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Introduction The condition of trauma patients and the urgent need for timely resuscitation present unique challenges to trauma teams. These difficulties are exacerbated for military trauma teams in combat environments. Consequently, there is a need for continued improvement of nontechnical skills (NTS) training for trauma teams. However, current approaches to NTS assessment rely on subjective ratings, which can introduce bias. Accordingly, objective methods of NTS evaluation are needed. Eye-tracking (ET) methods have been applied to studying communication, situation awareness, and leadership in many health care settings, and could be applied to studying physicians' NTS during trauma situations. In this study, we aimed to assess the relationship between trauma team leaders' objective gaze patterns and subjective expert NTS ratings during patient care simulations. Materials and Methods After Institutional Review Board approval, 9 trauma teams from first-year post-graduate general surgery and emergency medicine residents were recruited to participate in 1 of 2 trauma simulations (a difficult airway case and a multi-patient trauma). Each scenario lasted approximately 15 minutes. All team leaders wore a mobile ET system to evaluate gaze metrics—time to first fixation (TTFF), average fixation duration (AFD), and total percentage of the scenario (TPS) focused on Areas of Interest (AOI), which included patient, care team, diagnostic equipment, and patient care equipment. Trained faculty raters completed the Non-Technical Skills for Surgeons (NOTSS) assessment tool and the Trauma Non-Technical Skills (T-NOTECHS) scale. One-way analysis of variance, Kruskal-Wallis, and appropriate post-hoc pairwise comparison tests were run to assess differences between ET metrics across AOI groups. Spearman's Rho tests were used to assess correlations between ET and subjective NTS ratings. Results Compared to other NTS domains, trauma teams scored relatively poorly on communication across both T-NOTECHS (3.29 |$ \pm $| 0.61, maximum = 5) and NOTSS (2.87 |$ \pm $| 0.66, maximum = 4). We found significant differences in trauma team leaders' TTFF between teammates and the patient (Team: 1.56 vs Patient: 29.82 seconds, P  < .001). TTFF on the diagnostic equipment was negatively correlated (P  < .05) to multiple measures of subjective NTS assessments. There were no significant differences in AFD between AOIs, and AFD on teammates was positively correlated (P  < .05) to communication and teamwork. There were significant differences in TPS across most AOI pairs (P  < .05), and the average TPS fixated was highest on the patient (32%). Finally, there were several significant correlations between additional ET and NTS metrics. Conclusions This study utilized a mixed methods approach to assess trauma team leaders' NTS in simulated acute care trauma simulations. Our results provide several objective insights into trauma team leaders' NTS behaviors during patient care simulations. Such objective insights provide a more comprehensive understanding of NTS behaviors and can be leveraged to guide NTS training of trauma physicians in the future. More studies are needed to apply these methods to capture NTS from a larger sample of teams in both simulated and real trauma environments. [ABSTRACT FROM AUTHOR]

Objectives: Hypertension (HTN) affects nearly half of US adults. Our multi-institutional survey revealed that Internal Medicine residents lack proficiency in advanced HTN topics.We developed a curriculum to address knowledge gaps in these topics and aimed to assess the effects of the curriculum on residents' confidence, desire for future training, and knowledge in advanced HTN topics. Methods: HTN experts taught four advanced topics in HTN: conducting aworkup for secondary HTN, managing HTN in chronic kidney disease, managing HTN in patients who are or may become pregnant, and managing hypertensive urgency (severe asymptomatic HTN) in the outpatient setting. The setting of the curriculum was an ambulatory educational half-day, during which residents rotated through small-group sessions dedicated to each HTN topic.We developed pre-, immediate post-, and 8 weeks postcurriculum surveys assessing residents' confidence and desire for future training in the four topics (4-point Likert scales), and multiple-choice quizzes to assess changes in knowledge. We used repeated-measures analysis of variance to compare means between time points for surveys and quizzes. Results: A total of 112 Internal Medicine residents participated in the curriculum. Themean confidence scores for all four topics increased from 1.79 to 2.61 precurriculum to 2.90 to 3.45 immediately postcurriculum (all P < 0.001) and remained higher (2.53-3.18) than precurriculum at 8 weeks postcurriculum (all P < 0.02). The mean desire for future training scores decreased from 2.74 to 2.96 precurriculum to 2.06 to 2.36 immediately postcurriculum (all P < 0.001 except for managing HTN in patients who are or may become pregnant, which was P = 0.17) and remained lower (2.08-2.36) than precurriculum at 8 weeks postcurriculum (all P ≤ 0.003). The mean knowledge score increased from 48% precurriculumto 62%immediate postcurriculum (P<0.001) andremained higher (55%) than precurriculum at 8 weeks postcurriculum (P = 0.015). Conclusions: A curriculum on advanced HTN topics produced durable gains in confidence and knowledge and partially satisfied the desire for future learning among Internal Medicine residents. [ABSTRACT FROM AUTHOR]

Introduction The integration of Point of Care Ultrasound (POCUS) into the care of trauma patients, specifically the E-FAST, has improved the accuracy of initial diagnoses and improved time to surgical intervention in critically ill patients. Physician assistants (PAs) are critically important members of any military trauma resuscitation team and are often team leaders in a pre-hospital setting. They may receive training in ultrasound but there are little data to support their use or evaluate their effectiveness in using POCUS. We designed a study to evaluate the image quality of an E-FAST Exam performed by Emergency Medicine Physician Assistant (EMPA) Fellows and Emergency Medicine (EM) Interns following identical training. Our hypothesis is that image quality obtained by EMPAs will be non-inferior to those images obtained by EM Interns. Materials and Methods This is a prospective single-blinded study comparing the image quality of E-FAST exams performed by first year EM interns and first year EMPA fellows. All participants completed standard POCUS training prior to enrollment in the study. A total of 8 EMPAs and 8 EM first year residents completed 10 recorded E-FAST exams to be used as study images. Participants also viewed a 15-question slide show containing images of positive (6) and negative (9) E-FAST exams and recorded their interpretations. Images were reviewed by expert reviewers who were blinded to which images were collected by which group. An image quality score was recorded for each view as well as an overall image quality score. Image quality was rated on a 1 to 5 image quality scale. Results For overall image quality, the mean score for EMPAs was 3.6 ± 0.5 and for EM residents was 3.2 ± 0.5 with statistical significance favoring better image quality from the EMPAs. The time to completion for the EFAST exam for EMPAs was 4.8 ± 1.3 minutes and for interns it was 3.4 ± 1.4 minutes (P value = 0.02). There was no difference in image interpretation quiz scores between the groups (mean score 92% among interns and 95% among PAs). Conclusions POCUS is an imaging modality which is very portable and relatively inexpensive which makes it ideal for military medicine. PAs are essential members of military trauma teams, and often run an initial trauma resuscitation. Being able to correctly identify patients who have free fluid early in the course of treatment allows for more correct evacuation criteria to ensure the sickest patients get to care the fastest. Although there are limited data to support POCUS use by non-physicians, our data support a growing body of evidence that it is not the profession or baseline medical education that determines an individual's ability to use and incorporate ultrasound into bedside and clinical practice. Our study shows that with training and experience PAs or other members of the military health care team can use the EFAST to better care for trauma patients. [ABSTRACT FROM AUTHOR]

