Much of the literature on mentoring physicians-in-training has focused on choosing a specialty, but not on providing guidance about the nature of the work these health professionals will do over their careers.^1-4 Medical students may lose sleep over choosing a clinical specialty, and residents worry about whether to pursue subspecialty fellowship training. However, early-career physicians need guidance to consider nonclinical aspects of their work.

The authors have extensive experience mentoring trainees, especially those seeking to leverage clinical training to broaden their professional portfolio in research, education, organizational leadership, policy, and public health. While coaching models support

ABSTRACT

Background Despite increasing focus on developing senior residents’ teaching and supervisory skills, few studies have identified the components of the supervisory resident role. To develop curricula to prepare residents for this role, we must clearly define the supervising role.

Objective To summarize the literature regarding the characteristics and behaviors of effective supervising residents and to propose a model of the supervisory resident role.

Methods We performed a narrative review, searching PubMed and SCOPUS for literature discussing the supervisory resident role. Titles, abstracts, and articles were screened for inclusion, as were the reference sections of included articles. Using inductive thematic analysis, we coded qualitative statements, survey items, and curriculum goals and organized them into themes based on iterative, reflexive discussion. We used these themes to present a model of the supervisory role.

Results Thirty-six works met our inclusion criteria. The articles represented perspectives from faculty members, residents, and medical students and utilized qualitative and quantitative methods. They indicated that the supervising resident is responsible for teaching, managing daily tasks, advocating on behalf of their team members’ well-being, and creating a psychologically safe learning environment. Emphasis on each of these components varied by role on the medical team.

Conclusions This is one of the first studies to incorporate multiple perspectives to describe the multifaceted role of the supervising resident, and suggests that individuals’ positions on the medical team guide their perception of this role. The literature lacks adequate exploration of junior residents’, medical students’, interdisciplinary team members’, and patients’ and families’ descriptions of this role.

ABSTRACT

Background Program signaling is a relatively new tool in the residency application process, introduced to help applicants express genuine interest in programs amid rising application numbers. While its use has rapidly expanded across specialties, the number and type of signals vary. Limited cross-specialty analysis hinders identification of best practices, leaving applicants and programs without standardized guidance about how to use signaling to achieve specific goals.

Objective This review summarizes the quantitative effects of program signaling on application volume and interview yield, stakeholder perceptions, and evolving trends in signaling use.

Methods A systematic search on 3 databases was conducted from January 2021 through May 2024. Four independent reviewers screened studies for original, empirical data on program signaling. A narrative review synthesized findings on outcomes and stakeholder opinions.

Results Of 98 studies screened, 31 (32%) met inclusion criteria. Data from multiple specialties showed that signaling increased interview yield, though benefits did not scale with the number of signals offered. Allowing more signals was associated with fewer applications per program in some specialties. Both applicants and program directors generally viewed signaling positively. Applicant satisfaction was higher in specialties with fewer signals. Over time, there has been a trend toward increasing signals and implementing tiered models.

Conclusions Program signaling is associated with increased interview yield across specialties. Most program directors and applicants support its continued use. Applicants desire greater transparency in how programs use signals.

ABSTRACT

Background Increasing evidence suggests that supervisors exhibit different assessment behaviors for residents from their own discipline compared to those completing a rotation from another discipline. As programs of assessment rely on collecting robust performance data to inform high-stakes decisions about progress and promotion, it is important to examine the quality of such inputs.

Objective To compare the quality of workplace-based assessments (WBAs) of emergency medicine (EM) residents by EM and non-EM assessors.

Methods This retrospective database study compared the quality of WBAs using the Quality of Assessment of Learning (QuAL) score (range 0-5), a previously published measure of WBA quality that has demonstrated strong psychometric characteristics. Five entrustable professional activities (EPAs), 3 procedural and 2 non-procedural, mapped to both EM and non-EM rotations, were selected for inclusion. Two hundred and fifty WBAs (50 WBAs per EPA; 25 EM and 25 non-EM), completed from July 2019 to June 2021, were rated by 3 blinded EM physician raters. QuAL scores were analysed using factorial ANOVA.

Results Mean QuAL scores for WBAs completed during EM rotations were significantly higher compared to those completed during non-EM rotations (3.66±0.99 vs 3.02±0.99). Further, mean QuAL score for procedural EPAs was significantly higher than non-procedural EPAs (3.61±1.00 vs 3.16±1.03).

Conclusions In this study, the quality of WBAs completed for EM residents during non-EM rotations was of lower quality compared to assessments on EM rotations.

The Challenge

Overnight work shifts during medical training pose serious challenges to cognitive, emotional, and physical well-being. Residents must manage disrupted sleep, fatigue, social isolation from friends/family, and increased risk of error. Adapting, through strategies like pre-shift naps, efficient workflows, and recovery planning, can help to mitigate the strain of irregular hours on trainee well-being and patient safety.