Journal of graduate medical education最新文献

Background Residency education in the United States faces challenges from evolving external influence on evidence-based reproductive and gender-affirming health care (R/GAHC). Curricula must incorporate information and resources to assist residents in navigating changes. Objective To illustrate a process for expeditiously adapting curriculum in response to changing laws affecting R/GAHC. Methods A 6-step model was used to tailor an R/GAHC module within an existing curriculum. Steps included identifying the medical education problem; conducting needs assessments with residents and educators; and designing, implementing, and evaluating the curriculum. The module was piloted in 2022 with internal medicine residents in 3 training programs at one institution during 4-hour small-group academic half-days. We evaluated the module's feasibility with time and cost analysis and residents' self-reported readiness to provide R/GAHC through essential tasks and knowledge. We evaluated acceptability by assessing whether residents and educators engaged in and completed the curriculum, and evidence of administrative support. Results A needs assessment clarified the educational problem as an urgent need to educate residents on the implications of legal changes affecting R/GAHC. Curriculum planning occurred over 2 months and implementation over 3 months. Of 175 eligible residents, 164 (94%) were trained. Evaluation showed that the curriculum was well received by residents, whose post-training self-assessment showed readiness to provide R/GAHC. Faculty time to plan and implement the module was substantial (estimated 207 person hours), yet participation was consistent, and administrative commitment constant. Conclusions We demonstrated a generalizable approach for expeditiously tailoring curricula to prepare residents to navigate changing laws affecting health care provision.

Background Despite global awareness of the impacts of climate change on human health, assessment of resident physicians' confidence in environmental health is limited. Lack of confidence in explaining environmental health topics can affect both patient education and advocacy efforts. Objective To determine how confident resident physicians are in their environmental health training and their ability to explain climate health topics. Methods An online survey was distributed to internal medicine residents at a large university-affiliated program in 2023. Self-perceived confidence levels in explaining various environmental health topics to a peer were measured using a Likert scale (from 1=not confident at all, to 5=completely confident) and a subsequent rank-order analysis of the response means. Results The response rate was 56% (62 out of 110 residents). A mean confidence score of 2.22 was reported on all topics, with hazardous waste (m=1.73), endocrine disruptors (m=1.76), water quality (m=1.9), toxicology (m=2.02), and environmental justice (m=2.04) representing lowest scores. Highest mean scores were reported in food security (m=2.71) and emerging infectious disease (m=2.92). Twenty-seven of 62 (44%) residents reported no confidence at all in their ability to discuss environmental justice concepts, with 17 of 62 (27%) reporting slight confidence in doing so. Conclusions Physician trainees report low confidence levels regarding their ability to explain multiple environmental topics to their peers. Forty-four of 62 (71%) residents report either no or slight confidence in their ability to explain environmental justice to a colleague.

Background Physicians have a responsibility to reduce the environmental harms from health care waste. Residents contribute to waste during bedside procedures. Objective To calculate waste and estimated cost reduction with the introduction of a novel resident-designed paracentesis kit at a single academic center in Texas in 2023. Methods We calculated waste through observation of bedside diagnostic paracentesis performed by internal medical residents, tracking which components were discarded without use from the hospital-provided kit. Residents designed a novel kit containing only procedural essentials. We calculated possible waste reduction when using the novel kit, as well as potential cost savings by comparing the average cost of the current hospital kit across multiple medical equipment retailers to the summed cost of the components of the novel kit. Results Sixteen items were discarded without use from the commercially available kit, out of 29 total items. The estimated cost saving per diagnostic paracentesis was $95. Conclusions This resident-led development of a diagnostic paracentesis kit was successful in decreasing both waste and cost, while involving residents in improving the environmental impact of their practices.