With the rise in nurse practitioner (NP) residency programs, evaluations have largely focused on retention and competency completion for residents. There is a need for expanded evaluation to ensure the sustainability of NP residency programs, to ensure timely adaptations to address resident satisfaction, and to solidify a long-term pathway of NPs well prepared for rural practice. We created a family nurse practitioner (FNP) residency program with a comprehensive evaluation framework to prepare residents for practice in rural settings. The evaluation framework was developed through collaborative engagement of an external evaluation team, program leadership, and clinical site representatives. The evaluation framework of the FNP residency program combined resident assessment and holistic program evaluation, using a rapid continuous quality improvement (QI) approach. The evaluation considered three distinct perspectives: the resident, the peer coach, and the clinical site. The rapid continuous QI approach allowed program leadership to respond swiftly to programmatic challenges, improve the residency program in response to residents' reported experiences, and emphasize sustainability for continued program impact, while assessing residents' learning and performance. The program's data-driven evaluation approach has demonstrated its success in meeting the goals of the Health Resources and Services Administration funding by increasing the number of primary care providers in rural settings. The program's expansion and continued success have further validated the efficacy of this evaluation framework in assessing, improving, and ensuring the sustainability of APRN residency programs. This article calls for the adoption of similar evaluation strategies in future residency programs to promote their long-term success and impact in rural health care settings. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to analyze the experiences of new nurses during their first year of hospital employment to gather data for the development of an evidence-based new nurse residency program focused on adaptability. Methods: This study was conducted at a tertiary hospital in Korea between March and August 2021 with 80 new nurses who wrote in critical reflective journals during their first year of work. NetMiner 4.5.0 was used to conduct a text network analysis of the critical reflective journals to uncover core keywords and topics across three periods. Results: In the journals, over time, degree centrality emerged as "study" and "patient understanding" for 1 to 3 months, "insufficient" and "stress" for 4 to 6 months, and "handover" and "preparation" for 7 to 12 months. Major sub-themes at 1 to 3 months were: "rounds," "intravenous-cannulation," "medical device," and "patient understanding"; at 4 to 6 months they were "admission," "discharge," "oxygen therapy," and "disease"; and at 7 to 12 months they were "burden," "independence," and "solution." Conclusion: These results provide valuable insights into the challenges and experiences encountered by new nurses during different stages of their field adaptation process. This information may highlight the best nurse leadership methods for improving institutional education and supporting new nurses' transitions to the hospital work environment. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the extent to which personal well-being may be associated with empathy, while controlling for potential confounders. Settings/Location: Residency programs throughout the United States. Subjects: A total of 407 medical residents from residencies including general medicine, surgery, specialized and diagnostic medicine participated in this study. Outcome Measures: Well-being was measured using the modified existential well-being subscale of the spiritual well-being scale. Empathy was measured using the Jefferson Scale of Empathy. Results: Well-being was found to be positively correlated with empathy when adjusted for possible confounders (p < 0.001). In addition to well-being, other factors noted to be statistically significant contributors to higher empathy scores while controlling for the others included age, gender, year in residency, specialty, and work-hours (p < 0.05 for each). After controlling for these factors, a resident's year in residency was not found to be a statistically significant contributor to empathy score. Conclusions: In this study, well-being was associated with empathy in medical and surgical residents. Empathy is a fundamental component of physician competency, and its development is an essential aspect of medical training. These findings suggest that efforts to increase well-being may promote empathy among medical residents. [ABSTRACT FROM AUTHOR]

Background: Cardiothoracic anesthesiology training presents learners with unique challenges, procedural skills, and the management of high-intensity critical scenarios. An effective relationship between educator and learner can serve as the backbone for effective learning, which is crucial for the development of budding anesthesiologists. Strengthening this educational alliance between teachers and trainees involves understanding the educational values educators and learners find most important to their learning experiences. This study aimed to identify the key educational values related to cardiothoracic anesthesia for both learners and educators. By identifying these values in separate cohorts (learners and educators), the importance of various educational values can be examined and compared between the trainees and teachers. Methods: Two separate surveys (one for learners and one for teachers) were adapted from the Pratt and Collins Teaching Perspectives Inventory to establish the importance of various educational values related to cardiothoracic anesthesia. Surveys were sent to 165 Accreditation Council for Graduate Medical Education-accredited anesthesiology residency training programs in the United States to trainees (residents and cardiothoracic anesthesiology fellows) and educators (board-certified cardiothoracic anesthesiologists). Results: Analysis of survey results from 19 educators and 57 learners revealed no statistical differences across the two groups, except Q15: “Let trainee perform critical technical steps” (P value = 0.02). Conclusions: While learners and educators in cardiothoracic anesthesia hold similar values regarding cardiac anesthesia education, they differ in the degree to which critical technical steps should be performed by learners. [ABSTRACT FROM AUTHOR]

Background: Even now the further training in surgery faces considerable challenges. The planned hospital structural reform will result in new bureaucratic and organizational hurdles, which could lead to a considerable loss of quality in advanced surgical training across all disciplines. Objective: The aim of this position paper is to describe the current and future challenges for advanced surgical training and to identify possible approaches and opportunities for the further development against the background of the planned hospital structural reform. Material and methods: For the development of this position paper a committee of representatives of the Young Forums of the German surgical societies identified and critically discussed current problems and challenges of the present residency training system and formulated a list of demands for a sustainable residency training concept. Results: The planned shift to outpatient treatment and centralization were identified as central challenges for surgical residency training. Surgical training must be considered consistently and from the outset in all political reform efforts. In addition to a transparent and cost-appropriate financing of residency training, we call for the involvement of all German surgical societies in the reform process. Furthermore, the social framework conditions for junior surgeons should be considered. Conclusion: The structural change in the hospital landscape in Germany, which is being forced by politicians, harbors the risk of a further loss of quality and experience in surgical treatment and training. At the same time, the planned hospital reform offers a unique opportunity to address existing problems and challenges in surgical training and to consider them as a starting point for structural changes which are fit for the future. [ABSTRACT FROM AUTHOR]

Purpose More than 1,500,000 adolescents in the United States report using emergency services for the majority of their medical needs. Although the American Council for Graduate Medical Education offers some guidance on the inclusion of pediatric topics in an emergency medicine (EM) residency curriculum, it does not specifically address adolescent-related competencies. We aimed to develop a consensus on which adolescent health topics are most important to cover in a didactic curriculum for EM residents. Methods Physicians from multiple specialties, such as EM, pediatric EM, and adolescent medicine, were invited as panelists in a modified Delphi process. In round 1, the panelists were asked to determine which competencies in adolescent medicine are most important for a graduating EM resident to master. In round 2, they were asked to specify the competencies that should be included in an EM residency didactic curriculum. In round 3, they prioritized the most critical competencies for curriculum inclusion. Results Consensus was reached on a total of 26 topics that were found crucial to be included in a didactic curriculum for EM residents. Of these, the panel prioritized the following: (1) “manage a patient presenting after reported sexual assault,” (2) “accurately diagnose ovarian torsion,” and (3) “manage a patient presenting for symptoms of sexually transmitted infection.” Conclusion The modified Delphi process yielded recommendations to guide the development of an adolescent medicine curriculum for EM residents. Sexual and reproductive healthcare issues were identified as the most important topics.

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

Background: Studies in many countries have reported that the coronavirus disease 2019 (COVID-19) pandemic disrupted surgical residency training. While a few qualitative studies have been conducted to investigate the effect of this disruption in Nigeria, a country with a small surgical workforce, no known quantitative research has assessed the effect of the pandemic on surgical residency training in the country. We, therefore, conducted this study to evaluate the effects of COVID-19 on the training of resident doctors in surgical specialties at the University College Hospital (UCH), Ibadan, Nigeria, using quantitative indicators. Methods: Questionnaires were distributed to surgical resident doctors across different subspecialties at UCH, Ibadan. Data were analyzed with descriptive statistics, chi-squared test, Wilcoxon signed-rank test, and logistic regression. Results: A total of 87 surgical trainees (response rate, 89.7%) participated in the survey. Some surgical trainees reported an increase in overall working hours (28.6%) and the frequency of weekend calls (9.5%). Only 22.4% continued to work in their primary subspecialty. In comparison with the pre-pandemic period, there was a significant reduction (% deviation in mean±standard deviation; p value) in the time, hours per week, spent in the outpatient clinic (−38±31; p < 0.001), on ward rounds (−25±96; p < 0.001), and in the theater (−35±87; p < 0.001), and major surgeries performed (−48±55; p < 0.001) at the height of the pandemic. Senior surgical trainees were half as likely as junior trainees to feel that the pandemic would cause an extension in the normal duration of their training (adjusted odds ratio, 0.64; confidence interval, 0.20–2.01; p = 0.444). Conclusion: The pandemic caused a reduction in work hours spent performing subspecialty duties and the procedures performed by surgical trainees at UCH, Ibadan. Hospitals should develop strategies to minimize disruptions to surgical residency training programs during pandemics and other healthcare crises.

