Preparing Future Pediatric Care Providers with a Clinical Informatics Elective.

BACKGROUND: Clinical informatics (CI) has reshaped how medical information is shared, evaluated, and utilized in health care delivery. The widespread integration of electronic health records (EHRs) mandates proficiency among physicians and practitioners, yet medical trainees face a scarcity of opportunities for CI education. OBJECTIVES: We developed a CI rotation at a tertiary pediatric care center to teach categorical pediatric, pediatric-neurology, and medicine-pediatric residents foundational CI knowledge and applicable EHR skills. METHODS: Created in 2017 and redesigned in 2020, a CI rotation aimed to provide foundational CI knowledge, promote longitudinal learning, and encourage real-world application of CI skills/tools. Led by a team of five physician informaticist faculty, the curriculum offers personalized rotation schedules and individual sessions with faculty for each trainee. Trainees were tasked with completing an informatics project, knowledge assessment, and self-efficacy perception survey before and after rotation. Paired t-test analyses were used to compare pre- and postcurriculum perception survey. RESULTS: Thirty-one residents have completed the elective with their projects contributing to diverse areas such as medical education, division-specific initiatives, documentation improvement, regulatory compliance, and operating plan goals. The mean knowledge assessment percentage score increased from 77% (11.6) to 92% (10.6; p ≤ 0.05). Residents' perception surveys demonstrated improved understanding and confidence across various informatics concepts and tools (p ≤ 0.05). CONCLUSION: Medical trainees are increasingly interested in CI education and find it valuable. Our medical education curriculum was successful at increasing residents' understanding, self-efficacy, and confidence in utilizing CI concepts and EHR tools. Future data are needed to assess the impact such curricula have on graduates' proficiency and efficiency in the use of CI tools in the clinical workplace.

Assessing the Impact of Prior Authorizations on Dermatology Residents.

INTRODUCTION: Prior authorizations (PAs) are administrative tasks commonly required by insurers to approve medications or therapies for patients. Dermatology practices frequently employ coordinators to focus on completing PAs, among other solutions. The degree to which this support is offered in academic centers and, importantly, how much time dermatology residents spend on PAs over educational pursuits is largely unknown. The authors sought to identify the impact of PAs on dermatology residents. METHODS: An IRB-approved (#NCR213814) 13-question survey was distributed nationwide to dermatology residents regarding the impact of PAs on aspects of clinical and scholarly activities.  Results: 150 of 1462 dermatology residents, 10.3%, responded to the survey. 70% of responding residents contribute to obtaining PAs. 58.7% indicated that their program employed a PA coordinator; though, of these, 63.6% still relied on residents for PAs. 84% indicated that for the following month they feared the burden of PAs would lead to a lapse in treatment for patients. 72.7% avoided prescribing certain medications due to PAs. 64% indicated the PA burden impedes their ability to perform scholarly activities. 80.7% indicated the PA burden contributed to burnout or decreased morale. CONCLUSION: Our data highlight that dermatology residents are negatively impacted by the burden of PAs, resulting in reduced time to study, research, and best care for their patients. Dermatology residents and patients would benefit from reducing the burden of PAs, especially on residents by reforms or regulations that reduce dermatologic PAs, or by academic institutions removing these responsibilities from residents as best as possible. Drugs Dermatol. 2024;23(6):485-488.    doi:10.36849/JDD.7617.

Critères influençant le choix du premier poste après l'internat de chirurgie orale en France.

