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2.
J Surg Res ; 257: 246-251, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32862052

RESUMO

BACKGROUND: Training diverse house staff, including those who are underrepresented in medicine, is vital to provide high-quality patient care for the communities that we serve. In 2018, the Accreditation Council for Graduate Medical Education announced new common program requirements for systematic efforts to recruit and retain a diverse workforce. However, questions remain about how to implement such efforts. MATERIALS AND METHODS: Electronic Residency Application Service (ERAS) data from eight residency programs spanning two recruitment cycles (2017-2018, 2018-2019) was reviewed. The number of candidates at each stage in the process (applicant, invited to interview, interviewed, and matched) was examined by self-identified race or ethnicity. These data were presented to residency program directors at our Graduate Medical Education committee meeting before the next recruitment cycle. Data were analyzed following the 2019-20 residency match. Odds ratios and Pearson's chi-squared test were used to assess statistical significance. RESULTS: A total of 10,445 and 10,982 medical students applied to our 8 core residency programs in 2017 and 2018, respectively. Medical students who applied and self-identified as Asian, Black or African American, and Hispanic or Latino or Spanish origin had lower odds of being invited to interview than those who self-identified as White. After data presentation, the odds of inviting Black or African American applicants to interview increased significantly. The odds of attending an interview once invited were the same across groups. CONCLUSIONS: Sharing ERAS data patterns with residency program directors was associated with a significant year over year change in interviewee diversity. Structured analysis of institutional ERAS data can provide insight into the resident selection process and may be a useful tool to improve house staff diversity.


Assuntos
Diversidade Cultural , Mão de Obra em Saúde/organização & administração , Internato e Residência/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Seleção de Pessoal/organização & administração , Estudantes de Medicina/estatística & dados numéricos , Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Estudos de Viabilidade , Mão de Obra em Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Internato e Residência/organização & administração , Candidatura a Emprego , Seleção de Pessoal/estatística & dados numéricos , Estados Unidos
3.
Am J Med Genet A ; 185(1): 68-72, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33051968

RESUMO

The national importance of telemedicine for safe and effective patient care has been highlighted by the current COVID-19 pandemic. Prior to the 2020 pandemic the Division of Genetics and Metabolism piloted a telemedicine program focused on initial and follow-up visits in the patients' home. The goals were to increase access to care, decrease missed work, improve scheduling, and avoid the transport and exposure of medically fragile patients. Visits were conducted by physician medical geneticists, genetic counselors, and biochemical dietitians, together and separately. This allowed the program to develop detailed standard operating procedures. At the onset of the COVID-19 pandemic, this pilot-program was deployed by the full team of 22 providers in one business day. Two physicians remained on-site for patients requiring in-person evaluations. This model optimized patient safety and workforce preservation while providing full access to patients during a pandemic. We provide initial data on visit numbers, types of diagnoses, and no-show rates. Experience in this implementation before and during the pandemic has confirmed the effectiveness and value of telemedicine for a highly complex medical population. This program is a model that can and will be continued well-beyond the current crisis.


Assuntos
/epidemiologia , Assistência à Saúde/organização & administração , Endocrinologia/organização & administração , Genética Médica/organização & administração , Modelos Organizacionais , Pandemias , Telemedicina/organização & administração , Adolescente , Adulto , Criança , Pré-Escolar , Assistência à Saúde/métodos , Assistência à Saúde/normas , Endocrinologia/educação , Feminino , Aconselhamento Genético/métodos , Aconselhamento Genético/organização & administração , Aconselhamento Genético/normas , Doenças Genéticas Inatas/epidemiologia , Doenças Genéticas Inatas/terapia , Testes Genéticos/métodos , Testes Genéticos/normas , Genética Médica/educação , Humanos , Ciência da Implementação , Lactente , Recém-Nascido , Internato e Residência/métodos , Internato e Residência/organização & administração , Internato e Residência/normas , Masculino , Doenças Metabólicas/epidemiologia , Doenças Metabólicas/terapia , Pessoa de Meia-Idade , Segurança do Paciente , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Telemedicina/métodos , Adulto Jovem
4.
Acad Med ; 96(1): 50-55, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-32910007

