Assessment of Plastic Surgery Residency Applications without United States Medical Licensing Examination Step 1 Scores.

SUMMARY: The United States Medical Licensing Examination announced the changing of Step 1 score reporting from a three-digit number to pass/fail beginning on January 1, 2022. Plastic surgery residency programs have traditionally used United States Medical Licensing Examination Step 1 scores to compare plastic surgery residency applicants. Without a numerical score, the plastic surgery residency application review process will likely change. This article discusses advantages, disadvantages, and steps forward for residency programs related to the upcoming change. The authors encourage programs to continue to seek innovative methods of objectively and holistically evaluating applications.

Using a resident-led patient safety quality council to educate future QI leaders.

Resident-led councils represent an important initiative to involve trainees in patient safety, but little is known about how to create and sustain one of these councils. We evaluated the impact of a resident-led patient safety council in an internal medicine residency program. We assessed change in resident perception of safety issues over 3 years, scholarship activities, and behavioral choices to participate or lead patient safety activities after residency.The Stony Brook Internal Medicine Residency Program formed the Patient Safety and Quality Council (PSQC) in 2014, consisting of fifteen peer-nominated residents serving a three-year term. Surveys were distributed annually from 2014 to 2017 to measure resident council members' perception of patient safety. The number of safety-related abstract/publications were tracked during and one year after graduation. Additionally, graduates from the council were surveyed to assess the influence of the council on post residency involvement and leadership in safety activities.A total of 18 residents have participated in the council from 2014 to 2017. Overall, resident perception of safety culture improved. A total of 17/18 (94%) PSQC resident members demonstrated scholarship activities in safety during residency: 8/18 (44%) were engaged in an independent Quality Improvement (QI) project, 5/18 (27%) achieved a quality improvement leadership role post residency. A total of 15 of 18 (83%) recent graduates suggest that involvement with the safety council during residency fostered future involvement in patient safety.Implementation of a resident-led safety council can help to improve the safety culture, generate scholarly activities, and encourage continued participation in patient safety after graduation.

Clinical supervision in general practice training: the interweaving of supervisor, trainee and patient entrustment with clinical oversight, patient safety and trainee learning.

Australian general practice trainees typically consult with patients from their first week of training, seeking in-consultation supervisory assistance only when not sufficiently confident to complete patient consultations independently. Trainee help-seeking plays a key role in supervisor oversight of trainee consultations. This study used focus groups and interviews with general practice supervisors to explore their approaches to trainee help-seeking and in-consultation supervision. Supervisor approaches are discussed under three themes: establishing a help-seeking culture; perceptions of in-consultation assistance required; and scripts for help provision. Within these themes, three interwoven entrustment processes were identified: supervisor entrustment; trainee self-entrustment; and 'patient entrustment' (patient confidence in the trainee's clinical management). Entrustment appears to develop rapidly, holistically and informally in general practice training, partly in response to workflow pressure and time constraints. Typical supervisor scripts and etiquette for help-provision involve indirect, soft correction strategies to build trainee self-entrustment. These scripts appear to be difficult to adapt appropriately to under-performing trainees. Importantly, supervisor scripts also promote patient entrustment, increasing the likelihood of patients returning to the trainee and training practice for subsequent review, which is a major mechanism for ensuring patient safety in general practice. Theories of entrustment in general practice training must account for the interplay between supervisor, trainee and patient entrustment processes, and work-related constraints. Gaps between entrustment as espoused in theory, and entrustment as enacted, may suggest limitations of entrustment theory when extended to the general practice context, and/or room for improvement in the oversight of trainee consultations in general practice training.

Clinical academic research internships for nurses, midwives and allied health professionals: a qualitative evaluation.

BACKGROUND: Nurses, midwives and allied health professionals are integral to research, yet rarely engage simultaneously in research and clinical practice. Clinical academic internships offer a route for accessing academic research training. AIM: To determine facilitators and barriers to nurses' participation and engagement in research internships, and to suggest improvements for future programmes. DISCUSSION: The experiences of ten health professional research interns were explored, using a method based on a synthesis between grounded theory and content analysis. Four categories emerged: integrating clinical and research aspirations; support - or lack of it; the hidden curriculum; and the legacy effect. Respondents identified facilitators and barriers to engagement in these categories, including unforeseen challenges. CONCLUSION: Formal support is necessary but is insufficient for fostering engagement and maximising benefits. Participation must be supported by colleagues and enabled by institutional structures. The potential effects of internships on engagement with research is considerable but requires collaboration between all stakeholders. IMPLICATIONS FOR PRACTICE: Deeper institutional engagement is needed so that internship opportunities are fully supported by all colleagues and practically enabled by institutional structures. Future schemes should attempt to promote opportunities to collaborate through group projects to reduce researchers' isolation.

