Journal of graduate medical education最新文献

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.

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 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.

Background Gossip is a ubiquitous sociocultural phenomenon serving many functions in human interactions, including in workplace and academic settings. Gossip can have profound positive and negative impacts; however, its impact on medical residents and their learning environment is unknown. Objective To understand the function and impact of workplace gossip-from and about colleagues and supervisors-on medical residents' experiences in their learning environment. Methods This exploratory study used principles of constructivist grounded theory. Data were collected from residents in the obstetrics and gynecology and psychiatry programs at a large academic institution via semistructured interviews in 2021. Seven residents were interviewed. Transcripts were analyzed using inductive coding, and themes were identified. Results Thematic analysis revealed perceived positive and negative impacts of gossip. Perceived positive impacts included affirmation and roadmapping. Perceived negative impacts included anxiety/fear and the role of gossip in reinforcing the educational hierarchy. Other themes, which are perceived to have both positive and negative impacts, included the role of gossip in learning and in group status. The identity of the gossiper, audience, and subject of gossip also impacted its effects. Gossip between residents about faculty members was perceived as roadmapping, or an affirming role, whereas gossip involving faculty members created anxiety and reinforced negative aspects of the hierarchy. Conclusions Workplace gossip serves both positive and negative roles within the medical learning environment. It can function as informal debriefing and can also threaten psychological safety. Its impact on residents is affected by the identities of the gossiper, subject, and audience.