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OBJECTIVE: The COVID-19 pandemic resulted in training programs restructuring their curricula. Fellowship programs are required to monitor each fellow's training progress through a combination of formal evaluations, competency tracking, and measures of knowledge acquisition. The American Board of Pediatrics administers subspecialty in-training examinations (SITE) to pediatric fellowship trainees annually and board certification exams at the completion of the fellowship. The objective of this study was to compare SITE scores and certification exam passing rates before and during the pandemic. METHODS: In this retrospective observational study, we collected summative data on SITE scores and certification exam passing rates for all pediatric subspecialties from 2018 to 2022. Trends over time were assessed using analysis of variance (ANOVA) analysis to test for trends across years within one group and t-test analysis to compare groups before and during the pandemic. RESULTS: Data were obtained from 14 pediatric subspecialties. Comparing prepandemic to pandemic scores, Infectious Diseases, Cardiology, and Critical Care Medicine saw statistically significant decreases in SITE scores. Conversely, Child Abuse and Emergency Medicine saw increases in SITE scores. Emergency Medicine saw a statistically significant increase in certification exam passing rates, while Gastroenterology and Pulmonology saw decreases in exam passing rates. CONCLUSIONS: The COVID-19 pandemic resulted in restructuring didactics and clinical care based on the needs of the hospital. There were also societal changes affecting patients and trainees. Subspecialty programs with declining scores and certification exam passing rates may need to assess their educational and clinical programs and adapt to the needs of trainees' learning edges. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We sought to assess whether the change from in-person to virtual interviews was associated with differences in applicant and match location geography. METHODS: We conducted a retrospective study of all U.S. applicants to a large pediatric residency. Distances from applicants to our residency program (applicant-to-program) and residency location (applicant-to-match) were compared across demographic subgroups and eras, defined as pre-COVID (2018-2020) and COVID (2021-2022). RESULTS: Applicant-to-program distance (pre-COVID median 737 miles, IQR 265, 1254; COVID median 739 miles; IQR 268, 1284, P = .31) did not change across eras. While overall applicant-to-match distance (pre-COVID median 425 miles, IQR 88, 1142; COVID median 354 miles; IQR 80, 1084, P = .11) did not change, subgroup analysis revealed that applicant-to-match distance for those not participating in a couples match was farther during the pre-COVID era (430 vs 340 miles, P = .04). CONCLUSIONS: A transition to virtual interviews was associated with shorter distance between applicants and residency location for those matching alone at a large, urban pediatric residency. While decisions about where to apply appeared unchanged, rank list decisions may have been impacted by virtual interviews for these applicants. Further study to describe geographic considerations in the virtual era are needed to inform advancement of larger workforce goals. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The Accreditation Council of Graduate Medical Education requires an "individualized curriculum" (IC) in pediatric residency. A shared understanding across programs of methods to evaluate the IC is lacking. We explored pediatric program leaders' perceptions of assessment and evaluation within the IC to further understand and inform most useful practices. METHODS: We conducted a phenomenology study using semi-structured interviews to 1) determine what IC assessment and evaluation strategies are utilized in pediatric residency programs, and 2) explore program leaders' perceptions of the feasibility and value of assessment and evaluation in the IC. We recruited a purposive sample of leaders from 15 pediatric residency programs of various sizes and regions. Interviews were recorded and transcribed. Data were analyzed to produce themes. RESULTS: Three themes arose from our analysis: 1) Systematic assessment of the IC, though desired, is not robust in pediatric residency training; 2) Program differences present unique barriers and facilitators that impact the feasibility of assessment within the IC; and 3) Meaningfulness of assessment in the IC varies by stakeholder. Themes reflected perspectives on individual learner assessment and program evaluation. CONCLUSIONS: While systematic assessment and evaluation of the IC in pediatric residency training is lacking, program leaders desire feasible strategies that are meaningful to the resident, the program, and its leadership team. Leveraging current assessment and evaluation tools and aligning new assessment strategies could promote the integration of IC assessment with other assessments, minimizing burden. More structured IC assessment and evaluation could inform how to best achieve curricular goals of the IC. [ABSTRACT FROM AUTHOR]

Objective: To identify factors associated with effective scholarly activity and identify barriers to research during urology residency.Methods: An online survey was sent to 134 urology residency program directors in the United States. The survey assessed program characteristics, available support, and barriers for scholarly activity. Logistic regression analysis was used to identify characteristics of programs in the top quintile for success in scholarly activity.Results: There was a 40% response rate (n = 40). The majority of programs (86%) were university affiliated. Nearly all programs (98%) require participation in scholarly activity as a requirement for graduation. There were 3 primary outcomes evaluated: participation in original research, published scholarly activity and presentation of scholarly activity. Factors significantly associated with participation in original research were required research time (P = 0.06), lack of experienced faculty (P = 0.006), statistical and IRB support (P = 0.03, P = 0.01), funding (P = 0.02), and research curriculum (P = 0.006). Factors significantly associated with publication in peer reviewed journals were lack of funding and experienced faculty (P = 0.07, P = 0.01). Factors significantly associated with presentation of scholarly activity included research director (P = 0.05), chairman support (P = 0.02), research training (P = 0.03), protected time for faculty (P = 0.07), and faculty /resident attitudes toward conducting scholarly activity (P = 0.08, P = 0.02) and resident promotion linked to scholarly activity (P = 0.01).Conclusion: Training urology residents in research is essential. Current methods and available resources are variable. Programs should identify resources and barriers that have the greatest impact on resident success in scholarly activity, and may implement changes to improve productivity within their program. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to sample the opinions of radiation oncologists and trainees in the United States regarding residency expansion, what action(s) should be taken to limit residency supply, if any, and the proposed Accreditation Council for Graduate Medical Education (ACGME) changes.Methods and Materials: An online survey was distributed to 1048 attending radiation oncologists by e-mail and approximately 800 residents through their program coordinators. The survey asked respondents to rank how strongly they agreed with certain statements regarding residency supply, possible solutions to address any perceived oversupply, and the proposed ACGME changes on a 1-to-10 disagreement-to-agreement scale. The 16% response rate yielded 294 responses for analysis.Results: Of the respondents, 90 (30%) were residents, and 204 (70%) were attendings, of whom 117 (57%) were academic and 87 (43%) were nonacademic. Eighty-six percent agreed that there is a residency oversupply issue, and 91% agreed that actions should be taken to limit residency expansion. On χ2 test, residents and attendings were similarly likely to agree that there is a residency oversupply issue (93% and 89%, P = .27), although residents were more likely to agree that this oversupply should be acted upon compared with attendings (100% and 88%, P < .01). Regarding possible solutions, respondents were most likely to agree that further expansion should be limited (90%), program requirements should be made more stringent (76%), and the use of the Supplemental Offer and Acceptance Program should be limited (69%). Proposed ACGME changes that respondents were most likely to agree with included requiring that programs have modern image guidance, stereotactic radiation therapy, and brachytherapy techniques (98%) and have 4+ faculty members and maintain a faculty-to-resident ratio of >1.5:1 (86%). Case log minimums most supported to be increased were 4 uterus (65%) and 11 postmastectomy breast (61%) simulations.Conclusions: The majority of respondents agree that there is a residency oversupply issue and that actions should be taken to limit residency expansion and make program requirements more stringent. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Combined pediatrics-anesthesiology programs uniquely prepare residents to care for critically ill children, but trainees in these combined programs face challenges as residents within 2 specialties. Social belonging predicts motivation and achievement and protects against burnout. The objective of our study was to evaluate sense of belonging and self-identified professional identity of current combined pediatrics-anesthesiology residents. METHODS: All current residents in combined pediatrics-anesthesiology programs were invited to participate in an anonymous survey assessing sense of belonging and professional identity. Open-ended responses were qualitatively analyzed using an inductive coding process and thematic analysis. Likert questions were analyzed using paired t-tests. RESULTS: Thirty-two of 36 residents completed the survey (89% response rate). A total of 92% of respondents had a lower sense of belonging in pediatrics than anesthesiology (3.32 vs 3.94) and more self-identified as anesthesiologists than pediatricians. Thematic analysis yielded 5 themes 1) the team-based nature of pediatrics results in strong initial bonds, but feelings of isolation as training pathways diverge; 2) the individual nature of anesthesiology results in less social interaction within daily work, but easier transitions in and out of anesthesiology; 3) divergent training timelines result in feeling left behind socially and academically; 4) residents identify different professional and personal characteristics of pediatricians and anesthesiologists that impact their sense of belonging; and 5) the structure of the combined program results in experiences unique to combined residents. CONCLUSIONS: Most residents in combined pediatrics-anesthesiology programs had a higher sense of belonging and self-identification in anesthesiology than pediatrics. Program structure and autonomy had significant impacts. [ABSTRACT FROM AUTHOR]

