Many important medical education research questions cry out for a qualitative research approach: How do teacher characteristics affect learning? Why do learners choose particular specialties? How is professionalism influenced by experiences, mentors, or the curriculum? The medical paradigm, the “hard” science most often taught in medical schools, usually employs quantitative approaches.1 As a result, clinicians may be less familiar with qualitative research or its applicability to medical education questions. For these why types of questions, qualitative or mixed qualitative and quantitative approaches may be more appropriate and helpful.2 Thus, we wish to encourage submissions
Miller's pyramid of competence (figure) provides a useful 4-level model for the assessment of learners. The “does” level at the top of the pyramid is the real world. It is the most authentic and valid level above the “knows,” “knows how,” and “shows how” levels.1 At the top of the pyramid, above the clouds of the structured educational world of tests and simulations, assessment focuses on what our trainees do in practice. How do we evaluate this, and what information can we provide them to guide further learning and professional development?
In the first of two editorials on qualitative research, Sullivan and Sargeant discuss attributes. They note qualitative approaches are useful when issues are being explored, theory is being generated rather than confirmed, and studies seek to provide an explanation (pp 449).
In their editorial on multisource feedback (MSF), ten Cate and Sargeant assert that MSF provides meaningful ways to assess competencies that are difficult to evaluate with traditional approaches, including professionalism, health advocacy, practice-based learning, teamwork and interpersonal skills (pp 453).
Perspectives
In their perspective on teaching and working with Generation Y, Eckleberry-Hunt and Tucciarone suggest that flexibility and
Generation Y, otherwise known as the millennial generation, refers to individuals born between 1982 and 2005.1 This is the newest generation to enter the workforce. Leaders across disciplines are taking note of the challenges and opportunities associated with training this unique group. In contrast, medical education appears to be lagging behind in understanding the different learning needs of Generation Y and the ramifications this has for advanced training. This can lead to misunderstanding and frustration. Consider this example:
A young resident advances in training but does not seem to be taking on additional responsibilities as would be developmentally
A main objective of restricting working time for residents, whether it is the Accreditation Council for Graduate Medical Education (ACGME) regulation or the European Working Time Directive (EWTD), is to protect patients from exhausted doctors. However, in the Netherlands, legislation enacted in 1993 to reduce working hours for junior doctors, as residents are termed, and midwives was prompted by trainees in a teaching hospital who complained to members of parliament about long working hours and miserable personal lives. At the time, public working hours were mandated to no more than 38 h/wk. An arbitrary 10 hours was added for education and training:
Role modeling is an integral component of medical education. The literature suggests that being a clinically excellent academic physician and serving as a role model for trainees are integrally related.
Purpose
To explore the relationship between being considered clinically excellent and being considered an effective role model.
Methods
Two independent surveys were administered to clinically active faculty (asked to name clinically excellent colleagues) and internal medicine residents (asked to name faculty role models). We compared frequency counts of clinically excellent faculty mentioned and frequency counts of role models mentioned by respondents. Spearman correlations and odds ratios with 95% confidence intervals were used to assess the relationship between the responses.
Results
A total of 39 of 66 faculty (59%) and 45 of 50 residents (90%) responded. There were 31 faculty members judged to be clinically excellent and 67 faculty identified as role models. Thirty faculty members appeared on both lists. There was a moderately high correlation between these groups (Spearman correlation coefficient = 0.54, P < .001). Faculty members who were among those named as clinically excellent by their peers were more likely to be named 3 or more times as a role model by trainees (odds ratio, 24.6; confidence interval, 2.9–207).
Conclusions
This study tested and confirmed the correlation between clinical excellence and role modeling, illustrating the value of these faculty members at teaching hospitals.
Fewer residents are choosing general internal medicine (GIM) careers, and their choice may be influenced by the continuity clinic experience during residency. We sought to explore the relationship between resident satisfaction with the continuity clinic experience and expressed interest in pursuing a GIM career.
Methods
We surveyed internal medicine residents by using the Veterans Health Administration Office of Academic Affiliations Learners' Perceptions Survey—a 76-item instrument with established reliability and validity that measures satisfaction with faculty interactions, and learning, working, clinical, and physical environments, and personal experience. We identified 15 reliable subscales within the survey and asked participants whether their experience would prompt them to consider future employment opportunities in GIM. We examined the association between satisfaction measures and future GIM interest with 1-way analyses of variance followed by Student-Newman-Keuls post hoc tests.