Introduction: Health professions education is challenging in terms of developing ways to construct and assess the amalgamation of knowledge, skills and attitudes that result in novice graduatesto be self aware and confident to practice without supervision. Currently, the Physiotherapy internship program in India does not have a comprehensive competency-based framework. Withthe current batch of interns facing the wrath of the COVID-19 pandemic during their undergraduate training, it is a matter of concern to ensure they have developed the required competencies to treat patients independently.Methods: This is a single-group interventional study using convenience sampling. A competency framework inclusive of a comprehensive assessment and training module was developed and introduced to 27 physiotherapy interns. Every intern underwent 10 training sessions along with 8 competency assessments during 6 months of internship training. A pre-post indigenous questionnaire was used to assess their self-perceived competency along with feedback questionnaire taken at the end of the module.Results: Implementation of the competency framework revealed a statistically significant difference in the self-perceived competency (pre=84.36±10.98, post=98.55±8.74, P≤0.000). Having uniformity in assessment techniques among the faculty, being exposed to challenging cases during assessment, having training module at the beginning of the internship were some of the suggestions given by the participants.Conclusion: Competency based education offers to be an effective technique in health professional program. Incorporating a competency-based training would help the learners tounderstand their strengths and weaknesses that would go a long way to develop competent health-care professionals. Developing such framework in curriculum will emphasize standardization of learning outcomes, thereby resulting in quality education, furtherenhancing patient care, and improving the health outcomes worldwide.

Introduction: Medical residents commonly experience depressive and anxiety symptoms at higher rates compared to the general population. These symptoms have been associated with various sociodemographic risk factors as well as academic and healthcare demands. Objective: To determine the frequency of depressive or anxiety symptoms and associated factors among medical-surgical specialty students. Methods: A cross-sectional study was conducted in 2021, involving residents in medical-surgical specialties at a university in Medellín. Participants provided informed consent to participate. Three instruments were used: a sociodemographic and clinical survey, the Beck Anxiety Inventory, and the Beck Depression Inventory-II. Chi-square or Fisher’s exact tests were used to explore associations, and prevalence ratios (PR) with 95% confidence intervals were estimated. Multivariate analysis using binomial regression was also performed. Results: The study included 80 residents, of whom 57.5% were female. The median age was 28 (27-30 years). 17.5% had a personal history of mental illness, and 33.8% had a family history of mental illness. 72.5% consumed alcohol. 40% had depressive symptoms, and 11.3% had both anxiety and depressive symptoms. Factors associated with depressive symptoms were mistreatment, long working hours, and sleep disturbances. In the multivariate analysis, only sleep disturbance remained significantly associated (PR 8.7; 95% CI 1.2-63.2; p = 0.03). The variable associated with anxiety symptoms was mistreatment (PR 4.2; 95% CI 1.2-15.7; p = 0.02). Conclusion: A higher prevalence of depressive symptoms, contrary to expectations, was found compared to anxiety symptoms. The variables associated with depressive or anxiety symptoms were consistent with previous reports.

This study examines the challenges and accommodations for medical residentswith disabilitieswithin physicalmedicine and rehabilitation training programs. Medical residency presents unique stressors and responsibilities, with the potential for added complexities for residents with disabilities. Few data exist regarding the prevalence and experiences of people with disabilities as medical trainees and the limited studies available highlight an underrepresentation of individuals with disability in medical training and practice. Through cross-sectional surveys administered to physical medicine and rehabilitation residents, this research assesses disability prevalence, characterizations, barriers to training, and accommodations provided. Of 140 respondents, 9.3% identified as having disabilities, with varying prevalence among genders and disability types. Results revealed distinct challenges for residents with mobility and nonmobility disabilities, spanning learning environments, standardized testing, procedural skills, and accessibility. Self-provided accommodations exceeded program-provided ones, indicating room for improvement in program support. These findings underscore the need for proactive dialog between residents and leadership to address barriers, enhance accommodations, and create an inclusive training environment. The study's insights emphasize the importance of advocating for equal opportunities and cultivating supportive conditions to enable individuals with disabilities to thrive in medical residency programs, ultimately contributing to more diverse and inclusive medical communities. [ABSTRACT FROM AUTHOR]

Background: Reporting medical errors, near misses, and adverse events is an important component of improving patient safety and resident learning. Studies have revealed that event reporting rates can be low for physicians, resident physicians, and fellows. The objective of this quality improvement project was to improve resident reporting of patient safety and quality events and engage residents in the analysis of events at a community-based teaching hospital in the United States. Methods: We developed a program to engage 122 residents from 6 Accreditation Council for Graduate Medical Education– accredited residency programs using a multifaceted approach that included instructing residents how to use the hospital’s adverse event reporting system; requiring first-year residents to submit at least 1 report; reviewing all resident reports during a monthly multidisciplinary meeting; and ensuring that each resident who submitted a report received feedback on how the concern was being addressed. Results: The program resulted in a 41.8% (95% CI 31%-53%) absolute increase in the number of residents reporting a concern, and resident submissions led to several documented improvements in patient care. A survey was administered to the residents who submitted reports, and the majority (76.0% response rate) expressed satisfaction with both the reporting system and the feedback about how their submission was being addressed. The responding residents agreed that they were more likely to submit reports because of their experience with the program and that they felt the program would improve safety and the quality of care at the institution. Conclusion: This quality improvement project successfully increased resident event reporting and engaged residents in the review of submitted events. The program can serve as a model for other teaching hospitals. [ABSTRACT FROM AUTHOR]

Objective Behavioral performance of health professionals is essential for adequate patient care. This study aimed to assess the behavioral skills of fellows in neonatology before and after a simulation training program on neonatal resuscitation. Study Design From March 2019 to February 2020, a prospective cohort with 12 second-year fellows in neonatology were evaluated during three training cycles (16 hours each) in manikin-based simulation of neonatal resuscitation with standardized scenarios. Each cycle lasted 1 month, followed by a 3-month interval. One video-recorded scenario of approximately 10 minutes was performed for each fellow at the beginning and at the end of each training cycle. Therefore, each fellow was recorded six times, before and after each one of three training cycles. Anxiety of the fellows was assessed by the Beck Anxiety Inventory applied before the first training cycle. The videos were independently analyzed in a random order by three trained facilitators using the Behavioral Assessment Tool. The behavioral performance was evaluated by repeated measures of analysis of variance adjusted for anxiety and for previous experience in neonatal resuscitation. Results Fellows' overall behavioral performance improved comparing the moment before the first training and after the second training. The specific skills, such as communication with the team, delegation of tasks, allocation of attention, use of information, use of resources, and professional posture, showed a significant improvement after the second month of training. No further gains were noted with the third training cycle. Anxiety was observed in 42% of the fellows and its presence worsened their behavioral performance. Conclusion An improvement in behavioral performance was observed, comparing the moment before the first training and after the second training, without further gains after the third training. It is worth noting the important role of anxiety as a modulator of acquisition and retention of behavioral skills in health professionals in training. Key Points Simulation training should improve technical and behavioral skills of providers Behavioral skills improve after a first cycle of training, but not after a repeat cycle Anxiety modulates trainees' behavioral performance [ABSTRACT FROM AUTHOR]

Background: The Korean Neurosurgical Society's 60th anniversary in 2022 compelled us to reflect on the changes within the education programs of neurosurgery residents. Traditional apprenticeship has witnessed a structural shift to manual-based education, and content has transitioned from time-based to competency-based education, driven further by the implementation of the 80-hour work-per-week regulation. Current Concepts: Despite reduced training hours, neurosurgery residents strive to gain more surgical participation and research opportunities while working 80 hours per week. To address this conflicting scenario, the Korean Neurosurgical Society implemented proactive measures to enhance resident education. This included the development of a competency-based training curriculum and guidelines for supervising physicians to prepare residents with the essential skills for independence. Additionally, evaluation guidelines and feedback mechanisms were established to provide objective assessments and facilitate self-improvement. Establishing operational guidelines and developing an e-portfolio would help minimize variations in educational effects among residents. Discussion and Conclusion: Failure to adapt to the changing environment, including the 80-hour work week, by maintaining outdated training methods would result in stagnation or a decline in the efficiency of resident education. Therefore, providing a unified educational curriculum and ensuring sustainable, high-quality training according to the evaluation systems of the Korean Neurosurgical Society is essential. This curriculum must be reviewed on an ongoing basis to recognize the society's expertise and develop educational policies based on scientific evidence and the opinions of society members. [ABSTRACT FROM AUTHOR]

