Beyond a Hashtag: Strategies to Move Toward a More Inclusive Physiatry Workforce.

ABSTRACT: The field of physical medicine and rehabilitation should strive for a physician workforce that is ethnically/racially, sex, and ability diverse. Considering the recent realities of disparities in health outcomes related to COVID-19 and in racial injustice in the United States, we are called to be champions for antiracism and equity. The specialty of physical medicine and rehabilitation should be the leaders in fostering a culture of inclusion and pay special attention to the population of applicants who are underrepresented in medicine. The specialty needs tools to start addressing these disparities. This article aims to provide strategic and intentional evidence-based recommendations for programs to follow. Holistic review, implicit bias training, structured interviews, and targeted outreach for those underrepresented in medicine are some of the tools that will help students enter and become successful in our specialty. Furthermore, this article provides novel guidance and considerations for virtual interviews during the COVID-19 pandemic.

2019 United States Osteopathic Medical Regulatory Summit: Consensus, Recommendations, and Next Steps in Defining Osteopathic Distinctiveness.

BACKGROUND: Osteopathic distinctiveness is a result of professional education, identity formation, training, credentialing, and qualifications. With the advancement of a single graduate medical education (GME) accreditation system and the continued growth of the osteopathic medical profession, osteopathic distinctiveness and professional identity are seen as lacking clarity and pose a challenge. SUMMIT: To achieve consensus on a succinct definition of osteopathic distinctiveness and to identify steps to more clearly define and advance that distinctiveness, particularly in professional self-regulation, a representative group of osteopathic medical students, residents, physicians, and members of the licensing, GME, and undergraduate medical education (UME) communities convened the 2019 United States Osteopathic Medical Regulatory Summit in February 2019. Key features of osteopathic distinctiveness were discussed. Growth in the profession; changes in health care delivery, technology, and demographics within the profession and patient communities; and associated challenges and opportunities for osteopathic medical practice and patients were considered. CONSENSUS: Osteopathic medicine is a distinctive practice that brings unique, added value to patients, the public, and the health care community at large. A universal definition and common understanding of that distinctiveness is lacking. Efforts to unify messaging that defines osteopathic distinctiveness, to align the distinctive elements of osteopathic medical education and professional self-regulation across a continuum, and to advance research on care and educational program outcomes are critical to the future of the osteopathic medical profession. RECOMMENDATIONS: (1) Convene a task force of groups represented at the Summit to develop a succinct and consistent message defining osteopathic distinctiveness. (2) Demonstrate uniqueness of the profession through research demonstrating efficacy of care and patient outcomes, adding to the public good. (3) Harmonize GME and UME by beginning to align entrustable professional activities with UME milestones. (4) Convene representatives from osteopathic specialty colleges and certification boards to define curricular elements across GME, certification, and osteopathic continuous certification. (5) Build on the Project in Osteopathic Medical Education and Empathy study.

Active Learning Strategies to Improve Progression from Knowledge to Action.

Lectures, a form of passive learning, are a modality of teaching used in medical education. Active learning strategies allow learners and teachers to interact and be more engaged with the subject matter in a manner that encourages discussion, critical thinking, and advanced clinical reasoning skills. Learning to be effective requires vigilance, which promotes memory retention and should afford a way for learners to build on preexisting knowledge via scaffolding and concept mapping that uses critical thinking. Educators should also to use evaluation models that seek to improve patient care, health care systems, and community health.

Integration of a Mandatory Palliative Care Education Into Hematology-Oncology Fellowship Training in a Comprehensive Cancer Center: A Survey of Hematology Oncology Fellows.

