ABSTRACT

Background

Residency applicants feel increasing pressure to maximize their chances of successfully matching into the program of their choice, and are applying to more programs than ever before.

Objective

In this narrative review, we examined the most common and highly rated factors used to select applicants for interviews. We also examined the literature surrounding those factors to illuminate the advantages and disadvantages of using them as differentiating elements in interviewee selection.

Methods

Using the 2018 NRMP Program Director Survey as a framework, we examined the last 10 years of literature to ascertain how residency directors are using these common factors to grant residency interviews, and whether these factors are predictive of success in residency.

Results

Residency program directors identified 12 factors that contribute substantially to the decision to invite applicants for interviews. Although United States Medical Licensing Examination (USMLE) Step 1 is often used as a comparative factor, most studies do not demonstrate its predictive value for resident performance, except in the case of test failure. We also found that structured letters of recommendation from within a specialty carry increased benefit when compared with generic letters. Failing USMLE Step 1 or 2 and unprofessional behavior predicted lower performance in residency.

Conclusions

We found that the evidence basis for the factors most commonly used by residency directors is decidedly mixed in terms of predicting success in residency and beyond. Given these limitations, program directors should be skeptical of making summative decisions based on any one factor.

ABSTRACT

Background

Residents regularly care for hospitalized patients for whom they are not the primary provider (cross-cover), often without guidance.

Objective

We identified and defined components of safe cross-cover care.

Methods

Sixty medical and surgical faculty physicians and chief residents from the Midwest were invited to participate in a Delphi study analyzing the appropriateness of cross-covering residents evaluating patients at bedside, deferring issues to the primary team, documenting a note, contacting the attending, and communicating with nurses. The first survey was free text, and responses were categorized. In the second survey, physicians rated categorized responses based on appropriateness using a 5-point Likert scale. High consensus was defined as ≥ 80% agreement, approaching consensus as 51% to 79% agreement, and nonconsensus as ≤ 50% agreement. Results were analyzed by specialty and cross-cover experience in the past year using Pearson χ² test or Fisher exact test.

Results

Forty respondents (67%) completed the first survey and 30 (50%) completed the second. Responses led to 46 categories. Twenty-eight items (60%) achieved high consensus, 8 (17%) approached consensus, and 10 (22%) did not achieve consensus, with no difference based on specialty or experience. Responses with 100% consensus included: residents should evaluate a patient at bedside whenever asked by the nurse; documentation should occur for change in level of care, death, code, or rapid response team activation; and physician-nurse communication should be respectful and closed loop.

Conclusions

This regional physician panel reached consensus on 28 elements important in cross-cover care, which can be used for training and future studies.

ABSTRACT

Background

Research suggests that workplace-based assessment (WBA) tools using entrustment anchors provide more reliable assessments than those using traditional anchors. There is a lack of evidence describing how and why entrustment anchors work.

Objective

The purpose of this study is to better understand the experience of residents and faculty with respect to traditional and entrustment anchors.

Methods

We used constructivist grounded theory to guide data collection and analysis (March–December 2017) and semistructured interviews to gather reflections on anchors. Phase 1 involved residents and faculty (n = 12) who had only used assessment tools with traditional anchors. Phase 2 involved participants who had used tools with entrustment anchors (n = 10). Data were analyzed iteratively.

Results

Participants expressed that the pragmatic language of entrustment anchors made WBA (1) concrete and justifiable; (2) transparent as they explicitly link clinical assessment and learning progress; and (3) align with training outcomes, enabling better feedback. Participants with no prior experience using entrustment anchors outlined contextual concerns regarding their use. Participants with experience described how they addressed these concerns. Participants expressed that entrustment anchors leave a gap in assessment information because they do not provide normative data.

Conclusions

Insights from this analysis contribute to a theoretical framework of benefits and challenges related to the adoption of entrustment anchors. This richer understanding of faculty and resident perspectives of entrustment anchors may assist WBA developers in creating more acceptable tools and inform the necessary faculty development initiatives that must accompany the use of these new WBA tools.

The Challenge

Soon-to-be residency and fellowship graduates are often challenged by how best to structure their curriculum vitae (CV). This involves making choices about whether to include certain information, like activities that predate medical school, and how to best highlight activities and accomplishments. The development of a CV is further challenged by individual academic institutions and potential employers having particular specifications regarding the order, format, and content.

What Is Known

A CV provides fellowship programs, employers, and/or academic promotion and tenure committees with a chronological story. A CV highlights your education, skills, experiences, and achievements (academic, scientific, teaching, and clinical).

Setting and Problem

The poor well-being of resident physicians is a cause for significant concern. Burnout rates are high, and the consequences, including depression, impaired cognitive function, and increased rates of medical errors, are serious.

Employees who rate their leaders highly in terms of communication, willingness to listen, and response to concerns have significantly better well-being and job satisfaction compared to peers. Thus, we implemented a communications bundle to help residents feel supported and heard.

Intervention

To improve communication with residents, starting in January 2017, we initiated a group of interventions that we described with the mnemonic RAPID (Real-time, Anonymous,

One of the Many

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