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OBJECTIVES Performance of a technically sound left internal thoracic artery to left anterior descending artery (LITA-LAD) anastomosis during coronary artery bypass grafting (CABG) is critically important. We used prospectively collected data from the multicentre, randomized REGROUP (Randomized Endograft Vein Perspective) trial to investigate CABG outcomes based on whether a resident or an attending surgeon performed the LITA-LAD anastomosis. METHODS This was a post hoc subanalysis of the REGROUP trial, which randomized veterans undergoing isolated on-pump CABG to endoscopic versus open vein harvest from 2014 through 2017. The primary end point was major cardiac adverse events, defined as the composite of all-cause deaths, nonfatal myocardial infarctions or repeat revascularizations. RESULTS Among 1,084 patients, 344 (31.8%) LITA-LAD anastomoses were performed by residents and 740 (68.2%), by attending surgeons. Residents (compared to attendings) operated on fewer patients with high tercile SYNTAX scores (22.1% vs 37.4%, P  < 0.001), performed fewer multiarterial CABGs (5.2% vs 14.6%, P  < 0.001) and performed more anastomoses to distal targets with diameters > 2.0 mm (19.0% vs 10.9%, P  < 0.001) and non-calcified landing zones (25.1% vs 21.6%, P  < 0.001). During a median observation time of 4.7 years (interquartile range 3.84–5.45), major cardiac adverse events occurred in 77 patients (22.4%) in the group treated by residents and 169 patients (22.8%) in the group treated by attendings (unadjusted HR 1.00; 95% confidence interval, 0.76–1.33; P  = 0.99). Outcomes persisted on adjusted analyses. CONCLUSIONS Based on this REGROUP trial subanalysis, under careful supervision and with appropriate patient selection, LITA-LAD anastomoses performed by the residents yielded clinical outcomes similar to those of the attendings. [ABSTRACT FROM AUTHOR]

Introduction. The effect of policies to improve residents’ well-being, in terms of professional burnout and work commitment is controversial, and its result after the implementation of the “residents’ law” (1917/2018) in Colombia is unknown. This study explores the effect of this law on Colombian surgical residents. Methods. Explanatory sequential mixed methods study. Initially, all surgical residents in the country were invited to self-complete the UWES-17 and MBI-HSS questionnaires to evaluate work commitment (vigor, dedication, and absorption) and professional burnout (emotional exhaustion, depersonalization, and low personal accomplishment) before (2019) and after (2022) the implementation of the law. Different hypotheses were tested using structural equation models. The results were explored with surgeons through focus groups. Qualitative information was analyzed manually and by artificial intelligence, and reported into main themes. Results. 400 residents participated in the study. Burnout rates were 24.8% before and 15.8% after (p=0.032). The structural equations analysis confirmed that emotional exhaustion over professional burnout was lower in 2022 (p=0.022). No significant changes in work commitment were identified. The main explanation was attributed to the economic benefits of the law. Conclusion. The burnout rate in Colombian surgical residents was significantly reduced after the implementation of the “residents’ law”. These findings have implications for practice and improving the quality of education. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionFew studies have focused on medical students and residents’ mental health impact on medical residency selection (MRS) performance. The authors evaluated the association of performance in MRS with depressive and anxiety symptoms and with a reported psychiatric diagnosis (rPD).The authors enrolled candidates after the second round of MRS examinations at a Brazilian Medical School. Performance was assessed by final grade. Depressive and anxiety symptoms were assessed by the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) and the State-Trait Anxiety Inventory (STAI). The authors performed mediation analysis and multiple linear regression analysis to investigate the impact of rPD, state and trait anxiety, and depressive symptom severity on performance.515 of the 643 MRS candidates (80.1%) participated in the study. Higher age, attending a preparatory course for MRS, rPD, and the number of MRS applications that year were associated with poorer performance. In mediation analysis, trait anxiety was associated with a direct effect on performance and an indirect effect mediated by rPD.The data suggest that psychiatric diagnosis is associated with poorer performance on MRS, regardless of current symptoms of anxiety and depression. Additionally, increased levels of trait anxiety may negatively impact performance, directly and indirectly. [ABSTRACT FROM AUTHOR]

Research engagement during physical medicine and rehabilitation residency and fellowship training is essential for advancing evidence-based medicine and fostering the development of clinicianscientists. Current Accreditation Council for Graduate Medical Education guidelines regarding research requirements during physical medicine and rehabilitation training are ambiguous, and it is unknown whether physical medicine and rehabilitation trainees receive adequate support to pursue research at the level they desire. This anonymous survey study aimed to identify perceived barriers and facilitators to research engagement among US physical medicine and rehabilitation residents and fellows. Our findings suggest that physical medicine and rehabilitation trainees value research engagement. However, research productivity during physical medicine and rehabilitation residency is limited, with many trainees reporting inadequate support and time to participate in research in a meaningful way. Additional support from residency and fellowship programs, including protected time for research, as well as research-specific education and mentorship should be considered to enhance physical medicine and rehabilitation trainee research engagement. [ABSTRACT FROM AUTHOR]

Objectives To compare the differences in antibiotic use between COPD and non-COPD residents, and to explore the effect of COPD on antibiotic use. Methods Participants aged 40 years old or over from the Songjiang Adult Cohort were included. Information on prescription and baseline survey was collected based on the health information system. A logit-negative binomial Hurdle model was used to explore correlations between COPD and percentage of antibiotic use and average rate of antibiotic prescribing of different types of antibiotic. Multinomial logistic regression was used to assess the association between COPD and antimicrobial combination therapy and routes of administration. Results A total of 34576 individuals were included and 1594 (4.6%) were COPD patients. During the 6 years' follow-up, the percentage of antibiotic use for COPD patients was 98.4%, which was 7.88 (95%CI: 5.24–11.85) times of that for non-COPD patients after adjusting for potential confounders. The prescribing rate was 3220 prescriptions (95%CI: 3063.6–3385.2) per 1000 person-years for COPD patients, which was 1.96 (95%CI: 1.87–2.06) times of that for non-COPD patients. Other beta-lactam antibacterials, Macrolides, lincosamides and streptogramins, and quinolone antibacterials were the most commonly used types of antibiotic. Except for aminoglycoside antibacterials, both percentage of antibiotic use and rate of antibiotic prescription were increased in COPD patients. COPD patients were more likely to be prescribed a maximum of two antibiotics (OR=1.34, 95%CI: 1.20–1.50); and were more likely to use antibiotics intravenously (OR=2.77, 95%CI: 2.47–3.11). Conclusion COPD patients were more likely to have increased antibiotic use in a large-scale population-based adult cohort, suggesting COPD patients are a high-priority group for the management of antibiotic use in communities. [ABSTRACT FROM AUTHOR]

Background: Combined clinical and research training is common in residency programs outside emergency medicine (EM), and these pathways are particularly valuable for combined MD/PhD graduates planning to pursue a career as a physician‐scientist. However, EM departments may not know what resources to provide these trainees during residency to create research‐focused, productive, future faculty, and trainees may not know which programs support their goal of becoming a physician‐scientist in EM. The objective of this study was to describe research training and resources available to MD/PhD graduates in EM residency training with a focus on dedicated research pathways. Methods: This study was a cross‐sectional inventory conducted through an electronic survey of EM residency program directors. We sought to identify dedicated MD/PhD research training pathways, with a focus on both resources and training priorities. Descriptive statistics were used to summarize survey responses. Results: We collected 192 survey responses (69.6% response rate). Among respondents, 41 programs (21.4%) offered a research pathway/track, 52 (27.4%) offered a research fellowship, 22 (11.5%) offered both a residency research pathway/track and a research fellowship, and two (1.0%) offered a dedicated EM physician‐scientist training pathway. Most programs considered research a priority and were enthusiastic about interviewing applicants planning a research career, but recruitment of physician‐scientist applicants was not generally prioritized. Conclusions: Some EM residency programs offer combined clinical and mentored research training for prospective physician‐scientists, and nearly all residency programs considered research important. Future work will focus on improving the EM physician‐scientist pipeline by optimizing pathways available to trainees during residency and fellowship. [ABSTRACT FROM AUTHOR]

Background Advancing health equity requires more contextualised evidence. Objectives To synthesise published evidence using an existing framework on the origins of health disparities and determine care-related outcome disparities for residents of long-term care, comparing minoritised populations to the context-specific dominant population. Design Systematic review. Subjects Residents of 24-hour long-term care homes. Methods The protocol was registered a priori with PROSPERO (CRD42021269489). Literature published between 1 January 2000 and 26 September 2021, was searched, including studies comparing baseline characteristics and outcomes in minoritised versus dominant populations. Dual screening, two-reviewer verification for extraction, and risk of bias assessments were conducted to ensure rigour. Studies were synthesized using a conceptual framework to contextualise evidence according to multi-level factors contributing to the development of care disparities. Results Twenty-one of 34 included studies demonstrated disparities in care outcomes for minoritised groups compared to majority groups. Thirty-one studies observed differences in individual-level characteristics (e.g. age, education, underlying conditions) upon entry to homes, with several outcome disparities (e.g. restraint use, number of medications) present at baseline and remaining or worsening over time. Significant gaps in evidence were identified, particularly an absence of literature on provider information and evidence on the experience of intersecting minority identities that contribute to care-related outcome disparities in long-term care. Conclusion This review found differences in minoritised populations' care-related outcomes. The findings provide guidance for future health equity policy and research—supporting diverse and intersectional capacity building in long-term care. [ABSTRACT FROM AUTHOR]