PURPOSE: The primary aim of this study was to determine the attitudes and beliefs of hematology and medical oncology (HMO) fellows regarding palliative care (PC) after they completed a 4-week mandatory PC rotation. METHODS: The PC rotation included a 4-week standardized curriculum covering all PC domains. HMO fellows were provided educational materials and attended all didactic sessions. All had clinical rotation in an acute PC unit and an outpatient clinic. All HMO fellows from 2004 to 2017 were asked to complete a 32-item survey on oncology trainee perception of PC. RESULTS: Of 105 HMO fellows, 77 (73%) completed the survey. HMO fellows reported that PC rotation improved assessment and management of symptoms (98%); opioid prescription (89%), opioid rotation (78%), and identification of opioid adverse effects (87%); communication with patients and families (91%), including advance care planning discussion (88%) and do-not-resuscitate discussion (88%); and they reported comfort with discussing ethical issues (74%). Participants reported improvement in knowledge of symptom assessment and management (n = 76; 98%) as compared with efficacy in ethics (n = 57 [74%]; P = .0001) and for coping with stress of terminal illness (n = 45 [58%]; P = .0001). The PC rotation educational experience was considered either far better or better (53%) or the same (45%) as other oncology rotations. Most respondents (98%) would recommend PC rotations to other HMO fellows, and 95% felt rotation should be mandatory. CONCLUSION: HMO fellows reported PC rotation improved their attitudes and knowledge in all PC domains. PC rotation was considered better than other oncology rotations and should be mandatory.

Core Competencies for Pediatric Consultation-Liaison Psychiatry in Child and Adolescent Psychiatry Fellowship Training.

BACKGROUND: Learners developing competency-based skills, attitudes, and knowledge through the achievement of defined milestones is a core feature of competency-based medical education. In 2017, a special interest study group of the American Academy of Child and Adolescent Psychiatry convened a panel of specialists to describe pediatric consultation-liaison psychiatry (CLP) best educational practices during child and adolescent psychiatry fellowship. OBJECTIVE: The objective of this project was to develop a national consensus on pediatric CLP competencies to help guide training in this specialty. METHODS: An expert working group developed a list of candidate competences based on previously established educational outcomes for CLP (formerly Psychosomatic Medicine), child and adolescent psychiatry, and general psychiatry. A survey was distributed to members of the American Academy of Child and Adolescent Psychiatry Physically Ill Child Committee to determine child and adolescent psychiatry fellowship educational needs on pediatric CLP services and generate consensus regarding pediatric CLP competencies. RESULTS: Most survey respondents were supportive of the need for a national consensus on core competencies for pediatric CLP. Consensus from a panel of experts in the field of pediatric CLP generated a list of proposed core competencies that track the Accreditation Council for Graduate Medical Education's six core competencies. CONCLUSIONS: Consistent learning outcomes provide the foundation for further development of tools to support training in pediatric CLP. There is a need to develop further tools including outcome assessment instruments and self-directed learning materials that can be used to support lifelong learning.

Entrustable Professional Activities in General Surgery: Development and Implementation.

Entrustable Professional Activities are a holistic assessment framework developed in the Netherlands in 2005, which have recently been adopted in undergraduate medical education in the United States. As part of an increased focus on competency-based assessment, the specialty of pediatrics has led the way in incorporating them into graduate medical education. We describe the development and initial pilot process of implementation of EPAs into the assessment of General Surgery trainees.

Creating Consensus: Revisiting the Emergency Medicine Resident Scholarly Activity Requirement.

INTRODUCTION: In the context of the upcoming single accreditation system for graduate medical education resulting from an agreement between the Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association and American Association of Colleges of Osteopathic Medicine, we saw the opportunity for charting a new course for emergency medicine (EM) scholarly activity (SA). Our goal was to engage relevant stakeholders to produce a consensus document. METHODS: Consensus building focused on the goals, definition, and endpoints of SA. Representatives from stakeholder organizations were asked to help develop a survey regarding the SA requirement. The survey was then distributed to those with vested interests. We used the preliminary data to find areas of concordance and discordance and presented them at a consensus-building session. Outcomes were then re-ranked. RESULTS: By consensus, the primary role(s) of SA should be the following: 1) instruct residents in the process of scientific inquiry; 2) expose them to the mechanics of research; 3) teach them lifelong skills, including search strategies and critical appraisal; and 4) teach them how to formulate a question, search for the answer, and evaluate its strength. To meet these goals, the activity should have the general elements of hypothesis generation, data collection and analytical thinking, and interpretation of results. We also determined consensus on the endpoints, and acceptable documentation of the outcome. CONCLUSION: This consensus document may serve as a best-practices guideline for EM residency programs by delineating the goals, definitions, and endpoints for EM residents' SA. However, each residency program must evaluate its available scholarly activity resources and individually implement requirements by balancing the ACGME Review Committee for Emergency Medicine requirements with their own circumstances.

