Journal of graduate medical education最新文献

Background It can be challenging to successfully identify and prioritize wellness resources for residency programs within financially strained or smaller hospital systems. As part of COMPADRE (California Oregon Medical Partnership to Address Disparities in Rural Education and Health), trainee well-being was identified as a key priority due to the significant challenges graduate medical education (GME) programs face in supporting residents. Objective To develop a portable collaborative wellness programming model for GME leaders to use in support of trainee well-being. Methods The wellness model was developed in 2020 following an initial needs assessment with 31 GME programs, including rural sites in Oregon and Northern California and 2 urban academic medical centers. During the final year of the grant, a focus group was conducted to evaluate the impact of the model and included well-being faculty and staff leaders from multiple GME programs who consistently participated in our wellness programs. Results In response to the initial needs assessment, a wellness collaborative model was created, which included a wellness curriculum, peer support training, and a wellness community of practice (CoP). On average, 10 of the 31 GME programs participated in each of these offerings. Four modules were created in the following wellness domains: narrative reflection, belonging, mental health, and sense of purpose. During the final year of the grant, a semistructured focus group was conducted to evaluate the peer support trainings and CoP. A final needs assessment done by grant leadership revealed sustaining the program beyond the grant was a priority for most participants. Conclusions An adaptable collaborative wellness model was developed and met the wellness needs of GME programs by providing a wellness curriculum, peer support training, and a community of practice.

Background What does skilled coaching look like when learners discuss diverse racial or ethnic identities, or when such diversity occurs within the coach-coachee dyad? Medical education literature is sparse, and the extensive business and wellness coaching literature does not account for physician identity formation or the inherent hierarchies in graduate medical education. Objective To understand best practices for coaching racially and ethnically diverse learners through qualitative sampling of a range of expert perspectives. Methods Using constructivist grounded theory, 2 groups, expert coaches outside of medicine and leaders of academic coaching programs within medicine, underwent sequential semistructured interviews using snowball sampling. Topics included the role of coach and coachee identity in coaching, whether racial or ethnic dyad diversity influences coaching, and errors a coach may make through inquiry or lack thereof. Using iterative inductive coding, final themes were identified, and a conceptual map was created. Results In 2023, 16 subjects were interviewed (10 and 6 in each group). Five themes emerged from Group 1: (1) Contextually managing relationships; (2) Leveraging coaching competencies, in particular to create a trusted relationship; (3) Ongoing self-development; (4) Seeing the whole person; and (5) Selecting a coach with similar identity. Group 2 responses demonstrated 4 themes: (1) Intentionally building connection and rapport; (2) Navigating power differentials; (3) Acknowledging the lived experience; and (4) Exercising self-awareness. Conclusions This qualitative study of coaching experts provides themes and best practices related to how identity, particularly underrepresented racial/ethnic identity, can be addressed skillfully in the graduate medical education coaching relationship.

Background Effective patient communication is a critical skill developed during medical education, but it lacks standardized teaching methods. There is little data on how trainees learn these skills, impeding the development of evidence-based educational initiatives. Social learning theory, particularly communities of practice, is a valuable lens to study how residents develop these competencies as they progress toward unsupervised practice. Objective The authors sought to understand obstetrics and gynecology (OB/GYN) residents' views of their learning about patient counseling and informed consent through the framework of social learning theory. Methods Using constructivist grounded theory, the authors conducted semistructured interviews with residents from all years of a postgraduate residency program in OB/GYN (n=13) at a single academic medical center from 2023 to 2024. Residents were prompted to reflect on specific influential experiences in patient counseling. Through constant comparison and iterative analysis, key themes and conceptual relationships were identified. Results Residents constructed their learning of counseling and informed consent during 3 simultaneously occurring and iterative phases: preparing, conversing, and evolving in practice. In the preparing phase, residents established fundamentals through experiential and didactic learning. The conversing phase described the growth that occurred when trainees counseled patients unsupervised, as they learned how to word and structure conversations and develop the physician-patient relationship, facilitating shared decision-making. Finally, trainees evolved in practice as autonomy increased and they understood nuances within their field more firmly, contributing to professional identity formation. Conclusions This study describes how trainees learn counseling and informed consent as they move toward unsupervised practice.

Background The emigration of highly skilled physicians, or "brain drain," from lower- to higher-income countries poses major health care system challenges, yet data on Middle East radiology residents are limited. Objective To examine the emigration and retention patterns of radiology residents graduating from a large academic institution in Lebanon. Methods We retrospectively examined graduates of the internationally accredited radiology residency program at the American University of Beirut Medical Center, Lebanon, from 2004 to 2024. Data were collected from departmental records and alumni databases by 2 investigators, supplemented by public sources to corroborate information. For each graduate, we collected sex, nationality, year of graduation, current country of practice, current professional position, and subspecialty training. Descriptive statistics were used to calculate frequencies and percentages, and to examine trends in emigration over time. Results Fifty of the 60 total included radiology graduates (83.3%) left Lebanon post-residency, with most (42 of 60, 70.0%) relocating to the United States. This pattern intensified in recent years, increasing from 55.6% (5 of 9) emigration among the 2004-2008 cohort to 93.3% (14 of 15) and 100% (16 of 16) among the 2017-2020 and 2021-2024 cohorts, respectively. As of 2025, only 10 graduates (16.7%) remained in Lebanon. Conclusions From 2004 to 2024, 83.3% of radiology residency graduates from a major academic program in Lebanon emigrated, with the emigration rate reaching 100% in the most recent cohorts. Most graduates relocated to the United States, and all non-Lebanese graduates also emigrated after completing their training.

Background While residents play a critical role as teachers in the clinical learning environment, knowledge of how they develop the necessary skills to teach and how graduate medical education programs can support their development as teachers remains limited. Objective This study aims to use the pedagogical content knowledge framework to explore how residents' workplace-based experiences influence their development as clinical teachers. Methods This qualitative study used focus groups and semistructured interviews with senior residents across departments of emergency medicine, general surgery, and internal medicine at the University of California, San Francisco. We used purposive sampling to recruit participants. Twenty-five residents agreed to participate. We interviewed participants based on availability and ceased data collection when we stopped identifying new concepts. We conducted 2 focus groups and 13 interviews with 18 participants, with data collection occurring between July 2023 and March 2024. The authors used thematic analysis with pedagogical content knowledge as a sensitizing concept to identify themes. Results The authors identified 3 themes characterizing how residents learn to teach through their workplace-based experiences: learning from being a learner, developing teaching skills through experience, and gathering and responding to feedback. The process of residents' development as teachers was largely similar across all 3 specialties. Differences in the specific experiences that shaped residents' development were influenced by specialty-specific workplace demands and differences in practice contexts. Conclusions Residents' development as clinical teachers occur through the integration of their experiences as learners, expanding clinical and teaching expertise, and feedback and reflection on their ongoing teaching practice.