Hypersensitivity Pneumonitis: An Updated Diagnostic Guide for Internists.

This summary highlights updated definitions, terminology, and classification systems proposed in the diagnosis of hypersensitivity pneumonitis. Clinical presentation, epidemiology, and pathophysiology are reviewed from the most recent data. Radiographic and histopathologic diagnostic criteria are presented in a manner relevant to the practice of general medicine internists, including new guideline recommendations. The role of adjunctive tests, such as serum IgG testing, bronchoalveolar lavage lymphocyte analysis, and pulmonary function testing is discussed in the context of supporting diagnostic confidence for hypersensitivity pneumonitis diagnosis. Finally, new diagnostic algorithms are synthesized and applied to the general internal medicine setting.

Navigate the Challenges of Simulation for Assessment: A Faculty Development Workshop.

Introduction: Given barriers to learner assessment in the authentic clinical environment, simulated patient encounters are gaining attention as a valuable opportunity for competency assessment across the health professions. Simulation-based assessments offer advantages over traditional methods by providing realistic clinical scenarios through which a range of technical, analytical, and communication skills can be demonstrated. However, simulation for the purpose of assessment represents a paradigm shift with unique challenges, including preservation of a safe learning environment, standardization across learners, and application of valid assessment tools. Our goal was to create an interactive workshop to equip educators with the knowledge and skills needed to conduct assessments in a simulated environment. Methods: Participants engaged in a 90-minute workshop with large-group facilitated discussions and small-group activities for practical skill development. Facilitators guided attendees through a simulated grading exercise followed by in-depth analysis of three types of assessment tools. Participants designed a comprehensive simulation-based assessment encounter, including selection or creation of an assessment tool. Results: We have led two iterations of this workshop, including an in-person format at an international conference and a virtual format at our institution during the COVID-19 pandemic, with a total of 93 participants. Survey responses indicated strong overall ratings and impactfulness of the workshop. Discussion: Our workshop provides a practical, evidence-based framework to guide educators in the development of a simulation-based assessment program, including optimization of the environment, design of the simulated case, and utilization of meaningful, valid assessment tools.

Parenting While in Training: A Comprehensive Needs Assessment of Residents and Fellows.

BACKGROUND: Parenting issues can affect physicians' choice of specialty or subspecialty, as well as their selection of individual training programs, because of the distinctive challenges facing residents and fellows with children. Specific information about how residents perceive these challenges is limited. OBJECTIVE: We sought to better understand the challenges associated with parenting during residency and fellowship training in order to inform policy and research. METHODS: In 2017, a voluntary online questionnaire was distributed to all 2214 Partners HealthCare graduate medical education trainees across 285 training programs. The survey queried attitudes of and about trainees with children and assessed needs and experiences related to parental leave, lactation, and childcare. Responses were compared between subgroups, including gender, surgical versus nonsurgical specialty, parental status, and whether the respondent was planning to become a parent. RESULTS: A total of 578 trainees (26%) responded to the questionnaire. Of these, 195 (34%) became parents during training. An additional 298 (52%) planned to become parents during training. Respondents overwhelmingly agreed that their institution should support trainees with children (95%) and that doing so is important for trainee wellness (98%). However, 25% felt that trainees with children burden trainees without children. Childcare access, affordability, and availability for sufficient hours were identified as key challenges, along with issues related to parental leave, lactation facilities, and effect on peers. CONCLUSIONS: This survey highlights trainees' perspectives about parenting during their clinical training, signaling parental leave, lactation facilities, and childcare access and affordability as particular challenges and potential targets for future interventions.