Beyond the United States Medical Licensing Examination Score: Assessing Competence for Entering Residency.

Assessments of physician learners during the transition from undergraduate to graduate medical education generate information that may inform their learning and improvement needs, determine readiness to move along the medical education continuum, and predict success in their residency programs. To achieve a constructive transition for the learner, residency program, and patients, high-quality assessments should provide meaningful information regarding applicant characteristics, academic achievement, and competence that lead to a suitable match between the learner and the residency program's culture and focus.The authors discuss alternative assessment models that may correlate with resident physician clinical performance and patient care outcomes. Currently, passing the United States Medical Licensing Examination Step examinations provides one element of reliable assessment data that could inform judgments about a learner's likelihood for success in residency. Yet, learner capabilities in areas beyond those traditionally valued in future physicians, such as life experiences, community engagement, language skills, and leadership attributes, are not afforded the same level of influence when candidate selections are made.While promising new methods of screening and assessment-such as objective structured clinical examinations, holistic assessments, and competency-based assessments-have attracted increased attention in the medical education community, currently they may be expensive, be less psychometrically sound, lack a national comparison group, or be complicated to administer. Future research and experimentation are needed to establish measures that can best meet the needs of programs, faculty, staff, students, and, more importantly, patients.

Single Accreditation System for Graduate Medical Education: Transition Update.

In 2014, the American Osteopathic Association, the American Association of Colleges of Osteopathic Medicine, and the Accreditation Council for Graduate Medical Education agreed to establish a new, single accreditation system for graduate medical education in the United States. This article focuses on recent policy enhancements and modifications to facilitate the transition to the single accreditation system and concludes with a discussion of the current transition planning after the end of the transition period on June 30, 2020.

Women's Health Curricula in Internal Medicine Residency Programs: A Scoping Review.

Background: Despite national efforts to expand women's health education, internal medicine (IM) residents remain unprepared to provide comprehensive care to women. The objectives of this scoping review are to provide an overview of published women's health curricula in IM residency programs and to identify potential areas for improvement. Materials and Methods: Studies were identified using PubMed, Embase, Cochrane Library, Scopus, Education Resources Information Center (ERIC), Web of Science, and MedEdPORTAL. Inclusion criteria included the following: (1) women's health as defined by the authors (2) description of a curriculum (3) designed for IM residents (4) based in North America, and (5) published between 1998 and 2018. Data abstracted included content, educational and assessment methods, and quality. Descriptive analysis was used to compare data. Results: Sixteen articles met the inclusion criteria. The most common women's health topics were intimate partner violence (31%) and menopause (31%). Twelve curricula (75%) were implemented in the outpatient setting. Of the teaching methods, didactics (69%) and in-clinic teaching (44%) were most commonly used. All studies that assessed attitudes, knowledge, and/or behavior showed an improvement post-intervention. No studies evaluated patient outcomes. Conclusion: To our knowledge, this is the first review summarizing published women's health curricula in IM residency. There were a limited number of published articles describing women's health curricula. Although content varied, the curricula were effective in improving attitudes, knowledge, and/or behavior with regard to women's health topics. We encourage IM residency programs to develop and disseminate women's health curricula to inform future improvements and advancements in women's health education.

From opening the 'black box' to looking behind the curtain: cognition and context in assessor-based judgements.