Home Visits Improve Attitudes and Self-Efficacy: A Longitudinal Curriculum for Residents.

OBJECTIVES: To develop a competency-based, adaptable home visit curricula and clinical framework for family medicine (FM) residents, and to examine resident attitudes, self-efficacy, and skills following implementation. DESIGN: Quantitative analysis of resident survey responses and qualitative thematic analysis of written resident reflections. SETTING: Urban FM residency program. PARTICIPANTS: A total of 43 residents and 20 homebound patients in a home-based primary care program. INTERVENTION: A home-based primary care practice and accompanying curriculum for FM residents was developed and implemented to improve learners' confidence and skills to perform home visits. MEASUREMENTS: A 10-question survey with a 4-point Likert scale and open-ended responses. Written resident reflections following home visits. RESULTS: Over 3 years, 43 unique respondents completed a total of 79 surveys evaluating attitudes, skills, and barriers to home care. Some residents may have completed the survey more than once at different stages in their training. Overall, 86% are interested in home visits in future practice, and 78% of survey responses indicated an increased likelihood to perform home visits with more training. Learners with two or more home visits reported significantly improved confidence. Themes across all resident reflections included social determinants of health, patient-physician relationship, patient-home assessment, patient autonomy/independence, and physician wellness/attitudes. Residents described how home visits encourage more holistic care to improve outcomes for patients who are homebound. CONCLUSION: Our home visit curriculum provided new learning, an enhanced desire to practice home-based primary care, improved learner confidence, and could help residents meet the need of a growing population of adults who are homebound. J Am Geriatr Soc 68:852-858, 2020.

Challenges in surgical oncology training in Brazil: From history to a board-certified specialization.

The Brazilian Society of Surgical Oncology was established over 30 years ago. Despite that, surgical oncology was finally recognized as a Board-Certified medical specialty in 2017 and has strengthened its role in the standardization of surgical and multimodal approaches in our country. This article aims to describe the process and the main challenges of the specialists training who are qualified for job opportunities and who meet the expectations of the recently created competence matrix for surgical oncologists in Brazil. Thus, we hope to expose the challenges of teaching surgical oncology, describe its history and experiences in important country services, and outline the minimum requirements for creating a more humanistic surgical oncologist who is updated and fully committed with multidisciplinary treatment for cancer patients. We conclude that the main characteristic that the surgical oncologist must have is the ability to offer holistic treatments to the patient, based on the highest level of evidence, love, and compassion, to direct the treatment and understand all of the afflictions that arise with a cancer diagnosis. Moreover, the surgical oncologist in training and in the field must be continuously updating himself to offer the best options of treatment to patients.

Internal Medicine Residency Program Responses to the Increase of Residency Applications: Differences by Program Type and Characteristics.

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.

A model for sustainable laser tattoo removal services for adult probationers.

PURPOSE: The purpose of this paper is to describe a sustainable free laser tattoo removal clinic for economically disadvantaged adult probationers. DESIGN/METHODOLOGY/APPROACH: This paper describes the partnerships, methods and challenges/lessons learned from the implementation of a free monthly laser tattoo removal program for adult probationers within a medical school setting in California. FINDINGS: Possible patients are identified via a collaboration with the county's Probation Department. Founded in 2016, this monthly program has provided tattoo removal services to >37 adult patient probationers, many of whom receive follow-up treatments. Clients seek to remove about four blue/black ink tattoos. Since its inception, 23 dermatology residents have volunteered in the program. Challenges to patients' ongoing participation primarily pertain to scheduling issues; strategies for overcoming barriers to participation are provided. No safety concerns have emerged. SOCIAL IMPLICATIONS: Programs such as this public-private partnership may benefit probationers by eliminating financial barriers associated with tattoo removal. This model supports the training of cohorts of dermatologists seeking community service opportunities related to laser medicine. Others seeking to implement a similar program may also consider expanding treatment days/times to facilitate access for working probationers, providing enrollment options for other health and social services (e.g. public insurance, food stamp programs) and hosting a mobile onsite clinic to address clients' physical and mental health needs. ORIGINALITY/VALUE: This paper describes a unique collaboration between law enforcement and a medical school and it may assist other jurisdictions in establishing free tattoo removal programs for the benefit of probationers. The methods described overcome challenges regarding the implementation of this specialized clinical service.

