Journal of graduate medical education最新文献

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.

Background Although Clinical Competency Committees (CCCs) were implemented to facilitate the goals of competency-based medical education, implementation has been variable, and we do not know if and how these committees affected programs and assessment in graduate medical education (GME). Objective To explore the roles CCCs fulfill in GME and their effect on trainees, faculty, and programs. Methods We conducted a narrative review of CCC primary research with the following inclusion criteria: all articles must be research in nature, focused on GME and specifically studying CCCs, and published in English language journals from January 2013 to November 2022. Results The main results are as follows: (1) The primary role of the CCC (decision-making on trainee progress) is mostly described in "snapshots" (ie, focusing on a single aspect of this role at a single point in time); (2) CCCs are taking on secondary roles, some of which were anticipated (eg, remediation, feedback) whereas others were "unanticipated" (eg, use of CCC data to validate trainee self-assessment, predict trainee performance in other settings such as certifying examinations, investigate gender bias in assessment); and (3) Articles briefly mentioned short-term outcomes of CCCs at the level of the trainees, faculty, and programs. However, most studies described interventions to aid CCC work and did not specifically aim at investigating short-term (eg, curriculum changes) or long-term outcomes (eg, improved patient outcomes). Conclusions CCCs fulfill a range of roles in assessment beyond their intended purpose. A more systematic approach is needed to investigate the outcomes of CCC implementation on GME.

Background Climate change threatens humanity's health and well-being. While climate change topics have been increasingly incorporated into undergraduate medical education, it is unclear to what extent they have been incorporated into graduate medical education (GME) curricula in the United States. Objective To examine how climate change has been incorporated into GME curricula in the United States. Methods We conducted a scoping review of published literature from January 2013 through November 2023. PubMed and Scopus were searched, with articles assessed by 3 reviewers in a blinded fashion. Resources were included if they described how climate change is incorporated into GME curricula in the United States, and if they discussed topics such as disaster medicine, mass casualty events, environmental medicine, public health, health policy, wilderness medicine, quality improvement, and sustainability. Articles were analyzed using descriptive numerical analysis and qualitative assessment to identify article characteristics and themes. Results The inclusion criteria generated 17 articles that examined climate change incorporation into GME curricula and curriculum interventions covering topics used for inclusion. The most common type of article (5 of 17, 29%) employed surveys of program directors on the inclusion of climate-related topics. Conclusions Published accounts of climate-related topics in US GME program curricula are few. More content is found in topics related to emergency medicine. Curricula frameworks have been proposed for pediatric and internal medicine residency programs, but we know little about their efficacy. Future scholarship should fill these gaps to educate learners to improve health care sustainability and resiliency.