Journal of graduate medical education最新文献

Background Leading medical organizations recognize climate change as an urgent threat to public health and social justice. Medical students created the Planetary Health Report Card (PHRC) to evaluate and spur climate action in medical schools. Graduate medical trainees lack a similar tool to evaluate and improve their training programs and institutions. Objective To adapt the PHRC to graduate medical education (GME) contexts and report preliminary validity evidence. Methods In 2023, based on literature review, we adapted the 2022 undergraduate medical PHRC metrics on curriculum and sustainability. We modified keywords in all PHRC domains to apply to GME. We recruited participants with expertise in planetary health, sustainability, and health equity affiliated with GME. Using a modified Delphi Panel method, we surveyed participants on adapted metric validity. We determined percent agreement among participants. Results We recruited 45 eligible participants, of whom 20 (44%) completed a first-round survey. Participants included a senior medical student, residents, fellows, faculty, and program directors from the United States, Canada, and the United Kingdom. Participants had a high level of agreement on metrics in the domains of curriculum, support for trainee-led initiatives, and sustainability. Some metrics in research and community engagement domains fell below the agreement threshold. Conclusions In the first round of a modified Delphi Panel survey, trainees and faculty agreed that metrics adapted from the PHRC are relevant to evaluating GME programs on planetary health, sustainability, and environmental justice.

Background Climate change and related pollution and environmental damage are an urgent focus for public health physicians. Curricular content is increasing in medical schools, but to date, only pediatrics has published guidance for residency education. Objective To survey program directors of Accreditation Council for Graduate Medical Education preventive medicine specialties (public health and preventive medicine [PHPM], occupational and environmental medicine [OEM], and aerospace medicine [AM]) for current teaching on climate and health issues. Methods Links to an online 9-question confidential survey were sent to all program directors through Listservs January through March 2024. Questions were developed with guidance from a climate health expert. Responses were analyzed via summary statistics for continuous data, as well as Fisher's Exact, Kruskal-Wallis, and Wilcoxon pairwise comparison tests for nominal data. Results Thirty-five of 71 programs responded (49.3%), including 21 of 42 PHPM, 12 of 23 OEM, and 2 of 6 AM programs. Two (5.9%) reported having a formal curriculum for climate and health issues, and 2 (5.9%) reported not covering any included topics. Programs differed by topic emphasis with OEM and AM more likely to address fire, smoke, wind, and flooding effects. Lectures and local or state health department rotations were the most frequent teaching strategies. Of complete responders, 23 of 34 (67.6%) expressed interest in joining a workgroup to develop shared curricula. Conclusions This survey of preventive medicine residency programs found that most include climate and health topics, but only 2 have a formal curriculum, and 2 reported no topics included in the survey.

Background As future health care leaders who work and train in diverse clinical settings, resident physicians are uniquely positioned to advance sustainable health care systems. However, residents are insufficiently educated about health care sustainability and given limited opportunities to engage in planetary health. Objective This article introduces and reports on the early outcomes of the Trainee-Led Research and Audit for Sustainability in Healthcare Canada (TRASH-CAN), a resident-driven initiative launched in 2023 with the aim of reducing Canadian health care's environmental impact. Methods In 2023-2024, we developed a web-based platform that facilitates trainee-led action to support the promotion of sustainability literature, collaboration with national and international institutions, and execution of quality improvement projects to reduce health care waste under the 3 brand pillars of Learning, Leadership, and Delivery. We have promoted TRASH-CAN and its website through conference presentations, social media, mailing lists, and word of mouth. These activities support our goals of engaging trainees, pairing them with mentors, and initiating a variety of quality improvement projects focused on planetary health. Results In its first year of operation, TRASH-CAN has developed a fully functional website hosting intake forms and detailing ongoing projects and opportunities. We have enrolled 15 faculty mentors and 16 residents and medical students, with ongoing projects such as transitioning hospitals to reusable alternatives and optimizing procedural custom operating room equipment packs. Conclusions TRASH-CAN's inaugural year has led to the initiation of 11 sustainability projects and the enrollment of 31 faculty mentors and trainees.