Results
Of 217 residents, 90 (41%) completed the survey. Residents felt continuity clinic influenced career choice, with 22% more likely to choose a GIM career and 43% less likely. Those more likely to choose a GIM career had higher satisfaction with the learning (P = .001) and clinical (P = .002) environments and personal experience (P < .001). They also had higher satisfaction with learning processes (P = .002), patient diversity (P < .001), coordination of care (P = .009), workflow (P = .001), professional/personal satisfaction (P < .001), and work/life balance (P < .001).
Conclusions
The continuity clinic experience may influence residents' GIM career choice. Residents who indicate they are more likely to pursue GIM based on that clinical experience have higher levels of satisfaction. Further prospective data are needed to assess if changes in continuity clinic toward these particular factors can enhance career choice.
Pediatricians and family physicians are responsible for providing newborn resuscitation, yet Accreditation Council for Graduate Medical Education requirements for training in this area during residency differ markedly for the two specialties. Our objectives were to determine (1) the extent to which neonatal resuscitation training differs for pediatric and family medicine residents; (2) the extent to which general pediatricians and family physicians engage in newborn resuscitation in their practice; and (3) whether use of resuscitation skills differs between urban/suburban and rural providers.
Methods
We surveyed a national cohort of pediatricians and family physicians who obtained board certification between 2001 and 2005. Data were analyzed based on type of physician and setting of current practice.
Results
Survey response rate was 22% (382 of 1736). Compared with family medicine physicians, pediatricians received more neonatal resuscitation training during residency. Most members of both groups had attended no deliveries in the year prior to the survey (75% [111 of 148] versus 74% [114 of 154]). In their current practice, the groups were equally likely to have provided a newborn bag and mask ventilation, chest compressions, and resuscitation medications. Pediatricians were more likely than family physicians to have attempted to either intubate a newborn (20% [28 of 148] versus 10% [16 of 153]; P = .0495) or insert umbilical catheters (15% [22 of 148] versus 5% [8 of 153]; P = .005). Regardless of specialty, rural physicians were much more likely to report that they attended deliveries (61% [41 of 67] versus 15% [36 of 234]; P < .001). Among rural pediatricians attending deliveries, 44% (7 of 16) reported feeling inadequately prepared for at least one delivery in the past year.
Conclusions
Few primary care pediatricians and family physicians provide newborn resuscitation after residency. For those who do attend deliveries, current training may provide insufficient preparation. Flexible, individualized residency curricula could target intensive resuscitation training to individuals who plan to practice in rural areas and/or attend deliveries after graduation.
Due to increasing time constraints, the use of bedside presentations in resident education has declined. We examined whether patient satisfaction in the emergency department is affected when first-year residents present at the bedside with attendings.
Methods
We performed an observational, prospective, nonblinded study in the emergency department of a military teaching hospital. We alternately assigned first-year residents to present a convenience sample of 248 patients to the attending physician at the patient's bedside or away from the patient. We measured patient satisfaction by using the Patient Satisfaction Questionaire-18 (PSQ-18), a validated survey instrument that utilizes a Likert scale, and additional nonvalidated survey questions involving Likert and visual analog scales.
Results
While the median PSQ-18 score of 74 (95% confidence interval [CI], 72–76) was higher for patient satisfaction when residents made bedside presentations than that for standard presentations, 72 (95% CI, 70–74), the difference did not reach statistical significance (P = .33).
Conclusion
There was no significant difference in overall patient satisfaction between residents' bedside presentations and presentations to attendings away from the patient. Although not significant, the differences noted in PSQ-18 subscales of communication, general satisfaction, and interpersonal manner warrant further investigation. Patients did not appear to be uncomfortable with having their care discussed and with having subsequent resident education at the bedside. Future research on patient satisfaction after implementation of standardized bedside teaching techniques may help further elucidate this relationship.
To examine whether resident communication skills evaluated through patient satisfaction surveys demonstrate evidence of decline through the 3 years of internal medicine residency.
Methods
Data for this study were collected retrospectively from a database of patient satisfaction surveys completed for internal medicine residents at different levels of training. Patient satisfaction was measured with the Aggregated EVGFP (excellent, very good, good, fair, or poor) questionnaire recommended by the American Board of Internal Medicine.