Objectives: Dental residents experience high stress in their demanding programs and gender‐based harassment/discrimination can contribute to their stress. The objectives were to compare stress, satisfaction, experienced sexual harassment and observed discrimination of women in dental graduate programs with high, medium, and low percentages of women and to explore relationships between these constructs of interest. Methods: Note that, 112 pediatric dentistry (PD), 44 prosthodontics, and 56 oral and maxillofacial surgery (OMS) residents responded to a survey. Results: PD residents had the lowest personal life‐related stress (4‐point scale with 4 = very stressful: PD = 2.99/P = 3.67/OMS = 3.56; p < 0.001), faculty‐related stress (2.68/3.66/3.03; p < 0.001), lack of confidence‐related stress (2.79/3.31/2.96; p < 0.01) and academic stress (2.65/3.24/3.02; p < 0.001), while prosthodontics residents had the highest stress levels. The average frequency of experiencing sexual harassment was highest for OMS residents and lowest for PD residents (5‐point scale with 1 = never: 1.15/2.62/2.74; p < 0.001). PD residents observed least and OMS residents most frequently that female residents were treated less positively by other residents because of their gender (1.59/2.57/3.00; p < 0.001). Prosthodontics residents had the lowest job satisfaction score (5‐point scale with 1 = lowest satisfaction: 4.12/3.14/4.20; p < 0.001). The more frequently male and female residents experienced sexual harassment, the higher their personal life‐related stress, faculty‐related stress, lack of confidence‐related stress, and academic stress, and the lower their career satisfaction, specialty content satisfaction, and stress‐related satisfaction. Women's frequencies of observed gender‐based discrimination were associated with higher stress and lower satisfaction, while men's frequencies of these observations were not associated with stress, but associated with increased satisfaction. Conclusions: Dental residents' stress, career satisfaction, experienced sexual harassment, and observed discrimination of women residents differ depending on the dental specialty program. Both male and female residents report more stress and less satisfaction the more they experience sexual harassment. The more women observe discrimination of women, the more stressed and the less satisfied they are. For men, the frequencies of these observations are not associated with stress, but positively associated with increased satisfaction. [ABSTRACT FROM AUTHOR]

Purpose/objectives: The objectives of this study were to assess the influence of learner‐ and education‐related factors on standardized in‐service examination performance and determine whether in‐service examination scores predict residency outcomes. Methods: American Academy of Periodontology (AAP) In‐service Examination (AIE) scores from 10 periodontics residency classes at a single center were recorded and compared against a panel of learner‐ and education‐related variables using multiple linear regression models. Defined residency outcome measures were analyzed against AIE scores using binomial logistic regression. Results: No evaluated learner‐ or education‐related variable was a statistically significant predictor of AIE score in this study sample. Likewise, AIE score was not a statistically significant predictor of any assessed residency outcome. Conclusions: The AAP has performed a tremendous service to periodontics residents and programs by marshaling the leadership and expertise necessary to offer a professionally constructed assessment instrument. However, in the current study, no relationship could be identified between AIE score and any outcome, including first‐attempt board certification. The AAP In‐service Committee appears well situated to provide additional leadership focusing on exam implementation, which may enhance AIE value in competency decision making. [ABSTRACT FROM AUTHOR]

Introduction: Publication rates, characterization, and assessment for predictors of publication in post‐graduate year 2 (PGY2) solid organ transplant (SOT) are lacking. Objectives: This study was conducted to determine the publication rate of PGY2 SOT pharmacy resident projects, understand practices surrounding resident research, and assess characteristics of published manuscripts. Methods: An electronic survey of PGY2 SOT residency programs was distributed. Invitation for participation was sent by email to residency program directors (RPDs), and information related to the PGY2 SOT program, RPDs, research mentors/preceptors, residents, and each research project was gathered for residents graduating between 2016 and 2019. Characteristics influencing publication success were assessed with multivariate logistic regression modeling. Results: Thirty‐eight RPD responses were analyzed (67.8% response rate). All PGY2 SOT programs were American Society of Health‐System Pharmacists (ASHP) accredited, 92% were at academic medical centers, and more than 80% were active over 6 years with a median of 10 (interquartile range [IQR] 5–13) graduated residents. In total, 35/97 (36.1%) of SOT PGY2 research projects were published, 22.7% intend to submit or have a manuscript under revision, and 39.2% will not pursue publication. Of published projects, 81% were in medical journals. Median impact factor was 2.9 (IQR 1.5–2.9). Programs active more than 10 years (odds ratio [OR] 4.0, 95% confidence interval [CI] 1.41–11.17, p = 0.009) and utilization of additional resources (OR 4.2, 95% CI 1.23–14.37, p = 0.022), including availability of a biostatistician/epidemiologist or pharmacy student, were independently predictive of publication. Fifty percent of RPDs rated their programs as either "effective" or "extremely effective" in enabling publication. Perceived barriers to publication, most often continuity of PGY2 SOT involvement after residency, were identified. Conclusion: Overall, 36.1% of PGY2 SOT pharmacy resident research projects achieved publication over a 4‐year period at the time of the survey. Years of PGY2 SOT program activity and having additional resources were independently associated with publication. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To characterize laparoscopy teaching in Medical Residency Programs in Gynecology and Obstetrics in Brazil, and to evaluate preceptors’ characteristics in laparoscopy programs and map laparoscopic training practice scenarios. Methods This descriptive cross-sectional study evaluated questionnaire responses from coordinators of the Medical Residency Programs in Gynecology and Obstetrics from 2019 to 2021. Results The questionnaire was sent to 175 programs, and 90 responses were received (51.4%). From the 85 valid responses, it was noted that 67 programs had laparoscopic training. Of the 64 responses received regarding location, 32 replies (50%) indicated the Southeast of Brazil, particularly some country’s capitals. In 37.3% (n=25) of the cases, the program coordinator performed laparoscopy. The chief of the laparoscopy sector has advanced experience in most 52.5% (n=10) medical residency services; the preceptors also had advanced experience in 89.4% (n=59) of the services. Residents received laboratory training in 39.4% (n=26) of the services. In most cases, training was performed using a physical simulator. Of the 26 medical residency services with laparoscopy training outside the operating room, 80.8% (n=21) performed them as part of the curriculum, 61.5% (n=16) had a schedule for the same, and only 3.9% (n=1) were objectively evaluated. Conclusion Laparoscopy teaching in Brazil is heterogeneous, with only a few programs offering any training in laparoscopy. The preceptors had advanced experience and participated in laboratory and operating room training. Only a few programs have their own laboratories or training centers, and most teaching programs do not plan to set up training centers.

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Implicit bias has been linked to gender disparities in medical careers, impacting not only access to leadership positions but also early career opportunities. We aimed to evaluate if there were differences in the assessment of Neurology residents according to gender. We collected publicly available grades and rankings of two major evaluations that residents are submitted to, one at the beginning and another at the end of the neurology residency program, the National Board Exam and neurology examination, respectively. The National Board Examination is a multiple-choice gender-blinded evaluation, while the neurology examination is an oral gender-unblinded evaluation. We found that 36.5% of women and 21.6% of men were in the first quartile of the National Board Examination ranking, which reflects a similar representation among top classifications when assessed through a gender-blinded examination. On the other hand, the percentage of men who were in the top classification of NE, a gender-unblinded evaluation, was more than twice as high compared to women (37.8% vs 18.3%, p < 0.05). The findings of the present study may imply that there could be a disparity in women’s career progression among neurology residents in Portugal, although the recruitment seems balanced between genders.