The increasing use of direct observation tools to assess routine performance has resulted in the growing reliance on assessor-based judgements in the workplace. However, we have a limited understanding of how assessors make judgements and formulate ratings in real world contexts. The current research on assessor cognition has largely focused on the cognitive domain but the contextual factors are equally important, and both are closely interconnected. This study aimed to explore the perceived cognitive and contextual factors influencing Mini-CEX assessor judgements in the Emergency Department setting. We used a conceptual framework of assessor-based judgement to develop a sequential mixed methods study. We analysed and integrated survey and focus group results to illustrate self-reported cognitive and contextual factors influencing assessor judgements. We used situated cognition theory as a sensitizing lens to explore the interactions between people and their environment. The major factors highlighted through our mixed methods study were: clarity of the assessment, reliance on and variable approach to overall impression (gestalt), role tension especially when giving constructive feedback, prior knowledge of the trainee and case complexity. We identified prevailing tensions between participants (assessors and trainees), interactions (assessment and feedback) and setting. The two practical implications of our research are the need to broaden assessor training to incorporate both cognitive and contextual domains, and the need to develop a more holistic understanding of assessor-based judgements in real world contexts to better inform future research and development in workplace-based assessments.

A quality framework for the role of invasive, non-interventional cardiologists in the present-day cardiac catheterization laboratory: A multidisciplinary SCAI/HFSA expert consensus statement.

The present-day cardiac catheterization laboratory (CCL) is home to varied practitioners who perform both diagnostic, interventional, and complex invasive procedures. Invasive, non-interventional cardiologists are performing a significant proportion of the work as the CCL environment has evolved. This not only includes those who perform diagnostic-only cardiac catheterization but also heart failure specialists who may be involved in hemodynamic assessment and in mechanical circulatory support and pulmonary hypertension specialists and transplant cardiologists. As such, the training background of those who work in the CCL is varied. While most quality metrics in the CCL are directed towards evaluation of patients who undergo traditional interventional procedures, there has not been a focus upon providing these invasive, noninterventional cardiologists, hospital/CCL administrators, and CCL directors a platform for quality metrics. This document focuses on benchmarking quality for the invasive, noninterventional practice, providing this physician community with guidance towards a patient-centered approach to care, and offering tools to the invasive, noninterventionalists to help their professional growth. This consensus statement aims to establish a foundation upon which the invasive, noninterventional cardiologists can thrive in the CCL environment and work collaboratively with their interventional colleagues while ensuring that the highest quality of care is being delivered to all patients.

Guidelines for hospital privileges in vascular surgery and endovascular interventions: Recommendations of the Society for Vascular Surgery.

The Hospital Privileges Practice Guideline Writing Group of the Society for Vascular Surgery is making the following five recommendations concerning guidelines for hospital privileges for vascular surgery and endovascular therapy. Advanced endovascular procedures are currently entrenched in the everyday practice of specialized vascular interventionalists, including vascular surgeons, but open vascular surgery remains uniquely essential to the specialty. First, we endorse the Residency Review Committee for Surgery recommendations regarding open and endovascular cases during vascular residency and fellowship training. Second, applicants for new hospital privileges wishing to perform vascular surgery should have completed an Accreditation Council for Graduate Medical Education-accredited vascular surgery residency or fellowship or American Osteopathic Association-accredited training program before 2020 and should obtain American Board of Surgery certification in vascular surgery or American Osteopathic Association certification within 7 years of completion of their training. Third, we recommend that applicants for renewal of hospital privileges in vascular surgery include physicians who are board certified in vascular surgery, general surgery, or cardiothoracic surgery. These physicians with an established practice in vascular surgery should participate in Maintenance of Certification programs as established by the American Board of Surgery and maintain their respective board certification. Fourth, we provide recommendations concerning guidelines for endovascular procedures for vascular surgeons and other vascular interventionalists who are applying for new or renewed hospital privileges. All physicians performing open or endovascular procedures should track outcomes using nationally validated registries, ideally by the Vascular Quality Initiative. Fifth, we endorse the Intersocietal Accreditation Commission recommendations for noninvasive vascular laboratory interpretations and examinations to become a Registered Physician in Vascular Interpretation, which is included in the requirements for board eligibility in vascular surgery, but recommend that only physicians with demonstrated clinical experience in the diagnosis and management of vascular disease be allowed to interpret these studies.

Single Accreditation System Update: A Year of Progress.