The Development of a Pediatric Osteopathic Recognition Track.

It is clear that graduates of osteopathic medical schools desire to maintain their Osteopathic Manipulative Medicine (OMM) and Osteopathic Principles and Practice (OPP) skills and mindset of their professional identity. In a recent survey, 68% of 1,523 third year osteopathic medical students indicated that it would be more appealing to attend a residency with osteopathic recognition, with more than half indicating this would play an important role in how they made their rank list. There are currently few options available to DO students that would like to maintain their OMM and OPP skills during pediatric residency programs, and with an increasing number of DO graduates each year, there may be a need to provide more opportunities for them. In this article we describe our pediatric Osteopathic Recognition Track, which has the goal of providing an appropriate level of osteopathic focused training to our small number of residents in the track (4 annually) while incorporating them fully into a large and very busy pediatric program. We use Bloom's taxonomy as the framework upon which to provide details about our approach.

Radiation oncology resident education in palliative care.

Palliative and supportive care education for radiation oncologists in training is essential to deliver comprehensive care to patients. Surveys on palliative care education among radiation oncology program directors and residents demonstrate a disparity in formal teaching and didactics. Integration of formal didactics, communications skills programs, and teaching modules are being piloted at academic centers. A dedicated palliative radiation oncology service has been implemented and the experience evaluated. Future directions to improve resident education in palliative care include improving access and time dedicated to formal didactics, online and interactive modules, rotation in a palliative care service, emphasis on board examinations, and consideration of an advanced palliative care fellowship for radiation oncologists. This is the first review of the available literature reviewing formal palliative education in radiation oncology training programs in the United States.

Knowledge and Self-Efficacy Assessment of Residents and Fellows Following Palliative Care Unit Rotation: A Pilot Study.

BACKGROUND: In Germany, some units of specialized palliative care (SPC) offer a 6- to 12-month rotation for resident physicians (RPs) and fellows from different specialties. OBJECTIVE: This pilot study aimed to evaluate feasibility of assessing palliative care knowledge (PCK) and palliative care self-efficacy (PCSE) using a paper-based questionnaire. METHODS: Palliative care knowledge and PCSE were assessed by introducing a score, followed by a descriptive analysis (determination of frequency, mean, median, and range) using nonparametric tests (χ2 test, Mann-Whitney U test). RESULTS: We assessed 17 RPs following SPC rotation and 16 board-certified specialists (BCSs) who had no experience in SPC from 3 German comprehensive cancer centers. Resident physicians were predominantly enrolled in residency programs of hematology and oncology (n = 6), anesthesiology (n = 6), and psychosomatic medicine (n = 3). Resident physicians rotated between year 1 and 8 of residency. Fifteen RPs (88%) had elected this rotation and 72% preferred 12-month duration. The total PCK score of PCK was 27 (RPs) and 24 (BCSs; P = .002). Mean PCSE scores were 46 (RPs) and 39 (BCSs; P = .016). Of 71% of RPs, only 27% of BCSs knew how support of hospice service was initiated ( P = .004). Participants rated the items as comprehensible (n = 24; 73%), relevant (n = 25; 76%) and the questionnaire as adequately long (n = 23; 70%). CONCLUSION: An improved PCK and PCSE were observed in physicians who rotated through an SPC unit; this resulted in an increased tangibility of local palliative care and hospice services. The questionnaire was comprehensible, relevant in terms of content, and adequate in length for a prospective multicenter survey.

O treinamento formal em pesquisa científica aumenta a participação de residentes de Cirurgia Plástica em artigos revisados por pares / Formal training in scientific research increases the participation of plastic surgery residents in peer-reviewed articles

