. Residents over 3 academic years (2003–2005) were surveyed to measure stress in residency. Ten years later, these residents were sought out for a second survey measuring current stress and burnout in professional practice.
Results
From 2003 to 2005, 143 of 155 residents participated in the initial assessment (92% response rate). Of those, 21 were excluded in 2015 due to lack of contact information; follow-up surveys were distributed to 122 participants, and 81 responses were received (66% response rate and 57% of original participants). Emotional distress in residency correlated with emotional distress in professional practice (correlation coefficient = 0.45, P < .0001), emotional exhaustion (correlation coefficient = 0.30, P = .007), and depersonalization (correlation coefficient = 0.25, P = .029). Multivariate linear regression showed that emotional distress in residency was associated with future emotional distress (β estimate = 0.57, P = .005) and depersonalization (β estimate = 2.29, P = .028).
Conclusions
We showed emotional distress as a resident persists into individuals' professional practice 10 years later and has an association with burnout in practice.
MD,
MD, MS,
MD,
MD,
MD, and
Emergency Medicine Education Research Alliance (EMERA)
ABSTRACT
Background
The Maslach Burnout Inventory (MBI) is considered the “gold standard” for measuring burnout, encompassing 3 scales: emotional exhaustion, depersonalization, and personal accomplishment. Other well-being instruments have shown utility in various settings, and correlations between MBI and these instruments could provide evidence of relationships among key variables to guide well-being efforts.
Objective
We explored correlations between the MBI and other well-being instruments.
Methods
We fielded a multicenter survey of 9 emergency medicine (EM) residencies, administering the MBI and 4 published well-being instruments: a quality-of-life assessment, a work-life balance rating, an appraisal of career satisfaction, and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire 2 question screen. Consistent with the Maslach definition, burnout was defined by high emotional exhaustion (> 26) and high depersonalization (> 12).
Results
Of 334 residents, 261 (78%) responded. Residents who reported lower quality of life had higher emotional exhaustion (ρ = –0.437, P < .0001), higher depersonalization (ρ = –0.18, P < .005), and lower personal accomplishment (ρ = 0.347, P < .001). Residents who reported a negative work-life balance had emotional exhaustion (P < .001) and depersonalization (P < .009). Positive career satisfaction was associated with lower emotional exhaustion (P < .0001), lower depersonalization (P < .005), and higher personal accomplishment (P < .05). A positive depression screen was associated with higher emotional exhaustion, higher depersonalization, and lower personal achievement (all P < .0001).
Conclusions
Our multicenter study of EM residents demonstrated that assessments using the MBI correlate with other well-being instruments.
Formal Versus Informal Judgments: Faculty Experiences With Entrustment in Graduate Medical Education
MSc,
PhD, MD,
PhD, and
PhD, MD
ABSTRACT
Background
Entrustment of residents has been formalized in many competency-based graduate medical education programs, but its relationship with informal decisions to entrust residents with clinical tasks is unclear. In addition, the effects of formal entrustment on training practice are still unknown.
Objective
Our objective was to learn from faculty members in training programs with extensive experience in formal entrustment how formal entrustment relates to informal entrustment decisions.
Methods
A questionnaire was e-mailed to all Dutch obstetrics and gynecology program directors to gather information on how faculty entrusts residents with clinical independence. We also interviewed faculty members to explore the relationship between formal entrustment and informal entrustment. Interviews were analyzed with conventional content analysis.
Results
Of 92 programs, 54 program directors completed the questionnaire (59% response rate). Results showed that formal entrustment was seen as valuable for generating formative feedback and giving insight into residents' progress in technical competencies. Interviewed faculty members (n = 12) used both formal and informal entrustment to determine the level of resident independence. Faculty reported they tended to favor informal entrustment because it can be reconsidered. In contrast, formal entrustment was reported to feel like a fixed state.
Conclusions
In a graduate medical education program where formal entrustment has been used for more than a decade, faculty used a combination of formal and informal entrustment. Informal entrustment is key in deciding if a resident can work independently. Faculty members reported being unsure how to optimally use formal entrustment in practice next to their informal decisions.
MEd,
DO, MEd,
DO,
DO,
DO, MEd, and
MS
ABSTRACT
Background
The primary goal of residency programs is to select and educate qualified candidates to become competent physicians. Program directors often use performance on licensure examinations to evaluate the ability of candidates during the resident application process. The American College of Osteopathic Family Physicians (ACOFP) administers an in-service examination (ISE) to residents annually. There are few prior studies of the relationship between the Comprehensive Osteopathic Medical Licensing Examination of the United States of America (COMLEX-USA) series and formative assessments of residents in training.
