Values-Based Resident Selection in an Internal Medicine-Pediatrics Residency Program.

BACKGROUND: There is no consensus regarding values important for medical resident success, and current methods for selecting residents correlate poorly with success in residency. OBJECTIVE: We developed and validated a set of values demonstrated by exemplary residents in the Internal Medicine-Pediatrics program at the University of Utah and used them to inform our resident selection process. DESIGN: We utilized a modified Delphi method to identify and internally validate values of successful residents. We implemented these values into the interview evaluation rubric. PARTICIPANTS: Four members of the Internal Medicine-Pediatrics residency program leadership and eleven current residents aided in value generation. Nine faculty from leadership positions in the residency programs of Internal Medicine-Pediatrics, Internal Medicine, and Pediatrics formed a local expert panel for validation. APPROACH: We performed a literature review and engaged local stakeholders in a semi-structured group interview to generate 107 values. After consolidation based on redundancy, two iterative cycles of expert review using a modified Delphi approach, and alignment with the Accreditation Council for Graduate Medical Education core competencies, eleven values achieved expert agreement and were integrated into an interview rubric to aid in resident selection. KEY RESULTS: We identified eleven values important for resident success: academic strength, intellectual curiosity, compassion, communication, work ethic, teamwork, leadership, self-awareness, DEI (diversity, equity, and inclusion), professionalism, and adaptability. The rank list from 2021 was found to correlate with a score based on values, but not Step 2 score, as it did in 2017. CONCLUSIONS: We applied a modified Delphi method to generate eleven observable values present in the ideal Internal Medicine-Pediatric resident at one academic health center in the Intermountain West. Higher Step 2 scores no longer correlated with higher ranking when we used these values to inform our rank list.

The power of interdependence: Linking health systems, communities, and health professions educational programs to better meet the needs of patients and populations.

Promoting optimal health outcomes for diverse patients and populations requires the acknowledgement and strengthening of interdependent relationships between health professions education programs, health systems, and the communities they serve. Educational programs must recognize their role as integral components of a larger system. Educators must strive to break down silos and synergize efforts to foster a health care workforce positioned for collaborative, equitable, community-oriented practice. Sharing interprofessional and interinstitutional strategies can foster wide propagation of educational innovation while accommodating local contexts. This paper outlines how member schools of the American Medical Association Accelerating Change in Medical Education Consortium leveraged interdependence to accomplish transformative innovations catalyzed by systems thinking and a community of innovation.

What's in a Transition? An Integrative Perspective on Transitions in Medical Education.

This Conversation Starters article presents a selected research abstract from the 2016 Association of American Medical Colleges Western Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of three experts who shared their thoughts stimulated by the needs assessment study. These thoughts explore how the general theoretical mechanisms of transition may be integrated with cognitive load theory in order to design interventions and environments that foster transition.

Using Natural Language Processing and Machine Learning to Identify Internal Medicine-Pediatrics Residency Values in Applications.

PROBLEM: Although holistic review has been used successfully in some residency programs to decrease bias, such review is time-consuming and unsustainable for many programs without initial prescreening. The unstructured qualitative data in residency applications, including notable experiences, letters of recommendation, personal statement, and medical student performance evaluations, require extensive time, resources, and metrics to evaluate; therefore, previous applicant screening relied heavily on quantitative metrics, which can be socioeconomically and racially biased. APPROACH: Using residency applications to the University of Utah internal medicine-pediatrics program from 2015 to 2019, the authors extracted relevant snippets of text from the narrative sections of applications. Expert reviewers annotated these snippets into specific values (academic strength; intellectual curiosity; compassion; communication; work ethic; teamwork; leadership; self-awareness; diversity, equity, and inclusion; professionalism; and adaptability) previously identified as associated with resident success. The authors prospectively applied a machine learning model (MLM) to snippets from applications from 2023, and output was compared with a manual holistic review performed without knowledge of MLM results. OUTCOMES: Overall, the MLM had a sensitivity of 0.64, specificity of 0.97, positive predictive value of 0.62, negative predictive value of 0.97, and F1 score of 0.63. The mean (SD) total number of annotations per application was significantly correlated with invited for interview status (invited: 208.6 [59.1]; not invited: 145.2 [57.2]; P < .001). In addition, 8 of the 10 individual values were significantly predictive of an applicant's invited for interview status. NEXT STEPS: The authors created an MLM that can identify several values important for resident success in internal medicine-pediatrics programs with moderate sensitivity and high specificity. The authors will continue to refine the MLM by increasing the number of annotations, exploring parameter tuning and feature engineering options, and identifying which application sections have the highest correlation with invited for interview status.

Times of Medical Education Crisis Require New Evaluation Approaches: Proof of Concept of a System-Based Program Evaluation Model.

There are no program evaluation approaches designed for a crisis, such as the COVID-19 pandemic. It is critical to evaluate the educational impact of COVID-19 to keep administrators informed and guide decision-making. The authors used systems thinking to design an evaluation model. The evaluation results suggest complex interactions between individuals and course level changes due to COVID-19. Specifically, year 1-2 students found more education metrics lacking relative to year 3-4 students, faculty, and course directors. There was no consensus for the value of similar instructional/assessment adaptations. The evaluation model can be adapted by other medical schools to fit systems-based needs.

