Considering Burnout and Well-Being: Emergency Medicine Resident Shift Scheduling Platform and Satisfaction Insights from a Quality Improvement Project.

Few studies explore emergency medicine (EM) residency shift scheduling software as a mechanism to reduce administrative demands and broader resident burnout. A local needs assessment demonstrated a learning curve for chief resident schedulers and several areas for improvement. In an institutional quality improvement project, we utilized an external online cross-sectional convenience sampling pilot survey of United States EM residency programs to collect information on manual versus software-based resident shift scheduling practices and associated scheduler and scheduler-perceived resident satisfaction. Our external survey response rate was 19/253 (8%), with all United States regions (i.e., northeast, southeast, midwest, west, and southwest) represented. Two programs (11%) reported manual scheduling without any software. ShiftAdmin was the most popularly reported scheduling software (53%). Although not statistically significant, manual scheduling had the lowest satisfaction score and programs with ≤30 residents reported the highest levels of satisfaction. Our data suggest that improvements in existing software-based technologies are needed. Artificial intelligence technologies may prove useful for reducing administrative scheduling demands and optimizing resident scheduling satisfaction.

Benchtop fine needle aspirations: An untapped source of cytologic educational material.

Fine needle aspirations (FNAs) are a valuable tool for the diagnosis of a wide variety of lesions. However, obtaining proficiency in performing FNAs and finding simulated scenarios where one can practice specimen adequacy and slide smearing can all be challenging. Benchtop FNAs of fresh surgical specimens offer a novel training opportunity that addresses these needs. In this study, we describe the feasibility and practicality of benchtop FNAs of fresh surgical specimens as a training tool. We performed benchtop FNAs on multiple specimen types, although most were partial and radical nephrectomies. We documented this approach to cytology training and have provided examples of slides that were generated, along with the surgical pathology correlate. Our results suggest that benchtop FNAs of fresh surgical specimens can be a valuable training tool in the arsenal of today's cytopathologist. This technique offers several advantages over traditional training methods, including the ability to generate high-quality cytology slides, provide cyto-histo correlation, and practice almost immediate gross-microscopic correlation. However, there are also some disadvantages to this approach, including the need for immediate access to fresh surgical specimens and the potential for artifacts to be introduced. Overall, we believe that benchtop FNAs of fresh surgical specimens offer a promising new training tool that can maximize training opportunities, especially in institutions where the FNA volume is low.

Advocating for Training in End-Of-Life Conversations With Seriously Ill Patients During Residency.

According to section IV.B.1.e of common residency program requirements from the Accreditation Council for Graduate Medical Education (ACGME), "[r]esidents must learn to communicate with patients and families to partner with them to assess their care goals, including, when appropriate, end-of-care [EOL] goals". EOL conversations are frequently appropriate for patients suffering from serious, life-threatening diseases (ie, terminal illness) or otherwise chronic health conditions with poor disease trajectories. These conversations are often followed with services and care from palliative medicine or hospice specialists depending on patients' projected prognoses (ie, 6 months or less). The focus of this patient-centered care, then, is on relieving patient and caregiver suffering, establishing clear treatment goals, and managing the physical, psychosocial, and spiritual burdens of disease. Although palliative medicine and hospice care have been shown to reduce health care costs and improve the overall care of patients who require these services, recent literature still suggests a gap in training programs being able to provide effective, educational strategies to their trainees regarding the appropriate and competent delivery of EOL conversations. Herein, this commentary will provide a discussion on what EOL is, palliative vs hospice care indications, and address current literature regarding EOL exposure within training programs while offering our personal insight and advocacy on the manner.

Evaluation of the Workplace-Based Assessment Anaesthesia-Clinical Evaluation Exercise (A-CEX) and Its Role in the Royal College of Anaesthetists 2021 Curriculum.