In 2014, the American Osteopathic Association (AOA), the American Association of Colleges of Osteopathic Medicine, and the Accreditation Council for Graduate Medical Education (ACGME) agreed to establish a new, single accreditation system for graduate medical education in the United States. The 5-year transition period, from July 1, 2015, through June 30, 2020, gives AOA training programs time to apply for and receive ACGME accreditation before the AOA ceases its postdoctoral accreditation functions. This article discusses policies to protect osteopathic residents during training, addresses program size, reviews progress at the midpoint of the 5-year transition, and looks at next steps in the establishment of the single accreditation system.

Understanding ACGME Scholarly Activity Requirements for General Surgery Programs in the Era of Single Accreditation and the Next Accreditation System.

Becoming compliant with the Accreditation Council for Graduate Medical Education (ACGME) requirements for scholarly activity and remaining compliant over time requires time and attention to the development of an environment of inquiry, which is reflected in detailed documentation submitted in program applications and annual updates. Since the beginning of the next accreditation system, all ACGME programs have been required to submit evidence of scholarly activity of both residents and faculty on an annual basis. Since 2014, American Osteopathic Association-accredited programs have been able to apply for ACGME accreditation under the Single Graduate Medical Education Accreditation initiative. The Residency Program Director, Chair, Designated Institutional Official, Faculty, and coordinator need to work cohesively to ensure compliance with all program requirements, including scholarly activity in order for American Osteopathic Association-accredited programs to receive Initial ACGME Accreditation and for current ACGME-accredited programs to maintain accreditation. Fortunately, there are many ways to show the type of scholarly activity that is required for the training of surgeons. In this article, we will review the ACGME General Surgery Program Requirements and definitions of scholarly activity. We will also offer suggestions for how programs may show evidence of scholarly activity.

Perceived Importance of Pursuing Osteopathic Recognition in the Single Accreditation System: A Survey of Medical Students, Residents, and Faculty.

CONTEXT: As graduate medical education evolves under the single accreditation system, osteopathic residency programs and consortia strive for sustainable ways to achieve and support the Osteopathic Recognition (OR) designation. OBJECTIVE: To determine whether differences existed in perceived importance of OR from 3 cohorts of osteopathic stakeholders: students, residents, and faculty. METHODS: A nonexperimental quantitative cross-sectional online survey was administered during February and March 2016 to osteopathic medical students at Michigan State University College of Osteopathic Medicine and residents and faculty from the affiliated Statewide Campus System. After examining final working dataset patterns, a series of Kruskal-Wallis tests were conducted to identify statistically significant differences in perceived OR importance response categories across sample subgroups, including program specialty and primary vs non-primary care specialty. RESULTS: The final analytic sample comprised 278 osteopathic medical students, 359 residents, and 94 faculty members. Of 728 respondents, 497 (67.9%) indicated that OR was "somewhat important," "important," or "very important." The overall perceived importance category patterns varied significantly across students, residents, and faculty cohort respondents (, P<.001) and program specialty (, P<.001), as well as between primary care and non-primary care residents and faculty (, P<.001). CONCLUSION: Based on these initial results, OR is generally valued across osteopathic stakeholder groups, but significant differences may exist between different types of students, residents, and faculty. Pre- and postgraduate educational support structures designed to reduce barriers to OR implementation may help to sustain osteopathic principles and practice in the single accreditation system.

[Ultrasound training in the professional development of radiological specialists : Concepts and challenges]. / Sonografische Weiterbildung auf dem Weg zum radiologischen Facharzt : Konzepte und Herausforderungen.