Objective
We explored the relationship between performance on COMLEX-USA and the ACOFP in-service examination to offer support on the use of licensing examinations in resident selection.
Methods
In 2016, performance data from the COMLEX-USA and the ISE were matched for 3 resident cohorts (2011–2013, inclusive; N = 1384). Correlations were calculated to examine the relationship between COMLEX-USA and ISE scores. Multiple linear regression models were used to determine if performance on COMLEX-USA significantly predicted third-year ISE (ISE-3) scores.
Results
Findings indicated that correlations among performance on COMLEX-USA and ISE were statistically significant (all P < .001), and there was strong intercorrelation between COMLEX-USA Level 3 and ISE-1 performance (r = 0.57, P < .001). Performance on the COMLEX-USA Levels 1 and 2–Cognitive Examination significantly predicted performance on the ISE-3 (F(2,1381) = 228.8, P < .001).
Conclusions
The results support using COMLEX-USA as a part of resident selection in family medicine. Additionally, program directors may use performance on COMLEX-USA to predict success on the ISE-3.
MD, MPH,
MA,
MD, MPH, and
MD, MPH
ABSTRACT
Background
Evidence from several specialties suggests that practice patterns developed in residency influence the quality and cost of care long after completion of training. Improving the quality, cost, and patient experience of care (the “Triple Aim”) is foundational to future health systems change.
Objective
We measured variation in Triple Aim measures among family medicine residency programs in a regional quality improvement collaborative (I3 Population Health Collaborative).
Methods
We calculated medians and interquartile ranges for each of 11 Triple Aim measures and compared them with median splits of population and practice characteristics, including payer mix, patient race and age, electronic health record used, registry use, and National Committee for Quality Assurance patient-centered medical home recognition.
Results
All 22 participating family medicine residency programs provided baseline data. The number of practices reporting data on individual measures ranged from 9 to 17 (41%–77%). We found variation averaging 51% across all measures, from a low of 12% for readmission rates to 94% for emergency department visit rates. Variations were stable over time. We found no significant relationships between practice or population characteristics and measures, nor between practice characteristics and outcomes variation.
Conclusions
The 22 family medicine residency programs in our study showed substantial variation in quality, cost, and patient experience of care. These variations did not appear to result from differences in practice characteristics, payer mix, or patient demographics.
EDUCATIONAL INNOVATION
MD,
DO,
MD, and
MD
ABSTRACT
Background
Good medical care relies on communication as much as technical expertise, yet physicians often overestimate the efficacy of their patient communication skills. Teaching communication skills can be cost- and time-intensive, and efforts have rarely focused on challenging situations, such as conveying the news of a patient's brain death to a family member.
Objective
We developed a resource-sensitive simulation program to teach residents how to diagnose brain death and how to show empathy in discussing the diagnosis with the patient's family.
Methods
From 2015 to 2017, 3 cohorts of incoming neurology residents participated in the 3-day training exercise. The 2-hour preintervention assessment involved making the diagnosis of brain death and sharing the news with an actor portraying the patient's family member. The scoring via checklists consisted of 15 clinical skills, 9 apnea test–related skills, and 37 verbal skills related to family discussion. The 5-hour didactic intervention focused on technical aspects of the brain death examination and lessons in communication with role-playing. The 2-hour postintervention assessment repeated the brain death examination and family discussion simulations. Data were analyzed using the Wilcoxon signed rank test.
Results
A total of 18 residents (100%) were assessed, with significant differences between preintervention and postintervention testing across all areas, including clinical assessment (45%–76%, P < .001), apnea testing (57%–92%, P < .001), and verbal communication (46%–73%, P < .001).
Conclusions
The findings suggest a benefit in simulation training for brain death examination, apnea testing, and the subsequent family discussion regarding the patient's diagnosis.
MD,
MD,
MD, and
MD
ABSTRACT
Background
Panel management is emphasized as a subcompetency in internal medicine graduate medical education. Despite its importance, there are few published curricula on population medicine in internal medicine residency programs.
Objective
We explored resident experiences and clinical outcomes of a 5-month diabetes and obesity ambulatory panel management curriculum.
Methods
From August through December 2016, internal medicine residents at the University of Vermont Medical Center reviewed registries of their patients with diabetes, prediabetes, and obesity; completed learning modules; coordinated patient outreach; and updated gaps in care. Resident worksheets, surveys, and reflections were analyzed using descriptive and thematic analyses. Before and after mean hemoglobin A1c results were obtained for patients in the diabetic group.