INTRODUCTION: The Specialized Diploma in Oral Surgery (Diplôme d’études spécialisées en chirurgie orale) was established in 2011. It gives its holders a unique combination of medical and surgical expertise. As a specialty, oral surgery can be pursued via both medical and dental pathways. However, the criteria guiding students’ choice of first job after residency remain largely unknown. PURPOSE OF THE RESEARCH: The primary objective was to evaluate the factors influencing students’ choice of first job after completing their oral surgery residency. RESULTS: The main geographical factors influencing job choice were the presence of family or friends, a short commute, and the location of the spouse’s place of work. Key practice conditions included access to advanced technical facilities and an operating theater offering general anesthesia. Clinical activities ranged from pre-implant grafts to general oral surgery. The likelihood of pursuing a hospital-based position in the same facility was correlated with the well-being experienced during the residency (p < 0.05) and with the oral surgeons’ medical background (p = 0.001). Significant associations exist between region of origin, internship location, and practice region (p < 0.001; p <0.001). CONCLUSIONS: The main factors influencing the choice of first position after oral surgery residency depend on family-related and technical criteria.

Should my recommendation letter be written by artificial intelligence?

SummaryLetters of recommendation are increasingly important for the residency match. We assessed whether an artificial intelligence (AI) tool could help in writing letters of recommendation by analyzing recommendation letters written by 3 academic staff and AI duplicate versions for 13 applicants. The preferred letters were selected by 3 blinded orthopedic program directors based on a pre-determined set of criteria. The first orthopedic program director selected the AI letter for 31% of applicants, and the 2 remaining program directors selected the AI letter for 38% of applicants, with the staff-written versions selected more often by all of the program directors (p < 0.05). The first program director recognized only 15% of the AI-written letters, the second was able to identify 92%, and the third director identified 77% of AI-written letters (p < 0.05).

A national virtual job search series for neonatal-perinatal medicine fellows.

BACKGROUND: A standardized approach to prepare trainees for the job search has not been described. The objective of this study was to describe and evaluate an educational series on the job search for Neonatal-Perinatal Medicine (NPM) fellows and identify participants' job search knowledge gaps. METHODS: During the 2020-2021 academic year, we created a virtual, seven-part job search series for NPM fellows that required no funding. The series has been repeated annually. We use REDCap surveys to register participants, collect baseline/demographic information, and evaluate the series' impact at the beginning and end of the job search timeline. RESULTS: In the 2021-2022 academic year, 290 individuals registered for the series, and 89% completed the baseline/demographic survey. The majority were NPM fellows (89%). Early career neonatologists, NPM hospitalists, and pediatric residents also utilized the series (11%). Less than 25% reported being "knowledgeable" or "very knowledgeable" of core job search components, including the timeline of the job search, contract negotiation, and the general roles and responsibilities of junior faculty. Of those who completed the final job search survey and underwent a job search (60%, 97 of 162), the majority (86%) felt that career planning during training was stressful and believed that job search preparation should be structured into the NPM fellowship curriculum (81%). Many felt that the Job Search Series was helpful in elucidating components of the job search. CONCLUSIONS: We identified several knowledge gaps in NPM fellows' understanding of how to find, prepare for, and negotiate their first post-training job. We strongly believe these knowledge gaps are not unique to NPM fellows and that all graduate medical education trainees would benefit from a similar, easy-to-implement, no-cost series.

Acceptability and feasibility of an evaluation table to assess the competency of general medicine interns during ambulatory rotations in Brest.

BACKGROUND: General practitioner interns need to acquire the expected clinical, communication, personal and professional competencies. Internship evaluations use qualitative evaluation tables to assess competency acquisition. However, there is no standardised evaluation table used in France. Some faculties use the exhaustive, precise, and manageable Exceler evaluation tool. We aim to evaluate opinions of General practice interns in Brest about the acceptability and feasibility of using the Exceler evaluation tool to monitor competency acquisition during internships. METHODS: This qualitative study used intern focus groups. Six-open ended questions with optional follow-up questions were asked. Cards from the Dixit® game were used to guide and facilitate discussion. Open, axial, then integrative analysis of the verbatim was performed. RESULTS: This is the first study to evaluate intern opinions about GP internship evaluations using focus groups. Participants felt that the quality of existing evaluations was insufficient, and it was difficult to monitor their progress. Adapting evaluations to individual profiles and backgrounds seemed necessary. Exceler appeared to be a possible solution due to its content validity, flexibility of use and accessibility. However, there were comments about possible modifications. CONCLUSIONS: Analysing opinions of tutors, supervisors and other practice centers could help identify potential barriers and reveal solutions to facilitate its implementation and use. TRIAL REGISTRATION: Not applicable.