Purpose: Although supported by most men and women, paternity leave is heavily underused across industries owing in part to external pressures and inconsistent availability. The goal of this study was to assess the use of paternity leave in radiation oncology (RO) practices and identify any associated barriers.Methods and Materials: A 36-item survey was distributed via e-mail to 536 male domestic RO attending and resident physicians. Questions assessed paternity leave policies, use, and departmental support. Data were collected using Research Electronic Data Capture from January to February 2021. Descriptive statistics were obtained for analysis, and logistic regression was performed to analyze the association between practice type and presence of policy.Results: The survey response rate was 20% (n = 108), with 98% of participants completing all applicable questions. Respondents included 63 attending physicians (58%) and 45 resident physicians (42%). The median age of all respondents was 35 years. Among all participants, 51 (47%) stated their practice had a formal paternity leave policy. The median time allowed for leave was 4 weeks (range, 0.5 weeks to unlimited), whereas the median time taken was 2 weeks (range, 0.5-12 weeks). Sixteen men felt pressure to take less leave than what was allowed by their policy, and 46% of men stated that in retrospect, they would have taken more time off for paternity leave.Conclusions: To the authors' knowledge, this is the first study to investigate the use of paternity leave in RO practices in the United States. Integrating expanded family leave policies, including specifically allowing for paternity leave and accompanying these policies with cultural changes acknowledging the importance of family leave, would be beneficial to improving quality of life and work-life balance for parents. [ABSTRACT FROM AUTHOR]

Background: Specialty training in cardiovascular diseases is consistently perceived to have adverse job conditions and interfere with family life. There is a dearth of universal workforce support for trainees who become parents during training.Objectives: This study sought to identify parental policies across cardiovascular training programs internationally.Methods: An Internet-based international survey study available from August 2020 to October 2020 was sent via social media. The survey was administered 1 time and anonymously. Participants shared experiences regarding parental benefits/policies and perception of barriers for trainees. Participants were divided into 3 groups: training program directors, trainees pregnant during cardiology fellowship, and trainees not pregnant during training.Results: A total of 417 replies were received from physicians, including 47 responses (11.3%) from training program directors, 146 responses (35%) from current or former trainees pregnant during cardiology training, and 224 responses (53.7%) from current or former trainees that were not pregnant during cardiology training. Among trainees, 280 (67.1%) were parents during training. Family benefits and policies were not uniformly available across institutions, and knowledge regarding the existence of such policies was low. Average parental leave ranged from 1 to 2 months in the United States compared with >4 months outside the United States, and in all countries, paternity leave was uncommon (only 11 participants [2.6%]). Coverage during family leave was primarily provided by peers (n = 184 [44.1%]), and 168 (91.3%) were without additional monetary or time compensation.Conclusions: This is the first international survey evaluating and comparing parental benefits and policies among cardiovascular training programs. There is great variability among institutions, highlighting disparities in real-world experiences. [ABSTRACT FROM AUTHOR]

This pilot outcome evaluation assesses the effectiveness of an online curriculum, the Keystones of Development, aimed at improving residents' knowledge, attitudes, and reported behaviors around promoting positive parenting and childhood development in well-child visits. We used an explanatory mixed-methods approach, including a single-arm pre-posttest of intervention effects on self-reported behavioral outcomes (discussing, modeling, and praising) and secondary outcomes (knowledge, perceived barriers, attitudes, and self-efficacy). Following this, a subset of residents participated in in-depth interviews to describe participant responses to the intervention. The study was conducted at 8 pediatric residency programs across the United States with 67 pediatric residents (mean age = 29; 79% female; 57% PGY1). Within one month postintervention, there was a statistically significant increase in the behaviors that promote positive parenting: discussing (P <. 01;d = 0.73) and modeling (P <. 01;d = 0.61) but not praising (P =. 05; d = 0.3). Significant changes in the secondary outcomes: knowledge (P <. 01), perceived barriers, (P <. 01), and retrospective self-efficacy (P <. 01) were seen. Interviews revealed that integration of curriculum content into clinical practice was due to the relevance of the material to primary care and the modeling of how to apply in the clinical setting. Curriculum format, content, and clinical application helped participants weave recommendations into the well-child visit. In this study, we demonstrated that the online curriculum, Keystones of Development , increased resident behaviors, knowledge, and self-efficacy, and decreased perceived barriers to promote parenting behaviors associated with improved child development outcomes in well-child visits. These findings were observed across participants demonstrating equal success regardless of demographic characteristics or study site. [ABSTRACT FROM AUTHOR]

Background: Program directors use US Medical Licensing Exam (USMLE) scores as criteria for ranking applicants. First-time pass rates of the American Board of Surgery (ABS) Qualifying (QE) and Certifying (CE) Examinations have become important measures of residency program quality. USMLE Step 1 will become pass/fail in 2022.Study Design: American Board of Surgery QE and CE success rates were assessed considering multiple characteristics of highly ranked (top 20) applicants to 22 general surgery programs in 2011. Chi-square, t-test, Wilcoxon Rank sum, linear and logistic regression were used, as appropriate.Results: The QE and CE first attempt pass rates were 96% (235/244) and 86% (190/221), respectively. QE/CE success was not significantly associated with sex, race, research experience, or publications. Alpha Omega Alpha (AΩA) status was associated with success on the index CE (98% vs 83%; p = 0.008). Step 1 and Step 2 Clinical Knowledge (CK) scores of surgeons who passed QE on their first attempt were higher than scores of those who failed (Step 1: 233 vs 218; p = 0.016); (Step 2CK: 244 vs 228, p = 0.009). For every 10-point increase in Step 1 and 2CK scores, the odds of passing CE on the first attempt increased 1.5 times (95% CI 1.12, 2.0; p = 0.006) and 1.5 times (95% CI 1.11, 2.02, p = 0.008), respectively. For every 10-point increase in Steps 1 and 2CK scores, the odds of passing the QE on the first attempt increased 1.85 times (95% CI 1.11, 3.09; p = 0.018) and 1.86 times (95% CI 1.14, 3.06, p = 0.013), respectively.Conclusions: USMLE Step 1 and Step 2 CK examination scores correlate with American Board of Surgery QE and CE performance and success. The USMLE decision to transition Step 1 to a pass/fail examination will require program directors to identify other factors that predict ABS performance for ranking applicants. [ABSTRACT FROM AUTHOR]