Results
Over a span of 5 years (2005–2009), a total of 768 patient rating forms were completed for 67 residents during their 3 years of residency training. In postgraduate year (PGY)–1, the residents had a mean satisfaction rating of 4.33 ± 0.48 compared to a mean rating of 4.37 ± 0.45 in their PGY-3 year. Analysis of variance indicated no significant difference by PGY level.
Conclusion
Our findings demonstrate that resident communication skills and patient satisfaction do not decline during the 3 years of residency. This is contrary to our hypothesis that patient satisfaction would worsen as residents progressed through training.
Few studies have examined residents' retained knowledge and confidence regarding essential evidence-based medicine (EBM) topics.
Objective
To compare postgraduate year-3 (PGY-3) residents' confidence with EBM topics taught during internship with that of PGY-1 residents before and after exposure to an EBM curriculum.
Methods
All residents participated in an EBM curriculum during their intern year. We surveyed residents in 2009. PGY-1 residents completed a Likert-scale type survey (which included questions from the validated Berlin questionnaire and others, developed based on input from local EBM experts). We administered the Berlin questionnaire to a subset of PGY-3 residents.
Results
Forty-five PGY-3 (88%; n = 51) and 42 PGY-1 (91%; n = 46) residents completed the survey. Compared with PGY-1 residents pre-curriculum, PGY-3 residents were significantly more confident in their knowledge of pre- and posttest probability (mean difference, 1.14; P = .002), number needed to harm (mean difference, 1.09; P = .002), likelihood ratio (mean difference, 1.01; P = .003), formulation of a focused clinical question (mean difference, 0.98; P = .001), and critical appraisal of therapy articles (mean difference, 0.91; P = .002). Perceived confidence was significantly lower for PGY-3 than post-curriculum PGY-1 residents on relative risk (mean difference, −0.86; P = .002), study design for prognosis questions (mean difference, −0.75; P = .004), number needed to harm (mean difference, −0.67; P = .01), ability to critically appraise systematic reviews (mean difference, −0.65, P = .009), and retrieval of evidence (mean difference, −0.56; P = .008), among others. There was no relationship between confidence with and actual knowledge of EBM topics.
Conclusions
Our findings demonstrate lower confidence among PGY-3 than among PGY-1 internal medicine residents for several EBM topics. PGY-3 residents demonstrated poor knowledge of several core topics taught during internship. Longitudinal EBM curricula throughout residency may help reinforce residents' EBM knowledge and their confidence.
Many medical students find choosing a residency challenging. There are several steps involved, including determining one's own priorities, arranging electives, choosing a training program and site, and preparing an in-depth application and a rank order list. Many resources are available to assist students, including the Canadian Resident Matching Service website, program websites, career counselors, career information sessions, mentors, peers, family/friends, and the Canadian Medical Residency Guide. Our study explored the relative impact of these resources on the career decision-making process.
Method
We invited medical students in their final year at 12 Canadian medical schools to complete an online survey. Questions included identifying the relative utility of resources in the context of each component of the decision-making process. Responses were analyzed using descriptive statistics.
Results
The response rate was 71% (1076 of 1518). Overall, mentors, family/friends, and peers had the most impact on students' decision making. Career counselors, websites, and the Canadian Medical Residency Guide had much less impact. Family/friends were most frequently cited as essential to the process; however, family/friends and peers were equal in having some impact.
Conclusions
Our findings suggest that students are most influenced by family, friends, and peers, who are not involved in the formal residency selection effort. Appreciating the impact of these influences on students' decision making is important to understanding how they decide on their future careers. The study supports continuation of mentorship programs. Future work could focus on qualitative research to further characterize resource use.
Residents learn and participate in care within hospital cultures that may tolerate unprofessional conduct and cynical attitudes, labeled the “hidden curriculum.” We hypothesized that this hidden curriculum may have deleterious effects on residents' professional development and investigated whether witnessing unprofessional behavior during residency was associated with burnout and cynicism.
Methods
We surveyed internal medicine residents at 2 academic centers for 3 years (2008–2010). Hidden curriculum items assessed exposure to unprofessional conduct. We used regression analyses to examine if hidden curriculum scores were associated with cynicism and the Maslach Burnout Inventory depersonalization and emotional exhaustion domain scores.
Results
The response rate was 48% (337 of 708). In the 284 surveys analyzed, 45% of respondents met burnout criteria and had significantly higher hidden curriculum scores (26 versus 19, P < .001) than those not meeting criteria. In cross-sectional analyses, the hidden curriculum score was significantly associated with residents' depersonalization, emotional exhaustion, and cynicism scores. Cynicism scores were also associated with burnout.
