ABSTRACT

Background

Flipped classroom (FC) instruction has become increasingly common in graduate medical education (GME).

Objective

The purpose of this study was to profile the use of FC in the GME setting and assess the current status of research quality.

Methods

We conducted a systematic literature search of major health and social science databases from July 2017 to July 2018. Articles were screened to ensure they described use of the FC method in an Accreditation Council for Graduate Medical Education–accredited residency program and included research outcomes. Resulting articles were analyzed, described, and evaluated for research quality using the Kirkpatrick framework and the Medical Education Research Study Quality Instrument (MERSQI).

Results

Twenty-two articles were identified, all of which were recently published. Five were only indirectly related to FC methods. Most studies reported Kirkpatrick-level outcomes. Studies involving resident learner opinions were generally positive. Pre-posttest studies resulted in large positive improvements in knowledge or skills attainment. Control group study results ranged from large positive (1.56) to negative effects (–0.51). Average MERSQI scores of 12.1 (range, 8.5–15.5) were comparable to GME research norms.

Conclusions

Varying methods for implementing and studying the FC in GME has led to variable results. While residents expressed a positive attitude toward FC learning, shortcomings were reported. Approximately half of the studies comparing the flipped to the traditional classroom reported better achievement under the FC design. As indicated by the MERSQI score, studies captured by this review, on average, were as rigorous as typical research on residency education.

ABSTRACT

Background

The residency match process for competitive specialties hinders programs' ability to holistically review applications.

Objective

A computer simulation model of the residency application process was created to test the hypotheses that (1) it is advantageous to medical students to apply to the maximum number of programs under the current system, and (2) including a medical student's residency program preferences at the beginning of the application process improves the efficiency of the system for applicants and programs as quantified by the number of interview invitations received.

Methods

The study was conducted in 2016 using 2014 Otolaryngology Match data. A computer model was created to perform simulations for multiple scenarios to test the hypotheses. Students were assigned scores representing easy and hard metrics and program preferences, simulating a mixture of individual student preference and general program popularity.

Results

We modeled a system of 99 otolaryngology residency programs with 292 residency spots and 460 student applicants. While it was individually advantageous for an applicant to apply to the maximum number of programs, this led to a poor result for the majority of students when all applicants undertook the strategy. The number of interview invitations improved for most applicants when preference was revealed.

Conclusions

Offering applicants an option to provide program preference improves the practical number of interview invitations. This enables programs to review applicants holistically—instead of using single parameters such as United States Medical Licensing Examination scores—which facilitates a selection of applicants who will be successful in residency.

ABSTRACT

Background

Individuals who have agentic traits (eg, assertive, confident, competent) that are more commonly associated with men are often selected for leadership roles. For women, this poses a potential barrier to entry into the higher ranks of academic medicine.

Objective

We analyzed anesthesiology resident feedback for differences in the use of agentic descriptors using qualitative and quantitative methods based on resident gender and year of training.

Methods

This study uses textual analysis of 435 assessments of residents over a 1-year period within a single residency program. We performed a qualitative content analysis on the words used in resident feedback and performed negative binomial regression analyses to determine significant differences in the way residents were described based on gender and year of training.

Results

Female residents were less likely than male residents to be described as agentic after controlling for excerpt length, year of training, and evaluator variability (β = –0.347; 95% confidence interval [CI] –0.666, –0.028; P = .033). Senior residents were more likely to be described as agentic (β = 0.702; 95% CI 0.402–1.002; P < .001) compared to junior residents. The increased number of agentic codes among senior residents was driven by increased agentic description of female residents' ratings in the senior cohort (β = 0.704; 95% CI 0.084–1.324; P = .026).

Conclusions

Female residents were described as agentic less often than male residents in early years of training, but the gap was not present among senior residents.

What a privilege, what a trial

this stripping down to spirit and shell

strange untethering from all we've been

threads that stitch us whole, undone

together in the upside-down of

no-day

day-night

Turkey-Christmas-New Year's

dinner on a tray

we gained a new sense,

somewhere between sight and hope

scent and despair

to touch

feel the fabric of all we do

texture of smoke, beautiful trickery

excuse me a moment

while I set about my task:

not to write orders,

no physical exam,

but spin a just story

from a throng of ragged strands

Once, flipping back to days

a blessed