The Impact of Training in Multimodal Communication Skills on Psychotropic Medication Use in Dementia Care.

Aim This study aimed to assess the trends in psychotropic drug prescriptions among elderly residents with dementia following the continuous implementation of multimodal comprehensive care communication skills training for staff in a long-term care facility. Methods This retrospective single-center cross-sectional study utilized the database of an urban public hospital that included a long-term care facility. The data were collected from 2016 to 2020. All 130 staff members at the hospital (52 nurses, 48 professional caregivers, seven rehabilitation staff members, three physicians, and three pharmacists) initiated multimodal comprehensive care communication skills basic training from October 2014 to December 2015, which was followed by continuous monthly training until the end of 2020. Antipsychotic prescription rates for residents aged over 65 years with dementia were measured throughout the study period. Results A total of 506 eligible residents were identified, the median age was 86.0 years (IQR: 81.0-90.0), and 283 (55.9%) residents were females. The prescription rates for psychotropic drugs among residents with dementia decreased significantly (43.5% in 2016, 27.0% in 2020; p=0.01). Notably, the percentage of patients prescribed anxiolytics decreased significantly (from 4.7% to 0.0%), while the percentage of patients receiving antipsychotic drugs, hypnotics, antidepressants, or antiepileptic drugs remained unchanged over time. The prescription rates for antidementia drugs significantly decreased from 15.3% to 4.0%. Conclusion The prescription rates of psychotropic drugs were significantly reduced following multimodal comprehensive care communication skills training for staff at a long-term care facility. The improvement in communication skills among staff at long-term care facilities has a tangible impact on reducing drug use among elderly residents with dementia.

The 7 Elements Communication Rating Form for Teaching and Assessing Medical Communication Competency.

INTRODUCTION: Medical communication skills are a critical component of clinical medicine and patient satisfaction. Communication skills are difficult to teach and evaluate, necessitating tools that are effective and efficient. This study presents and validates the 7 Elements Communication Rating Form (7E-CRF), a streamlined, dual-purpose, evidence-based medical communication checklist that functions as a teaching and assessment tool. METHOD: A 14-item teaching and assessment tool is described and validated using face, concurrent, and predictive validity indices. The study was conducted with 661 medical students from the West Virginia School of Osteopathic Medicine (WVSOM). Student performance was assessed in year 1 labs, year 2 labs, and year 2 and year 3 objective structured clinical examination (OSCE). These internal indices were compared with student performance on the Humanistic Domain of the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2-Performance Evaluation (PE), a licensure exam previously taken in years 3 or 4 of osteopathic medical schools. RESULTS: The evidence of interrater reliability and predictive validity is strong. Data from the 7E-CRF is compared to performance on the COMLEX Level 2-PE, Humanistic Domain. The 7E-CRF can identify students who are at a 10-fold increased risk of failure on the COMLEX Level 2-PE Humanistic Domain.  Conclusions: The 7E-CRF integrates instruction and assessment, based on a national and international model. The simplicity, foundation in professional consensus, ease of use, and predictive efficacy make the 7E-CRF a highly valuable instrument for medical schools in teaching and evaluating competency in medical communication skills.

Perceptions of a virtual education platform: how plastic surgery education has progressed during the COVID-19 pandemic at one academic institution.

BACKGROUND: To continue education during the COVID-19 pandemic, we implemented a Virtual Education Platform (VEP) and Virtual Visiting Professorship (VVP) in March 2020 into our plastic surgery residency curriculum. This study investigated resident and guest speaker perceptions of the VEP since the start of the pandemic. METHODS: The VEP consists of weekly VVP lectures and usual conferences held over Zoom. In May 2020, residents and speakers completed surveys that assessed the perceptions of the VEP using a 5-point Likert scale and open-ended responses. In August 2021, residents also completed follow-up surveys. RESULTS: A total of 19 (100%) residents and 10 (100%) speakers responded to the 2020 surveys and 15 (88.2%) residents responded to the 2021 follow-up survey. Speakers represented nine academic institutions, one international. 74% of residents responded that they learned a lot or a great deal from the VVP. In 2021, 100% of residents agreed that virtual conferences should remain a core component in PRS residency education, even after social distancing requirements subside. The VVP lectures were mentioned as the most helpful lectures in both years. Easy accessibility without travel time was the most mentioned advantage of the VEP in both years, with significantly more residents citing this benefit in 2021 (p = 0.0076). The most reported disadvantage for residents was the lack of social interaction and community in both years, with significantly more residents in 2021 citing this as a disadvantage (p = 0.0307). Residents' attitudes also shifted such that significantly more residents liked and were satisfied with the VVP lectures from 2020 to 2021 (p = 0.04). CONCLUSION: Over a year into the COVID-19 pandemic, resident perceptions of a virtual education platform and virtual visiting professorship were very positive. The quick development, implementation, and high efficacy of these educational experiences underscore that learning is possible in alternative forms in unprecedented times.