Prior studies have found suboptimal knowledge about post-acute care (PAC) among inpatient providers and poor communication at discharge that can lead to unsafe discharge transitions, but little is known about residents and the PAC transition. The aim of this study is to assess internal medicine residents' knowledge, attitudes, and current practice regarding patient transitions to PAC. A multisite, cross-sectional 36-question survey. Internal Medicine and Medicine-Pediatrics residents at 3 university-based Internal Medicine training programs in the United States. Methods : Survey delivered electronically to residents in 2018 and 2019. Survey responses were described by collapsing 4-point Likert responses into dichotomous variables, and thematic content analysis was used to evaluate free text responses. Results: Of 482 residents surveyed, 236 responded (49%). Despite high reported confidence in their ability to transition patients to PAC, only 31% of residents knew how often patients received skilled therapies at skilled nursing facilities (SNFs) and 23% knew how frequently nursing services are provided. The majority of residents (79%) identified the discharge summary as the main way they communicated care instructions to the SNF, but only 55% reported always completing it prior to discharge. Upper-level residents were more likely to know how much therapy patients received at a SNF, but resident knowledge about PAC did not vary by residency year in other domains. Residents who experienced a clinical rotation at a SNF had higher levels of knowledge compared to residents who did not. This national survey of internal medicine residents identified common knowledge gaps regarding PAC. These knowledge gaps did not improve throughout residency without deliberate exposure to PAC environments. This suggests a need for dedicated curriculum development as discharges to PAC continue to rise exponentially. [ABSTRACT FROM AUTHOR]

Purpose: Applications to radiation oncology in the United States have decreased the past 3 years, resulting in unfilled residency positions (30 [14.5%] in 2019 and 35 [18.5%] in 2020). The aim of this study is to understand the concerns among radiation oncology applicants and whether these concerns may have led to a decline in applications.Methods and Materials: An Internet-based survey was e-mailed to all radiation oncology applicants participating in the 2020 National Resident Matching Program Match for whom e-mail addresses could be obtained (n = 145, 78.8%). The survey was open from May to September 2020.Results: Survey responses were received for 98 applicants out of 145 (67.6%) available applicant e-mails. Applicants' top-rated concerns were location of practice restrictions and residency expansion/oversupply of practicing physicians. Applicants were less concerned about a lack of exposure to the field of radiation oncology, competitiveness of the match, and the content of residency training. The sources of information which applicants used most, which applicants trusted most, and which promoted the most optimism among applicants were radiation oncology attending and resident physicians. The sources of information which applicants used least, which applicants trusted least, and which promoted the most pessimism among applicants were online resources. As a result of their concerns, 27 (28%) respondents strongly considered choosing a different field of medicine. Applicants identified 93 fellow graduating medical students who were interested in radiation oncology but chose not to apply; applicants reported that potential applicants chose not to apply most often due to concerns about location of practice restrictions and residency expansion/oversupply of practicing physicians.Conclusions: Applicant concerns about residency expansion and location of practice restrictions are prevalent and may have led to declining applications to radiation oncology. To assuage applicant concerns, radiation oncology stakeholders must address these concerns by mitigating underlying problems. [ABSTRACT FROM AUTHOR]

The article focuses on addressing racial microaggressions within pediatric clinical learning environments, emphasizing the impact on Black, Indigenous, and People of Color trainees' well-being. It mentions the approach involves a longitudinal Diversity, Equity, and Inclusion curriculum, including a four-hour workshop with race-based affinity groups, leading to increased resident comfort in recognizing and addressing microaggressions.

To describe pediatric residency program's virtual presence and opportunities for the 2021 application cycle. A total of 202 pediatric residency programs from the Electronic Residency Application Service (ERAS) were reviewed for departmental and residency Twitter, Instagram, and Facebook accounts. These accounts, residency websites, and the Visiting Student Application Service (VSAS) were reviewed for open house opportunities and virtual subinternships. All data were collected from October 12–15, 2020. A total of 261 social media accounts were identified. 123 (61%) programs had at least one account, with 32 (16%) programs having presence on all 3 platforms. 68 (34%) programs established new accounts after March 1, 2020. Instagram appeared most utilized with 106 (52%) programs having accounts. A total of 115 virtual open house opportunities were offered with most offers on Instagram by 61 (30%) programs. Only 2 virtual subinternships were listed on program websites, 2 on Twitter, 1 on Instagram, and 1 on Facebook. COVID-19 increased the number of social media accounts used by residency programs. Approximately one-third of all accounts were created after March 1, 2020. However, only 16% of residency programs have a presence on all 3 platforms, allowing for more online growth. [ABSTRACT FROM AUTHOR]

Purpose: To report trends in the number and types of applicants and matched trainees to radiation oncology in comparison to other specialties participating in the National Resident Matching Program (NRMP) between 2010 and 2020.Methods and Materials: Data from the NRMP and Electronic Residency Application System (ERAS) were obtained for 18 medical specialties between 2010 and 2020. We assessed the numbers and types of applicants and matched trainees relative to available positions in the NRMP and Supplemental Offer and Acceptance Program (SOAP).Results: In the 2020 NRMP, 122 US MD senior graduates preferentially ranked radiation oncology, a significant decrease from a median of 187 between 2010 to 2019 (interquartile range [IQR], 170-192; P < .001). Across all 18 specialties, radiation oncology experienced the greatest declines in the 2020 NRMP cycle relative to 2010 to 2019, in both the number of ERAS applicants from the United States and Canada (-31%) and the percentage of positions filled by US MD or DO senior graduates (-28%). Of 189 available positions, 81% (n = 154) filled in the NRMP prior to the SOAP, of which 65% (n = 122) were "matched" by US MD senior graduates who preferentially ranked radiation oncology as their top choice of specialty, representing a significant decrease from a median of 92% between 2010 to 2019 (IQR, 88%-94%; P = .002). The percentages of radiation oncology programs and positions unfilled in the NRMP prior to the SOAP were significantly increased in 2020 compared with 2010 to 2019 (programs: 29% vs 8% [IQR, 5%-8%; P < .001]; positions: 19% vs 4% [IQR, 2%-4%; P <.001]). Despite >99% (n = 127 of 128) of US MD or DO senior applicants preferring radiation oncology successfully matching to a radiation oncology position in the 2020 NRMP, 16 of 35 remaining unfilled positions were filled via the SOAP. Radiation oncology was the top user of the SOAP across all specialties participating in the 2020 NRMP, filling 15% of total positions versus a median of 0.9% (IQR, 0.3%-2.3%; P <.001).Conclusions: The supply of radiation oncology residency positions now far exceeds demand by graduating US medical students. Efforts to nullify a market correction revealed by medical student behavior via continued reliance on the SOAP to fill historical levels of training positions may not be in the best of interest of trainees, individual programs, or the specialty as a whole. [ABSTRACT FROM AUTHOR]

