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Background: Burnout is common among physicians and physician leaders, including residency program directors (PDs). The effects of the COVID-19 pandemic and other stressors in 2020 on PDs is unknown. Objective: To measure the prevalence of burnout among internal medicine (IM) residency PDs 6 months into the COVID-19 pandemic. Methods: A total of 429 IM PDs, representing 83% of accredited residency programs, were surveyed from August to December 2020. Burnout, using a 2-item screening tool, and self-reported consideration of resigning in 2020, were compared to their annual prevalence since 2012 and tested for possible associations with pandemic stressors and program characteristics. Results: The survey response rate was 61.5% (264 of 429). One-third (33.6%, 87 of 259) of PD respondents met burnout criteria, and 45.1% (110 of 244) reported considering resigning in the past year, which were within the range of preceding years. PDs who reported feeling highly supported by institutional leadership were less likely to meet burnout criteria and to have considered resigning. There were no associations between burnout or consideration of resigning and the amount of clinical time PDs spent in their roles, duration of maximum stress on programs, budget cuts to programs, or geographic region. Conclusions: The prevalence of burnout among PDs in fall 2020 was similar to the prevalence of burnout in pre-pandemic years despite uniquely extreme stressors. PDs' perception of being highly supported by institutional leadership was associated with lower prevalence of burnout and consideration of resigning. Perceived leadership support may be a protective factor against burnout during periods of high stress.
Assuntos
Esgotamento Profissional , COVID-19 , Internato e Residência , Esgotamento Profissional/epidemiologia , Esgotamento Psicológico , Humanos , Pandemias , Inquéritos e QuestionáriosRESUMO
Challenges persist for female physicians and physicians in training who desire to have children. A scoping review in this issue of Academic Medicine identifies 4 major themes that have evolved over time and have surged in numbers as more women have entered the medical profession and as the sociopolitical environment has progressed: the impact of pregnancy on the physician and her colleagues, pregnant physician work productivity, physician maternity leave policies, and physician maternal-fetal health outcomes. The persistence of themes over time should compel the medical profession and society to address the challenges that face female physicians and physicians in training who desire to have children and to find solutions for them. Women should be able to be physicians, have children if they wish, and have the same health care considerations as nonphysician women. Institutional, departmental, and personal support structures must become a priority.
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Medicina , Médicas , Médicos , Criança , Eficiência , Emprego , Feminino , Humanos , GravidezAssuntos
Intoxicação por Chumbo/diagnóstico , Ayurveda/efeitos adversos , Dor Abdominal/etiologia , Idoso , Anemia/etiologia , Anorexia/etiologia , Terapia por Quelação , Diagnóstico Diferencial , Dieta Cetogênica/efeitos adversos , Feminino , Humanos , Chumbo/sangue , Intoxicação por Chumbo/complicações , Intoxicação por Chumbo/metabolismo , Intoxicação por Chumbo/terapia , Desnutrição/diagnóstico , Transtornos da Memória/etiologia , Porfiria Aguda Intermitente/diagnóstico , Porfiria Aguda Intermitente/metabolismo , Porfirias/diagnóstico , Ideação Suicida , Tomografia Computadorizada por Raios X , Redução de PesoRESUMO
BACKGROUND: Clinician-educator tracks improve teaching behaviors in trainees. However, detailed curriculum descriptions to fully understand, compare, and reproduce them are often lacking. We aimed to describe and evaluate a medical education curriculum for senior residents. METHODS: Based on Kolb's experiential learning model, we designed a one-month curriculum to increase teaching effectiveness. PGY 2-4 internal medicine and medicine-pediatrics residents in a university-based training program participated in the course from 2015-2019. In a pre-post design, participants completed a survey to evaluate the curriculum. Survey items related to four constructs in medical education: knowledge, confidence, skills, and importance (5-point Likert scale; 1=low, 5=high). We assessed the difference in the means for each construct before and after the curriculum. RESULTS: Thirty-nine residents completed the curriculum (19% of total residents), and 100% of participants completed the surveys. We observed an increase in the mean self-rated level of teaching knowledge (2.63 [SD 0.57] vs. 4.43 [SD 0.42], p<0.005), confidence (3.31 [SD 0.4] vs. 4.29 [SD 0.32], p<0.005), and skills (2.9 [SD 0.63] vs. 4.14 [SD 0.38], p<0.005) after completing the course. Residents consistently graded individual curricular components highly. CONCLUSIONS: We describe a one-month medical education curriculum with a strong foundation in learning theory. The curriculum is feasible and presented in sufficient detail to allow reproduction. Our findings suggest that it increases participants' self-perceptions of teaching knowledge, confidence, and skills.