Interpersonal and communication skills development in general nursing preceptorship education and training programmes: A scoping review.

AIM: The aim of this systematic scoping review is to examine and synthesise the available literature on developing interpersonal and communication skills in general nursing preceptorship education programmes. BACKGROUND: Highly developed interpersonal and communication skills are an essential component of nursing preceptorship. Preceptors are integral in facilitating, guiding, and developing positive interpersonal relationships between the nursing student (the preceptee), the qualified nurse (the preceptor), and patients. They also have a responsibility to foster and develop preceptees' interpersonal and communication skills and assess and deem preceptees as competent in such skills. Furthermore, preceptors require effective interpersonal and communication skills to carry out key responsibilities of their role, including creating a safe clinical learning environment, teaching, and providing effective feedback. DESIGN: A scoping review was conducted using the methodological framework of Arksey and O'Malley. The PRISMA Extension for Scoping Reviews guided the reporting. METHODS: Five electronic databases were searched for relevant articles in consultation with a librarian, supplemented by hand-searching and internet searches for grey literature. A total of 19,431 potentially relevant articles published between Jan 2000 and August 2021 were retrieved from the initial search, and an additional six articles were obtained from the supplemental search. A total of 146 articles were independently reviewed by two researchers, resulting in 24 articles eligible for inclusion in the review. RESULTS: Several themes were identified in the literature that influenced the development of interpersonal and communication skills in preceptorship education and training programmes, including design and development of programmes, key learning outcomes, pedagogical approaches of preceptorship education and training programmes and interpersonal & communication skills development in preceptorship education and training programmes. Conclusions This review highlighted that research on developing interpersonal and communication skills amongst preceptors is mainly absent from the literature. Further research to address these knowledge gaps is warranted. The results from this review can be used to inform future curriculum design and development of nursing preceptorship education and training programmes.

Patients benefi ts from physicians empathy and results of including of empathy development into medical training.

BACKGROUND:  The extent of empathy is an individual human property, not completely dependent on cognitive intelligence. People arise with certain genetic fundament for empathy but the ability to perceive empathically develops further during the life. There has been much discussion in the medical literature about the importance of empathy and physician communication style in medical practice. Empathy has been shown to have a very real positive eff ect on patients outcomes. The literature suggests that empathy training is warranted and should be incorporated into surgical residencies through didactics, role-playing and simulations, and apprenticeship to empathic attending role models. PURPOSE: This paper reviews empathy and its importance as it pertains to the physician-patient relationship and improving patients outcomes, and the need for increased education in empathy during medical training.

Supervision of Surgical Trainees During Operative Procedures: Implementation of a Formal Preoperative Surgical Checklist.

Background Trainers in surgery have an educational obligation to train trainees in performing operative procedures. Objective We hypothesized that poor concordance manifests as discrepancies between the trainee and the trainer, with an associated reduction in satisfaction with the training experience, perception of training quality, and completion of workplace-based assessments (WBAs). This study also aimed to validate the novel Supervised Training Operative Procedure (STOP) online tool. Method We developed an online proforma (STOP online tool) and conducted a prospective, single-blinded study of 53 orthopedic operative procedures with 53 trainees between January 19, 2019, and August 27, 2019. Results Forty-four (82%) trainees were listed as the primary surgeon. The overall mean trainee satisfaction (on a 0-10 Likert scale) was 8.25 (range: 3-10), and the mean trainer satisfaction was 8.28 (range: 4-10). A preoperative discussion between the trainee and the trainer occurred in 96.2% of the cases. Forty-eight (91%) trainers preoperatively established trainees' objectives and 91% (n = 48) of the cases showed postoperative completion of objectives. Forty-four (83%) trainers anticipated workplace-based assessment (WBA) completion for trainees, and this translated into 41 (77%) completed WBAs. Overall, 47 (92.9%) trainees felt that the STOP tool would be useful as a surgical training checklist and in the completion of WBAs. Conclusion The STOP checklist is useful in understanding qualitative and quantitative measures of the overall trainee performance of an operative case. This holistic approach will enable us to establish a structured perioperative surgical training checklist, as trainee and trainer requirements are dependent on one another.

