ABSTRACT

Background

Two criteria that have been investigated for evaluating orthopedic surgery residency candidates are achieving an “honors” grade during a surgery clerkship and the total number of honors grades received in all clerkships. Unfortunately, the rate of honors grades given and the criteria for earning an honors grade differ between medical schools, making comparison of applicants from different medical schools difficult.

Objective

We measured the rate of honors grades in clerkships at different medical schools in the United States to examine the utility of clerkship grades in evaluating orthopedic surgery residency applicants.

Methods

Adequate data via the Electronic Residency Application Service were available for 86 of 142 Association of American Medical Colleges medical schools from the 2017 Match cycle. Descriptive statistics and Wilcoxon rank sum tests were performed to identify differences in grade distributions within each clerkship and in school ranking for research by U.S. News & World Report.

Results

For the surgery clerkship, the median rate of honors grades given was 32.5% (range 5%–67%). There was a high rate of interinstitutional variability in all clerkships. We were unable to demonstrate a statistically significant relationship between research ranking and percentage honors grades given for individual clerkships.

Conclusions

A standardized method for grading medical students during clinical clerkships does not exist, resulting in a high degree of interinstitutional variability. Surgery clerkship grades are an unreliable measure for comparing orthopedic surgery residency applicants from different medical schools. Standardized measures of applicant evaluation might be helpful in the future.

ABSTRACT

Background

The entrustable professional activity (EPA) assessment framework allows supervisors to assign entrustment levels to physician trainees for specific activities. Limited opportunity for direct observation of trainees hampers entrustment decisions, in particular for infrequently performed activities. Simulation allows for direct observation, so tools to assess performance of EPAs in simulation could potentially provide additional data to complement clinical assessments.

Objective

We developed and collected validity evidence for a simulation-based tool grounded in the EPA framework.

Methods

We developed E-ASSESS (EPA Assessment for Structured Simulated Emergency ScenarioS) to assess performance in 2 EPAs among pediatric residents participating in simulation-based team training in 2017–2018. We collected validity data, applying Messick's unitary view. Three raters used E-ASSESS to assign entrustment levels based on performance in simulation. We compared those ratings to entrustment levels assigned by clinical supervisors (different from the study raters) for the same residents on a separate tool designed for clinical practice. We calculated intraclass correlation (ICC) for each tool and Pearson correlation coefficients to compare ratings between tools.

Results

Twenty-eight residents participated in the study. The ICC between the 3 raters for entrustment ratings on E-ASSESS ranged from 0.65 to 0.77, while ICC among raters of the clinical tool were 0.59 and 0.57. We found no significant correlations between E-ASSESS ratings and clinical practice ratings for either EPA (r = -0.35 and 0.38, P > .05).

Conclusions

Assessment following an EPA framework in the simulation context may be useful to provide data points to inform entrustment decisions as part of resident assessment.

ABSTRACT

Background

Parenting issues can affect physicians' choice of specialty or subspecialty, as well as their selection of individual training programs, because of the distinctive challenges facing residents and fellows with children. Specific information about how residents perceive these challenges is limited.

Objective

We sought to better understand the challenges associated with parenting during residency and fellowship training in order to inform policy and research.

Methods

In 2017, a voluntary online questionnaire was distributed to all 2214 Partners HealthCare graduate medical education trainees across 285 training programs. The survey queried attitudes of and about trainees with children and assessed needs and experiences related to parental leave, lactation, and childcare. Responses were compared between subgroups, including gender, surgical versus nonsurgical specialty, parental status, and whether the respondent was planning to become a parent.

Results

A total of 578 trainees (26%) responded to the questionnaire. Of these, 195 (34%) became parents during training. An additional 298 (52%) planned to become parents during training. Respondents overwhelmingly agreed that their institution should support trainees with children (95%) and that doing so is important for trainee wellness (98%). However, 25% felt that trainees with children burden trainees without children. Childcare access, affordability, and availability for sufficient hours were identified as key challenges, along with issues related to parental leave, lactation facilities, and effect on peers.

Conclusions

This survey highlights trainees' perspectives about parenting during their clinical training, signaling parental leave, lactation facilities, and childcare access and affordability as particular challenges and potential targets for future interventions.

The Challenge

The physical features of the clinical learning environment (CLE) have critical effects on trainees and educators, including acquisition and application of knowledge, skills, and values. Though dynamic and mutable, the physical CLE is often viewed as static and unchanging. Interpersonal factors (eg, social dynamics, personnel roles, and positioning in space) affect how learners and educators experience and utilize the physical environment. There is limited dedicated literature regarding how educators and trainees can use spaces in the clinical setting for optimal education during active patient care in feasible and effective ways.

What Is Known

The CLE can influence learners'