Introdução: Os objetivos deste estudo foram: (1) delinear um programa de treinamento em habilidades de pesquisa científica, (2) avaliar o perfil da participação dos residentes de Cirurgia Plástica em artigos, e (3) analisar o impacto da implementação do programa de treinamento sobre índices bibliométricos quantitativos. Métodos: Trata-se de uma análise bibliométrica da participação de residentes de Cirurgia Plástica de uma única instituição em artigos publicados em periódicos revisados por pares entre 2006 e 2014. Dados coletados: número de autores, posição dos residentes entre os autores, títulos, bases de indexação e fator de impacto dos periódicos, desenhos dos estudos e níveis de evidência. Dois períodos (janeiro/2006- janeiro/2010 [A] e fevereiro/2010-fevereiro/2014 [B]) foram criados para estudar o perfil evolutivo do impacto da implementação do programa de treinamento delineado neste estudo. Resultados: Houve predomínio significativo (p < 0,05) de artigos publicados em periódicos nacionais, em língua portuguesa, nas bases de dados SciELO e LILACS, artigos sem residentes como autor correspondente, sem fator de impacto, sem hipóteses e com nível de evidência III (estudos retrospectivos). A análise comparativa interperíodos revelou um aumento significativo (p < 0,05) de artigos publicados, de residentes com publicações ao término da residência, da participação de um ou mais residentes e de artigos publicados em inglês (período A < período B). Conclusão: A implementação do programa de treinamento em habilidades de pesquisa científica determinou um aumento da atividade de pesquisa (artigos revisados por pares) durante a residência.

Introduction: The objectives of this study were as follows: (1) to outline a scientific research skills training program, (2) to evaluate the profile of participation of plastic surgery residents in articles, and (3) to analyze the impact of the implementation of the training program on quantitative bibliometric indexes. Methods: This was a bibliometric analysis of the participation of plastic surgery residents of a single institution in articles published in peer-reviewed journals between 2006 and 2014. The data collected were the number of authors, position of residents among authors, article titles, indexing databases and impact factor of the journals, study design, and levels of evidence. Two periods (January 2006 to January 2010 [A] and February 2010 to February 2014 [B]) were created to study the evolutionary profile of the impact of the implementation of the training program outlined in this study. Results: A significant predominance (p < 0.05) was observed among articles published in national journals in the Portuguese language and in the SciELO and LILACS databases, and articles without residents as corresponding author, without impact factor, without assumptions, and with a level of evidence III (retrospective studies). The inter-period comparative analysis revealed a significant increase (p < 0.05) in the numbers of published articles and residents with publications at the end of their residency, in the involvement of one or more residents, and in the articles published in English (period A < period B). Conclusion: The implementation of a scientific research skills training program led to an increase in research activity of (peer-reviewed articles) during the residency.

Variability of Burnout and Stress Measures in Pediatric Residents: An Exploratory Single-Center Study From the Pediatric Resident Burnout-Resilience Study Consortium.

Residency is a high-risk period for physician burnout. We aimed to determine the short-term stability of factors associated with burnout, application of these data to previous conceptual models, and the relationship of these factors over 3 months. Physician wellness questionnaire results were analyzed at 2 time points 3 months apart. Associations among variables within and across time points were analyzed. Logistic regression was used to predict burnout and compassionate care. A total of 74% of residents completed surveys. Over 3 months, burnout ( P = .005) and empathy ( P = .04) worsened. The most significant cross-sectional relationship was between stress and emotional exhaustion (time 1 r = 0.61, time 2 r = 0.68). Resilience was predictive of increased compassionate care and decreased burnout ( P < .05). Mindfulness was predictive of decreased burnout ( P < .05). Mitigating stress and fostering mindfulness and resilience longitudinally may be key areas of focus for improved wellness in pediatric residents. Larger studies are needed to better develop targeted wellness interventions.

Unmatched Integrated Cardiothoracic Surgery Program Applicants: Where Do They End Up?

BACKGROUND: With the recent introduction of Integrated Cardiothoracic Surgery Residency Programs (IPs), limited data exist on unmatched applicants. We aimed to determine the dropout rate in individuals who applied for IP but did not match. METHODS: An online Institutional Review Board-approved survey was sent to current residents (n = 409), provided by the Thoracic Surgery Directors Association, to evaluate preferences and pathway to cardiothoracic surgery (CTS). Descriptive analysis was performed on quantitative data. Main Residency Match Data from 2008 to 2017 were collected. RESULTS: Of 250 respondents, 89 (36%) were in IPs. In the cohort, 110 (44%) applied for at least one IP, whereas only 10 of the remaining 140 CTS residents had contemplated applying. From written comments of those 140 residents, the most common reasons against applying for IP programs were (1) uncertainty of IP training/belief that general surgery offered more well-rounded training and (2) uncommitted to CTS as a medical student. Interestingly, 96% of IP residents were set on a cardiac career, whereas a larger proportion of 4/3 and traditional residents were interested in general thoracic (36%). According to the National Resident Matching Program, 147 individuals applied to IP programs from 2008 to 2011 and were unmatched. Only 20 of those individuals (14%), from our results, ended up in a CTS residency program. CONCLUSIONS: Only a small percentage of applicants that did not match to an IP from 2008 to 2011 have ended up in CTS. As IPs continue to develop and improve, the concerns brought about by current CTS residents must be addressed to attract the next generation of exceptional surgeons.