Results
Most residents completed the worksheet, survey, and reflection (93%–98%, N = 42). The worksheets showed 70% of participants in the diabetic group had appointments scheduled after outreach, 42% were offered referrals to the Community Health Team, and 69% had overdue laboratory tests ordered. Residents reported they worked well with staff (95%), were successful in coordinating outreach (67%), and increased their sense of patient care ownership (66%). In reflections, identified successes were improved patient care, teamwork, and relationship with patients, while barriers included difficulty ensuring follow-up, competing patient priorities, and difficulty with patient engagement. Precurricular mean hemoglobin A1c was 7.7%, and postcurricular was 7.6% (P = .41).
Conclusions
The curriculum offered a feasible, longitudinal model to introduce residents to population health skills and interdisciplinary care coordination. Although mean hemoglobin A1c did not change, residents reported improved patient care. Identified barriers present opportunities for resident education in patient engagement.
MD,
MD, MPH,
MD, MHPE,
,
PhD,
MD, ScM,
RN, MS, CPHRM,
MD, MPH,
MD, MPP, and
MD
ABSTRACT
Background
The Accreditation Council for Graduate Medical Education Clinical Learning Environment Review recommends that quality improvement/patient safety (QI/PS) experts, program faculty, and trainees collectively develop QI/PS education.
Objective
Faculty, hospital leaders, and resident and fellow champions at the University of Chicago designed an interdepartmental curriculum to train postgraduate year 1 (PGY-1) residents on core QI/PS principles, measuring outcomes of knowledge, attitudes, and event reporting.
Methods
The curriculum consisted of 3 sessions: PS, quality assessment, and QI. Faculty and resident and fellow leaders taught foundational knowledge, and hospital leaders discussed institutional priorities. PGY-1 residents attended during protected conference times, and they completed in-class activities. Knowledge and attitudes were assessed using pretests and posttests; graduating residents (PGY-3–PGY-8) were controls. Event reporting was compared to a concurrent control group of nonparticipating PGY-1 residents.
Results
From 2015 to 2017, 140 interns in internal medicine (49%), pediatrics (33%), and surgery (13%) enrolled, with 112 (80%) participating and completing pretests and posttests. Overall, knowledge scores improved (44% versus 57%, P < .001), and 72% of residents demonstrated increased knowledge. Confidence comprehending quality dashboards increased (13% versus 49%, P < .001). PGY-1 posttest responses were similar to those of 252 graduate controls for accessibility of hospital leaders, filing event reports, and quality dashboards. PGY-1 residents in the QI/PS curriculum reported more patient safety events than PGY-1 residents not exposed to the curriculum (0.39 events per trainee versus 0.10, P < .001).
Conclusions
An interdepartmental curriculum was acceptable to residents and feasible across 3 specialties, and it was associated with increased event reporting by participating PGY-1 residents.
MD, MA,
MD, PhD,
PhD,
MD,
MD,
MD, MHPE,
MD,
MD, and
MD
ABSTRACT
Background
While leadership training is increasingly incorporated into residency education, existing assessment tools to provide feedback on leadership skills are only applicable in limited contexts.
Objective
We developed an instrument, the Leadership Observation and Feedback Tool (LOFT), for assessing clinical leadership.
Methods
We used an iterative process to develop the tool, beginning with adapting the Leadership Practices Inventory to create an open-ended survey for identification of clinical leadership behaviors. We presented these to leadership experts who defined essential behaviors through a modified Delphi approach. In May 2014 we tested the resulting 29-item tool among residents in the internal medicine and pediatrics departments at 2 academic medical centers. We analyzed instrument performance using Cronbach's alpha, interrater reliability using intraclass correlation coefficients (ICCs), and item performance using linear-by-linear test comparisons of responses by postgraduate year, site, and specialty.
Results
A total of 377 (of 526, 72%) team members completed the LOFT for 95 (of 519, 18%) residents. Overall ratings were high—only 14% scored at the novice level. Cronbach's alpha was 0.79, and the ICC ranged from 0.20 to 0.79. Linear-by-linear test comparisons revealed significant differences between postgraduate year groups for some items, but no significant differences by site or specialty. Acceptability and usefulness ratings by respondents were high.
Conclusions
Despite a rigorous approach to instrument design, we were unable to collect convincing validity evidence for our instrument. The tool may still have some usefulness for providing formative feedback to residents on their clinical leadership skills.
BRIEF REPORT
DO,
MD,
MD, MHPE,
MD, and
MD, MPH
ABSTRACT
Background
Training residents to become competent in common bedside procedures can be challenging. Some hospitals have attending physician–led procedure teams with oversight of all procedures to improve procedural training, but these teams require significant resources to establish and maintain.
