Journal of graduate medical education最新文献

Background Patients who decompensate overnight experience worse outcomes than those who do so during the day. Just-in-time (JIT) simulation could improve on-call resident preparedness but has been minimally evaluated in critical care medicine (CCM) to date. Objective To determine whether JIT training can improve residents' performance in simulation and if those skills would transfer to better clinical management in adult CCM. Methods Second-year medicine residents participated in simulated decompensation events aligned to common medical intensive care unit (MICU) emergencies predicted to occur overnight by their attending intensivist. Simulation faculty scored their performance via critical action checklists. If the event occurred, MICU attendings rated residents' clinical management as well. At the rotation's conclusion, a variant of one previously trained scenario was simulated to assess for performance improvement. Resident perceptions were surveyed before, during, and after completion of the study. Results Twenty-eight residents participated; 22 of 28 (79%) completed the curriculum. Management of simulated decompensations improved following training (initial simulation checklist completion rate 60% vs 80% final simulation, P≤.001, Wilcoxon r=0.5). Predicted events occurred in 27 (45%) of the 60 shifts evaluated, with no observed difference in faculty ratings of overnight performance (median rating 4.5 if trained vs 3.0 if untrained; U=58.50; P=.12; Mann-Whitney r=0.30). Residents' self-reported preparedness to manage MICU emergencies improved significantly following training, from a median of 3.0 to 4.0 (P=.006, Wilcoxon r=0.42). Conclusions JIT simulation training improved residents' performance in simulation.

Background Physicians require climate-related training, but not enough is known about actual or desired training at the graduate medical education level. Objective To quantify the climate curriculum provided within a network of family medicine residency programs in the Northwestern United States, to assess barriers to adoption of climate curricula, and to identify preferred climate-related content, delivery methods, and program actions. Methods In fall 2021, residents and faculty in a family medicine residency network responded to a 25-item, anonymous, online survey about climate-related training within their programs. Likert scales were used to assess the extent of current and desired climate curricula in respondent programs, and a paired samples t test was used to compare them. Drop-down menus and frequencies were used to identify top barriers to integration of a climate curriculum, and preferred curricular content, delivery methods, and program actions. Results Responses were received from 19.3% (246 of 1275) of potential respondents. Nearly ninety percent (215 of 240) reported little or no climate content in their programs. Respondents desired significantly more climate-related training (t[237]=18.17; P<.001; Cohen's d=1.18) but identified several barriers, including insufficient time/competing curricular priorities (80.7%, 192 of 238), concern about the political/controversial nature of the topic (27.3%, 65 of 238), and perceived irrelevance (10.9%, 26 of 238). More respondents selected integration of climate content throughout relevant didactics (62.2%, 145 of 233) than other delivery methods. Over 42% of respondents selected each of the climate-related topics and program actions suggested. Conclusions Despite a number of barriers, most family medicine faculty and residents desire significantly more climate-related content in their training curricula.

Background With an increased focus on climate change in graduate medical education (GME), the environmental implications of travel for board certification examinations remain poorly described. The return to the mandatory in-person applied examination (AE) for board eligible anesthesiologists presents potentially sizeable greenhouse gas (GHG) emissions when compared to the virtual format administered during the COVID-19 pandemic. Objective To estimate the GHG emissions from air travel to the in-person AE and discuss its implications for various specialties as they return to in-person examinations. Methods An estimate of the GHG emissions was conducted using data from the 2023 NRMP Main Residency Match: Match Rates by Specialty and State report, utilizing residency training site as a proxy for anesthesiologists' home. An alternative estimate was made using the anesthesiologists' predicted state distribution postgraduation. We estimated annual GHG emissions, expressed as metric tons of carbon dioxide equivalent (MTCO2e), produced from graduating residents flying to The American Board of Anesthesiology testing center in Raleigh, North Carolina, USA. We collected emissions using the International Civil Aviation Organization emissions calculator. Results Annual emissions of examinee travel from their respective residency training state was estimated to be 517.37 MTCO2e. The alternative estimate using anesthesiologists' predicted postgraduation state was 568.05 MTCO2e. This estimate of CO2e roughly equates to the average annual emissions produced by 112 passenger vehicles. Conclusions The AE in-person format results in an estimated 517 to 568 MTCO2e.

[This corrects the article DOI: 10.4300/JGME-D-23-00862.1.].

Background There are limited objective studies regarding the effectiveness of strategies to alleviate the documentation burden on resident physicians. Objective To develop and implement diagnosis-specific templates for the plan of care section of inpatient admission notes, aiming to reduce documentation time. Methods Twelve templates for the plan of care section of admission notes were written by the study authors, reviewed by attending physicians, and shared with the residents through the electronic health record (EHR) on September 23, 2022. EHR audit log data were collected to examine admission note writing times, supplemented by resident feedback on acceptability via an anonymous survey. Feasibility measures included time investment, experience with the EHR, and resident training. Results Between July 1, 2021 and June 30, 2023, 62 pediatric residents contributed 9840 admission notes. The templates were used in 557 admission notes. The mean total time spent on an admission note decreased from 97.9 minutes pre-intervention to 71.0 minutes post-intervention with the use of a template; an adjusted reduction of 23% (95% CI 16%-30%; P<.001). The mean attending time spent editing an admission note was unchanged. The survey results underscored wide acceptability of the templates among the residents. Feasibility data showed that the project required minimal time investment from the health care informatics team and minimal resident training. Conclusions Using templates in the care plan section of admission notes reduces the time residents spend writing admission notes.