Journal of graduate medical education最新文献

Thomas J. Nasca, MD, MACP, served as the President and Chief Executive Officer (CEO) of the Accreditation Council for Graduate Medical Education (ACGME) for 17 years, with his tenure ending December 2024. During this time he led and supported significant changes in accreditation and medical education. This article will examine the changes during this period through the lens of key themes, including the redesign of the graduate medical education (GME) accreditation model and new and expanded roles that the ACGME assumed during 3 phases between 2007 and 2024: (1) the development years leading to the Next Accreditation System (NAS), (2) implementation of the NAS, and (3) the COVID-19 pandemic. Launched in 2012, the NAS redesigned accreditation as a balanced combination of assurance- and improvement-focused policies and activities. The NAS served as the foundation for harmonizing GME training through the creation of the single accreditation system. The ACGME also took on new roles within the professional self-regulatory system by tackling difficult issues such as wellness and physician suicide, as well as diversity, equity, and inclusion in medical education. In addition, the ACGME substantially expanded its role as facilitator and educator via the introduction of multiple resources to support GME. However, the medical education landscape remains complex and faces continued uncertainty, especially as it emerges from the effects of the COVID-19 pandemic. The next ACGME President and CEO faces critical issues in GME.

Background Treatment of obesity is a public health priority. However, little training in obesity medicine is currently integrated into residency programs. We integrated a 12-month obesity medicine training experience within a New York internal medicine residency program. Objective We describe the structure, feasibility and acceptability, resident assessments, and patient weight loss outcomes of an optional longitudinal obesity medicine training experience for internal medicine residents. Methods Between July 2016 and June 2021, 26 second-year residents participated in the 12-month program, which comprised 10 educational/clinical sessions overseen by obesity medicine attendings. Residents completed baseline and post-program 5-point surveys of knowledge, competence, and attitudes. Differences at 12 months were analyzed using paired t tests. Resident patient weight loss was analyzed using the Wilcoxon signed rank test. Results The training experience was successfully integrated over the study period and remains ongoing at present, demonstrating feasibility and acceptability. Fourteen of 26 (54%) residents completed post-program surveys. Significant improvements in all measures of knowledge and competence were seen. The greatest improvements were in comfort discussing weight loss with patients (+1.1; 95% CI 0.8-1.5; P<.001) and prescribing weight loss medications (+1.4; 95% CI 1.1-1.6; P<.001). The 98 patients seen by residents lost an average of 4.5 kilograms (95% CI 3.0-6.0; P<.001). Conclusions The training experience was feasible and acceptable, and demonstrated improvements in resident outcomes and patient weight.

Background Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that often results in poor academic performance. Little is known about how ADHD manifests in residents and fellows. Objective To describe the prevalence and phenotype of ADHD among residents and fellows referred to a centralized remediation program. Methods We conducted a retrospective review of data obtained from referrals to a single-center centralized graduate medical education remediation program from 2017 to 2023. Data included demographic variables, ADHD and mental health history, and training performance characteristics. ADHD was determined by self-report, clinical diagnosis by mental health provider, or neuropsychological testing. Results A total of 173 trainees were referred in the study period. The prevalence of ADHD was 20% (35 of 173). ADHD was most commonly diagnosed in childhood (57%, 20 of 35); however, 26% (9 of 35) were diagnosed during or after medical school. Only 37% (13 of 35) were on medication, and 69% (24 of 35) disclosed at least one concomitant mental health diagnosis. Performance deficits were common in professionalism (69%, 24 of 35), organization/efficiency (O/E; 63%, 22 of 35), and medical knowledge (46%, 16 of 35). Repeated errors in patient care were made by 34% (12 of 35); 29% (10 of 35) failed at least one board examination, and 20% (7 of 35) required extension of residency or fellowship training. When compared to referrals without ADHD, residents and fellows with ADHD were more likely to struggle with O/E, failure to engage, and repeated errors. Conclusions One in 5 trainees referred to a GME remediation program had ADHD, and most were not being treated for ADHD when referred. The deficits identified suggest an ADHD phenotype in GME which may be considered for struggling residents and fellows.

Background Graduate medical education programs must prepare physicians to adapt their care for patients whose health equity and outcomes are being threatened by climate change. This article presents the implementation of a longitudinal climate justice curriculum within a pediatrics residency program. Objective To measure the self-reported changes in attitudes and intentions for change in behavior after implementation of a climate justice curriculum. Methods A longitudinal, 4-part, climate justice and health equity (CJHE) curriculum was implemented from 2023 to 2024 into the broader advocacy training of a pediatrics residency program. Resident participants completed pre- and post-session surveys that assessed their attitudes toward climate change and health, as well as their intentions to engage in climate advocacy. Paired deidentified responses were analyzed via Wilcoxon signed-rank test. Results Thus far, facilitators have conducted 4 introduction sessions, 4 narrative medicine sessions, and 3 health system sustainability sessions. Sixty-eight of 100 residents (68%) completed both pre- and post-session surveys. The curriculum was associated with increased self-reported understanding of how climate change impacts human health (CJHE 1: median of pairwise averages of pair-differences [MPA]=1.00, P<.001; CJHE 3-4: MPA=1.00, P<.001), increased agreement that health care providers can be effective climate advocates (CJHE 1: MPA=2.00, P<.001; CJHE 3-4: MPA=1.50, P<.001), and increased intention to discuss the health impacts of climate change in future patient encounters (CJHE 1: MPA=1.00, P<.001; CJHE 3-4: MPA=1.00, P<.001). Conclusions This longitudinal CJHE curriculum demonstrated acceptability and increased participants' self-reported understanding of how climate change impacts human health and the ways in which physicians can act as advocates.

Background There is an increasing body of evidence demonstrating the impacts of climate change on health. Physicians recognize the significance but feel unprepared to address it. Despite a call to action from prominent medical organizations, climate change and health (CCH) education has remained sparse. Objective To describe the development and feasibility of a formal climate change curriculum tailored to pediatric residency programs and to assess residents' pre-intervention knowledge and self-reported comfort with this topic. Methods We created a longitudinal, single-institution CCH curriculum for pediatric and combined internal medicine-pediatrics residents. Implementation and evaluation began in May 2023 and is ongoing. Several educational strategies are utilized, and assessment tools include knowledge- and attitudes-based assessments, case-based exercises, reflective writing, grading rubrics, and patient encounter assessments. Feasibility was tracked. Results Sixty-one residents were eligible for participation at the beginning of the study. Pre-intervention knowledge-based assessments were completed by 14 of the 61 residents (23.0%), and attitude-based questions were completed by 12 residents (19.7%). Baseline knowledge assessment showed varied proficiency in CCH topics, and attitudes data showed that while most respondents felt CCH education was important (11 of 12, 91.7%), no respondents felt "very comfortable" discussing these topics with patients. In the first year of the curriculum, after residents applied knowledge in a small-group, case-based exercise, most groups were graded as "not yet competent" in all categories utilizing a rubric. Conclusions This study demonstrates that a CCH curriculum can be feasibly designed and implemented.