Consensus-derived Recommended Skills for Transition to Residency Courses.

PURPOSE: Transition to residency (TTR) courses facilitate the medical student-residency transition and are an integral part of senior medical student training. The authors established a common set of skills for TTR courses and an expected level of entrustment students should demonstrate in each skill on TTR course completion. METHOD: A modified Delphi approach was used with 3 survey iterations between 2020 and 2022 to establish skills to be included in a TTR course. Nine TTR experts suggested general candidate skills and conducted a literature search to ensure no vital skills were missed. A stakeholder panel was solicited from email lists of TTR educators, residency program directors, and residents at the panelists' institutions. Consensus was defined as more than 75% of participants selecting a positive inclusion response. An entrustment questionnaire asked panelists to assign a level of expected entrustment to each skill, with 1 indicating observation only and 6 indicating perform independently. RESULTS: The stakeholder panel initially consisted of 118 respondents with representation across educational contexts and clinical specialties. Response rates were 54% in iteration 2, 42% in iteration 3, and 33% on the entrustment questionnaire. After 3 iterations, 54 skills met consensus and were consolidated into 37 final skills categorized into 18 clinical skills (e.g., assessment and management of inpatient concerns), 14 communication skills (e.g., delivering serious news or having difficult conversations), 4 personal and professional skills (e.g., prioritization of clinical tasks), and 1 procedural skill (mask ventilation). Median entrustment levels were reported for all skills, with 19 skills having a level of expected entrustment of 4 (perform independently and have all findings double-checked). CONCLUSIONS: These consensus skills can serve as the foundation of a standardized national TTR curriculum framework. Entrustment guidance may help educational leaders optimize training and allocation of resources for TTR curriculum development and implementation.

Transition to Residency Courses: Recommendations for Creation and Implementation.

Transition to Residency (TTR) courses help ease the critical transition from medical school to residency, yet there is little guidance for developing and running these courses. In this perspective, the authors use their expertise as well as a review of the literature to provide guidance and review possible solutions to challenges unique to these courses. TTR courses should be specialty-specific, allow for flexibility, and utilize active learning techniques. A needs assessment can help guide course content, which should focus on what is necessary to be ready for day one of residency. The use of residents in course planning and delivery can help create a sense of community and ensure that content is practical. While course assessments are largely formative, instructors should anticipate the need for remediation, especially for skills likely to be performed with limited supervision during residency. Additionally, TTR courses should incorporate learner self-assessment and goal setting; this may be valuable information to share with learners' future residency programs. Lastly, TTR courses should undergo continuous quality improvement based on course evaluations and surveys. These recommendations are essential for effective TTR course implementation and improvement.

Application of Frequent, Spaced Multiple-choice Questions as an Educational Tool in the Pediatric Emergency Department.

OBJECTIVES: The objective was to assess the feasibility of using spaced multiple-choice questions (MCQs) to teach residents during their pediatric emergency department (PED) rotation and determine whether this teaching improves knowledge retention about pediatric rashes. METHODS: Residents rotating in the PED from four sites were randomized to four groups: pretest and intervention, pretest and no intervention, no pretest and intervention, and no pretest and no intervention. Residents in intervention groups were automatically e-mailed quizlets with two MCQs every other day over 4 weeks (20 questions total) via an automated e-mail service with answers e-mailed 2 days later. Retention of knowledge was assessed 70 days after enrollment with a posttest of 20 unique, content-matched questions. RESULTS: Between August 2015 and November 2016, a total 234 residents were enrolled. The completion rate of individual quizlets ranged from 93% on the first and 76% on the 10th quizlet. Sixty-six residents (55%) completed all 10 quizlets. One-hundred seventy-three residents (74%) completed the posttest. There was no difference in posttest scores between residents who received a pretest (61.0% ± 14.5%) and those who did not (64.6% ± 14.0%; mean difference = -3.7, 95% confidence interval [CI] = -8.0 to 0. 6) nor between residents who received the intervention (64.5% ± 13.3%) and those who did not receive the intervention (61.2% ± 15.2%; mean difference = 3.2, 95% CI = -1.1 to 7.5). For those who received a pretest, scores improved from the pretest to the posttest (46.4% vs. 60.1%, respectively; 95% CI = 9.7 to 19.5). CONCLUSION: Providing spaced MCQs every other day to residents rotating through the PED is a feasible teaching tool with a high participation rate. There was no difference in posttest scores regardless of pretest or intervention. Repeated exposure to the same MCQs and an increase in the number of questions sent to residents may increase the impact of this educational strategy.

Educational Benefits of Allowing Pediatrician Supervision of Emergency Medicine Residents.