Translation, cultural adaptation and linguistic validation of the postgraduate hospital educational environment measure into Arabic.

BACKGROUND: Assessment of the clinical learning environment (CLE) is an essential step that teaching hospitals routinely undertake to ensure the environment is conducive, learning-oriented and supportive of junior doctors' education. The Postgraduate Hospital Educational Environment Measure (PHEEM) is an internationally recognized tool for assessing the CLE with evidence of high reliability and validity. Translation of PHEEM into other languages such as Spanish, Japanese and Persian enabled wider adoption of the instrument in the world. However, in Syria and other Arabic countries, a validated Arabic translation of PHEEM is still not available, making it difficult to adopt it and use it in Arabic contexts. This study aims to translate and culturally adapt the PHEEM from English into Arabic. METHODS: This study followed the structured translation and validation process guideline proposed by Sousa & Rojjanasrirat 2010. First, the PHEEM went through forward translation by three translators, then reconciled with the aid of a fourth translator. Afterwards, two professional bicultural and bilingual translators conducted back translation into English and compared it with the original version. This formed the Pre-final Version (PFV) which was then pretested for clarity on a sample of medical residents in Damascus, Syria. Following appropriate modifications, the PFV was sent to a panel of experts for a comprehensive review of language clarity and to assess content validity. RESULTS: A total of thirty-five medical residents were recruited. Ten items with language clarity issues were identified and modified according to the elicited suggestions. Thereafter, the modified PFV was presented to ten subject experts who identified three items in need of revision. The item-content Validity Index (CVI) was over 0.78 for all of the 40 items; the calculated scale-CVI was 0.945. DISCUSSION: This study provided the first linguistically valid Arabic translation of the widely used PHEEM inventory. The next step is to conduct a full psychometric analysis of the Arabic PHEEM to provide further evidence of validity and reliability.

Increasing Trainee Comfort with Nutrition.

OBJECTIVES: Nutrition counseling is necessary for the prevention and treatment of many chronic diseases. US survey data demonstrate that 61% of Internal Medicine (IM) residents receive little to no nutrition training. The objective of our study was to develop a curriculum to increase IM resident comfort and ability in conducting a nutritional assessment. METHODS: Categorical IM residents at a large academic medical center participated in a curriculum that included a lecture, a small-group discussion, and a skills exercise. Residents completed pre- and posttest surveys that evaluated their attitudes and comfort level with nutritional assessment. RESULTS: Eighty percent (84/105) of the residents participated in the curriculum and 48% (40/84) of them completed both pre- and postsession surveys. Residents who considered themselves moderately to extremely comfortable completing a nutritional assessment increased after the program (27.5% to 87.5%, P < 0.0001). The proportion of those who agreed or strongly agreed with the statement, "Nutritional counseling should be included in any routine appointment, just like diagnosis and treatment," increased from 62.50% to 80.00% (P = 0.012). The proportion of residents who considered lack of individual knowledge to be a barrier for nutrition counseling decreased from 65.79% to 42.11% (P = 0.0126). CONCLUSIONS: This curriculum was successful in increasing IM resident comfort with conducting a nutritional assessment.

Efficacy of educational stepwise robot-assisted radical prostatectomy procedure for urology residents.