Abstract Background Emergency departments globally are overburdened, and emergency medicine residency is losing popularity among students and physicians. This raises concerns about the collapse of a life-saving system. Our goal was to identify the key workforce reasoning and question medical staff employment behavior. Methods This was a prospective cross-sectional study. In December 2022, medical students and pre-residency doctors in Slovenia were invited to complete a web-based questionnaire. The data were analyzed using T-test, chi-square test, Mann‒Whitney-Wilcoxon tests, and principal component analysis. Open-ended questions were hand-categorized. Results There were 686 participatns who clicked on the first page and 436 of those finished the survey. 4% of participants gave a clear positive response, while 11% responded positively regarding their decision to pursue emergency medicine residency. The popularity of emergency medicine decreases significantly among recent medical school graduates upon their initial employment. People who choose emergency medicine are less concerned about its complexity and pressure compared to others. Most respondents preferred 12-hour shift lengths. The preferred base salary range for residents was I$ 3623–4529, and for specialists, it was I$ 5435–6341. The sample’s primary personal priorities are achieving a satisfactory work-life balance, earning respect from colleagues, and engaging in academic activities. Factors that attract individuals to choose emergency medicine include high hourly wages, establishment of standards and norms, and reduced working hours. Conclusions Our findings indicate that enhancing compensation, establishing achievable standards and norms, facilitating a beneficial work-life equilibrium, providing assistance with initial property acquisition, stimulating participation in deficit residency programs, fostering collegiality among peers, restricting the duration of shifts, and enabling pension accrual may be imperative in attracting more individuals to pursue emergency medicine residency.

Objectives To evaluate the gender composition of departmental chairs and program leadership of Accreditation Council for Graduate Medical Education–accredited pathology residencies and American Board of Pathology–certified subspecialty fellowships across the United States. Methods In this cross-sectional analysis, we examined the gender of individuals holding leadership positions in academic pathology in the United States. Using publicly available online data, 2 authors independently coded perceived gender (ie, man/woman/other) with 100% concordance. Results In 144 pathology residency programs, more women hold residency program director positions (52.1% [75/144]). Among 11 pathology subspecialties, women overall hold fewer fellowship program director positions (45.0% [212/471]). Among the residency-associated pathology department chair positions identified, women hold fewer positions (31.8% [42/132]). There is some geographic variation in pathology leadership gender composition when stratified using US Census regions. Conclusions Women in academic pathology departments are well represented in residency and overall fellowship program leadership but are underrepresented in department chair and certain pathology subspecialty leadership positions. The disproportionate number of women in department chair positions is observed across medical specialties, highlighting the need for improved gender equity among high-level academic medicine positions. [ABSTRACT FROM AUTHOR]

Background: The rapid evolution of neuroendovascular intervention has resulted in the inclusion of endovascular techniques as a core competency in neurosurgical residency training. Methods: We conducted a literature review of studies involving the training of neurosurgical residents in cerebrovascular and endovascular neurosurgery. We reviewed the evolution of cerebrovascular neurosurgery and the effects of these changes on residency, and we propose interventions to supplement contemporary training. Results: A to tal of 48 studies were included for full review. Studies evaluated trainee education and competency (29.2%, 14/48), neuroendovascular training models (20.8%, 10/48), and open cerebrovascular training models (52.1%, 25/48), with some overlap. We used a qualitative analysis of reviewed reports to generate a series of suggested training supplements to optimize cerebrovascular education. Conclusion: Cerebrovascular neurosurgery is at a crossroads where trainees must develop disparate skill sets with inverse trends in volume. Continued longitudinal exposure to both endovascular and open cerebrovascular surgical fields should be mandated in general resident education, and blended learning tactics using adjunct simulation systems and models should be incorporated with didactics to both optimize learning and alleviate restraints placed by decreased volume and autonomy. [ABSTRACT FROM AUTHOR]

Background Limited evidence exists on the short- and long-term safety of discontinuing versus continuing chronic opioid therapy (COT) among patients with Alzheimer's disease and related dementias (ADRD). Methods This cohort study was conducted among 162,677 older residents with ADRD and receipt of COT using a 100% Medicare nursing home sample. Discontinuation of COT was defined as no opioid refills for ≥90 days. Primary outcomes were rates of pain-related hospitalisation, pain-related emergency department visit, injury, opioid use disorder (OUD) and opioid overdose (OD) measured by diagnosis codes at quarterly intervals during 1- and 2-year follow-ups. Poisson regression models were fit using generalised estimating equations with inverse probability of treatment weights to model quarterly outcome rates between residents who discontinued versus continued COT. Results The study sample consisted of 218,040 resident episodes with COT; of these episodes, 180,916 residents (83%) continued COT, whereas 37,124 residents (17%) subsequently discontinued COT. Discontinuing (vs. continuing) COT was associated with higher rates of all outcomes in the first quarter, but these associations attenuated over time. The adjusted rates of injury, OUD and OD were 0, 69 and 60% lower at the 1-year follow-up and 11, 81 and 79% lower at the 2-year follow-up, respectively, for residents who discontinued versus continued COT, with no difference in the adjusted rates of pain-related hospitalisations or emergency department visits. Conclusions The rates of adverse outcomes were higher in the first quarter but lower or non-differential at 1-year and 2-year follow-ups between COT discontinuers versus continuers among older residents with ADRD. [ABSTRACT FROM AUTHOR]

Over half of opioid misusers last obtained access to opioids via a friend or relative, a problematic reflection of the opioid reservoir phenomenon, which results from an unused backlog of excess prescription opioids that are typically stored in the American home. We aim to determine if a voluntary educational intervention containing standard opioid and nonopioid analgesic prescribing ranges for common surgeries is effective in altering postoperative prescribing practice. We utilized a mixed methods approach and sent out a questionnaire to American podiatric physicians, including residents (baseline group A), via email in early 2020 for baseline data; then, we interviewed foot and ankle surgeons and the primary themes of these semistructured interviews informed us to target residents for an educational intervention. We repeated the survey 3 years later in summer 2022 (preintervention group B). We created an opioid guide and emailed it to residents in fall 2022. Another repeat survey was done in spring 2023 (postintervention group C). We used the Mann-Whitney U test to examine differences between the groups among their reported postoperative opioid quantities for a first metatarsal osteotomy surgical scenario. Groups A, B, and C had 60, 100, and 99 residents, respectively. There was no significant difference (p =.9873) between baseline group A and preintervention group B. There was a difference (p <.0001; -5 median) between preintervention group B and postintervention group C (same residency year). In postintervention group C , a majority (91/99) reported viewing the guide at least once, and the number of residents that reported supplementing with NSAIDs also doubled compared to preintervention group B. This novel opioid educational intervention resulted in meaningful change in self-reported postoperative prescribing behavior among residents. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe and compare the current postgraduate training opportunities (PTOs) in the United States (US) for which doctors of chiropractic are eligible, namely, residencies, fellowships, and board certifications. An internet search of publicly available English-language websites on Google.com was executed using a cache-cleared private browser and key search phrases. Following webpage data extraction, e-mail and telephone follow-up were completed with officials from institutions offering doctor of chiropractic programs possessing accreditation by the Council on Chiropractic Education (CCE) in the US. Additional programs identified were annotated and incorporated into the data set if they met the inclusion criteria. Descriptive statistics were generated following data aggregation. Three-hundred internet search results were screened, 70 of which were assessed for eligibility and 47 included for descriptive analysis. Among the 16 CCE-accredited institutions solicited, 13 returned correspondence (81.3% response rate), resulting in the addition of 2 programs to the data set ascertained by the initial web search. There were 49 PTOs for chiropractors. Of programs available, residencies represented 49.0% (24/49) of programs, and fellowships represented 12.2% (6/49) of programs. There were 19 board specialty diplomate programs, constituting 38.8% of PTOs. This work details preliminary descriptive information on the current state of US-based PTOs for chiropractors. [ABSTRACT FROM AUTHOR]

Background The perception of an ideal nose is influenced by a variety of factors, with demographic characteristics playing a significant role in what is considered an ideal nose. The nasolabial angle (NLA) is considered one of the defining features shaping the nose. Objectives In this study we set out to capture the perception of the ideal nasolabial angle among Canadian, Saudi, Kuwaiti, and Lebanese populations. Methods An online questionnaire-based cross-sectional study was conducted to investigate the ideal nasolabial angle among Canadian, Saudi, Kuwaiti, and Lebanese populations (n = 197). Participants were patients attending outpatient clinics, plastic surgery residents, and medical students. The questionnaire included demographics and the perception of respondents of the ideal NLA for each gender: male (85°, 90°, 95°, 100°, 110°) and females (95°, 100°, 110°, 115°). Results The majority of respondents were female (81.2%), ages between 20 and 39 (84.3%). The mean and standard deviation of ideal NLA choices in both male and female models were 97.1 ± 6.39 and 109.5 ± 5.32, respectively. The ideal male NLA choices were found to correlate significantly with age (P =.044) and work status (P =.019). In choosing the ideal female NLA, age was a significant factor (P =.012). Conclusions Identifying the ideal NLA is essential to establishing aesthetic goals for patient and surgeon alike. It is important to understand the effects of demographics on the choice of the ideal NLA, which ultimately influences the planning and outcome of the rhinoplasty procedure. Level of Evidence: 5 [ABSTRACT FROM AUTHOR]