Purpose: Multiple efforts have been made in recent years to establish national benchmarks for research productivity among US radiation oncology residents. Morgan et al found a mean of 1.01 first-author, PubMed-searchable articles published by US radiation oncology residents over 4 years of residency between 2002 and 2007, whereas Verma et al found a mean of 1.97 first-author, PubMed-searchable articles published by members of the graduating US radiation oncology residency classes of 2014 and 2015. In this study, we sought to establish new national benchmarks for US radiation oncology resident research productivity and characterize the scholarly work produced by graduating US radiation oncology residents.Methods and Materials: We built a database of US radiation oncology residents who graduated between 2015 and 2019 using multiple sources of publicly available data. We subsequently searched the PubMed database to identify all first-author publications for every resident in our database from the start of residency until 3 months after the completion of residency. Publications were categorized by type (original research, review, case report, or commentary) and content. We performed a secondary analysis to identify factors associated with an increased probability of publishing during residency.Results: We identified 909 US radiation oncology residency graduates from 89 residency programs between 2015 and 2019. Collectively, these graduates published 2637 first-author, PubMed-searchable articles (mean: 2.90; median: 2.0; range, 0-58; interquartile range, 1-4) in 392 distinct peer-reviewed journals during their residency, and 69.7% of the first-author publications comprised original research. On multivariable analysis, only residency size was predictive of publishing a first-author manuscript during residency. Among residents with at least 1 first-author manuscript, male sex, lack of a doctorate degree, and residency size were all significant predictors of the number of first-author manuscripts published during residency.Conclusions: US radiation oncology resident research productivity, as measured by the number of first-author, PubMed-searchable publications, has increased compared with historical data. However, substantial variability exists in resident research productivity nationwide. [ABSTRACT FROM AUTHOR]

Objective: To identify workforce related barriers to urologic care in Medically Underserved Areas (MUA) and Health Professional Shortage Areas (HPSA). Federally Qualified Health Centers (FQHC) are community-based organizations that aim to close gaps, but little is known about exposure to underserved areas during residency training.Methods: The objective of this study was to characterize the experiences of urology residents who participated in a rotation within a FQHC. The study consisted of: (1) 12-item post-rotation self-assessment (2) review of career paths of former graduates who completed the rotation, and (3) retrospective review of patients treated at FQHC from 2016 to 2018.Results: There were a total of 1735 patient visits, 97 were for cystoscopy, 76.36% of patients had Medicaid or no insurance. There were 1092 unique patients seen and 281 (25.73%) were referred for surgery. A majority of residents (100%) stated they had a better appreciation of treating patients in underserved areas. A majority of residents (71.6%) of residents said they were more likely to practice in an underserved area after residency. Among former graduates who rotated through the clinic, 100% (n = 4) were practicing in a MUA or HPSA.Conclusion: The integration of an FQHC during urology residency training was associated with highly favorable satisfaction by trainees. Given persistent workforce related shortages in urology, these findings support exposure to medically underserved areas during training. [ABSTRACT FROM AUTHOR]

Background: United States student loan debt has surpassed $1.7 trillion and continues to rise. Generally described as a "crisis," the state of student loan debt in the United States is a subject of increasing consideration, research, and analysis by federal government agencies, nonprofit organizations, economists, and students who carry the balance. Excessive student loan debt has been hypothesized to affect students' career choice, diminish quality of life, negatively affect their ability to give back to society at large, and delay progress on achieving other financial goals such as saving for retirement. Current available research evaluating the impact of this debt on student pharmacists and new practitioners is limited.Objective: To assess the impact of student loan debt on financial stability, career choice, professional development, and overall well-being among pharmacists who received first licensure in Ohio within a 5-year period; hereafter referred to as "new practitioners."Methods: An anonymous survey, consisting of 39 items, was administered using Verint survey software to new practitioners holding an active pharmacist license in Ohio with date of first licensure between May 1, 2012 and March 1, 2017.Results: Total of 4026 pharmacists were invited to participate in the survey, and there were 471 responses, yielding a response rate of 11.7%. Higher student loan debt was associated with perceived limitations regarding amount of available disposable income, career mobility, work satisfaction, charitable contributions, participation in professional organizations, retirement savings, purchasing a home, delay in starting a family, diminished quality of life, and worries about paying off student loans. However, this study did not find a statistically significant relationship between student loan debt and the decision to pursue a residency.Conclusion: On the basis of the results of this study, higher student loan debt has statistically significant effect on new practitioner's perception of their financial stability, ability to pursue professional development opportunities, and overall well-being. [ABSTRACT FROM AUTHOR]

Speaking up is increasingly recognized as essential for patient safety. We aimed to determine pediatric trainees' experiences, attitudes, and anticipated behaviors with speaking up about safety threats including unprofessional behavior. Anonymous, cross-sectional survey of 512 pediatric trainees at 2 large US academic children's hospitals that queried experiences, attitudes, barriers and facilitators, and vignette responses for unprofessional behavior and traditional safety threats. Responding trainees (223 of 512, 44%) more commonly observed unprofessional behavior than traditional safety threats (57%, 127 of 223 vs 34%, 75 of 223; P <.001), but reported speaking up about unprofessional behavior less commonly (48%, 27 of 56 vs 79%, 44 of 56; P <.001). Respondents reported feeling less safe speaking up about unprofessional behavior than patient safety concerns (52%, 117 of 223 vs 78%, 173 of 223; P <.001). Respondents were significantly less likely to speaking up to, and use assertive language with, an attending physician in the unprofessional behavior vignette than the traditional safety vignette (10%, 22 of 223 vs 64%, 143 of 223, P <.001 and 12%, 27 of 223 vs 57%, 128 of 223, P <.001, respectively); these differences persisted even among respondents that perceived high potential for patient harm in both vignettes (20%, 16 of 81 vs 69%, 56 of 81, P <.001 and 20%, 16 of 81 vs 69%, 56 of 81, P <.001, respectively). Fear of conflict was the predominant barrier to speaking up about unprofessional behavior and more commonly endorsed for unprofessional behavior than traditional safety threats (67%, 150 of 223 vs 45%, 100 of 223, P <.001). Findings suggest pediatric trainee reluctance to speak up when presented with unprofessional behavior compared to traditional safety threats and highlight a need to improve elements of the clinical learning environment to support speaking up. [ABSTRACT FROM AUTHOR]

Literature on the effectiveness of child poverty education in undergraduate medical education is scant. This study adds quantitative and qualitative support for incorporation of a multimodal curriculum to improve student knowledge, confidence, and attitudes toward child poverty. [ABSTRACT FROM AUTHOR]

Purpose: Visiting professorship is an enjoyable activity that is also influential in academic promotional processes as evidence of the invitee's national reputation. Little is known, however, about the factors considered when selecting visiting professors (VPs) or whether this practice reflects objective criteria. We sought to characterize the process and diversity of participants in visiting professorships within academic radiation oncology (RO) to determine whether opportunities are equitably distributed.Methods and Materials: Surveys were distributed to program directors (PDs) of every 2018 RO residency program accredited by the Accreditation Council for Graduate Medical Education. PDs were asked to identify all VPs over the past 2 years and to describe their departments' decision-making processes. Publicly available demographic and academic characteristics were obtained for each VP, and results were compared by VP gender and hosting program (HP) 2019 Doximity rank using the χ2 test for categorical data and t test for continuous data.Results: The PD response rate was 60 of 93 (65%); 6 surveys were ≥50% incomplete and were excluded. Over a 2-year timeframe, 51 of 54 departments hosted 233 VPs, of whom 29% were women. The mean number of hosted VPs (5; range, 1-19) and gender distribution (35% women; range, 0-100%) did not significantly differ by HP rank (P = .17 and 0.65, respectively), nor did the selection criteria by which VPs were primarily chosen (subject matter expertise, teaching reputation, and resident interest). Women received significantly lower honoraria amounts than men (P = .035) despite no significant differences by gender in academic rank (P = .71), VP department rank (0.19), or M-index (0.83).Conclusion: Although sample size is limited, this study suggests that academic RO programs have a relatively equitable approach to selecting VPs that emphasizes trainee education and reflects the gender diversity of RO faculty more generally. Care should be taken to ensure that these similarly qualified women are offered the same monetary amount of honoraria as their male colleagues. [ABSTRACT FROM AUTHOR]