How I Learned is How I Teach - Perspectives on How Faculty Surgeons Approach Informed Consent Education.

OBJECTIVE: To understand the variability of surgical attending experience and perspectives regarding informed consent and how it impacts resident education DESIGN: A novel survey was distributed electronically to explore faculty surgeon's personal learning experience, knowledge, clinical practice, teaching preferences and beliefs regarding informed consent. Chi-square and Kruskal-Wallis testing was performed to look for associations and a cluster analysis was performed to elucidate additional patterns among. SETTING: Single, tertiary, university-affiliated health care system (Yale New Haven Health in Connecticut), including 6 teaching hospitals. PARTICIPANTS: Clinical faculty within the Department of Surgery. RESULTS: A total of 85 surgeons responded (49% response rate), representing 17 specialties, both private practice and university and/or hospital-employed, with a range of years in practice. Across all ages, specialties, the most common method for both learning (86%) and teaching (82%) informed consent was observation of the attending. Respondents who stated they learned by observing attendings were more likely to report that they teach by having trainees observe them (OR 8.5, 95% CI 1.3-56.5) and participants who recalled learning by having attendings observe them were more likely to observe their trainees (OR 4.1, 95% CI 1.5-11.2).Cluster analysis revealed 5 different attending phenotypes with significant heterogeneity between groups. A cluster of younger attendings reported the least diverse learning experience and high levels of concern for legal liability and resident competency. They engaged in few strategies for teaching residents. By comparison, the cluster that reported the most diverse learning experience also reported the richest diversity of teaching strategies to residents but rarely allowed residents to perform consent with their patients. Meanwhile, 2 other cluster provided a more balanced experience with some opportunities for practice with patients and some diversity of teaching- these clusters, respectively, consist of older, experienced general surgeons and surgeons in trauma and/or critical care. CONCLUSIONS: Surgeon's demographics, personal experiences, and specialty appear to significantly influence their teaching styles and the educational experience residents receive regarding informed consent.

Improving Patient Satisfaction in the Hispanic American Community.

Hispanic Americans are the fastest growing ethnic group in the United States, with an ever-growing gap in the communicative capacity between patients and healthcare providers. This leads to linguistic marginalization and worse healthcare outcomes. There is an increasing need for Spanish literacy in healthcare professionals, including medical students. However, approximately half of medical schools don't offer a Spanish elective. We performed a scoping review of the literature to assess the relationship between medical Spanish electives, verbal fluency, auditory comprehension, and student comfort. This study was conducted using PubMed and Google Scholar to evaluate articles on Spanish electives in medical schools. Nine articles met inclusion criteria. Almost all studies demonstrated benefit as per outcome measures assessed with statistical significance. The available literature supports the need for Spanish elective courses, with numerous advantages conferred, e.g. increased self-perceived knowledge about specific health issues in the Hispanic American community and reduction in inadvertent communication errors in the patient-provider-interpreter interaction. However, most of the reports analyzed exhibited numerous limitations that warrant future research studies in order to eliminate variables such as bias and issues with generalizability. The authors suggest that more medical schools offer virtual Spanish electives with a focus on empathetic language strategies and patient satisfaction.

Experienced based co design: nursing preceptorship educational programme.

BACKGROUND: Patients play a central role in nursing preceptorship relationships, a professional educational relationship between a staff nurse and student nurse that is grounded in providing patient care. Yet the patient experiences and perspectives are largely uncaptured in the literature or represented in current preceptorship education programmes. Furthermore, the lack of student, staff nurse & patient involvement in the design of preceptorship education programmes has been noted. OBJECTIVE: To use a co-design process to develop an innovative educational programme for developing interpersonal and communication skills among nurses who act as preceptors. We sought to (a) clarify experiences and events from all three members involved in a preceptorship relationship (student nurse, preceptor, and patient (SPP) in order to develop a shared understanding of nursing preceptorship relationships and (b) identify the key informational and educational needs recommended by SPP for the educational programme. METHODS: Using the principles and the iterative process of Experienced Based Co Design (EBCD), data was collected from qualitative interviews and used to inform a series of co-design workshops and the co-production of the new educational programme. RESULTS: Twenty-six individuals, including undergraduate student nurses, staff nurses, patients, and a team of nursing, educational and educational technologist experts, contributed to developing a blended learning preceptorship educational programme that consists of three core elements (1) six online reusable learning objects, (2) two role play simulations and (3) a virtual reality storytelling simulated experience. CONCLUSIONS: The EBCD process ensured that the educational programme was developed to meet SPP viewpoints associated with fostering positive interpersonal relationships in a nursing preceptorship. EBCD is a valuable framework for developing human-centred educational resources that combine experiential knowledge (experiences) and scientific knowledge (literature-based knowledge). It facilitated the identification and the development of Interpersonal and Communications skills (IP & C skills) training required within a nursing preceptorship relationship, creating an authentic and memorable learning programme. The structure of EBCD harnesses SPP involvement throughout the research and development process, ensuring transparency and continuity of message, scope, and outcomes.

