Volume 16: Issue 1

Background The change from in-person to virtual interviews for graduate medical education (GME) provides the opportunity to compare the potential environmental effects.

Objective To explore and summarize the existing literature on the potential climate impact of medical residency interview travel through a scoping review.

Methods The search was conducted in October 2022 using 5 research databases. Results were screened for inclusion by 2 reviewers in a 2-tiered process. Inclusion criteria were limited to English language articles from the United States and Canada, with no limitations on the type of study, type of applicant (allopathic, osteopathic, or international medical graduate), or type of residency. A thematic analysis focusing on the objectives and main findings of identified studies was conducted and an iteratively created standardized data extraction worksheet was used such that all studies were explicitly assessed for the presence of the same themes.

Results The search identified 1480 unique articles, of which 16 passed title and abstract screening and 13 were ultimately included following full-text review. There were 3 main themes identified: the carbon footprint of residency travel, stakeholders’ perspectives on virtual interviews, and advocacy for virtual interviews. All 13 articles employed persuasive language on interview reform, ranging from neutral to strongly in favor of virtual interviews based wholly or in part on environmental concerns.

Conclusions Two main findings were identified: (1) Though carbon footprint estimates for in-person interviews vary, in-person interviews create considerable carbon emissions and (2) those working in GME are concerned about the climate effects of GME practices and describe them as a compelling reason to permanently adopt virtual interviewing.

Background Competency-based medical education (CBME) has been implemented in many residency training programs across Canada. A key component of CBME is documentation of frequent low-stakes workplace-based assessments to track trainee progression over time. Critically, the quality of narrative feedback is imperative for trainees to accumulate a body of evidence of their progress. Suboptimal narrative feedback will challenge accurate decision-making, such as promotion to the next stage of training.

Objective To explore the quality of documented feedback provided on workplace-based assessments by examining and scoring narrative comments using a published quality scoring framework.

Methods We employed a retrospective cohort secondary analysis of existing data using a sample of 25% of entrustable professional activity (EPA) observations from trainee portfolios from 24 programs in one institution in Canada from July 2019 to June 2020. Statistical analyses explore the variance of scores between programs (Kruskal-Wallis rank sum test) and potential associations between program size, CBME launch year, and medical versus surgical specialties (Spearman’s rho).

Results Mean quality scores of 5681 narrative comments ranged from 2.0±1.2 to 3.4±1.4 out of 5 across programs. A significant and moderate difference in the quality of feedback across programs was identified (χ²=321.38, P<.001, ε2=0.06). Smaller programs and those with an earlier launch year performed better (P<.001). No significant difference was found in quality score when comparing surgical/procedural and medical programs that transitioned to CBME in this institution (P=.65).

Conclusions This study illustrates the complexity of examining the quality of narrative comments provided to trainees through EPA assessments.

Background Although entrustment-supervision ratings are more intuitive compared to other rating scales, it is not known whether their use accurately assesses the appropriateness of care provided by a resident.

Objective To determine the frequency of incorrect entrustment ratings assigned by faculty and whether accuracy of an entrustment-supervision scale differed by resident performance when the scripted resident performance level is known.

Methods Faculty participants rated standardized residents in 10 videos using a 4-point entrustment-supervision scale. We calculated the frequency of rating a resident incorrectly. We performed generalizability (G) and decision (D) studies for all 10 cases (768 ratings) and repeated the analysis using only cases with an entrustment score of 2.

Results The mean score by 77 raters for all videos was 2.87 (SD=0.86) with a mean of 2.37 (SD=0.72), 3.11 (SD=0.67) and 3.78 (SD=0.43) for the scripted levels of 2, 3, and 4. Faculty ratings differed from the scripted score for 331of 768 (43%) ratings. Most errors were ratings higher than the scripted score (223, 67%). G studies estimated the variance proportions of rater and case to be 4.99% and 54.29%. D studies estimated that 3 raters would need to watch 10 cases. The variance proportion of rater was 8.5% when the analysis was restricted to level 2 entrustment, requiring 15 raters to watch 5 cases.

Conclusions Participants underestimated residents’ potential need for greater supervision. Overall agreement between raters and scripted scores were low.

The Challenge

It seems straightforward that each author’s contributions to a manuscript should determine authors’ inclusion and order. Yet research and personal experience indicate the surprisingly complex nature of authorship discussions and their potential for adverse effects on relationships and careers. As faculty and trainees often collaborate in the graduate medical education (GME) setting, differences in power and experience among authors, the transient nature of training, and the intensity of competing demands further complicate authorship decisions. Team members must employ strategies for accurately reflecting contributions while maintaining healthy dynamics that sustain long-term relationships.

Undergraduate medical education (UME) in the United States has undergone dramatic expansion over the past 22 years. In the spring of 2001, MD-granting schools graduated 15 793 physicians,¹ and DO-granting schools graduated 2510 physicians,² for a total of 18 303 domestic graduates. In the spring of 2023, MD-granting schools graduated 20 920, and DO-granting schools graduated 7895 physicians, for a total of 28 779 domestic graduates, an increase of 10 476 domestic graduates (57.2%) (see Figure 1).

Figure 1 MD Graduates, DO Graduates, and Total Occupied Entry-Year Positions in ACGME-Accredited Specialty Programs (Pipeline Programs) Abbreviation: ACGME, Accreditation Council for

Citation: Journal of Graduate Medical Education 16, 1; 10.4300/JGME-D-23-00947.1

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Background

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Qualified

The Climate Impact of Medical Residency Interview Travel in the United States and Canada: A Scoping Review

Exploring the Quality of Feedback in Entrustable Professional Activity Narratives Across 24 Residency Training Programs

Accuracy of Entrustment-Based Assessment: Implications for Programs and Patients

Changes in Gender and Racial/Ethnic Diversity in US Residency Program Applications From 2018 to 2022

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Improving Residents' Safe Opioid Prescribing for Chronic Pain Using an Objective Structured Clinical Examination

Integrating a Resident-Driven Longitudinal Quality Improvement Curriculum Within an Ambulatory Block Schedule

Skills for Interviewing Adolescent Patients: Sustainability of Structured Feedback in Undergraduate Education on Performance in Residency