Our goal was to identify aspects of residency applications predictive of subsequent performance during pediatric internship. We conducted a retrospective cohort study of graduates of US medical schools who began pediatric internship in a large pediatric residency program in the summers of 2013 to 2017. The primary outcome was the weighted average of subjects' Accreditation Council for Graduate Medical Education pediatric Milestone scores at the end of pediatric internship. To determine factors independently associated with performance, we conducted multivariate linear mixed-effects models controlling for match year and Milestone grading committee as random effects and the following application factors as fixed effects: letter of recommendation strength, clerkship grades, medical school reputation, master's or PhD degrees, gender, US Medical Licensing Examination Step 1 score, Alpha Omega Alpha membership, private medical school, and interview score. Our study population included 195 interns. In multivariate analyses, the aspects of applications significantly associated with composite Milestone scores at the end of internship were letter of recommendation strength (estimate 0.09, 95% confidence intervals [CI]: 0.04, 0.15), numbers of clerkship honors (est. 0.05, 95% CI: 0.01–0.09), medical school ranking (est. 0.04, 95% CI: 0.08–0.01), having a master's degree (est. 0.19, 95% CI: 0.03–0.36), and not having a PhD (est. 0.14, 95% CI: 0.02–0.26). Overall, the final model explained 18% of the variance in milestone scoring. Letter of recommendation strength, clerkship grades, medical school ranking, and having obtained a Master's degree were significantly associated with higher clinical performance during pediatric internship. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effect of the changing landscape of urologic residency education and training on resident operative exposure and inter-resident variability.Methods: The Accreditation Council for Graduate Medical Education (ACGME) case logs for graduating urology chief residents were reviewed from Academic Year (AY) 2009-2010 to 2016-2017. Cases were stratified into the 4 ACGME categories - general urology, endourology, oncology, and reconstruction. Linear regression models analyzed the association between training year, volume, and type of cases performed. Inter-resident variability in case exposure was calculated by the difference between the ACGME reported 10th and 90th percentiles.Results: During the study period, the mean number of cases performed per resident was 1092 (standard deviation 32.7). Although there was no significant change in total case volume, there were changes within case categories. Endoscopic, retroperitoneal oncology, and male reconstruction case volume all increased significantly (Δ20.1%, Δ 5.1%, Δ 8.2%, respectively, all P < .05). This was balanced with a concomitant decrease in pelvic oncology and female reconstruction cases (Δ 10.0% and Δ 14.5%, respectively, both P < .05). There was a 27.8% increase in laparoscopic/robotic cases (P < .001). The ratio difference between the 10th percentile and 90th percentile ranged from a low of 2.5 for retroperitoneal oncology cases to a high of 5.2 for extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy.Conclusion: From AY2009-2010 to 2016-2017, residency case volume has remained constant, but there has been a change in types of cases performed and proliferation of minimally invasive techniques. Significant variability of inter-resident operative experience was noted. [ABSTRACT FROM AUTHOR]

Background: Teaching assistant (TA) cases are a training mainstay, due to increased resident autonomy. Since 2014, the American Board of Surgery (ABS) requires a 25 TA case minimum for graduating resident eligibility for board certification. Herein, we analyze our institution's experience compared with the national average, for any change effected by the requirement.Study Design: ACGME case log data were obtained for the July 2001 to June 2018 academic years. We compared average TA cases of our program against the national average and national 50th percentile: 2001 to 2014, and 2014 to 2018 academic years. The program TA cases were also broken down by category, with a comparison before and after 2014. Values of p were calculated using a t-test and Mann-Whitney U test.Results: From July 2001 to June 2018, our program averaged 30.1 TA cases/resident, and national 50th percentile average was 28.1. For July 2001 to June 2014 AY (aka pre-2014) and July 2014 to June 2018 AY (aka post-2014) cases per resident, our program averages were 24.9 and 46.1, respectively, and the national 50th percentile averages were 24.4 and 40.3, respectively-both statistically significant increases. Average program percentiles were 46.4 (pre-2014), and 61.5 (post-2014), and 59.6% of program cases logged were biliary, large intestine, and hernia (2001 to 2018 AY), with a statistically significant increase in several case subcategories post-2014.Conclusions: Teaching assistant cases are an invaluable resource for residents, fostering increased autonomy. Since the 2014 minimum, a statistically significant increase in TA cases was noted in our program and nationally. The majority of sub-categories logged were core procedures. Unequivocally, the TA case minimum requirement has made a difference. This will hopefully lead to increased autonomy and therefore, more comfortable and capable general surgeons. Wide variability is noted in what counts as a TA case, with further clarification needed by the ACGME and ABS. [ABSTRACT FROM AUTHOR]

Background: The Accreditation Council for Graduate Medical Education (ACGME) requires diversity in residency. The self-identified race/ethnicities of general surgery applicants, residents, and core teaching faculty were assessed to evaluate underrepresented minority (URM) representation in surgery residency programs and to determine the impact of URM faculty and residents on URM applicants' selection for interview or match.Study Design: Data from the 2018 application cycle were collated for 10 general surgery programs. Applicants without a self-identified race/ethnicity were excluded. URMs were defined as those identifying as black/African American, Hispanic/Latino/of Spanish origin, and American Indian/Alaskan Native/Native Hawaiian/Pacific Islander-Samoan. Statistical analyses included chi-square tests and a multivariate model.Results: Ten surgery residency programs received 9,143 applications from 3,067 unique applicants. Applications from white, Asian, Hispanic/Latino, black/African American, and American Indian applicants constituted 66%, 19%, 8%, 7% and 1%, respectively, of those applications selected to interview and 66%, 13%, 11%, 8%, and 2%, respectively, of applications resulting in a match. Among programs' 272 core faculty and 318 current residents, 10% and 21%, respectively, were identified as URMs. As faculty diversity increased, there was no difference in selection to interview for URM (odds ratio [OR] 0.83; 95% CI 0.54 to 1.28, per 10% increase in faculty diversity) or non-URM applicants (OR 0.68; 95% CI 0.57 to 0.81). Similarly, greater URM representation among current residents did not affect the likelihood of being selected for an interview for URM (OR 1.20; 95%CI 0.90 to 1.61) vs non-URM applicants (OR 1.28; 95% CI 1.13 to 1.45). Current resident and faculty URM representation was correlated (r = 0.8; p = 0.005).Conclusions: Programs with a greater proportion of URM core faculty or residents did not select a greater proportion of URM applicants for interview. However, core faculty and resident racial diversity were correlated. Recruitment of racially/ethnically diverse trainees and faculty will require ongoing analysis to develop effective recruitment strategies. [ABSTRACT FROM AUTHOR]