Nursing preceptorship is a professional educational relationship between a staff nurse and student nurse based on providing patient care. The preceptor is a role model for the student, demonstrating professional roles and practice responsibilities. Furthermore, the preceptor accesses the student's clinical competence, providing valuable feedback, support and guidance. Therefore, an effective preceptor must develop interpersonal, teaching and competency assessment skills. This paper describes a co-design project that involved engaging nursing students, nurses, former patients, and educational and nursing specialists in creating a new nursing preceptorship education programme. The goal was to develop an educational programme that combined scientific evidence with real-life experiences of nursing students, nurses, and patients focusing on developing nurses' interpersonal and communication skills required to be an effective preceptor. Collaborative co-design workshops were held virtually over several months. Activities included one to one interviews, group discussions and feedback on various drafts of the developing educational programme. Participants provided their stories, opinions, and ideas to create an outline of the new programme. The co-design team then collaborated with educational technologists and a virtual reality production company to complete the state-of-the-art innovative educational programme. The programme is now ready to be piloted. It is hoped this new innovative programme that blends both scientific knowledge with real-life experiences will help nurses develop the interpersonal and communication skills required when interacting with students and patients.

Pregnancy During Surgical Training: Are Residency Programs Truly Supporting Their Trainees?

OBJECTIVE: Despite recent national improvements in family leave policies, there has been little focus on program-level support for surgical trainees. Trainees who may require clinical duty adjustments during pregnancy, who experience pregnancy loss, or who struggle with balancing work obligations with the demands of a new infant may face stigma when seeking schedule accommodations. The aim of this study was to describe program and colleague support of surgical trainees for pregnancy-related and postpartum health needs. DESIGN: Survey questionnaire. Participants responded to multiple-choice questions about their history of pregnancy loss, their experience with reduction of clinical duties during pregnancy, and their breastfeeding experience. Those who took time off after miscarriages or reduced their clinical duties during pregnancy were asked whether they perceived their colleagues and/or program leadership to be supportive using a 4-point Likert scale (1-strongly agree, 4-strongly disagree) which was dichotomized to agree/disagree. SETTING: Electronically distributed through social media and surgical societies from November 2020 to January 2021. PARTICIPANTS: Female surgical residents and fellows. RESULTS: 258 female surgical residents and fellows were included. Median age was 32 (IQR 30-35) years and 76.74% were white. Of the 52 respondents (20.2%) who reported a miscarriage, 38 (73.1%) took no time off after pregnancy loss, including 5 of 10 women (50%) whose loss occurred after 10 weeks' gestation. Of the 14 residents who took time off after a miscarriage, 4 (28.6%) disagreed their colleagues and/or leadership were supportive of time away from work. Among trainees who reported at least 1 live birth, only 18/114 (15.8%) reduced their work schedule during pregnancy. Of these, 11 (61.1%) described stigma and resentment from colleagues and 14 (77.8%) reported feeling guilty about burdening their colleagues. 100% of respondents reported a desire to breastfeed their infants, but nearly half (46.0%) were unable to reach their breastfeeding goals. 46 (80.7%) cited a lack of time to express breastmilk and 23 (40.4%) cited inadequate lactation facilities as barriers to achieving their breastfeeding goals. CONCLUSIONS: A minority of female trainees takes time off or reduces their clinical duties for pregnancy or postpartum health needs. National parental leave policies are insufficient without complementary program-level strategies that support schedule adjustments for pregnant trainees without engendering a sense of resentment or guilt for doing so. Surgical program leaders should initiate open dialogue, proactively offer clinical duty reductions, and ensure time and space for lactation needs to safeguard maternal-fetal health and improve the working environment for pregnant residents.