Conclusions
Exposure to unprofessional conduct was associated with higher burnout and cynicism scores among internal medicine residents. We also found that cynicism and burnout were significantly associated and may be measures of similar but not necessarily identical responses to the challenges posed by residency. Measuring the hidden curriculum and cynicism may provide direction for educators attempting to reform hospital culture and improve resident well-being.
Multisource feedback (MSF) is emerging as a central assessment method for several medical education competencies. Planning and resource requirements for a successful implementation can be significant. Our goal is to examine barriers and challenges to a successful multisite MSF implementation, and identify the benefits of MSF as perceived by participants.
Methods
We analyzed the 2007–2008 field trial implementation of the Assessment of Professional Behaviors, an MSF program of the National Board of Medical Examiners, conducted with 8 residency and fellowship programs at 4 institutions. We use a multimethod analysis that draws on quantitative process indicators and qualitative participant experience data. Process indicators include program attrition, completion of implementation milestones, number of participants at each site, number of MSF surveys assigned and completed, and adherence to an experimental rater training protocol. Qualitative data include communications with each program and semistructured interviews conducted with key field trial staff to elicit their experiences with implementation.
Results
Several implementation challenges are identified, including communication gaps and difficulty scheduling implementation and training workshops. Participant interviews indicate several program changes that should enhance feasibility, including increasing communication and streamlining the training process.
Conclusions
Multisource feedback is a complex educational intervention that has the potential to provide users with a better understanding of performance expectations in the graduate medical education environment. Standardization of the implementation processes and tools should reduce the burden on program administrators and participants. Further study is warranted to broaden our understanding of the resource requirements for a successful MSF implementation and to show how outcomes change as MSF gains broader acceptance.
Although never directly compared, structured interviews are reported as being more reliable than unstructured interviews. This study compared the reliability of both types of interview when applied to a common pool of applicants for positions in an emergency medicine residency program.
Methods
In 2008, one structured interview was added to the two unstructured interviews traditionally used in our resident selection process. A formal job analysis using the critical incident technique guided the development of the structured interview tool. This tool consisted of 7 scenarios assessing 4 of the domains deemed essential for success as a resident in this program. The traditional interview tool assessed 5 general criteria. In addition to these criteria, the unstructured panel members were asked to rate each candidate on the same 4 essential domains rated by the structured panel members. All 3 panels interviewed all candidates. Main outcomes were the overall, interitem, and interrater reliabilities, the correlations between interview panels, and the dimensionality of each interview tool.
Results
Thirty candidates were interviewed. The overall reliability reached 0.43 for the structured interview, and 0.81 and 0.71 for the unstructured interviews. Analyses of the variance components showed a high interrater, low interitem reliability for the structured interview, and a high interrater, high interitem reliability for the unstructured interviews. The summary measures from the 2 unstructured interviews were significantly correlated, but neither was correlated with the structured interview. Only the structured interview was multidimensional.
Conclusions
A structured interview did not yield a higher overall reliability than both unstructured interviews. The lower reliability is explained by a lower interitem reliability, which in turn is due to the multidimensionality of the interview tool. Both unstructured panels consistently rated a single dimension, even when prompted to assess the 4 specific domains established as essential to succeed in this residency program.
We describe a collaboration between the graduate medical education office and the Henry Ford Health System's Office of Clinical Quality and Safety to create an institution-wide communication skills curriculum pertinent to the institution's safety and patient- and family-centered care initiatives.
Methods
A multidisciplinary committee provided oversight for the curriculum design and used sentinel event and other quality and safety data to identify specific target areas. The curriculum consisted of 3 courses: “Informed Consent,” “Sharing Bad News,” and “Disclosure of Unanticipated Events.” Each course included 3 components: a multimedia online module; small group discussions led by the program director that focused on the use of communication scripts; and 2 objective structured clinical examinations (OSCEs) requiring residents to demonstrate use of the communication scripts. All first-year residents (N = 145) and faculty (N = 30) from 20 residency programs participated in this initiative. Evaluation of the residents consisted of a self-assessment; the standardized patients' assessment of the residents' performance; and faculty assessment of resident performance with verbal feedback.
