Journal of graduate medical education最新文献

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.

Background There remains limited understanding of effective strategies to increase diversity, equity, and inclusion within residency programs-highlighting the need for a comprehensive review of current interventions. Objective To synthesize literature regarding interventions to increase the representation of populations underrepresented in medicine (URiM) within US residency programs. Methods A scoping review of studies published from January 2000 to July 2023 was conducted. Data were extracted from PubMed, Embase, Cochrane Library, and Scopus. URiM was defined by race, ethnicity, and gender. Studies were included if an intervention was implemented by a graduate medical education residency program but were excluded if they did not describe a defined intervention or if they were published outside of the United States. Study interventions were categorized into 5 areas: applicant factors, selection measures, application screening, interviews, and post-interview communication. Results Initial search captured 2683 titles and abstracts; 257 full-text articles were reviewed, with 27 eligible articles meeting inclusion criteria. Eligible articles were categorized as: applicant-12 (44%), selection-8 (30%), screening-17 (63%), interview-8 (30%), and post-interview-4 (15%). Many articles addressed multiple interventions that positively impacted URiM composition, making it difficult to isolate the effect of individual interventions. Common, effective interventions included holistic reviews, clerkships, and standardized interviews. Conclusions This review demonstrates that interventions aimed at increasing diversity in residency programs vary in their approaches, but consistent evaluation and evidence of effectiveness are lacking from the current literature.