Gaps in Practice Management Skills After Training: A Qualitative Needs Assessment of Early Career Surgeons.

PURPOSE: Shifts in American healthcare delivery mechanisms pose significant hurdles to new physicians. Surgeons are particularly susceptible to these changes, but surgical residency educational efforts primarily focus on technical and clinical training to the exclusion of business and management practices. This study conducted a needs assessment of perceived gaps in practice management skills among early career surgeons to guide future training curricula. METHODS: This study was an exploratory qualitative study following the Consolidated Criteria for Reporting Qualitative Research. Purposive sampling was used to identify early career (<5 years following fellowship completion) surgeons across the United States. A semi-structured interview guide was created from interviews with surgical administrators and physician administrative curricula. Transcripts were de-identified and analyzed using a constructivist grounded theory approach. RESULTS: Ten surgeons from 6 specialties and 6 institutions were interviewed along with 3 surgeon administrators. Three major domains of need were identified: (1) fundamentals of procedural coding, clinical billing, & compliance, (2) finding/building a practice, and (3) navigating organizational challenges. First, surgeons thought trainees would benefit from a better understanding of reimbursement schema and the basics of health policy. They also thought that more exposure to malpractice litigation, especially for handling case review or expert witness requests, would be helpful for discerning how to handle such issues early in their career. In addition, early career surgeons expressed a desire to have dedicated mentorship time, a primer on evaluating job offers with simulated contract negotiation, and guidance regarding administrative roles. Finally, surgeons requested training in change management techniques, care pathway construction, and the basics of staffing decisions. CONCLUSIONS: There are significant practice management gaps in surgical training which may be amenable to targeted educational efforts during a residency or fellowship program. Future research will test the generalizability of these findings as well as build curricula that adequately meet these needs.

Does Surgical Trainee Participation Affect Infection Outcomes in Primary Total Knee Arthroplasty?

OBJECTIVE: To evaluate whether the involvement of surgeons-in-training was associated with increased infection rates, including both prosthetic joint infection (PJI) and surgical site infection (SSI), following primary total knee arthroplasty (TKA). DESIGN: This was a retrospective review of outcomes following primary total knee arthroplasty. Surgeries were divided into two groups: (a) attending-only and (b) trainee-involved. Association with PJI and SSI were evaluated with univariate analysis and multivariate analysis to adjust for sex, age, body mass index (BMI), Charlson Comorbidity Index (CCI), year of surgery, operative time, and hospital/surgeon volume. SETTING: A single, large North-American integrated healthcare system between January 1, 2014 and December 31, 2017. PARTICIPANTS: A total of 12,664 primary TKAs with a minimum of one-year (mean of 2-years, range 1-4.5) follow-up were evaluated. RESULTS: Residents and fellows were more likely to participate in cases with longer operative times (p<0.001) than the attending-only group. A significant difference existed on univariate analysis between the trainee-involved group and attending-only group for PJI incidence (p=0.015) but not for SSI (p=0.840). After adjusting for patient- and procedure-related features, however, neither PJI nor SSI were independently associated with trainee involvement (PJI: p=0.089; SSI: p=0.998). CONCLUSIONS: Trainee participation did not directly correlate with increased infection risk, despite their association with longer-operative times and increased medical complexity. Further approaches to mitigating the risk of SSI and PJI for patients with increased comorbidities and in complex TKA cases, which demand longer operative times, are still required.

Applying VitalTalkTM Techniques to Best Case/Worst Case Training to Increase Scalability and Improve Surgeon Confidence in Shared Decision-making.

