Browsing by Subject "Education, Medical, Graduate"
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Item Open Access A pilot study of orthopaedic resident self-assessment using a milestones' survey just prior to milestones implementation.(Int J Med Educ, 2016-01-11) Bradley, Kendall E; Andolsek, Kathryn MOBJECTIVE: To pilot test if Orthopaedic Surgery residents could self-assess their performance using newly created milestones, as defined by the Accreditation Council on Graduate Medical Education. METHODS: In June 2012, an email was sent to Program Directors and administrative coordinators of the 154 accredited Orthopaedic Surgery Programs, asking them to send their residents a link to an online survey. The survey was adapted from the Orthopaedic Surgery Milestone Project. Completed surveys were aggregated in an anonymous, confidential database. SAS 9.3 was used to perform the analyses. RESULTS: Responses from 71 residents were analyzed. First and second year residents indicated through self-assessment that they had substantially achieved Level 1 and Level 2 milestones. Third year residents reported they had substantially achieved 30/41, and fourth year residents, all Level 3 milestones. Fifth year, graduating residents, reported they had substantially achieved 17 Level 4 milestones, and were extremely close on another 15. No milestone was rated at Level 5, the maximum possible. Earlier in training, Patient Care and Medical Knowledge milestones were rated lower than the milestones reflecting the other four competencies of Practice Based Learning and Improvement, Systems Based Practice, Professionalism, and Interpersonal Communication. The gap was closed by the fourth year. CONCLUSIONS: Residents were able to successfully self-assess using the 41 Orthopaedic Surgery milestones. Respondents' rate improved proficiency over time. Graduating residents report they have substantially, or close to substantially, achieved all Level 4 milestones. Milestone self-assessment may be a useful tool as one component of a program's overall performance assessment strategy.Item Open Access Early Effects of COVID-19 Pandemic on Neurosurgical Training in the United States: A Case Volume Analysis of 8 Programs.(World neurosurgery, 2021-01) Aljuboori, Zaid S; Young, Christopher C; Srinivasan, Visish M; Kellogg, Ryan T; Quon, Jennifer L; Alshareef, Mohammed A; Chen, Stephanie H; Ivan, Michael; Grant, Gerald A; McEvoy, Sean D; Davanzo, Justin R; Majid, Sonia; Durfy, Sharon; Levitt, Michael R; Sieg, Emily P; Ellenbogen, Richard G; Nauta, Haring JObjective
To determine the impact of the 2019 novel coronavirus disease (COVID-19) pandemic on operative case volume in 8 U.S. neurosurgical residency training programs in early 2020 and to survey these programs regarding training activities during this period.Methods
A retrospective review was conducted of monthly operative case volumes and types for 8 residency programs for 2019 and January through April 2020. Cases were grouped as elective cranial, elective spine, and nonelective emergent cases. Programs were surveyed regarding residents' perceptions of the impact of COVID-19 on surgical training, didactics, and research participation. Data were analyzed for individual programs and pooled across programs.Results
Across programs, the 2019 monthly mean ± SD case volume was 211 ± 82; 2020 mean ± SD case volumes for January, February, March, and April were 228 ± 93, 214 ± 84, 180 ± 73, and 107 ± 45. Compared with 2019, March and April 2020 mean cases declined 15% (P = 0.003) and 49% (P = 0.002), respectively. COVID-19 affected surgical case volume for all programs; 75% reported didactics negatively affected, and 90% reported COVID-19 resulted in increased research time. Several neurosurgery residents required COVID-19 testing; however, to our knowledge, only 1 resident from the participating programs tested positive.Conclusions
This study documents a significant reduction in operative volume in 8 neurosurgery residency training programs in early 2020. During this time, neurosurgery residents engaged in online didactics and research-related activities, reporting increased research productivity. Residency programs should collect data to determine the educational impact of the COVID-19 pandemic on residents' operative case volumes, identify deficiencies, and develop plans to mitigate any effects.Item Open Access Establishing cutoff scores on assessments of surgical skills to determine surgical competence.