Journal of graduate medical education最新文献

Background Teaching faculty request timely feedback from residents to improve their skills. Yet even with anonymous processes, this upward feedback can be difficult to obtain as residents raise concerns about identification and repercussions. Objective To examine faculty perception of the quality and content of feedback from residents after increasing anonymity and sacrificing timeliness. Methods Between 2011 and 2017, an associate program director at a large internal medicine residency program met briefly with each resident individually to obtain feedback about their teaching faculty shortly after their rotation. To improve anonymity, residents were promised their feedback would not be released until they graduated. In 2019, all feedback was collated and released at one time to faculty. We administered 3 timed, voluntary, anonymous, 36-item closed-ended surveys to faculty asking about the content and value, and to self-identify whether the feedback was praise, constructive, or criticism. Results Exactly 189 faculty participated with 140 completing all 3 surveys (74.1% response rate). Faculty reported this feedback content to be of higher quality (81.0%, 81 of 100) and quantity (82.4%, 84 of 102) in contrast to prior feedback. More than 85.4% (88 of 103) of faculty agreed this feedback was more specific. Faculty identified less praise (median 35.0% vs median 50.0%, P<.001) and more negative constructive feedback (median 20.0% vs median 5.0%, P<.001) compared to prior feedback. More than 82% (116 of 140) of faculty reported it would change their behavior, but 3 months after receiving the feedback, only 63.6% (89 or 140) felt the same way (P<.001). Faculty were divided on the necessity of a time delay, with 41.4% (58 of 140) believing it reduced the feedback's value. Despite the delay, 32.1% (45 of 140) felt they could identify residents. Conclusions Offering a substantial delay in feedback delivery increased anonymity and enabled residents to furnish more nuanced and constructive comments; however, faculty opinions diverged on whether this postponement was valuable.

Background The COVID-19 pandemic led to rapid and wide-scale changes in graduate medical education and impacted the well-being of frontline physicians, including residents and fellows. While institutions and programs implemented initiatives to support the unique needs of trainees during the pandemic, there remains a gap in the literature in examining the approaches used, the domains of well-being addressed, and the effectiveness of these efforts. Objective To review the literature on interventions designed to promote resident and fellow well-being during the COVID-19 pandemic. Methods The authors conducted a scoping review of the literature published between January 1, 2020, and November 30, 2023, in PubMed, Scopus, Embase, PsycINFO, CINAHL, and ERIC to identify interventions to promote the well-being of trainees during the COVID-19 pandemic. Results Eighteen articles met inclusion criteria, mainly studies conducted in the United States (14 of 18, 77.8%). Most interventions targeted psychological well-being (16 of 18, 88.9%), with only a few studies that included interventions in the physical or social domains. Interventions entailed redeployment, schedule modifications, communication strategies, and expanded mental health support. Most interventions were limited to a few weeks' duration in the first surge phase of the pandemic. Only 11 studies (61%) reported outcome measures, and only 2 (11%) used instruments with validity evidence. Most studies did not report sufficient data to evaluate study quality. Conclusions While longer-term outcome data were often lacking, studies described a range of interventions to support resident well-being. Future research should focus on the effectiveness of well-being interventions and include cohorts from more diverse clinical settings.