RESUMO

The 2019 novel coronavirus (COVID-19) pandemic has led to dramatic changes in the 2020 residency application cycle, including halting away rotations and delaying the application timeline. These stressors are laid on top of a resident selection process already under duress with exploding application and interview numbers-the latter likely to be exacerbated with the widespread shift to virtual interviewing. Leveraging their trainee perspective, the authors propose enforcing a cap on the number of interviews that applicants may attend through a novel interview ticket system (ITS). Specialties electing to participate in the ITS would select an evidence-based, specialty-specific interview cap. Applicants would then receive unique electronic tickets-equal in number to the cap-that would be given to participating programs at the time of an interview, when the tickets would be marked as used. The system would be self-enforcing and would ensure each interview represents genuine interest between applicant and program, while potentially increasing the number of interviews-and thus match rate-for less competitive applicants. Limitations of the ITS and alternative approaches for interview capping, including an honor code system, are also discussed. Finally, in the context of capped interview numbers, the authors emphasize the need for transparent preinterview data from programs to inform applicants and their advisors on which interviews to attend, learning from prior experiences and studies on virtual interviewing, adherence to best practices for interviewing, and careful consideration of how virtual interviews may shift inequities in the resident selection process.


Assuntos
/epidemiologia , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência/organização & administração , Pandemias , Seleção de Pessoal , Estudantes de Medicina/estatística & dados numéricos , Humanos
10.
Acad Med ; 95(10): 1521-1523, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33006869

RESUMO

The COVID-19 pandemic is a public health emergency that demands leadership throughout the health care system. Leadership is the ability to guide a team or organization toward a stated goal or objective. In addition to hospital-wide leadership, there is need for leadership at the level of medical teams. Resident leadership is essential to ensure team function and patient care, yet residents are often overlooked as valuable leaders. This Perspective argues that residents can demonstrate leadership during a public health crisis by creating a culture of emotional intelligence in their medical teams. Emotional intelligence has been identified as a critical aspect of leadership and consists of self-awareness, self-management, social awareness, and relationship management. In psychiatry, patient interactions depend upon psychiatrists demonstrating a high level of attention to their own thoughts, feelings, and behaviors as well as those of the patient to communicate in a way that demonstrates both understanding and empathy. In this Perspective, a psychiatry resident uses expertise in emotional intelligence to recommend residents (1) be mindful, (2) ask and listen, (3) establish safety, and (4) unite around a common goal. These practical recommendations can be immediately implemented to increase emotional intelligence on medical teams to improve team function and patient care. Emotional intelligence is valuable at all levels of leadership, so hospital leadership and program directors should also heed these suggestions. While these recommendations are not unique to COVID-19, they are of paramount importance during the pandemic.


Assuntos
Infecções por Coronavirus/psicologia , Inteligência Emocional , Internato e Residência/organização & administração , Liderança , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/psicologia , Estudantes de Medicina/psicologia , Betacoronavirus , Humanos , Pandemias
12.
Am Surg ; 86(11): 1485-1491, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33125284