ISSUE: Ultrasound is an integral part of imaging diagnostics but, unlike CT or MRI, requires the physician to have advanced technical skills for the implementation and documentation of studies. CURRENT SITUATION: Owing to poor remuneration and the large effort required, ultrasound is not a priority at many institutions, and compared to CT, MRI or interventions, little reward is given to those committed to ultrasound. Intense practical teaching is rarely given. As a result, residents have to teach themselves or gain experience during rotations outside radiology. In some cases, they are not educated at all. Only rarely do residents in radiology participate in certified ultrasound courses, compared to other clinical disciplines. ONGOING DEVELOPMENTS: (1) Standardized ultrasound curricula accompanying resident training, training focused on contrast-enhanced ultrasound, ultrasound-guided interventions, vascular ultrasound, and typical radiological applications of ultrasound like image fusion for biopsies or therapeutic interventions; (2) interdisciplinary ultrasound centers; (3) fostering of ultrasound education by the German Radiological Society (DRG) through intensive courses during the annual meeting. ACHIEVEMENTS: The above measures will help to increase skill and dexterity of radiologists in ultrasound, to introduce typical radiological applications of ultrasound into a broader field of applications and increase the awareness of these methods, and to strengthen the role of ultrasound in resident training. FUTURE REQUIREMENTS: (1) One senior radiologist in charge of ultrasound in each department; (2) communication of and adherence to examination and documentation standards; (3) demonstration of ultrasound studies during rounds and boards; (4) interdisciplinary centers for ultrasound education.

Meeting ACGME Standards Under a Unified Accreditation System: Challenges for Osteopathic Graduate Medical Education Programs.

In 2014, the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine signed a memorandum of understanding (MOU) with the Accreditation Council for Graduate Medical Education (ACGME) to create a unified accreditation system for graduate medical education (GME) under the ACGME. The AOA will cease to accredit GME programs on June 30, 2020. By then, AOA-accredited programs need to apply for and achieve ACGME initial accreditation. The terms of the MOU also made it advantageous for some formerly nonteaching hospitals to establish AOA programs, chiefly in primary care, as a step toward future ACGME accreditation.In transitioning AOA programs to the ACGME system, hospitals with osteopathic GME can expect to encounter challenges related to major differences between AOA and ACGME standards. The minimum numbers of residents for ACGME programs in most specialties are greater than those for AOA programs, which will require hospitals that may already be at their federal caps to add additional residency positions. ACGME standards are also more faculty- and staff-intensive and require additional infrastructure, necessitating additional financial investments. In addition, greater curricular specificity in ACGME standards will generate new educational and financial challenges.To address these challenges, hospitals may need to reallocate resources and positions among their current AOA programs, reducing the number of programs (and specialties) they sponsor. It is expected that a number of established and new AOA programs will choose not to pursue ACGME accreditation or will fail to qualify for ACGME initial accreditation.

Allopathic and Osteopathic Medicine Unify GME Accreditation: A Historic Convergence.

BACKGROUND AND OBJECTIVES: In 1968, the American Medical Association resolved to accept qualified graduates of osteopathic medical schools into its accredited Graduate Medical Education (GME) programs. An equally momentous decision was arrived at in 2014 when the Accreditation Council for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), and the American Association of Colleges of Osteopathic Medicine (AACOM) resolved to institute a single unified GME accreditation system by July 1, 2020. As envisioned, the unified accreditation system will all but assure system-wide consistency of purpose and practice in anticipation of the Next Accreditation System (NAS) of the ACGME. Governance integration replete with AOA and AACOM and osteopathic representation on the ACGME Board of Directors is now well underway. What is more, osteopathic representation on current Review Committees (RCs) and in a newly established one with an osteopathic focus has been instituted. Viewed broadly, the unification of the GME accreditation system goes a long way toward recognizing the overlapping characteristics in the training and practice of allopathic and osteopathic medicine. As such, this momentous development represents the latest, indeed boldest leap toward convergence between the two historic branches of American medicine. In this Health Policy Analysis we seek to place the impending unification of the GME accreditation process in its historical context, delineate its near-term impact, and discuss the potential long-term implications thereof.

Single Accreditation System Update: Gaining Momentum.

In July 2014, the American Osteopathic Association House of Delegates endorsed the establishment of a new, single graduate medical education accreditation system in collaboration with the Accreditation Council for Graduate Medical Education and the American Association of Colleges of Osteopathic Medicine. Since that time, the osteopathic medical community has made substantial headway in the transition to the new system. This article provides an update on the transition.