(Am J Obstet Gynecol, 2010-07) Jelovsek, J Eric; Walters, Mark D; Korn, Abner; Klingele, Christopher; Zite, Nikki; Ridgeway, Beri; Barber, Matthew DOBJECTIVE: The aim of this study was to establish minimum cutoff scores on intraoperative assessments of surgical skills to determine surgical competence for vaginal hysterectomy. STUDY DESIGN: Two surgical rating scales, the Global Rating Scale of Operative Performance and the Vaginal Surgical Skills Index, were used to evaluate trainees while performing vaginal hysterectomy. Cutoff scores were determined using the Modified Angoff method. RESULTS: Two hundred twelve evaluations were analyzed on 76 surgeries performed by 27 trainees. Trainees were considered minimally competent to perform vaginal hysterectomy if total absolute scores (95% confidence interval) on Global Rating Scale = 18 (16.5-20.3) and Vaginal Surgical Skills Index = 32 (27.7-35.5). On average, trainees met new cutoffs after performing 21 and 27 vaginal hysterectomies, respectively. With the new cutoffs applied to the same cohort of fourth-year obstetrics and gynecology trainees, all residents achieved competency in performing vaginal hysterectomy by the end of their gynecology rotations. CONCLUSION: Standard-setting methods using cutoff scores may be used to establish competence in vaginal surgery.Item Open Access Global chronic disease research training for fellows: perspectives, challenges, and opportunities.(Circulation, 2010-03-23) Bloomfield, Gerald; Huffman, Mark DItem Open Access Holistic Review, Mitigating Bias, and Other Strategies in Residency Recruitment for Diversity, Equity, and Inclusion: An Evidence-based Guide to Best Practices from the Council of Residency Directors in Emergency Medicine.(The western journal of emergency medicine, 2022-05) Gallegos, Moises; Landry, Adaira; Alvarez, Al'ai; Davenport, Dayle; Caldwell, Martina T; Parsons, Melissa; Gottlieb, Michael; Natesan, SreejaAdvancement of diversity, equity, and inclusion (DEI) in emergency medicine can only occur with intentional recruitment of residency applicants underrepresented in medicine (UIM). Shared experiences from undergraduate and graduate medical education highlight considerations and practices that can contribute to improved diversity in the resident pool, such as holistic review and mitigating bias in the recruitment process. This review, written by members of the Council of Residency Directors in Emergency Medicine (CORD) Best Practices Subcommittee, offers best practice recommendations for the recruitment of UIM applicants. Recommendations address pre-interview readiness, interview approach, and post-interview strategies that residency leadership may use to implement holistic review and mitigate bias for recruitment of a diverse class.Item Open Access Impact of ACGME Accreditation Process on Quality of Program and Patient Care in the Community.(Journal of graduate medical education, 2016-10) Das, Samrat UItem Open Access Learnings From the Pilot Implementation of Mobile Medical Milestones Application.(Journal of graduate medical education, 2016-10) Page, Cristen P; Reid, Alfred; Coe, Catherine L; Carlough, Martha; Rosenbaum, Daryl; Beste, Janalynn; Fagan, Blake; Steinbacher, Erika; Jones, Geoffrey; Newton, Warren PBackground
Implementation of the educational milestones benefits from mobile technology that facilitates ready assessments in the clinical environment. We developed a point-of-care resident evaluation tool, the Mobile Medical Milestones Application (M3App), and piloted it in 8 North Carolina family medicine residency programs.Objective
We sought to examine variations we found in the use of the tool across programs and explored the experiences of program directors, faculty, and residents to better understand the perceived benefits and challenges of implementing the new tool.Methods
Residents and faculty completed presurveys and postsurveys about the tool and the evaluation process in their program. Program directors were interviewed individually. Interviews and open-ended survey responses were analyzed and coded using the constant comparative method, and responses were tabulated under themes.Results
Common perceptions included increased data collection, enhanced efficiency, and increased perceived quality of the information gathered with the M3App. Residents appreciated the timely, high-quality feedback they received. Faculty reported becoming more comfortable with the tool over time, and a more favorable evaluation of the tool was associated with higher utilization. Program directors reported improvements in faculty knowledge of the milestones and resident satisfaction with feedback.Conclusions
Faculty and residents credited the M3App with improving the quality and efficiency of resident feedback. Residents appreciated the frequency, proximity, and specificity of feedback, and faculty reported the app improved their familiarity with the milestones. Implementation challenges included lack of a physician champion and competing demands on faculty time.Item Open Access Objective assessment of vaginal surgical skills.