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Educação Médica , Internato e Residência , Criança , Competência Clínica , Currículo , Educação de Pós-Graduação em Medicina , Humanos , Medicina Interna/educaçãoRESUMO
INTRODUCTION: In 2020, roughly 25% of applicants who matched into internal medicine (IM) residencies were international medical graduates (IMGs). We examine 12-year trends in distribution of IMGs among IM training programs and explore differences in program perceptions towards IMG recruitment. METHODS: Since 2007, Association of Program Directors in Internal Medicine Annual Surveys have collected data about trainees by medical school graduate type. Sixteen additional questions regarding perceptions of IMGs were included in the 2017 spring survey. RESULTS: The 2017 survey response rate was 63.3% (236/373) and ranged from 61.9 to 70.2% for the 2007-2019 Annual Surveys. During that 12-year period, 55-70% of community programs' and 22-30% of university programs' PGY1 positions were filled by IMGs. In 2017, 45% of community programs' and 15% of university programs' interview and ranking positions were allocated to IMGs. Departmental pressure (university 45.6% [95% CI 43.7-47.5]; community 28.2% [95% CI 26.6-29.7]; p = 0.007), institutional priority (university 64.0% [95% CI 62.1-66.0]; community 41% [95% CI 36.9-44.6]; p = 0.001), and reputational concerns (university 52.8% [95% CI 50.0-55.6]; community 38.5% [95% CI 36.0-40.9]; p = 0.045) were cited as factors influencing recruitment of IMGs. CONCLUSION: Our study was limited to exploring program factors in residency recruitment and did not assess applicant preferences. There is a large, longstanding difference in the recruitment of IMGs to US community-based and university residencies, beginning during the interview and ranking process. Further research in disparities in IMG recruitment is needed, including exploring pressures, preferences, and potential biases associated with the recruitment of IMGs.
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Médicos Graduados Estrangeiros , Internato e Residência , Educação de Pós-Graduação em Medicina , Humanos , Medicina Interna/educação , Estudos Longitudinais , Estados UnidosRESUMO
OBJECTIVES: Physicians in training may be particularly vulnerable to the negative effects of discrimination and inappropriate behaviors by patients. We sought to determine the frequency of inappropriate behaviors by patients toward Internal Medicine (IM) residents, residents' confidence to manage the behaviors, and differences among demographic characteristics, including race, sex, and level of clinical experience. METHODS: We developed a curricular session to equip IM residents and faculty to respond to discrimination or inappropriate behaviors by patients. Before the session, we surveyed residents about their experiences with macroaggressions, microaggressions, and other inappropriate behaviors using a 16-question survey instrument. We used descriptive statistics to summarize the participants' characteristics and the χ2 or Fisher exact test for comparison between groups. RESULTS: Eighty-two percent (27 of 33) of residents who attended the workshop completed the survey. We found that the majority of residents experienced patient macro- and microaggressions. More than 50% had a personal experience or witnessed experience with a macroaggression related to race (56%) or gender (59%). Seventy percent of residents personally experienced a microaggression by a patient. Women and residents of color are more likely to experience these types of encounters, which become more common in residents with higher postgraduate year level. Confidence in how to appropriately respond to such encounters is low. CONCLUSIONS: Our study highlights that macro- and microaggressions by patients toward IM residents are common. Curricula are needed to equip trainees with tools to appropriately respond during such encounters.