Objective
We sought to improve resident procedural training by implementing a resident-run procedure team without routine attending involvement.
Methods
We created the role of a resident procedure coordinator (RPC). Interested residents on less time-intensive rotations voluntarily served as RPC. Medical providers in the hospital contacted the RPC through a designated pager when a bedside procedure was needed. A structured credentialing process, using direct observation and a procedure-specific checklist, was developed to determine residents' competence for completing procedures independently. Checklists were developed by the residency program and approved by institutional subspecialists. The service was implemented in June 2016 at an 850-bed academic medical center with 70 internal medicine and 32 medicine-pediatrics residents. The procedure service functioned without routine attending involvement. The impact was evaluated through resident procedure logs and surveys of residents and attending physicians.
Results
Compared with preimplementation procedure logs, there were substantial increases postimplementation in resident-performed procedures and the number of residents credentialed in paracenteses, thoracenteses, and lumbar punctures. Fifty-nine of 102 (58%) residents responded to the survey, with 42 (71%) reporting the initiative increased their ability to obtain procedural experience. Thirty-one of 36 (86%) attending respondents reported preferentially using the service.
Conclusions
The RPC model increased resident procedural training opportunities using a structured sign-off process and an operationalized service.
MD, MEd,
MD, and
PhD
ABSTRACT
Background
Graduate medical education programs are expected to conduct an annual program evaluation. While general guidelines exist, innovative and feasible approaches to program evaluations may help efforts at program improvement. Appreciative Inquiry is an approach that focuses on successful moments, effective processes, and programs' strengths.
Objective
We implemented a novel application of Appreciative Inquiry and its 4 phases (Inquire, Imagine, Innovate, and Implement) and demonstrate how it led to meaningful improvements in a pediatric pulmonology fellowship program.
Methods
As part of the Inquire and Imagine phases, the authors developed an interview guide that aligned with Appreciative Inquiry concepts. Two faculty members conducted semistructured interviews with a convenience sample of 11 of 14 fellowship alumni. Interviews were audiotaped, transcribed, and reviewed. A summary of the findings was presented to the Program Evaluation Committee, which then directed the Innovate and Implement phases.
Results
Appreciative Inquiry was acceptable to the alumni and feasible with the authors' self-directed learning approach and minimal administrative and financial support. In the Inquire phase, alumni identified program strengths and successes. In the Imagine phase, alumni identified program changes that could aid transition to independent practice for future fellows (an identified program goal). Based on the results of the Appreciative Inquiry, program leadership and the Program Evaluation Committee selected improvements for implementation.
Conclusions
For small programs, Appreciative Inquiry is an innovative and feasible approach to program evaluation that facilitates actionable program improvement recommendations.
MD,
MD,
MPH,
BA,
MD, and
MD
ABSTRACT
Background
Little research exists regarding factors that contribute to resident fatigue during home call.
Objective
We objectively tracked the number and type of pages received, as well as residents' sleep time, during home call. We then examined the relationship between paging volume, resident sleep, and resident fatigue.
Methods
A total of 4 of 4 urology residents (100%) at a single institution wore a FitBit Charge HR device from July 2015 to July 2016 to track sleep. Between January and July 2016, pages received by the on-call resident were counted as either floor (urology inpatient unit), clinic (after-hours answering service), or other. Postcall residents were defined as fatigued and excused at noon if they reported they were too tired to safely perform clinical duties.
Results
Residents slept an average of 408 minutes per night while not on call, versus 368 minutes while on call but not fatigued, and 181 minutes while on call and fatigued (P < .05). The most senior resident received fewer pages per night on average than the most junior resident. Each page was associated with 4.71 fewer minutes asleep on average for all residents. Pages in the other category were associated with 7.74 fewer minutes asleep per page for all residents, but only the most junior resident had significantly less sleep, 9.02 minutes, per floor page.
Conclusions
Objective sleep data correlate with subjective assessment of resident fatigue and with volume and type of pages received. Senior residents spent less time awake per page and received fewer pages.
RIP OUT
PhD (@laurenmaggio) and
PhD (@mededdoc)
The Challenge
As medical educators, we strive to implement up-to-date, evidence-based practices in our teaching, assessment, and research endeavors. One way to stay current in our field is to read the literature. While this seems straightforward, the multiple sources, varied formats, and sheer volume of available readings often lead to a feeling of information overload—or to a decision not to read at all. 1 To avoid information overload and efficiently separate the wheat from the chaff, strategies for curating the literature are needed.