OBJECTIVE: Best Case/Worst Case (BC/WC) is a communication tool designed to promote shared decision-making for high-risk procedures near the end of life. This study aimed to increase scalability of a BC/WC training program and measure its impact on surgeon confidence in and perceived importance of the methodology. DESIGN: A prospective cohort pre-post study; December 2018 to January 2019. SETTING: Multi-center tertiary care teaching hospital. PARTICIPANTS: Forty-eight resident surgeons from general surgery and otolaryngology. RESULTS: Learners were 24 to 37 years old with 52% in post graduate year 1 to 2. Although learners encountered high-stakes communication (HSC) frequently (3.6 [0.7] on 5-point Likert scale), most reported no HSC training in medical school (74.5%) or residency (87.5%). BC/WC training was accomplished with an instructor to learner ratio of 1-to-5.3. After training, learner confidence improved on all measured communication skills on a 5-point scale (e.g., exploring patient's values increased from 3.6 [0.8] to 4.1 [0.6], p = <0.0001); average within-person improvement was 0.72 (0.6) points across all skills. Perceived importance improved across all skills (e.g., basing a recommendation on patient's values increased from 4.4 [0.8] to 4.8 [0.5], p = 0.0009); average within-person improvement was 0.46 (0.5) points across all skills. Learners reported this training would likely help them in future interactions (4.4 [0.73] on 5-point scale) and 95.2% recommended it be offered to resident physicians in other residency programs and to attending surgeons. CONCLUSIONS: Formal training in BC/WC increases learners' perception of both the importance of HSC skills and their confidence in exercising those skills in clinical practice. VitalTalkTM methodology permitted scaling training to 5.3 learners per instructor and was highly recommended for other surgeons. Ongoing training, such as this, may support more patient-centered decision-making and care.

Operating Room Staff Perceptions of Medical Students.

OBJECTIVE: While the operating room (OR) is a keystone experience, medical students often report negative experiences and intimidation in the OR. The purpose of this study is to describe the perceived role of medical students in the OR by registered nurses and certified surgical technologists to improve medical student education. DESIGN: A cross-sectional survey of select Massachusetts General Hospital perioperative staff in surgery was conducted through an anonymous survey in March 2021. Statistical analysis included inductive thematic analysis, descriptive statistics, and Mann-Whitney U tests, with a p-value of <0.05. The survey instrument characterized the perception of medical student preparedness for OR-related tasks and free-text responses on the role of medical students in the OR and opportunities for improvement. SETTING: The study was conducted at the Massachusetts General Hospital, Boston, MA. PARTICIPANTS: Participants included Massachusetts General Hospital perioperative staff in the Department of Surgery, with 262 registered nurses and 90 certified surgical technologists receiving the survey. RESULTS: There were 86 completed responses (24.4% response rate). A total of 71.23% of respondents believe medical students should be observational learners in the OR. Areas for improvement include OR etiquette (37.5%), awareness of the surgical field (26.79%), and scrubbing skills (26.79%). A total of 48.8% of staff agreed they enjoy working with medical students, followed by 20.9% who somewhat agree. A total of 27.91% of respondents somewhat agreed that medical students were knowledgeable about OR sterility and scrubbing procedures, followed by 25.58% who somewhat disagreed. CONCLUSIONS: Operating room staff enjoy working with medical students. The majority of staff believe medical students' role in the OR is that of observational learning. Areas of improvement for medical students include OR etiquette, awareness of the surgical field, scrubbing and gowning skills, and assisting staff whenever needed. Possible solutions include incorporating nursing staff as surgery clerkship stakeholders to optimize medical student experiences in the OR.

Resident Night Float or 24-hour Call Hospital Coverage: Impact on Training, Patient Outcome, and Length of Stay.

OBJECTIVE: The impact of neurosurgical resident hospital coverage system, performed via a night float (12-hour shifts overnight) or a 24-hour call, on neurological surgery resident training and patient care is unknown. DESIGN: Retrospective review comparing night float and 24-hour call coverage on trainee surgical experience, elective time, annual program surveys, patient outcomes, and length of stay. SETTING: The Ohio State Wexner Medical Center Neurosurgery residency program, Columbus, Ohio. PARTICIPANTS: The neurosurgical residents from 2016 to 2019. RESULTS: Monthly cases performed by junior residents significantly increased after transitioning to a 24-hour call schedule (18 versus 30, p < 0.001). There were no differences for total cases among program graduates during this time (p = 0.7). Trainee elective time significantly increased after switching to 24-hour call coverage (18 versus 24 months after the transition; p = 0.004). Risk-adjusted mortality and length of stay indices were not different (0.5 versus 0.3, p = 0.1; 0.9 versus 0.9; p = 0.3). Program surveys had minimal change after the transition to 24-hour call. CONCLUSIONS: Transitioning from a night float to a 24-hour call coverage system led to improved junior resident case volume and elective time without detrimental effect on patient-related outcomes.

Interns Without Subinternships.