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Currículo , Medicina Interna/educação , Internato e Residência/métodos , Corpo Clínico Hospitalar/educação , Relações Médico-Paciente , Adulto , Agressão , Feminino , Assédio não Sexual , Humanos , Masculino , Corpo Clínico Hospitalar/psicologia , Pacientes/psicologia , Discriminação SocialRESUMO
Importance: Health disparities continue to exist despite the call to increase education of health care practitioners. An assessment of health disparities education has not been previously studied in a national cohort. Objective: To describe and compare the curriculum on health disparities from the perspective of program directors and perceptions of training among internal medicine residents. Design, Setting, and Participants: This cross-sectional survey study used a survey of US internal medicine program directors, the 2015 Association of Program Directors in Internal Medicine annual survey, which included questions about health disparities curriculum, and a 1-time survey of US internal medicine residents that asked questions related to their training in health disparities on the American College of Physicians 2015 Internal Medicine In-Training Examination. All internal medicine program directors who were members of Association of Program Directors in Internal Medicine (368 of 396 accredited programs), and internal medicine residents who took the Internal Medicine In-Training Examination were eligible. Final analysis of the merged data set was completed in 2018. Exposures: Questions were included on the annual Association of Program Directors in Internal Medicine survey and the Internal Medicine In-Training Examination. Main Outcomes and Measures: Program directors reported on presence of health disparities curriculum, educational methods, quality, barriers and challenges to curriculum, and Clinical Learning Environment Review. Residents reported whether they received training and quality of the training in health disparities. Results: A total of 227 program directors (response rate, 61.7%) and 22â¯723 residents (response rate, 87.2%) responded to the surveys. A total of 90 program directors (39.6%) reported a curriculum in health disparities, but among these, only 16 program directors (17.8%) felt quality of their education was very good or excellent. In more than half of the programs (52 programs [55.9%]), outcomes of the curriculum were not measured. After merging, the combined data set included 18â¯883 residents from 366 APDIM member programs with 225 program director responses. Among these, 13â¯251 residents (70.2%) reported some training in caring for patients at risk for health disparities. Of residents who reported receiving training, 10â¯494 (79.2%) rated the quality as very good or excellent. Conclusions and Relevance: These findings suggest that that despite the Clinical Learning Environment Review mandate and Accreditation Council for Graduate Medical Education required competencies for training in health disparities, relatively few internal medicine programs in the US provided educational curriculum. Additionally, the existence of health disparities curricula in internal medicine training programs was not associated with resident's perception of training or its quality.
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Educação de Pós-Graduação em Medicina , Disparidades em Assistência à Saúde , Medicina Interna/educação , Internato e Residência , Estudos Transversais , Currículo , Educação de Pós-Graduação em Medicina/normas , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Humanos , Internato e Residência/normas , Internato e Residência/estatística & dados numéricos , Médicos/estatística & dados numéricos , Estados UnidosRESUMO
This statement was released in June 2020 by the Alliance for Academic Internal Medicine to provide guidance for the 2020-2021 residency application cycle in light of the COVID-19 pandemic. While many of the recommendations are specific to this cycle, others, such as the Department Summary Letter of Evaluation, are meant to be an enduring change to the internal medicine residency application process. AAIM realizes that some schools may not yet have the tools or resources to implement the template fully this cycle and look toward collaboration within the internal medicine education community to facilitate adoption in the cycles to come.
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Infecções por Coronavirus , Correspondência como Assunto , Medicina Interna/organização & administração , Internato e Residência/organização & administração , Candidatura a Emprego , Pandemias , Pneumonia Viral , COVID-19 , HumanosRESUMO
PURPOSE: To examine internal medicine residency program directors' (PDs') screening practices and perceptions about current recruitment challenges. METHOD: In March-May 2017, the Association of Program Directors in Internal Medicine Survey Committee sent a survey to 373 Alliance for Academic Internal Medicine member residency programs. PDs rated the importance of 23 inclusion and 11 exclusion criteria for interview invitation decision making, provided United States Medical Licensing Examination (USMLE) cutoff scores for U.S. medical school and international medical graduates, and indicated changes in recruitment practices due to application inflation, including their ability to conduct holistic review and interest in potential solutions to address application inflation. Exploratory factor analysis was used to identify and confirm factors that were most important to interview invitation decision making. RESULTS: The response rate for eligible programs was 64% (233/363). USMLE Step 2 Clinical Knowledge scores were the criteria most frequently reported to be "very important" (131/233, 57%). Among respondents who reported any criteria as "very important," 155/222 (70%) identified a single most important (SMI) criterion. Non-USMLE criteria were frequently reported as an SMI criterion (68%). Concerning exclusion criteria, 157/231 (68%) reported they "absolutely would not invite" applicants with hints of unprofessional behavior. Of the 214/232 (92%) who reported an increase in applications, 138 (64%) adjusted recruitment practices. Respondents were most interested in limiting the number of applications per applicant (163/231, 71%), allowing applicants to indicate high interest in a subset of programs (151/229, 66%), and creating a national database of qualities of matched applicants for each program (121/228, 53%). CONCLUSIONS: PDs rely heavily on USMLE scores when making interview invitation decisions. However, collectively, non-USMLE criteria were more frequently reported as an SMI criterion. Most programs adjusted recruitment practices to respond to application volume. Several potential solutions to address application inflation garnered wide support.