(Am J Obstet Gynecol, 2010-07) Chen, Chi Chiung Grace; Korn, Abner; Klingele, Christopher; Barber, Matthew D; Paraiso, Marie Fidela R; Walters, Mark D; Jelovsek, J EricOBJECTIVE: To develop and validate an instrument to assess surgical skills during vaginal surgery. STUDY DESIGN: Trainees from 2 institutions were directly assessed in the operating room by supervising surgeons while performing a vaginal hysterectomy using the new Vaginal Surgical Skills Index, global rating scale, and visual analogue scale. Trainees were assessed again by the same surgeons 4 weeks after the live surgery and by a blinded outside reviewer using a videotape of the case. Internal consistency, interrater and intrarater reliability, and construct validity were evaluated. RESULTS: Two hundred twelve evaluations were analyzed on 76 surgeries from 27 trainees. There was good internal consistency, interrater, and intrarater reliability. Vaginal Surgical Skills Index scores correlated with global rating score and visual analog scale scores. Increasing Vaginal Surgical Skills Index scores significantly correlated with year of training and surgical volume with an estimated increase in score of 0.3 per hysterectomy performed. CONCLUSION: The Vaginal Surgical Skills Index is a feasible, reliable, and valid instrument to assess vaginal surgical skills.Item Open Access Objective Test Scores Throughout Orthopedic Surgery Residency Suggest Disparities in Training Experience.(Journal of surgical education, 2021-09) Foster, Norah; Price, Meghan; Bettger, Janet Prvu; Goodwin, C Rory; Erickson, MelissaDiversifying clinical residencies, particularly in fields that are historically dominated by majority male (M/M) cohorts, is critical to improve both the training experiences of residents and the overall physician workforce. Orthopedic surgery in particular has low numbers of females and under-represented minorities (F/URM) at all levels of training and practice. Despite efforts to increase its diversity, this field has become more homogeneous in recent years. To highlight potential barriers and disparate training environments that may contribute to this dynamic, we present 25 years' worth of institutional data on standardized exam performance throughout residency. We report that despite starting residency with standardized exam scores that were comparable to their M/M peers, F/URM orthopedic surgery residents performed progressively worse on Orthopaedic In-service Training Exams throughout residency and had lower first pass rates on the American Board of Orthopedic Surgery Part 1. Given these findings, we propose that disparate performance on standardized test scores throughout residency could identify trainees that may have different experiences that negatively impact their exam performance. Shedding light on these underlying disparities provides opportunities to find meaningful and sustained ways to develop a culture of diversity and inclusion. It may also allow for other programs to identify similar patterns within their training programs. Overall, we propose monitoring test performance on standardized exams throughout orthopedic surgery residency to identify potential disparities in training experience; further, we acknowledge that interventions to mitigate these disparities require a broad, systems wide approach and a firm institutional commitment to reducing bias and working toward sustainable change.Item Open Access Overcoming Challenges to Research Success in Cardiothoracic Anesthesiology Fellowship Training.(Journal of cardiothoracic and vascular anesthesia, 2024-10) Bottiger, Brandi A; Ghadimi, Kamrouz; Cherry, Anne; Mazzeffi, MichaelItem Open Access Providing successful faculty development to graduate medical education program directors.(International journal of medical education, 2017-09-11) Nagler, Alisa; Andolsek, Kathryn M; Rudd, Mariah; Kuhn, Catherine MItem Open Access Survey of the incidence and effect of major life events on graduate medical education trainees.(Med Educ Online, 2015) Grimm, Lars J; Nagler, Alisa; Maxfield, Charles MPURPOSE: This study aims to assess the incidence of major life events during graduate medical education (GME) training and to establish any associations with modifiable activities and career planning. METHODS: The authors surveyed graduating GME trainees from their parent institution in June 2013. Demographic information (clinical department, gender, training duration) and major life events (marriage, children, death/illness, home purchase, legal troubles, property loss) were surveyed. Respondents were queried about the relationship between life events and career planning. A multivariable logistic regression model tested for associations. RESULTS: A total of 53.2% (166/312) of graduates responded to the survey. 