Implementing a Narrative Medicine Curriculum During the Internship Year: An Internal Medicine Residency Program Experience.

INTRODUCTION: Narrative medicine develops professional and communication skills that align with Accreditation Council for Graduate Medical Education competencies. However, little is known about a narrative medicine curriculum's impact on physicians in training during residency. Implementing a narrative medicine curriculum during residency can be challenging because of time constraints and limited opportunity for nonclinical education. METHODS: Six sessions were implemented throughout one academic year to expose first-year internal medicine residents (interns) to narrative medicine. Attendance and participation were documented. At the end of the year, interns completed an open-ended survey to gauge their perception of their experience with the sessions. RESULTS: In total, 17 interns attended at least 1 narrative medicine session, and each session averaged 5.4 attendees. Thirteen eligible interns completed the survey. Thematic analysis identified 3 predominant themes: Mindfulness, physician well-being, and professionalism. DISCUSSION: Overall, the narrative medicine sessions were well attended and the curriculum was well received. This intervention demonstrates the value of a narrative medicine curriculum during medical resident training. Large prospective studies are necessary to identify the long-term benefits of such a curriculum.

Implantação da residência médica e multiprofissional em saúde da família em um município paulista: percepção de residentes da primeira turma (2014-2016) / Implementation of medical and multi-professional residency in family health in health in a São Paulo municipality: first class residents' perception of (2014-2016)

Introdução: No Sistema Único de Saúde (SUS), a implantação de novos modelos assistenciais, como a Estratégia Saúde da Família, vem demandando uma qualificação dos profissionais. Nessa direção, a Residência em Saúde constitui modalidade de ensino de pós-graduação lato sensu, caracterizada pela formação em serviço. Assim, no município de Sorocaba/SP, foram implantados Programas de Residência Médica e Multiprofissional em Saúde da Família. Objetivos: Identificar e analisar as percepções da primeira turma de residentes (2014-2016) a respeito de sua experiência nos Programas de Residência em Saúde da Família. Método: Foi utilizada a abordagem qualitativa de pesquisa, com a técnica do grupo focal. Foram realizados grupos com residentes de Enfermagem, Medicina e Odontologia. O material foi analisado segundo os princípios da análise temática. Resultados: Foram obtidas quatro categorias: a) as várias mudanças de 2014; b) a preceptoria e a tutoria; c) a estruturação do programa; d) a percepção do aprendizado ao final da residência. Discussão: Os residentes consideraram que a experiência vivida foi interessante e proveitosa. Vários dos pontos críticos apontados por eles são semelhantes às experiências de implantação de residência em Saúde da Família de outros municípios. Conclusão: O estudo aponta um caminho possível para a formação dos profissionais de saúde para o SUS, especialmente para sua principal estratégia de organização da Atenção Básica, que é a Estratégia de Saúde da Família.(AU)

Introduction: In the Brazilian Unified Health System, the implementation of novel healthcare models, such as Family Health Strategy, demands training and qualification of new professionals. In this setting, Healthcare Residency constitutes a lato sensu graduation marked by in-service education. In the city of Sorocaba/ SP, Medical and Multi-professional Family Health Residency Programs were implemented. Objectives: To pinpoint and analyze the perceptions of the first class residents regarding their experience in these Programs. Method: A qualitative research approach, with the focal group technique was used. Groups with residents that made up the Family Health core team (Nursing, Medicine and Dentistry) were created. The material was analyzed according to the principles of thematic analysis. Results: Four categories were obtained: a) the various changes in 2014; b) tutoring and mentoring; c) the structuring of the program; d) the learning perception at the end of the residency. Discussion: Residents have considered the experience they have been through to be very exciting and profitable. Several of the critical points raised by the residents are similar to implementation experiences of residency in Family Health in other cities. Conclusion: The study suggests a possible way to train healthcare professionals to the Unified Health System, especially for its main organization strategy of Basic Attention, which is the Family Health Strategy.(AU)