Results
Survey data showed that residents found the courses valuable, with residents identifying communication scripts they would use in clinical settings. Focus groups with faculty highlighted that the resident debriefing sessions provided them with insight into a resident's communication skills early in their training.
Conclusion
Our institutional curriculum was developed in a collaborative manner, and used an evidence-based approach to teach communication skills relevant to institutional safety and quality initiatives. Other institutions may wish to adopt our strategy of departmental collaboration and alignment of resident education with institutional initiatives.
The purpose of this study was to assess the effectiveness of high-fidelity simulation for teaching root cause analysis (RCA) in graduate medical education.
Methods
Thirty clinical anesthesiology-1 through clinical anesthesiology-3 residents were randomly assigned to 2 groups: group A participants received a 10-minute lecture on RCA and participated in a simulation exercise where a medical error occurs, and group B participants received the 10-minute lecture on RCA only. Participants completed baseline, postintervention, and 6-month follow-up assessments, and they were evaluated on their attitude toward as well as understanding of RCA and “systems-based” care.
Results
All 30 residents completed the surveys. Baseline attitudes and knowledge scores were similar between groups. Postintervention knowledge scores were also similar between groups; however, group B was significantly more skeptical (P < .001) about the use of RCA and “systems improvement” strategies. Six months later, group A demonstrated retained knowledge scores and unchanged attitude, whereas group B demonstrated significantly worse knowledge scores (P = .001) as well as continued skepticism toward a systems-based approach (P < .001) to medical error reduction.
Conclusion
High-fidelity simulation in conjunction with focused didactics is an effective strategy for teaching RCA and systems theory in graduate medical education. Our findings also suggest that there is greater retention of knowledge and increased positive attitude toward systems improvement when focused didactics are coupled with a high-fidelity simulation exercise.
Professional organizations have called for individualized training approaches, as well as for opportunities for resident scholarship, to ensure that internal medicine residents have sufficient knowledge and experience to make informed career choices.
Context and Purpose
To address these training issues within the University of California, San Francisco, internal medicine program, we created the Areas of Distinction (AoD) program to supplement regular clinical duties with specialized curricula designed to engage residents in clinical research, global health, health equities, medical education, molecular medicine, or physician leadership. We describe our AoD program and present this initiative's evaluation data.
Methods and Program Evaluation
We evaluated features of our AoD program, including program enrollment, resident satisfaction, recruitment surveys, quantity of scholarly products, and the results of our resident's certifying examination scores. Finally, we described the costs of implementing and maintaining the AoDs.
Results
AoD enrollment increased from 81% to 98% during the past 5 years. Both quantitative and qualitative data demonstrated a positive effect on recruitment and improved resident satisfaction with the program, and the number and breadth of scholarly presentations have increased without an adverse effect on our board certification pass rate.
Conclusions
The AoD system led to favorable outcomes in the domains of resident recruitment, satisfaction, scholarship, and board performance. Our intervention showed that residents can successfully obtain clinical training while engaging in specialized education beyond the bounds of core medicine training. Nurturing these interests may empower residents to better shape their careers by providing earlier insight into internist roles that transcend classic internal medicine training.
Avatars and virtual worlds offer medical educators new approaches to assess learners' competency in home-safety assessments that are less time-consuming and more flexible than traditional home visits. We sought to evaluate the feasibility and acceptability of implementing an avatar-mediated, 3-dimensional (3-D) home simulation as a virtual objective structured clinical examination station for geriatric medicine fellows.
Methods
We developed a 3-D home simulation in the virtual world Second Life (Linden Lab, San Francisco, CA) containing 50 safety hazards that could affect the safety of an elderly person at home. Eight geriatric medicine fellows participated in a 16-station objective structured clinical examination, with one station assigned to the 15-minute 3-D virtual world simulation, where the fellow's “home visit” was performed by navigating his or her avatar in the virtual world simulation. The fellows were instructed to find the home safety hazards in the simulated environment and then provide specific written recommendations. Two reviewers independently scored the fellows' written findings against an inventory-based checklist.
Results
The geriatric medicine fellows scored a mean of 43% ± SD 9 on the inventory-based checklist. The scoring of the 2 reviewers showed a high interrater reliability (88%). Six of the 8 participants (75%) rated the simulation as “excellent.” Four of the 5 women (80%) and none of the 3 men (20%) participating in the virtual objective structured clinical examination needed navigation assistance in the 3-D virtual house.