Survey research. Recently, the lymphatic system's role in edema management has been reported; however, it is unclear how this evidence has translated into hand therapy practice. Survey research was performed to explore edema education and management. A 22-question survey containing questions related to edema education and practice was administered to members of the American Society of Hand Therapists. Demographic data were obtained. Frequencies were examined using Chi-square and Fisher exact tests. A total of 436 members responded to the survey (92% occupational therapists [OTs]; 6% physical therapists [PTs]). Most hand therapists received edema education through on-the-job training and, or continuing education. PTs were more likely to learn the difference between acute, subacute, chronic edema (P <.01; 36% PTs, 17% OTs) and the role of the lymphatic system in edema management (P <.002; 36% PTs, 14% OTs) in entry-level education compared to OTs. OTs with an MS or OTD were more likely to learn the difference between acute, subacute, chronic edema (P <.001; 23% OTD, 24% MS, 10% BS) and the role of the lymphatic system in edema management (P <.004; 19% OTD, 19% MS, 7% BS) in entry-level education than BS-trained OTs. Duration and feel were common ways therapists assessed and identified differences in edema. Many therapists acknowledged the role of the lymphatic system in edema reduction, but responses lacked specificity. The survey results suggest most hand therapists learn edema management outside of academic programs, although this may be changing in OT with advancement of the entry-level degree. • Most hand therapists received edema training at work or via continuing education. • Physical therapists are more likely to receive edema training at the university than occupational therapists. • Occupational therapists with an MS or OTD were more likely to obtain edema training at the university. • Duration and feel were the most common ways by which therapists assessed edema. • There is ambiguity among hand therapists about the role of the lymphatics in edema. [ABSTRACT FROM AUTHOR]

Objective: To determine factors and barriers associated with scholarly activity among faculty members at urology residency programs in the United States.Methods: An online survey was sent to all 134 urology residency program directors. The survey assessed program characteristics including size, location and definition of scholarly activity. It assessed available support for and barriers to resident scholarly activity, faculty participation in scholarly activity and mentorship of residents. Linear regression analysis was used.Results: We had a 40% response rate (N = 40). Faculty attitudes toward conducting scholarly activity (P < .001) and lack of a research curriculum (P = .05) were barriers to the outcome 'participation in scholarly activity'. Faculty attitudes toward conducting scholarly activity was also a barrier to the outcomes 'mentorship of residents' (P = .004) and 'publication of at least 1 paper' (P = .004). Available statistician was positively associated with the outcomes 'publications' (P = .062) and 'presentations' (P = .032). A minimum requirement of a local presentation (P=0.04) and chairman support (P = .015) were positively associated with the outcome 'presentation at a conference.'Conclusion: Training residents in research matters for the resident, the institution and future generations of surgeon scientists. Higher levels of faculty scholarly activity were associated with a minimum requirement for residents to submit a manuscript for publication, strong chairman support for resident research, and the availability of a statistician. A common barrier to faculty scholarly activity, publications, and resident mentorship was faculty attitudes toward resident scholarly activity. Urology residency programs seeking to prioritize scholarly activity among faculty should consider these factors. [ABSTRACT FROM AUTHOR]

Previous studies of pediatric residents have identified educational gaps in caring for children with medical complexity. Training opportunities in complex care vary across residency programs. Defining core curricular topics in complex care is a priority in medical education. To identify core topics to include in a standard complex care curriculum for pediatric residents. An initial topic list was generated through literature review and proceedings of national meetings. Expert panelists were identified based on experience in complex care and residency education. A modified Delphi method was used to determine group consensus by asking participants to rate the importance of complex care curricular topics for pediatric residents. Consensus was defined as >70% of experts identifying a topic as essential. There was a predetermined maximum of 3 iterative, electronic survey rounds, with feedback provided to participants between each round. Sixteen experts participated. Response rate was 100% for all rounds. Experts were from the United States (44%) and Canada (56%); most were affiliated with an academic medical center (96%) involved in both inpatient and outpatient care (69%). Eleven topics were identified as essential across 3 rounds: feeding difficulties, pain/irritability, transition, feeding tube management, difficult discussions, team management/care coordination, dysmotility, aspiration, safety/emergency planning, neuromuscular/skeletal issues, and advocacy. Essential topics were organized according to the International Classification of Functioning, Disability and Health. Eleven curricular priorities in complex care were identified across multiple domains of the International Classification of Functioning, Disability and Health framework, serving as a guide for standardized curriculum development for future pediatricians. [ABSTRACT FROM AUTHOR]

To describe how pediatric educators effectively teach evidence-based medicine (EBM) in the clinical setting. Secondarily, to identify barriers hindering effective practice and teaching of EBM and strategies to overcome these barriers. The authors conducted a cross-sectional multi-institutional qualitative study from July 2016 to December 2017 in which they interviewed pediatric educators across many subspecialties who were identified as exemplary teachers of EBM at 3 academic pediatric residency programs. Pediatric residents who had recently worked with these faculty members were also interviewed to allow triangulation between participants. Qualitative analysis was complete once saturation was achieved. Twenty-six pediatric educators identified as exemplary teachers of EBM and 10 residents who worked with those educators participated in the study. Thirteen explicit teaching strategies and 2 implicit teaching strategies, namely disclosure of uncertainty and role modeling, were identified. Barriers to practicing clinical EBM included balancing patient responsibilities, inadequate time, and personal knowledge. Barriers to teaching clinical EBM were inadequate time and learner engagement. To overcome these barriers, faculty limit and focus teaching points, attempt to make EBM relevant to patient care, and incorporate follow-up strategies. Numerous teaching strategies are available to faculty to improve the clinical teaching of EBM and to overcome commonly encountered clinical EBM barriers. Familiarity with these clinical EBM teaching strategies can be used for faculty development and to enhance the teaching of EBM to learners. [ABSTRACT FROM AUTHOR]

Background Context: Pedicle screw placement is a demanding surgical skill as a spine surgeon can face challenges including variations in pedicle morphology and spinal deformities. Available CT simulators for spine pedicle placement can be very costly and hands-on cadaver courses are limited by specimen availability and are not readily accessible.Purpose: To conduct validation of a simulated training device for essential spine surgery skills.Design: Cross-sectional, empirical study of physician performance on a surgical simulator model.Sample: Spine attending physicians and residents from four different academic institutions across the United States.Outcome Measures: Performance metrics on two surgical simulator tasks.Methods: After IRB approval, an inexpensive ($30) simulator was developed to test two main psychomotor tasks (1) creation of the pedicle screw path with a standard gearshift probe without cortical breaks and (2) the ability to palpate for the presence or absence of cortical breaches as well as determine the location of wall defects. Orthopedic and neurosurgery residents (N=72) as well as spine attending surgeons (N=26) participated from four different institutions. To test construct validity, performance metrics were compared between participants of different training status through one-way analysis of variance and linear regression analysis, with significance set at p<.05.Results: Spine attending surgeons consistently scored higher than the residents, in the screw trajectory task with triangular base (p=.0027) and defect probing task (p=.0035). In defect probing, performance improved with linear trend by number of residency training years with approaching significance (p=.0721). In that task, independent of institutional affiliation, PGY-2 residents correctly identified an average of 1.25±0.43 fewer locations compared with attending physicians (p=.0049). More than 80% of the spine attendings reported they would use the simulator for training purposes.Conclusions: This low-cost fundamentals of spine surgery simulator detected differences in performances between spine attending surgeons and surgical residents. Programs should consider implementing a simulator such as fundamentals of spine surgery to assess and develop pedicle screw placement ability outside of the operating room. [ABSTRACT FROM AUTHOR]