Learning from failure: how eliminating required attendance sparked the beginning of a medical school transformation.

Concern about medical student attendance has been rising over the last decade. Thinking a required attendance policy would fix things, we instituted such a mandate in 2010 only to find that although students were present at lecture and other learning sessions they were disengaged. In addition, we experienced growing distrust between faculty and students and tensions between the Student Affairs and Curriculum offices. After five years, we dismantled the policy in favor of encouraged attendance. We discuss both positive and negative surprising consequences that followed this new approach to attendance which has reshaped our vision for the medical school learning experience. It has been transformative and has afforded us the opportunity to redefine our results in accord with the culture in which we aspire to live and work.

The Two-Stage Examination: A Method to Assess Individual Competence and Collaborative Problem Solving in Medical Students.

PROBLEM: Effectively solving problems as a team under stressful conditions is central to medical practice; however, because summative examinations in medical education must test individual competence, they are typically solitary assessments. APPROACH: Using two-stage examinations, in which students first answer questions individually (Stage 1) and then discuss them in teams prior to resubmitting their answers (Stage 2), is one method for rectifying this discordance. On the basis of principles of social constructivism, the authors hypothesized that two-stage examinations would lead to better retention of, specifically, items answered incorrectly at Stage 1.In fall 2014, they divided 104 first-year medical students into two groups of 52 students. Groups alternated each week between taking one- and two-stage examinations such that each student completed 6 one-stage and 6 two-stage examinations. The authors reassessed 61 concepts on a final examination and, using the Wilcoxon signed ranked tests, compared performance for all concepts and for just those students initially missed, between Stages 1 and 2. OUTCOMES: Final examination performance on all previously assessed concepts was not significantly different between the one-and two-stage conditions (P = .77); however, performance on only concepts that students initially answered incorrectly on a prior examination improved by 12% for the two-stage condition relative to the one-stage condition (P = .02, r = 0.17). NEXT STEPS: Team assessment may be most useful for assessing concepts students find difficult, as opposed to all content. More research is needed to determine whether these results apply to all medical school topics and student cohorts.

Comparison of unipedicled and bipedicled TRAM flap breast reconstructions: assessment of physical function and patient satisfaction.

Many variations of the transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction have been attempted since the procedure was first described. One common modification involves the use of both rectus muscles, which may accommodate a bilateral reconstruction or provide a more reliable blood supply to a unilateral reconstruction. Objective studies measuring various aspects of physical strength after bilateral rectus harvest and subjective reports of various physical symptoms have challenged the morbidity of a double-rectus harvest. Whether this represents increased morbidity in practical terms is best clarified by asking the patients. To answer this question, 124 TRAM flap reconstruction patients (62 unipedicled patients and 62 bipedicled patients) completed a survey containing questions regarding postoperative physical activities and abilities, outcome with regard to specific physical symptoms, and satisfaction with the procedure. The overwhelming majority of patients reported no untoward effect postoperatively regarding the following: workday performance (>or=90 percent), workday performance involving physical labor (>or=78 percent), physical recreation (>or=77 percent), abdominal appearance (>or=77 percent), standing posture (>or=95 percent), and back pain (>or=81 percent). When comparing unipedicled and bipedicled TRAM patient groups, there was no statistically significant difference between the two groups for any of these criteria. However, a subjective decrease in abdominal muscle strength was reported by 42 percent of unipedicled and 64 percent of bipedicled TRAM flap patients, and decreased abdominal muscle strength was the most frequently cited reason for dissatisfaction. Interestingly, this decreased strength did not affect the daily activities of the majority of patients, who were happy with the procedure (96 percent) and would recommend it to others (96 percent).

Who will care for me next? Transitioning to adulthood with hydrocephalus.

OBJECTIVES: Hydrocephalus is a prototypical chronic condition that follows children into adulthood. The objectives of this study were to (1) review how the health care needs of young adults with hydrocephalus are not being met, (2) estimate the numbers of adults with childhood-onset hydrocephalus, (3) describe a novel program to provide care for young adults with hydrocephalus and other chronic pediatric conditions, and (4) propose national strategies to promote successful hydrocephalus transition care. RESULTS: Adults with hydrocephalus need continuous access to expert surgical and medical providers. Existing care models fail to meet this need. The number of young adults who have hydrocephalus, are aged 18 to 35 and need treatment in the United States is predicted to exceed 40000 annually within the next 2 decades. We are developing integrated teams of pediatric and adult medical and surgical specialists to provide continuous, coordinated, comprehensive care for individuals with hydrocephalus in a pediatric setting. This setting will train our future physician workforce on optimal transition care. Coordinated national efforts are also needed. CONCLUSIONS: Providers need to implement appropriate management and transition care for individuals with hydrocephalus. We must work at local and national levels to transform the care model, improve the quality of health care delivery, and improve outcomes for young adults with hydrocephalus.