The Accreditation Council for Graduate Medical Education (ACGME) established the Clinical Learning Environment Review (CLER) program in 2012 to provide graduate medical education (GME) and executive leaders with formative feedback aimed at improving patient care.¹ Two areas of focus for the CLER program were quality improvement (QI) and patient safety (PS). Recommendations for integrating QI into residency training included education, engaging residents in QI activities, and designing interprofessional activities aligned with clinical site priorities.²

Despite these recommendations, several recent publications have highlighted the challenges with integrating QI initiatives and resident education. Residents often experience QI as isolated

ABSTRACT

Background

Standardized patient (SP) encounters are commonly used to assess communication skills in medical training. The impact of SP and resident demographics on the standardized communication ratings in residents has not been evaluated.

Objective

To examine the impact of gender and race on SP assessments of internal medicine (IM) residents' communication skills during postgraduate year (PGY) 1.

Methods

We performed a retrospective cohort study of all SP assessments of IM PGY-1 residents for a standardized communication exercise from 2012 to 2018. We performed descriptive analyses of numeric communication SP ratings by gender, race, and age (for residents and SPs). A generalized estimating equation model, clustered on individual SP, was used to determine the association of gender (among SP and residents) with communication ratings. A secondary analysis was performed to determine the impact of residents and SP racial concordance in communication scores.

Results

There were 1356 SP assessments of 379 IM residents (199 male residents [53%] and 178 female residents [47%]). There were significant differences in average numeric communication rating (mean 3.40 vs 3.34, P = .009) by gender of resident, with higher scores in female residents. There were no significant interactions between SP and resident gender across the communication domains. There were no significant interactions noted with racial concordance between interns and SPs.

Conclusions

Our data demonstrate an association of resident gender on ratings in standardized communication exercises, across multiple communication skills. There was not an interaction impact for gender or racial concordance between SPs and interns.

ABSTRACT

Background

Physicians require the expertise to care for an increasingly aging population. A robust understanding of geriatric educational interventions is needed to improve geriatric training for physicians.

Objective

To map the breadth of geriatric educational interventions for residents (in non-geriatric specialties).

Methods

We used a scoping review methodology. We searched MEDLINE, Embase, EMCare, CENTRAL, ERIC, and Scopus from 2004 to September 2019 for search terms related to “educational approaches” AND “geriatric” AND “residents.” Two authors independently selected eligible studies, extracted data (categorized by educational approaches and Kirkpatrick level outcomes), and critically appraised studies using the Mixed Methods Appraisal Tool.

Results

There were 63 included studies, with a total of 6976 participants. Twelve studies had comparators, including 5 randomized controlled trials. Fifty-three studies (84%) described multicomponent interventions, incorporating combinations of didactic or self-directed approaches with interactive, simulation, experiential, and/or group-based learning. Use of curricular process was explicitly reported in 34 studies (59%). Most studies met at least 4 of 5 Mixed Methods Appraisal Tool criteria. Studies commonly measured outcomes at Kirkpatrick levels 1 and 2 (reaction and learning), with 15 studies measuring performance outcomes (Kirkpatrick levels 3 and 4b). All included studies had at least one positive result.

Conclusions

All educational interventions had positive outcomes; however, curriculum-informed multicomponent interventions were the most common. This scoping review demonstrates that robust methodology with comparators, longer-term designs, and use of higher-level Kirkpatrick outcome measures is possible but not commonly used. Clear direction for future research is provided.

ABSTRACT

Background

Gender disparities are prevalent in medicine, but their impact on surgical training is not well studied.

Objective

To quantify gender disparities in trainee intraoperative experiences and explore the variables associated with ratings of surgical autonomy and performance.

Methods

From September 2015 to May 2019, attending surgeons and trainees from 71 programs assessed trainee autonomy on a 4-level Zwisch scale and performance on a 5-level modified Dreyfus scale after surgical procedures. Multivariable regression models were used to examine the association of trainee gender with autonomy and performance evaluations.

Results

A total of 3255 trainees and attending surgeons completed 94 619 evaluations. Attendings gave lower ratings of operative autonomy to female trainees than male trainees when controlling for training level, attending, and surgical procedure (effect size B = −0.0199, P = .008). There was no difference in ratings of autonomy at the beginning of training (P = .32); the gap emerged as trainees advanced in years (B = −0.0163, P = .020). The gender difference in autonomy was largest for the most complex cases (B = −0.0502, P = .002). However, there was no difference in attending ratings of surgical performance for female trainees compared to male trainees (B = −0.0124, P = .066). Female trainees rated themselves as having less autonomy and worse performance than males when controlling for training level, attending, procedure, case complexity, and attending ratings (autonomy B = −0.0669, P < .001; performance B = −0.0704, P < .001).

Conclusions

While there was no significant difference in ratings of operative performance, a small difference between ratings of operative autonomy for female and male surgical trainees was identified.

The Challenge

Assessments can provide meaningful performance data from expert observers, but this information is prone to harmful bias. Such assessment bias disproportionately affects trainees who do not resemble or share identities with those doing the assessment.¹ While hundreds of cognitive biases exist, some have particularly pernicious influences when building and sustaining diversity in medicine, with subtle differences in individual performance ratings systematically perpetuating the exclusion of marginalized groups.¹

What Is Known

Bias affects our perceptions of another's knowledge, ability, professionalism, and readiness for independent practice.² Over repeated assessments, these biases can result in an