BACKGROUND: According to the Accreditation Council for Graduate Medical Education emergency medicine (EM) program requirements, EM residents on EM rotations must be supervised by board-certified/board-prepared EM or pediatric EM (PEM) faculty. OBJECTIVE: We sought to understand the effect of allowing EM residents to be supervised by attending pediatricians while caring for pediatric urgent care patients. METHODS: The EM residents were permitted to staff pediatric urgent care patients with either an EM/PEM attending or an attending pediatrician from August 2017 to July 2018. Outcomes were assessed through resident focus groups, a mixed-methods survey of EM residents and EM/PEM/pediatrician attendings, and clinical outcomes, including length of stay, best evidence/clinical care guideline adherence, and 48-hour return visits requiring admission. Qualitative data were inductively coded using a phenomenological framework, with themes emerging from consensus discussion. RESULTS: Ninety percent of residents participated in 1 of 7 focus groups. Four key themes emerged from qualitative analysis of focus group transcripts: (1) pediatricians have unique skills that complement those of EM physicians; (2) EM resident education improved; (3) patients may get better care with dual staffing; and (4) other PEM department and urgent care team members may have benefited from the change. The survey response rate was 72%, and it did not uncover additional themes. Length of stay was shorter for patients supervised by attending pediatricians (114 versus 128 minutes, P < .001); there was no difference in best evidence/clinical care guideline adherence or 48-hour return visits requiring admission. CONCLUSIONS: Physicians' perceived education was improved by adding complementary perspectives without significant negative consequences for learners or patients.

Three-Dimensional Printed Pediatric Airway Model Improves Novice Learners' Flexible Bronchoscopy Skills With Minimal Direct Teaching From Faculty.

INTRODUCTION: Training in pediatric flexible bronchoscopy (FB) is predominantly completed on patients. Early trainees are less accurate and slower than experienced bronchoscopists. This report describes the development of a three-dimensional printed airway model and describes how the model was used to teach learners basic FB skills. METHODS: Postgraduate year two (PGY2) pediatric residents completing a 1-month pediatric pulmonology rotation with minimal previous exposure to FB were randomized into a simulation trainee group (n = 18) or a control resident group (n = 9). The simulation group received four 15-minute practice sessions (3 self-directed, 1 with feedback). Participants completed a bronchoscopy assessment on the model at prestudy, poststudy, and delayed (at least 2 months after the rotation) time points. Outcomes were identification of markers located in the six lung areas and completion time. RESULTS: There was no difference in prestudy scores between groups. In the poststudy assessment, the simulation participants correctly identified more lung area markers (median = 6 vs 1.5, P < 0.001) and were faster (median = 102 vs 600 seconds, P < 0.001). In the delayed assessment, correct marker identification trended toward improvement in the simulation group compared with controls (median = 4 vs 2, P = 0.077). CONCLUSIONS: With 1 hour of practice time, requiring 15 minutes of direct teaching, novice resident bronchoscopists are able to more accurately identify and visualize the five lung lobes and lingula via FB and are able to do so in less time than control residents. This anatomically accurate model could be used to train basic FB skills at a low cost compared with other models.

Study Skills and Test Taking Strategies for Coaching Medical Learners Based on Identified Areas of Struggle.

INTRODUCTION: Learners in high-performing contexts such as medical school and residency are presumed to have appropriate study skills to be successful. However, for those learners in academic difficulty who are identified as having weak study skills and poor test taking skills, faculty need tools to use to lead these struggling learners to academic success. In coaching learners on study skills, we frequently found that the study skills that helped them get into medical school or residency were no longer sufficient to make them successful in their new program. Given that there are multiple study strategies available, faculty coaches need mechanisms to first tease out which skills are the issue and then provide targeted strategies specific to each learner. METHODS: In meeting with a faculty coach, learners are briefly interviewed, complete a self-assessment to explore all possible root weaknesses in their study skills, and then read strategic solutions and review with faculty how they may be implemented. This tool has been offered to 52 students, 76 residents, and 20 fellows and faculty between 2010 and 2015. RESULTS: One hundred forty-eight individuals participated in this innovation, with more than 91% of all individuals going on to pass the exam that they had either failed or, in the case of the in-training exam, scored below the 30th percentile on. CONCLUSION: A self-assessment tool is key to individualized insight and action plans for improving study skills. Implementation must be supported with concurrent in-person coaching.

Latino families' experiences with family-centered rounds at an academic children's hospital.

OBJECTIVE: To characterize Latino families' experiences with family-centered rounds at an academic children's hospital to identify areas for improvement. METHODS: Five focus groups of families of Latino children hospitalized on a general medical ward were conducted in Spanish by a single bilingual facilitator. Participants were recruited from a convenience sample of Spanish-speaking Latino family members present at the patients' bedside. Data were transcribed verbatim, content coded, and analyzed in Spanish for emergent themes. RESULTS: Twenty-eight Latino family members of 21 hospitalized children participated in the 5 focus groups. Most spoke only Spanish (75%), and Spanish was the preferred language of all focus group participants. Qualitative data analysis indicated that families reported positive experiences with rounds involving a Spanish-speaking provider. Thematic issues focused on family-physician communication problems, lack of family empowerment, family and provider participants for family-centered rounds, and cultural needs. Parents were dissatisfied with telephonic interpretation services and preferred a live interpreter in the absence of a fluent, bilingual physician. Many families did not feel empowered to request interpretation assistance or health information; parents often felt embarrassed as a result of their inability to understand the primary language (English) of the care providers. Some parents felt inhibited to express themselves in the presence of other family members. Addressing cultural needs (e.g., chaplain support) was appreciated by families. CONCLUSIONS: Spanish-speaking Latino families are not consistently receiving optimal family-centered rounds. Different strategies are needed to fully engage and empower Latino families.