ABSTRACT

Background

Prior research has shown a gender gap in the evaluations of emergency medicine (EM) residents' competency on the Accreditation Council for Graduate Medical Education (ACGME) milestones, yet the practical implications of this are not fully understood.

Objective

To better understand the gender gap in evaluations, we examined qualitative differences in the feedback that male and female residents received from attending physicians.

Methods

This study used a longitudinal qualitative content analysis of narrative comments by attending physicians during real-time direct observation milestone evaluations of residents. Comments were collected over 2 years from 1 ACGME-accredited EM training program.

Results

In total, 1317 direct observation evaluations with comments from 67 faculty members were collected for 47 postgraduate year 3 EM residents. Analysis of the comments revealed that the ideal EM resident possesses many stereotypically masculine traits. Additionally, examination of a subset of the residents (those with 15 or more comments, n = 35) showed that when male residents struggled, they received consistent feedback from different attending physicians regarding aspects of their performance that needed work. In contrast, when female residents struggled, they received discordant feedback from different attending physicians, particularly regarding issues of autonomy and assertiveness.

Conclusions

Our study revealed qualitative differences in the kind of feedback that male and female EM residents received from attending physicians. The findings suggest that attending physicians should endeavor to provide male and female residents with consistent feedback and guard against gender bias in their perceptions of residents' capabilities.

ABSTRACT

Background

The Association of American Medical Colleges describes 13 core entrustable professional activities (EPAs) that every graduating medical student should be expected to perform proficiently on day 1 of residency, regardless of chosen specialty. Studies have shown wide variability in program director (PD) confidence in interns' abilities to perform these core EPAs. Little is known regarding comparison of United States Medical Licensing Examination (USMLE) scores with proficiency in EPAs.

Objective

We determined if PDs from a large health system felt confident in their postgraduate year 1 residents' abilities to perform the 13 core EPAs, and compared perceived EPA proficiency with USMLE Step 1 and Step 2 scores.

Methods

The PDs were asked to rate their residents' proficiency in each EPA and to provide residents' USMLE scores. Timing coincided with the reporting period for resident milestones.

Results

Surveys were completed on 204 of 328 residents (62%). PDs reported that 69% of residents (140 of 204) were prepared for EPA 4 (orders/prescriptions), 61% (117 of 192) for EPA 7 (form clinical questions), 68% (135 of 198) for EPA 8 (handovers), 63% (116 of 185) for EPA 11 (consent), and 38% (49 of 129) for EPA 13 (patient safety). EPA ratings and USMLE 1 and 2 were negatively correlated (r(101) = −0.23, P = .031).

Conclusions

PDs felt that a significant percentage of residents were not adequately prepared in order writing, forming clinical questions, handoffs, informed consent, and promoting a culture of patient safety. We found no positive association between USMLE scores and EPA ratings.

ABSTRACT

Background

Exposure to underserved areas during training may increase residents' likelihood of practice in these settings. The Marshall University Family Medicine Residency offers a supplemental continuity experience at a local free clinic to interested residents.

Objective

We assessed the association of such an experience with graduate practice choices.

Methods

We evaluated all residency graduates (N = 138) who completed our family medicine program from 1997 through 2014 and compared participants in the free clinic experience to nonparticipants. Various characteristics and outcome measures were collected retrospectively from resident records maintained for program accreditation.

Results

A total of 43 residents participated in the free clinic experience compared with 95 nonparticipants. Postgraduation practice in an area of need was seen for 56% (24 of 43) of participants compared with 31% (29 of 95) of nonparticipants (P = .005). The 53 graduates practicing in areas of need were nearly twice as likely to have taken part in the free clinic experience (45% [24 of 53] versus 22% [19 of 85], P = .005). Participants were more likely to practice in rural areas (63%, 27 of 43) than residents who did not participate (43% [41 of 95], P = .033). Board certification rates were high for both free clinic participants (98%, 42 of 43) and nonparticipants (95% [90 of 95], P = .43).

Conclusions

Resident participation in a supplemental continuity experience at a free clinic was associated with practicing in areas of need and rural communities after graduation.

Connecting to New Residents Via Twitter

In July, brand-new resident physicians were welcomed with pithy 140-character tweets that summarize “pearls” for surviving the intern year. #TipsForNewDocs provides newly minted physicians with bits of wisdom and brief anecdotes to supplement their formal curriculum and teaching. These tweets often prompt deep discussions from varied perspectives, and encourage followers to share meaningful personal experiences in medicine.

Focus on the Intern Experience

Unlike the hospital's intern orientation, the focus of #TipsForNewDocs is less on hospital policies and procedures, and more on wellness, interprofessional interaction, and patient-centered care. Tweets address navigating the tricky transition from

In the New Accreditation System (NAS), programs undergo a full accreditation site visit every 10 years, preceded by a comprehensive Self-Study that includes assessment of program-level aims, an analysis of strengths, areas for improvement, opportunities and threats, and formulating and documenting plans for improvement. The outcomes of improvement efforts are reviewed during the 10-Year Accreditation Site Visit 18 to 24 months later.

New areas will be broadly relevant to all programs, such as capacity for training competent physicians by graduation, efforts to address resident well-being, and promoting an optimal learning environment. Effective practices will be identified for dissemination.

In a