Background: Recognition of poor performance in General Practice trainees is important because underperformance compromises patients' health and safety. However, in General Practice, research on persistent underperformance while in training and its ultimate consequences is almost completely lacking. We aim to explore the unprofessional behaviours of residents in General Practice who were dismissed from training and who litigated against dismissal. Methods: We performed a structured analysis using open-source data from all General Practice cases before the Conciliation Board of the Royal Dutch Medical Association between 2011 and 2020. Anonymised law cases about residents from all Dutch GP training programmes were analysed in terms of the quantitative and qualitative aspects related to performance. Results: Between 2011 and 2020, 24 residents who were dismissed from training challenged their programme director's decision. Dismissed residents performed poorly in several competencies, including communication, medical expertise and most prominently, professionalism. Over 90% of dismissed residents failed on professionalism. Most lacked self-awareness and/or failed to profit from feedback. Approximately 80% failed on communication, and about 60% on medical expertise as well. A large majority (more than 80%) of dismissed residents had previously participated in some form of remediation. Conclusions: Deficiencies in both professionalism and communication were the most prevalent findings among the dismissed General Practice residents. These two deficiencies overlapped considerably. Dismissed residents who challenged their programme director's decision were considered to lack self-awareness, which requires introspection and the appreciation of feedback from others. [ABSTRACT FROM AUTHOR]

Whether integration of nurse practitioners (NPs) and physician assistants (PAs) into academic emergency departments (EDs) affects emergency medicine (EM) resident clinical learning opportunities is unclear. We sought to compare EM resident exposure to more-complex patients, as well as patients undergoing Accreditation Council for Graduate Medical Education (ACGME)–required procedures, at nonpediatric academic EDs with lower, moderate, and higher levels of NP/PA utilization. In this cross-sectional study of National Hospital Ambulatory Medical Care Survey (NHAMCS) data for 2016–2020, nonpediatric academic EDs were classified into the following three groups based on the percentage of patients seen by an NP or PA: lower (≤ 10%), moderate (10.1–30%), and higher (> 30%) NP/PA utilization. The proportion of EM resident–seen patients meeting previously established complex patient criteria was then determined for EDs at each level of NP/PA utilization. The proportion of EM resident–seen patients receiving certain ACGME-required procedures was also determined. Survey analytic procedures and weighting as recommended by NHAMCS were used to calculate and compare proportions using 95% CIs. The weighted 2016–2020 NHAMCS data sets represent 44,130,996 adult resident-seen patients presenting to nonpediatric academic EDs. The proportion of resident-seen patients meeting complex patient criteria did not significantly differ for lower (43.2%; 95% CI 30.6–56.8%), moderate (41.7%; 95% CI 33.0–50.9%), or higher (38.9%; 95% CI 29.3–49.4%) NP/PA utilization EDs. The proportion of patients undergoing an ACGME-required procedure also did not significantly differ across level of NP/PA utilization. Higher levels of NP/PA utilization in nonpediatric academic EDs do not appear to reduce EM resident exposure to more-complex patients or ACGME-required procedures. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Virtual training simulators have been introduced in several surgical disciplines to improve residents' abilities. Through the use of the LapSim® virtual training simulator (Surgical Science, Göteborg, Sweden), this study aims to plan an effective learning path in minimally invasive thoracic and general surgery. METHODS All thoracic and general surgery trainees in their 1st and 2nd year of residency at the University of Insubria were enrolled and randomized into 2 groups: residents undergoing an intensive twice-a-week virtual training programme (group A: n  = 8) and those undergoing a once-weekly non-intensive virtual training programme (group B: n  = 9). The virtual training programme was divided into 4 modules, each of 12 weeks. In the 1st module, trainees repeated grasping, cutting, clip application, lifting and grasping, and fine dissection exercises during each training session. Seal-and-cut exercise was performed as the initial and final test. Data on surgical manoeuvres (time and on mistakes) were collected; intra- and inter-group comparisons were planned. RESULTS No significant differences were observed between groups A and B at the 1st session, confirming that the 2 groups had similar skills at the beginning. After 12 weeks, both groups showed improvements, but comparing data between initial and final test, only Group A registered a significant reduction in total time (P -value = 0.0015), left (P -value = 0.0017) and right (P -value = 0.0186) instrument path lengths, and in left (P -value = 0.0010) and right (P -value = 0.0073) instrument angular path lengths, demonstrating that group A acquired greater precision in surgical manoeuvres. CONCLUSIONS Virtual simulator training programme performed at least twice a week was effective for implementing basic surgical skills required for the trainee's professional growth. Additional virtual training modules focused on more complex exercises are planned to confirm these preliminary results. [ABSTRACT FROM AUTHOR]

La réforme du 3e cycle des études médicales de 2017 a introduit le concept d'autonomie supervisée avec la création d'un nouveau statut de docteur junior (DJ). L'objectif de ce travail était d'interroger la première promotion de DJ de médecine interne et immunologie clinique (MIIC) concernant le déroulement et la mise en place de cette dernière année d'internat. Les DJ du diplôme d'études spécialisées de MIIC étaient invités à répondre à une enquête en ligne anonyme, sollicités par mail et via les réseaux sociaux. Le questionnaire a recueilli 36 réponses sur une cinquantaine de DJ estimés. La majorité des DJ consacrait plus de 70 % de leur temps en hospitalisation conventionnelle et moins de 20 % en hospitalisation programmée. La majorité aurait aimé faire davantage de consultation et d'avis. Le temps de travail hebdomadaire n'était pas respecté pour la majorité des DJ. Les temps de formation académiques et personnels n'étaient pas respectés pour 77,8 % d'entre eux. Au total, 75 % étaient satisfaits de l'autonomisation et 88,6 % estimaient que la transition avec le post-internat serait plus aisée grâce à la phase de consolidation. Un tiers rapportait que leur stage avait confirmé leur appréhension à exercer en tant qu'interniste voire que celle-ci pouvait remettre en question leur exercice futur. Cette enquête est un premier état des lieux concernant la mise en place de l'année de DJ dans le DES de MIIC. Un travail collectif autour de cette dernière année d'internat semble être indispensable pour garantir l'épanouissement personnel et professionnel des jeunes internistes. The 2017 reform of the 3rd cycle of medical studies introduced the concept of supervised autonomy with the creation of a new junior doctor (JD) status. The aim of this work was to interview the first class of JDs in internal medicine and clinical immunology (IMCI) regarding the progress and implementation of this final year of internship. The IMCI JDs were invited to complete an anonymous online survey, contacted by email and social networks. The questionnaire received 36 responses out of an estimated fifty JDs. The majority of JDs spent more than 70% of their time on conventional hospitalisation and less than 20% on scheduled hospitalisation. Most of them would have preferred to do more consultations and provide expert counsels. Weekly working hours were not respected for the majority of JDs. Personal education and academic formation were not respected for 77.8% of JDs. Overall, 75% were satisfied with their empowerment and 88.6% felt that the transition to post residency would be easier with the consolidation phase. A third reported that their residency had confirmed their apprehension about practising as an internist, and even that this apprehension might call into question their future practice. This survey is an initial assessment of the implementation of the JD year in the IMCI residency. A collective effort around this last year of internship seems to be essential to ensure the personal and professional development of young internists. [ABSTRACT FROM AUTHOR]

Background Understanding how analgesics are used in different countries can inform initiatives to improve the pharmacological management of pain in nursing homes. Aims To compare patterns of analgesic use among Australian and Japanese nursing home residents; and explore Australian and Japanese healthcare professionals' perspectives on analgesic use. Methods Part one involved a cross-sectional comparison among residents from 12 nursing homes in South Australia (N  = 550) in 2019 and four nursing homes in Tokyo (N  = 333) in 2020. Part two involved three focus groups with Australian and Japanese healthcare professionals (N  = 16) in 2023. Qualitative data were deductively content analysed using the World Health Organization six-step Guide to Good Prescribing. Results Australian and Japanese residents were similar in age (median: 89 vs 87) and sex (female: 73% vs 73%). Overall, 74% of Australian and 11% of Japanese residents used regular oral acetaminophen, non-steroidal anti-inflammatory drugs or opioids. Australian and Japanese healthcare professionals described individualising pain management and the first-line use of acetaminophen. Australian participants described their therapeutic goal was to alleviate pain and reported analgesics were often prescribed on a regular basis. Japanese participants described their therapeutic goal was to minimise impacts of pain on daily activities and reported analgesics were often prescribed for short-term durations, corresponding to episodes of pain. Japanese participants described regulations that limit opioid use for non-cancer pain in nursing homes. Conclusion Analgesic use is more prevalent in Australian than Japanese nursing homes. Differences in therapeutic goals, culture, analgesic regulations and treatment durations may contribute to this apparent difference. [ABSTRACT FROM AUTHOR]