Background A drawback to interviews having largely become virtual is candidates' difficulty sensing a program's fit. Programs have offered nonevaluative second looks to address this. There is concern that in-person contact with candidates would still indirectly contribute to a candidate's evaluation. Objective We describe implementing an alternative interview structure to incorporate the benefits of virtual and in-person interviews, and describe preliminary feasibility and acceptability data. Methods Our general surgery program selection process for the 2022-2023 application cycle included a first phase of holistic review and a second phase of interviews. The second phase had a first round of virtual interviews, then a second round of in-person interviews (with a virtual option). Only scores from the second interview were used in ranking. Prior to the Match, applicants and faculty were surveyed about the process. Results All 1175 applications to the program were reviewed. Of those, 190 (16.2%) were invited to interview virtually; 188 of 190 (98.9%) completed the virtual interview. Eighty-two of 188 (43.6%) were invited for a second interview; 69 of 82 (84.1%) chose to interview in-person, and 13 of 82 (15.9%) interviewed virtually. Sixty-eight of 188 (36.2%) applicants responded to the survey. Sixty-three of 68 (92.6%) agreed the 2-stage interview process was fair, and 51 of 68 (75%) felt that nonevaluative second looks were not truly nonevaluative. Fifteen faculty spent 3 hours over 6 weeks in holistic review. Twenty-four faculty completed 6 days of interviews, each spending 2.5 to 3 hours per day. Twelve of 24 faculty (50%) responded to their survey, with all 12 stating they would participate again. Conclusions A process of first-round virtual and second-round in-person interviews was feasible and perceived by applicants to be fair and beneficial.

Background Physician-patient racial and cultural concordance is essential to address health care disparities. Yet, limited literature on diversity, equity, and inclusion (DEI) outcomes in graduate medical education (GME) suggests the need for high-yield DEI resources. Objectives To describe and identify DEI efforts by US residency program director (PD) associations and areas for collaboration among the GME community. Methods Through bimonthly teleconferences and 5 iterative revisions from June to September 2022, the DEI workgroup of the US Organization of PD Associations developed a 17-question needs assessment survey to investigate DEI activities across residency PD associations, which was delivered twice electronically from September to November 2022 to 30 specialty PD association representatives. Results Survey response rate was 73% (22 of 30). Specialties track resident demographics more than PD demographics (11 of 22, 50% vs 7 of 22, 32%). Tracked demographics vary and include race, gender, and sexual orientation. Most PD associations have DEI committees (16 of 22, 73%) implementing various initiatives, the most common of which was providing resources to ensure diverse representation (11 of 16, 69%). Most specialties provide residency recruitment resources (14 of 22, 64%) and funding for visiting rotations or mentorship for underrepresented trainees (12 of 22, 54%). Resources for pipeline programs (7 of 22, 32%) and retention of diverse residents (7 of 22, 32%) were less common. Faculty development training focused more on teaching DEI to residents (14 of 22, 64%) than on teaching health disparities (7 of 22, 32%). Conclusions Our study demonstrates substantial DEI interventions among specialty PD associations. Yet, educational gaps exist in specific DEI content, faculty development, and curricular dissemination.

Background Graduate medical educators interested in designing and conducting education research may seek foundational general overview articles on education research methods. Objective We aimed to identify the most useful foundational education research methods articles for medical educators. Methods We identified candidate articles through a 2020 Ovid MEDLINE literature search augmented by the authors' personal files and by cross-checking references of included articles. Articles that were primarily about general education research principles were included; articles were excluded if they were not focused on medical education research methods, were published prior to the year 2000, were written in a non-English language, or had no available abstracts. We conducted a modified Delphi study with 10 participants representing a range of specialties and education research experience to find consensus about the most useful articles. We planned 3 rounds of the Delphi process, the first to eliminate any articles not deemed useful for this audience, and the second and third rounds to include articles that at least 80% of the panel deemed "most useful" to education researchers. Results Of 25 relevant articles identified in the literature search: one was excluded in round 1, 7 met the a priori threshold of 80% agreement for inclusion in round 2, and an additional 2 met inclusion in round 3. These 9 foundational education research methods articles relevant to graduate medical educators are described, along with a capsule summary and specific use for education researchers. Conclusions Our modified Delphi study of foundational education research methods articles identified 9 articles deemed useful for graduate medical educators who are seeking methods resources.