Conclusion
The 3-D, avatar-based, virtual geriatric home safety objective structured clinical examination is a practical and acceptable alternative to the traditional home safety visits in an objective structured clinical examination setting.
We describe an educational innovation piloted by the director of education at a university art museum and a physician-educator using the museum holdings as reflective triggers for medical learners. This innovation is distinct from the emerging trend of using art to build observation skills, enhance pattern recognition, and improve diagnostic acumen. Our intervention is specifically designed to promote individual reflection, foster empathy, increase appreciation for the psychosocial context of patient experience, and create a safe haven for learners to deepen their relationships with one another.
Methods
Individuals randomly selected a question from a set prepared by the authors to guide a reflective exploration of the galleries. Each question was different, but all invited an emotional response—a connection between a work of art and some aspect of life or medical practice, for example, “Focus on a memorable patient, and find a work of art that person would find meaningful or powerful” or “Find an image of a person with whom you have difficulty empathizing.” The exploration ended with a shared tour of evocative objects selected by the participants. The duration of the exercise was approximately 1.5 hours and required minimal faculty preparation.
Results
Most of the participants rated the exercise as 5 (excellent) on a 5-point Likert scale and particularly cited the effectiveness at stimulating reflection on meaningful issues and community building.
Discussion
The exercise is easily reproducible in any art gallery space. The same basic format and facilitation technique opens new and different conversations depending on the composition of the group and the choice of artwork. Museum-based reflection warrants further experimentation, analysis, and dissemination.
Multiple factors affect residency education, including duty-hour restrictions and documentation requirements for regulatory compliance. We designed a work sampling study to determine the proportion of time residents spend in structured education, direct patient care, indirect patient care that must be completed by a physician, indirect patient care that may be delegated to other health care workers, and personal activities while on an inpatient general practice unit.
Methods
The 3-month study in 2009 involved 14 categorical internal medicine residents who volunteered to use personal digital assistants to self-report their location and primary tasks while on an inpatient general practice unit.
Results
Residents reported spending most of their time at workstations (43%) and less time in patient rooms (20%). By task, residents spent 39% of time on indirect patient care that must be completed by a physician, 31% on structured education, 17% on direct patient care, 9% on indirect patient care that may be delegated to other health care workers, and 4% on personal activities. From these data we estimated that residents spend 34 minutes per patient per day completing indirect patient care tasks compared with 15 minutes per patient per day in direct patient care.
Conclusions
This single-institution time study objectively quantified a current state of how and where internal medicine residents spend their time while on a general practice unit, showing that residents overall spend less time on direct patient care compared with other activities.
Little is known about how faculty, residents, and fellows practice for oral presentations at academic meetings. We sought to categorize presenters' practice styles and the impact of feedback.
Methods
We surveyed oral presenters at 5 annual academic general internal medicine meetings between 2008 and 2010, using a cross-sectional design. Main measures were frequency and settings of practice, most helpful practice setting, changes made in response to feedback, impact of feedback, and perceived quality of presentation.
Results
The response rate was 63% (333/525 responders). Respondents represented 59 academic medical centers. Presenters reported practicing in a mean ± SD of 2.3 (±1.3) of 5 different settings. Of the 46% of presenters (152/333) who practiced in front of a group of more experienced colleagues, 80% of presenters (122/152) reported it was the most helpful setting. Eighty-one percent of presenters (268/333) practiced alone, and 25% of presenters (82/333) reported practicing alone was the most helpful setting. The mean numbers of change types reported by faculty were fewer than those reported by residents and fellows (mean 2.3 ± 1.8, and 3.1 ± 2.0, respectively; P < .001). Practicing alone was not associated with changes in content (P = .30), visual aids (P = .12), or delivery style (P = .53).
Conclusions
Practicing in front of a group of experienced colleagues was the most helpful setting in which to prepare for an oral academic meeting presentation, but it was not universally utilized. Feedback given at these sessions was more likely to result in changes made to the presentation; however, broader implementation of such sessions may require institutional support.
While much is known about how educational leaders at the medical school level (eg, deans) view the importance of formal training in education for medical school teachers, little is known about how leaders at the clinical level (eg, department chairs) view such training. We sought to determine how pediatric department chairs and residency program directors view the value of formal training in education, such as that at a Master of Education (MEd) level, and to estimate the number of clinical pediatric faculty with or pursuing such training.