Pediatric residency programs offer many conferences and activities to meet the educational needs of their residents. We developed and assessed the Pediatric Chief Resident Exchange Program where pediatric chief residents visited another institution for a day with the goal of sharing educational and curricular innovations between residency programs in an experiential manner. Pediatric chief residents participated in various activities during the exchange including educational conferences and discussions with residency program leadership at the host institutions. Surveys were administered to all participating chiefs to determine if any changes to educational conferences or curriculum were made or planned to be made at their home program based upon what they observed at the other institution and to have chiefs reflect on what they gained from the experience. Twenty-eight chief residents from 9 programs participated in the exchange program over 3 academic years (2015–2018). All respondents felt the exchange experience was worthwhile. The majority (67%) of programs planned to implement a change at their institution based on participation in the exchange with over half actually making a change by the end of the academic year. Participating chiefs gained a sense of camaraderie, appreciated that other programs experienced similar struggles, and developed further insight into the chief resident role. The Pediatric Chief Resident Exchange Program is a novel method of sharing educational practices between institutions that can lead to curricular changes at participating programs. It can also be an opportunity for chief resident professional development. [ABSTRACT FROM AUTHOR]

Purpose: Prior surveys suggest almost one-third of chief residents report insufficient exposure to treatment planning. We evaluated the state of treatment planning education among United States residents.Methods and Materials: A web-based survey was sent to current residents identified using the Association of Residents in Radiation Oncology directory.Results: The response rate was 33%. Twenty-six percent of residents reported a mandatory treatment planning rotation. Seventy-one percent of residents reported reviewing ≤50% of plans with an attending. Twenty-three percent of respondents were not at all or only slightly comfortable (1 or 2 on a 1-5 scale) evaluating treatment plans. Residents with mandatory treatment planning rotations were more comfortable evaluating plans compared with those without mandatory rotations (P = .045). Overall, 60% reported insufficient exposure to treatment planning. Among postgraduate year 5 residents, this rate was 52%. Ninety-two percent of residents expressed interest in free supplemental treatment planning resources.Conclusions: A significant proportion of residents surveyed report insufficient exposure to treatment planning. Development of a practical treatment planning curriculum would offer the opportunity to improve resident education, and ultimately quality of care, at the national level. [ABSTRACT FROM AUTHOR]

Objective: To analyze national performance trends of urology residents on the American Urological Association In-Service Examination (ISE) over the last 18 years.Methods: Trends in the national averages on the in-service examination for each year of residency training were collected and analyzed between the years 2000 and 2017. Mean and standard error were calculated for examination performance for each year of residency. Subject-specific performance was also determined for each given year of residency. Regression analysis was used to model trends in performance as a function of residency year.Results: There was no significant difference in examination performance over 18 years with respect to each specific residency year. While there was an overall improvement in total scores with each advancing training year, year-over-year improvement in total examination performance began to plateau after Uro-2. Largest absolute performance improvement from Pre-Uro to Uro-4 were in subjects of "Urinary Diversion," "Obstructive Uropathy" and "Neoplasm." Scores in "Sexual Dysfunction, Endocrinopathy, Fertility Problems", and "Congenital Anomalies, Embryology, Anatomy" were consistently the lowest regardless of year of training.Conclusion: No significant change in performance was seen in each given year of residency over the 18-year period. There was improvement in overall scores as residents progressed through training, but scores plateaued after Uro-2 with minimal improvement between Uro-3 and Uro-4 years. Difference in subject scores suggests a disparity in educational focus in residency curricula and a potential need to improve the teaching strategies for subjects that tested less well throughout residency training. [ABSTRACT FROM AUTHOR]

International medical graduates (IMGs) are medical graduates who have received their degree from international medical schools. IMGs must undertake a 3-step process to apply to the National Residency Matching Program match. First, they must obtain a valid standard certificate from the Educational Commission for Foreign Medical Graduates. Following certification, they must apply for and secure a position in a residency training program. Third, they must obtain a visa that would enable them to commence their training. In this article, we delve thoroughly into these stepladders to provide IMGs with a clear roadmap of the process as well as contacts to key agencies that may provide more comprehensive assistance. [ABSTRACT FROM AUTHOR]

Objective: To identify institutional factors that predict medical student decision to apply for the urology match.Materials and Methods: American Urological Association (AUA) Match data from 2015 to 2019 were used to determine the number of applicants from each medical school who submitted rank lists. Associations between the applicant counts from each medical school and medical school characteristics were assessed using multivariable Poisson regression models. Data were obtained using publicly available datasets and a survey of urology program coordinators.Results: There were 1916 medical students from 199 medical schools who submitted rank lists to the urology residency match. After adjusting for class size, schools with a urology residency program produced significantly greater number of urology applicants (RR 2.7; 95% CI, 2.2-3.4, p<0.001). Additional predictors included a shorter preclerkship curriculum (less than 18 months; RR 1.2, 95% CI 1.09-1.35, P <.001), number of urology residents (RR 1.11, 95% CI 1.05-1.17, P <.001), urology faculty (RR 1.1; 1.04-1.2; P = .01; per 10 faculty), top 20 residency ranking on Doximity (RR 1.2; 1.1-1.4, P <.001), and presence of urology interest group (RR 1.3, 95% CI 1.1-1.6, P = .005). Approximately 28% of applicants were female, and the percentage of female urology faculty at their institution significantly correlated with number of female applicants (β = 0.22, 95% CI: 0.01-0.44; P = .049).Conclusion: To recruit more medical students into urology, departments should foster early preclinical exposure to specialty-specific interest groups, interaction with residents, and development of a diverse faculty. [ABSTRACT FROM AUTHOR]

Objective: To characterize the status of mentorship programs for Urology residencies in the United States, highlight the importance of mentorship in the career of a urology resident, and identify the obstacles of implementing a mentorship program.Methods: With Internal Review Board exemption and approval from the Society of Academic Urologists, a survey was sent to the Program Directors of the Urology Residency programs in the United States containing questions about the presence and structure of a mentorship program in their department.Results: Response rate was 54%. Seventy-five percent of respondents approved of formal mentorship programs. Fifty-eight percent of respondents had 1 established. Five percent of programs had an official training course for faculty mentors. Thirty-eight percent of programs had no requirement on mentor and/or mentee meeting frequency. The most common reason for not having a formal mentorship program was because the program felt that informal mentorship sufficed.Conclusion: While the vast majority of Program Directors for Urology Residency programs in the United States approve of formal mentorship programs, only a little over half have 1 established. Programs should strive to create a formal mentorship program in their residency programs due to their recognized importance. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of burnout in urology trainees and examine the influence of personal, programmatic, and institutional factors on burnout rates.Study Design: We conducted an anonymous survey of burnout in urology residents across the United States using a 50-question REDCap-based electronic questionnaire in May of 2018. The survey included demographic questions, an inventory of stress-reduction techniques and the Maslach Burnout Inventory. Univariate analysis and multinomial logistic regression models were used to assess associations between individual, program, and organizational factors and resident burnout.Results: Overall response rate was 20.9%. Individual factors such as age, gender, exercise, and meditation were not associated with burnout while reading for relaxation (P = .022) and spending time with family (P = .025) were protective against burnout. Residents working >80 hours vs 60-80 hours and <60 hours per week were more likely to exhibit burnout (77.6% vs 66.1% vs 47.1%, respectively, P = .044). Institutional factors such as structured mentorship programs (P = .019) and access to mental health services (P <.001) were associated with decreased burnout. On multivariable analysis, unavailable or difficult-to-access mental health services were associated with increased odds of burnout (OR 5.38, 95%CI 2.20-13.16, P <.001, and OR 2.33, 95%CI 1.07-5.07, P = .034, respectively).Conclusion: The prevalence of burnout in urology trainees is high. Institutional factors such as formal mentorship and access to mental health services may play an important role in resident well-being. [ABSTRACT FROM AUTHOR]