Background Variability in parental leave policies across graduate medical education (GME) programs in the United States complicates efforts to support resident wellness and identify best practices for resident well-being. Objective This review aims to assess how formal parental leave policies affect trainees' well-being, professional satisfaction, and performance during training. Methods A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) 2020 guidelines was conducted and registered on PROSPERO in May 2023. Databases searched included MEDLINE, Embase, and Cochrane Central. Studies that evaluated parental leave policies of US-based GME programs and their direct impact on residents and/or fellows were included. Studies were screened for inclusion by 2 independent reviewers, and any conflicts were resolved by a third author. Results Of 1068 articles screened, 43 articles met inclusion criteria. These studies highlighted that leave durations of less than 6 weeks were associated with higher rates of burnout and postpartum depression among trainees. There was no evidence that taking parental leave increased program attrition rate; however, 3 studies reported more than one-third of trainees extended training as a result of taking leave. Trainees who had more than 8 weeks of parental leave reported more successful breastfeeding 6 months out from delivery than those with less than 8 weeks of leave. Conclusions Extended parental leave, notably beyond 6 weeks, improved trainee well-being and professional satisfaction. Based on trainees' perspectives, ideal parental leave policies offer a minimum of 6 to 8 weeks of leave, with a formal and clearly written policy available.

Background The proportion of women surgeons is increasing, but studies show that women in surgical residency are granted less autonomy than men. Objective We utilized the Surgical Autonomy Program (SAP), an educational framework, to evaluate gender differences in self-reported autonomy, attending-reported autonomy, and operative feedback among US neurosurgical residents. Methods The SAP tracks resident progression and guides teaching in neurosurgery. Surgeries are divided into zones of proximal development (opening, exposure, critical portion, and closure). Postoperatively, resident autonomy is rated on a 4-point scale by the resident and the attending for each part of the case, or zone. We utilized data from July 2017 to February 2024 from 8 institutions. Ordinal regression was used to evaluate the odds of self- and attending-evaluated autonomy, accounting for gender, training year, case difficulty, and institution. Differences between attending assessment and self-assessment were calculated across time. Chi-square analyses were used to measure any differences in feedback given to men and women. Results From 128 residents (32 women, 25%), 11894 cases were included. Women were granted less autonomy (OR 0.81; 95% CI 0.74-0.89; P<.001) and self-evaluated as having less autonomy (OR 0.73; 95% CI 0.67-0.80; P<.001). The odds of women operating at higher autonomy were similar to the odds of operating on a hard case compared to average difficulty (OR 0.77; 95% CI 0.71-0.84; P<.001). Men's and women's self-assessment became closer to attending assessment over time, with women improving more quickly for the critical portions of surgeries. Women residents received meaningful postoperative feedback on fewer cases (women: 74.2%, men: 80.5%; X²=31.929; P<.001). Conclusions Women operated with lower autonomy by both attending and self-assessment, but the assessment gap between genders decreased over time. Women also received less feedback from their attendings.

Background Despite many benefits of end-of-life (EOL) planning, only 1 in 3 adults has EOL documentation, with low rates in resident primary care clinics as well. Objective To increase clinic completion of life-sustaining treatment (LST) notes and advance directives (AD) for veterans at highest risk for death. Methods The setting was a Veterans Affairs (VA) internal medicine primary care clinic. All clinic residents in the 2021-2022 academic year and all clinic patients identified through a VA risk-stratification tool as highest risk for death were included. Baseline AD and LST completion rates were determined through manual chart review. Our interventions included 2 hours of teaching to increase resident knowledge of EOL planning and a systematic process improvement to complete EOL planning appointments. Outcomes assessed included anonymous resident pre- and post-surveys of self-assessed knowledge and comfort with EOL conversations, as well as rates of LST and AD completion determined through serial chart review. Results In the 2021-2022 academic year, 22 residents (100%) and 54 patients were included. Post-intervention surveys (n=22, 100%) showed improved self-assessed knowledge of EOL concepts and comfort with patient discussions (median Likert increase 3 to 4). The number of residents who completed an EOL planning visit increased from 9 of 22 (41%) to 15 (68%). LST completion increased from 9 of 54 (17%) to 29 (54%), and AD completion increased from 18 of 54 (33%) to 33 (61%). Conclusions A brief teaching intervention to prepare residents for comprehensive EOL visits combined with process improvement to offer EOL planning visits improved self-reported knowledge and comfort and completion of EOL visits.