OBJECTIVE: To evaluate the effectiveness of an educational stepwise robot-assisted radical prostatectomy (RARP) procedure for urology residents. METHODS: We performed a detailed evaluation of 42 RARP procedures performed by a single urology resident from July 2019 to February 2022. The RARP procedures were divided into the following nine steps: (1) bladder dissection, (2) endopelvic fascia dissection, (3) bladder neck dissection, (4) seminal vesicle dissection, (5) Denonvilliers' fascia dissection, (6) dorsal vascular complex ligation, (7) dissection of the prostatic apex, (8) posterior anastomosis, and (9) urethro-vesical anastomosis. The procedures were further subcategorized as anatomical understanding, spatial recognition, and technical skills for evaluation of resident training. The surgeries were divided into first and second halves, and patient characteristics and operative outcomes were statistically analyzed. The operative time of each of the nine steps and the reasons for proctor intervention were compared. RESULTS: Among 42 patients, there were no significant differences in operative outcomes between the two groups. The median operative time was 169 min (164 vs. 179 min, p = .12), and the median console time was 128 min (127 vs. 130 min, p = .74). Although there were no significant differences in the time of the nine steps, the resident significantly overcame (7) dissection of the prostatic apex and (8) posterior anastomosis based on the evaluation of the proctored reasons for intervention. CONCLUSIONS: Urology residents can safely perform and efficiently learn RARP with this stepwise educational system. This educational stepwise RARP procedure can effectively help residents to develop their skills.

An evaluation of a Transition to Foundations curriculum for first year pediatric residents in Competency Based Medical Education.

A Transition to Foundations (TTF) curriculum that includes didactic and simulation components prepares first-year pediatric residents for increased roles and responsibilities in the Foundations of Discipline stage of Competency Based Medical Education, including junior night float rotations. Simulations of acute presentations improve resident comfort before overnight on-call experiences.

Un programme de transition vers les fondements de la discipline (TTF) comportant des volets didactique et de simulation prépare les résidents de première année en pédiatrie à des rôles et des responsabilités accrus à l'étape des fondements de la discipline dans le cadre d'une approche par compétences, notamment aux stages de nuit des résidents juniors. Les simulations de présentations aiguës améliorent le confort des résidents avant les gardes de nuit.

Designing a touchless physical examination for a virtual Objective Structured Clinical Examination.

Purpose: Given the COVID-19 pandemic, many Objective Structured Clinical Examinations (OSCEs) have been adapted to virtual formats without addressing whether physical examination maneuvers can or should be assessed virtually. In response, we developed a novel touchless physical examination station for a virtual OSCE and gathered validity evidence for its use. Methods: We used a touchless physical examination OSCE station pilot-tested in a virtual OSCE in which Internal Medicine residents had to verbalize their approach to the physical examination, interpret images and videos of findings provided upon request, and make a diagnosis. We explored differences in performance by training year using ANOVA. In addition, we analyzed data using elements of Bloom's taxonomy of learning, i.e. knowledge, understanding, and synthesis. Results: Sixty-seven residents (PGY1-3) participated in the OSCE. Scores on the pilot station were significantly different between training levels (F=3.936, p = 0.024, ηp2 = 0.11). The pilot station-total correlation (STC) was r = 0.558, and the item-station correlations ranged from r = 0.115-0.571, with the most discriminating items being those that assessed application of knowledge (interpretation and synthesis) rather than recall. Conclusion: This touchless physical examination station was feasible, had acceptable psychometric characteristics, and discriminated between residents at different levels of training.