Objective: To elucidate whether urology residents in the United States feel bullied by nurses, how respected they feel at work, and whether this impacts personal and patient care.Methods: We distributed an Institutional Review Board-approved online, validated, revised Negative Acts Questionnaire to US urology residents in their first year or above. We evaluated bullying through scoring work (total range 5-25), person (total range 9-45), and physical intimidation (total range 3-15) related bullying domains. We also solicited how respected residents feel by different staff on a Likert scale and the perceived personal and professional impact of bullying. Bullying domains were assessed with descriptive statistics and mean total bullying scores (MTBS) and demographics compared.Results: We received 102 responses (82% MD, 18% DO). One resident reported never experiencing bullying. Overall average MTBS was 28.9 ± 0.9 (17-68). 98.0%, 82.4%, and 77.5% of residents reported at least 1 incident of work, person, and physical intimidation-related bullying, respectively. DO residents reported higher MTBS than MD residents (33.7 ± 2.2vs 27.8 ± 1.0, P = .015). Higher MTBS scores were seen in residents who feared retaliation and considered transferring programs, while lower scores were seen where the resident-nurse relationship was nurtured.Conclusion: Ninety percent of residents perceived some degree of bullying and report a negative impact on personal performance and patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: To compare the expectations of urology trainees with the experience of practicing urologists.Methods: Residents, fellows, and practicing urologists were surveyed in 2018 regarding weekly work hours, number of hospitals covered, call nights per week, administrative workload relative to residency, annual net income, and time to pursue personal interests and hobbies. Urology trainees, defined as residents and fellows, were also surveyed regarding their expectations for clinical practice. The expectations of trainees were compared with the reported experience of practicing urologists using 1-tailed t test and chi-square analysis. Trainee expectations were also stratified by age, gender, training level, relationship status, and whether trainees had dependent children.Results: The expectations of 99 trainees were compared with the reported experience of 377 practicing urologists. Trainees expect to work more hours but less call nights per week than reported by practicing urologists while annual net income was either consistent or underestimated. Compared to practicing urologists, however, trainees appear to underestimate the administrative workload relative to residency and overestimate time to pursue personal interests and hobbies. Junior residents were more likely to underestimate administrative workload than senior residents and fellows.Conclusion: While the expectations of urology trainees for work hours and annual net income were fairly consistent with those reported by practicing urologists, trainees may underestimate administrative workload and overestimate time to pursue personal interests and hobbies. [ABSTRACT FROM AUTHOR]

Abstract With the prevalent problem of nurse retention and the lack of confidence new nurses experience, it is critical for nurse residency programs to have supportive factors that enhance residency experiences. By incorporating mentorship, preceptors, and debriefing components into these programs, skills in communication, organization, clinical reasoning, stress management, and self-confidence increase. This quantitative study was a descriptive analysis of secondary data using a cross-sectional design. Two instruments were used to gather data, the Demographic Information Survey and the Evaluation of the RN Residency Survey. The sample was comprised of 1078 graduate nurses completing nurse residency programs throughout the United States. The findings indicated that higher residency ratings were significantly related to higher preceptor and debriefing experiences. Results also showed no significant interaction effects of reduced stress due to mentoring on the relationship between preceptorship experiences or debriefing experiences and ratings of nurse residency. Consequently, it is important that new nurses are given the opportunity to take part in programs offering mentorship, preceptors, and debriefing elements, as nursing residents have found them to be highly beneficial. Furthermore, debriefing sessions strengthened their skills and built confidence during their first year of employment. Highlights • Residency experiences were associated with debriefing and preceptor experiences. • A total of 59.4% reported reduced stress due to mentoring. • Debriefing experiences were positive and associated with higher residency ratings. • Preceptor experiences were positive and associated with higher residency ratings. [ABSTRACT FROM AUTHOR]

Objective: To examine trends in the financial relationship between biomedical companies and leaders in urologic education during the first 3 full calendar years since implementation of the Sunshine Act.Methods: All accredited American Urological Association (AUA) residency programs were identified using the AUA website. Urology program directors and department chairs of the affiliated institutions were identified using residency program or urology department websites. Urology journal editors who practice in the United States were identified using the SCImago Journal & Country Rank website. All identified individuals were categorized by urologic subspecialty and AUA region based on information stated on their corresponding websites. Payment data for each individual from 2014 to 2016 was accessed using the Centers for Medicare and Medicaid Services Open Payments website, and statistical analyses were performed to elucidate trends based on leadership position, urologic specialty, AUA region, payment type, and overall payments over time.Results: Out of the 239 urologists identified, 85%, 78%, and 91% received some sort of payment in 2014, 2015, and 2016, respectively. Department chairs accepted payments more readily than program directors and journal editors in all years. Average total payments for all urologists increased yearly, with mean general payments trending down and mean research payments trending up.Conclusion: The Sunshine Act was passed in part to promote transparency of the physician-industry relationship. Though the proportion of urologic leaders accepting payments between 2014 and 2016 did not change significantly, increased public scrutiny could have contributed to the decrease in yearly general payments and the increase in yearly research payments. [ABSTRACT FROM AUTHOR]

Objective: To assess the incidence of violations to the National Resident Matching Program Code of Conduct during the Urology Match.Materials and Methods: We sent a survey to all 285 applicants to a single urologic program during 2017 Match cycle; the questions pertained to illegal interview questions, postinterview communication, second-look qualifications, and the applicant's perceived impact of these factors.Results: At total of 166 responses were obtained (response rate 58%). Ninety-six (58%) applicants received follow-up communication from at least 1 program, the majority from multiple programs. Of those who received postinterview communication, 13% reported verbal communication, and 19% felt misled by communication to believe they had a higher chance of matching at a program. Fifty (30%) respondents did a second-look visit, and 44% reported feeling obligated to do so in order to match. Finally, 141 of 166 (85%) applicants reported being asked illegal questions regarding personal life, rank list, and/or other interviews. Female applicants reported being asked illegal questions significantly more frequently than male applicants (P < .01).Conclusion: During the 2017 Urology Match, a high proportion of applicants experienced violations of the National Resident Matching Program Code of Conduct. Violations included illegal questions, postinterview written and verbal communication, and pressure to do second-look visits. These findings corroborate numerous anecdotal reports, and may provide the groundwork to improve the fairness of the residency application process for the future. [ABSTRACT FROM AUTHOR]

Objective: To understand the frequency and nature of postinterview communication as it relates to the rules and regulations of the American Urological Association Urology Residency Match, as well as the impact of such communication on the outcomes of the match.Methods: An anonymous, electronic survey questionnaire was sent to all applicants to a single urology residency training program during the 2017 American Urological Association match cycle. The survey was administered 1 month after the release of match results and queried applicants regarding their experiences with postinterview communication.Results: Of 231 surveys sent, 78 were returned completed for a 34% response rate. Among respondents, 47 (60%) reported receiving postinterview communication from at least one residency program, 20 (26%) were asked to reveal where they would be ranking a program on their rank list, and 15 (19%) reported that postinterview communication caused them to rank a program higher than initially planned, or to keep the program ranked at #1 if currently ranked there. Postinterview communication via telephone was associated with significantly increased odds of matching at the contacting program (odds ratio 20.0, 95% confidence interval 2.12-188.66, P = 0.003).Conclusion: Postinterview communication between applicants and urology residency programs is prevalent, with numerous violations of the rules of the match. Prohibited communication may impact the rank lists of urology applicants. [ABSTRACT FROM AUTHOR]