Methods
A survey designed to assess the value placed on formal training in education and to estimate the number of clinical faculty with or pursuing such training was mailed to pediatric department chair persons and residency program directors at all 131 allopathic medical schools in the United States and Puerto Rico.
Results
Eighty department chairs (61%) responded, and most indicated that when hiring new faculty, they view an applicant with an MEd as having an advantage. Both chairs and residency directors considered an MEd to be advantageous for a residency director by a ranking of 4.5 and 4.2, respectively, on a scale of 1 to 5 (P = .008). Of the 80 chairs who responded, 58.8% of respondents reported one or more faculty in their department had or was pursuing an MEd. Of the 72 responding residency directors (55%), 11 respondents (15.3%) indicated that they had an MEd.
Conclusion
More than half the medical school pediatric chairs responding to the survey had one or more clinical faculty with or pursuing an MEd in their departments. Survey results indicated that such training is valued by both department chairs and residency directors. Given the time and expense involved in obtaining an MEd, awareness of these data may be helpful to those considering pursuing, offering, or requiring such training.
Quality improvement (QI) education in residency training is important and necessary for accreditation. Although the literature on this topic has been growing, some specialties, in particular psychiatry, have been underrepresented.
Methods
We developed a didactic and experiential QI curriculum within a US psychiatry residency program that included a seminar series and development of QI projects. Evaluation included resident knowledge using the Quality Improvement Knowledge Application Tool, implementation of resident QI projects, and qualitative and quantitative satisfaction with the curriculum.
Results
Our curriculum significantly improved QI knowledge in 2 cohorts of residents (N = 16) as measured by the Quality Improvement Knowledge Application Tool. All resident QI projects (100%) in the first cohort were implemented. Residents and faculty reported satisfaction with the curriculum.
Conclusions
Our curriculum incorporated QI education through didactic and experiential learning in a moderately sized US psychiatry residency program. Important factors included a longitudinal experience with protected time for residents to develop QI projects and a process for developing faculty competence in QI. Further studies should use a control group of residents and examine interprofessional QI curricula.
Board certification is an important professional qualification and a prerequisite for credentialing, and the Accreditation Council for Graduate Medical Education (ACGME) assesses board certification rates as a component of residency program effectiveness. To date, research has shown that preresidency measures, including National Board of Medical Examiners scores, Alpha Omega Alpha Honor Medical Society membership, or medical school grades poorly predict postresidency board examination scores. However, learning styles and temperament have been identified as factors that may affect test-taking performance. The purpose of this study is to characterize the learning styles and temperaments of pediatric residents and to evaluate their relationships to yearly in-service and postresidency board examination scores.
Methods
This cross-sectional study analyzed the learning styles and temperaments of current and past pediatric residents by administration of 3 validated tools: the Kolb Learning Style Inventory, the Keirsey Temperament Sorter, and the Felder-Silverman Learning Style test. These results were compared with known, normative, general and medical population data and evaluated for correlation to in-service examination and postresidency board examination scores.
Results
The predominant learning style for pediatric residents was converging 44% (33 of 75 residents) and the predominant temperament was guardian 61% (34 of 56 residents). The learning style and temperament distribution of the residents was significantly different from published population data (P = .002 and .04, respectively). Learning styles, with one exception, were found to be unrelated to standardized test scores.
Conclusions
The predominant learning style and temperament of pediatric residents is significantly different than that of the populations of general and medical trainees. However, learning styles and temperament do not predict outcomes on standardized in-service and board examinations in pediatric residents.
The Accreditation Council for Graduate Medical Education 2011 duty hour standards became effective on July 1, 2011. One of the new standards allows residents to exceed the limit on continuous duty hours in unusual circumstances relating to patient or family need or rare educational opportunities. There are no data about how often or in what circumstances residents would consider exceeding their duty hour limits using this new provision in the standards. We surveyed internal medicine residents to explore these questions.
Methods
We conducted an anonymous cross-sectional survey of internal medicine residents at a midwestern tertiary-care hospital to determine how often they had considered exceeding duty hour limits in the preceding 2 weeks. We analyzed responses using descriptive statistics and χ2 tests for comparisons.
Results
We obtained responses from 51 of 86 residents (59%). Of those residents, 69% (35/51) indicated that they had wanted to exceed duty hour limits at least once in the prior 2 weeks. The most common reason cited was to provide continuity of care for a patient. The 24 + 6–hour rule was the standard most likely to be broken (cited by 66%; 23/35).