The workplace-based assessment (WPBA) Anaesthesia-Clinical Evaluation Exercise (A-CEX) is used in anaesthetic training in the Royal College of Anaesthetists 2021 curriculum. WBPAs are part of a multimodal approach to assess competencies, but can be limited by their granularity. They are an essential component of assessment and are used in both a formative and summative capacity. The A-CEX is a form of WBPA which evaluates knowledge, behaviours and skill of anaesthetists in training across a variety of 'real world' situations. An entrustment scale is assigned to the evaluation which has implications for future practice and ongoing supervision requirements. Despite being a key component in the curriculum the A-CEX has drawbacks. Its qualitative nature results in variation in feedback provided amongst assessors, which may have ongoing implications for clinical practice. Furthermore, the completion of an A-CEX can be viewed as a 'tick box' exercise and does not guarantee that learning has taken place.  Currently no direct evidence exists as to the benefit of the A-CEX in anaesthetic training, but extrapolated data from other studies may show validity. However, the assessment remains a key part of the 2021 curriculum, Future areas for consideration include education for those assessing trainees via A-CEX, altering the matrix of assessment to a less granular approach and a longitudinal study as to the utility of A-CEX in anaesthetics training.

Medical genetics education for pediatrics residents: A brief report.

PURPOSE: Genetic testing is ubiquitous in the field of medicine and is often ordered or requested by primary care providers, nongenetics subspecialists, and patients themselves. Other studies have shown that providers are often not comfortable ordering genetic testing. There have been initiatives to teach these concepts via continuing medical education; however, there is not a standardized training program for teaching resident physicians about genetic testing. METHODS: During September to October 2020, we recruited all the pediatrics residents at our institution via email (N = 102). Residents were invited to complete a Qualtrics electronic survey that addressed self-perceived level of knowledge about core concepts of genetic testing, as well as self-perceived confidence discussing these concepts with families. RESULTS: Response rate was 46 to 102 (45%). Proportions of respondents reporting they felt insufficiently knowledgeable ranged from 28% (basic concepts of genetics) to 80% (Genetic Information Nondiscrimination Act). Most pediatrics residents agreed that a curriculum teaching basics of genetic testing would be helpful to them. Desired curricular topics included indications and limitations of genetic testing, testing procedures, and counseling families. CONCLUSION: Despite its expanding importance across medicine, genetics education is lacking in pediatrics residency programs and residents would benefit from a curriculum teaching basic concepts of genetic testing.

Rigorous Curricular Innovation: Development, Integration, and Evaluation of Anatomic Clinical Correlations Module.

OBJECTIVE: To develop an anatomy clinical correlations module utilizing modern instructional design techniques and theoretically structured student feedback for course improvements. DESIGN: A pre-experimental, single group post-test study. Eleven module sessions were structured using the 5-E instructional strategy (engage, explore, explain, elaborate, and evaluate). Learning impact was measured using Keller's ARCS framework (attention, relevance, confidence, and satisfaction) and narrative student feedback was collected to inform case alterations. The course was repeated the following year with the integrated feedback and year-on-year comparisons were drawn. SETTING: Single-institution study at the University of Central Florida College of Medicine. PARTICIPANTS: Medical students currently enrolled in the first-year anatomy course. RESULTS: Year-on-year comparisons for AY18-19 (n = 78) and AY19-20 (n = 118) yielded statistically significant improvements in attention (4.69-4.76, p = 0.01) and relevance (4.54 to 4.75, p ≤ 0.001) with high total combined survey response rates (n = 196/238, 82.4%). Internal consistency was good for attention and strong for the following scales: total scale, relevance, confidence, and satisfaction. Narrative feedback referenced the importance of applied anatomy, clinical context and decision-making, the format of the sessions. CONCLUSIONS: We structured a series of anatomic clinical correlations using an evidence-based instructional strategy, assessed its impact, and improved on the course to optimize the motivation to learn anatomy. Systematic use of structured student feedback is important to ensure case difficulty is within the zone of proximal development.

Medical Education During the COVID-19 Pandemic.

All aspects of medical education were affected by the COVID-19 pandemic. Several challenges were experienced by trainees and programs alike, including economic repercussions of the pandemic; social distancing affecting the delivery of medical education, testing, and interviewing; the surge of patients affecting redeployment of personnel and potential compromises in core training; and the overall impact on the wellness and mental health of trainees and educators. The ability of medical teams and researchers to peer review, conduct clinical research, and keep up with literature was similarly challenged by the rapid growth in peer-reviewed and preprint literature. This article reviews these challenges and shares strategies that institutions, educators, and learners adopted, adapted, and developed to provide quality education during these unprecedented times.