Surgical interns who have completed medical school in the era of Covid-19 will not have the same experience gained through the traditional multi-month fourth-year surgical subinternships. During subinternships, medical students learn relevant anatomic and radiographic features of surgical pathologies, hone technical skills, and gain exposure to surgical consults and procedures. This lack of intensive exposure will have this cohort starting at a lower comfort and knowledge level compared to years prior. Residency programs, especially subspeciality programs, should review and utilize national resources to facilitate the transition to intern year, such as the American College of Surgeons Entering Resident Readiness Assessment and American College of Surgeons/ Association of Program Directors in Surgery/Association for Surgical Education Resident Prep Curriculum. We recommend the use of a specialty-tailored intern boot-camp and longitudinal curriculum that focuses on learning procedural skills and surgical conditions, anatomy, pathology, clinical examination, radiographic findings, surgical approach, and postoperative complications. These steps will help address knowledge gaps and promote intern readiness in this cohort of individuals.

Building Communication and Conflict Management Awareness in Surgical Education.

OBJECTIVE: A group of surgeons and a medical educator constructed a curriculum to strengthen communication and emotional intelligence skills in the surgical setting. DESIGN: The curriculum consisted of a small group discussion series occurring during medical students' eight-week surgery clerkship. The curriculum targeted the following objectives: building team rapport, exploring self-management strategies in team communication, recognizing communication styles, diagnosing conflict, identifying opportunities in professional and personal development, and discussing professionalism in medicine. Students completed pre-post Likert style tests about their knowledge and understanding of the above-mentioned topics. SETTING: Texas A&M University College of Medicine, Surgical Clerkship at Baylor Scott and White Medical Center, a level 1 trauma center, in Temple, TX. PARTICIPANTS: Twenty-four students in their third year of medical school completed the communication curriculum. RESULTS: Wilcoxon sign test was used to analyze the non-parametric data and multiple repeat tests required the significance level (p-Value) be adjusted to 0.003. Students showed significant increase in understanding of conflict management, their ability to communicate effectively, and their awareness of communication preferences (p < 0.001). In addition, they recognized better ways to engage with other students, residents, and staff on their rotation (p = 0.002) and felt more confident in their ability to handle feedback (p = 0.001). Open-ended responses on the post-test had overwhelmingly positive feedback with themes of awareness, psychological safety, and team rapport. Finally, students requested that the curriculum be taught longitudinally throughout their third-year clerkships. CONCLUSIONS: Our curriculum enabled students to improve their awareness of communication, conflict management, team dynamics, and professionalism. These important competencies will support students throughout their training and in their practice as future surgeons.

Take 10: A Resident Well-Being Initiative and Burnout Mitigation Strategy.

OBJECTIVE: Physician training is associated with stressors which contribute to burnout. Individual and institutional level strategies can be employed to address resident burnout; however, time is an often-reported barrier in initiating recommended well-being activities. We hypothesize that brief bursts of well-being activities that are conducive to a resident schedule can mitigate burnout. DESIGN: This is a prospective observational study following burnout after implementation of an institution-wide, well-being initiative called "Take 10." SETTING: In the present study, the "Take 10" initiative, meditating or exercising for a minimum of 10 minutes per day 3 times a week, was encouraged at Vanderbilt University Medical Center, a tertiary care center in Nashville, Tennessee. PARTICIPANTS: Following implementation of the initiative, 254 residents from surgical, procedural, and non-procedural specialties were invited to complete surveys assessing compliance with encouraged "Take 10" activities as well as rates of burnout over a 5-month period. A total of 201 surveys were completed during the study period. RESULTS: Overall, burnout rates were worse for females (Odds Ratio [OR] = 3.7 | Confidence Interval [CI] = 1.57, 9.05), better for those living with others (OR = 0.22 | CI = 0.07, 0.64), and better for those participating in "Take 10" initiatives (OR = 0.71 | CI = 0.58, 0.86). There was a significant difference in resident-reported burnout (Control = 85.3% vs Intervention = 58.2% | p < 0.01) and Resident Well-Being Index score (Control = 3.73 vs Intervention=2.93 | p < 0.01), when "Take 10" initiatives were employed. CONCLUSIONS: "Take 10" is a low cost and low intensity initiative for individuals and programs to use to mitigate burnout.

Trends in Female Plastic Surgery Resident Authorship - Signs of Changing Times?