Background Our institution has established priorities for graduate medical education (GME) simulation which include increasing adoption of, garnering additional financial support for, and creating a core simulation curriculum. Better understanding of the Accreditation Council for Graduate Medical Education (ACGME) simulation requirements will inform our efforts and serve as a guide for other institutions. Objective The purpose of this study was to perform a structured review of ACGME simulation standards using a document analysis to guide GME simulation activities at an institutional level. Methods A document analysis was performed from May 2023 to June 2024 to select and search ACGME Institutional and Program Requirements corresponding to the primary specialties for 21 clinical departments that financially support our simulation center. Content relevant to simulation was identified, and iterative coding with investigator team consensus was performed to assign categories, characterize the requirements, and interpret the findings. Results Twenty-four documents included 120 simulation requirements that were assigned to 12 categories; 70 (58%) requirements were mandatory whereas 50 (42%) were not, and 48 (40%) were simulation-specific, whereas 72 (60%) were simulation-optional. All reviewed specialties had simulation requirements (average 5.4, range 2-12), but the ACGME Institutional Requirements did not. Moderate to strong evidence supported (1) simulation usage by all 21 departments; (2) the need for institutional resource support; and (3) institutional-level patient safety simulation curricula. Conclusions This study identified a large number of simulation requirements, including mandatory patient safety curricula requirements, for all specialties analyzed.

Background Many trainees complete rotations in intensive care units (ICUs), but little is known about how ICU rotations impact learners. Understanding residents' experiences in ICU rotations is a crucial step toward improving resident education and understanding the consequences, intended and unintended, of critical care learning. Objective We performed a qualitative study to understand how pediatric and emergency medicine residents experience a pediatric ICU (PICU) rotation. Methods For this phenomenological study, we explored residents' experiences with critical care learning by focusing on the high-stakes, emotionally charged PICU environment. Semistructured interviews were conducted with 12 residents after their first PICU rotation from July 2019 through March 2020. Data were analyzed through line-by-line coding, serial discussions, and consensus meetings. Finally, emergent themes and convergent narratives were constructed around the resident PICU experience. Results Residents perceived the PICU as a challenging environment for independent, self-driven, and active learning. They suffered adverse psychological effects, leading some to "give up" and many to experience feelings consistent with acute traumatic stress. Despite these challenges, residents described their PICU rotation as a "rite of passage" and reported increased comfort with caring for "sick kids." Conclusions Residents describe their PICU rotations as intense experiences that result in increased physician comfort. However, they also endure psychologically traumatic experiences that may hinder them, and the independent practitioners they become, from caring for certain types of patients in the future.

Background Firearm-related injury is the leading cause of death among US children and adolescents. Residents across specialties report low preparedness to provide firearm safety counseling. Virtual reality (VR) may offer a modality to support residents' skills through deliberate practice in a simulated setting. Objective To describe a novel screen-based VR curriculum on firearm safety counseling and report feasibility and acceptability outcomes, including residents' perceptions. Methods Fifteen senior pediatric residents were recruited from 2 large children's hospitals. The curriculum included 4 simulated scenarios in VR during which residents verbally counseled graphical caregivers who responded in real time, driven by a human facilitator. The curriculum focused on introducing firearm safety, discussing storage devices, and navigating the conversation through motivational interviewing. Following participation, residents completed the Measurement, Effects, Conditions Spatial Presence Questionnaire (MEC-SPQ) to indicate the degree of immersion in the virtual environment. Additional study data were derived from semistructured interviews. We used a constructivist general inductive approach to explore perspectives via coding and pattern identification. Results Quantitatively 14 of 14 residents completing the survey indicated notable attention allocation and spatial presence in the VR environment. During the 15 interviews, residents identified VR as an acceptable modality for deliberate practice of firearm safety counseling skills in a realistic, scaffolded manner. They indicated the rehearsal of specific verbiage as critical to supporting behavior change. Notably, residents reported that the training helped overcome prior barriers to counseling by providing a framework for efficient counseling. Conclusions Among pediatric residents, VR proved a feasible and acceptable modality for training on firearm safety counseling.

Background For physicians to effectively combat the growing health crisis that is climate change, they should begin learning during medical training about its health implications. However, there is little data on residents' knowledge of the climate crisis, and even less data regarding the effectiveness and acceptability of climate change education in graduate medical training programs. Objective To incorporate a new educational session on the health implications of climate change into a residency curriculum and evaluate the acceptability of the session and its effects on residents' knowledge, attitudes, and perceptions of the topic. Methods In July 2021, a 90-minute, interactive, small-group format educational session on the health implications of climate change was incorporated into the first-year curriculum of a pediatric residency program. From July 2021 through June 2023, resident participants completed pre- and post-session surveys that assessed their knowledge, attitudes, and perceptions regarding health implications of climate change. Likert scale data were analyzed using Wilcoxon signed-rank tests. Results Of the 109 residents scheduled to participate, 50 (46%) completed both the pre- and post-session surveys. Session participation increased residents' self-reported knowledge of how climate change impacts health and how physicians can act as climate advocates. Ninety-eight percent of all post-session respondents (58 of 59) agreed that they would recommend the session to other residents. With 3 facilitators, the monthly session required ≤4 hours of preparation and ≤12 hours of direct teaching time per facilitator each academic year. Conclusions A single educational session improved residents' self-reported knowledge of the health implications of climate change and was well-received by participants.