Objet: Compte tenu de la pandémie de COVID-19, de nombreux examens cliniques objectifs structurés (ECOS) ont été adaptés vers un format virtuel sans que l'on se questionne à savoir si les manœuvres d'examen physique peuvent ou doivent être évaluées virtuellement. Conséquemment, nous avons développé une nouvelle station d'examen physique sans contact pour un ECOS virtuel et recueilli des preuves de validité concernant son utilisation. Méthodes: Nous avons utilisé une station d'examen physique sans contact testée dans le cadre d'un ECOS virtuel pendant lequel les résidents en médecine interne devaient verbaliser leur approche concernant l'examen physique, interpréter des images et des vidéos d'examens fournis sur demande, et poser un diagnostic. Nous avons étudié les différences de rendement en fonction de l'année de formation à l'aide de l'ANOVA. En outre, nous avons analysé les données en utilisant les éléments de la taxonomie de l'apprentissage de Bloom, c'est-à-dire la connaissance, la compréhension et la synthèse. Résultats: Soixante-sept résidents (PGY1-3) ont participé à l'ECOS. Les scores de la station pilote étaient significativement différents entre les niveaux de formation (F=3.936, p=0.024, ηp2=0.11). La corrélation totale de la station pilote (STC) était de r=0,558, et les corrélations question-station variaient de r=0,115-0,571, les questions les plus discriminantes étant celles qui évaluaient l'application (interprétation et synthèse) plutôt que le rappel de connaissances. Conclusion: Cette station d'examen physique sans contact était réalisable, a présenté des caractéristiques psychométriques acceptables et a permis d'établir une discrimination entre les résidents de différents niveaux de formation.

Selection of international medical graduates into postgraduate training positions in Canada. Who applies? Who is selected?

Background: International medical graduates (IMGs) are an essential part of the Canadian physician workforce. Considering current pressures on the health care system, an update regarding application numbers and match rates for IMGs to postgraduate positions in Canada is needed. Methods: We conducted a quantitative cross-sectional study to explore the characteristics of IMGs who are currently applying to the Canadian Residency Matching Service (CaRMS) positions to gain a broad understanding of the composition of this group and the factors associated with successful matching. Results: Out of 1,725 applicants in 2019, 14.1% matched on the first attempt and 6.4% after two to three attempts. Only 22.7% matched with a position (57.6% women). Applicants submitted an average 19.6 site/program applications. The percentage of IMGs matched did not statistically differ by gender. The relationship between the year of graduation or geographic area of medical school qualified and matching was significant for the first and second iterations, with current-year graduates and Oceania/Pacific Islands applicants more likely to match. Conclusions: This study provided us with accurate numbers and information about the Canadians studying abroad and IMG groups applying, and factors associated with being matched to the IMG positions through CaRMS, which will be instrumental in informing future selection implications for Canada.

Contexte: Les diplômés hors du Canada et des États-Unis (DHCEU) constituent un élément essentiel de la main-d'œuvre médicale au Canada. Compte tenu des pressions qui s'exercent actuellement sur le système de santé, il est nécessaire de faire le point sur le nombre de candidatures et les taux de jumelage des DHCEU à des postes de résidence au Canada. Méthodes: Nous avons mené une étude quantitative transversale pour explorer les caractéristiques des DHCEU qui postulent actuellement aux postes du Service canadien de jumelage des résidents (CaRMS) afin de mieux comprendre la composition de ce groupe et les facteurs associés à un jumelage réussi. Résultats: Sur 1 725 candidats en 2019, 14,1 % ont été jumelés dès leur première tentative et 6,4 % après 2 ou 3 tentatives. Seulement 22,7 % des candidats ont obtenu un poste (57,6 % de femmes). En moyenne, les candidats ont soumis des demandes à 19,6 endroits/programmes. Le pourcentage de DHCEU jumelés n'était pas statistiquement différent selon le sexe. La relation entre l'année d'obtention du diplôme ou la zone géographique de la faculté de médecine où il avait été obtenu et le jumelage était significative pour le premier et le deuxième tours, les diplômés de l'année en cours et les candidats de l'Océanie/îles du Pacifique étant plus susceptibles d'être jumelés. Conclusions: Cette étude nous a fourni des chiffres et des renseignements précis sur les Canadiens qui étudient à l'étranger et les groupes de DHCEU qui posent leur candidature aux postes destinés aux DHCEU dans le cadre du CaRMS, ainsi que sur les facteurs associés à un jumelage réussi, ce qui contribuera à guider la sélection des futurs candidats au Canada.

Making assessment a team sport: a qualitative study of facilitated group feedback in internal medicine residency.