Conclusions
Program leadership should anticipate that residents will commonly identify situations in which they will consider exceeding duty hour limits. It will be important to provide guidance to residents early in the year about the situations that would be appropriate for the application of this new standard.
The Accreditation Council for Graduate Medical Education (ACGME) requires programs to develop goals and objectives for each educational level and distribute them to residents and faculty in written or electronic form,1 and specifies that these learning objectives “must be accomplished through an appropriate blend of supervised patient care responsibilities, clinical teaching, and didactic educational events.”1 These requirements reflect an understanding that explicit goals and objectives contribute to the planning, conduct, and evaluation of programs that prepare residents able to practice independently at the completion of training. The purpose of this article is to provide
In this issue of the Journal of Graduate Medical Education, Wood et al1 present their work entitled Neonatal Resuscitation Skills Among Pediatricians and Family Physicians: Is Residency Training Preparing for Post-Residency Practice?1 Their report analyzes 302 completed surveys from practicing primary care pediatricians and family practitioners, 22% of whom were practicing in rural areas and 78% were practicing in urban/suburban areas. The pediatrician respondents reported having more experience with attending deliveries and neonatal resuscitation skills during residency training than family medicine physicians, an expected result given the more prescriptive Accreditation Council for Graduate
By reflection… I would be understood to mean, that notice which the mind takes of its own operations… not barely the actions of the mind about its ideas, but some sort of passions arising sometimes from them, such as is the satisfaction or uneasiness arising from any thought.
What role should the humanities play in medical education? There are 2 major streams of thought on this.2–4 One is that the humanities should offer learners a restorative refuge from the stresses of assimilating scientific data and clinical
The overall quality of American health care and medical education is negatively affected by disparities in patients' access to care.1 Many internal medicine residency programs provide primary care to patients with Medicaid. We hypothesized that Medicaid patients lack full access to ambulatory subspecialty care (SC), which necessarily affects the educational experiences of residents who provide their primary care.
Clinic attending physicians (chiefs) at all 17 residency teaching clinics in Connecticut responded to an e-mail questionnaire asking about the frequency of Medicaid patients' timely access to ambulatory and (when needed) procedural SC (table).
Editor's Note: The ACGME News and Views section of JGME includes data reports, updates, and perspectives from the ACGME and its review committees. The decision to publish the article is made by the ACGME.
Introduction
As a result of the decisions made in the Summer of 2011 to increase the federal debt limit of the United States,1 the Joint Select Committee on Deficit Reduction (the “Super Committee”) was formed to recommend to the Congress by December 2011 reductions in federal spending to be accomplished over the next 10 years. Among the entitlement program elements being examined by
Editor’s Note: The ACGME News and Views section of JGME includes data reports, updates, and perspectives from the ACGME and its review committees. The decision to publish the article is made by the ACGME.
Question: Who influenced you early in your career?
When I started in surgical education, it was Dr. John Landor. He hired me into my first faculty position at the fledgling Rutgers University medical school, after it developed to a 4-year campus and started residency programs. Before that, 2 years in the military had given me a sense what it was like to be a
An effective working relationship between chief residents and residency program directors is critical to a residency program's success. Despite the importance of this relationship, few studies have explored the characteristics of an effective program director-chief resident partnership or how to facilitate collaboration between the 2 roles, which collectively are important to program quality and resident satisfaction. We describe the development and impact of a novel workshop that paired program directors with their incoming chief residents to facilitate improved partnerships.
Methods
The Accreditation Council for Graduate Medical Education sponsored a full-day workshop for residency program directors and their incoming chief residents. Sessions focused on increased understanding of personality styles, using experiential learning, and open communication between chief residents and program directors, related to feedback and expectations of each other. Participants completed an anonymous survey immediately after the workshop and again 8 months later to assess its long-term impact.
Results
Participants found the workshop to be a valuable experience, with comments revealing common themes. Program directors and chief residents expect each other to act as a role model for the residents, be approachable and available, and to be transparent and fair in their decision-making processes; both groups wanted feedback on performance and clear expectations from each other for roles and responsibilities; and both groups identified the need to be innovative and supportive of changes in the program. Respondents to the follow-up survey reported that workshop participation improved their relationships with their co-chiefs and program directors.
Conclusion
Participation in this experiential workshop improved the working relationships between chief residents and program directors. The themes that were identified can be used to foster communication between incoming chief residents and residency directors and to develop a curriculum for chief resident development.