What Is Known
To help mitigate information overload, individuals have turned to strategies for
ON TEACHING
MD
D isheveled, unkempt, seems normal, wearing sunglasses, histrionic, blanket from home, 10 family members, wearing paper scrubs. Sustained attention in a patient's room can provide an enormous amount of information. The cross-sectional snapshot becomes more valuable as experience increases. An emergency room physician with 20 years of experience can capture the whole room by the time the third-year medical student confirms she is interviewing the right patient.
“Sick or not sick?” is the most frequent, important, complex, and loaded judgment we make as physicians. The art of collapsing this duality into a 5-minute initial encounter is at the
MD, MPH
An 83-year-old woman is admitted to the medical floor with a diagnosis of pulmonary embolism seen on ventilation/perfusion scan. A common condition affecting more than 5 per 1000 individuals over the age of 75 years, pulmonary embolism is a garden-variety medical diagnosis that even senior medical students are expected to readily recognize. Accordingly, the nighttime admitting team had already started anticoagulation for the patient after reviewing the initial imaging report, adhering to the standard treatment protocol. However, this patient would come to tell a different story.
Mrs James is a pleasant elderly woman who described to us an active life.
MD, MSc and
MD
I stood huddled among my classmates, full of anticipation, gripping my Match Day envelope in my hand. Time came to a standstill as my neighbors' chatter faded and a distant voice counted down the final moments. The rustle of tearing paper filled the room, then cheers, a scream, and a crescendo of applause. Friends and family embraced in celebration.
Unlike my photographic memories of Match Day, the first weeks of internship were a blur—a whirl of electrocardiograms, chest radiographs, and blood gas reports. I lost myself in the ceaseless momentum of residency until, without warning, my last day as an
TO THE EDITOR
MD
I read “Postinterview Communication: Strategies for a New Generation of Residency Applicants” in the August issue of the Journal of Graduate Medical Education with great interest. 1 As a physician who just completed residency and fellowship training and is now stepping into the role of an academic attending physician, the authors' perspectives bring to light a few points of which I feel compelled to respond.
“Thank you notes are a specific subset of postinterview communication that deserves comment . . . However, this strategy can result in a significant workload for applicants . . .” 1
Rouge on the Lips of Silence
Yuki TeramotoMD, PhD
Evaluating Methodology for Increasing Diversity in US Residency Training Programs: A Scoping Review
Lauren BoeckermannMD, MPH,
Dennis MenjivarBS,
Emily E. HagnMD,
Melissa PreviteraMLIS,
Samuel H. CheshierMD, PhD,
Hilary C. McCraryMD, MPH, and
Jeremiah A. AltMD, PhD
Scoping Review of Simulation-Based Training for Social Determinants of Health Within Residency Programs
Nathan TunellMS,
Sehr KhanMD,
Ashley PavlicMD, MA, and
Taylor SonnenbergMD, MSGH
Career Outcomes Among Graduates of 2 Urban Health Primary Care Training Programs
Preetham BachinaBS,
Ariel G. VilidnitskyMD,
Katherine ShawMD,
Monica MixMD, MPH,
Talia Robledo-GilMD, and
Leonard FeldmanMD, FACP, FAAP, MHM
Trends in MedEdPORTAL Faculty Development Resources for Clinician Educators
Amna AneesMD, FACP,
Craig NoronhaMD,
Aashish DidwaniaMD, and
Karen FriedmanMD, MS
The Effect of Paging Reminders on Fellowship Conference Attendance: A Multi-Program Randomized Crossover Study
Joshua SmithMD,
Lorenzo ZaffiriMD,
Julie ClaryMD, MBA,
Tyler DavisMD, and
Gabriel T. BossletMD, MA
A Values Affirmation Intervention to Improve Female Residents' Surgical Performance
Arghavan SallesMD, PhD,
Claudia M. MuellerPhD, MD, and
Geoffrey L. CohenPhD
Improving Residents' Safe Opioid Prescribing for Chronic Pain Using an Objective Structured Clinical Examination
Daniel P. AlfordMD, MPH,
Brittany L. CarneyMS,
Belle Brett EDD,
Sharon J. ParishMD, and
Angela H. JacksonMD
Integrating a Resident-Driven Longitudinal Quality Improvement Curriculum Within an Ambulatory Block Schedule
Aleksey TentlerMD,
Mirela FeurdeanMD,
Steven KellerPhD, and
Neil KothariMD
Skills for Interviewing Adolescent Patients: Sustainability of Structured Feedback in Undergraduate Education on Performance in Residency
Nadim JoukhadarBSc,
Genna BourgetMD,
Sarah ManosMD,
Karen MannPhD,
Jill HatchettePhD, and
Kim BlakeMD
eISSN: 1949-8357
ISSN: 1949-8349
Powered by PubFactory