Purpose: Competency-based medical education relies on feedback from workplace-based assessment (WBA) to direct learning. Unfortunately, WBAs often lack rich narrative feedback and show bias towards Medical Expert aspects of care. Building on research examining interactive assessment approaches, the Queen's University Internal Medicine residency program introduced a facilitated, team-based assessment initiative ("Feedback Fridays") in July 2017, aimed at improving holistic assessment of resident performance on the inpatient medicine teaching units. In this study, we aim to explore how Feedback Fridays contributed to formative assessment of Internal Medicine residents within our current model of competency-based training. Method: A total of 53 residents participated in facilitated, biweekly group assessment sessions during the 2017 and 2018 academic year. Each session was a 30-minute facilitated assessment discussion done with one inpatient team, which included medical students, residents, and their supervising attending. Feedback from the discussion was collected, summarized, and documented in narrative form in electronic WBA forms by the program's assessment officer for the residents. For research purposes, verbatim transcripts of feedback sessions were analyzed thematically. Results: The researchers identified four major themes for feedback: communication, intra- and inter-personal awareness, leadership and teamwork, and learning opportunities. Although feedback related to a broad range of activities, it showed strong emphasis on competencies within the intrinsic CanMEDS roles. Additionally, a clear formative focus in the feedback was another important finding. Conclusions: The introduction of facilitated team-based assessment in the Queen's Internal Medicine program filled an important gap in WBA by providing learners with detailed feedback across all CanMEDS roles and by providing constructive recommendations for identified areas for improvement.

Objectif: La formation médicale fondée sur les compétences s'appuie sur la rétroaction faite lors de l'évaluation des apprentissages par observation directe dans le milieu de travail. Malheureusement, les évaluations dans le milieu de travail omettent souvent de fournir une rétroaction narrative exhaustive et privilégient les aspects des soins relevant de l'expertise médicale. En se basant sur la recherche ayant étudié les approches d'évaluation interactive, le programme de résidence en médecine interne de l'Université Queen's a introduit en juillet 2017 une initiative d'évaluation facilitée et en équipe (« Les vendredis rétroaction ¼), visant à améliorer l'évaluation holistique du rendement des résidents dans les unités d'enseignement clinique en médecine interne. Dans cette étude, nous visons à explorer comment ces « vendredis rétroaction ¼ ont contribué à l'évaluation formative des résidents en médecine interne dans le cadre de notre modèle actuel de formation axée sur les compétences. Méthode: Au total, 53 résidents ont participé à des séances d'évaluation de groupe facilitées et bi-hebdomadaires au cours de l'année universitaire 2017-2018. Chaque séance consistait en une discussion d'évaluation facilitée de 30 minutes menée avec une équipe de l'unité de soins, qui comprenait des étudiants en médecine, des résidents et le médecin superviseur. Les commentaires issus de la discussion ont été recueillis, résumés et documentés sous forme narrative dans des formulaires électroniques d'observation directe dans le milieu de travail par le responsable de l'évaluation du programme de résidence. À des fins de recherche, les transcriptions verbatim des séances de rétroaction ont été analysées de façon thématique. Résultats: Les chercheurs ont identifié quatre thèmes principaux pour les commentaires : la communication, la conscience intra- et interpersonnelle, le leadership et le travail d'équipe, et les occasions d'apprentissage. Bien que la rétroaction concerne un large éventail d'activités, elle met fortement l'accent sur les compétences liées aux rôles intrinsèques de CanMEDS. De plus, le fait que la rétroaction avait un rôle clairement formatif est une autre constatation importante. Conclusions: L'introduction de l'évaluation en équipe facilitée dans le programme de médecine interne à Queen's a comblé une lacune importante dans l'apprentissage par observation directe dans le milieu de travail en fournissant aux apprenants une rétroaction détaillée sur tous les rôles CanMEDS et en formulant des recommandations constructives sur les domaines à améliorer.

Hospital Use of a Web-Based Clinical Knowledge Support System and In-Training Examination Performance Among Postgraduate Resident Physicians in Japan: Nationwide Observational Study.