OBJECTIVE: Gender discrepancies exist in academia for leadership positions, advancement opportunities, and research. As of 2019, the ratio of total male-to-female attending plastic and reconstructive surgeons was 4.8:1. However, the ratio of male-to-female residents in integrated plastic surgery programs fell to 1.3:1, indicating rising female representation. With more balanced gender distributions of residents, the authors sought to determine whether this translates to greater equality of opportunities and achievements. Specifically, this study compares the academic productivity of male and female integrated plastic surgery residents. METHODS: A list of integrated plastic surgery residency programs was obtained from the Accreditation Council for Graduate Medical Education website and ranked by reputation using the Doximity Residency Navigator. Integrated plastic surgery residents from 2019 to 2020 were identified via program websites and social media accounts. Works published during residency were identified through PubMed and Scopus from July 1 of each resident's intern year through August 10, 2020. Demographic variables for residents, including training class and medical school, as well as for programs, including geographic region, Doximity ranking, and medical school affiliation, were collected. Medical schools were ranked according to US News by research. Research productivity was assessed through the number of total research articles with authorship position (first, second, or last), the number of articles published in plastic surgery journals with the highest impact factors (Plastic and Reconstructive Surgery and Aesthetic Surgery Journal), and H-indices. Chi-Squared tests and Mann-Whitney U-tests were used to make comparisons between male and female residents (α = 0.05). RESULTS: In total, 931 residents in 81 integrated plastic surgery programs were identified, including 534 (57.4%) male and 397 (42.6%) female residents. There were no differences between male and female residents in terms of training year or program geography. Female residents were more likely to come from a top-50 medical school than males (54.7% vs. 48.1%, p = 0.049). There were no significant differences in gender distribution of residents from top-20 programs or programs affiliated with a top-20 medical school. The median (IQR) number of publications in total, and for each gender, was 3 (1-6). There was no difference in the number of total publications by training year by gender, besides the second-year resident class where male residents had a median (IQR) of 2 (1-4) compared to 1 (0-3) (p = 0.028). Male and female residents did not differ with regards to authorship position or proportion of times publishing in top journals. The distribution of H-indices for male residents was slightly higher than female residents (p = 0.003), but the median (IQR) was the same at 3 (1-5). CONCLUSIONS: Currently, male and female integrated plastic surgery residents have similar levels of academic productivity. This suggests that female representation is slowly increasing along the pipeline in academia, representing a paradigm shift from previous trends of gender inequality in plastic surgery.

"You Remember Those Days"-A Qualitative Study of Resident Surgeon Responses to Complications and Deaths.

OBJECTIVE: Postoperative complications and deaths are unavoidable aspects of a surgical career, but little is known about the impacts of these unwanted outcomes on resident surgeons. The goal of this study was to characterize the impact of complications and deaths on surgery residents in order to facilitate development of improved support systems. DESIGN: This qualitative study was designed to explore resident surgeons' experiences with unwanted outcomes, including postoperative complications and death. Semi-structured interviews explored a range of topics related to personal experiences with unwanted outcomes. Analyses of interview transcripts were performed iteratively and informed by thematic analysis. SETTING: An anthropologist at the University of Michigan conducted interviews with general surgery residents from academic, community, and hybrid training programs across the country. PARTICIPANTS: Twenty-eight mid-level and senior residents (PGY3 and above) were recruited for participation from 14 different training programs across the United States. RESULTS: Resident surgeons described an initial period of emotional response, characterized by feelings of sadness, frustration, or grief. Simultaneously or soon afterward, interviewees described a period of intellectual response aimed at understanding how and why an outcome occurred, with the expressed goal of learning from it. Many residents described impacts to their personal lives. Several factors that influenced the duration and intensity of these responses were identified, including a sense of ownership, which was a powerful driver for improvement. CONCLUSIONS: This qualitative study provides a nuanced description of resident surgeons' responses to unwanted outcomes. While emotional responses were characterized by strong feelings, such as sadness and grief, intellectual responses were focused on learning from the events. These data may help inform the development of structured support systems by residency programs. STRUCTURED ABSTRACT: Facing post-operative complications and deaths is an unavoidable aspect of surgical training, but the impacts on surgery residents has not been well characterized. Through semi-structured interviews with general surgery residents from programs across the United States, this qualitative study explored the ways that residents respond to unwanted outcomes. Residents described an initial period of emotional response, characterized by strong feelings, often of sadness or grief. There was a subsequent or concomitant period of intellectual response, in which residents examined how and why this outcome occurred, with the goal of learning from it. A feeling of ownership was strengthened by involvement in patient care and length of rotation. In light of this detailed description of resident experiences, residency programs can foster the development of improved support for trainees as they navigate these profoundly impactful events.