Background The Atrial fibrillation Better Care (ABC) pathway is the gold-standard approach to atrial fibrillation (AF) management, but the effect of implementation on health outcomes in care home residents is unknown. Objective To examine associations between ABC pathway adherence and stroke, transient ischaemic attack, cardiovascular hospitalisation, major bleeding, mortality and a composite of all these outcomes in care home residents. Methods A retrospective cohort study of older care home residents (≥65 years) in Wales with AF was conducted between 1 January 2003 and 31 December 2018 using the Secure Anonymised Information Linkage Databank. Adherence to the ABC pathway was assessed at care home entry using pre-specified definitions. Cox proportional hazard and competing risk models were used to estimate the risk of health outcomes according to ABC adherence. Results From 14,493 residents (median [interquartile range] age 87.0 [82.6–91.2] years, 35.2% male) with AF, 5,531 (38.2%) were ABC pathway adherent. Pathway adherence was not significantly associated with risk of the composite outcome (adjusted hazard ratio, 95% confidence interval [CI]: 1.01 [0.97–1.05]). There was a significant independent association observed between ABC pathway adherence and a reduced risk of myocardial infarction (0.70 [0.50–0.98]), but a higher risk of haemorrhagic stroke (1.59 [1.06–2.39]). ABC pathway adherence was not significantly associated with any other individual health outcomes examined. Conclusion An ABC adherent approach in care home residents was not consistently associated with improved health outcomes. Findings should be interpreted with caution owing to difficulties in defining pathway adherence using routinely collected data and an individualised approach is recommended. [ABSTRACT FROM AUTHOR]

Background The impact of the COVID-19 pandemic on long-term care residents remains of wide interest, but most analyses focus on the initial wave of infections. Objective To examine change over time in: (i) The size, duration, classification and pattern of care-home outbreaks of COVID-19 and associated mortality and (ii) characteristics associated with an outbreak. Design Retrospective observational cohort study using routinely-collected data. Setting All adult care-homes in Scotland (1,092 homes, 41,299 places). Methods Analysis was undertaken at care-home level, over three periods. Period (P)1 01/03/2020-31/08/2020; P2 01/09/2020-31/05/2021 and P3 01/06/2021–31/10/2021. Outcomes were the presence and characteristics of outbreaks and mortality within the care-home. Cluster analysis was used to compare the pattern of outbreaks. Logistic regression examined care-home characteristics associated with outbreaks. Results In total 296 (27.1%) care-homes had one outbreak, 220 (20.1%) had two, 91 (8.3%) had three, and 68 (6.2%) had four or more. There were 1,313 outbreaks involving residents: 431 outbreaks in P1, 559 in P2 and 323 in P3. The COVID-19 mortality rate per 1,000 beds fell from 45.8 in P1, to 29.3 in P2, and 3.5 in P3. Larger care-homes were much more likely to have an outbreak, but associations between size and outbreaks were weaker in later periods. Conclusions COVID-19 mitigation measures appear to have been beneficial, although the impact on residents remained severe until early 2021. Care-home residents, staff, relatives and providers are critical groups for consideration and involvement in future pandemic planning. [ABSTRACT FROM AUTHOR]

Background A substantial number of Emergency Department (ED) attendances by care home residents are potentially avoidable. Health Call Digital Care Homes is an app-based technology that aims to streamline residents' care by recording their observations such as vital parameters electronically. Observations are triaged by remote clinical staff. This study assessed the effectiveness of the Health Call technology to reduce unplanned secondary care usage and associated costs. Methods A retrospective analysis of health outcomes and economic impact based on an intervention. The study involved 118 care homes across the North East of UK from 2018 to 2021. Routinely collected NHS secondary care data from County Durham and Darlington NHS Foundation Trust was linked with data from the Health Call app. Three outcomes were modelled monthly using Generalised Linear Mixed Models: counts of emergency attendances, emergency admissions and length of stay of emergency admissions. A similar approach was taken for costs. The impact of Health Call was tested on each outcome using the models. Findings Data from 8,702 residents were used in the analysis. Results show Health Call reduces the number of emergency attendances by 11% [6–15%], emergency admissions by 25% [20–39%] and length of stay by 11% [3–18%] (with an additional month-by-month decrease of 28% [24–34%]). The cost analysis found a cost reduction of £57 per resident in 2018, increasing to £113 in 2021. Interpretation The introduction of a digital technology, such as Health Call, could significantly reduce contacts with and costs resulting from unplanned secondary care usage by care home residents. [ABSTRACT FROM AUTHOR]

Objective: To analyze the prevalence of burnout among radiology residents. Method: Five databases (PubMed, Web of Science, Embase, PsycINFO, and Scopus) were searched for studies reporting burnout in radiology residents for the period up to November 7, 2022. Results: A total of 423 studies were identified, and eventually, 16 studies were selected for the qualitative analysis, of which 11 studies were used in the meta-analysis. There was a total of 2164 radiology residents. Six studies reported the prevalence of burnout but the data could not be pooled due to their inconsistent definitions of burnout. The mean scores of three burnout subscales indicated a moderate to high degree of severity: emotional exhaustion = 25.2 (95% CI, 22.1–28.3; I2 = 94.4%), depersonalization = 10.2 (95% CI, 8.5–11.9; I2 = 93.0%), and low perception of personal accomplishment = 32.9 (95% CI, 30.5–35.4; I2 = 94.4%). The pooled prevalence of high-degree emotional exhaustion was 49.9% (95% CI, 43.6–56.1%; I2 = 55.7%), high-degree depersonalization was 45.1% (95% CI, 38.3–52.0%; I2 = 63.2%), and high-degree diminished personal accomplishment was 58.2% (95% CI, 36.0–77.6%; I2 = 84.9%). The impact of the COVID-19 pandemic on radiology residents was not investigated. In addition, there are inconsistent findings on the effects of female sex, seniority, and social support on burnout. Conclusions: About half of the radiology residents showed at least one of the three burnout manifestations (emotional exhaustion, depersonalization, and personal accomplishment), with a moderate to high degree of severity. Clinical relevance statement: Such a high prevalence and severity of burnout among radiology residents warrant the attention of residency program directors. Key Points: • Burnout, not uncommon among radiology residents, has not been effectively analyzed. • Nearly half of the radiology residents experience at least one of the three manifestations of burnout to a moderate to high degree. • The high prevalence and severe degree of burnout among radiology residents warrant the attention of residency program directors. [ABSTRACT FROM AUTHOR]

Background: While individuals exposed to radiation in hospitals are typically registered as radiation workers, with regulated exposure levels, many interns and residents who are not registered as radiation workers are occupationally exposed to radiation. This study aimed to assess the current status and awareness of radiation exposure and related protective practices among interns and residents. Methods: An online survey was conducted nationwide from June 3 to June 16, 2023, engaging 262 interns and 799 residents. Descriptive analyses were conducted to summarize the status of occupational radiation exposure and radiation protection practices. Results: Approximately 6% of interns and 18% of residents reported receiving personal dosimeters, and 6% and 20%, respectively, were registered as radiation workers. In contrast, compliance with personal radiation protection equipment, such as lead aprons and thyroid shields, exceeded 85% during tasks involving radiation exposure. On average, interns spent 7 months (standard deviation [SD], 2.1) and residents 8.1 months (SD, 4.8) in main departments with potential radiation exposure. While overall safety performance showed improvement, the provision of personal dosimeters and radiation worker registration remained low (14.7%, 16.6%). Conclusion: Despite improvements in radiation protection education and the provision of personal protective equipment, the registration rate for radiation workers among interns and residents remains low. Ensuring these medical professionals are registered and managed as radiation workers is crucial for prioritizing their safety and well-being. [ABSTRACT FROM AUTHOR]

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