Background: The relationship between educational outcomes and the use of web-based clinical knowledge support systems in teaching hospitals remains unknown in Japan. A previous study on this topic could have been affected by recall bias because of the use of a self-reported questionnaire. Objective: We aimed to explore the relationship between the use of the Wolters Kluwer UpToDate clinical knowledge support system in teaching hospitals and residents' General Medicine In-Training Examination (GM-ITE) scores. In this study, we objectively evaluated the relationship between the total number of UpToDate hospital use logs and the GM-ITE scores. Methods: This nationwide cross-sectional study included postgraduate year-1 and -2 residents who had taken the examination in the 2020 academic year. Hospital-level information was obtained from published web pages, and UpToDate hospital use logs were provided by Wolters Kluwer. We evaluated the relationship between the total number of UpToDate hospital use logs and residents' GM-ITE scores. We analyzed 215 teaching hospitals with at least 5 GM-ITE examinees and hospital use logs from 2017 to 2019. Results: The study population consisted of 3013 residents from 215 teaching hospitals with at least 5 GM-ITE examinees and web-based resource use log data from 2017 to 2019. High-use hospital residents had significantly higher GM-ITE scores than low-use hospital residents (mean 26.9, SD 2.0 vs mean 26.2, SD 2.3; P=.009; Cohen d=0.35, 95% CI 0.08-0.62). The GM-ITE scores were significantly correlated with the total number of hospital use logs (Pearson r=0.28; P<.001). The multilevel analysis revealed a positive association between the total number of logs divided by the number of hospital physicians and the GM-ITE scores (estimated coefficient=0.36, 95% CI 0.14-0.59; P=.001). Conclusions: The findings suggest that the development of residents' clinical reasoning abilities through UpToDate is associated with high GM-ITE scores. Thus, higher use of UpToDate may lead physicians and residents in high-use hospitals to increase the implementation of evidence-based medicine, leading to high educational outcomes.

Surgeon and Surgical Trainee Experiences After Adverse Patient Events.

Importance: Adverse patient events are inevitable in surgical practice. Objectives: To characterize the impact of adverse patient events on surgeons and trainees, identify coping mechanisms, and assess whether current forms of support are sufficient. Design, Setting, and Participants: In this mixed-methods study, a validated survey instrument was adapted and distributed to surgical trainees from 7 programs, and qualitative interviews were conducted with faculty from 4 surgical departments in an urban academic health system. Main Outcomes and Measures: The personal impact of adverse patient events, current coping mechanisms, and desired forms of support. Results: Of 216 invited trainees, 93 (43.1%) completed the survey (49 [52.7%] male; 60 [64.5%] in third postgraduate year or higher; 23 [24.7%] Asian or Pacific Islander, 6 [6.5%] Black, 51 [54.8%] White, and 8 [8.6%] other race; 13 [14.0%] Hispanic or Latinx ethnicity). Twenty-three of 29 (79.3%) invited faculty completed interviews (13 [56.5%] male; median [IQR] years in practice, 11.0 [7.5-20.0]). Of the trainees, 77 (82.8%) endorsed involvement in at least 1 recent adverse event. Most reported embarrassment (67 of 79 trainees [84.8%]), rumination (64 of 78 trainees [82.1%]), and fear of attempting future procedures (51 of 78 trainees [65.4%]); 28 of 78 trainees (35.9%) had considered quitting. Female trainees and trainees who identified as having a race and/or ethnicity other than non-Hispanic White consistently reported more negative consequences compared with male and White trainees. The most desired form of support was the opportunity to discuss the incident with an attending physician (76 of 78 respondents [97.4%]). Similarly, faculty described feelings of guilt and shame, loss of confidence, and distraction after adverse events. Most described the utility of confiding in peers and senior colleagues, although some expressed unwillingness to reach out. Several suggested designating a departmental point person for event debriefing. Conclusions and Relevance: In this mixed-methods study of the personal impact of adverse events on surgeons and trainees, these events were nearly universally experienced and caused significant distress. Providing formal support mechanisms for both surgical trainees and faculty may decrease stigma and restore confidence, particularly for underrepresented groups.