RESUMO

BACKGROUND: Rural access to surgical care has reached crisis level. Practicing in rural America offers unique challenges with limited resources and specialists. Most training programs do not provide enough exposure to the endoscopic or the surgical subspecialty skills to prepare a resident for an isolated rural environment. As awareness has increased, many programs have modified curriculum to address this need. The Advisory Council on Rural Surgery (ACRS) of the American College of Surgeons set out to delineate important components of rural training programs and measure to what degree the existing heterogeneous programs contain these components. STUDY DESIGN: The ACRS identified 4 essential components of rural surgical training based on literature and expert opinion. These components included rotations in a rural setting, broad exposure to surgical specialties, endoscopy experience, and lack of competing specialty learners. A list of Accreditation Council for Graduate Medical Education programs from a prior publication was updated with the 2019 Fellowship and Residency Electronic Interactive Database self-identified "rural track" programs, reviewed, and categorized. RESULTS: We identified 39 programs that self-identified as having a rural emphasis. Depending on the extent of which 4 essential components were included, programs were categorized as either "Broad" (12 programs), "Basic" (20 programs), or "Indeterminate" (7 programs). CONCLUSION: The ACRS described the optimal components of a rural surgical training program and identified which components are present in those surgical residencies which self-identified as having a rural focus. This information is valuable to students planning a future in rural surgery and benefits programs hoping to enhance their curriculum to meet this critical need.


Assuntos
Cirurgia Geral/educação , Serviços de Saúde Rural , Acesso aos Serviços de Saúde , Humanos , Internato e Residência/organização & administração , Sociedades Médicas , Estados Unidos
14.
Can J Surg ; 63(5): E454-E459, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107817

RESUMO

SUMMARY: Small surgical residency programs like plastic surgery can be challenging environments to accommodate parental leave. This study aimed to report the experiences, attitudes and perceived support of Canadian plastic surgery residents, recent graduates and staff surgeons with respect to pregnancy and parenting during training. Residents and staff surgeons were invited via email to participate in an online survey. The results presented here explore experiences of pregnancy and parental leave of current plastic surgery residents and staff surgeons. Residents' and staff surgeons' perceptions of program director support, policies, negative comments and the impact of parental leave on the workload of others were also explored. Although the findings suggest that there may be improvements in the support of program directors, there continues to be a negative attitude in surgical culture toward pregnancy during residency. The perceived confusion of respondents with respect to programspecific policies emphasizes the need for open conversations and standardization of parental leave.


Assuntos
Atitude do Pessoal de Saúde , Internato e Residência/estatística & dados numéricos , Licença Parental/estatística & dados numéricos , Gravidez/psicologia , Cirurgia Plástica/educação , Adulto , Canadá , Feminino , Humanos , Internato e Residência/organização & administração , Masculino , Pessoa de Meia-Idade , Diretores Médicos/psicologia , Políticas , Gravidez/estatística & dados numéricos , Cirurgiões/psicologia , Cirurgiões/estatística & dados numéricos , Cirurgia Plástica/psicologia , Cirurgia Plástica/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos
15.
Soins ; 65(846): 29-31, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-33012415

RESUMO

With the 2009 reference frame, the internship became a clinical apprenticeship. It is not up to the supervisors in the departments and in the training environment to assess the student, but the tutor. Disparities in learning persist, often linked to the organisation of the departments.


Assuntos
Educação em Enfermagem/organização & administração , Internato e Residência/organização & administração , Relações Interprofissionais , Humanos , Aprendizagem , Pesquisa em Educação de Enfermagem , Organização e Administração , Estudantes de Enfermagem/psicologia
16.
Nephrol Nurs J ; 47(5): 429-435, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107715

RESUMO

New graduate registered nurses (NGRNs) can become competent in providing acute care hemodialysis for complex medical and critically ill patients. As the renal patient population grows, nephrology nursing will need RNs prepared to provide high-quality, patient-centered care through evidence-based practice. This article describes the successful development and implementation of a comprehensive Nephrology Nurse Residency Program at Emory University Hospital. Utilizing Benner's Novice to Expert theory, this project evaluated providing NGRNs with the essential residency experiences to become nephrology nurses who are competent in the provision of acute care hemodialysis, with the ability to care for medically complex and critically ill patients. It is recommended that this program be offered at health care institutions that provide acute dialysis services.