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Competência Clínica , Tomada de Decisões , Educação de Pós-Graduação em Medicina , Medicina Interna/educação , Critérios de Admissão Escolar , Humanos , Entrevistas como Assunto , Licenciamento em Medicina , Seleção de Pessoal , Inquéritos e Questionários , Estados UnidosRESUMO
BACKGROUND: Over the past decade, the number of residency applications has increased substantially, causing many residency programs to change their recruitment practices. OBJECTIVE: We determined how internal medicine (IM) residency programs have responded to increased applications by program type (community-based, community-based/university-affiliated, and university-based) and characteristics (percentage of international medical graduates, program size, and program director [PD] tenure). METHODS: The Association of Program Directors in Internal Medicine conducted a national survey of 363 IM PDs in 2017. Five questions assessed IM program responses to the increased number of residency applications in 3 areas: changes in recruitment strategies, impact on ability to perform holistic review, and interest in 5 potential solutions. We performed a subgroup analysis to measure differences by program type and characteristics. RESULTS: The response rate was 64% (233 of 363). There were no differences by program type or characteristics for experiencing an increase in the number of applicants, altering recruitment practices, or conducting holistic reviews. There were moderate differences in alterations of recruitment practices by program characteristics and moderate differences in interest in proposed solutions by program type. Community-based programs had the greatest interest in a program-specific statement (59%, P = .032) and the lowest percentage in a national database of matched applicants (44%, P = .034). CONCLUSIONS: IM residency programs are experiencing an increasing number of applications and are accommodating by adjusting recruitment practices in a variety of ways. A majority of IM PDs supported 4 of the 5 solutions, although the level of interest differed by program type.
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Educação de Pós-Graduação em Medicina/organização & administração , Medicina Interna/organização & administração , Internato e Residência/organização & administração , Medicina Comunitária , Médicos Graduados Estrangeiros , Humanos , Medicina Interna/educação , Seleção de Pessoal/métodos , Inquéritos e Questionários , Estados UnidosAssuntos
Anemia Falciforme/complicações , Debilidade Muscular/etiologia , Músculo Esquelético/patologia , Miastenia Gravis/diagnóstico , Proteínas Tirosina Quinases/imunologia , Autoanticorpos/sangue , Análise Química do Sangue , Diagnóstico Diferencial , Dispneia/etiologia , Estimulação Elétrica , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Transtornos de Enxaqueca/complicações , Doença de Moyamoya/etiologia , Músculo Esquelético/imunologia , Músculo Esquelético/fisiopatologia , Miastenia Gravis/complicações , Miastenia Gravis/tratamento farmacológico , Miastenia Gravis/patologia , Adulto JovemRESUMO
Tens of thousands of senior medical students interview for medical residency positions each year. As the applicant pool shifts to include more women, married individuals, and young parents, the criteria by which interviewees evaluate programs are also changing. Concerns including parental leave policies, lactation facilities, access to childcare, partner recruitment resources, and inclusivity in the work environment are important in selecting an ideal program. However, the National Resident Matching Program Match Communication Code of Conduct prohibits interviewers from addressing gender, marital status, and intent to bear children, so the burden of introducing such topics falls on the interviewees. These topics can be difficult to discuss with potential employers, especially when weighed against the pressure to obtain a competitive position through the Match.In this Invited Commentary, the authors draw on personal experience to examine the questions that residency programs need to answer, encouraging both applicants and programs to improve communication during the residency interview process.
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Escolha da Profissão , Comunicação , Educação de Pós-Graduação em Medicina/organização & administração , Internato e Residência/organização & administração , Seleção de Pessoal , Estudantes de Medicina/psicologia , Feminino , Humanos , Estudantes de Medicina/estatística & dados numéricosRESUMO
PURPOSE: Guidelines surrounding postinterview communication (PIC) after residency interviews were issued by the National Resident Matching Program and Association of Program Directors in Internal Medicine. How they have influenced PIC and program directors' (PDs') reasons for PIC is unknown. METHOD: Annual surveys of 365 U.S. internal medicine residency PDs in 2013 and 368 in 2015 were used. Questions about frequency, intent, and usefulness of PIC and knowledge of guidelines before and after new PIC guidelines were included. Chi-square tests were used to compare data sets, and multivariate logistic regression was performed for 2015 data to identify factors predicting engagement in PIC, using program characteristics, PD characteristics, and beliefs about the benefits of PIC as independent variables. RESULTS: There were 265 (73%) respondents in 2013 and 227 (62%) in 2015. While the number of programs with a PIC policy increased 43%, the level of contact increased 7%. Few PDs indicated PIC was helpful to them; however, PDs who felt PIC helps target applicants were more likely to engage in PIC (OR 4.21, SE 1.88, P = .001). The main reason for continuing PIC (50% of PDs) was that PIC, part of their program's culture, was considered "good manners." CONCLUSIONS: New guidelines increased the number of programs with a PIC policy, but the overall rate of applicant contact did not change despite few PDs feeling PIC was helpful to recruitment. The culture surrounding PIC may be difficult to overcome via guidelines alone, and more definitive rules are necessary to implement change.