Factors leading to lapses in professional behaviour of Gynae residents in Pakistan: a study reflecting through the lenses of patients and family, consultants and residents.

INTRODUCTION: Professional behaviour is the first manifestation of professionalism. In teaching hospitals, the residents can be considered vulnerable to lapses in professional behaviour when they fail to meet the set standards of professionalism. Residents of some specialties are more at risk of lapses in professional behaviour due to the demanding nature of work. Research focusing on the behaviour of residents in the field of Gynae and the underlying factors contributing to such behaviour is notably lacking in the literature. Additionally, there is a gap in understanding the perspectives of patients from Pakistan on this matter, as it remains unexplored thus far, which constitutes the central focus of this study. An increase in complaints lodged against Gynae resident's professional behaviour in Pakistan Citizen Portal (PCP) was observed. Therefore, an exploratory qualitative study was conducted to investigate the factors and rationales contributing to the lapses in resident's professional behaviour. The study collected the viewpoints of three stakeholder groups: patients and their families, consultants and residents. The study was conducted in three phases. First, the document analysis of written complaints was conducted, followed by face-to-face interviews (11 per group) conducted by trained researchers from an independent 3rd party. Finally, the interview data was transcribed, coded and analysed. In total 15 themes were identified from the interviews with 3 stakeholders, which were then categorized and resulted in 6 overlapping themes. The most prevalent lapse reported by all 3 stakeholders was poor verbal behaviour of residents. CONCLUSION: The highly ranked factors contributing to triggering the situation were associated with workplace challenges, well-being of residents, limited resources, patients and family characteristics, patients' expectations, lack of administrative and paramedic support, cultural factors and challenges specific to Gynae specialty. Another intriguing and emerging theme was related to the characteristics of patients and attendants which helped in understanding the causes and implications of conflicting environments. The value of competency also emphasized that can be accomplished by training and mentoring systems. The thorough examination of these factors by key stakeholders aided in accurately analysing the issue, its causes, and possible solutions. The study's findings will assist higher authorities in implementing corrective actions and offering evidence-based guidance to policymakers to improve healthcare system.

Evaluating the new family medicine internship programmes in the Western Cape, South Africa.

BACKGROUND:  In 2021, South Africa introduced a new 6-month internship in family medicine and primary care. This study aimed to assess the new rotation at district health facilities in the Western Cape. METHODS:  A descriptive survey of interns and supervisors, as phase-two of an exploratory sequential mixed methods study. Questionnaires were developed from a descriptive exploratory qualitative study. Data were analysed with the Statistical Package for Social Sciences. RESULTS:  Questionnaires were completed by 72 interns (response rate 21%) and 36 supervisors (response rate 90%), across 10 training programmes. Interns felt more independent (97.2%), confident (90.3%) and resilient (91.6%). They learnt to manage undifferentiated and chronic conditions (91.6%), to refer patients (94.3%) and conduct procedures (77.8%). Most interns were not exposed to community-based services (68.0%) and continuity of care (54.1%). Supervision was mostly adequate during the day (79.1%) and afterhours (80.6%). Many interns reported no structured teaching programme (41.7% - 55.6%). Most supervision was from medical officers and registrars. Supervisors saw interns as valuable members of the clinical team (100.0%), who required extra support and administration (42.5%). The majority of interns (75.0%) and supervisors (72.7%) thought the rotation was the right length and the best preparation for community service (67.6%). CONCLUSION:  The rotation met most expectations of the Health Professions Council of South Africa. Programmes need to improve exposure to community-orientated primary care, public health medicine, palliative and ongoing care. Supervision and orientation of interns needs improvement.Contribution: This is the first evaluation of the new family medicine internship programme in South Africa.