50% (83/166) of respondents were female. Major life events occurred in 96.4% (160/166) of respondents. Male trainees were more likely (56.1% [46/82] vs. 30.1% [25/83]) to have a child during training (p=0.01). A total of 41.6% (69/166) of responders consciously engaged or avoided activities during GME training, while 31.9% (53/166) of responders reported that life events influenced their career plans. Trainees in lifestyle residencies (p=0.02), those who experienced the death or illness of a close associate (p=0.01), and those with legal troubles (p=0.04) were significantly more likely to consciously control life events. CONCLUSION: Major life events are very common and changed career plans in nearly a third of GME trainees. Furthermore, many trainees consciously avoided activities due to their responsibilities during training. GME training programs should closely assess the institutional support systems available to trainees during this difficult time.Item Open Access Teaching neuraxial anesthesia techniques for obstetric care in a Ghanaian referral hospital: achievements and obstacles.(Anesth Analg, 2015-06) Olufolabi, Adeyemi J; Atito-Narh, Evans; Eshun, Millicent; Ross, Vernon H; Muir, Holly A; Owen, Medge DAnesthesia providers in low-income countries may infrequently provide regional anesthesia techniques for obstetrics due to insufficient training and supplies, limited manpower, and a lack of perceived need. In 2007, Kybele, Inc. began a 5-year collaboration in Ghana to improve obstetric anesthesia services. A program was designed to teach spinal anesthesia for cesarean delivery and spinal labor analgesia at Ridge Regional Hospital, Accra, the second largest obstetric unit in Ghana. The use of spinal anesthesia for cesarean delivery increased significantly from 6% in 2006 to 89% in 2009. By 2012, >90% of cesarean deliveries were conducted with spinal anesthesia, despite a doubling of the number performed. A trial of spinal labor analgesia was assessed in a small cohort of parturients with minimal complications; however, protocol deviations were observed. Although subsequent efforts to provide spinal analgesia in the labor ward were hampered by anesthesia provider shortages, spinal anesthesia for cesarean delivery proved to be practical and sustainable.Item Open Access Variation in Oral Board Examination Accommodations Among Specialties.(JAMA network open, 2024-05) Rowe, Dana G; Charles, Antoinette J; Luo, Emily J; Arango, Alissa M; Herndon, James E; Hockenberry, Harrison; Shortell, Cynthia K; Goodwin, C Rory; Erickson, Melissa MImportance
Board certification can have broad implications for candidates' career trajectories, and prior research has found sociodemographic disparities in pass rates. Barriers in the format and administration of the oral board examinations may disproportionately affect certain candidates.Objective
To characterize oral certifying examination policies and practices of the 16 Accreditation Council for Graduate Medical Education (ACGME)-accredited specialties that require oral examinations.Design, setting, and participants
This cross-sectional study was conducted from March 1 to April 15, 2023, using data on oral examination practices and policies (examination format, dates, and setting; lactation accommodations; and accommodations for military deployment, family emergency, or medical leave) as well as the gender composition of the specialties' boards of directors obtained from websites, telephone calls and email correspondence with certifying specialists. The percentages of female residents and residents of racial and ethnic backgrounds who are historically underrepresented in medicine (URM) in each specialty as of December 31, 2021, were obtained from the Graduate Medical Education 2021 to 2022 report.Main outcome and measures
For each specialty, accommodation scores were measured by a modified objective scoring system (score range: 1-13, with higher scores indicating more accommodations). Poisson regression was used to assess the association between accommodation score and the diversity of residents in that specialty, as measured by the percentages of female and URM residents. Linear regression was used to assess whether gender diversity of a specialty's board of directors was associated with accommodation scores.Results
Included in the analysis were 16 specialties with a total of 46 027 residents (26 533 males [57.6%]) and 233 members of boards of directors (152 males [65.2%]). The mean (SD) total accommodation score was 8.28 (3.79), and the median (IQR) score was 9.25 (5.00-12.00). No association was found between test accommodation score and the percentage of female or URM residents. However, for each 1-point increase in the test accommodation score, the relative risk that a resident was female was 1.05 (95% CI, 0.96-1.16), and the relative risk that an individual was a URM resident was 1.04 (95% CI, 1.00-1.07). An association was found between the percentage of female board members and the accommodation score: for each 10% increase in the percentage of board members who were female, the accommodation score increased by 1.20 points (95% CI, 0.23-2.16 points; P = .03).Conclusions and relevance
This cross-sectional study found considerable variability in oral board examination accommodations among ACGME-accredited specialties, highlighting opportunities for improvement and standardization. Promoting diversity in leadership bodies may lead to greater accommodations for examinees in extenuating circumstances.