Assuntos
Educação de Pós-Graduação em Enfermagem/organização & administração , Internato e Residência/organização & administração , Nefrologia/educação , Diálise Renal/enfermagem , Humanos
17.
Curr Urol Rep ; 21(12): 50, 2020 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-33090272

RESUMO

PURPOSE OF REVIEW: This article aims to describe the impact of the COVID-19 pandemic on American urology trainees, with a focus on virtual learning initiatives. RECENT FINDINGS: Urological education was forced to rapidly adapt to the COVID-19 pandemic in 2020. Significant challenges included quarantines, redeployment of residents and faculty, and suspension of regularly scheduled conferences. In response, urologists across the country adopted web-based platforms to develop virtual lecture series to fill the gap. Popular programs for residents included UCSF's COViD (Collaborative Online Video Didactics) series and the New York Section of the American Urological Association's EMPIRE (Educational Multi-institutional Program for Instructing REsidents) series. Virtual education programs have enabled urology trainees to pursue their education during the pandemic. While the long-term impact of the pandemic on urology training remains unknown, some good may be found in the innovative solutions that have arisen in urology education.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Educação a Distância/organização & administração , Internato e Residência/organização & administração , Pneumonia Viral/epidemiologia , Urologia/educação , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Estados Unidos , Realidade Virtual
18.
Urology ; 146: 36-42, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33007312

RESUMO

OBJECTIVE: To capture the perspective of prospective urology applicants experiencing unique challenges in the context of COVID-19. METHODS: A voluntary, anonymous survey was distributed online, assessing the impact of COVID-19 on a large sample of US medical students planning to apply to urology residencies. Themes of (1) specialty discernment, (2) alterations to medical education, and (3) the residency application process were explored. RESULTS: A total of 238 medical students, 87% third and fourth years, responded to the survey. While 85% indicated that the pandemic had not deterred their specialty choice, they noted substantial impacts on education, including 82% reporting decreased exposure to urology. Nearly half of students reported changes to required rotations and 35% reported changes to urology-specific rotations at their home institutions. Students shared concerns about suspending in-person experiences, including the impact on letters of recommendation (68% "very concerned) and program choice (73% "very concerned"). Looking to the possibility of virtual interactions, students identified the importance of small group and one-on-one communication with residents (83% "very important") and opportunities to learn about hospital facilities (72% "very important"). CONCLUSION: Despite the impacts of COVID-19 on medical education, prospective urology applicants appear to remain confident in their specialty choice. Students' biggest concerns involve disruption of away rotations, including impacts on obtaining letters of recommendation and choosing a residency program.


Assuntos
Internato e Residência/estatística & dados numéricos , Pandemias , Estudantes de Medicina/estatística & dados numéricos , Urologia/educação , Escolha da Profissão , Humanos , Internet , Internato e Residência/organização & administração , Candidatura a Emprego , Estudantes de Medicina/psicologia , Inquéritos e Questionários , Estados Unidos , Urologia/normas , Urologia/estatística & dados numéricos
19.
JAMA Surg ; 155(9): 870-875, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32936281

RESUMO

On March 1, 2020, the first case of coronavirus disease 2019 (COVID-19) was confirmed in New York, New York. Since then, the city has emerged as an epicenter for the ongoing pandemic in the US. To meet the anticipated demand caused by the predicted surge of patients with COVID-19, the Department of Surgery at NewYork-Presbyterian Hospital/Weill Cornell Medicine developed and executed an emergent restructuring of general surgery resident teams and educational infrastructure. The restructuring of surgical services described in this Special Communication details the methodology used to safely deploy the necessary amount of the resident workforce to support pandemic efforts while maintaining staffing for emergency surgical care, limiting unnecessary exposure of residents to infection risk, effectively placing residents in critical care units, and maintaining surgical education and board eligibility for the training program as a whole.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Educação de Pós-Graduação em Medicina/organização & administração , Cirurgia Geral/educação , Internato e Residência/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Cidade de Nova Iorque , Pneumonia Viral/transmissão
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