ABSTRACT

Background

Horizontal care, in which clinicians assume roles outside of their usual responsibilities, is an important health care systems response to emergency situations. Allocating residents and fellows into skill-concordant clinical roles, however, is challenging. The most efficient method to accomplish graduate medical education (GME) assessment and deployment for horizontal care is not known.

Objective

We designed a categorization schema that can efficiently facilitate clinical and educational horizontal care delivery for trainees within a given institution.

Methods

In September 2019, as part of a general emergency response preparation, a 4-tiered system of trainee categorization was developed at one academic medical center. All residents and fellows were mapped to this system. This single institution model was disseminated to other institutions in 2020 as the COVID-19 pandemic began to affect hospitals nationally. In March 2020, a multi-institution collaborative launched the Trainee Pandemic Role Allocation Tool (TPRAT), which allows institutions to map institutional programs to COVID-19 roles within minutes. This was disseminated to other GME programs for use and refinement.

Results

The emergency response preparation plan was disseminated and selectively implemented with a positive response from the emergency preparedness team, program directors, and trainees. The TPRAT website was visited more than 100 times in the 2 weeks after its launch. Institutions suggested rapid refinements via webinars and e-mails, and we developed an online user's manual.

Conclusions

This tool to assess and deploy trainees horizontally during emergency situations appears feasible and scalable to other GME institutions.

ABSTRACT

Background

Studies examining mitigating factors associated with residents' experience of burnout have found mixed results; thus the most effective approaches for programs to prevent resident burnout are unclear.

Objective

We used mixed methods to explore the association of 4 psychological constructs thought to be important protective factors for burnout—grit, resiliency, social support, and psychological flexibility—across a wide variety of residency programs at 1 institution.

Methods

The explanatory sequential study design included an online survey of previously published scales measuring burnout, grit, resiliency, social support, and psychological flexibility. The survey was sent to 20 residency programs in a single institution during the 2017–2018 academic year. Data were analyzed using descriptive statistics and ordinal logistic regressions to determine the association of protective factors and demographic variables. Interviews with 13 residents were conducted and analyzed deductively and inductively to identify when and how residents employed the protective factors.

Results

Among the 268 responders (51% response rate), grit, resiliency, social support, and psychological flexibility were individually inversely associated with burnout level. However, resiliency and relationship status were no longer associated with burnout when all 4 factors were included in the model. Interviews revealed that grit both protects from and contributes to burnout, residents prefer peer support, and they cognitively “step back” when stress is high.

Conclusions

Although many programs and institutions focus on resiliency in wellness programs, there may be other factors to consider, such as grit and equipping students with tools to disengage psychologically when feeling stressed or overwhelmed.

ABSTRACT

Background

The Accreditation Council for Graduate Medical Education specifies that trainees must receive clinical outcomes and quality benchmark data at specific levels related to institutional patient populations. Program directors (PDs) are challenged to identify meaningful data and provide them in formats acceptable to trainees.

Objective

We sought to understand what types of patients, data/metrics, and data delivery systems trainees and PDs prefer for supplying trainees with clinical outcomes data.

Methods

Trainees (n = 21) and PDs (n = 12) from multiple specialties participated in focus groups during academic year 2017–2018. They described key themes for providing clinical outcomes data to trainees.

Results

Trainees and PDs differed in how they identified patients for clinical outcomes data for trainees. Trainees were interested in encounters where they felt a sense of responsibility or had autonomy/independent decision-making opportunities, continuity, or learned something new; PDs used broader criteria including all patients cared for by their trainees. Both groups thought trainees should be given trainee-level metrics and consistently highlighted the importance of comparison to peers and/or benchmarks. Both groups found value in “push” and “pull” data systems, although trainees wanted both, while PDs wanted one or the other. Both groups agreed that trainees should review data with specific faculty. Trainees expressed concern about being judged based on their patients' clinical outcomes.

Conclusions

Trainee and PD perspectives on which patients they would like outcomes data for differed, but they overlapped for types of metrics, formats, and review processes for the data.

Setting and Problem

Trainees with child or elder care responsibilities can face unexpected disruption of care arrangements that may cause further ripples of disruption among colleagues in their training program. Even the possibility of an interruption in care arrangements can cause stresses beyond the scope of that trainee's family. To help mitigate these stresses, we implemented an Emergency Care Back-up Service (ECBS) for all trainees at our institution on a trial basis. This program was not considered research.

figure. Usage by Age Group — **figure** Usage by Age Group
Citation: Journal of Graduate Medical Education 12, 3; 10.4300/JGME-D-19-00846.1

Intervention

We contracted with a commercial ECBS to provide this service. Messaging

Setting and Problem

Over the past several decades, hospitalized patients have become increasingly complex, often with multisystem needs. In response, hospital teams now rely heavily on subspecialty consultants and interprofessional colleagues. While this has improved care delivery, fragmentation of responsibilities has changed the clinical learning environment, and graduate medical education has suffered.

By the mid-2020s, collaborative models of care made it unclear who was responsible for teaching and evaluating residents. Subspecialty consultation—particularly e-consults—were common, but residents and fellows rarely met face-to-face, forfeiting opportunities for workplace learning. Isolation and anonymity overtook any sense of community in the hospital, and rates of